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Tambe R, Patil S, Gohil K, Parikh R, Nadeem A, Wanjari M, Mittal G. Spontaneous isolated iliac artery dissection in a young male: Case report and review of literature. Radiol Case Rep 2024; 19:5682-5687. [PMID: 39308626 PMCID: PMC11415835 DOI: 10.1016/j.radcr.2024.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 09/25/2024] Open
Abstract
Spontaneous isolated dissection of the iliac artery (SID-IA) is a rare vascular condition typically associated with trauma or connective tissue disorders. We present a unique case of a 39-year-old male without known risk factors or trauma history who presented with lower abdominal pain. Diagnostic imaging revealed SID-IA involving the right external iliac artery with thrombus formation. Despite negative findings for connective tissue disorders, the patient underwent successful endovascular stenting following initial medical management. Vigilance in diagnosis and prompt intervention are crucial in managing SID-IA to prevent complications such as limb ischemia and aneurysm formation. This case emphasizes the importance of considering SID-IA in young patients presenting with abdominal pain, even in the absence of traditional risk factors, and highlights evolving treatment options for this rare condition.
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Affiliation(s)
- Rahul Tambe
- DNB Internal Medicine, Department of Internal Medicine, Nanavati Max Super Specialty Hospital, Mumbai, Maharashtra, India
| | - Sushant Patil
- DNB Cardiology, Department of Cardiology, Nanavati Max Super Specialty Hospital, Mumbai, Maharashtra, India
| | - Krutika Gohil
- Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. Rustom Narsi Cooper Municipal General Hospital, Mumbai, Maharashtra, India
| | - Rashmi Parikh
- DNB Radiology, Department of Radiology, Nanavati Max Super Specialty Hospital, Mumbai, Maharashtra, India
| | - Arsalan Nadeem
- Department of Radiology, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Mayur Wanjari
- Department of Research and Development, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Gaurav Mittal
- Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
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de Freitas RA, Dos Passos RR, Dos Santos FCA, Bressan AFM, Carneiro FS, Lima VV, Giachini FRC. Interleukin-10 deficiency induces thoracic perivascular adipose tissue whitening and vascular remodeling. J Mol Histol 2024; 55:527-537. [PMID: 38898139 DOI: 10.1007/s10735-024-10202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 05/15/2024] [Indexed: 06/21/2024]
Abstract
Perivascular adipose tissue (PVAT) is an adipose layer, surrounding blood vessels, with a local modulatory role. Interleukin-10 (IL-10) has been shown to modulate vascular tissue. This study aimed to characterize the endogenous role of IL-10 in vascular remodeling, and PVAT phenotyping. Thoracic aortic segments from control (C57BL/6J) and IL-10 knockout (IL-10-/-) male mice were used. Analyzes of aorta/PVAT morphometry, and elastin, collagen and reticulin deposition were performed. Tissue uncoupling protein 1 (UCP1) was accessed by Western blotting. Endogenous absence of IL-10 reduced total PVAT area (p = 0.0310), and wall/lumen ratio (p = 0.0024), whereas increased vascular area and thickness (p < 0.0001). Total collagen deposition was augmented in IL-10-/-, but under polarized light, the reduction of collagen-I (p = 0.0075) and the increase of collagen-III (p = 0.0055) was found, simultaneously with reduced elastic fibers deposition (p = 0.0282) and increased deposition of reticular fibers (p < 0.0001). Adipocyte area was augmented in the IL-10 absence (p = 0.0225), and UCP1 expression was reduced (p = 0.0420). Moreover, relative frequency of white adipose cells and connective tissue was augmented in IL-10-/- (p < 0.0001), added to a reduction in brown adipose cells (p < 0.0001). Altogether, these data characterize aorta PVAT from IL-10-/- as a white-like adipocyte phenotype. Endogenous IL-10 prevents vascular remodeling and favors a brown-like adipocyte phenotype, suggesting a modulatory role for IL-10 in PVAT plasticity.
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Affiliation(s)
- Raiany A de Freitas
- Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil
- Federal University of Mato Grosso Institute of Biological and Health Sciences, Barra do Garças, MT, Brazil
| | | | | | - Alecsander F M Bressan
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Fernando S Carneiro
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Victor V Lima
- Federal University of Mato Grosso Institute of Biological and Health Sciences, Barra do Garças, MT, Brazil
| | - Fernanda R C Giachini
- Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil.
- Federal University of Mato Grosso Institute of Biological and Health Sciences, Barra do Garças, MT, Brazil.
