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Sample records for dissection case noticed

  1. Dissecting the unspeakable: a fatal case of aortic dissection.

    PubMed

    Dherange, Parinita A; Patel, Sarah; Singh, Nirmal; Suryanarayana, Prakash

    2015-01-01

    A 47-year-old man with diabetes and hypertension presented with sudden onset of chest pain and subsequently developed expressive aphasia. Brain imaging revealed multiple areas of ischaemic infarcts. Transoesophageal echocardiogram revealed aortic dissection with a free-floating thrombus on the dissection flap, which was the source of emboli. Given the poor prognosis, surgical intervention was not pursued and artificial support was withdrawn. Aortic dissection is a highly fatal condition with varied presentation including heart failure, myocardial infarction, neurological deficits, abdominal pain or acute renal failure. Aortic dissection is a relatively uncommon but catastrophic condition. A high degree of clinical suspicion is required for early and accurate diagnosis since mortality is high and increases by the hour. The mechanism for stroke in our case was due to an artery-to-artery embolism from a thrombus, which developed on the intimal surface of the dissected artery. This is an infrequent complication with a very unique mechanism. PMID:26077807

  2. [Aortic dissection and pregnancy. Apropos of a case].

    PubMed

    Helms, E; Uguen, T; Amaranto, P; Carton, M J; Ducreux, J C; Tempelhoff, C

    1995-03-01

    Aortic dissection is a serious disease which rarely affects young women. In this context, it occurs in nearly one out of two cases during pregnancy, usually during the third term. The authors report acute dissection of the ascending aorta (de Bakey type 2) during pregnancy for which rapid cardiothoracic surgical management as a semi-emergency resulted in a favourable outcome for mother and child. PMID:7487294

  3. Unusual Case of Overt Aortic Dissection Mimicking Aortic Intramural Hematoma

    PubMed Central

    Disha, Kushtrim; Kuntze, Thomas; Girdauskas, Evaldas

    2016-01-01

    We report an interesting case in which overt aortic dissection mimicked two episodes of aortic intramural hematoma (IMH) (Stanford A, DeBakey I). This took place over the course of four days and had a major influence on the surgical treatment strategy. The first episode of IMH regressed completely within 15 hours after it was clinically diagnosed and verified using imaging techniques. The recurrence of IMH was detected three days thereafter, resulting in an urgent surgical intervention. Overt aortic dissection with evidence of an intimal tear was diagnosed intraoperatively. PMID:27066437

  4. Unusual Case of Overt Aortic Dissection Mimicking Aortic Intramural Hematoma.

    PubMed

    Disha, Kushtrim; Kuntze, Thomas; Girdauskas, Evaldas

    2016-04-01

    We report an interesting case in which overt aortic dissection mimicked two episodes of aortic intramural hematoma (IMH) (Stanford A, DeBakey I). This took place over the course of four days and had a major influence on the surgical treatment strategy. The first episode of IMH regressed completely within 15 hours after it was clinically diagnosed and verified using imaging techniques. The recurrence of IMH was detected three days thereafter, resulting in an urgent surgical intervention. Overt aortic dissection with evidence of an intimal tear was diagnosed intraoperatively. PMID:27066437

  5. Three cases of cervicocephalic artery dissection in an amusement park.

    PubMed

    Kurita, Naohide; Ueno, Yuji; Watanabe, Masao; Miyamoto, Nobukazu; Shimura, Hideki; Nonaka, Senshu; Tsutsumi, Satoshi; Yasumoto, Yukimasa; Hattori, Nobutaka; Urabe, Takao

    2014-01-01

    About 20 cases of cerebrovascular accidents in amusement parks have been documented. However, only a few cases of amusement park stroke (APS) after roller coaster rides have been reported. Here, we present triggers of stroke, clinical characteristics, and the angiographic appearance of 3 consecutive patients of APS. Their clinical characteristics included young age, absence of atherosclerotic risk factors, and severe injuries. Serial changes in angiographic appearance led to the diagnosis of cervicocephalic artery dissection (CAD). Patients A and B were diagnosed with isolated middle cerebral artery (MCA) dissection, and patient C was diagnosed with internal carotid artery dissection involving MCA dissection. Running excitedly toward an attraction in patient A, a go-kart ride in patient B, and riding in an enhanced motion vehicle in patient C were considered as the likely triggers for APS. We had specific cases with APS associated with CAD, which can occur under diverse contexts other than roller coaster rides at amusement parks. Our findings suggest that the variable directions of the high gravitational forces induced by vehicle riding or running excitedly might injure the MCA or internal carotid artery, and thereby cause CAD in the amusement park. PMID:25263648

  6. Dissection Dissected.

    ERIC Educational Resources Information Center

    Berman, William

    1984-01-01

    Discusses the role of dissection in science courses, examining essential lessons students can learn (such as developing an abiding respect for all forms of life, including the animal being dissected). Also presents a list of tips related to classroom dissection and comments on formaldehyde and formalin substitutes. (JN)

  7. Dissecting Dissection.

    ERIC Educational Resources Information Center

    AV Magazine, 1996

    1996-01-01

    This journal features articles covering various aspects of dissection. "Biology--The Study of Life" (George Russell) offers students experiments that do not require using invasive procedures. "Animal Cruelty--Behind the Scenes" (Zoe Weil) describes sources of laboratory animals. "Doing without Dissection" (Juliana Texley) discusses objections over…

  8. Open retrograde endovascular stenting for left common carotid artery dissection secondary to surgical repair of acute aortic dissection: a case report and review of the literature.

    PubMed

    Gao, Peng; Wang, Yabing; Chen, Yanfei; Jiao, Liqun

    2015-07-01

    A 30-year-old male presented with an acute aortic artery dissection (Stanford type A) and underwent total arch replacement using a stented elephant trunk technique. One month later, the patient developed dissections in the innominate and left common carotid artery (CCA). The innominate artery dissection caused occlusion in the right internal carotid artery (ICA) and a major stroke. Dissection of the left CCA progressed and extended to the bifurcation site. Antegrade access for a left carotid intervention was deemed as difficult because of the previously implanted stent and the additional risks of embolic events and dissection enlargement. Hybrid procedures combining left carotid bifurcation exposure and retrograde endovascular stenting were successfully completed. This report is a rare case of retrograde endovascular reconstruction for the left CCA dissection following surgical repair of an aortic artery dissection. Here, we also review previous cases of iatrogenic carotid dissections following surgical intervention. PMID:25765635

  9. Successful angioplasty of three cases of coronary artery dissections using hydrophilic wires

    PubMed Central

    Menon, Rajeev; Kapadia, Anuj

    2014-01-01

    Three cases of successful angioplasty of high-grade coronary dissections using hydrophilic wires were reported. Our first case had edge dissection after a stent deployed in the left anterior descending artery, after which we found it impossible to track the second stent over the regular wires, and which was successful when we tried with a stiffer hydrophilic wire. The second had spontaneous coronary artery dissections (SCAD), and the third case was a complicated plaque with multiple stenotic and ectatic segments along with dissection and successful angioplasty carried out using the same wires and without additional hardware. These wires also provided adequate support in tracking the required balloons and stents PMID:25489325

  10. Spontaneous coronary artery dissection: a case series and literature review

    PubMed Central

    Garcia, Nelson A. Telles; Khan, Abul N.; Boppana, Ratna C.; Smith, Hayden L.

    2014-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare and often lethal cause of acute coronary syndrome, which typically affects young women and otherwise healthy individuals. SCAD can be diagnosed in patients undergoing coronary angiography and can be underestimated. Special techniques such as optical coherence tomography (OCT) and intravascular ultrasound should be used when there is suspicion of the condition. In the majority of cases, the left anterior descending (LAD) artery is involved; however, a few cases of the right coronary artery (RCA) involvement have been reported. This article describes three cases of SCAD in women of different ages, all presenting with chest pain. Coronary angiography in conjunction with OCT was used for diagnosis in two of the cases. One of the patients had involvement of the proximal RCA and underwent percutaneous coronary intervention, whereas the other two patients had mid-LAD disease and were treated conservatively with medical therapy. Presently, there are no specific guidelines for the treatment of SCAD, and therapy is individualized according to extent and severity of the condition. PMID:25317273

  11. A Case of Acute Aortic Dissection Presenting with Chest Pain Relieved by Sublingual Nitroglycerin

    PubMed Central

    Kim, Hyun Joo; Lee, Hyun-Ki

    2013-01-01

    Acute aortic dissection is an uncommon disorder which can have fatal results in the event of treatment delay or misdiagnosis. This case examines a 77-year-old woman presenting with chest pain relieved by nitroglycerin. She was referred to the emergency room with clinical suspicion of acute coronary syndrome (ACS). However, she was later diagnosed with acute aortic dissection and an emergency operation was performed with successful recovery. Aortic dissection may manifest in various ways depending on the site involved and may mimic other disorders such as ACS or pulmonary embolism. Therefore, clinicians must always be aware of aortic dissection and its different clinical manifestations must be understood. PMID:24340165

  12. [Spontaneous dissection of the internal carotid artery: description of a case with lower cranial nerve palsy].

    PubMed

    Macarini, Luca; Zeppa, Pio; Genovese, Eugenio Annibale; Scialpi, Michele; Raucci, Antonio

    2012-11-01

    Spontaneous dissection of the extracranial internal carotid artery is a well recognized cause of headache and juvenile stroke; lower cranial nerve palsy as a complication of dissection is rare. We report the case of a female patient with bilateral dissecting aneurysm of the internal carotid artery, associated with unilateral cranial nerve XII palsy and oculosympathetic palsy. Neuroradiological findings, in particular those obtained by Magnetic Resonance imaging, allow the identification of the dissecting pathology and the correlation of the aneurysmal formation with nerve palsy. PMID:23096747

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

    PubMed Central

    Liu, Wen-Pin; Chen, Wei-Kung; Ng, Kim-Choy

    2002-01-01

    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. Images Figure 1 Figure 2 PMID:12784971

  14. Spontaneous coronary artery dissection in a young man - case report.

    PubMed

    Schmid, Julia; Auer, Johann

    2011-01-01

    A 31 year old man with a 17-year-history of drug abuse (heroine and cannabis) was admitted with recurrent chest pain over a period of about three weeks. Chest discomfort severely worsened during the 5 hours before hospital admission. Electrocardiography revealed poor R-wave progression and non specific repolarization abnormalities. Echocardiography showed extensive left ventricular anterior and apical wall motion abnormalities and a ventricular thrombus located at the apex of the left ventricle was present. Subsequently, a diagnosis of acute coronary syndrome was made. Coronary angiography revealed spontaneous coronary artery dissection of the left anterior descending (LAD) artery with Thrombolysis In Myocardial Infarction (TIMI) flow 2 to 3. We managed the patient conservatively. The clinical course was uneventful and repeated angiography on day 4 demonstrated spontaneous healing of large parts of the dissection with TIMI 3 flow in the LAD. PMID:21371317

  15. Isolated Celiac and Splenic Artery Dissection: A Case Report and Review of the Literature

    PubMed Central

    Moussa, Tania; Nawfal, Georges; Assi, Tarek; El Rassy, Elie; Massoud, Elie; Daou, Iskandar

    2015-01-01

    An isolated dissection of the celiac artery is an extremely rare condition that requires a high level of suspicion to evoke the diagnosis. Once established, the natural course is unpredictable in view of the discrepancies in its management requiring a case-by-case analysis. In this paper, we report an unusual case of spontaneous abdominal pain that was diagnosed with celiac and splenic artery rupture secondary to physical stress. This paper underlines the necessity to maintain a high level of suspicion for arterial dissections and we also review the management plan in such cases. PMID:26819797

  16. Spontaneous isolated dissection at renal upper abdominal aortic: a rare case report

    PubMed Central

    Liu, Jian-Ping; Liu, Feng-En; Duan, Qing; Ye, Rong; Xiao, Jun-Qi

    2015-01-01

    Arterial dissection is defined as a cleavage of the arterial wall caused by intramural hematoma. Isolated extra-aortic arterial dissection has been reported in renal and carotid arteries in few literatures but suprarenal aorta dissection associated with retrograde formation of a giant descending thoracic aneurysm is considered very rare. We present a quite unusual case of suprarenal aorta dissection associated with retrograde formation of a giant descending thoracic aneurysm sparing both renal and mesenteric vessels, without any branch vessel involvement or visceral damage. Because of the patient’s persistent epigastric pain, endovascular celiac artery stent implantation was performed with 3 multiple overlapping uncovered stents. Twelve months after the procedure, computed tomographic angiography (CTA) of the abdomen showed patency of both celiac stents with thrombus formation in the retrograde dissection sac, and the patient remained asymptomatic. This case and others in the medical literature suggest that endovascular treatment can be feasible in symptomatic patients with spontaneous isolated dissection at renal upper abdominal aortic. PMID:26221391

  17. A rare case of aortic dissection presenting as pure transient global amnesia.

    PubMed

    Kaveeshvar, Hirsh; Kashouty, Rabih; Loomba, Vivek; Yono, Noor

    2015-01-01

    Transient global amnesia (TGA) is a well-described neurological phenomenon. Clinically, it manifests with the sudden onset of a paroxysmal, transient loss of anterograde memory and disorientation but with intact consciousness. Typically, symptoms last for only a few hours. We present an unusual case of aortic dissection presenting with pure TGA in a patient, who had a positive outcome. This is the second case report of a patient with aortic dissection presenting with pure TGA syndrome, but it is the first case in which the patient survived. PMID:26659651

  18. Debating Dissection.

    ERIC Educational Resources Information Center

    Orlans, F. Barbara

    1988-01-01

    Argues the pros, cons, and alternatives to animal dissection. Discusses several cases involving student objections and the enactment of a California state law which upholds the right of a student to conscientious objection to dissection involving the harmful or destructive use of animals. (RT)

  19. Using d-dimer to diagnose painless acute aortic dissection: a case report.

    PubMed

    Barniol, Caroline; Vall, Baptiste; Dehours, Emilie; Charpentier, Sandrine; Bounes, Vincent; Lauque, Dominique

    2011-01-01

    Introduction. Aortic dissection is a cardiovascular emergency; the most frequent symptom is chest pain, but clinical presentation can be varied and atypical. Case Presentation. We report the case of a 66-year-old Caucasian male who presented a syncope immediately followed by a left-arm weakness while driving his car. Clinical examination was normal, but bilateral jugular vein distension was noted. Electrocardiogram and chest radiography were unremarkable. Among blood tests performed, troponin I test result was negative, and D-dimer test concentration was >4000?ng/mL. Since D-dimer test result was positive, chest computer tomography angiogram was performed and found a thoracic aortic dissection. Conclusion. Our case report shows that acute aortic dissection diagnosis is difficult and must be associated with the interpretation of various clinical signs and D-dimer measurement. It could be helpful for the emergency physician to have a pretest probability D-dimer like in pulmonary embolism diagnosis. PMID:23326692

  20. Isolated Spontaneous Dissection of the Celiac Artery: Report of Two Cases

    PubMed Central

    2014-01-01

    Isolated spontaneous dissection of the celiac artery (DCA) is extremely rare and its therapeutic strategy is still not established. We report two cases of DCA, in which 58-year-old and 43-year-old male patients with right hypogastralgia and back pain, respectively, were diagnosed by enhanced computed tomography and treated conservatively with antihypertensive agents. They were doing well under circumspect medical management without recurrence of symptoms or progression of dissection after 3.5 years and 3 months, respectively, after detection of DCA. Conservative treatment with blood pressure control and careful surveillance is considered to be applicable in most cases of DCA. PMID:24719666

  1. TREATMENT OF A CEREBRAL DISSECTING ANEURYSM IN ANTERIOR CIRCULATION: REPORT OF 11 SUBARACHNOID HEMORRHAGE CASES

    PubMed Central

    OYAMA, HIROFUMI; KITO, AKIRA; MAKI, HIDEKI; HATTORI, KENICHI; NODA, TOMOYUKI; WADA, KENTARO

    2012-01-01

    ABSTRACT This report presents 8 cases of internal carotid artery aneurysms, 1 case of a middle cerebral artery aneurysm, and 2 cases of anterior cerebral artery aneurysms, together with a discussion of the treatment of aneurysms in anterior circulation. All cases showed subarachnoid hemorrhage. Two of the 8 internal carotid artery aneurysms were trapped with a low-flow bypass; however, both patients died of an immediate hemodynamic infarction or vasospasm-induced infarction. Five of the 8 internal carotid artery aneurysms were trapped after revascularization with high flow bypass. Four of those patients were self-supporting at discharge, but one patient was discharged in a vegetative state due to the sacrifice of arterial branches which were included in the dissecting portion. One case of the dissecting aneurysm in the M2 portion of the middle cerebral artery was trapped after low-flow bypass. This patient was self-supporting at discharge. In 2 cases of anterior cerebral artery aneurysms, the lesions were first wrapped with Bemsheets, and then the aneurysmal clip was applied on the wrapped dome. Trapping following high-flow bypass is the best method for treating a dissecting aneurysm in the internal carotid artery. Trapping also can be used to treat a dissecting aneurysm of the middle cerebral artery, after low-flow bypass. Clipping on the wrapped aneurysm can also be performed successfully in the anterior cerebral artery aneurysm. PMID:23092105

  2. Stent-assisted Coiling for Ruptured Basilar Artery Dissecting Aneurysms: An Initial Experience of Four Cases

    PubMed Central

    KOIZUMI, Satoshi; SHOJIMA, Masaaki; IIJIMA, Akira; OYA, Soichi; MATSUI, Toru; YOSHIKAWA, Gakushi; TSUTSUMI, Kazuo; NAKATOMI, Hirofumi; SAITO, Nobuhito

    2016-01-01

    No treatment strategy has been established for subarachnoid hemorrhages due to basilar artery (BA) trunk dissecting aneurysms. Our aim was to report our initial experience performing stent-assisted coiling (SAC) for ruptured BA dissecting aneurysms to validate the effectiveness of this treatment. We experienced four consecutive cases of ruptured dissecting BA trunk aneurysm treated with SAC between 2008 and 2014 at three institutions. Aneurysm rebleeding was prevented without causing severe brainstem ischemia in all cases. In our opinion, both the blockage of the inflow to aneurysms and the preservation of the antegrade flow of the BA can be achieved by SAC, although controversies regarding long-term stability and appropriate antiplatelet therapy remain. PMID:26667082

  3. A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

    PubMed Central

    Abu Arqoub, Ahmad; Isbitan, Ahmad; Shamoon, Fayez

    2016-01-01

    Acute aortic dissection (AD) is the most common life-threatening disorder affecting the aorta with an incidence that ranges between 5 to 30 cases per million people per year. The symptoms of aortic dissection may be variable and can mimic other more common conditions such as myocardial ischemia. We report a case of a 60-year-old male who presented with inferior wall ST-elevation myocardial infarction (MI). Emergent coronary angiography revealed an ascending aortic dissection with normal coronary arteries. In addition, his aortic dissection was complicated with pericardial tamponade. The patient was managed with an immediate surgical repair, after that he had an uncomplicated postoperative course and was discharged in a stable condition. This case report illustrates the importance of having a high index of suspicion for AD in cases of chest pain. If AD is suspected in a patient with acute coronary syndrome (ACS), confirming the diagnosis with the appropriate imaging studies should be done as quickly as possible, as misdiagnosis with ACS may lead to the inappropriate administration of thrombolytic or anticoagulant agents resulting in catastrophic outcomes. PMID:27054106

  4. Stanford type A aortic dissection in a patient with Marfan syndrome during pregnancy: a case report

    PubMed Central

    Bae, Jisue; Choi, Seung Won; Lee, Jong-Hwan; Kim, Chung Su; Cho, Hyun Sung; Lee, Sangmin M.

    2016-01-01

    Aortic dissection during pregnancy is a devastating event for both the pregnant woman and the baby. We report a case of acute aortic dissection (Stanford type A) in a pregnant woman with Marfan syndrome at the 29th week of gestation. She underwent a cesarean section followed by an ascending aorta and total arch replacement with cardiopulmonary bypass, without a prior sternotomy. The hemodynamic parameters were kept stable during the cesarean section by using inotropes and vasopressors under transesophageal echocardiography monitoring. The newborn survived after endotracheal intubation and management in a neonatal intensive care unit. PMID:26885307

  5. Stanford type A aortic dissection in a patient with Marfan syndrome during pregnancy: a case report.

    PubMed

    Kim, Won Ho; Bae, Jisue; Choi, Seung Won; Lee, Jong-Hwan; Kim, Chung Su; Cho, Hyun Sung; Lee, Sangmin M

    2016-02-01

    Aortic dissection during pregnancy is a devastating event for both the pregnant woman and the baby. We report a case of acute aortic dissection (Stanford type A) in a pregnant woman with Marfan syndrome at the 29(th) week of gestation. She underwent a cesarean section followed by an ascending aorta and total arch replacement with cardiopulmonary bypass, without a prior sternotomy. The hemodynamic parameters were kept stable during the cesarean section by using inotropes and vasopressors under transesophageal echocardiography monitoring. The newborn survived after endotracheal intubation and management in a neonatal intensive care unit. PMID:26885307

  6. Esthetic neck dissection using an endoscope via retroauricular incision: a report of two cases

    PubMed Central

    Kim, Jae-Young; Cho, Hoon; Cha, In-Ho

    2014-01-01

    Various surgical techniques, such as endoscopic surgery and robotic surgery, are developed to optimize the esthetic outcome even in operations for malignancy. A modified face-lift or retroauricular approach are used to minimize postoperative scarring. Recently, robot-assisted surgery is being done in various fields and considered as favorable treatment method by many surgeons. However its high cost is a nonnegligible fraction for many patients. On the other hand, endoscopic surgery, which is cheaper than robotic surgery, is minimally invasive with contentable neck dissection. Although it is a difficult technique for a beginner surgeon due to its limited operation view, we suppose it as an alternative method for robotic surgery. Herein, we report two cases of endoscopic neck dissection via retroauricular incision with a discussion regarding the pros and cons of endoscopic neck dissection. PMID:24627840

  7. Aortic Dissection Presenting as Acute Subtotal Left Main Coronary Artery Occlusion: A Case Approach and Review of the Literature

    PubMed Central

    Ruisi, Michael; Fallahi, Arzhang; Lala, Moinakhtar; Kanei, Yumiko

    2015-01-01

    Aortic dissection is the most common fatal condition of the aorta, yet it is often missed on initial clinical presentation. Aortic dissection associated with acute coronary syndrome (ACS) is relatively rare, but if it occurs, it can be diagnostically challenging, and the condition can be fatal. Here we describe a case of aortic dissection presenting as ST-segment elevation myocardial infarction (STEMI) managed via the transradial approach. We describe the current literature on the subject. PMID:25780485

  8. Aortic Dissection Caused by Percutaneous Coronary Intervention: 2 New Case Reports and Detailed Analysis of 86 Previous Cases

    PubMed Central

    Bajaj, Sharad; Shamoon, Fayez

    2016-01-01

    Aortic dissection, a rare sequela of percutaneous coronary intervention, can be fatal when it is not recognized and treated promptly. Treatment varies from conservative management to invasive aortic repair and revascularization. We report the cases of 2 patients whose aortic dissection was caused by percutaneous coronary intervention. In addition, we present detailed analyses of 86 previously reported cases. Aortic dissection was most often seen during intervention to the right coronary artery (in 76.7% of instances). The 2 most frequently reported causes were catheter trauma (in 54% of cases) and balloon inflation (in 23.8%). The overall mortality rate was 7.1%. We conclude that most patients can be treated conservatively or by means of stenting alone, with no need for surgical intervention.

  9. Dissecting peripheral superior cerebellar artery aneurysms: Report of two cases and review of the literature

    PubMed Central

    Nussbaum, Eric S.; Defillo, Archie; Zelensky, Andrea; Stoller, Richard; Nussbaum, Leslie

    2011-01-01

    Background: Only a limited number of dissecting aneurysms of the peripheral cerebellar arteries have been previously described, and very few of these cases involve the superior cerebellar artery (SCA). Due to the rarity of these lesions, there is little consensus regarding prognosis and management. We describe our experience with two cases of complex peripheral SCA dissecting aneurysms and review the existing literature on this fascinating entity. Case Description: Two patients, both with SCA dissecting aneurysms not amenable to endovascular treatment underwent microsurgical clipping, one with the associated removal of a tentorial meningioma. In each procedure a combined subtemporal, presigmoidal approach was performed. Surgical clips were utilized to reconstruct the aneurysms, and both patients were discharged without complication. Surgical management of complex distal SCA fusiform aneurysm is challenging and options include wrap/clip reconstruction, proximal occlusion, trapping, and distal outflow occlusion. When possible, preservation of the parent artery is preferred to mitigate the risk of brainstem infarction. If proximal occlusion or trapping are employed, we have advocated for the use of combined distal revascularization techniques to prevent permanent ischemic damage of the brainstem and cerebellar hemisphere. Conclusions: Peripherally dissecting aneurysm of the SCA is an uncommon entity. Management of these lesions is best handled by an experienced neuro-endovascular team combined with a neurovascular surgeon skilled in skull base approaches. PMID:21697986

  10. Guide Catheter-Induced Aortic Dissection Complicated by Pericardial Effusion with Pulsus Paradoxus: A Case Report of Successful Medical Management

    PubMed Central

    Avadhani, Sriya A.; Marmur, Jonathan D.

