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At least 1,621 records · Page 90Linked to original sources

PubMed2002

[Acute aortic dissection].

OBJECTIVE: Acute aortic dissection is a medical emergency associated with high rates of mortality. Despite recent diagnostic advances, prompt and accurate diagnosis is difficult. We present a review of the a medical emergency service experience to diagnosis, factors associated to prompt diagnosis and inhospital evolution. MATERIAL AND METHOD: We studied 86 consecutive patients who had aortic dissections, to assess the presentation, management, and outcome. RESULTS: Mean age 61.9 +/- 12.5 years, 80% male. Hypertension was the most common predisposing factor (65% of patients overall). Chest pain was the most common initial complaint (58%). The initial clinical impression was aortic dissection in 56% of patients overall. Computed tomography was diagnostic in 96% when used. 62% underwent surgery. Overall in-hospital mortality was 28%. CONCLUSIONS: Acute aortic dissection presents with a wide range of manifestations. A high clinical index of suspicion and a prompt computed tomography should to improve recognition of aortic dissection.

Acute Disease↗

PubMed2002

[Aortic dissection in pregnant woman with the Marfan syndrome].

In patients with Marfan syndrome, pregnancy is associated with a potential higher risk of aortic dissection. To determine the incidence and characteristics of aortic dissection in pregnancy, clinical courses of 8 patients with Marfan syndrome were reviewed. Aortic dissection occurred in 3 patients, one of whom had developed rapid dilatation of the ascending aorta during pregnancy. The patient underwent Bentall operation subsequent to cesarean section and simple hysterectomy. All patients tolerated pregnancy well, with favorable maternal and fetal outcomes. Follow-up echocardiography showed no apparent worsening of cardiovascular status attributable to pregnancy such as aortic dilatation and aortic regurgitation except for one patient. Dilatation of the ascending aorta during pregnancy is considered to be an important predictor for aortic dissection. Close observation should be mandatory in such patients. In patients with serious cardiovascular involvement such as acute aortic dissection, cesarean section is preferable for delivery. To prevent hemorrhagic complications under systemic heparinization, simultaneous hysterectomy should be considered as one option.

Adult↗

PubMed2002

Nonocclusive intestinal ischemia in patients with acute aortic dissection.

BACKGROUND: In aortic dissection, visceral complications that result from aortic branch compromise have been described extensively, whereas intestinal ischemia not associated with the false lumen anatomy has rarely been discussed. The aim of this report is to identify clinical factors that may contribute to the development of this form of acute mesenteric ischemia, to profile the patients at greatest risk, and to review diagnostic and treatment methods that emerged from our experience. METHODS: With a computerized database, we identified 371 patients who underwent treatment in our institution with a diagnosis of aortic dissection between July 15, 1985, and January 10, 2001. Mesenteric ischemia was present in 73 patients (19%). In 36 patients (9%), bowel ischemia was not associated with a false lumen anatomy or an extension of the dissection process. From a general analysis of the determinants of mesenteric ischemia in aortic dissection, we investigated, with univariate and multivariate analysis, the specific characteristics of these patients with nonocclusive ischemia. A retrospective analysis of the oxygen metabolic profile of patients who underwent operation also was performed. RESULTS: The mortality rate in patients with nonocclusive mesenteric ischemia was 86%; sepsis and multiple organ failure were the causes of death in all nonsurvivors. Surgical treatment was beneficial only in the early phases of the disease. The results of the multivariate analysis showed the multifactorial origin of nonocclusive mesenteric ischemia; cerebral ischemia, thrombosis of the false lumen, severe coagulation disorders, chronic obstructive pulmonary disease, aortic calcinosis, prolonged hypotension, chronic renal insufficiency, and low cardiac output were independent predictors of the condition. In patients who underwent operation, the significant risk factors were severe coagulation disorders, postoperative cerebral ischemia, maximal oxygen extraction rate of more than 0.40, aortic calcinosis, chronic obstructive pulmonary disease, thrombosis of the false lumen, inotropic support, and chronic renal insufficiency. An oxygen extraction rate of more than 0.4 at 6 hours after operation was found to be an index of intestinal damage sufficient to initiate an evaluation for visceral ischemia. Significant differences with occlusive ischemia also were evidenced with this study. CONCLUSION: In aortic dissection, nonocclusive mesenteric ischemia shows some unique clinical and individual predisposing factors. Most instrumental investigations are of poor diagnostic value, and prognosis is poor, especially when mesenteric gangrene had already taken place. Prevention can be exercised only with a heightening of our awareness of this condition and with timely correction of metabolic disturbances. In suspected cases, an aggressive surgical attitude may represent the only means for reducing mortality.

