SEARCH · PubMed Health

Results for “Dissection”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 901 records · Page 50Linked to original sources

PubMed1997

[Rational extent of lymph node dissection for carcinoma of the lower third of the thoracic ESOP-hagus of T2 or T3 stage with abdominal lymph node metastasis].

We discussed the rational extent of the lymph node dissection for carcinoma of the lower third of the esophagus of T2 or T3 stage with abdominal lymph node metastasis. Lymph node metastasis developed in 89.5% of patients. Cervical lymph node metastasis was seen in 35.8%. In the cases with positive abdominal lymph node, 40.9% of the patients had cervical node metastasis. The most frequent site of the positive node in the neck is the area along the right recurrent laryngeal nerve. On the stand point of removal of metastatic lymph node, neck dissection should be required. Three-field dissection yielded better survival rate than two-field dissection but statistical significance was not obtained. When the patients have cervical lymph node metastasis, they have greater possibility of developing blood borne metastasis. However, this observation does not deny the validity of the three-field dissection. Because this dissection may help reducing nodal spread and nodal recurrence. We have to wait for accumulation of the patients to analyze the definite extent of node dissection for T2 or T3 stage of carcinoma of the lower third of the esophagus with positive abdominal lymph node.

Abdomen↗

PubMed2003

Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients.

The highly variable clinical course of cervical artery dissections still poses a major challenge to the treating physician. This study was conducted (1) to describe the differences in clinical and angiographic presentation of patients with carotid and vertebral artery dissections (CAD, VAD), (2) to define the circumstances that are related to bilateral arterial dissections, and (3) to determine factors that predict a poor outcome. Retrospectively and by standardised interview, we studied 126 patients with cervical artery dissections. Preceding traumata, vascular risk factors, presenting local and ischemic symptoms, and patient-outcome were evaluated. Patients with CAD presented more often with a partial Horner's syndrome and had a higher prevalence of fibromuscular dysplasia than patients with VAD. Patients with VAD complained more often of neck pain, more frequently reported a preceding chiropractic manipulation and had a higher incidence of bilateral dissections than patients with CAD. Bilateral VAD was significantly related to a preceding chiropractic manipulation. Multivariate analysis showed that the variables stroke and arterial occlusion were the only independent factors associated with a poor outcome. This study emphasises the potential dangers of chiropractic manipulation of the cervical spine. Probably owing to the systematic use of forceful neck-rotation to both sides, this treatment was significantly associated with bilateral VAD. Patients with dissection-related cervical artery occlusion had a significantly increased risk of suffering a disabling stroke.

Adult↗

PubMed2005

Treatment of spontaneous arterial dissections with stent placement for preservation of the parent artery.

BACKGROUND: A wide variety of treatment regimens have been advocated for dissections involving the intracranial arteries. Recently, the stent can be used to exclude the aneurysm from the circulation and preserve the parent artery. We evaluated the safety and efficacy of stent angioplasty for intracranial arterial dissections. METHODS: Ten patients with spontaneous dissections, nine vertebral artery and one internal carotid artery lesions underwent endovascular treatment using stent placement as primary treatment modality. One stent placement was attempted in five patients initially. Three patients were intentionally treated with two overlapping stents which completely covered the aneurysm orifice. Two tandem stents were used in one patient to allow spanning the entire length of the dissection. Stent-assisted coil embolization was performed in one patient. RESULTS: Of the 10 patients in whom stenting was tried, the overall success in reaching the target lesion with stents was 90%. Of the 9 patients treated with stents, stent release and positioning were considered optimal in 7 patients (77.8%) and suboptimal in two. Lesions of 8 patients were improved or stable in angiographic follow-up. However, one pseudo-aneurysm was enlarged, and subsequently, was treated by proximal occlusion using coils. There were no instances of postprocedural ischaemic attacks, new neurological deficits, and no new minor or major strokes prior to patient discharge. All parent arteries of the patient who underwent the successful procedure were preserved. On the modified Rankin scale used for the follow up, all patients were assessed as functionally improved or of stable clinical status. CONCLUSIONS: The success in reducing dissection-induced stenosis or pseudo-aneurysm, the patency rate obtained at follow-up, and the lack of strokes (ischaemic or haemorrhagic) suggest that stent placement offers a viable alternative to complex surgical procedures or deconstructive procedures. The long-term efficacy and durability of stent placement for arterial dissection remains to be determined in a large series.