    2015-01-01

    Aortic dissection is a rare but potentially fatal complication of percutaneous coronary intervention (PCI). Management strategies of PCI induced dissection are not clearly identified in literature; such occurrences often mandate surgical repair of the aortic root with reimplantation of the coronary arteries. Another trend seen in case reports is the use of coronary-aortic stenting if such lesions permit. Several factors impact the management decision including the hemodynamic stability of the patient; mechanism of aortic injury; size, severity, and direction of propagation of the dissection; presence of an intimal flap; and preexisting atherosclerotic disease. We describe a case of a 65-year-old woman who underwent PCI for a chronic right coronary artery (RCA) occlusion, which was complicated by aortic dissection and pericardial effusion. Our case report suggests that nonsurgical management may also be appropriate for PCI induced dissections, and potentially even those associated with new pericardial effusion. PMID:25685153

  11. Surgical Fenestration for Lower Limb Ischemia Developing from Chronic Type B Aortic Dissection: A Report of 2 Cases.

    PubMed

    Ikeda, Akihiko; Kudo, Yohei; Konishi, Taisuke; Matsuzaki, Kanji; Jikuya, Tomoaki

    2016-02-01

    Lower limb ischemia caused by type B aortic dissection typically presents with a leg-threatening condition in the acute phase. However, in some cases, lower limb ischemia symptom develops as intermittent claudication in the chronic phase. Although surgical fenestration has been used for treating ischemic complications of aortic dissection, it has recently become an alternative option for such cases because of the significant advance of endovascular treatments. We report 2 cases of chronic type B aortic dissection complicated by lower limb ischemia. Two male patients aged 57 and 43 years presented with intermittent claudication more than 2 weeks after the onset of the disease. On the basis of anatomic condition of the dissected aorta, we successfully performed surgical fenestration through a median laparotomy. In the current endovascular era, surgical fenestration remains an effective and durable option for treating lower limb ischemia caused by chronic type B aortic dissection. PMID:26627318

  12. A Case of Acute Ischemic Duodenal Ulcer Associated with Superior Mesenteric Artery Dissection After Transarterial Chemoembolization for Hepatocellular Carcinoma

    SciTech Connect

    Jang, Eun Sun; Jeong, Sook-Hyang Kim, Jin Wook; Lee, Sang Hyub; Yoon, Chang Jin; Kang, Sung Gwon

    2009-03-15

    We report a case of transarterial chemoembolization (TACE)-related acute ischemic duodenal ulcer that developed in association with dissection of the superior mesenteric artery. We conclude that the acute duodenal ulcer was developed by ischemia related to superior mesenteric artery dissection during TACE. TACE should be conducted carefully with continuous observation of abdominal arteries.

  13. Isolated dissection of the superior mesenteric artery after living donor liver transplantation: a case report.

    PubMed

    Kokai, H; Sato, Y; Yamamoto, S; Oya, H; Kobayashi, T; Watanabe, T; Miura, K; Hatakeyama, K

    2012-03-01

    Isolated dissection of the superior mesenteric artery (SMA) not associated with aortic dissection is rare, particularly after living donor liver transplantation (LDLT). We experienced a case of isolated dissection of the SMA after LDLT performed in a 56-year-old man diagnosed with hepatitis B virus-related cirrhosis and hepatocellular carcinoma within the Milan criteria. He had no past history of hypertension or diabetes mellitus. At 6 days after LDLT, the patient underwent an emergency portal vein thrombectomy with ligation of a huge left gastric vein shunt. Thereafter anticoagulant and antiplatelet therapy were initiated. At 12 days after LDLT, a contrast-enhanced computer assisted tomography (CT) scan revealed the presence of a thrombus in a false lumen and a thin flap enlarged in the SMA. Because he presented neither abdominal pain nor biochemical data suggesting mesenteric ischemia, he was treated with antihypertensive agents in addition to anticoagulant and antiplatelet therapy. The thrombus in the false lumen was reduced and the intimal flap in the SMA disappeared according to the results of a CT scan 4 months after LDLT. He has remained free of symptoms for 4 years. The strategy to treat isolated SMA dissection is not well established. Urgent surgery is indicated for acute symptomatic forms with a suspicion of mesenteric ischemia; conservative treatment is indicated for patients with minimal, resolving, or no pain, but requires close follow-up. PMID:22410076

  14. Neck dissection

    MedlinePlus

    Radical neck dissection; Modified radical neck dissection; Selective neck dissection; Lymph node removal - neck ... spread. There are three main types of neck dissection surgery: Radical neck dissection: All the tissue on the side of ...

  15. Chyle leak following right axillary lymph node dissection: A case report and review of current literature

    PubMed Central

    Daggett, J.D.; Watt, A.W.; Smith, P.D.

    2016-01-01

    This report discusses the case of a chyle leak following a right axillary lymph node dissection for breast cancer. This presented as a sudden change in drainage character from a right axillary surgical drain from serous to milky white shortly after restarting a diet. The diagnosis of chyle leak was confirmed by laboratory testing of the fluid and managed with closed suction drainage. Chyle leak is a rare, but increasingly recognized complication following axillary clearance for breast cancer and melanoma. PMID:26826928

  16. Delayed esophageal perforation occurring with endoscopic submucosal dissection: A report of two cases

    PubMed Central

    Matsuda, Yasuhiro; Kataoka, Naoki; Yamaguchi, Tomoyuki; Tomita, Masafumi; Sakamoto, Kazuki; Makimoto, Shinichiro

    2015-01-01

    We report two cases of delayed esophageal perforation occurring with endoscopic submucosal dissection. Our cases involved delayed perforation after 10 d in case 1 and after 6 d in case 2. Both cases were related to solid food. We performed subtotal esophagectomy with gastric tube reconstruction of the esophagus via the subcutaneous route anterior to the thoracic wall without conservative treatment because both cases involved chest pain and major leakage of food into the mediastinum. Postoperative complications were a local factor (including suture failure and esophageal stricture) in case 1, and we performed endoscopic balloon dilatation five times for esophageal stricture. There was no intrathoracic and mediastinal infection in either case. Surgical treatment for delayed esophageal perforation can be performed safely and surely if diagnosis and assessment are not delayed. PMID:26225195

  17. Congenital contractural arachnodactyly complicated with aortic dilatation and dissection: Case report and review of literature.

    PubMed

    Takeda, Norifumi; Morita, Hiroyuki; Fujita, Daishi; Inuzuka, Ryo; Taniguchi, Yuki; Imai, Yasushi; Hirata, Yasunobu; Komuro, Issei

    2015-10-01

    Congenital contractural arachnodactyly (CCA) is a connective tissue disease caused by mutations of the FBN2, which encodes fibrillin-2. CCA patients have a marfanoid habitus; however, aortic dilatation and/or dissection as observed in Marfan syndrome have been rarely documented. Here, we report on a Japanese familial case of CCA resulting from a FBN2 splicing mutation (IVS32+5g→a), which leads to exon 32 being skipped, and the patients developed aortic dilatation and type A dissection. Although CCA patients have been believed to have favorable prognoses, repetitive aortic imaging studies must be performed in some patients to detect possible aortic disease early, and genetic testing of FBN2 might be useful to identify such high-risk patients. PMID:25975422

  18. Right axillary arterial perfusion for a ruptured type B aortic dissection: report of a case.

    PubMed

    Katoh, T; Gohra, H; Hamano, K; Noda, H; Fujimura, Y; Zempo, N; Esato, K

    1999-01-01

    The results of surgical treatment for a ruptured type B aortic dissection remain far from satisfactory. It is believed that additional perfusion from the right axillary artery might be more beneficial than perfusion from only the femoral artery during surgery for a ruptured thoracic aneurysm. The right axillary perfusion is more likely to perfuse the vital organs proximal to the ruptured area, and thus avoid retrograde emboli. In addition, if the open proximal method is performed, then the right axillary perfusion is able to facilitate the evacuation of air from the aortic lumen. We present herein the case of a patient in whom a ruptured type B acute aortic dissection was successfully treated by applying right axillary perfusion through a left thoracotomy. PMID:10639716

  19. Extensive intracranial involvement with multiple dissections in a case of giant cell arteritis

    PubMed Central

    Parra, Joana; Domingues, Joana; Sargento-Freitas, João; Santana, Isabel

    2014-01-01

    A 56-year-old man presented with weight loss, articular pain and minor neurological symptoms progressing over 1 month. Neurosonological evaluation suggested occlusion in intracranial segments of the left vertebral artery (VA) and of both internal carotid arteries (ICA) and hypoechoic halo sign in both superficial temporal arteries. The diagnosis of giant cell arteritis was supported by inflammatory markers and confirmed by biopsy. Despite early steroid initiation, he manifested fluctuant vascular deficits and became lethargic. Brain MRI indicated watershed infarcts and intracranial dissections of left VA and both ICA. The patient was stabilised with the association of prednisolone 2 mg/kg, methotrexate and oral anticoagulation. Since then he has been neurologically asymptomatic and control imaging showed only residual intracranial left VA stenosis, with no signs of temporal artery inflammation or new vascular lesions. This is to the best of our knowledge, the first reported clinical case with such an extensive intracranial involvement with multiple dissections. PMID:24728901

  20. A Rare Case of Pulmonary Artery Dissection Associated With Infective Endocarditis.

    PubMed

    Shi, Xiaoqing; Wang, Xiaoqin; Wang, Chuan; Zhou, Kaiyu; Li, Yifei; Hua, Yimin

    2016-05-01

    Pulmonary artery dissection (PAD) is a rare condition with high mortality and has not been reported in patient with infective endocarditis (IE). Here, we report the first case of such patient who experienced PDA and survived after surgical intervention.A 10-year-old female child was diagnosed as IE with a patent ductus arteriosis (PDA) and a vegetation on the left side of pulmonary artery trunk (10 × 5 mm). Following 3-week antibacterial treatment, the body temperature of patient returned to normal, and the size of vegetation reduced (7 × 3 mm). However, the patient had a sudden attack of sustained and crushing right chest pain, orthopnea with increasing respiratory rate (> 60/min), and acute high fever. Echocardiography revealed the detachment of vegetation on the first day and dissection of pulmonary artery on the next day. The patient received immediate surgical intervention. It was found that aneurysm had a size of 28 × 20 mm and its orifice (the dissecting site) located on the opposite side of the PDA opening (right side of the pulmonary artery trunk). The dissected left wall of pulmonary artery trunk was reconstructed followed by the closure of PDA with suture. The patient recovered uneventfully.From this case, we learned that the surgical intervention should be considered at an early time for IE patients who have a vegetation in pulmonary artery and PDA. After the infection is under control, the earlier surgery may prevent severe complications. PMID:27175632

  1. Case report of using curved tip electrothermal bipolar coagulation to improve hilar dissection in VATS lobectomy

    PubMed Central

    Fikfak, Vid; Gaur, Puja; Chan, Edward Y.; Kim, Min P.

    2016-01-01

    Introduction Thoracoscopic lobectomy has gained a pivotal role in the resection of lung cancer. To facilitate the minimally invasive approach, new surgical devices have been developed to help improve the feasibility of performing complex cases. Recently, we adopted the use of a 5 mm curved tip electrothermal bipolar sealing device. Presentation of case We highlight two patients with different type of hilum during VATS lobectomy. First patient had a peripheral lung cancer with simple hilum while second patient had bronchiectasis with very complex hilum. In both cases, use of 5 mm curved tip electrothermal bipolar sealing device helped in successful completion of video-assisted thoracoscopic lobectomy. Discussion In these two cases, we were able to take advantage of the 5 mm curved tip electrothermal bipolar sealing device in completion of the hilar dissection. Conclusion Curved tip electrothermal bipolar sealing device allows complete dissection of hilar structures more easily during a lobectomy for simple and complex hilum. Use of this device may lead to more efficient VATS lobectomy. PMID:27100955

  2. Diagnostic difficulties of neurological complications after surgical treatment of acute ascending aorta dissection - a case report.

    PubMed

    Olszewski, Krzysztof; Stążka, Janusz; Krawczyk, Elżbieta; Kozłowicz, Michał

    2011-02-01

    Adverse drug reactions deteriorate patient state, delay proper diagnosis and therapy. Drug-induced extrapyramidal syndromes caused by use of receptor D2 antagonists are relatively rare. We present a case of acute dystonia with upper limbs tremors after medication with metoclopramide and neuroleptic drugs in young patient operated on acute aortic dissection. Besides a rare comlication in the shape of right temporo-maxillary joint luxation and somatic symptoms of anxiety reaction occured, what made difficult the proper diagnosis and fast treatment. PMID:22166288

  3. A case of an occlusive right coronary artery dissection after stent implantation: dilemmas and challenges.

    PubMed

    Panoulas, Vasileios F; Figini, Filippo; Giustino, Gennaro; Carlino, Mauro; Chieffo, Alaide; Latib, Azeem; Colombo, Antonio

    2015-01-01

    A 53-year-old man with stable angina had a staged percutaneous coronary intervention to a critical focal stenosis of the mid-segment of the right coronary artery (RCA). Two hours after successful RCA stent implantation, the patient re-presented with inferior ST elevation secondary to acute dissection originating at the distal edge of the stent, causing subtotal occlusion of the distal RCA. The patient had TIMI-2 flow in the posterolateral branch and occlusion of the posterior descending artery. This case describes the procedural challenges the operators were faced with and successful use of the "rescue STAR" technique as a last resort. PMID:25589705

  4. Surgical Position, Cause of Extracranial Internal Carotid Artery Dissection, Presenting as Pourfour Du Petit Syndrome: Case Report and Literature Review.

    PubMed

    Villalba Martinez, Gloria; Navalpotro Gomez, Irene; Serrano Perez, Laura; Gonzalez Ortiz, Sofia; Fernández-Candil, Juan L; Steinhauer, Eva Giralt

    2015-01-01

    Dissection of the internal carotid artery is a rare cause of stroke overall, but causes 22% of strokes in younger patients. A common clinical presentation is as Claude Bernard Horner syndrome. We report a craniotomy with 30 degrees rotation of the neck (standard position) in a patient with no major risk factors for carotid dissection, who showed a Pourfour du Petit syndrome due to a dissection of the internal carotid artery. To the best of our knowledge, this is the first reported case in which a common surgical position causes an internal carotid artery dissection in a patient without relevant risk factors. The presentation with Pourfour du Petit syndrome is extremely unusual. PMID:26242349

  5. Spontaneous coronary artery dissection: Case series from two institutions with literature review.

    PubMed

    Uribe, Carlos Esteban; Ramirez-Barrera, Juan David; Rubio, Carlos; Gallegos, Cesia; Ocampo, Luz Adriana; Saldarriaga, Clara; Eusse, Carlos; Tenorio, Carlos; Lopez, Nilson; Moreno, Andres; Jaramillo, Natalia Gonzalez; Chehrazi-Raffle, Alexander Morteza; Singh, Vikas; Martinez-Clark, Pedro

    2015-05-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Consequently, its presentation and optimal treatment are yet to be clearly defined. In the current literature, all case series report less than 50 patients, most of whom are either young peripartum women or women who have used oral contraceptives over long periods. All information in this study was compiled by the database service from two hospitals, the first one between 2003 and 2012 and the second one between 2007 and 2012, to include the clinical characteristics, angiography. and treatment approaches in the study population. The study population consisted in four women (50%) and four men (50%) whose ages ranged between 28 and 57 years. Two women had a history of oral contraceptive use and three women presented during peripartum. None of the patients had traditional cardiovascular risk factors or previous heart disease. In 88% of the cases, the principal diagnoses were non-ST segment elevation myocardial infarction and unstable angina. All patients underwent emergency coronary angiography and percutaneous coronary intervention. Half of them were treated with drug-eluting stents and the other half with bare metal stents. The most frequent type of dissection was NIHBL Type E, and the right coronary artery was the most frequently compromised. SCAD is a rare cause of ACS; however, its identification has improved due to the availability of angiography and new complementary techniques. Regarding treatment, PCI seems effective with adequate long-term results. PMID:25993713

  6. Diabetes and Reduced Risk for Thoracic Aortic Aneurysms and Dissections: A Nationwide Case-Control Study

    PubMed Central

    Prakash, Siddharth K.; Pedroza, Claudia; Khalil, Yameen A.; Milewicz, Dianna M.

    2012-01-01

    Background Vascular diseases are the principal causes of death and disability in people with diabetes. At the same time, studies suggest a protective role of diabetes in the development of abdominal aortic aneurysms. We sought to determine whether diabetes is associated with decreased hospitalization due to thoracic aortic aneurysms and dissections (TAAD). Methods and Results We used the 2006 and 2007 Nationwide Inpatient Sample (NIS) to determine TAAD discharge rates. Control subjects were randomly selected to achieve three controls per case. Predictor variables in multilevel logistic regression included age, race, median income, diabetes, and hypertension. We estimated that the average rate of hospital discharge for TAAD among individuals diagnosed with diabetes was 9.7 per 10 000, compared to 15.6 per 10 000 among all discharges. The prevalence of diabetes was substantially lower in TAAD (13%) than in control (22%) records. After adjustment for demographic characteristics, the negative association between diabetes and TAAD remained highly significant in both NIS datasets. Compared to discharges without diabetes, those with chronic complications of diabetes were least likely to be diagnosed with TAAD (OR [odds ratio] 0.17, 95% CI, 0.12–0.23). A significant association remained between uncomplicated diabetes and TAAD. We replicated these findings in an independent group of patients who were hospitalized with acute thoracic aortic dissections. Conclusions The principal implication of our findings is that diabetes is independently associated with a decreased rate of hospitalization due to TAAD in proportion to the severity of diabetic complications. Future studies should consider diabetes in predictive models of aneurysm expansion or dissection. (J Am Heart Assoc. 2012;1:jah3-e000323 doi: 10.1161/JAHA.111.000323.) PMID:23130125

  7. [Spontaneous renal artery dissection. Case report and review of the literature].

    PubMed

    Veeckman, P; Voss, E U

    1992-01-01

    Focal idiopathic renal arterial dissection (RAD) is a rare event. Nevertheless, a RAD should always be considered in the differential diagnosis in patients with flank pain or acute abdomen, since only an immediate diagnosis and correction can guarantee the maintenance of kidney function. Early operation is also necessary because other clinical pictures with a similarly dramatic clinical course and similar symptoms can likewise only be treated surgically. These include a renal arterial aneurysm with endo-aneurysmatic thrombus and poststenotic dilatation in fibromuscular dysplasia. We describe the case of an isolated idiopathic RAD which could only be diagnosed in the context of abdominal pain symptoms. Clinical, pathophysiological and therapeutic aspects of RAD are discussed with reference to the case report and the international specialist literature. PMID:1529639

  8. Efficacy of octreotide against chylothorax following lateral neck dissection for thyroid cancer: A case report

    PubMed Central

    Hayashibara, Noriaki; Ogawa, Toshihisa; Tsuji, Eiichi; Ishizuna, Kazuo

    2016-01-01

    Introduction Postsurgical chylothorax is a rare complication of cervical dissection for thyroid cancer. We report that octreotide, a synthetic analog of somatostatin, is effective in treating chylothorax after thyroid carcinoma surgery. Presentation of case The patient was a 48-year-old woman who presented to our institution complaining of a left anterior cervical mass. We diagnosed this as thyroid papillary carcinoma and performed a subtotal excision of the thyroid gland with left cervical lymph node dissection. The patient developed dyspnea, and a chest X-ray revealed bilateral chylothorax on Day 4 post-surgery. Octreotide was administered since bilateral chylothorax was noted. A marked decrease in chyle effusion was noted just 3 days after starting octreotide, and after a total of 9 days of treatment, there were no further signs of chylous effusion. Discussion Octreotide is effective against postsurgical chylothorax; however, if there are no signs of improvement, we believe surgical treatment should be considered. Conclusion Octreotide should be administered first to treat postsurgical chylothorax before surgical treatment is considered. PMID:26963261

  9. [Retrograde Ascending Aortic Dissection during Thoracic Endovascular Stent Graft Repair: A Case Report].

    PubMed

    Fujita, Masahide; Fukuda, Taeko; Yaguchi, Yuichi; Sato, Masataka; Watanabe, Yasunori; Nakajima, Kotarou; Tanaka, Makoto

    2015-10-01

    A 66-year-old man (166 cm and 64 kg) with a history of hypertension was diagnosed with a.chronic aortic dissection (DeBakey IIIa type). He underwent thoracic endovascular aortic repair (TEVAR) under general anesthesia (sevoflurane and remifentanil) in an angiography room. After deploying a stent graft (Zenith TX2, Cook Japan, Tokyo) in the descending aorta via the right femoral artery, we checked the condition of the stent by angiography. No remarkable change of vital signs was observed. However, the angiography revealed a decrease in blood flow of both brachiocephalic and left common carotid arteries. The decision was made to operate immediately. The patient was transferred to the operating room under sedation with propofol. Cardiopulmonary bypass commenced 1 hour and 25 minutes after the decision to operate. Exploration of the aortic arch confirmed a retrograde ascending aortic dissection (rAAD). Ascending-arch vascular prosthesis was performed during circulatory arrest. The patient was extubated successfully the day after surgery. The present case demonstrates an intraoperative rAAD following stent placement TEVAR is believed to be less invasive compared to surgical treatment. However, it should be noted that TEVAR could provoke life-threatening complications such as rAAD. PMID:26742415

  10. Acquired infantile Horner syndrome and spontaneous internal carotid artery dissection: a case report and review of literature.

    PubMed

    Pirouzian, Amir; Holz, Huck A; Ip, Kenneth C; Sudesh, Rattehalli

    2010-04-01

    Horner syndrome, a triad of ptosis, anisocoria, and anhidrosis, results from interruption in the oculosympathetic pathway. It is classically described as either congenital or acquired to depict its underlying pathophysiology and requisite work-up. We report a case of a 10-month-old infant presenting with an acute onset of left Horner syndrome secondary to a spontaneous extracranial internal carotid artery dissection. To the best of our knowledge, this is the first case report in the literature of acute onset of acquired infantile Horner syndrome in association with spontaneous carotid artery dissection confirmed with magnetic resonance angiogram. PMID:20451860

  11. Open Removal of Penetrating Inferior Vena Cava Filter with Repair of Secondary Aortic Dissection: Case Report.

    PubMed

    Chauhan, Yusuf; Al Jabbari, Odeaa; Abu Saleh, Walid K; Loh, Thomas; Ali, Irshad; Lumsden, Alan

    2016-04-01

    Inferior vena cava (IVC) filters are indicated for the management of venous thromboembolism in patients who are not candidates for anticoagulation, have a contraindication to anticoagulation or who have recurrent thromboembolism despite anticoagulation. As IVC filter usage has increased, there has been a corresponding increase in presentation of filter-related complications. Filter leg penetration is commonly seen although is infrequently associated with complications. But in a small percentage of patients, penetration can result in damage to adjacent structures: duodenum, lumbar spine, and rarely the aorta. We report the case of a 77-year-old man with a chronic aortoiliac dissection secondary to aortic IVC filter penetration who underwent open filter retrieval and aortic repair. PMID:26806231

  12. [Spontaneous intracranial internal carotid artery dissection: 6 case reports and a review of 39 cases in the literature].

    PubMed

    Nagumo, Kiyomi; Nakamori, Akitoshi; Kojima, Shigeyuki

    2003-06-01

    Angiographic, CT and MR findings, precipitating factors, and clinical features of spontaneous intracranial internal carotid artery dissection, in particular the terminal segment of the ICA, are described. Patients who had a possible posttraumatic dissection were excluded from the study. Six patients, 3 men and 3 women, mean age 25.8 years, were studied. Spontaneous ICA dissection accounted for 0.63 percent of 797 patients with ischemic stroke and 14 percent of 36 patients with ischemic stroke who were 45 years of age or younger. Headache was absent in two but clearly preceded the onset of cerebral stroke in four patients, the interval ranging from less than a few minutes to 6 hours. Focal cerebral ischemic symptoms were present in all six patients. Four presented with loss of consciousness. Only one patient had a subarachnoid hemorrhage (SAH). Dissection occurred at the level of the carotid knee portion just beyond the origin of the ophthalmic artery in all the patients. Moreover, there was additional involvement of the ipsilateral MCA in four and ipsilateral ACA in three. Angiographic features of the six ICAs that involved dissection were a smooth tapered luminal narrowing or occlusion in two patients, irregular narrowing in three, a pearl and string sign in one, and retention of the contrast media in three. Follow up angiography or magnetic resonance (MR) angiography was performed on all the patients. The interval from the initial to follow-up angiography was one to six months. Stenosis persisted in one artery but was resolved in the other five arteries. MR angiography showed segmental narrowing of the right supraclinoid internal carotid artery in one patient. MR angiographic source images showed a narrow lumen in the right intracavernous portion of the ICA and a crescent-shaped filling defect. Follow-up MR imaging and MR angiography, 6 months after the initial study, showed amelioration of the luminal narrowing and no filling defect. The filling defect is considered to be due to a thrombosed pseudolumen. Treatment consisted of anticoagulation therapy for two patients, hyperbaric therapy for two, and supportive measures only for two. Follow-up ranged from ten months to three years. Of these six patients with completed stroke, four had full recovery, and two some residual neurological deficits. Trivial precipitating events were reported by five of the patients (playing tennis, running, bicycling, and drinking alcohol). Migraine headaches were cited by one patient, use of oral contraceptives by another, and use of tobacco by a third. All the patients were normotensive. In none of them was family history contributory, nor was any underlying arteriopathy identified. Of the six personal cases and the reviewed 25 cases during the last 15 years, represented on the Glasgow Outcome Scale, good recovery was achieved in 61%. The outcomes for these patients was better than previously reported. Spontaneous intracranial ICA dissection may cause ischemic stroke, with or without subarachnoid hemorrhage, especially in young patients. PMID:14503348

  13. Dissecting the Dissection

    PubMed Central

    Sherif, Hisham M.F.

