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 1,657 records · Page 92Linked to original sources

PubMed1991

[Type A aortic dissection: the role of angiography in identifying morphologic features in comparison with autopsy and surgical findings].

To evaluate the reliability of cineangiography in identifying some morphologic characteristics of type A aortic dissection, the angiograms of 36 consecutive patients were retrospectively revised and compared with the surgical of necropsy findings. The following features were examined: site and extension of intimal tear (s); extension of the wall dissection; coronary and brachiocephalic arteries involvement; coexisting anuloaortic ectasia; aortic valve state. The angiographic diagnosis of site and extension of the intimal tear was correct in 97 (35/36) and 100% of cases respectively. In one case the presence of an intimal tear at the level of the aortic arch was missed because of the superimposition of the innominate artery. The extension of the wall dissection was correctly identified in 24 out of 25 patients. In one case the presence of distal false lumen thrombosis made the correct diagnosis impossible. The brachiocephalic arteries involvement was always correctly stated while the coronary involvement was suspected in 6 and confirmed in 5 (1 false positive). Anuloectasia was suspected in 12 and confirmed in 10 (2 false positives). In our experience the most challenging diagnosed were the presence of aortic arch tears and the aortic arch and coronary arteries involvement in the dissection. This study confirms that many morphologic features of type A aortic dissection can be adequately assessed by cineangiography.

Adult↗

PubMed1990

[Non-invasive diagnosis of dissecting aneurysm of the aorta].

Possibilities of noninvasive radial diagnostics were studied in examination of 27 patients with dissecting aneurysms of the aorta. Classical X-ray examinations of chest organs have diagnosed aorta wall dissection in 2 of 24 patients. In 19 patients the diagnosis of aorta dissection was suspected. The ultrasound examination gave correct diagnosis in 3 of 4 patients examined. The non-contrast computed tomography has revealed dissecting aneurysms in 8 of 24 patients, an investigation with the intravenous injection of the contrast substance--in 13 of 15 patients. The diagnosis was based upon the detection of 2 canals of the aorta with the dissected intima between them, thrombosis of the false aorta canal and accumulation of the liquid in the pleura and pericardium cavity. When planning operative procedures it becomes necessary to perform aortography.

Adult↗

PubMed1990

The diagnosis and management of aortic dissection.

Aortic dissection is a severe disease. Most untreated patients with types I and II (proximal) dissection and over half of those with type III (distal) dissection die within 1 year. Most of the deaths occur within 2 weeks and are caused by rupture, aortic insufficiency, and branch vessel obstruction. Aortic dissection is suspected in patients with anterior chest and back pain that progresses downward. Diagnosis is confirmed by computed tomography, aortography, or echocardiography. Appropriate medical treatment and corrective surgery, including total aortic replacement, performed in the acute and chronic stages, are now successful in over 90% of the cases; long-term results of treatment are steadily improving and are expected to exceed 50% at 10 years. The keys to a successful outcome are being aware of the symptoms of dissection, early diagnosis, and prompt application of appropriate treatment; diligent follow-up includes controlling blood pressure, decreasing the velocity of left ventricular contraction, monitoring the size of the residual aorta, and taking appropriate action if redissection, aneurysmal formation, or rupture occurs.

Acute Disease↗

PubMed1990

Medial smooth-muscle cell lesions and dissection of the aorta and muscular arteries.

We report a case of aortic, coronary, and renal artery dissections associated with pregnancy. The histologic changes related to the hemorrhages included smooth-muscle cell (SMC) proliferation with fibrosis, elastin fragmentation and collagen degeneration, and SMC vacuolar degeneration and coagulation necrosis. These lesions seemed to be prototypes for dissection, since they were associated with aortic and muscular artery dissections in three additional cases unrelated to pregnancy. In each case, dissections seemed to result from SMC activity that also involved the systemic vasculature, veins, and visceral smooth muscle in histologic patterns that could be explained as a product of SMC metabolism. We propose that the histologic changes associated with dissections are best explained as a product of the metabolism of SMCs that function as multifunctional mesenchyma in a manner controlled by variable penetrance of a gene that controls their metabolism.

