Case Of Acute Type Research Articles

A dreadful sign of aortic dissection: Aortic intimo-intimal intussusception with prominent intimal flap prolapsing into the left ventricular apex

Intimo-intimal intussusception is an unusual clinical form of aortic dissection resulting from circumferential detachment of the intima. Clinical presentation varies according to the level of detached intima in the aorta. We present a case of acute type A dissection with prominent prolapse of the circumferential detachment intimal flap into the left ventricular cavity extended to the apex.

左室流出路にflapエコーの逸脱を認めたStanford A型大動脈解離

左室流出路にflapエコーの逸脱を認めたStanford A型大動脈解離

Aorto-Atrial Fistula 10 Days After Dissection Repair in Giant Cell Arteritis

Active aortitis caused by giant cell arteritis occurs more commonly than has been previously appreciated, and ascending aortic dissection may occur despite medical therapy, without a preexisting aneurysm or ectasia. We report a case of acute type A aortic dissection in a patient already treated for giant cell arteritis. The aortic root was left intact during the initial surgery, but was completely removed 10 days later after an early postoperative aorto-atrial fistula. Complete removal of the aortic root (Bentall procedure) has been advocated in these patients to prevent late additional aortic complications.

Giant cell arteritis of the aorta: Catastrophic complications without a preexisting aneurysm

Giant cell arteritis (GCA) is a chronic systemic vasculitis affecting medium and large-sized arteries. A chest X-ray and a multislice computerized tomography can mostly detect anatomical modifications such as aortic aneurysm or wall thickening [1]. Aggressive steroid and immunosuppressive therapy are indicated to control the diffuse disease in the aortic wall. Nevertheless, aortic dissection without a preexisting aneurysm may occur despite medical treatment. While conventional surgery may be life saving, complete removal of the diseased aortic root has been advocated to prevent late additional aortic complications [2]. Knowing the severity and precise extent of the disease in the aortic wall is a determinant factor in planning for the surgical strategy, in order to avoid further life threatening complications. We hereby report a case of acute type A aortic dissection in a patient already treated forGCA.The aortic rootwas left intact during the initial surgery, but was completely removed 10 days later following an early postoperative aorto-atrial fistula.

Type B aortic dissection associated with coarctation of the aorta

We describe a case of acute type B dissection associated with coarctation of the aorta, a rare pathological combination. An intimal tear was located just distal to the coarctation. Aortic dilatation started below the coarctation and extended to the level of the diaphragm. We performed descending aorta replacement from the distal aortic arch to the level of the 9th intercostal arteries through a left posterolateral thoracotomy in the fifth intercostal space. Arterial cannulations were placed on the right femoral artery and just proximal to the coarctation site in the descending aorta. To preserve the patent 10th and lower intercostal arteries, longitudinal plication of dilated pseudo-lumen was applied from the distal cut end to the level of the diaphragm. The postoperative course was uneventful.

A case of acute type B dissection with limb and visceral ischemia controlled by axillo-femoral bypass

A case of acute type B dissection with limb and visceral ischemia controlled by axillo-femoral bypass

Hybrid antegrade repair of the arch and descending thoracic aorta with a new integrated stent-Dacron graft in acute type A aortic dissection: a look into the future with new devices

A young male patient underwent supracoronary replacement of the ascending aorta for acute type A dissection under hypothermic circulatory arrest. After discharge, he was readmitted two weeks later due to severe aortic regurgitation and acute arch redissection. Under a second period of hypothermic circulatory arrest three weeks after the initial operation, radical treatment with aortic valve replacement, replacement of the ascending aorta and arch, together with antegrade deployment of a stent-graft in the true lumen for frozen elephant-trunk technique, were successfully performed. Computed tomography at four weeks showed complete proximal repair and thrombosis of the false lumen. Transesophageal echocardiography at eight weeks confirmed repair. The patient is currently leading an active life. A hybrid approach for complex cases of acute type A dissection with arch involvement can be considered for the future.