Adult↗

PubMed2002

Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection.

Vascular compromise seen with pulse deficits is common in patients with type A dissection. However, patient characteristics and in-hospital outcomes associated with pulse deficits have not been evaluated. Accordingly, we studied 513 patients (mean age 62 +/- 14 years, 65% men) with acute type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection. Pulse deficits, defined as decreased or absent carotid or peripheral pulses as noted by clinicians and later confirmed by diagnostic imaging, at surgery or at autopsy were noted in 154 patients (30%). Age <70 years, male gender, neurologic deficit(s), altered mental status, and hypotension, shock, or tamponade on admission were all significantly higher in patients with than without pulse deficits. The etiology of aortic dissection, clinical symptoms, and imaging findings were similar in the 2 groups. In-hospital complications (hypotension, coma, renal failure, and limb ischemia) and mortality (41% vs 25%, p = 0.0002) were significantly higher in patients with pulse deficit. Cox proportional-hazards regression analysis identified pulse deficit as an independent predictor of 5-day in-hospital mortality (risk ratio 2.73, 95% confidence interval 1.7 to 4.4; p <0.0001). Further, overall mortality rates increased with an increasing number of pulse deficits (p for trend <0.0001). Pulse deficits are common findings in patients with type A aortic dissection and identify those at high risk of in-hospital adverse events. This simple clinical sign should direct physicians to consider a diagnosis of aortic dissection in patients with acute chest pain, and should help identify a subgroup of patients who would benefit from more aggressive strategies.

Aged↗

PubMed2005

[Diagnosis and follow-up of cervical arterial dissections--results of the SFNV-SFNR study].

INTRODUCTION: the objective of this study was to determine the role of radiological techniques in the diagnosis, assessment of severity and follow-up of cervical arterial dissections. MATERIAL AND METHODS: from 1995 to 2001 a multicentre retrospective study was conducted in 24 hospital centers. A multiple-choice questionnaire was sent to each center in order to collect clinical information and imaging details regarding the diagnosis and follow-up of cervical arterial dissections. RESULTS: information was gathered on 459 patients, comprising a total of 384 carotid artery dissections and 170 vertebral artery dissections. A mean of 4.85 diagnostic examinations per patient were conducted. Morphological imaging of the brain by CT or by MRI was performed on all except 3 patients. Cervical Doppler ultrasound examination was the most frequently performed test throughout the entire study period (performed in 87% of patients). Conventional arteriography was a routinely employed test in 1995 whereas by 2001 it comprised only 31.2% of requested examinations, having been progressively replaced by MRI and MRA scanning, which comprised 60% of all examinations performed by 2001. A combination of cervical Doppler ultrasonography, axial MRI and MRA of the neck vessels were performed in 39.6% of patients in 2001. Examination of the intracranial vessels was performed by transcranial Doppler ultrasound in 40% of cases and by MRA in 30% of cases. For the follow-up of arterial dissections, an average of 1.4 examinations was performed per patient. The majority of such follow-up examinations comprised Doppler ultrasound and/or MRA of the neck arteries. CONCLUSION: The imaging diagnosis and follow-up of cervical arterial dissections will increasingly rely on non-invasive imaging techniques.

Carotid Artery, Internal, Dissection↗

PubMed2005

[Spontaneous dissection of the subclavian artery and its branches].

