SummaryPopliteal artery entrapment syndrome (PAES) is rare in young adults. Claudication of the young patient, which is often overlooked, is a very rare symptom for orthopedic surgeons. In elder patients, the physician might expect atherosclerotic claudication, however in young patients, popliteal artery entrapment syndrome (PAES) should be considered as a possibility in the cases of claudication. Here, an unusual presentation of an uncommon disease that is not widely known by orthopedic surgeons is reported.

Cardiopulmonary bypass increases the blood levels of various immune mediators, thereby leading to a systemic inflammatory response syndrome, e.g. sepsis, with some hemodynamic alterations, such as vasodilatation, tachycardia, and a decrease in systemic vascular resistance. Perioperative hemofiltration is one of the treatment modalities proposed to prevent this syndrome. Modified hemofiltration has been introduced recently by investigators who recommend that the former standard techniques are ineffective in eliminating the inflammatory mediators. The purpose of this study was to determine the effects of the modified technique on these mediators and on hemodynamic parameters. Forty patients undergoing coronary artery bypass grafting were randomized into equal control and hemofiltered groups. The hemodynamic parameters, as well as blood samples, were taken before and after hemofiltration to assess blood concentrations of interleukin-6, interleukin-8 and neopterin. The hemodynamic parameters and immune mediator levels did not differ between the two groups during the course of the study, except in the immediate postoperative periods, where cardiac output, cardiac index, and systemic vascular resistance values were significantly greater in the hemofiltered group while there were no differences in the immune mediators. The results of our study suggest that the effects of modified hemofiltration on immune mediators are still debatable. The improvement found in cardiac performance could be attributed to the prevention of hemodilution and hypervolemia.

The aim of this study was to determine the relationship between splanchnic perfusion and oxygen consumption, and flow types in cardiopulmonary bypass (CPB), by measuring gastric intramucosal pH. Twenty patients undergoing elective open-heart surgery were prospectively randomized to receive either pulsatile or nonpulsatile flow during CPB. Gastric intramucosal pH was measured using gastric tonometry. A flowmeter was used to measure the inferior caval vein flow. A catheter was inserted through the femoral vein to sample blood from the iliac vein. Systemic vascular resistance index, gastric intramucosal pH, inferior caval vein flow and arterial, inferior vena caval and iliac venous blood gases were recorded at different times. Gastric intramucosal pH decreased in all patients; only in the nonpulsatile group was this decrease statistically significant. After 45 min of CPB, the pH was 7.37 +/- 0.03 compared with the prebypass value of 7.48 +/- 0.04 (p = 0.00016). After weaning from CPB, the pH was 7.358 +/- 0.02 compared with the prebypass value (p = 0.000037). At 2 h post-operatively the pH was 7.416 +/- 0.025 (p = 0.02). Systemic vascular resistance index rose in all patients during bypass in both groups. These changes did not have any statistical significances and after weaning from bypass returned to prebypass levels. We conclude that nonpulsatile flow in CPB is associated with reduced gastric intramucosal pH and the measurement of intramucosal pH during open-heart surgery provides important information about splanchnic perfusion.

In dogs, the peritoneum may be used as graft material for reconstruction of the inferior vena cava, provided a distal arteriovenous fistula is constructed.

Hydatid disease is caused by the larval stage of Echinococcus granulosus, and the resultant fluid-filled cysts almost invariably affect the liver. Primary involvement of the aortic wall is very rare. We report a case of hydatid disease presenting as a huge cyst invading the wall of the descending aorta and complicated by a false aneurysm. Diagnostic problems and operative management are reviewed.