Direct Innominate Artery Cannulation in Acute Type A Dissection and Severe Thoracic Aortic Atheroma

ACUTE TYPE A aortic dissection is a surgical emergency.1 Integrated perioperative management is associated with improved clinical outcome, despite aortic arch repair with deep hypothermic circulatory arrest (DHCA).2,3 Femoral arterial cannulation is safe for all phases of operative repair (before aortic arch repair; after aortic arch repair), with a 2.5% incidence of malperfusion events.4 Although the femoral artery is the authors’ standard site for arterial cannulation in this setting, a case of acute type A dissection in a severely atheromatous aorta is reported that prompted a search for an alternative arterial cannulation site because of concerns about cerebral atheroembolization.

D-dimer serum levels in a case of type B aortic dissection. A rapid test for the early diagnosis of acute aortic disease?

This article reports on a case of acute type B aortic dissection presenting with electrocardiographic abnormalities mimicking an acute coronary syndrome, associated with high D-dimer levels in the acute phase and normalization in the chronic phase of the disease process. This case report is consistent with recent data from the literature suggesting that D-dimer levels might be a useful biochemical tool in the diagnostic work-up of patients with suspected acute aortic dissection.

A Case of Acute Type B Aortic Dissection in the Presence of Coexisting Chronic Fusiform Abdominal Aortic Aneurysm

A Case of Acute Type B Aortic Dissection in the Presence of Coexisting Chronic Fusiform Abdominal Aortic Aneurysm

Aortic Fenestration: A Why, When, and How-to Guide

The management of aortic dissection can be challenging. Most cases of acute type A dissection are managed surgically. Most cases of acute type B dissection are managed medically, although open surgery or stent-graft placement is sometimes performed. Patients with type B or surgically treated type A dissection may develop vascular complications such as mesenteric or peripheral ischemia, which cannot be managed medically. Aortic fenestration is a method for decompressing the hypertensive false lumen by creating a hole in the distal part of the dissection flap. This procedure allows outflow from the false lumen, thereby reducing intraluminal pressure, relieving branch vessel obstruction, and reducing the risk of extension of the dissection. Urgent revascularization is required to correct mesenteric and renal ischemia and to reestablish distal perfusion if there is resting ischemia. Few operators will acquire extensive personal experience with percutaneous aortic fenestration. Nevertheless, with a good understanding of the pathologic condition, careful demonstration of the anatomy, good technical skills, and access to high-quality imaging (including intravascular ultrasonography) and the requisite equipment, most interventional radiologists skilled in arterial interventions should be capable of performing this procedure. However, because further interventions are frequently required, the radiologist needs to maintain contact with the patient to ensure timely treatment of any subsequent complications.

三腔構造を呈する慢性Ｂ型解離に急性Ａ型解離が重複した１例

症例は41歳,女性.胸痛と呼吸苦を主訴に来院.CTにて慢性B型三腔解離に重複した急性A型解離と診断し,緊急手術を施行した.右腋窩動脈の内腔が狭小化していたため,大腿動脈からのみ送血し,上行大動脈を人工血管にて置換した.病理組織上,中膜壊死や血管炎などの所見は認めなかった.経過は良好で,現在外来で二期手術に対し経過観察中である.三腔解離は通常の解離と比べ残存解離腔の拡大をきたしやすく,また破裂の可能性も高いとされており,可及的早期の二期手術が必要である.三腔構造を伴う重複大動脈解離に対する手術を行うさいには,malperfusion防止のため主要分枝の分岐の確認と,体外循環の送血部位の選択が重要である.

Discussion: Session 3—Dissection

Discussion: Session 3—Dissection

A case of acute type A aortic dissection with thrombosed false lumen which has disappeared by conservative therapy, though redissection occurred on the 22nd day from the onset

A case of acute type A aortic dissection with thrombosed false lumen which has disappeared by conservative therapy, though redissection occurred on the 22nd day from the onset