A 51-year-old woman suffering from vertigo presented to our cerebrovascular laboratory. MRI revealed a right-sided cerebellar infarction. On ultrasound examination, we found a dissection with wall hematoma of the right subclavian artery extending to the first segment of the vertebral artery and to the thyrocervical trunc, as well as a dissection of the left vertebral artery in the cranio-cervical junction. On follow-up evaluation, all stenoses resulting from dissection were recanalized within 2 months and findings of wall hematoma disappeared completely within 7 months. There was no evidence of a traumatic or iatrogenic cause of dissection; an aortic dissection was excluded by MRI. So we diagnosed a spontaneous dissection of the subclavian artery--an extremely rare but apparently existing vascular condition.

Aortic Dissection↗

PubMed2005

Retropharyngeal space and lymph nodes: an anatomical guide for surgical dissection.

Identification of the alar fascia is the key part of surgical dissection of the retropharyngeal lymph nodes (RPLNs). In cases where mandibulotomy is not performed for the removal of the primary tumor and/or the posterior pharyngeal wall is not incised, the medial or lateral approaches described in this paper can be performed. Surgical dissection of the RPLNs may improve prognosis and locoregional control in oropharyngeal, hypopharyngeal and cervical esophageal carcinomas. There have been no previous anatomical studies concerning landmarks and approaches for the surgical dissection of the RPLNs. This study was designed to illustrate the fascial anatomy of the retropharyngeal region (RPR), provide anatomical guidelines for RPLN dissection and describe and compare approaches for surgical removal of the RPLNs. Twelve fixed cadavers were used. Slices were obtained from the necks of the first three cadavers and the RPRs of the slices were dissected under an operating microscope. The other nine cadavers were dissected in a surgical position to expose the RPLNs and the fasciae of the RPR. In the coronal plane, the alar fascia divides the space between the buccopharyngeal and prevertebral fasciae into two compartments and constitutes the posterior border of the retropharyngeal space, which contains the RPLNs. The alar fascia, an important landmark for reaching the RPLNs, can be identified by the cervical sympathetic trunk, superior sympathetic ganglion and superior laryngeal nerve. Two approaches can be performed to remove the RPLNs, namely medial or lateral to the internal and external carotid arteries, internal jugular vein and vagus nerve.

Cadaver↗

PubMed2006

Do extracellular-matrix-regulating enzymes play a role in cervical artery dissection?

BACKGROUND: An underlying extracellular matrix defect is suspected in patients with spontaneous cervical artery dissection (SCAD). We test the hypothesis that levels of matrix metalloproteinase (MMP) 2 and 9, and elastase, extracellular-matrix-regulating enzymes involved in the vascular wall remodeling process, are modified in SCAD. METHODS: The authors prospectively and consecutively recruited 47 patients with SCAD and 52 patients with an ischemic stroke from another cause in 2 centers, and measured their plasmatic level of MMP-2, MMP-9 and elastase 3 months after the vascular event. RESULTS: Patients with SCAD had a higher mean MMP-2 level compared with controls [379.2 (SD = 76.6) vs. 355.9 (75.1) ng/ml; p = 0.11] and had more frequently a high level of MMP-2 (>326 ng/ml) than controls (77.8 vs. 54.5%, p = 0.019). This association was stronger in patients with multiple dissection than single artery dissection or controls (84.6, 75.0 and 54.5%, respectively, p = 0.018). The levels of MMP-9 and elastase were similar in cases and controls, but more patients had a high level of these enzymes in the group with multiple dissections than in the group with single artery dissection or controls. CONCLUSION: Patients with SCAD have higher plasma levels of proteases, particularly MMP-2. The association is stronger in patients with multiple dissections.

Adult↗

PubMed2002

[Craniocervical artery dissection].

BACKGROUND: In recent years, new radiographic diagnostics have increased our knowledge about dissection of the carotid and vertebral arteries as a cause of stroke, probably an underdiagnosed condition. Carotid dissection is now considered one of the most frequent aetiologies of ischaemic stroke in patients less than 50 years of age and it accounts for 20% of all cases under the age of 30. MATERIAL AND METHODS: In this paper we describe clinical course and investigations in four patients who had dissection of the precerebral arteries. RESULTS: Three patients had carotid artery dissection, one vertebral artery dissection. Three patients had ischaemic symptoms. One patient had symptoms following physiotherapy to the neck. INTERPRETATION: Patients with craniocervical arterial dissection should be investigated with ultrasound techniques and MRI or CT; antiplatelet agents or anticoagulation therapy should be considered.