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Khaibullina DK, Esin RG. [Neurological aspects of connective tissue dysplasia]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:7-11. [PMID: 37490659 DOI: 10.17116/jnevro20231230717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Disturbances in the formation of connective tissue lead to significant pathological changes in both individual organs and tissues, and at the organismal level. The complexity of diagnostics is also connected with the fact that there is no single terminology, a single view of the diagnostic criteria, a single approach among doctors of different specialties. The prevalence of external phenotypic signs of connective dysplasia is quite high, which can lead to overdiagnosis. On the other hand, insufficient attention to the manifestations of dysplasia can lead to delayed diagnosis, which can cause adverse complications. The most studied are clinical manifestations in dysplastic changes in the cardiovascular system, musculoskeletal system. This article provides an overview of current data on changes in the nervous system. Sufficient attention was paid to the pathology of the nervous system in differentiated forms (Marfan syndrome, Ehlers-Danlos, etc.). Currently, the role of various vascular anomalies, aneurysms associated with undifferentiated forms of connective tissue dysplasia is widely discussed. Much attention is also paid to clinical manifestations of the autonomic nervous system: sympathicotonic manifestations predominate in connective tissue dysplasia. There is evidence of an association of headaches, musculoskeletal pain, and connective tissue dysplasia in both children and adults.
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Affiliation(s)
- D Kh Khaibullina
- Kazan State Medical Academy - Branch of the Russian Medical Academy of Continuing Professional Education, Kazan, Russia
| | - R G Esin
- Kazan State Medical Academy - Branch of the Russian Medical Academy of Continuing Professional Education, Kazan, Russia
- Kazan (Volga Region) Federal University, Kazan, Russia
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Alqahtani M, Claudinot A, Gaudry M, Bartoli A, Barral PA, Vidal V, Boyer L, Busa T, Cadour F, Jacquier A, De Masi M, Bal L. Endovascular Management of Vascular Complications in Ehlers-Danlos Syndrome Type IV. J Clin Med 2022; 11:6344. [PMID: 36362573 PMCID: PMC9658028 DOI: 10.3390/jcm11216344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2023] Open
Abstract
(1) Background: The vascular type of Ehlers-Danlos syndrome (vEDS) is a rare genetic connective tissue disorder caused by pathogenic variants in the COL3A1 gene that result in arterial and organ fragility and premature death. We present five cases of vEDS that highlight the diagnosis and treatment challenges encountered by clinicians with these patients. (2) Case presentations: we present the cases of five patients with vascular complications of vEDS who were successfully managed using endovascular interventions or hybrid techniques at our institution from 2005 to 2022. (3) Conclusions: These data emphasize that a multidisciplinary approach is needed for vEDS patients and that when endovascular or hybrid treatment is performed in a timely manner by a skilled team of interventional radiologists, good results can be achieved. Our report also demonstrates that the prognosis of vEDS patients has improved over the past 20 years with a new prevention program including celiprolol therapy, physical activity adaptation and limitation, and scheduled monitoring by expert clinicians.
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Affiliation(s)
- Mubarak Alqahtani
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
| | | | - Marine Gaudry
- Aortic Center, Hopital de la Timone, AP-HM, 13005 Marseille, France
- Department of Vascular Surgery, Hopital de la Timone, AP-HM, 13005 Marseille, France
| | - Axel Bartoli
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
- CRMBM-UMR CNRS 7339, Aix-Marseille University, 13007 Marseille, France
| | | | - Vincent Vidal
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
| | - Louis Boyer
- Department of Radiology, University Hospital, 63100 Clermont-Ferrand, France
| | - Tiffany Busa
- Department of Medical Genetics, Hopital Enfants de la Timone, AP-HM, 13005 Marseille, France
- Regional Reference Department for Marfan and Related Diseases, AP-HM, 13005 Marseille, France
| | - Farah Cadour
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
- CRMBM-UMR CNRS 7339, Aix-Marseille University, 13007 Marseille, France
| | - Mariangela De Masi
- Aortic Center, Hopital de la Timone, AP-HM, 13005 Marseille, France
- Department of Vascular Surgery, Hopital de la Timone, AP-HM, 13005 Marseille, France
| | - Laurence Bal
- Aortic Center, Hopital de la Timone, AP-HM, 13005 Marseille, France
- Department of Vascular Surgery, Hopital de la Timone, AP-HM, 13005 Marseille, France
- Regional Reference Department for Marfan and Related Diseases, AP-HM, 13005 Marseille, France
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Tanda E, Genadiev GG, Zappadu S, Donno GD, Camparini S. Spontaneous Isolated Dissection of Iliac Artery Treated with Endovascular Repair: A Case Report. Vasc Specialist Int 2021; 37:38. [PMID: 34961749 PMCID: PMC8720578 DOI: 10.5758/vsi.210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/23/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022] Open
Abstract
Spontaneous isolated dissection of the iliac artery (SID-IA) is a rare pathologic condition. The predisposing factors and best treatment strategies are still being debated. We present the case of a 59-year-old male with acute right lower limb ischemia characterized by the sudden occurrence of rest pain, hypoesthesia, and paresis. Angiography showed SID-IA extending down to the femoral bifurcation. The patient had no risk factors for SID-IA; however, he survived an electrocution and had arterial hypertension at admission. Endovascular revascularization was successfully performed, with complete restoration of limb blood flow and remission of symptoms. Follow-up ultrasonography at 1 year confirmed stent patency and absence of clinical symptoms. Endovascular stenting is a good therapeutic option for symptomatic SID-IA without rupture.