CLINICAL CHARACTERIZATION OF XANTHOGRANULOMATOUS CHOLECYSTITIS

Clinical characterization of xanthogranulomatous cholecystitis (XGC) was attempted by studying the records of 1507 patients who underwent cholecystectomy over the past 21 years. XGC was found in 49 cases (3.3%), consisting of 29 males (mean age ± SD: 54.3 ± 13.5 years) and 20 females (59.7 ± 7.8 years). All of these 49 patients complained of pain in the right hypochondrium and the epigastric region. Swelling of the right hypochondrium was seen in 8 (16%) of the 49 cases. The incidence of complication by gallstones was 98%. Incarceration of gallstones into the gallbladder neck was seen in 76%. Gallbladder cancer complicated in 8% of the 49 cases. XCG was clinically divided into a chronic inflammation type (16 cases or 32.7%, complaining of pain in the right hypochondrium and the epigastric region alone) and an acute inflammation type (33 cases or 67.3%, accompanied by fever and leukocytosis). The percentage of cases suspected of having gallbladder carcinoma before surgery was high for cases of chronic type XGC. The duration of illness was significantly longer in the chronic type cases than in the acute type cases (p<0.05).

Chromosome aberrations and clinical features of adult T cell leukemia- lymphoma not associated with human T cell leukemia virus type I

Chromosome aberrations and clinical features of three patients with adult T cell leukemia-lymphoma (ATL) not associated with human T cell leukemia virus type I (HTLV-I) are described. From their clinical features, two patients were diagnosed as acute type and one patient was diagnosed as chronic type, which later converted to acute crisis. Clonal and many chromosomal abnormalities were observed before therapy in the two acute type cases and at relapse in the chronic type case. Karyotype aberrations, including trisomy 3, trisomy 7, trisomy 21, del(6)(q21), del(10)(p13), 14q11 translocation, and loss of X chromosome, all of which are frequently found in HTLV-I associated ATL, were also seen in these cases of HTLV-I-negative ATL.

Chromosome Aberrations and Clinical Features of Adult T Cell Leukemia-Lymphoma Not Associated With Human T Cell Leukemia Virus Type I

Chromosome aberrations and clinical features of three patients with adult T cell leukemia-lymphoma (ATL) not associated with human T cell leukemia virus type I (HTLV-I) are described. From their clinical features, two patients were diagnosed as acute type and one patient was diagnosed as chronic type, which later converted to acute crisis. Clonal and many chromosomal abnormalities were observed before therapy in the two acute type cases and at relapse in the chronic type case. Karyotype aberrations, including trisomy 3, trisomy 7, trisomy 21, del(6)(q21), del(10)(p13), 14q11 translocation, and loss of X chromosome, all of which are frequently found in HTLV-I associated ATL, were also seen in these cases of HTLV-I-negative ATL.

Hepatitis B Infection in Other Hospital Personnel

To the Editor.— We recently participated in a multicenter study of risk factors associated with the diagnosis of acute viral hepatitis. 1 Francis et al found that of the acute type B hepatitis infections reported to the five centers participating in this study, 12% occurred in persons employed in medical care work settings. It has long been recognized that among medical care workers, hospital personnel have an increased risk of type B hepatitis, but not type A hepatitis, because of occupational contact with blood and other serum-containing patient secretions. Apart from the obvious risk to nurses, medical laboratory technicians, and certain physicians, little information is available on risk of type B hepatitis in hospital ancillary personnel who do not have routine patient or specimen contact. Between Jan 1, 1980, and Dec 31, 1983, there were 459 cases of acute type B hepatitis in Jefferson County, Alabama residents reported to the

Change of hepatitis B surface antigen in patients with hepatitis during a five-year period.

Between January 1970 and December 1974, 122 cases of acute type B hepatitis were subtyped; 66 (54%) were of the ad type and 56 (46%) were of the ay type. "Cluster" cases (from a dialysis unit) were not considered. During the first period, subtype ad predominated, whereas in the second year there was a clear predominance of the ay subtype; the difference was statistically significant (P less than 0.02). In yearly periods the differences were significant between the years 1970 and 1974 (P less than 0.05), 1972 and 1974 (P less than 0.05), and 1972 and 1973 (P less than 0.05). If only patients without parenteral exposure are considered, there was clearly a shift between 1970-1972 and 1973-1974 in favor of the ay subtype (P less than 0.01). Since epidemiological factors such as injections and transfusions seem not to be responsible, it is suggested that a change of virus strain may be responsible for the different distribution of subtypes of hepatitis B surface antigen in the last year.