Acute Disease↗

PubMed2002

[Antegrade selective cerebral perfusion for extended total arch replacement using separated graft technique; reassessment from the type of aneurysms and dissections].

One hundred eighty two patients with thoracic aortic aneurysms or dissections who required total arch replacement (TAR) were operated on with separated graft technique and selective cerebral perfusion (SCP) between 1991 and 2000. These patients were divided into 4 groups according to the pathology as follows: group 1; acute type A dissection, group 2; chronic type A dissection, group 3; distal arch aneurysm and group 4; proximal arch aneurysm. For SCP, both the innominate artery and the left common carotid artery were cannulated when the patient was cooled to a rectal temperature of 22 degrees C. Hospital mortalities were 27% in group 1, 14% in group 2, 19% in group 3, and 8% in group 4. Independent predictors of hospital mortality were shock, visceral, and leg ischemia in group 1, and circulatory arrest time of the lower half body to be more than 1 hour and cardiopulmonary bypass time to be more than 5 hours in group 3. Permanent neurological complication occurred in 3% in group 1 and 8% in group 3. Hospital mortality was affected by the type of aneurysms and dissections. It is necessary to give careful consideration to the indication of TAR with SCP, especially in acute type A dissection and distal arch aneurysm.

Aged↗

PubMed2002

[Epidemiology and pathophysiology of spontaneous cervical artery dissection].

Spontaneous cervical artery dissections are produced by the penetration of circulating blood into the vessel wall of one or more cervical arteries, without a preceding major trauma. Dissection is one of the most frequent etiologies of ischemic stroke in young patients. Its annual incidence is about 3 per 100,000. Pathophysiology of cervical artery dissection remains misunderstood. Triggering factors such as minor trauma and infection have been identified. However, they are too trivial to explain alone the occurrence of a mural hematoma. Several abnormalities suggesting an underlying arteriopathy related to an extracellular matrix defect which could predispose to dissection have been reported: arterial redundancies, intracranial aneurysms, aortic root dilatation, common carotid artery distensibility increase, fibromuscular dysplasia, inherited connective tissue disorders, ultrastructural dermal connective tissue abnormalities. Other factors associated with dissection, such as migraine, hyperhomocysteinemia and alpha-1 antitrypsin deficiency, suggest arterial wall fragility secondary to hyperactivity of some proteases. If an underlying arteriopathy is likely, its nature remains unidentified to date and does not seem to be unique.

Aortic Dissection↗

PubMed2001

[Clinical comparison of bilateral neck dissection for supraglottic carcinoma].

OBJECTIVE: In order to rise the survival rate and quality of life, the patients with bilateral neck dissection was investigated in supraglottic carcinoma. METHOD: 76 cases were retrospectively analyzed. In terms of clinical diagnosis, 33 cases who had bilateral neck metastasis had received simultaneously bilateral neck dissection. 43 patients first diagnosed unilateral neck metastasis got subsequent bilateral neck dissection. All of the patients were pathologically diagnosed. RESULT: The 3 and 5 year survival rates, in the 33 cases who had received simultaneous bilateral neck dissection, were 81.5% (22/27) and 61.5%(16/26) respectively, while in the other 43 cases, was 69.2%(27/39) and 27.8%(10/36) respectively. CONCLUSION: It is necessary for those patients who have suffered from supraglottic carcinoma with bilateral neck metastasis to have simultaneous bilateral neck dissections. Meanwhile, the preservation of bilateral internal jugular veins is the best choice, at least one should be preserved.

Adult↗

PubMed2002

The syndrome of inappropriate antidiuretic hormone secretion after bilateral radical neck dissections.