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Affiliation(s)
- Elisabetta Tanda
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu.,Department of Surgery, University of Cagliari, Monserrato, Italy
| | - Genadi G Genadiev
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu
| | - Sara Zappadu
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu.,Department of Surgery, University of Cagliari, Monserrato, Italy
| | - Gabriele De Donno
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu.,Department of Surgery, University of Cagliari, Monserrato, Italy
| | - Stefano Camparini
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu
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Kakinuma D, Yamada T, Kanazawa Y, Matsuno K, Sahara T, Yoshida H. A case of vascular Ehlers-Danlos syndrome with a ruptured hepatic artery after surgical treatment of peritonitis caused by the perforation of the colon. Surg Case Rep 2021; 7:74. [PMID: 33755833 PMCID: PMC7988026 DOI: 10.1186/s40792-021-01156-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ehlers–Danlos syndrome (EDS) is an inherited disorder that causes connective tissue fragility. The vascular type of EDS (vEDS) caused by defective collagen type III production accounts for 5%–10% of all EDS cases. Patients can develop gastrointestinal or arterial ruptures, which cause poor prognosis. We report a case of a patient who experienced colonic rupture, which was immediately followed by arterial rupture. Case presentation A 40-year-old man who had been genetically diagnosed with vEDS 6 years previously was admitted to our hospital with ischemic colitis. After 3 days of conservative treatment, his abdominal pain worsened, and computed tomography (CT) revealed free air in the abdominal cavity. Pan-peritonitis due to perforation of the sigmoid colon was diagnosed. Intraperitoneal lavage and drainage and Hartmann’s operation were urgently performed. Because the patient had confirmed vEDS, we performed the surgery in a protective manner. The postoperative course was initially good, and he was transferred to the general ward 3 days after surgery. However, 5 days after surgery, massive intra-abdominal hemorrhage suddenly occurred, and contrast-enhanced CT showed an aneurysm in the common hepatic artery that had ruptured; this aneurysm was not present before surgery and was far from the surgical field. Although we considered an emergency operation, the patient suddenly experienced cardiac arrest and was unresponsive to resuscitation. Conclusions In cases of vEDS, vascular rupture can occur immediately after surgery for intestinal rupture. We recommend paying special attention to vascular complications in patients in their forties, as such complications are the most common causes of death.
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Affiliation(s)
- Daisuke Kakinuma
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yoshikazu Kanazawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kunihiko Matsuno
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tomoko Sahara
- Division of Personalized Genetic Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Ehlers-Danlos Syndrome: Immunologic contrasts and connective tissue comparisons. J Transl Autoimmun 2021; 4:100077. [PMID: 33437956 PMCID: PMC7786113 DOI: 10.1016/j.jtauto.2020.100077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
Ehlers-Danlos Syndrome (EDS) is a family of multisystemic hereditary connective tissue disorders now comprised of 13 recognized subtypes, classical, classical-like, cardiac-valvular, vascular, hypermobile, arthrochlasia, dermosparaxis, kyphoscoliotic, brittle cornea syndrome, spondylodysplastic, musculocontractural, myopathic, and periodontal, as designated by the most recent 2017 International classification system. Clinical presentation of this disease can range from mild manifestations including skin hyperextensibility and joint hypermobility, to more severe complications such as vascular and organ rupture. While there may be accompanying inflammation in some of the subtypes of EDS, the pathogenic mechanisms have not been clearly defined. Thorough evaluation incorporates clinical examination, family history, laboratory testing, and imaging. In recent years, studies have identified multiple gene variants involved in the pathogenesis of specific EDS subtypes as well as elaborate clinical diagnostic criteria and classification models used to differentiate overlapping conditions. The differential diagnosis of EDS includes hypermobility spectrum disorders, Marfan syndrome, Loey-Dietz syndrome, Cutis laxa syndromes, autosomal dominant polycystic kidney disease, osteogenesis Imperfecta Type 1, fibromyalgia, depression, and chronic fatigue syndrome. Surgical treatment is reserved for complications, or emergencies involving vascular or orthopedic injury because of the risk of poor wound healing. Management techniques each have their own consequences and benefits, which will also be discussed in this review article. Patients affected by this spectrum of disorders are impacted both phenotypically and psychosocially, diminishing their quality of life. There are 13 of EDS as defined by the International EDS Consortium, some with an identified genetic etiology. Skin hyperextensibility, joint hypermobility, easy bruising, and organ rupture are common features of EDS. Hypermobile EDS is a poorly defined entity that has been associated with MCAS and POTs. The association of hEDS, MCAS and POTS has not been confirmed. There is a paucity of evidence for an immunological mechanism for EDS.
