Malignant Solitary Fibrous Tumor of the Renal Vein Presenting as a Giant Renal Artery Aneurysm: A Case Report and Review of Literature

OBJECTIVES

To discuss an unusual presentation of solitary fibrous tumor (SFT) as well as the first description of SFT originating from the renal vein.

CASE REPORT

In this article, we report the case of a 56-year-old man who presented with nonspecific epigastric pain and was found on computed tomography to have a large 10-cm renal artery aneurysm with evidence of contained rupture, segmental ischemia of the kidney, and suggestion of renal vein thrombosis. This was treated by a multidisciplinary team of urologists, vascular surgeons, and interventional radiologists with both renal artery coil embolization and radical nephrectomy. The thrombosis was found on pathologic review to be a malignant SFT originating from the renal vein with likely erosion into the renal artery.

CONCLUSION

This report describes the first case of SFT originating from the renal vein and demonstrates the potential for mimicry as a giant renal artery aneurysm.

Incidence of low vitamin A levels and ocular symptoms after Roux-en-Y gastric bypass

BACKGROUND

Previous reports have demonstrated a significant incidence of fat-soluble vitamin deficiency after bariatric surgery. The purpose of the present study was to determine the incidence of vitamin A deficiency after Roux-en-Y gastric bypass and to correlate the laboratory findings with ocular symptoms potentially related to vitamin A deficiency.

METHODS

All patients who had undergone Roux-en-Y gastric bypass were invited to participate in a nutritional screening. The patients completed a detailed survey concerning ocular symptoms and had their vitamin A level evaluated.

RESULTS

A low vitamin A level was identified in 7 (11%) of 64 RYBG patients. Ocular xerosis was present in 18 patients (27%), with night vision changes reported in 45 (68%). Visual disturbances were present in 7 patients (11%) found to have low vitamin A levels, with hypovitaminosis A present in 22% of patients with xerosis (P <.05).

CONCLUSION

Low vitamin A levels and frequent ocular complaints that might be associated with decreased vitamin A are common findings in the post-RYBG patient population. Additional study is needed to assess the role of routine vitamin A screening and replacement in the postbariatric surgery patient.

Cardiovascular risk factor screening and follow-up in a military population aged 40 years and older

OBJECTIVE

This study analyzed a worksite-based cardiovascular risk assessment offered to soldiers aged 40 and older to identify unrecognized cardiovascular risk and evaluate compliance with instructions to follow up for further evaluation.

METHODS

Participants had fasting blood tests, waist circumference and blood pressure measurement and a carotid artery duplex scan performed at their worksite. A healthcare professional discussed the participants' results with them and, if indicated, recommended follow up within the following one month.

RESULTS

Seventy-six (46%) of the 163 eligible soldiers agreed to participate. Twenty-nine (38%) of the 76 participants were instructed to follow up for elevated blood pressure, glucose, or lipids. Only 7 of 29 (24%) complied with follow-up instructions.

CONCLUSION

Voluntary worksite-based interventions can effectively identify soldiers with unmanaged cardiovascular risk factors, but a more aggressive follow-up strategy should be used to ensure these soldiers receive indicated medical intervention.

Advances in vascular imaging

Advances in vascular surgery have mirrored advances in diagnostic imaging. Indeed, the endovascular revolution has been made possible largely by advances in computed tomography, magnetic resonance imaging, and vascular ultrasound. As technology allows better noninvasive vascular diagnosis, conventional angiography, once the gold standard for the diagnosis of vascular disease, is now reserved largely for intervention. This article discusses the current state of vascular imaging. Specific emphasis is placed on the comparative clinical utility of different imaging modalities in the detection and management of vascular disease.

The response of venous valvular endothelium to autotransplantation and in vitro preservation

Intraoperative preservation techniques in popular use produced endothelial damage in venous valves of dogs. This damage was evident with only 20 minutes of preservation. Severe endothelial damage was also evident after surgical autologous transfer of valve-bearing vein segments. The damage evolved over a period of days. At 28 days there was essentially complete desquamation of the valve apparatus with exposure of the collagen fibrils to the bloodstream. Complete reendothelialization had occurred by 4 months. The clinical implications of these findings are discussed.

Dynamic mechanical properties of medical grade silicone elastomer stored in simulated body fluids

Medical grade silicone rubber samples were immersed in distilled water and in pseudo-extracellular fluid (PECF) at 37.5 degrees C for up to four months. Periodically, the storage modulus and log decrement of the samples were measured on a torsion pendulum. Up to 20% increases in storage modulus and about 40% decreases in log decrement were found over the four months independent of sample surface area. Similar trends were seen in both distilled water and in PECF. Higher (59 degrees C) storage temperatures accelerated the changes. Small amounts of moisture uptake were detected. However, the presence of water in the samples did not cause the change in mechanical properties.

Growth of Pseudomonas fluorescens with sodium maleate as a carbon source

The growth of Pseudomonas fluorescens (ATCC 11150) on sodium maleate was observed, and the composition of the media was monitored in batch culture. Utilization of the maleate as the sole organic carbon source proceeded by stepwise conversion to fumarate and then to malate. Respiration rates of P. fluorescens on maleate, mixtures of maleate and fumarate salts, and mixtures of maleate and malate salts were measured. Complex effects, possibly due to a change in metabolic mechanism, were observed.