Aortic Dissection↗

PubMed2004

[Dissections of the carotid and vertebrobasilar arteries].

Ischaemic strokes and TIA are increasingly being found to be due to arterial cervical dissection, particularly in young adults. Physicians have better knowledge of this disease, and diagnostic neuroimagery has improved. Sometimes traumatic, arterial dissection can also be truly spontaneous or coincides with ordinary neck movement. Dissection consists in an intramural hematoma, and affects most commonly the carotid artery. In 25% of cases, two or more cervical arteries appear to be affected simultaneously, suggesting fibromuscular dysplasia. Pathophysiological considerations remain unclear and several hypotheses are considered. Clinical manifestations are evocative and cervical warning signs such as pain, headache or Horner's syndrom provide an opportunity to recognize the patients few hours or days before cerebral or ocular ischemia occurs. Conventional angiography remains the gold standard in the diagnosis of arterial dissections but ultrasonography and magnetic resonance techniques are more and more often informative. Although no therapeutical trial is available, anticoagulant therapy has been recommended, except in intracranial dissection. Recurrent dissections are very rare and long term functional prognosis seems to be favourable.

Basilar Artery↗

PubMed2005

The dissections of craniocervical arteries.

Dissection of craniocervical arteries internal carotid artery (ICA), or vertebral artery (VA) is an increasingly recognized entity and infrequent cause of stroke. We investigated 8 patients (4 women and 4 men) with dissections of the craniocervical arteries. Diagnostic procedures for detection of craniocervical dissection included: extracranial ultrasound-color Doppler flow imaging (CDFI) of carotid and vertebral arteries, transcranial Doppler sonography (TCD) and radiological computed tomography (CT) and digital subtractive angiography (DSA) examinations. Ultrasound findings (CDFI of carotid and vertebral arteries) were positive for vessel dissection in seven patients (or 87.5 per cent) and negative in one patient. DSA was consistent with dissection in five patients (or 62.5 per cent), negative in one, while in two patients the examination was not performed due to known allergy to contrast media. Five patients (62.5 per cent) were treated with anticoagulants, one with suppressors of platelet aggregation, and two patients were operated. Six patients (75 per cent) after the treatment showed partial recovery of neurological defects, and an improvement of ultrasound finding of dissected arteries. In one patient, following operation, stroke developed with deterioration of motor deficit, and one patient was readmitted three months later due to a newly developed stroke and soon died. The diagnosis should be suspected in any young or middle-age patient with new onset of otherwise unexplained unremitting headache or neck ache, especially in association with transient or permanent focal neurological deficits.

Adult↗

PubMed1999

Deep lamellar keratoplasty using viscoelastic dissection.

We describe a technique for performing deep lamellar keratoplasty using viscoelastic dissection. Deep lamellar dissections of the cornea using viscoelastic substances (sodium hyaluronate) were performed on 4 eyes of 4 patients. One patient with keratoconus and another with corneal scarring underwent lamellar keratoplasty using the technique as the sole procedure for visual rehabilitation. Two patients (2 eyes) with opaque corneas underwent deep lamellar dissection with removal of stromal tissue to allow visualization of the anterior segment structures prior to penetrating keratoplasty, thereby facilitating separation of iridocorneal adhesions as the Descemet membrane was incised. Deep lamellar dissection was performed without complications related to the procedure in all 4 eyes. The 2 lamellar grafts cleared completely, and both eyes achieved excellent visual acuity with spectacle correction. In the other 2 eyes, deep lamellar dissection provided clear visualization of anterior segment structures during incision of the Descemet membrane. Deep lamellar dissection using viscoelastic substances is a useful technique during lamellar keratoplasty.

Aged↗

PubMed1998

Cable grafting of the spinal accessory nerve after radical neck dissection.