OBJECTIVE: It is commonly believed that synchronous, bilateral radical neck dissection causes the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), presumably as a result of increased intracranial pressure. This belief is based mainly on the results of an experimental study published in 1978 in which occlusion of the superior vena cava in dogs resulted in increased intracranial pressure and SIADH. The purpose of the present study was to test this assumption in an animal model that more closely resembles the clinical condition of bilateral radical neck dissection, in an attempt to discover possible surgical methods for preventing SIADH. MATERIALS AND METHODS: The experiments were carried out in six adult mongrel dogs. In two animals the internal and external jugular veins were ligated on both sides of the neck, high in the neck and at the thoracic inlet, respectively. In four animals, a formal radical neck dissection was performed on both sides of the neck. Urine and serum osmolarity and serum electrolyte levels were measured prior to surgery and at 2.5, 24, 48 and 120 h after surgery, in order to monitor the development of SIADH. RESULTS: No significant changes in serum osmolarity, urine osmolarity or serum sodium levels were observed in any of the animals studied. CONCLUSIONS: Bilateral synchronous jugular vein ligation and bilateral radical neck dissections did not result in SIADH in a dog model. As these results contradict a commonly held belief in clinical practice, a prospective evaluation of the physiologic changes after bilateral radical neck dissections is warranted.

Animals↗

PubMed2003

[Features of radio wave tissue dissection in surgical practice].

Results of experimental and clinical investigations of using radioknife "Surgitron" for dissection and coagulation of tissues were compared. In 145 experiments the possibility to dissect different tissues (skin, muscles, fascia) and parenchymatous organs of the abdominal cavity was studied. The specific course of reparative processes was analyzed at different periods after operation. In clinical conditions the radioknife was used for operative interventions on 520 patients: in 91 cases the device was used for dissection and coagulation of hollow organs and in 73 cases--of parenchymatous organs of the abdominal cavity, in 356 patients radioknife was used for plastic operations. The radioknife "Surgitron" was established to be very good for dissection of tissues. The coagulating effect was weak. The zone of undesirable lateral necrosis was negligible, and often it was absent that makes favorable conditions for the reparative processes. On the basis of clinical and experimental investigations it was established that using radioknife "Surgitron" is indicated and expedient in plastic and esthetic surgery because it is in this field where the positive properties of radiowave action can have maximal realization taking into account the requirements of the means and quality of dissection of tissues.

Dissection↗

PubMed2000

[Lateral neck dissection of hypopharyngeal cancer with clinically regional metastasis].

OBJECTIVE: To assess whether lateral neck dissection can control the hypopharyngeal cancer with clinically regional metastasis. METHODS: A retrospective review of medical chart from 1975 to 1992 was performed. Ninety-three hypopharyngeal squamous cell carcinoma patients who had performed RND were included. The distribution of metastatic neck lymph node was analyzed. RESULTS: Submandibular triangle lymph node metastasis was occult in only 3 patients. Histological lymph node metastasis to the posterior triangle was found in 5.9% of patients with N0, 7.0% with N1, 37.5% with N2a and 36% with N2b-N3. Histological neck lymph node metastasis to the posterior triangle was found in 4.0% of patients without inferior jugular lymph node metastasis and 34.1% of patients with inferior jugular lymph node metastasis. CONCLUSIONS: Lateral neck dissection was recommended to treat hypopharyngeal cancers of N0 and N1. N2 and N3 should be treated with neck dissection including II-V group lymph nodes. After lateral neck dissection, frozen section of the inferior jugular lymph node should be performed. If the result of the frozen section is positive, V group dissection should be performed.

Adult↗

PubMedDate not supplied

Aortic dissection presenting as acute lower extremity ischemia: report of a case.

Although not common, acute leg ischemia is an important element in the clinical presentation of a patient with aortic dissection. This report describes a case of aortic dissection in which the main feature at presentation was acute right leg ischemia. The angiography showed right common iliac artery and external iliac artery occlusion. Diagnosis was made by clinical evaluation and angiography. Embolectomy was then attempted immediately but failed. Aortic dissection was highly suspected and confirmed by emergency computed tomography. Fortunately, the patient had good recovery. Aortic dissection is potentially lethal if misdiagnosed or if recognition is delayed. As such, aortic dissection should be considered in the differential diagnosis.

Adult↗

PubMed2003

Acute aortic dissection associated with left ventricular dysfunction in a postpartum and normotensive young woman.

Aortic dissection is uncommon in young women and is associated with clinical conditions such as pregnancy and Marfan's syndrome. Owing to the low incidence, diagnosis of acute aortic dissection in young women might be missed or delayed in patients who have neither risk factors nor typical clinical manifestations. We report the case of a 28-year-old postpartum woman with aortic dissection. The patient complained of abdominal discomfort, transient back pain, and general malaise at our emergency department 1 week after delivery of a healthy baby. She had no history of hypertension, connective tissue disease or congenital heart disease. Cardiovascular insult was not considered until the patient developed shock. Myocarditis or peripartum cardiomyopathy with left ventricular dysfunction was diagnosed based on imaging studies and cardiac enzyme levels. Finally, computed tomography revealed acute aortic dissection after hemodynamic collapse occurred. This case suggests that acute aortic dissection can be associated with left ventricular dysfunction, and non-specific clinical symptoms in young, normotensive, and postpartum women. A high index of clinical suspicion and alertness are needed to identify this condition.