Adult↗

PubMed1990

Alterations of elastic architecture in human aortic dissecting aneurysm.

Elastin of the ascending aortic media of 10 cases with type A dissecting aneurysm, 14 hypertensive cases, and 30 control cases were prepared by the treatment of aortas with hot formic acid, and three-dimensional architecture was observed by scanning electron microscopy. In the control cases, elastin showed framework-like continuous structure consisting of elastic laminae, and interlaminar fibers that interconnected the laminae. In 6 of 10 cases of dissecting aneurysm, the interlaminar fibers were apparently irregular in arrangement and shape, and decreased in number, especially in the outer media. This architectural alteration resulted in a rarefaction of interconnection between the elastic laminae in the media, and possibly resulted in the local weakness against the dissecting force of the laminae. This medial weakness may be related to the mechanism of initiation and progression of dissecting aneurysm. The cystic medial necrosis (CMN) was found in 3 cases, but only 1 of them was accompanied by a mild decrease of the interlaminar fibers in the area outside of CMN, suggesting that the initiation of CMN did not directly relate to the decrease of the interlaminar fibers. The aortic media of hypertensives generally showed an increase of interlaminar fibers, but their focal decrease was encountered in the outer media of 3 cases. These findings suggest that the decrease of the interlaminar fibers of medial elastin seen in dissecting aneurysms were related to hypertension.

Adult↗

PubMed1989

[The value and limitation of two-dimensional transesophageal echocardiography in diagnosis of dissecting aortic aneurysm].

The diagnostic value of two-dimensional transesophageal echocardiography (TEE) was evaluated in 29 patients with dissecting aortic aneurysm (DeBakey type I; 4, type II; 1, type IIIa; 6, type IIIb; 18) who were studied consecutively from May 1987 to August 1988. An intimal flap was demonstrated in all 29 cases. DeBakey type classification could be recognized in 26 of 29 patients (89.7%). The entry of aortic dissection could be identified in 26 of 29 patients (89.7%). The differentiation between true and false lumen could be performed in all 29 cases. The introduction of color Doppler and pulsed Doppler echocardiography has opened up an additional possibility, in particular an analysis of flow pattern of the lumen was valuable in differentiation between true and false lumen. TEE was also valuable in evaluation of operative procedure by means of intraoperative-TEE. The capability to visualize the lesion of descending aorta was superior to any other conventional diagnostic method such as CT, MRI, AOG. However, there were difficulties in scanning the distal part of the ascending aorta and aortic arch, and in identifying the reentry of arotic dissection except for DeBakey type IIIa dissection. Since transthoracic echocardiography was valuable in diagnosis of cardiac tamponade, aortic regurgitation, and DeBakey type I dissection, the diagnostic method of a combination of transthoracic and transesophageal echocardiography seems to be more valuable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Axillary dissection in cancer of the breast: a conservative approach].

It is common in oncology to have more than one alternative treatment for the same clinical situation. This is particularly true in breast cancer. Traditional treatments such as Halsted Radical Mastectomies are difficult to change. It is not uncommon to see this approach in Brazil, even in initial tumors, although it is considered unnecessary unless the pectoralis muscle is involved. Radical dissection of the axilla is another controversial issue in breast cancer today. Recent publications have given support to question the routine recommendation of axillary dissection in breast cancer. It is reasonable, under certain circumstances, not to perform axillary dissection or treat the axilla with other methods. Limited axillary dissection, for instance, may present good results with less risk of arm lymphedema. This paper illustrates this point showing preliminary results of 147 breast cancer patients with local tumor treated with conservative management. Half of the patients (74) had axillary surgery while the other 73 did not. Multivariate analysis using Cox's regression was performed and showed that axillary dissection did not change survival. This information confirms similar data published in the literature.