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Aydıner Ö, Hançer VS. A Novel COL3A1 c.2644G>T; p.(Gly882Cys) Variant in a Turkish Family with Vascular Ehlers-Danlos Syndrome. Mol Syndromol 2020; 11:110-114. [PMID: 32655343 DOI: 10.1159/000506585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 11/19/2022] Open
Abstract
Vascular Ehlers-Danlos syndrome (vEDS) is an autosomal dominant disease, also known as EDS type IV. The estimated prevalence for all EDS varies between 1/10,000 and 1/25,000 with EDS type IV representing approximately 5-10% of the cases. The vascular complications may affect all anatomical areas, with a tendency toward arteries of large and medium diameter. vEDS diagnosis is a challenging process. Patients usually have different phenotypic features and are unaware of the diagnosis at the time of initial vascular complications. The authors report the case of a 39-year-old male patient with EDS type IV, who developed internal carotid artery dissection and was diagnosed with clinical findings, imaging modalities, and a novel pathogenic COL3A1 variant.
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Affiliation(s)
- Ömer Aydıner
- Department of Radiology, Kartal Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Veysel S Hançer
- Department of Medical Biology, Faculty of Medicine, Istinye University, Istanbul, Turkey
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9
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Novotny R, Chlupac J, Beran J, Janousek L, Fronek J. Spontaneous Isolated Common Iliac Artery Dissection Treated with Self-Expandable Stent in a 38-year-old Patient: A Case Report. EJVES Short Rep 2018; 42:4-6. [PMID: 30582028 PMCID: PMC6297188 DOI: 10.1016/j.ejvssr.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/04/2018] [Accepted: 11/07/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Isolated iliac artery dissection (ISIAD) without the involvement of the aorta is a rare medical condition. REPORT A case of a 38-year-old man with sudden onset of rest pain and paraesthesia on the right lower limb (RLL) is presented. Upon admission, the RLL was pulseless, with mild paraesthesia in the foot. The patient underwent computed tomography angiography, which revealed isolated common iliac artery (CIA) dissection followed by endovascular treatment (stenting) of the CIA dissection, with an instant therapeutic effect. Hospital stay was uneventful. The patient was discharged on the third post-procedural day. DISCUSSION Endovascular treatment of ISIAD is a viable treatment modality, with low periprocedural complications, mortality, and morbidity. Owing to its mini-invasiveness, it is a viable treatment modality.
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Affiliation(s)
- Robert Novotny
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine Prague, Czech Republic
| | - Jaroslav Chlupac
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine Prague, Czech Republic
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Beran
- Department of Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Libor Janousek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Fronek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine Prague, Czech Republic
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Zhang W, Han Q, Zhou M, Ran F, Qiao T, Yi L, Liu C, Liu Z. Identification of a missense mutation of COL3A1 in a Chinese family with atypical Ehlers-Danlos syndrome using targeted next-generation sequencing. Mol Med Rep 2016; 15:936-940. [PMID: 28035354 PMCID: PMC5364830 DOI: 10.3892/mmr.2016.6082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/21/2016] [Indexed: 01/13/2023] Open
Abstract
Aortopathy represents an important cause of mortality in industrialized countries, with a number of genes identified as predispose factors. It can be difficult to identify the genetic lesions underlying this disorder, particularly when the phenotype is atypical. The present study performed targeted next-generation sequencing of 428 genes associated with cardiovascular diseases in a family with aortopathy, the proband of which presented with abdominal aortic aneurysm rupture only, with tissue fragility noted in surgery. After targeted capture, sequencing and bioinformatics analysis, a missense mutation, p.A1259T, was identified in the collagen type III α1 (COL3A1) gene and co-segregated with the disease in the family. Crystal structure modeling revealed abnormal hydrogen bonds generated by the mutation, which likely affected the spatial structure of the procollagen C-propeptide. Mutations in the procollagen C-propeptide are rare and genotype-phenotype correlation may explain the atypical manifestations of affected individuals. The results of the present study suggested that targeted gene capture combined with next-generation sequencing can serve as a useful technique in the genetic diagnosis of aortopathy, particularly in the content of an atypical phenotype.