Acute Disease↗

PubMed2003

Biomechanical effects of dissecting flexor carpi ulnaris.

Our aim was to determine whether the length and function of the flexor carpi ulnaris muscle were affected by separating it from its soft tissue connections. We measured the length of flexor carpi ulnaris before and after its dissection in ten patients with cerebral palsy. After tenotomy, tetanic contraction shortened the muscle by a mean of 8 mm. Subsequent dissection to separate it from all soft tissue connections, resulted in a further mean shortening of 17 mm (p < 0.001). This indicated that the dissected connective tissue had been strong enough to maintain the length of the contracting muscle. Passive extension of the wrist still lengthened the muscle after tenotomy, whereas this excursion significantly decreased after subsequent dissection. We conclude that the connective tissue envelope, which may be dissected during tendon transfer of flexor carpi ulnaris may act as a myofascial pathway for the transmission of force. This may have clinical implications for the outcome after tendon transfer.

Adolescent↗

PubMed1992

[Lung cancer simulating dissecting aneurysm of the aorta].

The report analyzes a rare case of lung cancer presenting as a dissecting aortic aneurysm. A 59-year-old patient was admitted to the Department of Cardiosurgery of the Institute of Cardiology, Poznań Medical School, with a preliminary diagnosis of dissecting aneurysm of ascending aorta. The patient had hypertension treated for 5 years and 3 year history of retrosternal pains. He had smoked 20 cigarettes daily for 20 years. On admission a strong chest pain radiating into the ++inter-scapular region was reported. After two days the radiation extended into the lumbosacral area. Blood pressure was 180/100 mmHg. After 7 days paresis of the lower extremities occurred. Ecg showed only hypertrophy of the left ventricle. Chest X-ray revealed dilatation of the mediastinum and enlargement of the lungs, without focal changes. Echo (M + 2D + Doppler) suggested aortic wall dissection in the ascending part and the arch. The DSA examination did not reveal the dissection, which in turn suggested mediastinal tumor. TC presented an extensive infiltration of the upper-medial part of the right lung and invaded right mediastinum. The final diagnosis, oat cell carcinoma, was established after the histopathological analysis of a biopsy specimen taken in the course of bronchoscopy. The patient died at home after two months of oncological treatment. Autopsy was not performed. In spite of considerable progress of the diagnostic technics both dissecting aortic aneurysm and lung cancer still present a very difficult clinical problem.

Aortic Dissection↗

PubMed1992

[Chronic dissecting aortic aneurysm and Turner's syndrome. Apropos of a case].

Turner's syndrome is a genetic abnormality which is associated with cardiovascular anomaly in 20% of cases. Coarctation of the aorta and bicuspid aortic valve are the commonest malformations. Aortic dissection is the most serious complication affecting these patients. The authors report the case of chronic aortic dissection of the ascending and transverse aorta in a 27 year old patient with Turner's syndrome. The dissection was diagnosed on angiography. Transthoracic echocardiography showed aneurysmal dilatation of the aortic root. Surgical treatment consisted in replacement of ascending and transverse aorta with a Dacron tube. The anatomopathological analysis showed cystic medianecrosis of the aortic wall. The immediate postoperative evolution was satisfactory. The long-term outcome with a 4 year follow-up was excellent from the clinical and echocardiographic point of view. Turner's syndrome is probably associated with a congenital abnormality of the connective tissue especially of the elastic fibres of the aortic wall, explaining the development, though rare, of aneurysmal dilatation of the ascending and transverse aorta and dissection. These patients should be followed up regularly clinically and by transthoracic echocardiography. Other investigations such as transoesophageal echocardiography, magnetic resonance imaging and angiography are indicated when aortic dilatation, aortic regurgitation or chest pain suggesting aortic dissection are observed.

Adult↗

PubMedDate not supplied

[Wallenberg's syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation].