Adult↗

PubMedDate not supplied

[The dissecting aorta: clinical analysis and anatomo-pathologic correlations in 30 cases].

The authors studied 30 cases of aortic dissection performed from January 1978 to December 1987. Dissection was classified as type A (intimal tear beginning in the ascending aorta or arch) and type B (intimal tear beginning in the descending aorta). Type A predominated (66.7%). Type B dissection was most frequent in patients older than 60. Precordial pain was the main symptom in type A cases, whereas 62.5% of type B cases showed no precordial pain. Most frequent findings in type A patients were hypotension (45.5%), murmur of aortic regurgitation (40.0%), and dyspnea (40.0%), whereas in type B patients, most frequent findings were hypertension (28.6%), and pulse deficit (42.9%). The major differential diagnosis for type A was myocardial infarction (43.8%), and for type B, peripheral artery failure (25.0%) and acute pneumonia (25.0%). 24 patients (80.0%) had hemorrhage. Hemorrhage into the pericardial sac occurred in 68.8% of type A patients, and 50.0% of type B patients had retroperitoneal hemorrhage. Systemic hypertension, atherosclerosis, medial cystic necrosis and endocrine disorders were considered predisposing factors for both type of dissection. A case of dissection after aortic valve replacement associated with ascending aorta tubular graft replacement was observed in this series. In type A patients, average survival was 6.3 days, and in type B, 11.1 days. The major cause of death was hemorrhage (70.0%).

Adult↗

PubMed1989

[A successful surgical treatment of acute dissecting aneurysm of the ascending aorta: repair of the proximal intimal tear necessitating bypass for the right coronary artery].

This is a case report of the successful surgical treatment of acute dissecting aneurysm of the ascending aorta. The patient was a 65-year-old female, who admitted to the hospital 3 hours after the onset of severe back pain. Enhanced CT of the chest and abdomen revealed acute dissection of the ascending aorta from its origin to the bilateral common iliac arteries. Thirteen hours initiation of the symptoms, operation was carried out using pump-oxygenator with hypothermia. Transverse incision of the ascending aorta revealed acute dissection in anterior aspect extending to two third of the circumference. The proximal small intimal tear was found 3 mm apart from the right coronary artery ostium. Upon closure of the tear resulting in obliteration of the right coronary artery, it required bypass procedure between the right coronary artery and the innominate artery using the saphenous vein graft. The aortic incision was directly closed using Dacron felt bolsters. Postoperative studies revealed disappearance of the proximal aortic dissection, patency of the bypass graft and existence of distal aortic dissection. Patient is in active life 6 months after operation.

Acute Disease↗

PubMed1989

[Ultrasonic study of 22 cases of carotid artery dissection].

The purpose of this study was to assess the value of duplex scanning and continuous wave Doppler velocimetry in the diagnosis and follow-up of ICA dissections. Between 1975 and 1988, 20 patients (11 women and 9 men; mean age 45 years) were admitted to the University Hospital of Angers for dissection of the ICA confirmed by angiography. The dissections were unrelated to direct cervical injury and were unilateral in 18 cases and bilateral in 2 cases. Six patients experienced transient cerebral ischaemic accidents (later completed in 2 cases) and 2 patients merely complained of ocular disorders of sympathetic origin. Fourteen patients were treated with heparin. All patients were examined by continuous wave Doppler ultrasound followed by duplex scanning. These examinations were performed 10 days on average before angiography. Continuous wave Doppler revealed signs of obstruction of the ICA in 95% of the cases: occlusion in 4 cases, tight stenosis in 13 cases and marked slowing of blood flow in the carotid and ophthalmic arteries in 4 cases. The acoustic signs of high or extensive ICA stenosis with reduced or retrograde ophthalmic artery blood flow were fairly suggestive of dissection. These results were completed by mode B which showed signs of dissection in 61% of the cases (tapering stenosis or occlusion, tubular ICA, separation of the vascular walls on rare occasions) and excluded atheromatous lesions in 81% of the patients. The tubular ICA image being non-specific was interpreted in relation to the clinical context and haemodynamic data, after discussion and exclusion of fibromuscular dysplasia, intracranial carotid stenosis causing severe reduction of blood flow and the exceptional hypoplasia of the ICA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

[Dissecting aneurysm of the vertebral artery--report of two cases and review of the literature].