    2015-01-01

    Aortic dissection remains one of the most devastating diseases. Current practice guidelines provide diagnostic and therapeutic interventions based primarily on the aortic diameter. The level of evidence supporting these recommendations is Level C or “Expert Opinion” Since aortic dissection is a catastrophic structural failure, its investigation along the guidelines of accident investigation may offer a useful alternative, utilizing process mapping and root-cause analysis methodology. Since the objective of practice guidelines is to address the risk of serious events, on the utilization of a probabilistic predictive modeling methodology, using bioinformatics tools, may offer a more comprehensive risk assessment. PMID:27069940

  14. Case Report: Delayed Type A Aortic Dissection Following Complete Debranching of the Aortic Arch and Stent Graft Placement

    PubMed Central

    Al Jabbari, Odeaa; Abu Saleh, Walid K.; Irshad, Ali; Christensen, Trolls; Bruckner, Brian; Bismuth, Jean; Loebe, Matthias

    2016-01-01

    Treatment options for aortic arch disease in high-risk patients includes supra-aortic debranching and thoracic endovascular aortic repair (TEVAR). Acute ascending aortic dissection is a concerning complication of this approach and has been reported to occur in a retrograde fashion. We report a case of a 60-year-old gentleman who had undergone thoracic endovascular aortic repair with debranching and presented 31 months later with acute isolated ascending aortic dissection. The patient underwent successful total replacement of the ascending aorta with a 30-mm gelwave Valsalva™ graft using cardiopulmonary bypass.

  15. Fracture of the clavicle following radical neck dissection and postoperative radiotherapy: a case report and review of the literature

    SciTech Connect

    Strauss, M.; Bushey, M.J.; Chung, C.; Baum, S.

    1982-11-01

    The treatment of head and neck cancer with radiotherapy and radical neck dissection has many recognized complications. Radiotherapy in therapeutic doses can produce devascularization and weakening of bone. Radical neck dissection results in altered mechanics of the shoulder girdle and a disruption of normally balanced forces acting on the clavicle. An unusual case of clavicle fracture which is considered to have resulted from an interaction of the effects of these therapies is discussed. An approach for recognizing and distinguishing this entity by its time course, and radiographic and nuclide bone scan appearance is presented.

  16. [Surgically resected local recurrence after endoscopic submucosal dissection of esophageal cancer--a case report].

    PubMed

    Okamura, Hiroko; Fujiwara, Hitoshi; Suchi, Kentarou; Okamura, Shinichi; Umehara, Seiji; Konishi, Hirotaka; Todo, Momoko; Kubota, Takeshi; Ichikawa, Daisuke; Kikuchi, Shojiro; Okamoto, Kazuma; Kuriu, Yoshiaki; Ikoma, Hisashi; Nakanishi, Masayoshi; Ochiai, Toshiya; Sakakura, Chouhei; Kokuba, Yukihito; Sonoyama, Teruhisa; Otsuji, Eigo

    2009-11-01

    We report a case of surgically resected esophageal cancer which was locally recurred after endoscopic submucosal dissection. A 66-year-old man was admitted to our hospital because of further examination and a treatment of superficial esophageal cancer. A type 0-IIb+IIa cancer occupying the whole circumference of the lumen of the middle to lower esophagus was revealed. The depth of the invasion was judged to be T1a-EP or LPM by endoscopic ultrasonography, and no metastasis to other organs or lymph nodes was detected. Endoscopic submucosal dissection (ESD) was performed. However, macroscopic residual cancer didn't seem to exist. Pathological diagnosis was squamous cell carcinoma, moderately differentiated, the depth of tumor invasion was T1a-LPM. The presence of the residual cancer of the horizontal cut margin could not be judged because en bloc resection could not be achieved. After that, endoscopic balloon dilatation of the esophageal stenosis was performed repeatedly for about one year. Then, he was diagnosed as the local recurrence of the squamous cell carcinoma of the esophagus. Thoraco-abdominal esophagectomy reconstructed by stomach tube via a retrosternal route was undergone. The final stage of the lesion was judged T3N1M0 (Stage III, UICC) by the histological examination from the resected specimen. After the operation, he is receiving adjuvant chemotherapy and alive without recurrence. When endoscopic resection of the esophageal cancer is performed to the lesion, which relatively indicated to endoscopic resection or outside the guideline criteria for endoscopic resection, it is important that we choose the appropriate treatment protocol obtaining an informed consent from the patient sufficiently. PMID:20037452

  17. A Case of Isolated Celiac Artery Dissection Accompanied by Splenic Infarction Detected by Ultrasonography in the Emergency Department

    PubMed Central

    Emori, Kazumasa; Takeuchi, Nobuhiro; Soneda, Junichi

    2016-01-01

    A 46-year-old male with a history of hypertension visited the emergency department (ED) by ambulance complaining of sudden pain in the left side of his back. Ultrasonography (USG) performed at ED revealed splenic infarction along with occlusion and dissection of the celiac and splenic arteries without abdominal artery dissection. Contrast enhanced computed tomography (CT) revealed the same result. Consequently, spontaneous isolated celiac artery dissection (SICAD) was diagnosed. Because his blood pressure was high (159/70 mmHg), antihypertensive medicine was administered (nicardipine and carvedilol). After his blood reached optimal levels (130/80 mmHg), symptoms disappeared. Follow-up USG and contrast enhanced CT performed 8 days and 4 months after onset revealed amelioration of splenic infarction and improvement of the narrowed artery. Here, we report a case of SICAD with splenic infarction presenting with severe left-sided back pain and discuss the relevance of USG in an emergency setting. PMID:27148460

  18. Intramural oesophageal dissection as an unusual presentation of chest pain: A case report

    PubMed Central

    Mizumoto, Ryo; Van Rooyen, Henk

    2015-01-01

    Introduction Intramural oesophageal dissection (IOD) is a rare clinical condition and there is a paucity of information regarding the appropriate diagnosis and management. It is described as bleeding in the submucosal plane of the oesophagus, and has various documented causes. Presentation of case We report a case of a 73 year old female who developed IOD. She presented with severe chest pain. Subsequent imaging revealed IOD and haematoma formation. This was confirmed on oesophagogastroduodenoscopy (OGD). She was on a bisphosphonate for her osteoporosis, as well as having age-related dysmotility of her oesophagus on manometric studies. She was also taking fish oil. Treatment was conservative and the patient was discharged with proton pump inhibitors and follow up. Discussion Spontaneous haematoma formation and IOD resulted likely from a combination of the anticoagulant effect of fish oil and oesophageal dysmotility. Bisphosphonates also have some well documented gastrointestinal side effects involving mucosal damage. The possibility that the concurrent use of bisphosphonate led to a pre-existing ulcer which could have contributed to the development of IOD in this patient should be considered. Conclusion spontaneous IOD can occur in elderly patients who are anticoagulated. Fish oil has not been previously reported as having an association with IOD. This is the first known reported case of spontaneous IOD occurring in association with concurrent use of a bisphosphonate and fish oil. IOD is a rare disorder, and any anticoagulated patients presenting with severe chest pain may need careful investigation prior to definitive management. PMID:26904189

  19. Survival with Collateral Circulation after Gastrointestinal Ischemia Caused by Aortic Dissection: A Case Report.

    PubMed

    Kusumoto, Eiji; Endo, Kazuya; Ota, Mitsuhiko; Tsutsumi, Norifumi; Hashimoto, Kenkichi; Egashira, Akinori; Sakaguchi, Yoshihisa; Kusumoto, Tetsuya; Ikejiri, Koji

    2015-07-01

    We report a case of a 43-year-old man who presented with gradually intensifying abdominal pain of acute onset and was shown by contrast-enhanced computed tomography (CT) examination to have acute aortic dissection (Stanford type B). A diagnosis of gastrointestinal necrosis was made and he underwent emergency surgery. At laparoscopy, he was found to have no superior mesenteric arterial pulse and intestinal necrosis from the upper jejunum to the right transverse colon. Resection of the superior mesenteric artery (SMA) perfusion area was performed. Postoperatively, ischemia in the perfusion area of the celiac artery was also diagnosed, manifesting as gallbladder necrosis, portal vein gas accompanying gastric wall necrosis, perforation of the remaining upper jejunum, and hepatic and splenic infarction. However, development of a collateral circulation originating in the left colic branch of the inferior mesenteric artery (IMA) enabled retrograde provision of blood to the celiac artery through the SMA pancreaticoduodenal arcade. Thus, in this case, spontaneous development of a natural bypass created a new route for arterial perfusion, contributing to the patient's survival. When ischemia of the celiac artery and SMA perfusion areas occur, collateral circulation can develop from the IMA. PMID:26462314

  20. Vertebral artery dissection due to an esophageal foreign body migration: a case report.

    PubMed

    Benmansour, Najib; Ouattassi, Naouar; Benmlih, Amine; Elalami, Mohamed Noureddine

    2014-01-01

    Unintentional foreign bodies' swallowing is a fairly common occurrence in ENT consultation especially among children. They usually pass through the gastrointestinal tract without complications. Migration of a foreign body through the esophageal wall is rare. It represents about 1% to 4% of all cases of foreign bodies' ingestion. A 16 year's old female patient has presented to ENT emergency with a painful dysphagia following an accidental ingestion of a metallic pin. Cervical X ray confirmed the presence of the pin while endoscopic investigations have shown no foreign body. Cervical CT scan revealed the migration of the foreign body through the esophageal wall with left vertebral artery dissection. Endoscopic management has been sufficient with an uneventful post operative follow up. Esophageal foreign bodies are very diverse mainly dominated by fish bones (60%) and chicken bones (16%). Metallic pins are rare. The major risks of migration of those foreign bodies are cervical abscess, mediastinitis and oeso-vascular fistulae. Cases of self extrusion through the skin have been reported. Migration of a foreign body through the esophageal wall is rare. Endoscopic management has been sufficient. PMID:25018833

  1. Vertebral artery dissection due to an esophageal foreign body migration: a case report

    PubMed Central

    Benmansour, Najib; Ouattassi, Naouar; Benmlih, Amine; Elalami, Mohamed Noureddine

    2014-01-01

    Unintentional foreign bodies‘ swallowing is a fairly common occurrence in ENT consultation especially among children. They usually pass through the gastrointestinal tract without complications. Migration of a foreign body through the esophageal wall is rare. It represents about 1% to 4% of all cases of foreign bodies‘ ingestion. A 16 year's old female patient has presented to ENT emergency with a painful dysphagia following an accidental ingestion of a metallic pin. Cervical X ray confirmed the presence of the pin while endoscopic investigations have shown no foreign body. Cervical CT scan revealed the migration of the foreign body through the esophageal wall with left vertebral artery dissection. Endoscopic management has been sufficient with an uneventful post operative follow up. Esophageal foreign bodies are very diverse mainly dominated by fish bones (60%) and chicken bones (16%). Metallic pins are rare. The major risks of migration of those foreign bodies are cervical abscess, mediastinitis and oeso-vascular fistulae. Cases of self extrusion through the skin have been reported. Migration of a foreign body through the esophageal wall is rare. Endoscopic management has been sufficient. PMID:25018833

  2. Digital imaging of the dissection and sexual abuse of a corpse - an exceptional case of necrophilia.

    PubMed

    Bauer, Martin; Tatschner, Thomas; Patzelt, Dieter

    2007-05-01

    Regular necrophilia refers to the sexually motivated abuse of corpses and is not considered as severe crime in many western countries. However, the risk of "switching" to necrophilic homicides, i.e., committing a homicide to obtain a dead body, has to be assessed by forensic experts. We present a case of semi-professional dissection, preservation and sexual abuse of the body and body parts of a 14-year-old girl. Every step was documented by the offender on thousands of digital images thus allowing an exact reconstruction of necrophilic acts and fantasies. Three months after the disappearance of the body the remains could be recovered and linked to the deceased by pathological examination and DNA analysis. The offender had excessively used the internet for downloading files with sadistic and necrophilic contents including autopsy instructions. The psychiatric examination of the socially integrated and married patient revealed a severe personality disorder. Two other, previously unsolved cases could be attributed to him showing a clear progression of fantasies and acts. PMID:17157546

  3. Spontaneous coronary artery dissection in a young man with a factor v leiden gene mutation: a case report and review of the literature.

    PubMed

    Khan, Tahir; Danyi, Peter; Topaz, On; Ali, Asghar; Jovin, Ion S

    2013-12-01

    Spontaneous coronary artery dissection is a rare but increasingly recognized cause of acute myocardial ischemia in young adults, especially in women. We report a case of spontaneous coronary dissection in a young healthy man who was also a carrier of the factor V Leiden gene mutation. PMID:24436622

  4. A case of anterior cerebral artery dissection caused by scuba diving.

    PubMed

    Fukuoka, Takuya; Kato, Yuji; Ohe, Yasuko; Deguchi, Ichiro; Maruyama, Hajime; Hayashi, Takeshi; Tanahashi, Norio

    2014-08-01

    A 51-year-old man was admitted with right hemiparesis during scuba diving, without headache. Brain magnetic resonance (MR) imaging depicted high-intensity areas in the left superior frontal and cingulate gyri on diffusion-weighted imaging. Dissection of the anterior cerebral artery (ACA) was detected using axial MR angiography and 3-dimensional MR cisternography. Dissection of the ACA during and after scuba diving has not been reported before. Dissection of the arteries should be included in the differential diagnosis when neurologic symptoms occur both during and after scuba diving, even if the patient does not experience headache. Furthermore, the combination of MR cisternography and MR angiography is useful to detect ACA dissection. PMID:24784014

  5. The importance of clinical suspicion in the diagnosis of a successfully managed case with De Bakey Type 1 acute aortic dissection: A case report

    PubMed Central

    Salman, A. Ebru; Çeliksoy, Muzaffer; Yetişir, Fahri; Atasoy, Şevket; Katırcıoğlu, Fehmi

    2014-01-01

    Type 1 aortic dissection is a catastrophic clinical entity originating from the ascending aorta. Clinical suspicion in patients with epigastric pain, chest pain and gastrointestinal symptoms might be life saving. Aortic dissection and acute mesenteric ischemia might be confusing in diagnosis of patients with epigastric pain, chest pain, gastrointestinal symptoms and high white blood cell count and D-dimer. In this case report of a patient who was admitted to the emergency room with a presentation resembling acute mesenteric ischemia, this diagnosis was excluded within the first 24 hours as a result of clinical suspicion. In this case report, the successful management in diagnosis and treatment of a 30-year-old male patient with type 1 aortic dissection is discussed in light of the literature. PMID:25931881

  6. Popliteal lymph node dissection for metastatic squamous cell carcinoma: a case report of an uncommon procedure for an uncommon presentation.

    PubMed

    Morcos, Basem B; Hashem, Sameh; Al-Ahmad, Firas

    2011-01-01

    Lymph node metastasis from cutaneous squamous cell carcinoma is uncommon. The popliteal fossa is rarely involved with metastasis. Popliteal lymph node dissection is uncommonly performed and not frequently discussed in the literature. We present a case of squamous cell carcinoma of the heel with popliteal and inguinal metastasis. This is followed by a description of the relevant anatomy of the popliteal fossa and the technique of popliteal lymphadenectomy. PMID:21999203

  7. Popliteal lymph node dissection for metastatic squamous cell carcinoma: a case report of an uncommon procedure for an uncommon presentation

    PubMed Central

    2011-01-01

    Lymph node metastasis from cutaneous squamous cell carcinoma is uncommon. The popliteal fossa is rarely involved with metastasis. Popliteal lymph node dissection is uncommonly performed and not frequently discussed in the literature. We present a case of squamous cell carcinoma of the heel with popliteal and inguinal metastasis. This is followed by a description of the relevant anatomy of the popliteal fossa and the technique of popliteal lymphadenectomy. PMID:21999203

  8. Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series.

    PubMed

    Chou, Annie Y; Sedlak, Tara; Aymong, Eve; Sheth, Tej; Starovoytov, Andrew; Humphries, Karin H; Mancini, G B John; Saw, Jacqueline

    2015-08-01

    Spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (TTC) can both cause myocardial infarction with subsequent normalization of wall motion abnormality. Angiograms of patients with TTC at Vancouver General Hospital were reviewed for SCAD. Clinical and investigational characteristics were recorded. Nine women with nonatherosclerotic SCAD were misdiagnosed as having TTC. Their average age was 55 years. Five patients had hypertension and 4 had emotional or physical stress. Fibromuscular dysplasia was present in 4 women. Wall motion abnormalities corresponded to dissected artery location and subsequently resolved. SCAD should be included in the differential diagnosis of patients suspected of having TTC and coronary angiograms scrutinized for subtle SCAD. PMID:26211710

  9. Bilateral middle cerebral artery infarction associated with traumatic common carotid artery dissection: a case report and review of literature.

    PubMed

    Chiba, Fumiko; Makino, Yohsuke; Motomura, Ayumi; Inokuchi, Go; Ishii, Namiko; Torimitsu, Suguru; Sakuma, Ayaka; Nagasawa, Sayaka; Saito, Hisako; Yajima, Daisuke; Hayakawa, Mutsumi; Iwase, Hirotaro

    2014-03-01

    Traumatic common carotid artery dissection is very rare, and although it is associated with mild symptoms, it can sometimes be fatal. Therefore, careful examination of common carotid artery dissection and additional pathological examination as appropriate are important during the autopsy of traumatic death patients. A 60-year-old previously healthy drunken woman was run over. She had remained unconscious shortly after the accident, and 15 h later, emerging bilateral cerebral infarction was confirmed using brain computed tomography. Despite conservative management, she died 4 days after the injury due to multiple chest traumas and broad cerebral infarction. A medico-legal autopsy was conducted. According to the autopsy results, microscopically identified common carotid artery dissections with thrombus formation were considered the cause of infarction. In the present case, macroscopic common carotid artery lesions were relatively mild, and this made diagnosis difficult. However, the correct diagnosis was achieved by a combined analysis of the antemortem images and autopsy results. Thus, in such cases, a combined comprehensive analysis of autopsy results and antemortem clinical images is important to determine the exact cause of death. PMID:24480785

  10. Celiac trunk and branches dissection due to energy drink consumption and heavy resistance exercise: case report and review of literature.

    PubMed

    González, Wilma; Altieri, Pablo I; Alvarado, Enrique; Banchs, Héctor L; Colón, Edgar; Escobales, Nelson; Crespo, María

    2015-01-01

    Higher doses and consumption of energy drinks leads to cardiovascular effects and potential consequences. Principal components found in energy drinks such as caffeine, guarana and taurine has been related to dilatation, aneurysm formation, dissection and ruptures. There is no evidence showing an integration of these components and its effects in endothelium and aortic walls due to higher levels of pressure during exercises. We report a case of a 44 years male with celiac trunk and branches dissection due to long-term consumption of energy drinks and intense exercise routine. Our proposition relates cell and vessel walls alterations including elasticity in endothelial wall due to higher blood pressure, resistance by intense exercise routine and long-term consumption of energy drinks. PMID:26035983

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

    PubMed

    D'Aloia, Antonio; Faggiano, Pompilio; Brentana, Loretta; Dei Cas, Livio

    2006-03-01

    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. PMID:16645389

  12. Prevalence of Post-tonsillectomy Bleeding as Day-case Surgery with Combination Method; Cold Dissection Tonsillectomy and Bipolar Diathermy Hemostasis

    PubMed Central

    Faramarzi, Abolahassan; Heydari, Seyed Taghi

    2010-01-01

    Objective Post-tonsillectomy hemorrhage remains an important factor in determining the safety of performing tonsillectomy as a day case procedure. The aim of this study was to determine the safety of day case tonsillectomy by using combination method, cold dissection tonsillectomy and bipolar diathermy hemostasis. Methods A prospective randomized clinical study conducted on the patients who had undergone day case tonsillectomy (DCT). There were two groups (DCT and control group) each group consisting of 150 cases. Tonsillectomy was performed by using combination method; cold dissection and hemostasis was achieved by ligation of vessels with bipolar electerocautery. Findings We found 3 cases of post-tonsillectomy bleeding in DCT group and 4 cases in the control group. There was no statistically significant difference in the rate of post-operative hemorrhage between the two groups. Conclusion The findings suggest the safety of the combination of cold dissection tonsillectomy and bipolar diathermy hemostasis as day case tonsillectomy. PMID:23056702

  13. A case of dissecting cellulitis and a review of the literature.

    PubMed

    Scheinfeld, Noah S

    2003-02-01

    Dissecting cellulitis (also called perifolliculitis capitis abscedens et suffodiens) manifests with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. It predominantly occurs in African American men between 20-40 years of age, but can occasionally affect other races and women too. Associated musculoskeletal findings are sometimes reported. When it occurs with acne conglobata, hidradenitis suppurativa, and pilonidal cysts, the syndrome is referred to as the follicular occlusion triad or tetrad. Its course is chronic and relapsing, and treatment is often difficult. Medical therapies include isotretinoin, antibiotics, and prednisone. Destructive therapies include X-ray therapy, surgical excision, and skin grafting. Laser epilation of hair follicles is a promising new therapy for dissecting cellulitis. PMID:12639466

  14. [Locally recurrent case of gastric cancer with serosal invasion after four months of endoscopic submucosal dissection].

    PubMed

    Takii, Mamiko; Tanaka, Hiroaki; Kuroda, Kenji; Asano, Yuka; Sakurai, Katsunobu; Muguruma, Kazuya; Kubo, Naoshi; Nagahara, Hisashi; Kimura, Kenjiro; Amano, Ryosuke; Noda, Eiji; Yamada, Nobuya; Maeda, Kiyoshi; Ohira, Masaichi; Hirakawa, Kosei

    2012-11-01

    A 52-year-old woman underwent endoscopic submucosal dissection (ESD) for early gastric cancer at the lesser curvature. Microscopic examination revealed tub1, pSM1, ly0, v0, pHM0, and pVM0, which were considered to be relative resection. Four months later, upper gastrointestinal endoscopy showed local recurrence with suspected SM massive tumor infiltration. We performed a laparoscopic distal gastrectomy with lymph node dissection. Postoperative pathology showed tub2, pT4a (SE), pN2, ly0, v0, and fStage IIIb. This indicated that a few remnant cancer cells were stimulated by the local inflammation associated with ESD. ESD is less invasive than open surgery, but strict observation following curative resection is essential to rule out inflammation-mediated recurrence. PMID:23268071

  15. [Acute type A aortic dissection with Birt-Hogg-Dubé syndrome; report of a case].

    PubMed

    Sakaguchi, Masayuki; Gotou, Hirohisa; Nakahara, Takashi; Fuke, Megumi; Nishimura, Kazunori; Kuraishi, Hiroshi; Furuya, Mitsuko

    2014-05-01

    We describe a 76-year-old woman with cardiac tamponade who was admitted to our hospital. She underwent ascending and partial arch aortic replacement to treat acute type A aortic dissection. However, postoperative respiratory failure developed and a chest X-ray revealed right lung pneumothorax. The lung was finally expanded after difficulties with prolonged tube drainage. Chest computed tomography(CT) showed multiple cystic changes in the bilateral lungs. Her sister and her daughter also had a history of spontaneous pneumothorax. We finally diagnosed Birt-Hogg-Dube syndrome after deoxyribonucleic asid(DNA)sequencing of folliculin( FLCN) gene. PMID:24917291

  16. [Carotid artery dissection with Horner syndrome as main manifestation: a case report].

    PubMed

    Fang, Xing; Xu, Zi-qi; Luo, Ben-yan; Yuan, Huai-wu; Zhu, Xiong-chao; Yuan, Yuan

    2015-03-01

    A 44-year old male patient was admitted to the First Affiliated Hospital, Zhejiang University School of Medicine with left ptosis and pain on the left head and neck for 20 days.Brain MRI showed subacute cerebral infarction on left parietal lobe and intramural hematoma on left internal carotid artery. CT angiography showed stenosis line on the C1 segment of left internal carotid artery. Digital subtraction angiography showed dissection on the C1 segment of left internal carotid artery.The condition of patients was improved after anticoagulant therapy. PMID:26038145

  17. Epstein-Barr virus-associated lymphoepithelioma-like early gastric carcinomas and endoscopic submucosal dissection: case series.

