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OBJECTIVE: Abdominal aortic aneurysm (AAA) is a condition that mainly affects elderly men. At present, there is no effective medical therapy that can retard aneurysm growth or prevent aneurysm rupture. There is evidence that angiogenesis within the wall of an aortic aneurysm may play key roles in aneurysm progression as well as rupture. The use of anti-angiogenic therapy as potential medical therapy in AAA is a promising strategy but has never been studied in detail. DESIGN: This paper discusses the basic mechanisms of angiogenesis, the role played by angiogenesis in aortic aneurysms and the potential therapeutic role of anti-angiogenic drugs against aneurysm expansion or rupture. RESULTS: Angiogenesis is a multi-step process which is fundamental for growth and differentiation of various tissues within a multi-cellular organism. Hypoxia and inflammation are key stimuli for activation of neoangiogenesis. Investigations in both human tissues and animal models of AAA have shown that angiogenesis is a pathological hallmark of AAA and appears to play a role in the development and progression of the condition. Pre-clinical studies have shown that anti-angiogenic drugs can potentially be effective in reducing the intensity of aneurysm formation, suggesting that such drugs may potentially be useful as novel drug therapy for AAA in humans. CONCLUSION: Current evidence suggests that angiogenesis contributes to the destructive processes within aneurysmal aortic wall. As novel drug therapy for aortic aneurysms (for use in humans) is still eluding researchers, anti-angiogenic pathway appears to be an attractive approach.

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PURPOSE: Extra-levator abdominal perineal excision of rectum (eLAPE) for low rectal tumours is associated with a lower incidence of circumferential resection involvement. However, there is no consensus on the ideal technique for perineal reconstruction following eLAPE. We thereby conducted a 5-year review of perineal closure outcomes following eLAPE. METHODS: A systematic review of the literature was conducted between 2006 and July 2012. Perineal wound healing and complications in the post-operative period were examined. RESULTS: Original data following eLAPE were found in 27 studies involving 963 individuals to inform a qualitative synthesis. Pooled analysis revealed that investigators most commonly employed either biomesh closure (12 studies, n = 149), myocutaneous flap closure (9 studies, n = 201) and primary closure (4, n = 578). The incidence of minor and major wound complications and perineal hernias across the latter groups was (27.5, 13.4 and 2.7 %), (29.4, 19.4 and 0 %) and (17.1, 6.4 and 1.2 %), respectively. Two studies utilised synthetic mesh closure (n = 4) and omentoplasty (n = 31). Objective assessment of wound healing was strikingly deficient across most studies, largely due to low level retrospective evidence lacking randomised controls. Modest cohort sizes with short follow-up data were evident due to the relative novelty of eLAPE. CONCLUSION: The paucity of high quality data, suggests that a prospective, randomised trial is needed to determine the ideal technique for perineal reconstruction following eLAPE.

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BACKGROUND: Recent studies from Australia, New Zealand, and Sweden have reported declines in abdominal aortic aneurysm (AAA) incidence, prevalence, and mortality. This finding may have important implications for screening programs. This study determined trends in AAA incidence and mortality in England and Wales. METHODS AND RESULTS: Cause-specific mortality data for England and Wales were obtained from UK Office for National Statistics, and hospital admissions and procedures data for England were obtained from Hospital Episode Statistics from 2001 to 2009. Poisson regression models were constructed to estimate the relative change over time. Age-standardized rates for AAA mortality in England and Wales fell significantly by 35.7% from 2001 to 2009, which was largely due to a 35.3% drop in age-standardized ruptured AAA deaths. During the same period, ruptured AAA admissions and emergency AAA repairs in England declined by 29.3% and 35.5%, respectively. In contrast, nonruptured AAA admissions remained static, and nonemergency AAA repairs increased by 17.2%. The average ages for hospital admissions for nonruptured AAAs and ruptured AAAs increased by 0.19 years of age per annum (P<0.001) and 0.09 years of age per annum (P<0.001), respectively. Nonruptured AAA admissions increased by 21.4% in age band 75 years or more but declined by 11.7% in ages <75 years. CONCLUSIONS: AAA mortality, ruptured AAA admission, and emergency AAA repair have declined in England and Wales. However, nonruptured AAA admission has remained steady, with an increasing rate in older population offsetting a decreasing rate in younger population. This suggests a shift in AAA presentation to the older population. Present screening strategies may need reassessment to include consideration for increasing the age at which to screen men for AAAs.

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BACKGROUND: The periaortitis seen with inflammatory abdominal aortic aneurysms usually resolves after repair by both open and endovascular techniques. Conversely, the de novo development of retroperitoneal fibrosis after endovascular aneurysm repair (EVAR) has also been rarely described, and we present a case and also review the literature. METHODS AND RESULTS: A 63-year-old man underwent EVAR for an asymptomatic, noninflammatory abdominal aortic aneurysm, presenting 9 months subsequently with left loin pain, raised inflammatory markers, and radiological evidence of periaortic inflammation causing significant left ureteric obstruction. Ureteric stenting resolved the hydronephrosis, and the periaortitis improved with combination of steroid and tamoxifen therapy. CONCLUSION: Periaortitis causing renal impairment after EVAR is a rare complication. Prompt recognition and ureteric stenting helps to prevent long-term renal damage. Steroid and tamoxifen therapy is recommended to treat and avoid recurrence of periaortitis.

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A young man from Jamaica was admitted with cachexia, postprandial epigastric pain and vomiting. His abdominal examination revealed a soft abdomen with hyperactive bowel sounds, the laboratory investigations showed mild anaemia and hypoalbuminaemia, and abdominal x ray showed dilated and oedematous bowel loops. A duodenal biopsy revealed larvae and eggs in the epithelium consisted with Strongyloides infection. In retrospect the patient was found to be HTLV-1 positive. Helminthic infections can present with bowel obstruction even in the absence of eosinophilia or diarrhoea, and should be considered in patients with the appropriate epidemiological background.