BACKGROUND: From January 1981 through March 1996, 20 patients with head and neck cancer underwent radical neck dissection with sacrifice of the spinal accessory nerve and immediate reconstruction of the nerve using a microsurgical technique and a cable graft of the great auricular nerve. METHODS: Postoperative shoulder function was assessed via a subjective questionnaire, objective strength testing, and/or postoperative electromyography. The latter was used to evaluate for the presence and amplitude of voluntary motor potentials, the presence of fibrillation potentials, and nerve conduction latency. The group of patients who underwent cable grafting of the spinal accessory nerve was compared with a group of patients who underwent modified radical neck dissection with preservation of the spinal accessory nerve and with another group of patients who underwent a classic neck dissection with sacrifice of the spinal accessory nerve and no reconstruction. RESULTS: In terms of shoulder function, the group of patients in whom the spinal accessory nerve was reconstructed occupied an intermediate position; ie, their postoperative shoulder function was better than that of the patients who underwent radical neck dissection without reconstruction but not as good as that of the patients who underwent modified neck dissection with preservation of the spinal accessory nerve. CONCLUSION: Cable grafting of the spinal accessory nerve that has been sacrificed during radical neck dissection results in improved shoulder function in the postoperative period.

Accessory Nerve↗

PubMed2000

Ipsilateral neck cancer recurrences after elective supraomohyoid neck dissection.

DESIGN: Retrospective analysis of a case series. SETTING: Referral center, private or institutional practice, hospitalized care. OBJECTIVE: To analyze the level (site) of ipsilateral neck recurrences after supraomohyoid (SOH) dissection in patients with lip, oral, and oropharyngeal cancer treated in a single institution. INTERVENTION: Supraomohyoid neck dissection. PATIENTS AND METHODS: From 1979 to 1997, 154 patients with oral and oropharyngeal carcinoma and no palpable lymph nodes at the neck underwent ipsilateral elective SOH dissection. RESULTS: Tumor sites were the lip, 5 cases (3.3%); oral cavity, 128 cases (83.1%); and oropharynx, 21 cases (13.6%). Tumor stages were T1, 13 cases (8.4%); T2, 77 cases (50.0%); T3, 40 cases (27.0%); and T4, 22 cases (14.3%). There were 7 cases (4.5%) of ipsilateral neck recurrences. Three were beyond the limits of the SOH dissection, and 4 were inside these limits. There was no association of neck recurrences with the pathological status of the lymph nodes. Six of the 7 recurrences were in patients who underwent postoperative radiotherapy. CONCLUSIONS: The incidence of neck recurrence after selective neck dissection was 4.5%, and it occurred either inside (57.1%) or beyond (42.9%) the limits of the selective neck dissection.

Adult↗

PubMed2001

The role of neck dissection after chemoradiotherapy for oropharyngeal cancer with advanced nodal disease.

OBJECTIVE: To analyze and compare the effectiveness of sequential platinum-based chemotherapy and radiotherapy with and without selective neck dissection in patients with N2a and greater stage node-positive squamous cell carcinoma of the oropharynx. DESIGN: Nonrandomized controlled trial. SETTING: Tertiary referral center. PATIENTS: Sixty-six patients with squamous cell carcinoma of the oropharynx staged N2a or greater. INTERVENTIONS: Platinum-based induction chemotherapy followed by definitive radiation therapy; and selective neck dissections 6 to 10 weeks following the completion of radiation therapy in patients with radiographic evidence suggesting residual neck disease. MAIN OUTCOME MEASURES: Locoregional recurrence and disease-free survival. RESULTS: Of 66 patients, 24 (36%) had complete responses in the primary local tumor (oropharynx) and regional disease (neck nodes), as assessed clinically and radiographically. These patients had lower rates of locoregional recurrence than did patients showing no or partial responses, but the differences were not significant (P>.05). Of 18 patients undergoing neck dissection, 10 (56%) had pathological evidence of residual tumor. Patients showing a complete response of regional and neck disease had significantly improved disease-specific and overall survival (P = .01 for both) compared with patients showing no or partial responses of their neck disease. Patients with no or partial responses who underwent neck dissections had significantly improved overall survival compared with similar patients who did not undergo neck dissections (P = .002). CONCLUSIONS: Even in patients with bulky nodal disease, a complete response in the neck to sequential chemotherapy and radiotherapy may indicate that neck surgery is not necessary for good locoregional control and improved disease-free survival. Neck dissection is recommended for patients with no or partial radiographic responses.