    PubMed

    Lee, Ji Young; Kim, Kyoung-Mee; Min, Byung-Hoon; Lee, Jun Haeng; Rhee, Poong-Lyul; Kim, Jae Jun

    2014-02-01

    Epstein-Barr virus (EBV)-associated lymphoepithelioma-like gastric carcinoma (LELC) is characterized by a lower lymph node (LN) metastasis rate and a higher survival rate than other forms of gastric cancer. Although current prognosis for LELC is favorable, the most common approach is radical gastrectomy involving an extensive D2 lymph node dissection. Here, we report four cases of EBV-associated early LELC that were treated by an alternative approach, endoscopic submucosal dissection (ESD). The long-term outcome of this procedure is discussed. All patients were treated by ESD en bloc, and all ESD specimens showed tumor-free lateral resection margins. None of the lesions showed lymphovascular invasion. A pathological examination of ESD specimens revealed submucosal invasion of more than 500 μm in all four cases. One patient underwent additional radical surgery post-ESD; no residual tumor or LN metastasis was noted in the surgical specimen. The other three patients did not undergo additional surgery, either because of severe comorbidity or their refusal to undergo operation, but were subjected to medical follow-up. None of the ESD-treated patients reported local recurrence or distant metastases during the 27-32 mo of follow-up after ESD. PMID:24574813

  18. Aortic dissection

    MedlinePlus

    ... to the back Can move to the shoulder, neck, arm, jaw, abdomen, or hips Changes position, often moving to the arms and legs as the aortic dissection gets worse Symptoms are caused by a decrease ...

  19. [Efficacy of Stent-Assisted Coil Embolization for a Dissecting Aneurysm of the Cervical Internal Carotid Artery Caused by a Systemic Vascular Disease: A Case Report].

    PubMed

    Takamiya, Soichiro; Osanai, Toshiya; Ushikoshi, Satoshi; Kurisu, Kota; Shimoda, Yusuke; Ito, Yasuhiro; Ishi, Yukitomo; Hokari, Masaaki; Nakayama, Naoki; Kazumata, Ken; Abumiya, Takeo; Shichinohe, Hideo; Houkin, Kiyohiro

    2016-01-01

    Systemic vascular diseases such as fibromuscular dysplasia, Ehlers-Danlos syndrome, Marfan syndrome, and Behçet's disease are known to cause spontaneous dissecting aneurysms of the cervical internal carotid artery. These diseases are generally associated with vascular fragility; therefore, invasive treatments are avoided in many cases of dissecting aneurysms, and a conservative approach is used for the primary disease. Surgical or intravascular treatment may be chosen when aneurysms are progressive or are associated with a high risk of hemorrhage; however, there is no consensus on which treatment is better. We report a case of a dissecting aneurysm of the cervical internal carotid artery in a patient with suspected Behçet's disease, which was treated using stent-assisted coil embolization. A man in his 40's, with suspected Behçet's disease, presented with an enlarged dissecting aneurysm of the right cervical internal carotid artery. The lesion was present for approximately 10 years. We performed stent-assisted coil embolization for the lesion. Post-surgery, no aneurysms were detected with carotid artery echography. Our case report suggests that stent-assisted coil embolization is a promising treatment for dissecting aneurysms of the cervical internal carotid artery. In addition, the procedure demonstrates the utility of carotid artery echograms for examining recanalization after stent-assisted coil embolization. PMID:26771095

  20. Locked in and out: a case of emerging basilar artery obstruction secondary to vertebral artery dissection thrombolysed with intravenous rt-PA

    PubMed Central

    Al-Raweshidy, Y H; Sinha, D M; Coward, L J; Guyler, P C; O’Brien, A

    2011-01-01

    The authors present a case in which intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) potentially saved a young man from locked-in syndrome or life threatening consequences. The patient presented with acute stroke secondary to vertebral artery dissection and was treated with intravenous rt-PA. There were no post thrombolysis complications and the patient left hospital with mild neurological symptoms. Our report suggests that in cases of acute posterior circulation stroke due to arterial dissection, treatment with intravenous thrombolysis is safe, practicable and effective. PMID:22696744

  1. Aortic dissection in women during the course of pregnancy or puerperium: a report of 11 cases in central south China

    PubMed Central

    Yang, Guifang; Peng, Wen; Zhao, Qin; Peng, Jing; Xiang, Xudong; Chai, Xiangping

    2015-01-01

    We have characterized 11 women diagnosed with aortic dissection during the course pregnancy or puerperium by analysis of 1,271 patients enrolled at the Second Xiangya Hospital in central south university of China from 2010 to 2013. The age of these patients ranged from 22 to 39 years old (30.6 ± 5.6 years old). Among which, 5 cases were noted secondary to Marfan syndrome. Three patients were diagnosed at the late stage of pregnancy, 6 cases were in the postpartum stage, and 2 cases occurred in the early stage of pregnancy. Six patients were Stanford A-type, 4 patients were Stanford B-type, and the rest one was diagnosed as aorta aneurysm. The major symptom for 9 patients was manifested by chest/back pain, 1 patient was characterized by chest pain along with dyspnea, while the other one was featured by dyspnea only. Five out of 6 A-type patients were undergone surgical treatment, and 3 patients were survived, while the rest 1 patient refused surgical treatment and died soon in a local hospital. All 4 B-type patients were survived after surgical therapy, and the patient with aorta aneurysm was also survived after surgical treatment. Together, our data suggest that pregnancy associated aortic dissection is more common in late pregnancy or puerperium, and Marfan’s syndrome is likely the highest risk factor to this special group of patients. A quick and accurate diagnosis along with appropriate surgical treatments would be necessary to save the lives for both mother and baby. PMID:26379991

  2. Case Report of an Endovascular Repair of a Residual Type A Dissection Using a Not CE Not FDA-Approved Najuta Thoracic Stent Graft System

    PubMed Central

    Mangialardi, N.; Ronchey, S.; Malaj, A.; Lachat, M.; Serrao, E.; Alberti, V.; Fazzini, S.

    2015-01-01

    Abstract This report describes an endovascular repair of a residual type A dissection using a medical device that is not marked by european conformity (CE) or Food and Drug Administration (FDA). The patient underwent ascending aortic surgery for acute type A dissection. The 2-year angio–computed tomography demonstrated patency of the residual false lumen with evolution into a 6 cm aneurysm, the extension of the dissection from the aortic arch to the aortic bifurcation with thrombosis of the right common iliac artery. There was no CE- or FDA-marked medical device indicated for this case or any other acceptable therapeutic alternative. We used the Najuta thoracic stent graft and successfully handled the pathology in a multiple-phase treatment. Technology is evolving with specific grafts for the ascending and fenestrated grafts for the aortic arch. In this single case the Najuta endograft, in spite of the periprocedural problems, was a valid therapeutic option. PMID:25621698

  3. An extensive DeBakey type IIIb aortic dissection with massive right pleural effusion presenting as abdominal pain and acute anemia: particular case report

    PubMed Central

    Yu, Hui-Chun; Wang, Zhen-Qing; Hao, Yuan-Yuan; An, Feng-Ping; Hu, Yu-Chuan; Deng, Rui-Bing; Yu, Peng; Cui, Guang-Bin; Li, He

    2015-01-01

    We describe the case of a 79-year-old male presented with sudden onset of abdominal pain and mild breathlessness, and complicated acute progressive anemia with haemoglobin which declined from 120 g/L to 70 g/L within five days. An urgent computed tomography angiography showed acute thoracic aortic dissection, DeBakey type IIIb, a dissecting aneurysm in the proximal descending thoracic aorta starting immediately after the origin of the left subclavian artery and extending distally below the renal arteries with evidence of rupture into the right pleural cavity for massive pleural effusion. Plasma D-dimer, brain natriuretic peptide and C reactive protein level were elevated. Our case showed that D-dimer can be used as a ‘rule-out’ test in patients with suspected aortic dissection. A raised BNP may exert a protective role through anti-inflammatory endothelial actions in the systemic circulation. PMID:26089858

  4. An extensive DeBakey type IIIb aortic dissection with massive right pleural effusion presenting as abdominal pain and acute anemia: particular case report.

    PubMed

    Yu, Hui-Chun; Wang, Zhen-Qing; Hao, Yuan-Yuan; An, Feng-Ping; Hu, Yu-Chuan; Deng, Rui-Bing; Yu, Peng; Cui, Guang-Bin; Li, He

    2015-05-01

    We describe the case of a 79-year-old male presented with sudden onset of abdominal pain and mild breathlessness, and complicated acute progressive anemia with haemoglobin which declined from 120 g/L to 70 g/L within five days. An urgent computed tomography angiography showed acute thoracic aortic dissection, DeBakey type IIIb, a dissecting aneurysm in the proximal descending thoracic aorta starting immediately after the origin of the left subclavian artery and extending distally below the renal arteries with evidence of rupture into the right pleural cavity for massive pleural effusion. Plasma D-dimer, brain natriuretic peptide and C reactive protein level were elevated. Our case showed that D-dimer can be used as a 'rule-out' test in patients with suspected aortic dissection. A raised BNP may exert a protective role through anti-inflammatory endothelial actions in the systemic circulation. PMID:26089858

  5. Internal carotid artery dissection after anterior cervical disc replacement: first case report and literature review of vascular complications of the approach.

    PubMed

    Loret, Jean-Edouard; Francois, Patrick; Papagiannaki, Chrysanthi; Cottier, Jean-Philippe; Terrier, Louis-Marie; Zemmoura, Ilyess

    2013-07-01

    We report the case of a 41-year-old woman who underwent cervical total disc replacement at C4C5 and C5C6 levels and fusion at C6C7 level through an anterior right-side approach. After anesthesia recovery, the patient presented left hemiparesia and facial palsy due to large right hemispheric stroke. Diffusion-weighted magnetic resonance imaging was performed as soon as the patient developed neurologic symptoms of stroke and revealed a right internal carotid artery dissection. Digital substraction angiography, endovascular stenting, angioplasty and thrombectomy were performed. Six months after treatment, clinical examination showed mild left-arm spasticity. To the best of our knowledge, only two cases of internal carotid artery stroke without dissection or thrombosis are reported. In conclusion, although vascular complications are rare after anterior cervical spine procedure, internal carotid artery dissection can occur. Suspected risk factors are prolonged retraction of the carotid artery and neck extension. PMID:23728441

  6. Treatment of internal carotid artery dissection with Willis covered stent: A case report of recurrent limb weakness and no response to medical therapy

    PubMed Central

    CAI, XUELI; GUAN, JIANHONG; REN, SHAOJUN; WEI, YIXIN; PENG, XIAO; QIU, WEIWEN; CHEN, JUN

    2016-01-01

    Internal carotid artery dissection (ICAD) is a major cause of ischemic stroke in young and middle-aged patients. Patients may be asymptomatic or present with symptoms ranging from headache and neck pain to severe cerebral ischemic events. Conventional treatment is medical anticlotting therapy or involves the use of interventional tools, such as endovascular treatment. Anticoagulation or antiplatelet therapy are the primary treatment modalities used to prevent thromboembolic complications from arterial dissections, however, they are unsuitable in certain cases of dissecting aneurysms. In the current study reports the case of a 52-year-old male patient presenting with the primary complaint of left limb weakness. Computed tomography angiography revealed a right ICAD located in the oropharyngeal segment. Subsequently, digital subtraction angiography was performed to assess the oropharyngeal segment. Antithrombotic therapy resulted in no improvement; therefore, endovascular treatment with the insertion of a Willis covered stent was performed, resulting in an improved outcome. PMID:27168838

  7. Malignant hypertension and acute aortic dissection associated with caffeine-based ephedra-free dietary supplements: a case report.

    PubMed

    Ahmed, Imdad

    2009-01-01

    The use of weight loss dietary supplements is prevalent in the United States, and over the past decade, there has been tremendous growth of the use of these products. It is well documented that ephedra-based products are associated with various cardiovascular adverse effects. With new restrictions placed on such products, companies are now manufacturing caffeine-based ephedra-free herbal supplements. We present the case of 36-year old, previously healthy female who developed malignant hypertension and aortic dissection while taking various caffeine-based dietary supplements. Given the lack of research studies in regards to their safety and efficacy, judicious care should be taken with the use of dietary supplements, including those designated as ephedra-free. PMID:20181166

  8. A Case of an Upper Gastrointestinal Bleeding Due to a Ruptured Dissection of a Right Aortic Arch

    SciTech Connect

    Born, Christine; Forster, Andreas; Rock, Clemens; Pfeifer, Klaus-Juergen; Rieger, Johannes; Reiser, Maximilian

    2003-09-15

    We report a case of severe upper gastrointestinal hemorrhage with a rare underlying cause. The patient was unconscious when he was admitted to the hospital. No chest radiogram was performed. Routine diagnostic measures, including endoscopy, failed to reveal the origin of the bleeding, which was believed to originate from the esophagus secondary to a peptic ulcer or varices. Exploratory laparotomy added no further information, but contrast-enhanced multislice computed tomography (MSCT) of the chest showed dextroposition of the widened aortic arch with a ruptured type-B dissection and a consecutive aorto-esophageal fistula (AEF). The patient died on the day of admission. Noninvasive MSCT angiography gives rapid diagnostic information on patients with occult upper gastrointestinal bleeding and should be considered before more invasive conventional angiography or surgery.

  9. Malignant hypertension and acute aortic dissection associated with caffeine-based ephedra-free dietary supplements: a case report

    PubMed Central

    2009-01-01

    The use of weight loss dietary supplements is prevalent in the United States, and over the past decade, there has been tremendous growth of the use of these products. It is well documented that ephedra-based products are associated with various cardiovascular adverse effects. With new restrictions placed on such products, companies are now manufacturing caffeine-based ephedra-free herbal supplements. We present the case of 36-year old, previously healthy female who developed malignant hypertension and aortic dissection while taking various caffeine-based dietary supplements. Given the lack of research studies in regards to their safety and efficacy, judicious care should be taken with the use of dietary supplements, including those designated as ephedra-free. PMID:20181166

  10. Successful treatment of a case of acute myocardial infarction due to type A aortic dissection by coronary artery stenting: A case report

    PubMed Central

    WANG, ZHENG-GUI; ZHAO, WEI; SHEN, BO-TAO; ZHENG, YANG; LIU, QUAN

    2015-01-01

    Acute type A aortic dissection (AD) has been recognized as a potentially life threatening condition, which sometimes involves the ostium of the coronary artery and may lead to acute myocardial infarction (AMI). In patients with acute type A AD presenting with clinical signs of AMI, it is crucial to establish the diagnosis rapidly in order to proceed with the correct treatment. The present study reports the diagnosis of a rare case of acute type A AD with the typical presentation of acute inferior MI and cardiogenic shock, which was accidentally diagnosed during catheterization and treated by right coronary ostial occlusion stenting, allowing for further surgical interventions. PMID:26622389

  11. The role of base-level change in the dissection of alluvial fans: case studies from southeast Spain and Nevada

    NASA Astrophysics Data System (ADS)

    Harvey, A. M.

    2002-06-01

    Tectonics, climate and base level are the underlying controls of alluvial fan development. On many fans base level is stable, but where base-level change occurs it may itself be a response to tectonics or climatic change. Tectonically induced base-level change will be temporally independent of climatic change, and will show spatial variability depending on the rate of propagation of tectonically induced regional dissection. This is illustrated by the Tabernas fans, southeast Spain. The timing of climatically induced base-level change follows the timing of climatic change itself, and will show more consistency of spatial relationships within groups of fans affected. Alluvial fans which toe out in coastal zones or at lake shorelines may be influenced by climatically controlled base-level changes. Conventionally, a fall in base level would be expected to cause dissection of the distal fan zone. However, the reverse may occur, with fan progradation taking place in response to a base-level fall, and dissection occurring in response to a base-level rise. Two contrasted case studies are considered, based in part on previously published work, from dry-region alluvial fan zones, the coastal Cabo de Gata fans in southeast Spain and the Stillwater and Cold Springs fans in Nevada, USA. In these areas, base-level changes occurred in response to late Quaternary eustatic changes of sea level, and changes in the levels of pluvial lakes, respectively. Within both areas there are fans not affected by base-level change (Cabo de Gata, west-coast and inland fans; Cold Springs fans), and others where base-level change has been important in fan evolution (Cabo de Gata, east-coast fans; Stillwater fans). The differences in geomorphic regime between those fans influenced by base-level changes and those not are expressed in morphometric contrasts and different fan profile and plan characteristics. Within those fans influenced by base-level changes, the different mechanisms have influenced the location and elevation of the zone of incision. The differences can be attributed in part to the temporal interactions of base-level change with climatically induced changes in sediment supply, and in part to differences in gradients of the foreshore exposed by the falling sea or lake base levels.

  12. Polyomino Dissections

    ERIC Educational Resources Information Center

    Hohn, Tiina; Liu, Andy

    2012-01-01

    One of Gardner's passions was to introduce puzzles into the classroom. From this point of view, polyomino dissections are an excellent topic. They require little background, provide training in geometric visualization, and mostly they are fun. In this article, we put together a large collection of such puzzles, introduce a new approach in solving…

  13. Polyomino Dissections

    ERIC Educational Resources Information Center

    Hohn, Tiina; Liu, Andy

    2012-01-01

    One of Gardner's passions was to introduce puzzles into the classroom. From this point of view, polyomino dissections are an excellent topic. They require little background, provide training in geometric visualization, and mostly they are fun. In this article, we put together a large collection of such puzzles, introduce a new approach in solving

  14. Abnormal bisubclavian trunk arising from the aortic arch determined by cadaver dissection of a native dog: A case report.

    PubMed

    Kamali, Younes; Tadjalli, Mina

    2015-01-01

    Congenital anomalies of the great thoracic vessels have been reported in 20% of dogs and cats. In some cases, the vascular ring anomalies remain unrecognized throughout the lifetime of an animal. This report describes a case with an unusual vascular ring anomaly (VRA) that was detected during dissection on a cadaver of an approximately two-year-old male native mixed breed dog. No history of the animal's life was available. But, good physical condition and age of the animal based on dentition indicated the anomaly was perhaps asymptomatic. Two main branches of the aorta were identified with the initial branch being a bicarotid trunk followed by a bisubclavian trunk. The left subclavian and aberrant right subclavian arteries formed a very short trunk and arose directly from the aortic arch. No dilatation cranial to the esophageal sulcus was found. To the authors' knowledge, our case is the first report of such anomalies perhaps without any clinical signs in a native dog in Iran. PMID:26893819

  15. Abnormal bisubclavian trunk arising from the aortic arch determined by cadaver dissection of a native dog: A case report

    PubMed Central

    Kamali, Younes; Tadjalli, Mina

    2015-01-01

    Congenital anomalies of the great thoracic vessels have been reported in 20% of dogs and cats. In some cases, the vascular ring anomalies remain unrecognized throughout the lifetime of an animal. This report describes a case with an unusual vascular ring anomaly (VRA) that was detected during dissection on a cadaver of an approximately two-year-old male native mixed breed dog. No history of the animal’s life was available. But, good physical condition and age of the animal based on dentition indicated the anomaly was perhaps asymptomatic. Two main branches of the aorta were identified with the initial branch being a bicarotid trunk followed by a bisubclavian trunk. The left subclavian and aberrant right subclavian arteries formed a very short trunk and arose directly from the aortic arch. No dilatation cranial to the esophageal sulcus was found. To the authors' knowledge, our case is the first report of such anomalies perhaps without any clinical signs in a native dog in Iran. PMID:26893819

  16. Neck dissection - discharge

    MedlinePlus

    Radical neck dissection - discharge; Modified radical neck dissection - discharge; Selective neck dissection - discharge ... Neck dissection is surgery to remove the lymph nodes in your neck. Cells from cancers in the mouth ...

  17. Intramural hematoma or aortic dissection - a diagnostic and therapeutic problem. A case report.

    PubMed

    Suder, Bogdan; Wasilewski, Grzegorz; Bartuś, Krzysztof; Sadowski, Jerzy; Kapelak, Bogusław

    2015-09-01

    The authors present a case report of a 60-year-old patient with an ascending aortic aneurysm along with the associated diagnostic and therapeutic problems. The choice of therapy in patients with aortic intramural hematoma is difficult and should be based on comprehensive evaluation of the patient's status as well as on the experience of the radiologist and surgeon. PMID:26702280

  18. Intramural hematoma or aortic dissection – a diagnostic and therapeutic problem. A case report

    PubMed Central

    Suder, Bogdan; Wasilewski, Grzegorz; Sadowski, Jerzy; Kapelak, Bogusław

    2015-01-01

    The authors present a case report of a 60-year-old patient with an ascending aortic aneurysm along with the associated diagnostic and therapeutic problems. The choice of therapy in patients with aortic intramural hematoma is difficult and should be based on comprehensive evaluation of the patient's status as well as on the experience of the radiologist and surgeon. PMID:26702280

  19. Association between Diabetes and Risk of Aortic Dissection: A Case-Control Study in a Chinese Population

    PubMed Central

    He, Xingwei; Liu, Xintian; Liu, Wanjun; Wang, Bei; Liu, Yujian; Li, Zhuxi; Wang, Tao; Tan, Rong; Gao, Bo; Zeng, Hesong

    2015-01-01

    Background It is well-recognized that diabetes represents a powerful independent risk factor for cardiovascular diseases. However, very few studies have investigated the relationship between diabetes and risk of aortic dissection (AD). Aim The aim of this case-control study was to evaluate the association between diabetes and risk of AD in Chinese population. Methods A hospital-based case-control study, consisting of 2160 AD patients and 4320 controls, was conducted in a Chinese population. Demographic, clinical characteristics and risk factors were collected. Diabetes rate of patients with overall AD, Stanford type A AD and type B AD group was compared with that of corresponding matched control groups. Logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for relationship between diabetes and AD risk. Results The prevalence of diabetes was lower in AD cases than that of control subjects, whether it is the overall AD, type A AD or type B AD group (4.7% vs. 10.0%, 2.9% vs. 8.8%, 5.9% vs. 10.9%, all P<0.001). Furthermore, in multivariate model, diabetes was found to be associated with lower AD risk, which not only applies to the overall AD (OR = 0.2, 95%CI: 0.15–0.26), but also type A AD (OR = 0.12, 95% CI: 0.07–0.20) and type B AD (OR = 0.25, 95%CI: 0.18–0.33). Conclusions We observed the paradoxical inverse relationship between DM and risk of AD in the Chinese population. These results suggest diabetes may play a protective role in the development of AD. However, further studies are needed to enrich related evidence, especially with regard to underlying mechanisms for these trends. PMID:26562793

  20. Horner syndrome secondary to internal carotid artery dissection after a short-distance endurance run: A case study and review

    PubMed Central

    Borgman, Christopher J.

    2012-01-01

    Oculosympathetic paresis, historically known as Horner sydrome, classically results in a triad of ptosis, miosis, and anhydrosis on the affected side. Any interruption or insult to any part of the sympathetic pathway to the eye can result in these classic findings. There are many possible etiologies along the three-neuron pathway, however, a few potentially life threatening causes must always be ruled out, especially in acute presentations. One life threatening etiology, in particular, to rule out is of internal carotid artery dissection (ICAD). A 38-year-old white female was referred to our clinic for a second opinion by her primary care physician for a sudden onset headache, ptosis, and miosis of the left side following a short endurance race 24–48 h prior. Entering visual acuities were 20/20 in the right eye (OD) and 20/20 in the left eye (OS). Emergent magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed a severe left ICAD. The patient was started on oral anticoagulants and oral steroids. Spontaneous resolution occurred three months later upon confirmation with repeat MRI/MRA. This case report reviews the clinical findings, diagnoses, treatment, and management of patients with Horner syndromes secondary to ICAD.

