Wednesday, April 27, 2016

Osteosarcoma

It originates more frequently in the metaphyseal region of tubular long bones, with 42% occurring in the femur, 19% in the tibia, and 10% in the humerus. About 8% of all cases occur in the skull and jaw, and another 8% in the pelvis.

CT Angiogram in Sarcoma patient




Tuesday, April 19, 2016

The impact of chronic renal insufficiency on vascular surgery patient outcomes

Renal insufficiency is associated with an increased incidence of poor outcomes, including cardiovascular events and death, in the general population. Renal dysfunction appears to have a particularly negative impact in patients undergoing vascular surgery and endovascular therapy. Although the exact mechanism is unknown, increased levels of inflammatory and biochemical modulators associated with adverse cardiovascular outcomes, as well as endothelial dysfunction, appear to play a role in the association between renal insufficiency and adverse outcomes. Outcomes after the surgical and endovascular treatment of abdominal aortic aneurysms, carotid disease, and peripheral arterial disease are all negatively affected by renal insufficiency. Patients with renal dysfunction may warrant intervention for the treatment of critical limb ischemia and symptomatic carotid stenosis, given the comparatively worse outcomes associated with medical management. Open repair of aortic aneurysms and carotid intervention for asymptomatic disease in patients with severe renal dysfunction should be performed with significant caution, as the risks of repair may outweigh the benefits in this population. Further study is needed to better delineate the risks of medical management for these conditions in patients with coexisting severe renal dysfunction.

Lastly, current guidelines for the management of vascular diseases, including objective performance goals for critical limb ischemia, are likely not applicable in patients with severe renal insufficiency.

Stages of chronic kidney disease.
CKD stageDescriptionGFR (mL/min/1.73 m2)
INormal or mildly decreased GFR≥90
IINormal or mildly decreased GFR60−89
IIIModerately decreased GFR30−59
IVSeverely decreased GFR15−29
VSeverely decreased GFR<15 td="">

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Abbreviations: CKD, chronic kidney disease; GFR, glomerular filtration rate.
http://www.semvascsurg.com/article/S0895-7967%2815%2900007-1/fulltext