Two cases of dissecting aneurysm of the vertebral artery are reported and the 70 cases reported previously are reviewed. Case 1 showed Wallenberg's syndrome following sudden headache on the right side without SAH. Angiograms demonstrated the "pearl and string sign" on the right vertebral artery, characteristic of a dissecting aneurysm. Through a right suboccipital craniectomy, the right vertebral artery was found to be discolored purplish-red and swollen, so the proximal vertebral artery was clipped. The postoperative course was uneventful. Case 2 showed Wallenberg's syndrome with antecedent headache. CT scan was normal and lumber puncture revealed xanthochromic CSF, which was attributed to a SAH several days before. Angiograms disclosed the "pearl and string sign" on the right vertebral artery, and right vertebral artery clipping was performed. Postoperatively it was uneventful. Intracranial dissecting aneurysms of the vertebrobasilar system are not as rare as previously thought. They can often be overlooked as fusiform aneurysms or as thrombosis associated with SAH and/or ischemic attacks. The difficulty in diagnosis, leads to a high morbidity and mortality rate. Recently many cases have been reported in sequence. These cases involving SAH were successfully treated by surgical procedure. However in addition to our cases, only two cases of successful surgical treatment after ischemic stroke, have been reported. We emphasize that surgical intervention should be carried out for dissecting aneurysms of the vertebro-basilar system, even without SAH, to prevent further dissection which could cause SAH or/and further brainstem infarction. Proximal vertebral artery occlusion is the most beneficial treatment of choice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

[Magnetic resonance imaging in dissection of the aorta].

In order to evaluate the usefulness of this new exploratory method in dissection of the aorta, 13 patients (10 men and 3 women, mean age 58 +/- 14 years) were examined by means of an 0.5 Tesla Magniscan 5000 nuclear magnetic resonance machine. Fifteen examinations were performed: 5 in patients with actual aortic dissection (type A 4 including one acute, type B1), 5 in patients previously operated upon for type A dissection and 5 for suspected acute aortic dissection unconfirmed by other examinations. Magnetic resonance imaging (MRI), synchronized with electrocardiography, was carried out using spin-echo techniques with 1 to 3 echoes and multiple contiguous sections along several planes. In the 5 patients with actual dissection the 2 channels separating the membrane could be demonstrated, thus providing a firm diagnosis (MRI proved superior to angiography in 2/5 patients). All 5 patients could be classified as either type A or type B. Extension to the cervical vessels was observed in 3 cases and the portal of entry was seen in one case, but the origin of the coronary arteries was never visualized. In the 5 patients previously operated upon MRI provided detailed analysis of the prosthesis of the supra-coronary ascending aorta implanted in all cases, of the aorta proximal and distal to that segment and of the periaortic mediastinum. By studying the signal from the false channel distal to the prosthesis information was obtained as to the presence in it (2 patients) or absence of circulating blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

[Usefulness of gallium 67 in research into the need for radical cervical lymph node dissection in patients with head and neck carcinomas].