INTRODUCTION: Chiropractic manipulations of the cervical region are techniques that are used more and more frequently to treat a number of osteomuscular pathologies, but can give rise to important complications, such as the dissection of the cervical arteries. Dissection of the vertebral artery generally presents as alternating syndromes, of which Wallenberg s syndrome, either complete or incomplete, is the most frequent. In this paper we review the literature published to date on the pathogenesis, risk factors, clinical features, chronopathology, diagnosis, treatment and prognosis of this complication. CASE REPORT: We describe the case of a young patient who suffered from incomplete Wallenberg s syndrome a few hours after a single session of cervical chiropractic manipulation, and we also show the resonance images that were used to support the diagnosis. CONCLUSIONS: The appearance of a pain in the neck and neurological symptoms in a patient who has undergone chiropractic manipulation in the last few hours or days must lead us to consider a possible dissection of the cervical arteries. Dissection of the vertebral artery usually gives rise to alternating syndromes, the most frequent of which is lateral bulbomedullary infarction or Wallenberg s syndrome due to proximal occlusion of the posteroinferior cerebellar artery. Magnetic resonance angiography of the supra aortic trunks and cranial magnetic resonance scanning are valid techniques for demonstrating the dissection of the artery and the associated ischemic lesion.

Adult↗

PubMed2003

Aortic dissection in children and young adults: diagnosis, patients at risk, and outcomes.

OBJECTIVE: To heighten the awareness of pediatricians and pediatric cardiologists to aortic dissection, a potentially dangerous medical condition. METHODS: We reviewed the charts of 13 patients, seen in four medical centers, who suffered acute or chronic aortic dissection over the period 1970 through 2000 whilst under the age of 25 years. RESULTS: There were seven male and six female patients, with the mean age at diagnosis being 12.1 years, with a range from one day to 25 years. Congenital cardiac defects were present in five patients, and Marfan syndrome in four. In three of the patients with congenital cardiac defects, aortic dissection developed as a complication of medical procedures. In three patients, dissection followed blunt trauma to the chest. We could not identify any risk factors in one patient. The presenting symptoms included chest pain in four patients, abdominal pain and signs of ischemic bowel in two, non-palpable femoral pulses in one, and obstruction of the superior caval vein in one. Angiography and magnetic resonance imaging were the main diagnostic tools. Overall mortality was 38%. Only six patients had successful surgical outcomes. CONCLUSION: Due to the rarity of aortic dissection a high index of suspicion is required to reach the diagnosis in a timely manner. It should be considered in young patients complaining of chest pain in association with Marfan syndrome, anomalies of the aortic valve and arch, and chest trauma.

Adult↗

PubMed2003

Spontaneous coronary artery dissection in a patient with systemic lupus erythematosis.

Spontaneous coronary artery dissection (SCAD) is an uncommon condition that may lead to sudden coronary artery occlusion resulting in a fatal acute myocardial infarction. It usually affects young to middle age women. A Medline search from 1966 to 2001 (using keywords: coronary artery dissection and systemic lupus erythematosis) revealed no prior reports of coronary dissection in a patient with systemic lupus erythematosis (SLE). We describe a 48-year old woman with SLE who sustained a fatal spontaneous left main coronary artery dissection. Coronary angiogram was notable for marked variability in the size of coronary lumen from systole to diastole. This case demonstrates the need to consider SCAD in the evaluation of chest pain and myocardial infarction in patients with SLE. Furthermore, in the absence of classical angiographic findings of coronary dissection, a detailed review of phasic changes in coronary lumen during a cardiac cycle could help reach this diagnosis.

Carotid Artery, Internal, Dissection↗

PubMed1992

[A case of intimal dissection of the aorta during transfemoral angiography].

A 54-year-old man underwent right transfemoral angiography because of left renal hematuria. During angiography, dissection of abdominal aorta and thoracic aorta was encountered. It was initiated by intramural catheter passage at the bifurcation of the internal and external iliac artery. Transaxillary aortography about one month after the first angiography showed occlusion of the dissecting space in the thoracic aorta and existence of dissecting space in the abdominal aorta. Communicating orifices between the true space and the false space existed not only at the bifurcation of internal iliac artery and external iliac artery, but also at the abdominal aorta near the left renal artery. CT 1.5 months after the first angiography did not demonstrate more improvement. Surgery was performed. It was impossible to sew up and close the orifices of the space because of the fragility of the intima. Surrounding abdominal aorta and common iliac artery were wrapped near orifices with a dacron graft. A follow-up CT obtained 3 months postoperatively showed that the dissecting space in the abdominal aorta had disappeared. Wrapping was very useful to promote organization of the dissecting space.

Aortic Dissection↗