Aortoiliac occlusive disease (AIOD), especially proximal to the transplant artery, in kidney transplant patient activates the renin-angiotensin-aldosterone system by limiting graft renal perfusion and causes symptoms that can occur with transplant renal artery stenosis (TRAS) such as refractory hypertension, water retention, and graft renal dysfunction. Immediate clinical suspicion is difficult due to the nature of the progressive disease unlike TRAS. Herein, we present an interesting case of bilateral common iliac artery occlusion (AIOD, TASC II, type C) that manifested as uncontrolled blood pressure and decreased allograft function in a patient who had kidney transplant 17 years ago. The patient was successfully diagnosed with duplex scan, ankle-brachial index (ABI) and computed tomography angiography and treated with percutaneous luminal angioplasty and stent graft insertion.
Allografts ; Angiography ; Angioplasty ; Ankle Brachial Index ; Arteries ; Blood Pressure ; Blood Vessel Prosthesis ; Humans ; Hypertension ; Iliac Artery ; Kidney Transplantation ; Kidney ; Perfusion ; Phenobarbital ; Renal Artery Obstruction ; Renin-Angiotensin System ; Transplants ; Water

PURPOSE: Papillary thyroid cancer (PTC) is known to have a favorable prognosis and low mortality. However, some PTC has aggressive propensity with loco-regional recurrence or distant metastasis, and it could cause poor quality of life. Many studies for predicting high-risk group in papillary thyroid cancer have been reported, however, more study is needed. The objective of this study is to assess the efficiency of inflammation indices including the Neutrophil-Lymphocyte Ratio (NLR) as a predictor for high-risk group in papillary thyroid cancer patients. METHODS: From January 2006 to November 2012, this study enrolled consecutive 164 patients who underwent total thyroidectomy and were confirmed with papillary thyroid cancer by histopathology. Among 164 patients, 23 were excluded because they had co-morbidities which could confound the inflammation related variables. We reviewed the medical records of 141 patients and assessed the correlation between inflammation indices including preoperative serum NLR and clinical prognostic parameters, including age at presentation, tumor size, extra-thyroidal extension, lymph node metastasis, TNM stage, and MACIS score. RESULTS: In the papillary thyroid cancer patients, preoperative value of NLR, ESR, CRP, platelet, and albumin showed no significant correlation with the risk factors. CONCLUSION: In this study, preoperative inflammatory parameters such as NLR had uncertain efficacy as risk factors for papillary thyroid cancer.
Blood Platelets ; Humans ; Inflammation ; Lymph Nodes ; Medical Records ; Mortality ; Neoplasm Metastasis ; Prognosis ; Quality of Life ; Recurrence ; Risk Factors ; Thyroid Neoplasms* ; Thyroidectomy

raumatic shoulder dislocations are one of the most common major dislocations in the general population. Injury to major vessels is rarely reported as a complication of shoulder dislocations. This case report presents the traumatic dissection of the axillary artery after a simple shoulder dislocation that was managed successfully with the placement of a self-expanding stent. With the clinical manifestations of a brachial plexus injury and progressive vascular compromise in the affected arm, a major vascular injury was detected on an angiogram, and a self-expanding stent was deployed. Through immediate diagnosis and prompt intervention, serious complications, such as hypovolemic shock and even death, were averted, ultimately achieving a favorable patient outcome.