  1. Three cases of Spontaneous Vertebral Artery Dissection (SVAD), resulting in two cases of Wallenberg syndrome and one case of Foville syndrome in young, healthy men

    PubMed Central

    Canepa Raggio, Carlo; Dasgupta, Aban

    2014-01-01

    First patient, presented with sudden onset of headache, left hypoacusia and right hemiparesis, posteriorly developing gaze-evoked nystagmus and worsening right-sided weakness. Diagnosis of vertebral artery dissection and Foville Syndrome were made through clinical assessment and CT-carotid angiogram–MR angiography. Second patient, presented with four episodes of pain over left side of the nose and left eye pain over 1 month; admitted for acute facial pain without limb weakness. During admission, tingling over V1/V2 facial territory, vertigo, hypotension, uvula deviation and right lower limb numbness. CT-carotid angiogram confirmed vertebral artery with dissection. MRI revealed left lateral medullary infarct. Third patient, presented with sudden onset of left facial numbness and right upper limb weakness; 1 day after, right arm and leg hypoesthesia with hoarseness. MRA revealed dissection of left distal vertebral artery and MRI showed infarction in lower medulla oblongata. PMID:24777086

  2. Cotyledonoid dissecting leiomyoma of the uterus: A report of four cases and a review of the literature

    PubMed Central

    XU, TIANMIN; WU, SHUYING; YANG, RULIN; ZHAO, LIPING; SUI, MINGXING; CUI, MANHUA; CHANG, WEIQIN

    2016-01-01

    Cotyledonoid dissecting leiomyoma (CDL), also termed Sternberg tumor, is a variant of uterine leiomyoma that is rarely diagnosed by clinical evaluation. At present, ~43 cases of CDL have been reported in the literature written in the English language. Due to the distinctive grapelike gross appearance of an exophytic mass resembles placental tissue, CDL is often misdiagnosed clinically as an ovarian tumor or uterine sarcoma. Therefore, an awareness of the features of the disease is important to prevent misdiagnosis and overtreatment. The present study reports 4 cases of CDL of the uterus that were treated at the Second Hospital of Jilin University between January 2009 and December 2011. All 4 patients in the current study presented with a palpable asymptomatic pelvic mass, which was detected during physical examinations, and cancer antigen 125 tumor marker levels that were within the normal range. The exploratory laparotomy of the 4 patients revealed lobulated tumors with a grapelike appearance extending from the lateral uterine wall into the ligament or the adjacent tissues. The frozen section and postoperative pathology were diagnosed as CDL. A total abdominal hysterectomy was performed in the first case of a 55-year-old woman that had been in menopause for 7 years. The patient was well and showed no evidence of disease subsequent to 48 months of follow-up. A total abdominal hysterectomy and right salpingo-oophorectomy were performed in the second case of a 43-year-old woman, who was well and showed no evidence of disease subsequent to 26 months of follow-up. A subtotal abdominal hysterectomy and bilateral salpingectomy were performed in the third case of a 37-year-old woman, who was well and showed no evidence of disease subsequent to 27 months of follow-up. A total abdominal hysterectomy and right-salpingectomy were performed with the removal of a retroperitoneal fibroid extension in the fourth case of a 48-year-old woman, who was well and showed no evidence of disease subsequent to 32 months of follow-up. PMID:27073566

  3. Spinal epidural abscess following glossectomy and neck dissection: A case report

    PubMed Central

    Cheng, Esther; Thorpe, Eric; Borrowdale, Richard

    2016-01-01

    Introduction Spinal epidural abscess is an uncommon but potentially life threatening entity that rarely occurs after otolaryngology procedures. Presentation of case We report a case of a diabetic patient who presented with a lumbar spinal epidural abscess eight days after head and neck oncologic surgery. Magnetic resonance imaging revealed an L4 spinal epidural abscess. Cultures from the spinal epidural abscess, blood, urine, and the previous neck incision grew Klebsiella pneumoniae. The patient recovered neurologic function after surgical decompression and drainage, long-term intravenous antibiotics, and physical therapy. Discussion The development of postoperative spinal epidural abscess is rare after otolaryngology procedures but has been reported in the cervical epidural space. To our knowledge, lumbar spinal epidural abscess has not yet been reported after head and neck oncologic surgery. Even more unique is the presence of the pathogen K. pneumoniae. Conclusion A high index of suspicion of this potential outcome is paramount as early recognition and intervention are keys to recovery of neurologic function. PMID:26799413

  4. Dissecting the determinants of depressive disorders outcome: an in depth analysis of two clinical cases

    PubMed Central

    Serretti, Alessandro; Calati, Raffaella; Oasi, Osmano; De Ronchi, Diana; Colombo, Cristina

    2007-01-01

    Clinicians face everyday the complexity of depression. Available pharmacotherapies and psychotherapies improve patients suffering in a large part of subjects, however up to half of patients do not respond to treatment. Clinicians may forecast to a good extent if a given patient will respond or not, based on a number of data and sensations that emerge from face to face assessment. Conversely, clinical predictors of non response emerging from literature are largely unsatisfactory. Here we try to fill this gap, suggesting a comprehensive assessment of patients that may overcome the limitation of standardized assessments and detecting the factors that plausibly contribute to so marked differences in depressive disorders outcome. For this aim we present and discuss two clinical cases. Mr. A was an industrial manager who came to psychiatric evaluation with a severe depressive episode. His employment was demanding and the depressive episode undermined his capacity to manage it. Based on standardized assessment, Mr. A condition appeared severe and potentially dramatic. Mrs. B was a housewife who came to psychiatric evaluation with a moderate depressive episode. Literature predictors would suggest Mrs. B state as associated with a more favourable outcome. However the clinician impression was not converging with the standardized assessment and in fact the outcome will reverse the prediction based on the initial formal standard evaluation. Although the present report is based on two clinical cases and no generalizability is possible, a more detailed analysis of personality, temperament, defense mechanisms, self esteem, intelligence and social adjustment may allow to formalize the clinical impressions used by clinicians for biologic and pharmacologic studies. PMID:17286859

  5. Getting ocean acidification on decision makers' to-do lists: dissecting the process through case studies

    USGS Publications Warehouse

    Cooley, Sarah R.; Jewett, Elizabeth B.; Reichert, Julie; Robbins, Lisa L.; Shrestha, Gyami; Wieczorek, Dan; Weisberg, Stephen B.

    2015-01-01

    Much of the detailed, incremental knowledge being generated by current scientific research on ocean acidification (OA) does not directly address the needs of decision makers, who are asking broad questions such as: Where will OA harm marine resources next? When will this happen? Who will be affected? And how much will it cost? In this review, we use a series of mainly US-based case studies to explore the needs of local to international-scale groups that are making decisions to address OA concerns. Decisions concerning OA have been made most naturally and easily when information needs were clearly defined and closely aligned with science outputs and initiatives. For decisions requiring more complex information, the process slows dramatically. Decision making about OA is greatly aided (1) when a mixture of specialists participates, including scientists, resource users and managers, and policy and law makers; (2) when goals can be clearly agreed upon at the beginning of the process; (3) when mixed groups of specialists plan and create translational documents explaining the likely outcomes of policy decisions on ecosystems and natural resources; (4) when regional work on OA fits into an existing set of priorities concerning climate or water quality; and (5) when decision making can be reviewed and enhanced.

  6. Giant pseudoaneurysm originated from distal middle cerebral artery dissection treated by trapping under sensitive evoked potential and motor evoked potential monitoring: Case report and discussion

    PubMed Central

    Gripp, Daniel Andrade; Nakasone, Fábio Jundy; Maldaun, Marcos Vinícius Calfat; de Aguiar, Paulo Henrique Pires; Mathias, Luis Roberto

    2016-01-01

    Background: Dissecting giant pseudoaneurysm of the middle cerebral artery (MCA) is a rare lesion often presenting challenges to neurosurgical teams dealing with this specific pathology. Giant pseudoaneurysm originating from a dissecting distal segment of the MCA treated with aneurysm trapping under motor and sensitive evoked potential monitoring with a successful outcome is presented in the article followed by a brief discussion on the subject. Case Description: A case of a previously healthy young female patient admitted at the emergency room of Santa Paula Hospital with a history of a sudden headache and syncope, dysphasia, and Grade 4 right hemiparesis due to a large brain hemorrhage secondary to a 25 mm ruptured pseudoaneurysm originated from a distal left MCA dissecting segment is described. Because the patient risked neurological worsening, aneurysm was treated with parent and efferent vessel trapping technique and no changes on the sensitive and motor evoked potential (MEP) from baseline informed on this decision. Hemorrhage was completely drained after aneurysm was secured. Conclusion: Neurophysiological sensitive and MEP monitoring, on this specific case was a valuable tool and informed on the decision of trapping of this large vascular lesion. PMID:27127710

  7. Carotid artery dissection following adenoidectomy.

    PubMed

    Garg, Arun; Singh, Yeeshu; Singh, Pankaj; Goel, Gaurav; Bhuyan, Susant

    2016-03-01

    Carotid dissection and cerebral infarction are extremely rare complications of adenoidectomy. We describe the case of seven year old girl, who suffered from left internal carotid artery dissection following adenoidectomy, leading to right hemiplegia with global aphasia. A CT angiogram confirmed a loop in contralateral right internal carotid artery. It is presumed that a similar loop also existed in left internal carotid artery, which possibly extended medially close to posterior pharyngeal wall and was injured during the course of surgery. PMID:26857324

  8. Aortic dissection presenting as pleural effusion

    PubMed Central

    Somasamudra, Pramod; Smith, Ed; Tandan, Ronja

    2011-01-01

    Aortic dissection is a life threatening emergency. This case illustrates the unusual way an aortic dissection can present. This patient presented with sharp, left interscapular pain, which subsided after a while and left-sided pleural effusion. Further investigations revealed that this was a case of thoracic aortic dissection with a leak into pleural space. She underwent thoracic endovascular aortic repair with stent graft insertion. PMID:22692486

  9. Aortic dissection associated with penetration of a spinal pedicle screw: a case report and review of the literature.

    PubMed

    Pillai, Saila T; Schoenhagen, Paul; Subrahmanyan, Lakshman; Mukherjee, Sandip K; McNamara, Robert L; Elefteriades, John; Svensson, Lars Georg

    2014-05-01

    A 30-year-old male underwent a corrective posterior instrumented spinal fusion for scoliosis. Six years later, he was found to have an aortic dissection after aortic penetration of a spinal pedicle screw. We review the literature, including diagnostic modalities, and treatment decision-making for this unusual complication. PMID:24707982

  10. 42 CFR 431.214 - Notice in cases of probable fraud.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Notice in cases of probable fraud. 431.214 Section... Hearings for Applicants and Recipients Notice § 431.214 Notice in cases of probable fraud. The agency may... indicating that action should be taken because of probable fraud by the recipient; and (b) The facts...

  11. 42 CFR 431.214 - Notice in cases of probable fraud.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Notice in cases of probable fraud. 431.214 Section... Hearings for Applicants and Beneficiaries Notice § 431.214 Notice in cases of probable fraud. The agency... facts indicating that action should be taken because of probable fraud by the beneficiary; and (b)...

  12. 42 CFR 431.214 - Notice in cases of probable fraud.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Notice in cases of probable fraud. 431.214 Section... Hearings for Applicants and Recipients Notice § 431.214 Notice in cases of probable fraud. The agency may... indicating that action should be taken because of probable fraud by the recipient; and (b) The facts...

  13. 42 CFR 431.214 - Notice in cases of probable fraud.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Notice in cases of probable fraud. 431.214 Section... Hearings for Applicants and Beneficiaries Notice § 431.214 Notice in cases of probable fraud. The agency... facts indicating that action should be taken because of probable fraud by the beneficiary; and (b)...

  14. 42 CFR 431.214 - Notice in cases of probable fraud.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Notice in cases of probable fraud. 431.214 Section... Hearings for Applicants and Beneficiaries Notice § 431.214 Notice in cases of probable fraud. The agency... facts indicating that action should be taken because of probable fraud by the beneficiary; and (b)...

  15. Vascular type Ehlers-Danlos Syndrome with fatal spontaneous rupture of a right common iliac artery dissection: case report and review of literature

    PubMed Central

    Abayazeed, Aly; Hayman, Emily; Moghadamfalahi, Mana; Cain, Darren

    2014-01-01

    Vascular Ehlers-Danlos Syndrome (previously Ehlers-Danlos IV) is a rare autosomal dominant collagen vascular disorder caused by a 2q31 COL3A1 gene mutation encoding pro-alpha1 chain of type III collagen (in contrast to classic Ehlers-Danlos, caused by a COL5A1 mutation). The vascular type accounts for less than 4% of all Ehlers-Danlos cases and usually has a poor prognosis due to life threatening vascular ruptures and difficult, frequently unsuccessful surgical and vascular interventions. In 70% of cases, vascular rupture or dissection, gastrointestinal perforation, or organ rupture is a presenting sign. We present a case of genetically proven vascular Ehlers-Danlos with fatal recurrent retroperitoneal hemorrhages secondary to a ruptured right common iliac artery dissection in a 30-year-old male. This case highlights the need to suspect collagen vascular disorders when a young adult presents with unexplained retroperitoneal hemorrhage, even without family history of such diseases. PMID:24967021

  16. Computed tomography: the investigation of choice for aortic dissection?

    PubMed Central

    Singh, H; Fitzgerald, E; Ruttley, M S

    1986-01-01

    Computed tomography has become established as complementary to aortography in the investigation of patients with suspected aortic dissection. Two cases of dissecting aneurysm are reported in which extensive aortography failed to show evidence of dissection. In both cases dissection was demonstrated by computed tomography. The diagnosis was confirmed in one case at operation and in the other case by follow up. It is suggested that computed tomography is the diagnostic method of first choice in aortic dissection. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:3730218

  17. Dissecting Classroom Ethics.

    ERIC Educational Resources Information Center

    Allchin, Douglas

    1991-01-01

    Described are activities that lead to values clarification. Issues such as dissection, bioengineering, birth control, medical resources, and death are discussed. Included is a student questionnaire on the subject of dissection and the use of animals in laboratories. (KR)

  18. 49 CFR 1105.12 - Sample newspaper notices for abandonment exemption cases.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... OF ENVIRONMENTAL LAWS § 1105.12 Sample newspaper notices for abandonment exemption cases. In every... 20423, a notice of exemption under 49 CFR 1152 Subpart F—Exempt Abandonments permitting the (abandonment... 49 Transportation 8 2013-10-01 2013-10-01 false Sample newspaper notices for abandonment...

  19. 49 CFR 1105.12 - Sample newspaper notices for abandonment exemption cases.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... OF ENVIRONMENTAL LAWS § 1105.12 Sample newspaper notices for abandonment exemption cases. In every... 20423, a notice of exemption under 49 CFR 1152 Subpart F—Exempt Abandonments permitting the (abandonment... 49 Transportation 8 2011-10-01 2011-10-01 false Sample newspaper notices for abandonment...

  20. 49 CFR 1105.12 - Sample newspaper notices for abandonment exemption cases.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... OF ENVIRONMENTAL LAWS § 1105.12 Sample newspaper notices for abandonment exemption cases. In every... 20423, a notice of exemption under 49 CFR 1152 Subpart F—Exempt Abandonments permitting the (abandonment... 49 Transportation 8 2012-10-01 2012-10-01 false Sample newspaper notices for abandonment...

  1. 49 CFR 1105.12 - Sample newspaper notices for abandonment exemption cases.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF ENVIRONMENTAL LAWS § 1105.12 Sample newspaper notices for abandonment exemption cases. In every... 20423, a notice of exemption under 49 CFR 1152 Subpart F—Exempt Abandonments permitting the (abandonment... 49 Transportation 8 2014-10-01 2014-10-01 false Sample newspaper notices for abandonment...

  2. 49 CFR 1105.12 - Sample newspaper notices for abandonment exemption cases.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... OF ENVIRONMENTAL LAWS § 1105.12 Sample newspaper notices for abandonment exemption cases. In every... 20423, a notice of exemption under 49 CFR 1152 Subpart F—Exempt Abandonments permitting the (abandonment... 49 Transportation 8 2010-10-01 2010-10-01 false Sample newspaper notices for abandonment...

  3. Cervicocerebral artery dissections.

    PubMed Central

    Ahmad, H A; Gerraty, R P; Davis, S M; Cameron, P A

    1999-01-01

    OBJECTIVE: To determine the aetiology, frequency, presentation, and outcome of blunt cervicocerebral arterial dissection presentations. PATIENTS AND METHODS: Cases were retrospectively identified through the stroke registers at Royal Melbourne Hospital (a tertiary teaching hospital) and Geelong Hospital (a regional referral centre). Medical notes were then reviewed. RESULTS: A total of 18 cases were identified, with ages ranging from 28 to 53 years. Fifty five per cent of the injuries sustained were to the internal carotid artery and 45% to the vertebral artery. The majority of the injuries were either spontaneous or associated with trivial forces. Other causes included motor vehicle accidents, falls, and cervical manipulations. Fifty five per cent of patients complained of significant neck pain before presentation. Most patients had delayed presentations, with only 39% presenting on the day of the incident. Seventy eight per cent presented with a neurological deficit. Initial computed tomography was normal in 71% of patients. The majority of patients were managed with anticoagulation, and had minimal functional deficit on discharge. Other treatment modalities included surgery (one patient) and thrombolysis (two patients). One patient was managed conservatively. CONCLUSIONS: The incidence of blunt cervicocerebral arterial dissection is unknown; however it is an uncommon diagnosis. The most common presentation is that of a delayed neurological event. Initial brain computed tomography is usually normal. Minimal adverse outcomes at discharge were noted in patients treated with anticoagulation only. PMID:10572814

  4. Anesthetic management of a patient with polycythemia vera undergoing emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting: a case report

    PubMed Central

    Im, Hyeongwoo; Yang, Jaeyoung; Lee, Sangmin Maria; Lee, Jong Hwan

    2015-01-01

    Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopathy, and as a result, the occurrence of thrombotic complications should be avoided after coronary anastomosis. Thus, optimizing the hemostatic balance is an important concern for anesthesiologists. However, only a few cases of anesthetic management in polycythemia vera patients undergoing concomitant aorta and coronary arterial bypass surgery have ever been reported. Here, we experience a polycythemia vera patient who underwent an emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting, and report this case with a review of the relevant literature. PMID:26634086

  5. Anesthetic management of a patient with polycythemia vera undergoing emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting: a case report.

    PubMed

    Im, Hyeongwoo; Min, Jeong Jin; Yang, Jaeyoung; Lee, Sangmin Maria; Lee, Jong Hwan

    2015-12-01

    Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopathy, and as a result, the occurrence of thrombotic complications should be avoided after coronary anastomosis. Thus, optimizing the hemostatic balance is an important concern for anesthesiologists. However, only a few cases of anesthetic management in polycythemia vera patients undergoing concomitant aorta and coronary arterial bypass surgery have ever been reported. Here, we experience a polycythemia vera patient who underwent an emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting, and report this case with a review of the relevant literature. PMID:26634086

  6. Delayed Carotid Dissection Following Lower Lip Revascularization in the Setting of Hyoid Fracture--A Case Report and Review of the Literature.

    PubMed

    Misra, Shantum; Haas, Corbett A; August, Meredith; Eberlin, Kyle R

    2016-01-01

    Traumatic injuries to the lip are common, but injuries that require revascularization of the lower lip are infrequent and pose a major challenge to the reconstructive surgeon. This report describes the case of a 53-year-old woman who sustained a lower lip avulsion injury, a comminuted mandibular parasymphyseal fracture, and a hyoid bone fracture secondary to a bicycle accident. Trauma workup included computed tomographic angiography of the head and neck, which did not show vascular injury. Despite successful revascularization of the lower lip, on postoperative day 11 the patient developed a large internal carotid artery dissection and middle cerebral artery stroke. This case highlights the importance of careful postoperative monitoring after high-energy facial trauma, particularly in the setting of vascular and bony injuries. PMID:26435401

  7. [Pregnancy and coronary artery dissection].

    PubMed

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. PMID:25795261

  8. The Problems of Dissection.

    ERIC Educational Resources Information Center

    Davis, Pat

    1997-01-01

    Describes some problems of classroom dissection including the cruelty that animals destined for the laboratory suffer. Discusses the multilevel approach that the National Anti-Vivisection Society (NAVS) has developed to address the problems of animal dissection such as offering a dissection hotline, exhibiting at science teacher conferences, and…

  9. Neck Dissection Through a Facelift Incision

    PubMed Central

    Melvin, Thuy-Anh N.; Eliades, Steven J.; Ha, Patrick K.; Fakhry, Carole; Saunders, John M.; Califano, Joseph A.; Blanco, Ray G. F.

    2013-01-01

    Obectives/Hypothesis To determine the feasibility and safety of neck dissection through a facelift incision. Study Design Prospective case series. Methods Cadavers and live subjects underwent neck dissection using a facelift incision with and without endoscopic assistance. In the live facelift neck dissection (FLND), the preoperative surgical indications, staging, adjuvant therapy, intraoperative technical procedure, pathology reports on lymph nodes, and short-term outcomes were reviewed. Results FLND was successfully performed in four cadavers and four live subjects, including selective (less than five neck levels removed) and comprehensive (levels I–V removed) neck dissections. All levels were accessible through this approach, with additional retraction required for levels I and IV. Endoscopic assistance was required in one neck dissection for adequate visualization. Short-term complications and number of excised lymph nodes were comparable to those from traditional neck dissection approaches. Conclusions Open neck dissection through a facelift incision is feasible and offers an alternate approach to traditional incisions. This can be performed without requiring robotic assistance and with endoscopic assistance only in certain cases. Endoscopic assistance can offer enhanced visualization of the surgical field and complement open direct approaches in neck dissection. Although FLND offers improved cosmetic outcomes when compared to those of traditional neck incisions, further study is required to determine its efficacy and indications. PMID:23023877

  10. A Case Report of Locked-in Syndrome Due to Bilateral Vertebral Artery Dissection After Cervical Spine Manipulation Treated by Arterial Embolectomy.

    PubMed

    Ke, Jiang-Qiong; Yin, Bo; Fu, Fang-Wang; Shao, Sheng-Min; Lin, Yan; Dong, Qi-Qiang; Wang, Xiao-Tong; Zheng, Guo-Qing

    2016-02-01

    Cervical spine manipulation (CSM) is a commonly spinal manipulative therapies for the relief of cervical spine-related conditions worldwide, but its use remains controversial. CSM may carry the potential for serious neurovascular complications, primarily due to vertebral artery dissection (VAD) and subsequent vertebrobasilar stroke. Here, we reported a rare case of locked-in syndrome (LIS) due to bilaterial VAD after CSM treated by arterial embolectomy.A 36-year-old right-handed man was admitted to our hospital with numbness and weakness of limbs after treating with CSM for neck for half an hour. Gradually, although the patient remained conscious, he could not speak but could communicate with the surrounding by blinking or moving his eyes, and turned to complete quadriplegia, complete facial and bulbar palsy, dyspnea at 4 hours after admission. He was diagnosed with LIS. Then, the patient was received cervical and brain computed tomography angiography that showed bilateral VAD. Aortocranial digital subtraction angiography showed vertebrobasilar thrombosis, blocking left vertebral artery, and stenosis of right vertebral artery. The patient was treated by using emergency arterial embolectomy and followed by antiplatelet therapy and supportive therapy in the intensive care unit and a general ward. Twenty-seven days later, the patient's physical function gradually improved and discharged but still left neurological deficit with muscle strength grade 3/5 and hyperreflexia of limbs.Our findings suggested that CSM might have potential severe side-effect like LIS due to bilaterial VAD, and arterial embolectomy is an important treatment choice. The practitioner must be aware of this complication and should give the patients informed consent to CSM, although not all stroke cases temporally related to SCM have pre-existing craniocervical artery dissection. PMID:26844510

  11. A Case Report of Locked-in Syndrome Due to Bilateral Vertebral Artery Dissection After Cervical Spine Manipulation Treated by Arterial Embolectomy

    PubMed Central

    Ke, Jiang-Qiong; Yin, Bo; Fu, Fang-Wang; Shao, Sheng-Min; Lin, Yan; Dong, Qi-Qiang; Wang, Xiao-Tong; Zheng, Guo-Qing

    2016-01-01

    Abstract Cervical spine manipulation (CSM) is a commonly spinal manipulative therapies for the relief of cervical spine-related conditions worldwide, but its use remains controversial. CSM may carry the potential for serious neurovascular complications, primarily due to vertebral artery dissection (VAD) and subsequent vertebrobasilar stroke. Here, we reported a rare case of locked-in syndrome (LIS) due to bilaterial VAD after CSM treated by arterial embolectomy. A 36-year-old right-handed man was admitted to our hospital with numbness and weakness of limbs after treating with CSM for neck for half an hour. Gradually, although the patient remained conscious, he could not speak but could communicate with the surrounding by blinking or moving his eyes, and turned to complete quadriplegia, complete facial and bulbar palsy, dyspnea at 4 hours after admission. He was diagnosed with LIS. Then, the patient was received cervical and brain computed tomography angiography that showed bilateral VAD. Aortocranial digital subtraction angiography showed vertebrobasilar thrombosis, blocking left vertebral artery, and stenosis of right vertebral artery. The patient was treated by using emergency arterial embolectomy and followed by antiplatelet therapy and supportive therapy in the intensive care unit and a general ward. Twenty-seven days later, the patient's physical function gradually improved and discharged but still left neurological deficit with muscle strength grade 3/5 and hyperreflexia of limbs. Our findings suggested that CSM might have potential severe side-effect like LIS due to bilaterial VAD, and arterial embolectomy is an important treatment choice. The practitioner must be aware of this complication and should give the patients informed consent to CSM, although not all stroke cases temporally related to SCM have pre-existing craniocervical artery dissection. PMID:26844510

  12. 75 FR 12746 - Difenzoquat; Registration Review Case Closure; Notice of Availability

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-17

    ...This notice announces the availability of EPA's notice of registration review case closure for the pesticide difenzoquat, case 0223. Registration review is EPA's periodic review of pesticide registrations to ensure that each pesticide continues to satisfy the statutory standard for registration, that is, that the pesticide can perform its intended function without causing unreasonable adverse......