Adult↗

PubMed1997

Effectiveness of selective neck dissection for management of the clinically negative neck.

OBJECTIVE: To determine the effectiveness of selective neck dissection for management of the clinically negative neck in head and neck squamous cell carcinoma. DESIGN: A retrospective comparison of patients treated electively with selective neck dissection and comprehensive neck dissection. SETTING: Academic tertiary referral center. PATIENTS: Patients with clinically negative necks and previously untreated head and neck squamous cell carcinoma. INTERVENTION: Elective neck dissection, surgical treatment of the primary lesion, and postoperative radiotherapy as indicated. OUTCOME MEASURES: Regional recurrence, distant metastasis, and disease-free survival. RESULTS: Selective neck dissection was as effective as comprehensive procedures for staging the clinically negative neck. Occult metastases had a statistically significant effect on patient outcome as measured by distant metastasis. CONCLUSION: Elective neck dissection provides invaluable staging information, which guides the decision for adjuvant therapy.

Adult↗

PubMed1977

Renal artery dissections.

Renal artery dissections encountered in 15 patients, aged 3 to 75 years, were categorized as to pathogenesis (blunt abdominal trauma, catheter injury, and spontaneous). Blunt traumatic dissections (seven patients) were characterized by hypertension, gross hematuria, and pain. Catheter-induced dissections (four patients) were asymptomatic, although two exhibited accelerated hypertension. Spontaneous dissections (four patients) were all associated with preexistent arterial disease. Symptoms in these patients were uncommon, despite accelerated hypertension in three cases. Intravenous pyelography lacked specific diagnostic value for renal artery dissections. Early arteriographic examination proved essential in diagnosis and surgical treatment. Criteria for operative intervention included existence of technically correctable dissections causing (1) hemodynamically significant occlusions of the main or major segmental renal arteries, (2) documented renovascular hypertension, or (3) significant deterioration of renal function.

Adult↗

PubMed1993

Microsurgical neck dissection for occultly metastasizing medullary thyroid carcinoma. Three-year results.

BACKGROUND: Medullary thyroid carcinoma (MTC) metastasizes early into the regional lymph nodes, but distant metastases occur late. Modified radical neck dissection might improve the treatment results for occultly metastasizing MTC. METHODS: The authors report 23 patients after a minimal follow-up of 2 years (median, 36 months). There were 11 female and 12 male patients. The mean age was 43 years (+/- 13 years). The surgical technique included the meticulous dissection of all compartments of the neck, resulting in a unilateral or bilateral modified radical neck dissection with the complete removal of the lymphatic and fatty tissue between important anatomical structures. The surgical boundaries extended cranially to the mastoid, caudally to the brachiocephalic vein involving a transcervical mediastinal dissection, and laterally to the edge of the trapezoid muscle. Ten patients were treated bilaterally and 13 patients unilaterally. RESULTS: The basal calcitonin values of 18 of the 23 patients were postoperatively normalized with 4 patients having normal basal and pentagastrin-stimulated calcitonin levels. Five patients with persistently elevated basal serum calcitonin values had a marked reduction of the postoperative calcitonin levels compared with their preoperative concentrations. However, in these five patients histologic abnormalities precluded a surgical cure. The permanent complication rates were tolerable (4 of 33 neck dissections). CONCLUSIONS: The microsurgically extended neck dissection can reduce basal and pentagastrin-stimulated serum calcitonin values to normal levels even after long intervals following primary thyroidectomy.

Adolescent↗