Fifty-nine patients with head and neck carcinoma were examined with 67Ga scintigraphy. All patients had undergone lymph node dissection of the neck. They were followed for a minimum of 2 years after the examination. The primary tumor, treated prior/contemporaneously to the lymph node dissection, did not evolve in this interval. Metastatic involvement of the lymph node capsule was observed in all 44 cases with metastatic lymph nodes; macroscopic radicality was surgically obtained since involvement of the capsule was only microscopic. Nevertheless, complementary radiotherapy was given. The whole of 17 recurrences in the soft tissues of the neck were found, within 2 years, in the group of 26 patients who had undergone dissection of lymph nodes with metastatic capsular involvement and whose postoperative 67Ga scintigraphy was positive. On the contrary, no recurrences in the soft tissues of the neck were observed in the group of 18 patients who had undergone dissection of lymph nodes with metastatic capsular involvement and whose scintigraphy was negative. This result proves (P less than 0.001) 67Ga capable of evidencing eventual microscopic diffusion. Such a possibility has not yet been realized in vivo with any other investigation technique. Scintigraphy was negative in a control group of 15 patients who had undergone lymph node dissection, and with nonmetastatic lymph nodes. This finding leads us to exclude that the use of 67Ga might result in misinterpreted findings in the exploration of relatively superficial tissues. In fact, the eventual accumulation of radioisotope in nonneoplastic pathologies is quite easily recognizable in the neck. We can therefore conclude that in those 9 cases with positive scintigraphy and in whom no recurrence was found, microscopic diffusion was probably present, but local recurrence of the disease was prevented by complementary radiotherapy.

Carcinoma↗

PubMed1988

New therapeutic approach to aortic dissection complicated by cardiac tamponade.

The management of aortic dissection with cardiac tamponade may result in increased blood pressure and thereby itself make the aortic dissection worse. Nevertheless, it is important to prevent cardiac failure caused by cardiac tamponade. We describe a case of aortic dissection with cardiac tamponade. Echocardiography and aortography showed DeBakey IIIb-type aortic dissection with retrograde dissection, complicated by cardiac tamponade and aortic insufficiency. To treat this condition, a new therapeutic approach was undertaken. A vasodilator was administered, then pericardiocentesis guided by echocardiography was performed. To prevent abrupt elevation of blood pressure in response to the relief of cardiac tamponade, the pericardial aspiration was carried out slowly--it took four hours for the complete drainage of 415 ml of blood--and a vasodilator, sodium nitroprusside, was administered. After drainage, cardiac function was reversed fully, and the systolic pressure was controlled under 140 mmHg. Then, using extra-corporeal circulation, the surgical procedure was performed successfully. We conclude that it is useful to treat cardiac tamponade by controlling blood pressure with slow drainage and use of a vasodilator in preparation for performing the surgical procedure.

Aortic Dissection↗

PubMed1987

[Giant, fusiform and dissecting aneurysms at the vertebro-basilar junction--report of five cases and their clinical pathophysiological aspects].

Five cases of giant, fusiform, and dissecting aneurysms of the vertebro-basilar junction, in which direct surgical treatment was not feasible, are reported. Their initial symptoms were as follows: 3 subarachnoid hemorrhages (2 fusiform aneurysms, 1 giant aneurysm), 1 mass sign (giant aneurysm), and 1 ischemic sign (dissecting aneurysm). In two patients, one with a giant and one with a dissecting aneurysm, preoperative proximal vertebral occlusion was carried out by inflated balloon for 30 to 100 minutes, under observation of clinical signs and measurement of distal arterial pressure. This catheter technique with an inflated balloon provides the means to assess the effect of vertebral artery occlusion in the alert patient, and to determine if occlusion is tolerated or not. In one case with a giant aneurysm, the proximal vertebral artery was occluded extracranially with no complications and no recurrent subarachnoid hemorrhage for 1 year. The other four patients (1 thrombosed giant aneurysm, 2 fusiform aneurysms, 1 dissecting aneurysm) whose contralateral vertebral arteries were hypoplastic, and who refused to operation, were treated conservatively for 6 months to 6 years. Their outcomes were better than expected, with no recurrent subarachnoid hemorrhage nor aggravation of clinical symptoms except for the one case with a dissecting aneurysm whose deterioration was presumed attributable to late cerebellar cortical atrophy.