  13. Aortic Dissection Type A in Alpine Skiers

    PubMed Central

    Schachner, Thomas; Fischler, Nikolaus; Dumfarth, Julia; Bonaros, Nikolaos; Krapf, Christoph; Schobersberger, Wolfgang; Grimm, Michael

    2013-01-01

    Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April). We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200) cm versus 175 (157–191) cm, P = 0.008) and heavier (90 (68–125) kg versus 80 (45–110) kg, P = 0.002) than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (P = 0.086). Hospital mortality of skiers was 6% versus 13% in nonskiers (P = 0.399). The skiers live at an altitude of 170 (0–853) m.a.s.l. and experience their dissection at 1602 (1185–3105; P < 0.001) m.a.s.l. In 82% symptom start was during recreational skiing without any trauma. Conclusion. Skiing associated aortic dissection type A is usually nontraumatic. The persons affected live at low altitudes and practice an outdoor sport at unusual high altitude at cold temperatures. Postoperative outcome is good. PMID:23971024

  14. Spontaneous dissection of coronary arteries.

    PubMed

    Patnaik, A N; Rao, D Seshagiri

    2005-01-01

    Spontaneous dissection of coronary arteries is an uncommon entity with varied presentation. It is commoner in young patients, specially females. We present three cases encountered by us in recent past. There were two males and the only female was in her post-partum period. All the three had diverse lines of management based on the angiographic picture, clinical background and myocardium at risk. PMID:16350685

  15. Endoscopic management of iatrogenic perforations during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for colorectal polyps: a case series

    PubMed Central

    Pissas, Dimitrios; Ypsilantis, Efthymios; Papagrigoriadis, Savvas; Hayee, Bu’Hussain

    2015-01-01

    Background: Iatrogenic perforation during therapeutic colonoscopy, reported in up to 1% of endoscopic mucosal resections (EMRs) and up to 14% of endoscopic submucosal dissections (ESDs), has conventionally been an indication for surgery. Aims: We present a case series of successful endoscopic management of iatrogenic colorectal perforation during EMR and ESD, demonstrating the feasibility and safety of the method. Methods: Retrospective analysis of a database of patients undergoing EMR and ESD for colorectal polyps in a tertiary referral centre in the United Kingdom. Results: Four cases of perforation were identified (two EMRs and two ESDs) in a series of 218 procedures (1.8%), all detected at the time of endoscopy and managed with endoscopic clips. Patients were observed in hospital and treated with antibiotics. Their median length of stay was 3 days (range 2–6 days), with no mortality or need for surgery. Conclusion: Surgery is no longer the first choice in the management of iatrogenic perforations during EMR and ESD for colorectal polyps; in selected patients with small perforations and minimal extraluminal contamination, conservative management with application of endoscopic clips, antibiotics and close patient monitoring constitute a safe and effective treatment option, avoiding the morbidity of major surgery. PMID:26136835

  16. Acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection

    PubMed Central

    Eagle, Kim A.; Vaishnava, Prashant

    2014-01-01

    Acute type B aortic dissection comprises approximately one-third of all aortic dissection cases. Although this catastrophic cardiovascular condition was first described in the medical literature over two centuries ago, data on the optimal diagnostic and treatment modalities for type B dissection was slow to evolve throughout the latter half of the twentieth century, even as newer diagnostic techniques and management strategies became commonplace. To further elucidate contemporary practice patterns and outcomes of aortic dissection, the International Registry of Acute Aortic Dissection (IRAD) was established in 1996. Over the past two decades, IRAD publications have steadily increased our knowledge and understanding about aortic dissection. Specifically in recent years, analyses of IRAD data have gone beyond simply characterizing the patient with acute type B aortic dissection and have attempted to identify the means by which the outcome of such a patient could be improved. Thus, we present herein three areas in which IRAD data has recently advanced our understanding of acute type B aortic dissection: temporal classification especially for the subacute time period, risk stratification for identifying complicated cases, and thoracic endovascular aortic repair (TEVAR). PMID:25133099

  17. Peripartum presentation of an acute aortic dissection.

    PubMed

    Lewis, S; Ryder, I; Lovell, A T

    2005-04-01

    We report the case of an acute type A aortic dissection occurring in a 35-year-old parturient. The initial diagnosis was missed; a subsequent emergency Caesarean section 3 weeks after presentation was followed by the development of left ventricular failure and pulmonary oedema in the early postoperative period. Echocardiography confirmed the diagnosis of aortic dissection and the patient underwent a successful surgical repair. PMID:15640303

  18. Thrombolytic therapy in spontaneous coronary artery dissection.

    PubMed

    Behnam, R; Tillinghast, S

    1991-07-01

    A 42-year-old female with no cardiac risk factors had an acute anterolateral myocardial infarction treated with intravenous (IV) tissue plasminogen activator (t-PA). Selective coronary cineangiography a week later revealed extensive dissection of the left anterior descending coronary artery (LAD) and its second diagonal branch. Sixteen months later, she is asymptomatic. This is the fifth reported case of spontaneous coronary artery dissection treated with thrombolytic therapy during the acute event with uneventful recovery. PMID:1747972

  19. 76 FR 76712 - Pelico Pipeline, LLC; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-08

    ... Energy Regulatory Commission Pelico Pipeline, LLC; Notice of Motion for Extension of Rate Case Filing...). Any person desiring to participate in this rate proceeding must file a motion to intervene or to... proceeding. Any person wishing to become a party must file a notice of intervention or motion to...

  20. 76 FR 1152 - Crosstex LIG, LLC; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-07

    ... Energy Regulatory Commission Crosstex LIG, LLC; Notice of Motion for Extension of Rate Case Filing... file a motion to intervene or to protest this filing must file in accordance with Rules 211 and 214 of... or motion to intervene, as appropriate. Such notices, motions, or protests must be filed on or...

  1. Isolated brachiocephalic artery dissection presenting as acute stroke.

    PubMed

    Mani, Hariharasudan; Ahluwalia, Sharat

    2015-01-01

    Isolated brachiocephalic artery dissection is an extremely rare condition. Its presentation as an acute stroke can pose a significant diagnostic challenge in patients because of its rarity. We present a case of isolated spontaneous brachiocephalic artery dissection presenting as acute cerebrovascular accident. This case also illustrates the treatment dilemma brachiocephalic artery dissection can present, whether to choose antithrombotic/anticoagulation therapy and/or surgery, and also the dilemma in blood pressure management. PMID:26315357

  2. Acute Aortic Dissection Extending Into the Lung.

    PubMed

    Makdisi, George; Said, Sameh M; Schaff, Hartzell V

    2015-07-01

    The radiologic manifestations of ruptured acute aortic dissection, Stanford type A aortic dissection, DeBakey type 1 can present in different radiographic scenarios with devastating outcomes. Here, we present a rare case of a 70-year-old man who presented to the emergency department with chest pain radiating to the back. A chest computed tomography scan showed a Stanford type A, DeBakey type 1, acute aortic dissection ruptured into the aortopulmonary window and stenosing the pulmonary trunk, both main pulmonary arteries, and dissecting the bronchovascular sheaths and flow into the pulmonary interstitium, causing pulmonary interstitial hemorrhage. The patient underwent emergent ascending aorta replacement with hemiarch replacement with circulatory arrest. The postoperative course was unremarkable. PMID:26140779

  3. Acute aortic dissection in pregnant women.

    PubMed

    Yang, Zhaohua; Yang, Shouguo; Wang, Fangshun; Wang, Chunsheng

    2016-05-01

    Acute aortic dissection occurring during pregnancy represents a lethal risk to both the mother and fetus. Management of parturient with acute aortic dissection is complex. We report our experience of two pregnancies with type A acute aortic dissection. One patient is a 31-year-old pregnant woman (33rd gestational week) with a bicuspid aortic valve and the other is a 32-year-old pregnant woman (30th gestational week) with the Marfan syndrome. In both cases, a combined emergency operation consisting of Cesarean section, total hysterectomy prior to corrective surgery for aortic dissection was successfully performed within a relatively short period of time after the onset. Both patients' postoperative recovery was uneventful, and we achieved a favorable maternal and fetal outcome. PMID:25085319

  4. Coronary Thrombosis without Dissection following Blunt Trauma

    PubMed Central

    Sibel, Michael; Thomas, Peter; Burt, Francis; Cipolla, James; Puleo, Peter; Baker, Keith

    2016-01-01

    Blunt trauma to the chest resulting in coronary thrombosis and ST elevation myocardial infarction (STEMI) is a rare but well-described occurrence in adults. Angiography in such cases has generally disclosed complete epicardial coronary occlusion with thrombus, indistinguishable from the findings commonly found in spontaneous plaque rupture due to atherosclerotic disease. In all previously reported cases in which coronary interrogation with intravascular ultrasound (IVUS) was performed in association with acute revascularization, coronary artery dissection was implicated as the etiology of coronary thrombosis. We present the first case report of blunt trauma-associated coronary thrombosis without underlying atherosclerosis or coronary dissection, as documented by IVUS imaging. PMID:27006836

  5. Iatrogenic left main artery dissection: A catastrophic complication

    PubMed Central

    Namazi, Mohammad Hassan; Rostami, Reza Tajik; Mohammadi, Afsaneh; Amini, Abdol Latifi; Safi, Morteza; Saadat, Habibollah; Vakili, Hosein; Motamedi, Mohammad Reza; Movahed, Mohammad Reza

    2012-01-01

    Iatrogenic left main artery (LM) dissection is a catastrophic complication of coronary angiography and angioplasty that requires prompt management using stenting. Although LM dissection can be prevented, it cannot always be avoided and has a reported incidence rate of 0.02%. In the present report, a case of iatrogenic LM dissection that was successfully treated with multiple stents is presented and followed by a brief review of the literature. PMID:23592948

  6. Acute aortic dissection caused by Clostridium septicum aortitis.

    PubMed

    Eplinius, Franziska; Hädrich, Carsten

    2014-11-01

    Clostridium septicum aortitis is a rare cause of aortic dissection. So far, only 28 cases have been described in literature before. Most of these cases occurred in elderly patients and an association to colonic neoplasms and/or atherosclerosis has been witnessed frequently. Here we report the case of a 32-year-old man with fatal aortic dissection due to aortic infection with C. septicum. Beside a case of a 22-year-old man who died of aortic dissection due to C. septicum aortitis this is the second case of C. septicum aortitis in a young individual with no signs of colonic neoplasms or atherosclerosis. PMID:25242573

  7. Parametric binary dissection

    NASA Technical Reports Server (NTRS)

    Bokhari, Shahid H.; Crockett, Thomas W.; Nicol, David M.

    1993-01-01

    Binary dissection is widely used to partition non-uniform domains over parallel computers. This algorithm does not consider the perimeter, surface area, or aspect ratio of the regions being generated and can yield decompositions that have poor communication to computation ratio. Parametric Binary Dissection (PBD) is a new algorithm in which each cut is chosen to minimize load + lambda x(shape). In a 2 (or 3) dimensional problem, load is the amount of computation to be performed in a subregion and shape could refer to the perimeter (respectively surface) of that subregion. Shape is a measure of communication overhead and the parameter permits us to trade off load imbalance against communication overhead. When A is zero, the algorithm reduces to plain binary dissection. This algorithm can be used to partition graphs embedded in 2 or 3-d. Load is the number of nodes in a subregion, shape the number of edges that leave that subregion, and lambda the ratio of time to communicate over an edge to the time to compute at a node. An algorithm is presented that finds the depth d parametric dissection of an embedded graph with n vertices and e edges in O(max(n log n, de)) time, which is an improvement over the O(dn log n) time of plain binary dissection. Parallel versions of this algorithm are also presented; the best of these requires O((n/p) log(sup 3)p) time on a p processor hypercube, assuming graphs of bounded degree. How PBD is applied to 3-d unstructured meshes and yields partitions that are better than those obtained by plain dissection is described. Its application to the color image quantization problem is also discussed, in which samples in a high-resolution color space are mapped onto a lower resolution space in a way that minimizes the color error.

  8. Acute aortic dissection diagnosed after embalming: macroscopic and microscopic findings.

    PubMed

    Savall, Frédéric; Dedouit, Fabrice; Piercecchi-Marti, Marie-Dominique; Leonetti, Georges; Rougé, Daniel; Telmon, Norbert

    2014-09-01

    A 58-year-old man died suddenly in Madagascar and poisoning was suspected. The body was embalmed after death and the general state of preservation was good. We found a major aortic dissection with a large false lumen from the aortic root to the common iliac arteries and a hemopericardium with formalinized blood clot. The intimal tear was on the ascending aorta, and an intramural hemorrhage was noted at the right coronary artery, attesting to a retrograde dissection. Microscopic studies confirmed aortic dissection with extensive intramural hemorrhage and also confirmed the retrograde dissection to the right coronary artery with a reduction of 90% of the true lumen. Classically, aortic dissection occurs in individuals with hypertension and individuals with genetic disorders of collagen formation. The diagnosis is often first established at the postmortem examination. Aortic dissection is therefore dealt with largely in necropsy studies. The usual cause of death is rupture into the pericardial sac. One case of bloodless dissection has been reported but the sudden death was explained by acute myocardial ischemia secondary to dissection of the left coronary artery. In our case, we found major hemopericardium and also intramural hemorrhage at the right coronary artery. We were able to make the diagnosis of aortic dissection and exclude the suspicion of homicide 15 days after death and after embalming. PMID:24684562

  9. Is dissection humane?

    PubMed Central

    Hasan, Tabinda

    2011-01-01

    Dissection is being jeopardized in the modern medical education. It has unrelentingly faced the lashes of time and has been the scapegoat for numerous convenient curricula reforms and subjective biases. The cadaver is unparallel in establishing core knowledge among the medical community and it needs to be appreciated in a new light in the cyber anatomy realm of today. This article elucidates the medical and ethical validity of continuing human body dissection in medicine which outweighs all the prejudices associated with it. PMID:23908746

  10. Is dissection humane?

    PubMed

    Hasan, Tabinda

    2011-01-01

    Dissection is being jeopardized in the modern medical education. It has unrelentingly faced the lashes of time and has been the scapegoat for numerous convenient curricula reforms and subjective biases. The cadaver is unparallel in establishing core knowledge among the medical community and it needs to be appreciated in a new light in the "cyber anatomy" realm of today. This article elucidates the medical and ethical validity of continuing human body dissection in medicine which outweighs all the prejudices associated with it. PMID:23908746

  11. Virtual reality haptic dissection.

    PubMed

    Erolin, Caroline; Wilkinson, Caroline; Soames, Roger

    2011-12-01

    This project aims to create a three-dimensional digital model of the human hand and wrist which can be virtually 'dissected' through a haptic interface. Tissue properties will be added to the various anatomical structures to replicate a realistic look and feel. The project will explore the role of the medical artist, and investigate cross-discipline collaborations in the field of virtual anatomy. The software will be used to train anatomy students in dissection skills, before experience on a real cadaver. The effectiveness of the software will be evaluated and assessed both quantitatively as well as qualitatively. PMID:22229585

  12. Traumatic Axillary Artery Dissection with Radial Artery Embolism

    SciTech Connect

    Chung, Hwan-Hoon; Cha, Sang Hoon Cho, Sung Bum; Kim, Jung Hyuck; Lee, Seung Hwa; Shin, Jae Seung; Park, Sang Woo

    2006-04-15

    This report describes a case of pathologically proven traumatic arterial dissection, presenting as complete occlusion of the axillary artery with radial artery embolism. Occlusion of the axillary artery by traumatic dissection mimicked transection and radial artery embolism mimicked congenital absence of the radial artery on the initial angiogram, but these were correctly diagnosed with the following sonogram.

  13. Dissecting Diversity Part II

    ERIC Educational Resources Information Center

    Matthews, Frank

    2005-01-01

    This article presents "Dissecting Diversity, Part II," the conclusion of a wide-ranging two-part roundtable discussion on diversity in higher education. The participants were as follows: Lezli Baskerville, J.D., President and CEO of the National Association for Equal Opportunity (NAFEO); Dr. Gerald E. Gipp, Executive Director of the American…

  14. Dissecting Diversity Part II

    ERIC Educational Resources Information Center

    Matthews, Frank

    2005-01-01

    This article presents "Dissecting Diversity, Part II," the conclusion of a wide-ranging two-part roundtable discussion on diversity in higher education. The participants were as follows: Lezli Baskerville, J.D., President and CEO of the National Association for Equal Opportunity (NAFEO); Dr. Gerald E. Gipp, Executive Director of the American

  15. Doing without Dissection.

    ERIC Educational Resources Information Center

    Texley, Juliana

    1992-01-01

    Both the National Science Teachers Association (NSTA) and the National Association of Biology Teachers (NABT) have issued position statements on the use of animals in the classroom. Dissection has not become extinct, but its role is far smaller than it used to be. (MLF)

  16. Intraoperative aortic dissection in pediatric heart surgery.

    PubMed

    Hibino, Narutoshi; Harada, Yorikazu; Hiramatsu, Takeshi; Yasukochi, Satoshi; Satomi, Gengi

    2006-06-01

    Intraoperative aortic dissection occurred in a 3-year-old-boy undergoing repair of an atrial septal defect. Transesophageal echocardiography was useful for the diagnosis, and conservative medical treatment under close observation was feasible in this case which involved a limited intimal tear. PMID:16714685

  17. Neck dissections: radical to conservative

    PubMed Central

    Harish, K

    2005-01-01

    Background Neck dissection is an important surgical procedure for the management of metastatic nodal disease in the neck. The gold standard of neck nodal management has been the radical neck dissection. Any modification in the neck dissection is always compared with this standard. Over the last few decades, in order to alleviate the morbidity of radical neck dissection, several modifications and conservative procedures have been advocated. These procedures retain certain lymphatic or non-lymphatic structures and have been shown not to compromise oncological safety. Methods A literature search of the Medline was carried out for all articles on neck dissections. The articles were systematically reviewed to analyze and trace the evolution of neck dissection. These were then categorized to address the nomenclature, management of node positive and node negative neck including those who had received chemoradiation. Results The present article discusses the neck nodal nomenclature, the radical neck dissection, its modifications and migration to more conservative procedures and possible advances in the near future. Conclusion Radical neck dissection is now replaced with modified radical neck dissections in most situations. Attempts are being made to replace modified radical neck dissections with selective neck dissections for early node positivity. Sentinel node biopsy is being studied to address the issue of node negative neck. More conservative surgeries are likely to replace the 'radical' surgeries of bygone era. This process is facilitated by earlier detection of the disease and better understanding of cancer biology. PMID:15836786

  18. NOTICE

    Atmospheric Science Data Center

    2013-09-26

    ASDC Notice Page   EOSDIS User Satisfaction Survey Extended Users of EOSDIS data centers should watch ... For the results of previous surveys, please see American Customer Satisfaction Index Reports. This year’s survey began on August 20 ...

  19. Bare Stent Implantation in Iatrogenic Dissecting Pseudoaneurysm of the Superior Mesenteric Artery

    SciTech Connect

    Kutlu, Ramazan Ara, Cengiz; Sarac, Kaya

    2007-02-15

    Iatrogenic arterial dissection leading to the development of dissecting pseudoaneurysms of the superior mesenteric artery (SMA) is a rare complication of angiography. Surgical and endovascular treatment options exist for this important condition. We report a case of bare stent implantation in dissecting pseudoaneurysm of the SMA that developed after angiography in a patient with acute mesenteric ischemia. Although it is rarely published, iatrogenic arterial dissection causing pseudoaneurysm can occur after diagnostic and interventional angiography. Bare stent implantation in dissecting pseudoaneurysm of the SMA could be an advantageous endovascular treatment option in selected cases due its to potential preservation of important side branches of the SMA.

  20. CrossFit-related cervical internal carotid artery dissection.

    PubMed

    Lu, Albert; Shen, Peter; Lee, Paul; Dahlin, Brian; Waldau, Ben; Nidecker, Anna E; Nundkumar, Anoop; Bobinski, Matthew

    2015-08-01

    CrossFit is a high-intensity strength and conditioning program that has gained popularity over the past decade. Potential injuries associated with CrossFit training have been suggested in past reports. We report three cases of cervical carotid dissection that are associated with CrossFit workouts. Patient 1 suffered a distal cervical internal carotid artery (ICA) dissection near the skull base and a small infarct in Wernicke's area. He was placed on anticoagulation and on follow-up has near complete recovery. Patient 2 suffered a proximal cervical ICA dissection that led to arterial occlusion and recurrent middle cerebral artery territory infarcts and significant neurological sequelae. Patient 3 had a skull base ICA dissection that led to a partial Horner's syndrome but no cerebral infarct. While direct causality cannot be proven, intense CrossFit workouts may have led to the ICA dissections in these patients. PMID:25917634

  1. Aortic dissection and dissecting aortic aneurysms.

    PubMed Central

    Crawford, E S; Svensson, L G; Coselli, J S; Safi, H J; Hess, K R

    1988-01-01

    Operation was employed in the treatment of 546 patients for complications of aortic dissection during the 32-year period of 1956-1988. Current concepts and operative techniques evolved during this period. Fortunately, about half the patients were treated during the latter 4 years, as modern therapy became standardized. The cumulative survival rate was 86% for all patients and 94% for those treated during recent years. Pathologic processes and requirements of operation became clearer by treating 174 patients who had had 198 previous operations by the time of referral. Reoperation was required for complications of operations now considered outdated, heart operations in patients with ascending aortic dilatation, and progressive dilatation of residual segments of the aorta. The 546 patients were followed, and a total of 838 operations were finally employed, resulting in total aortic replacement in 18, near total replacement in 41, entire thoracic aorta in 22, near total thoracic aorta in 33, and the entire thoracoabdominal aorta in 148 patients. Long-term survival in 439 patients after final operation was 66% and 44% at 5 and 10 years, respectively, despite the fact that the median age at first admission was 59. Operative treatment appears to be well-established for this disease. Images Figs. 12A-C. Figs. 12A-C. Figs. 1A and B. Figs. 2A and B. Fig. 3. Figs. 4A-D. Figs. 5A-C. Figs. 5A-C. Figs. 6A and B. Figs. 7A and B. Figs. 8A and B. Figs. 9A and B. Figs. 10A and B.,Figs. 11A and B. PMID:3421752

  2. Choosing the correct treatment for acute aortic type B dissection.

    PubMed

    Singh, M; Hager, E; Avgerinos, E; Genovese, E; Mapara, K; Makaroun, M

    2015-04-01

    Acute type B aortic dissection is a life threatening disease process, which remains a clinical dilemma despite advances in technology, surgical technique and postoperative management. The variability of presenting symptoms, lack of a consensus on indications for treatment and differing opinions about the optimal timing for repair have added to the management confusion. Medical management has been the standard of care for acute uncomplicated type B dissection. Surgical repair and endovascular intervention are reserved for those who present with, or subsequently develop, dissection-related complications. Complicated dissections occur in 25% of cases and may include organ malperfusion, aortic rupture, periaortic hematoma, and uncontrolled hypertension. In the past decade thoracic endovascular aortic repair (TEVAR) has gained widespread acceptance as the modality of choice for the treatment of complicated type B dissection. This transition is representative of advances in technology, physician experience with aortic endografts and lower morbidity and mortality rates associated with TEVAR. The best medical therapy remains the standard of care for uncomplicated dissection, however this strategy fails to prevent long-term aortic-related morbidity and mortality. Recent data suggest that early TEVAR lowers aortic-related events and improves long-term aortic specific survival by covering the entry tear, promoting false lumen thrombosis and inducing aortic wall remodeling. The paucity of supporting data has created controversy surrounding the optimal treatment strategy for acute type B dissection. Nonetheless, recent healthcare trends show a paradigm shift towards the utilization of early TEVAR in acute type B dissection. PMID:25644833

  3. Endovascular management of chronic post-dissection aneurysms

    PubMed Central

    Oikonomou, Kyriakos; Katsargyris, Athanasios; Ritter, Wolfgang; Spinelli, Domenico; Seto, Yuki

    2014-01-01

    Open repair is still the gold standard in acute type A dissection. Endovascular repair is advocated for complicated acute type B dissections. Recent evidence also supports the role of endovascular repair in a larger proportion of uncomplicated acute type B dissections. The role of endovascular repair in chronic post-dissection aneurysms, however, is still unclear. Most commonly, post-dissection aneurysms involve the thoracoabdominal aorta, making the use of fenestrated/branched stent-grafts to achieve complete aneurysm exclusion mandatory. These fenestrated/branched stent-grafts have been used with success in atherosclerotic thoracoabdominal aortic aneurysms (TAAAs). In chronic post-dissection aneurysms, however, additional technical challenges arise. The usually narrow true lumen makes the use of branches more tedious and overall planning difficult. A second technical challenge relates to the fact that visceral branches can also originate from the false lumen. In such cases, perforation of the stiff chronic dissection flap is required to obtain access to the vessel. During the period January 2010 to November 2013, 17 patients (13 males, mean age 65±7.8 years) with chronic thoracoabdominal aneurismal degeneration following acute dissection were treated in our department with the use of fenestrated/branched stent-grafts. Technical success was achieved in all cases (100%). Perioperative mortality was two (11.8%) patients. One patient died due to multiple organ failure and one due to cardiac failure. No case of paraplegia was observed. During a 12-month median follow-up (range, 4-28 months) no aneurysm-related deaths were observed. Reintervention was required in three cases to repair a type Ib endoleak from a side branch. Endovascular treatment with fenestrated/branched stent-grafts is feasible for chronic post-dissection aneurysms. Standard thoracic stent-grafting is an option in a minority of patients, when the aneurysm is limited to the thoracic segment. Fenestrated and branched devices can successfully be used for aneurysms extending to the thoracoabdominal aorta. PMID:24967171

  4. [Stent-assisted embolization for ruptured vertebral artery dissection involving the origin of the posterior inferior cerebellar artery:a case report of staged strategy].

