Ortner syndrome secondary to saccular thoracic aneurysm.

Mechanical stretching of the left laryngeal nerve secondary to an enlarged left atrium was first described by Dr Norbert Ortner in 1987. An extensive literature search revealed only 76 reported cases of Ortner syndrome, with the more recent reports describing other causes of the syndrome such as pulmonary hypertension, aortic dissection, and a thoracic aneurysm. We recently encountered this rare pathologic entity in an elderly man who had presented with severe hoarseness, presumed to be due to one of the aforementioned vascular anomalies.

Brescia-Cimino AV Fistula Complicated by Steal Syndrome.

The Brescia-Cimino AV fistula is most commonly performed and rarely associated with steal syndrome. A case is presented with details regarding its correction.

Genesis of Crural Revascularization.

Background: The purpose of this study is to recognize those investigators responsible for initiating progress in limb salvage where runoff beyond the arterial blockage was limited to the crural vasculature and to also describe how crural bypass has evolved into the contemporary setting where endovascular options have become increasingly prominent.

Methods: An extensive literature review of articles published from 1960 to 1979 was the basis for selecting and recognizing surgeons who pioneered infrageniculate revascularization. Documentation of patency and amputation rates were tabulated for these early series of distal limb bypass.

Rapid Degradation and Subsequent Endovascular Salvage of Upper Extremity Cryogenic Allograft Bypass.

It has long been reported that cryogenic allografts have suboptimal mid- and long-term patencies and consequently are only used in the absence of autologous vein, predominantly in lower extremity limb salvage situations. As such, we felt that our recent experience with an upper extremity bypass for limb salvage using a cryogenic saphenous vein allograft, which aneurysmally degenerated after one month and required multiple endovascular rescues, serves to re-emphasize such concerns and the importance of continuous postoperative surveillance.

Aberrant splenic artery complicated by aneurysm during pregnancy.

The aberrant splenic artery is an uncommon anomaly. It may become a challenging problem when it is associated with an aneurysm diagnosed during pregnancy. Our experience with a patient who underwent two interventions, each performed in the postpartum period without incident, highlights the need to employ techniques that ensure aneurysm closure and thus avoid recurrence and need for repetitive procedures.

Endovascular rescue of long-term vascular graft implants and need for continuous surveillance.

We present two cases of vascular graft degradation after long-term implantation. In both patients, endovascular techniques were employed to effect continued graft patency and function. Furthermore, these cases lend further credence to the doctrine of lifelong surveillance of all vascular interventions regardless of graft material.

True Aneurysm of the Anterior Tibial Artery.

Most anterior tibial aneurysm cases described in the literature are pseudoaneurysms resulting from trauma. Since 1967, only 8 cases published on true anterior tibial artery aneurysms were atraumatic. Recent experience with an atraumatic aneurysm of the anterior tibial artery prompted a literature review regarding their incidence, and accordingly, we feel the need exists for greater recognition and understanding of this entity.

Pseudoaneurysm of the subclavian-vertebral artery junction--case report and review of the literature.

Pseudoaneurysm of the subclavian-vertebral artery junction (SVJ) is a rare complication of internal jugular vein catheter placement. Because of its retroclavicular location, arterial injury at the SVJ poses a significant therapeutic challenge. A case report and review of the literature are presented.

Cholinergic antiinflammatory pathway inhibition of tumor necrosis factor during ischemia reperfusion.

Objective: Ischemia-reperfusion injury is a pathologic event characterized by tissue damage. It is mediated by tumor necrosis factor (TNF) and other cytokines that activate complement and proteases and stimulate fibrinolysis, degranulation of white blood cells, and free radical production. We recently reported that vagus nerve stimulation (VNS) suppresses endotoxin-induced cytokine synthesis through alpha bungarotoxin-sensitive cholinergic receptors.

Globin attenuates the innate immune response to endotoxin.

Hemoglobin is an endotoxin (lipopolysaccharide; LPS)-binding protein that synergistically increases the release of proinflammatory cytokines from the innate immune system in response to LPS. It has been suggested that this activity of hemoglobin facilitates the recognition of Gram-negative bacteria in a wound, thereby maximizing immune efficiency. This synergy may be important to the pathogenesis of a broad spectrum of clinical conditions because elevated hemoglobin levels frequently are observed in patients after the transfusion of red cells, trauma, cardiopulmonary bypass surgery, hemolysis, in addition to other disorders.

Pharmacological stimulation of the cholinergic antiinflammatory pathway.

Efferent activity in the vagus nerve can prevent endotoxin-induced shock by attenuating tumor necrosis factor (TNF) synthesis. Termed the "cholinergic antiinflammatory pathway," inhibition of TNF synthesis is dependent on nicotinic alpha-bungarotoxin-sensitive acetylcholine receptors on macrophages. Vagus nerve firing is also stimulated by CNI-1493, a tetravalent guanylhydrazone molecule that inhibits systemic inflammation.