Aortic Dissection↗

PubMed1986

Diagnostic difficulties in aortic dissection. Retrospective study of 89 surgically treated patients.

During the years 1964-1985, a total of 89 patients were operated on for aortic dissection: 55 were treated for proximal dissection and 34 for distal dissection of the aorta. In the former group a diagnostic delay more than 24 hours after hospitalization occurred in 17 instances (31%), and in the latter group in 18 instances (53%). The most common incorrect diagnosis in both groups was myocardial infarction. In the proximal group of aortic dissection, other cardiac diseases suspected were pericarditis, endocarditis and congestive heart failure. In the distal group of aortic dissection, acute surgical abdomen was the most common cause of incorrect diagnosis after ischaemic heart disease. Four case reports with diagnostic delay are presented.

Aortic Dissection↗

PubMed1987

Visualization of thoracic dissecting aortic aneurysm by transesophageal Doppler color flow mapping.

Real-time color flow mapping by two-dimensional Doppler has now come into widespread use. However, its application via conventional transcutaneous approaches to dissecting aortic aneurysm has some limitations where visualization of the descending aorta is concerned. Its transesophageal approach to this disorder has hitherto remained unreported except by the authors. Transesophageal Doppler color flow mapping has been performed in twelve patients for diagnosis of dissecting aortic aneurysm, and the clinical significance of this method was evaluated. The system used for transesophageal color flow mapping was an Aloka SSD-880 ultrasound scanner with a 5 MHz probe. In all cases, the entire thoracic aorta except for the upper ascending aorta was visualized and both, real-time flow dynamics and structural information, were ascertained. Differentiation of the type of dissection, identification of the entry, and differentiation of the true and false lumina were performed in all cases. Information concerning the reentry was gained in seven cases (58%); aortic regurgitation was graded in three cases, in two of which prolapse of the intimal flap was observed. In five cases, aortography was needed in order to delineate the involvement of aortic branches in the dissection; and in the other seven cases, transesophageal Doppler information was sufficient. In four cases who were operated, the postoperative state was well evaluated. Transesophageal Doppler color flow mapping was found to be a useful method for visualization of the whole thoracic aorta apart from the upper ascending section, and for precise evaluation of the structure and hemodynamics of dissecting aortic aneurysms.

Aortic Dissection↗

PubMed1987

[Color Doppler echocardiography in the diagnosis of aortic dissection and aortic wall abscesses].

In eleven patients with aortic dissection or perforated endocarditic aortic wall abscess cavity, the diagnostic usefulness of Color Doppler Echocardiography (CDE) for the identification of true and false lumen as well as the perforation jet was assessed by comparison with the findings of angiography, digital subtraction angiography, computed tomography and surgery. The information gained in addition to that of these procedures, as well as to that of the four conventional echocardiographic techniques was evaluated. Six patients had aortic dissections of DeBakey type I or III; in all of them the diagnosis had been established with conventional ultrasonic techniques. Similarly, in all patients with aortic dissection of DeBakey type I, a clear differentiation between true and false lumen in the aortic root and ascending aorta could already be made by grey-scaled echocardiography. In these patients, however, CDE made the additional demonstration of the perforation jet into the false lumen possible. In those three patients with aortic dissection of DeBakey type III as well as in the abdominal aortic region of DeBakey type I, color Doppler echocardiography was the only method to define true and false lumen and to clearly localize the perforation sites. Two further patients were found to have a small, local dissection, which could only be assumed by conventional echocardiography; the color Doppler M-mode image led to a clear diagnosis. In three patients an endocarditic abscess cavity of the aortic wall could be detected by conventional echocardiography. Two-dimensional color Doppler echocardiography additionally enabled us to visualize the presence and the course of perforation flows. In two patients color-coded Doppler echocardiography made it possible to detect perforations in regions which could not be localized either with conventional echocardiographic techniques or the above-mentioned control procedures.

Abscess↗