    PubMed

    Fukuda, Kenji; Higashi, Toshio; Yoshioka, Tsutomu; Shigemori, Yutaka; Iwaasa, Mitsutoshi; Miki, Koichi; Inoue, Tooru

    2015-04-01

    We report a ruptured vertebral artery dissection (VAD) involving the origin of the posterior inferior cerebellar artery(PICA)treated by a staged strategy with stent-assisted coil embolization. A 52-year-old woman was admitted with a ruptured right VAD involving the origin of the developed PICA. Endovascular internal trapping of the enlarged distal VAD was performed (Stage 1). After 1 month, following confirmation of platelet inhabitation (Stage 2) an Enterprise stent (Cordis Neurovascular, Miami Lakes, FL) placement from the PICA to the proximal VA with coil embolization for proximal VAD was performed under dual antiplatelet therapy. The dissected VA segment was occluded by coil embolization and the PICA was preserved. Advantages of this staged treatment are the avoidance of ischemic/hemorrhagic complications due to antithrombotic therapy when stent placement to the PICA is planned during the acute stage of SAH and confirmation of platelet inhabitation before stent placement in second treatment. VAD can be occluded, and this challenging endovascular treatment can be a therapeutic option for a ruptured VAD. PMID:25838304

  5. Spontaneous coronary artery dissection presenting as acute myocardial infarction.

    PubMed Central

    Mahenthiran, J.; Revankar, R.; Koka, V.; Hoo, J.; Shenoy, M.

    2000-01-01

    Spontaneous coronary artery dissection is a rare entity being increasingly diagnosed as a cause of acute myocardial infarction, especially in cases of low cardiac risk female patients. This is one such case report of a black female patient, who suffered an acute anterior wall myocardial infarction due to an idiopathic spontaneous coronary artery dissection of the left anterior descending artery. She was treated with a thrombolytic agent in the acute phase, uneventfully. An urgent coronary angiogram demonstrated an intimal tear with a dissection of the left anterior descending artery. She survived the acute event and her subsequent hospital course was uncomplicated. Hence she was treated medically for her ischemic event and left ventricular systolic dysfunction with a favorable outcome. This case is yet another report of a survivor treated with a thrombolytic agent for the acute myocardial infarction due to spontaneous coronary artery dissection. Images Figure 2 Figure 3 PMID:10800297

  6. J incision in neck dissections.

    PubMed

    Acar, A; Dursun, G; Aydin, O; Akbaş, Y

    1998-01-01

    Metastasis in the neck lymph system of primary tumours of the head and neck is frequently seen. In order to prevent this metastasis, neck dissection is carried out by various types of skin incisions. In this study, types of skin incision used in neck dissections were defined, and the advantages, disadvantages and results of J incisions, which have been performed on 320 radical neck dissection patients in our clinic between 1985-1996, were compared with those of other incision types. PMID:9538447

  7. Conservatively treated Type B intramural hematoma: Progression into acute aortic dissection followed by spontaneous resolution, assessed by CT

    PubMed Central

    Buitrago, Guadalupe; Vasaturo, Sabina; Kroft, Lucia J.M.

    2015-01-01

    This case report shows the full spectrum evolution of type B intramural hematoma under conservative treatment, with initial progression into a true aortic dissection, followed by extremely rare near-complete healing of the dissection at followup.

  8. 76 FR 2902 - National Fuel Gas Distribution Corporation; Notice of Motion for Extension of Rate Case Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-18

    ... Motion for Extension of Rate Case Filing Deadline January 11, 2011. Take notice that on January 10, 2011...). Any person desiring to participate in this rate proceeding must file a motion to intervene or to... proceeding. Any person wishing to become a party must file a notice of intervention or motion to...

  9. 76 FR 18754 - J-W Pipeline Company; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-05

    ... Energy Regulatory Commission J-W Pipeline Company; Notice of Motion for Extension of Rate Case Filing... desiring to participate in this rate proceeding must file a motion to intervene or to protest this filing... to become a party must file a notice of intervention or motion to intervene, as appropriate....

  10. 76 FR 39869 - Lee 8 Storage Partnership; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-07

    ... Energy Regulatory Commission Lee 8 Storage Partnership; Notice of Motion for Extension of Rate Case...,150 (May 20, 2010). Any person desiring to participate in this rate proceeding must file a motion to... the proceeding. Any person wishing to become a party must file a notice of intervention or motion...

  11. 76 FR 51969 - New Mexico Gas Company, Inc.; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-19

    ... Energy Regulatory Commission New Mexico Gas Company, Inc.; Notice of Motion for Extension of Rate Case...,150 (May 20, 2010). Any person desiring to participate in this rate proceeding must file a motion to... the proceeding. Any person wishing to become a party must file a notice of intervention or motion...

  12. 75 FR 56093 - Eagle Rock Desoto Pipeline, LP; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-15

    ... Energy Regulatory Commission Eagle Rock Desoto Pipeline, LP; Notice of Motion for Extension of Rate Case... ] 61,150 (May 20, 2010). Any person desiring to participate in this rate proceeding must file a motion... to the proceeding. Any person wishing to become a party must file a notice of intervention or...

  13. 76 FR 41240 - Northwest Natural Gas Company; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ... Energy Regulatory Commission Northwest Natural Gas Company; Notice of Motion for Extension of Rate Case... file a motion to intervene or to protest this filing must file in accordance with Rules 211 and 214 of... or motion to intervene, as appropriate. Such notices, motions, or protests must be filed on or...

  14. 76 FR 23808 - Humble Gas Pipeline Company; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-28

    ... Energy Regulatory Commission Humble Gas Pipeline Company; Notice of Motion for Extension of Rate Case...,150 (May 20, 2010). Any person desiring to participate in this rate proceeding must file a motion to... the proceeding. Any person wishing to become a party must file a notice of intervention or motion...

  15. 76 FR 40907 - Ohio Valley Hub, LLC; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-12

    ... Energy Regulatory Commission Ohio Valley Hub, LLC; Notice of Motion for Extension of Rate Case Filing... desiring to participate in this rate proceeding must file a motion to intervene or to protest this filing... to become a party must file a notice of intervention or motion to intervene, as appropriate....

  16. 76 FR 81927 - EasTrans, LLC; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-29

    ... Energy Regulatory Commission EasTrans, LLC; Notice of Motion for Extension of Rate Case Filing Deadline...). Any person desiring to participate in this rate proceeding must file a motion to intervene or to... proceeding. Any person wishing to become a party must file a notice of intervention or motion to...

  17. 76 FR 36913 - Washington Gas Light Company; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-23

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Washington Gas Light Company; Notice of Motion for Extension of Rate Case Filing Deadline Take notice that on June 15, 2011, Washington Gas Light Company (Washington Gas) filed...

  18. 76 FR 76711 - DCP Raptor Pipeline, LLC; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-08

    ... Energy Regulatory Commission DCP Raptor Pipeline, LLC; Notice of Motion for Extension of Rate Case Filing Deadline Take notice that on November 30, 2011, DCP Raptor Pipeline, LLC (Raptor) filed a request for an...\\ Therefore, Raptor requests that the date for its next rate filing be extended to September 1, 2014, which...

  19. Biomarkers in aortic dissection.

    PubMed

    Wen, Dan; Zhou, Xian-Liang; Li, Jian-Jun; Hui, Ru-Tai

    2011-04-11

    Aortic dissection (AD) is a severe cardiovascular disease with high mortality and morbidity, which is characterized by acute onset and rapid progress. Mechanically, it has been considered that circulating blood flows into the media of the aorta through the rupture of the intima forming true and false lumens. Generally, its pathologic process is considered as follows: initially, inflammatory reaction, inflammatory cells infiltration in aortic wall, and then apoptosis of vascular smooth muscle cells, degenerating of aortic media, elastin fracture, and degradation. At last, the ingredients of the aorta are destroyed and lead to aortic dilatation, aneurysm formation, dissection and rupture. Currently, several biomarkers in peripheral blood including C-reactive protein (CRP), matrix metalloproteinases (MMPs), soluble elastin fragments (sELAF), D-dimer, smooth muscle myosin heavy chain, calponin, N-terminal pro-brain natriuretic peptide (NT-proBNP), big endothelin-1 (Big ET-1), genetic markers and so on, have been demonstrated to play a major role in evaluation of AD, for example, making early diagnosis and classifying of AD. Additionally, those markers may also guide our treatment therapies and predict the prognosis. The aims of this review mainly focus on the clinical implications of the biomarkers in AD. PMID:21237193

  20. Diagnosis of lateral pelvic lymph node metastasis of T1 lower rectal cancer using diffusion-weighted magnetic resonance imaging: A case report with lateral pelvic lymph node dissection of lower rectal cancer

    PubMed Central

    OGAWA, SHIMPEI; ITABASHI, MICHIO; HIROSAWA, TOMOICHIRO; HASHIMOTO, TAKUZO; BAMBA, YOSHIKO; OKAMOTO, TAKAHIRO

    2016-01-01

    The present study presented a 35-year-old female patient in whom fecal occult blood was detected in a medical check-up. Colonoscopy revealed a superficial elevated-type tumor with central depression in the lower rectum. The tumor was diagnosed as T1 deep invasive cancer. No swollen lymph nodes or distant metastasis were found on computed tomography or [18F]-fluorodeoxyglucose-positron emission tomography with computed tomography. However, a swollen right lateral pelvic lymph node (LPLN; short axis 4 mm) was revealed on magnetic resonance imaging (MRI). This lymph node exhibited high intensity on diffusion-weighted imaging (DWI), suggesting metastasis. Low anterior resection, regional lymph node dissection and right LPLN dissection (LPLD) were performed. Histological analysis revealed metastasis in the right LPLN, as suggested by the high DWI intensity. The indication for LPLD in the current Japanese guidelines is based on the tumor location and depth of invasion (≥T3), however, not on the status of LPLN metastasis in pre-operative evaluation. The present case was cT1, which is not included in this indication. DWI is sensitive for the diagnosis of lymph node metastasis of colorectal cancer, although inflammation-induced swelling of lymph nodes in advanced rectal cancer may cause a false-positive result, which is uncommon in T1 cases. Therefore, an LPLN with a high intensity DWI signal in T1 cases is likely to be metastasis-positive. Pre-operative DWI-MRI may be useful for identifying LPLN metastasis when planning the treatment strategy in these cases. The present study suggested reinvestigation of the indication for LPLD with inclusion of LPLN status on pre-operative imaging. PMID:27123286

  1. Coincidental detection of T-cell rich B cell lymphoma in the para-aortic lymph nodes of a woman undergoing lymph node dissection for cervical cancer: a case report.

    PubMed

    Abali, H; Eren, O O; Erman, M; Uner, A H; Kose, F; Guler, N

    2003-01-01

    The diagnosis of cervical squamous cell carcinoma with concurrent T-cell rich B cell lymphoma in dissected lymph nodes has not been reported to our knowledge. In our case, the biopsy of an exophytic lesion at the uterine cervix showed squamous cell carcinoma in a 50-year-old woman presenting with postcoital bleeding. Type III hysterectomy, bilateral salpingo-oophorectemy, bilateral pelvic, para-aortic lymph node dissections were performed. Pathologic examination revealed a T-cell rich B cell lymphoma in some lymph nodes beside squamous cell carcinoma in several of others. ELISA for human immuno-deficiency virus (HIV) was negative. The cervical carcinoma was staged as FIGO clinical stage IB1 and the lymphoma as Ann Arbor IIA. Six cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolon) chemotherapy for the lymphoma and concomitant pelvic chemoradiotherapy with cisplatin for cervical cancer were given. In this rare coincidence, the best available therapy for each of the diseases should be considered individually. We also suggest that HIV screennig test be carried out, because both diseases may be related to human immuno-deficiency virus, although our patient is HIV-negative. PMID:14675356

  2. Thoraco-abdominal Aorta Dissection: Look Again Before You Leap

    PubMed Central

    Zeina, Abdel-Rauf; Trachtengerts, Victoria; Abadi, Sobhi; Jarchowsky, Jacob; Soimu, Uri; Nachtigal, Alicia

    2009-01-01

    Aortic dissection is a life-threatening condition that might require immediate assessment and therapy. We present the case of a 71-year-old woman with essential hypertension complaining about low back pain; unenhanced thoracic-lumbar spine computed tomography examination (CT) revealed a hyperdense thin line across the aorta with an appearance of "double aortic lumen". Enhanced CT scan confirmed the diagnosis of type B aortic dissection. Radiologists should be familiar with this finding that could be considered a new radiological sign of aortic dissection on unenhanced CT examination. PMID:22470686

  3. Successful subcarinal dissection using a laparoscopic transhiatal approach for esophageal cancer with an anomalous pulmonary vein.

    PubMed

    Shiozaki, Atsushi; Fujiwara, Hitoshi; Konishi, Hirotaka; Kosuga, Toshiyuki; Komatsu, Shuhei; Ichikawa, Daisuke; Okamoto, Kazuma; Otsuji, Eigo

    2016-04-01

    We herein reported a case of a dangerous anomaly of a pulmonary vein in subcarinal dissection. A 74-year-old man underwent esophagectomy with systematic nodal dissection using a laparoscopic transhiatal approach. Under pneumomediastinum pressure, dissection of the posterior plane of the pericardium was extended, and a vessel that independently drained into the left atrium was identified. Although this anomalous vein penetrated the subcarinal lymph nodes and crossed behind the right main bronchi, subcarinal dissection was successfully performed without its injury. Our surgical procedure enabled the intraoperative identification of this rare abnormality, an aberrant segmental vein in the right upper lobe, and safe en bloc subcarinal dissection. PMID:26856596

  4. Retrograde type A dissection after thoracic endovascular repair due to the barb.

    PubMed

    Tanaka, Koyu; Saito, Masahito; Ohata, Toshihiro

    2016-05-01

    We present a case of retrograde ascending aortic dissection in a 65-year-old man 8 months after emergency thoracic endovascular repair of an atherosclerotic aneurysm. Intraoperative findings identified a retrograde ascending aortic dissection due to the barb of the stent-graft. Retrograde type A dissection is a rare but fatal complication after thoracic endovascular aortic repair. There are some reports of retrograde ascending aortic dissection, but the etiology remains unclear. The subtle back-and-forth motion of the barb during the cardiac cycle may cause aortic injuries that result in retrograde ascending aortic dissection. PMID:25406404

  5. Eosinophilic Coronary Periarteritis with Arterial Dissection: The Mast Cell Hypothesis.

    PubMed

    Mandal, Rakesh; Brooks, Erin G; Corliss, Robert F

    2015-07-01

    A subset of coronary arterial dissections is associated with eosinophilic coronary periarteritis (ECPA); however, the pathogenesis of the process remains unclear. Mast cells normally reside in coronary arterial adventitia and are known mediators of eosinophilic inflammatory conditions such as type I hypersensitivity reactions. We report two cases in which coronary arterial dissection with ECPA was detected at autopsy. Tryptase, CD68, CD4, CD8, and CD1a immunohistochemical staining was performed to better characterize inflammation. While eosinophils represented a prominent periadventitial inflammatory cell, there were slightly more lymphocytes: CD4/CD8 ratios were within expected reference ranges. There were moderate numbers of macrophages, and few neutrophils or dendritic cells. Numbers of mast cells in dissected versus nondissected sections were compared: adventitial mast cell densities were threefold higher in dissected portions and showed a trend toward increased degranulation. These findings suggest that mast cells may play a role in orchestrating inflammation in cases of ECPA. PMID:25771824

  6. "Dissection" of a Hair Dryer

    ERIC Educational Resources Information Center

    Eisenstein, Stan; Simpson, Jeff

    2008-01-01

    The electrical design of the common hair dryer is based almost entirely on relatively simple principles learned in introductory physics classes. Just as biology students dissect a frog to see the principles of anatomy in action, physics students can "dissect" a hair dryer to see how principles of electricity are used in a real system. They can

  7. "Dissection" of a Hair Dryer

    ERIC Educational Resources Information Center

    Eisenstein, Stan; Simpson, Jeff

    2008-01-01

    The electrical design of the common hair dryer is based almost entirely on relatively simple principles learned in introductory physics classes. Just as biology students dissect a frog to see the principles of anatomy in action, physics students can "dissect" a hair dryer to see how principles of electricity are used in a real system. They can…

  8. Thoracic aortic aneurysm and dissection.

    PubMed

    Goldfinger, Judith Z; Halperin, Jonathan L; Marin, Michael L; Stewart, Allan S; Eagle, Kim A; Fuster, Valentin

    2014-10-21

    Aortic dissection is the most devastating complication of thoracic aortic disease. In the more than 250 years since thoracic aortic dissection was first described, much has been learned about diseases of the thoracic aorta. In this review, we describe normal thoracic aortic size; risk factors for dissection, including genetic and inflammatory conditions; the underpinnings of genetic diseases associated with aneurysm and dissection, including Marfan syndrome and the role of transforming growth factor beta signaling; data on the role for medical therapies in aneurysmal disease, including beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors; prophylactic surgery for aneurysm; surgical techniques for the aortic root; and surgical and endovascular management of aneurysm and dissection for different aortic segments. PMID:25323262

  9. Isolated Spontaneous Renal Artery Dissection Presented with Flank Pain

    PubMed Central

    Gandhi, Shruti P.; Patel, Kajal; Pal, Bipin C.

    2015-01-01

    Spontaneous renal artery dissection is a rare but important cause of flank pain. We report a case of isolated spontaneous renal artery dissection in 56-year-old man complicated by renal infarction presented with flank pain. Doppler study pointed towards vascular pathology. Computed tomography (CT) angiography was used to make final diagnosis which demonstrated intimal flap in main renal artery with renal infarction. PMID:26090259

  10. Automatic Dissection Of Plantlets

    NASA Astrophysics Data System (ADS)

    Batchelor, B. G.; Harris, I. P.; Marchant, J. A.; Tillett, R. D.

    1989-03-01

    Micropropagation is a technique used in horticulture for generating a monoclonal colony of plants. A tiny plantlet is cut into several parts, each of which is then replanted. At the moment, the cutting is performed manually. Automating this task would have significant economic benefits. A robot designed to dissect plants would need to be equipped with intelligent visual sensing. This article is concerned with the image acquisition and processing techniques which such a machine might use. A program, which can calculate where to cut a plant with an "open" structure, is presented. This is expressed in the ProVision language, which is described in another article presented at this conference. (Article 1002-65)

  11. Spontaneous Coronary Artery Dissection.

    PubMed

    Tweet, Marysia S; Gulati, Rajiv; Hayes, Sharonne N

    2016-07-01

    Spontaneous coronary artery dissection is an important etiology of nonatherosclerotic acute coronary syndrome, myocardial infarction, and sudden death. Innovations in the catheterization laboratory including optical coherence tomography and intravascular ultrasound have enhanced the ability to visualize intimal disruption and intramural hematoma associated with SCAD. Formerly considered "rare," these technological advances and heightened awareness suggest that SCAD is more prevalent than prior estimates. SCAD is associated with female sex, young age, extreme emotional stress, or extreme exertion, pregnancy, and fibromuscular dysplasia. The clinical characteristics and management strategies of SCAD patients are different than for atherosclerotic heart disease and deserve specific consideration. This review will highlight recent discoveries about SCAD as well as describe current efforts to elucidate remaining gaps in knowledge. PMID:27216840

  12. 48 CFR 6101.2 - Filing cases; time limits for filing; notice of docketing; consolidation [Rule 2].

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Filing cases; time limits for filing; notice of docketing; consolidation . 6101.2 Section 6101.2 Federal Acquisition Regulations System CIVILIAN BOARD OF CONTRACT APPEALS, GENERAL SERVICES ADMINISTRATION CONTRACT DISPUTE CASES 6101.2 Filing cases; time limits for...

  13. 48 CFR 6101.2 - Filing cases; time limits for filing; notice of docketing; consolidation [Rule 2].

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Filing cases; time limits... Filing cases; time limits for filing; notice of docketing; consolidation . (a) Filing cases. Filing of a... machine number, and e-mail address, if available, of the contracting officer whose decision is...

  14. 48 CFR 6101.2 - Filing cases; time limits for filing; notice of docketing; consolidation [Rule 2].

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Filing cases; time limits... Filing cases; time limits for filing; notice of docketing; consolidation . (a) Filing cases. Filing of a... machine number, and e-mail address, if available, of the contracting officer whose decision is...

  15. 48 CFR 6101.2 - Filing cases; time limits for filing; notice of docketing; consolidation [Rule 2].

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Filing cases; time limits... Filing cases; time limits for filing; notice of docketing; consolidation . (a) Filing cases. Filing of a... machine number, and e-mail address, if available, of the contracting officer whose decision is...

  16. 48 CFR 6101.2 - Filing cases; time limits for filing; notice of docketing; consolidation [Rule 2].

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 7 2011-10-01 2011-10-01 false Filing cases; time limits... Filing cases; time limits for filing; notice of docketing; consolidation . (a) Filing cases. Filing of a... machine number, and e-mail address, if available, of the contracting officer whose decision is...

  17. Donors' attitudes towards body donation for dissection.

    PubMed

    Richardson, R; Hurwitz, B

    1995-07-29

    We report a survey in the UK of potential whole-body donors for dissection. 218 people (age range 19-97 years) answered a postal questionnaire, giving information about themselves, their reasons for donation, attitudes towards the dead body, funeral preferences and medical giving and receiving. In addition to altruism, motives included the wish to avoid funeral ceremonies, to avoid waste, and in a few cases, to evade the expense of a funeral. 44% understood that their bodies would be used as teaching material, 42% for experiments. Whilst 69% believed in one or more supernatural phenomena, only 39% said they were religious. 69% requested cremation after dissection; 2% wanted to be buried. The notion of money incentives to promote donation was overwhelmingly rejected. PMID:7630248

  18. [Thoracic aortic dissection revealed by systemic cholesterol embolism].

    PubMed

    Braem, L; Paule, P; Héno, P; Morand, J J; Mafart, B; La Folie, T; Varlet, P; Mioulet, D; Fourcade, L

    2006-10-01

    Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination. PMID:17078270

  19. Brachial plexus endoscopic dissection and correlation with open dissection.

    PubMed

    Lafosse, T; Masmejean, E; Bihel, T; Lafosse, L

    2015-12-01

    Shoulder endoscopy is evolving and becoming extra-articular. More and more procedures are taking place in the area of the brachial plexus (BP). We carried out an anatomical study to describe the endoscopic anatomy of the BP and the technique used to dissect and expose the BP endoscopically. Thirteen fresh cadavers were dissected. We first performed an endoscopic dissection of the BP, using classical extra-articular shoulder arthroscopy portals. Through each portal, we dissected as many structures as possible and identified them. We then did an open dissection to corroborate the endoscopic findings and to look for damage to the neighboring structures. In the supraclavicular area, we were able to expose the C5, C6 and C7 roots, and the superior and middle trunks in 11 of 13 specimens through two transtrapezial portals by following the suprascapular nerve. The entire infraclavicular portion of the BP (except the medial cord and its branches) was exposed in 11 of 13 specimens. The approach to the infraclavicular portion of the BP led directly to the lateral and posterior cords, but the axillary artery hid the medial cord. The musculocutaneous nerve was the first nerve encountered when dissecting medially from the anterior aspect of the coracoid process. The axillary nerve was the first nerve encountered when following the anterior border of the subscapularis medially from the posterior aspect of the coracoid process. Knowledge of the endoscopic anatomy of the BP is mandatory to expose and protect this structure while performing advanced arthroscopic shoulder procedures. PMID:26585998

  20. Titchener's ⊥ dissected.

    PubMed

    Landwehr, Klaus

    2015-08-01

    In three experiments, two independent samples of 12 observers each visually inspected modified versions of Titchener's ⊥ from which the T-junctions had been deleted. For Experiment 1, the ⊥'s two lines had been replaced by dashed lines not meeting in a common point; for Experiment 2, the ⊥ had been reduced to five dots, representing the original lines' end- and midpoints; and for Experiment 3 (in which the second sample of observers served), the ⊥ had been dissected into two separate lines, differently spaced from each other. Observers haptically indicated the lengths of the two orthogonal lines of the modified ⊥s and verbally judged their relative lengths or the distances between the corresponding dots. The common perceptual illusions persisted in Experiments 1 and 2, but were markedly weakened in Experiment 3. Implications for a neurophysiological account of the illusions in terms of bottom-up, long-range interactions between orientation-sensitive mechanisms versus top-down activation of a figural schema are spelled out. PMID:25893471

  1. Biomedicine: an ontological dissection.

    PubMed

    Baronov, David

    2008-01-01

    Though ubiquitous across the medical social sciences literature, the term "biomedicine" as an analytical concept remains remarkably slippery. It is argued here that this imprecision is due in part to the fact that biomedicine is comprised of three interrelated ontological spheres, each of which frames biomedicine as a distinct subject of investigation. This suggests that, depending upon one's ontological commitment, the meaning of biomedicine will shift. From an empirical perspective, biomedicine takes on the appearance of a scientific enterprise and is defined as a derivative category of Western science more generally. From an interpretive perspective, biomedicine represents a symbolic-cultural expression whose adherence to the principles of scientific objectivity conceals an ideological agenda. From a conceptual perspective, biomedicine represents an expression of social power that reflects structures of power and privilege within capitalist society. No one perspective exists in isolation and so the image of biomedicine from any one presents an incomplete understanding. It is the mutually-conditioning interrelations between these ontological spheres that account for biomedicine's ongoing development. Thus, the ontological dissection of biomedicine that follows, with particular emphasis on the period of its formal crystallization in the latter nineteenth and early twentieth century, is intended to deepen our understanding of biomedicine as an analytical concept across the medical social sciences literature. PMID:18802784

  2. Experience with parametric binary dissection

    NASA Technical Reports Server (NTRS)

    Bokhari, Shahid H.