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Affiliation(s)
- Wenwen Zhang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Qian Han
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Feng Ran
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Tong Qiao
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Long Yi
- Center for Translational Medicine, Nanjing University Medical School, Nanjing, Jiangsu 210093, P.R. China
| | - Changjian Liu
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Zhao Liu
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
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Ohshita N, Kanazumi M, Tsuji K, Yoshida H, Morita S, Momota Y, Tsutsumi YM. Anesthetic Management of a Patient With Ehlers-Danlos Syndrome. Anesth Prog 2016; 63:204-207. [PMID: 27973938 DOI: 10.2344/16-00003.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We describe the case of a 37-year-old woman who had been diagnosed with Ehlers-Danlos syndrome (EDS) 4 years earlier and was scheduled to undergo removal of synovial chondromatosis in the temporomandibular joint. EDS is a heritable connective tissue disorder and has 6 types. In this case, the patient was classified into EDS hypermobility type. The major clinical feature of this type is joint hypermobility. The patient had sprain or subluxation of the elbows and ankles and dislocation of the knees. Anticipated problems during general anesthesia would be affected by the disease type. For this patient, extra attention was directed to positional injury-induced neuropathy and articular luxation, cutaneous injuries, injuries related to intubation and ventilation, and postoperative pain. Anesthesia was induced with propofol, remifentanil, and rocuronium and maintained with oxygen-air-desflurane, propofol, remifentanil, fentanyl, and rocuronium. In this case, the patient was safely managed without adverse events.
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Affiliation(s)
- Naohiro Ohshita
- Department of Anesthesiology, Osaka Dental University, Osaka, Japan
| | | | - Kaname Tsuji
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
| | - Hiroaki Yoshida
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
| | - Shosuke Morita
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
| | - Yoshihiro Momota
- Department of Anesthesiology, Osaka Dental University, Osaka, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology, Tokushima University, Tokushima, Japan
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12
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Spinella G, Pane B, Perfumo MC, Palombo D. Spontaneous iliac artery dissection treated with a combination of covered and self-expandable stents to preserve hypogastric patency. J Vasc Surg Cases 2016; 2:14-17. [PMID: 31724645 PMCID: PMC6849993 DOI: 10.1016/j.jvsc.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/02/2016] [Indexed: 11/29/2022] Open
Abstract
A 56-year-old man presented with abdominal pain in the left lower quadrant. Computed tomography angiography showed the presence of an iliac axis dissection. Two Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) covered stents were placed, starting from the beginning of the left common iliac artery to the iliac bifurcation, closing the proximal dissection tear in the left common iliac artery. A self-expandable EverFlex stent (EV3-Covidien, Plymouth, Minn) was then placed, bridging the covered stent and the left external iliac artery, covering the re-entry tear. There were no postoperative complications. During follow-up, we observed a progressive and complete thrombosis of the false lumen in 12 months.
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Affiliation(s)
- Giovanni Spinella
- Vascular and Endovascular Surgery Unit, University Hospital IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Unit, University Hospital IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Maria Cecilia Perfumo
- Vascular and Endovascular Surgery Unit, University Hospital IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, University Hospital IRCCS San Martino-IST, University of Genoa, Genoa, Italy
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Spontaneous Dissection of the Renal Artery in Vascular Ehlers-Danlos Syndrome. Case Rep Crit Care 2015; 2015:804252. [PMID: 26175915 PMCID: PMC4484843 DOI: 10.1155/2015/804252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 11/17/2022] Open
Abstract
Ehlers-Danlos syndrome (EDS) is a rare heterogeneous group of connective tissue disorders. The vascular type (vEDS) is an autosomal dominant disorder caused by heterozygous mutations in the COL3A1 gene predisposing to premature arterial, intestinal, or uterine rupture. We report a case of a 38-year-old woman with a recent diagnosis of vEDS admitted in the Emergency Department with a suspicion of a pyelonephritis that evolved to a cardiopulmonary arrest. A fatal retroperitoneal hematoma related with a haemorrhagic dissection of the right renal artery was found after emergency surgery. This case highlights the need to be aware of the particular characteristics of vEDS, such as a severe vascular complication that can lead to a fatal outcome.
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