    1993-01-01

    Parametric Binary Dissection (PBD) is a new algorithm that can be used for partitioning graphs embedded in 2- or 3-dimensional space. It partitions explicitly on the basis of nodes + (lambda)x(edges cut), where lambda is the ratio of time to communicate over an edge to the time to compute at a node. The new algorithm is faster than the original binary dissection algorithm and attempts to obtain better partitions than the older algorithm, which only takes nodes into account. The performance of parametric dissection with plain binary dissection on 3 large unstructured 3-d meshes obtained from computational fluid dynamics and on 2 random graphs were compared. It was showm that the new algorithm can usually yield partitions that are substantially superior, but that its performance is heavily dependent on the input data.

  3. Dissecting Aneurysm of the Superior Mesenteric Artery Successfully Treated by Endovascular Stent-Graft Placement

    SciTech Connect

    Ishida, Masaki Kato, Noriyuki; Hirano, Tadanori; Suzuki, Tomoaki; Shomura, Yu; Yada, Isao; Takeda, Kan

    2003-08-15

    Spontaneous and isolated dissecting aneurysm of the superior mesenteric artery is a rare event that has been successfully treated by surgery in several reported cases. To our knowledge, we present the first case of a patient with spontaneous and isolated dissecting aneurysm of the superior mesenteric artery that was successfully treated by endovascular stent-graft placement.

  4. [A case of elder gastric cancer patient who relapsed at the local stomach wall and the regional lymph node at the time of six months after endoscopic submucosal dissection (ESD)].

    PubMed

    Nasu, Keiichi; Maeshiro, Tsuyoshi; Shida, Dai; Miyamoto, Sachio; Inoue, Satoru; Umekita, Nobutaka; Ara, Kuniyoshi

    2009-11-01

    A case is a woman of 81-year-old. She was admitted to our hospital for a close examination of anemia from her family doctor. Gastroscopy revealed a 15 mm diameter of the type 0-IIa+IIc lesion at the posterior wall to the lesser curvature of the gastric body. And the biopsy of the lesion revealed a moderately differentiated adenocarcinoma (tub2). In consideration of the gastrectomy at this point, but firstly, an endoscopic submucosal dissection (ESD) was planned to perform for gaining the total pathological diagnosis of the lesion. Pathological findings revealed that the cancer cell invaded massively to submucosa (sm2), and that lymphatic permeation and venous permeation were also presented (ly2, v2). We explained it to the patient about the necessity of additional gastric resection, but she rejected the operation. So we had no choice but to observe the patient closely. Two months after the ESD, gastroscopy revealed no recurrent signs. But six months after the ESD, the local area of the stomach was revealed type 2 advanced gastric cancer, and computed tomography (CT) revealed a lymphoid swelling at the side of lesser curvature. We performed distal gastrectomy and D2 lymphoid dissection at this point. The final pathological diagnosis was T2 (ss) N2H0P0M0, Stage IIIA, based on the Japanese classification of gastric cancer. Adjuvant chemotherapy (oral fluoropylimidine) was interrupted in short period because of the side effects such as nausea, appetite loss, and diarrhea. There has been no recurrence for 1 year and six months since the operation. ESD is a minimally invasive technique and it is safe, convenient, and efficacious from the gastric functional point of view. However, the therapeutic strategies of the early gastric cancer, especially submucosally invasive gastric cancer, must be decided carefully and individually, considering the risk factors and the postoperative quality of life (QOL). PMID:20037325

  5. Laparoscopic condom dissection: new technique of retroperitoneoscopy.

    PubMed

    Gaur, D D; Agarwal, D K; Purohit, K C; Darshane, A S

    1994-04-01

    The laparoscopic condom dissection is an advancement on the recently described balloon dissection technique of retroperitoneoscopy. It allows a simultaneous balloon dissection and retroperitoneal laparoscopic dissection using a telescope placed inside a condom balloon. In spite of a mild masking effect by the balloon, the clarity of vision was satisfactory, and adequate dissection could be carried out in all five patients in whom the condom was placed deep to the fascia transversalis or Gerota's fascia. PMID:8061674

  6. Acute myocardial infarction and coronary artery dissection following rugby-related blunt chest trauma in France

    PubMed Central

    Poyet, R.; Capilla, E.; Kerebel, S.; Brocq, F. X.; Pons, F.; Jego, C.; Cellarier, G.R.

    2015-01-01

    Coronary artery (CA) dissection following blunt chest trauma is a life-threatening and rare event. Its occurrence in the setting of a contact sport like rugby is even less common. We report on two cases of young adult presenting with segment elevation myocardial infarction related to CA dissection following rugby game. Both were successfully treated with stent implantation. We discuss the mechanism, diagnosis, and optimal management of blunt chest trauma-induced CA dissection. PMID:25949042

  7. Acute Myocardial Infarction Due to Spontaneous Dissection of the Right Coronary Artery in a Young Male

    SciTech Connect

    Papadopoulos, Dimitris P. Moyssakis, Ioannis; Perakis, Alexandros; Athanasiou, Andreas; Anagnostopoulou, Sophia; Benos, Ioannis; Votteas, Vassilios E.

    2004-09-15

    Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction. We report a case of a 33-year-old male who presented with an acute inferior myocardial infarction. Coronary arteriography performed 3 hours after the episode revealed a dissection involving the middle segment of right coronary artery. Because of a spiral form of dissection and the TIMI 3 flow grade, our patient was treated medically and repeat coronary angiography 6 months later was decided.

  8. Acute myocardial infarction and coronary artery dissection following rugby-related blunt chest trauma in France.

    PubMed

    Poyet, R; Capilla, E; Kerebel, S; Brocq, F X; Pons, F; Jego, C; Cellarier, G R

    2015-01-01

    Coronary artery (CA) dissection following blunt chest trauma is a life-threatening and rare event. Its occurrence in the setting of a contact sport like rugby is even less common. We report on two cases of young adult presenting with segment elevation myocardial infarction related to CA dissection following rugby game. Both were successfully treated with stent implantation. We discuss the mechanism, diagnosis, and optimal management of blunt chest trauma-induced CA dissection. PMID:25949042

  9. Traumatic Carotid Artery Dissection: A Different Entity without Specific Guidelines

    PubMed Central

    Galyfos, George; Filis, Konstantinos; Sigala, Fragiska; Sianou, Argiri

    2016-01-01

    According to literature data, there are no distinct guidelines regarding the proper diagnostic and therapeutic management of traumatic carotid artery dissection (TCAD). Although most of cases evaluated in research studies refer to spontaneous carotid artery dissection, traumatic cases demand special considerations as far as diagnosis and treatment are concerned. Although both types of dissection share some common characteristics, a patient with TCAD usually presents with several concomitant injuries as well as a higher bleeding risk, thus complicating decision making in such patients. Therefore, aim of this review is to present available data regarding epidemiology, clinical presentation, diagnostics and treatment strategy in cases with TCAD in order to produce useful conclusions for everyday clinical practice. PMID:27051653

  10. 75 FR 73075 - Calpine Texas Pipeline, L.P.; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ... Energy Regulatory Commission Calpine Texas Pipeline, L.P.; Notice of Motion for Extension of Rate Case.... (Calpine Texas) filed a motion to extend the date for filing its next rate case to August 22, 2013. Calpine... file a motion to intervene or to protest this filing must file in accordance with Rules 211 and 214...

  11. 77 FR 12598 - Notice Correction; A Multi-Center International Hospital-Based Case-Control Study of Lymphoma in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-01

    ...-Based Case-Control Study of Lymphoma in Asia (AsiaLymph) (NCI) The Federal Register notice published on February 24, 2012 (77 FR 11136) announcing the submission to OMB of the project titled, ``A multi-center international hospital-based case-control study of lymphoma in Asia (AsiaLymph) (NCI)'' was submitted with...

  12. Dynamic aortic obstruction in a patient with acute type B dissection.

    PubMed

    Mega, Jessica L; Opotowsky, Alexander R; Curillova, Zelmira; O'Gara, Patrick T

    2006-01-01

    There are at least 7000 aortic dissections diagnosed in the United States each year. Type B dissections accounted for 38% of cases enrolled in the prospective International Registry of Aortic Dissection. We report a case of a 48-year-old hypertensive woman with an acute type B aortic dissection causing significant dynamic obstruction of the aorta. Intravascular ultrasound of her aorta revealed a mobile intimal flap nearly obliterating the true lumen with each systolic contraction. Simultaneous pressure tracings obtained from her ascending aorta and femoral artery demonstrated a systolic pressure gradient in excess of 100 mm Hg. The patient developed progressive renal failure and ultimately underwent successful operative replacement of the proximal descending thoracic aorta with a Dacron graft. In this case presentation, we highlight the unusual physiology exemplified by this case and explore contemporary management strategies for complicated type B aortic dissection, including surgery and catheter-based techniques. PMID:16628024

  13. Reconstructive endovascular treatment of ruptured vertebral artery dissection involving the posterior inferior cerebellar artery.

    PubMed

    Ota, Takahiro; Sato, Masayuki; Amano, Tatsuo; Saito, Akira; Matsumaru, Yuji

    2016-06-01

    Two cases with ruptured vertebral artery (VA) dissection involving the origin of the posterior inferior cerebellar artery (PICA) are presented. Endovascular proximal occlusion of the dissected segment proximal to the PICA origin was performed, leaving the PICA patent in the acute stage. Stent placement from the PICA to the VA through the contralateral VA and coil embolization were added to the residual dissection in the chronic stage. Rebleedings were not observed. This is the first report of a staged, combined strategy for the treatment of a ruptured PICA involving VA dissection, which enabled preservation of the PICA without bypass surgery. PMID:27038168

  14. Ischemia-reperfusion injury in an aortic dissection patient.

    PubMed

    Yin, Zhuo; Yang, J R; Wei, Y S; Liang, B L; Wei, Y B; Zhou, K Q; Wang, Z; Yan, B; Gao, Y L

    2015-07-01

    Aortic dissection is a life-threatening emergency. Well-established risk factors include systemic hypertension, hereditary connective tissue diseases (Marfan syndrome and Ehlers-Danlos syndrome), coarctation of the aorta, bicuspid aortic valve, aortitis, and arch hypoplasia. Ischemia of the viscera, the kidneys, the spinal cord, or the lower extremities due to malperfusion constitutes life-threatening complications that have to be considered in the treatment strategy.We report a rare case of symptomatic ischemia of the lower extremities due to aortic dissection. This case demonstrates that the treating physician needs to be vigilant for ischemia reperfusion injuries such as osteofascial compartment syndrome and acute renal failure in aortic dissection. PMID:25667158

  15. [Could apoptosis be contributed to the occurrence of aortic dissection?].

    PubMed

    Shirasawa, B; Hamano, K; Kobayashi, T; Kawamura, T; Gohra, H; Katoh, T; Fujimura, Y; Zempo, N; Esato, K

    2000-03-01

    This clinical study was conducted to determine whether apoptosis is contributed to the occurrence of aortic dissection. The subjects comprised 11 patients who underwent Stanford type A aortic dissection and 4 autopsy cases, being the control group. The occurrence of apoptosis was determined by the TUNEL assay using an aortic wall specimen, and the distribution of macrophages and h-MMP-9 was examined by immunohistological staining. Apoptotic cells were observed in the aortic specimens for all of the 11 patients who underwent Standford type A aortic dissection, but not in any of the 4 autopsy cases. Moreover, apoptotic cells were present in large numbers on the surface of the false lumen strongly in 8 patients who underwent surgery within 1 month after aortic dissection, but not in 3 who underwent treatment after than 1 month. Those phenomena were also observed in the immunohistological staining of CD 68 and h-MMP-9. These findings indicate that apoptosis could be contributed to the occurrence of aortic dissection. PMID:10714110

  16. Virtual reality haptic human dissection.

    PubMed

    Needham, Caroline; Wilkinson, Caroline; Soames, Roger

    2011-01-01

    This project aims to create a three-dimensional digital model of the human hand and wrist which can be virtually 'dissected' through a haptic interface. Tissue properties will be added to the various anatomical structures to replicate a realistic look and feel. The project will explore the role of the medical artist and investigate the cross-discipline collaborations required in the field of virtual anatomy. The software will be used to train anatomy students in dissection skills before experience on a real cadaver. The effectiveness of the software will be evaluated and assessed both quantitatively as well as qualitatively. PMID:21335827

  17. Open surgery with frozen elephant trunk for the treatment of proximal stent graft-induced new entry in type B aortic dissection: a case report.

    PubMed

    Ren, Changwei; Xu, Shangdong; Lai, Yongqiang; Zheng, Jun; Sun, Lizhong

    2015-08-01

    Stent graft-induced new entry (SINE) is an infrequent complication, but high mortality rates have been observed after thoracic endovascular aortic repair. New entry after a stent-graft implantation of 50 mm is rare. To our knowledge, this article is the first-reported case of the surgical management of SINE after a large stent-graft implantation. PMID:26028462

  18. Symptomatic Internal Carotid Artery Dissecting Pseudoaneurysm: Endovascular Treatment by Stent-Graft

    SciTech Connect

    Heye, Sam Maleux, Geert; Vandenberghe, Rik; Wilms, Guido

    2005-05-15

    Dissecting pseudoaneurysm of the extracranial portion of the internal carotid artery (ICA) is a usually benign complication of spontaneous ICA dissection. We report a case in which pseudoaneurysm volume enlarged progressively and new clinical symptoms developed 9 months following disease onset. Placement of a coronary stent-graft resulted in immediate complete resolution of clinical symptoms and radiologic restoration of normal flow.

  19. Aortic tear and dissection related to connective tissues abnormalities resembling Marfan syndrome in a Great Dane.

    PubMed

    Lenz, Jennifer A; Bach, Jonathan F; Bell, Cynthia M; Stepien, Rebecca L

    2015-06-01

    Aortic tears and acute aortic dissection are rarely reported in dogs. This report describes a case of aortic dissection and probable sinus of Valsalva rupture in a young Great Dane with associated histopathologic findings suggestive of a connective tissue abnormality. PMID:25890485

  20. Rare Complication of Takotsubo Cardiomyopathy: Ventricular Septal Perforation with Septal Dissection.

    PubMed

    Miyake, Keisuke; Funatsu, Toshihiro; Kondoh, Haruhiko; Taniguchi, Kazuhiro

    2016-03-01

    We describe a rare case of takotsubo cardiomyopathy complicated by acute ventricular septal perforation with ventricular septal dissection. The ventricular perforation was successfully closed by repairing the dissecting site with a bovine pericardial patch. doi: 10.1111/jocs.12676 (J Card Surg 2016;31:150-153). PMID:26632246

  1. Relative Afferent Pupillary Defect: An Unusual Manifestation of Carotid Artery Dissection

    PubMed Central

    Lazar, David; Rodman, Adam; Vidal, Gabriel

    2012-01-01

    We report the case of a man with a carotid dissection who had relative afferent pupillary defect (RAPD) that persisted throughout his hospital course. Other causes for RAPD were quickly ruled out. Carotid dissections often have ophthalmic manifestations—including RAPD, which, although uncommon as a presenting sign, can be tested for with the swinging flashlight test. PMID:22778685

  2. Acute aortic dissection mimicking acute abdomen in a 14-year-old boy.

    PubMed

    Besli, Gulser Esen; Durakbasa, Cigdem Ulukaya; Yildirim, Sema; Acar, Murat; Cakir, Busra

    2015-12-01

    Aortic dissection is extremely rare in children. Although it usually presents with severe chest pain, atypical clinical presentations mimicking various illnesses may cause misdiagnosis. In this report, the case of a 14-year-old boy with symptoms suggestive of acute abdomen, which was finally diagnosed as aortic dissection, is discussed. PMID:26420506

  3. Gallium localization in dissecting aortic aneurysm

    SciTech Connect

    Haden, H.T.; Lippman, H.R.

    1988-08-01

    Gallium concentration was demonstrated in a dissecting aneurysm of the aortic arch, imaged approximately 2 weeks after dissection. Concentration of gallium was apparently due to the inflammatory reaction associated with the organizing intramural hematoma.

  4. Dissect Your Squid and Eat It Too!

    ERIC Educational Resources Information Center

    McGinnis, Patricia

    2001-01-01

    Introduces a science lab activity in which students dissect fresh squids in groups of four and observe the anatomy. Parent volunteers cook the squid mantle for kids to taste. Includes directions for squid dissection. (YDS)

  5. Animal Rights Activism Threatens Dissection.

    ERIC Educational Resources Information Center

    Holden, Constance

    1990-01-01

    Discussed is the movement against the use of dissections in science laboratories. Examples of protests across the United States are included. Compared is the plight of using animals in a biology classroom and the demise of the teaching of evolution in some areas. (KR)

  6. Dissection & Science Fairs. [Information Packet.

    ERIC Educational Resources Information Center

    National Anti-Vivisection Society, Chicago, IL.

    This collection of pamphlets and articles reprinted from other National Anti-Vivisection Society (NAVS) publications was compiled to address the issues of classroom laboratory dissection and the use of animals in science fair projects. Three of the pamphlets contained in this packet are student handbooks designed to help students of elementary,…

  7. Isolated middle cerebral artery dissection: a systematic review.

    PubMed

    Asaithambi, Ganesh; Saravanapavan, Pradeepan; Rastogi, Vaibhav; Khan, Sheema; Bidari, Sharatchandra; Khanna, Anna Y; Ganti, Latha; Qureshi, Adnan I; Hedna, Vishnumurthy Shushrutha

    2014-01-01

    Acute stroke can be missed in the emergency department, particularly in younger patients and in those with more vague symptoms such as headache or dizziness. Cervicocephalic dissections are one group of etiologies for acute stroke in the young. While cervicocephalic dissections are not uncommon in clinical practice, isolated middle cerebral artery dissection (MCAD) has been rarely reported as a cause for stroke. We sought to review the clinical implications and pathophysiology of an isolated MCAD. We searched the medical literature for isolated MCAD in clinical stroke patients using MEDLINE, HighWire, and Google Scholar databases from 1966 to 2013 using the keywords 'middle cerebral artery dissection,' 'intracerebral artery dissection,' and 'middle cerebral artery dissection stroke.' We reviewed cases to learn various characteristics of isolated MCAD. A total of 61 cases (62.3% male, mean age 44.16??19.17 years) were reviewed from 54 publications. Most cases were reported from Asian countries (78.7%). Ischemic strokes were more common than hemorrhagic strokes (68.9%). Digital subtraction angiography was the most common imaging modality used to diagnose isolated MCAD (75.4%). Surgery was the preferred form of therapeutic intervention (39.3%). Males (n?=?27/48, p?=?0.0008) and those who presented with only ischemic syndromes (n?=?22/48, p?=?0.0009) had significantly higher rates of favorable outcome. Isolated MCAD is a rare disease that can contribute to the stroke burden of young patients. Further studies are needed to better characterize optimal treatment strategies and define outcomes for this rare condition. PMID:25593617

  8. Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

    PubMed Central

    Ashraf, Mohamed C; Singh, Sankalp; Raj, Dharma; Ramakrishnan, Sujatha; Esteves, Sandro C

    2013-01-01

    CONTEXT: Non-obstructive azoospermia (NOA) is an unfavorable prognostic condition for male infertility since spermatogenesis is disrupted. Sperm retrieval (SR) coupled with intracytoplasmic sperm injection (ICSI) is the only option for men with NOA who seek fertility. Among the SR techniques, microdissection testicular sperm extraction (micro-TESE) has been applied with encouraging results. AIMS: We describe how we implemented the micro-TESE procedure and present initial micro-TESE experience in a group of men with NOA and poor prognosis for SR. SETTINGS AND DESIGN: Case series of men with NOA treated in a tertiary healthcare center. MATERIALS AND METHODS: An Assisted Reproductive Technology (ART) facility was setup to perform SR using microsurgery. Fourteen men with NOA and previous failed retrievals or unfavorable histologic results underwent micro-TESE while their female partners received ovarian stimulation for oocyte pickup (OCP). Micro-TESE was performed the day prior to OCP and testicular sperm were used for sperm injections. We assessed retrieval rates and ICSI outcomes. STATISTICAL ANALYSIS: Outcomes of SR and ICSI were analyzed descriptively. Mann-Whitney and Fisher exact test were used to compare characteristics of men with successful and failed SR. RESULTS: The success of micro-TESE was 50.0% with no major complications. A clear microscopic distinction between enlarged and collapsed seminiferous tubules was seen in 35.7% of the cases, and sperm were retrieved in all but one of these cases. Patients with successful and failed retrieval did not differ with respect to baseline characteristics, use of medical therapy, presence of varicocele, and testicular histology. Sperm injections resulted in normal fertilization and embryo cleavage of 64% and 75%, respectively. A total of five transfers with an average of 1.5 embryos resulted in a cumulative clinical pregnancy rate per ICSI cycle of 28.6%, with an implantation rate of 33.3%. CONCLUSIONS: We were successful in integrating the micro-TESE procedures to the in vitro fertilization (IVF) laboratory. Our initial experience with micro-TESE applied to the most difficult cases of azoospermia is reassuring. PMID:24082652

  9. Evaluation of Educator & Student Use of & Attitudes toward Dissection & Dissection Alternatives

    ERIC Educational Resources Information Center

    Osenkowski, Pamela; Green, Che; Tjaden, Anne; Cunniff, Peggy

    2015-01-01

    Animal dissection has been routinely practiced in American biology classrooms for decades. With technological advancements, more states adopting student choice measures, and increased awareness about ethical concerns surrounding dissection, many useful dissection alternatives have been developed. To understand the current use of animal dissection

  10. External iliac artery dissection causing early renal transplant dysfunction

    PubMed Central

    Lee, Gwyn; Barlow, Adam; Doughman, Tahir; Nicholson, Michael L

    2014-01-01

    External iliac artery dissection after kidney transplantation is a rare, catastrophic but potentially reversible complication. Treatment which may save both the transplant and the patient requires clinical suspicion, timely imaging, and prompt intervention. This case report describes successful diagnosis of this complication and surgical intervention which saved the kidney and safeguarded blood supply to the patient's leg. PMID:24695666

  11. A sinister cause of anterograde amnesia: painless aortic dissection.

    PubMed

    April, Michael D; Fossum, Kurt; Hounshell, Charles; Stolper, Katherine; Spear, Leigh; Semelrath, Kevin

    2015-07-01

    Aortic dissection is a frequently devastating diagnosis classically associated with severe chest pain.We present a case of painless aortic dissection with anterograde amnesia. An 84-year-old man was brought to the emergency department by ambulance, when his wife noted that he developed acute onset complete loss of short-term memory. Medical history was notable for a 4.5-cm fusiform thoracic aortic root aneurysm. On arrival,he denied pain or syncope.On examination, he was mildly hypotensive(110/59 mm Hg); and there were no murmurs, pulse deficits, or focal neurologic deficits. During his stay, he developed left flank pain. Chest radiography demonstrated subtle mediastinal widening and obscuration of the aortic knob compared with previous films. Computed tomography revealed an extensive intimal flap consistent with an aortic dissection involving the sinus of Valsalva and left renal artery. The patient subsequently developed acute onset chest pain after which he became unresponsive. Echocardiography demonstrated tamponade physiology.The family decided to transition to comfort care measures, and the patient died soon after.We identified 7 other cases in the literature of aortic dissection cases with presentations consistent with transient global amnesia,5 of which without neurologic deficits and 3 of which without pain. This case highlights the imperative of a thorough history and high index of suspicion for this catastrophic diagnosis in patients with transient global amnesia who otherwise might be expected to have an excellent prognosis and little need for diagnostic work-up. PMID:25649752

  12. Apathetic syndrome from carotid dissection: a dangerous condition

    PubMed Central

    Gerace, Carmela; Corsi, Fabio Massimo; Comanducci, Giovanna

    2013-01-01

    Isolated behavioural disturbances can mimic psychiatric diseases and delay diagnosis of acute brain disease. We reported the case of a patient with carotid dissection manifesting only with apathetic syndrome that was initially considered as a possible postpartum depression, causing a threatening diagnostic delay. PMID:24000207

  13. Hybrid treatment of aortic dissection associated with Kommerell's diverticulum.

    PubMed

    Kozlov, Boris N; Panfilov, Dmitry S; Saushkin, Victor V; Shipulin, Vladimir M

    2016-06-01

    This clinical case demonstrates a successful simultaneous approach for Type B aortic dissection in association with Kommerell's diverticulum using an E-vita OPEN PLUS Hybrid prosthesis. Computed tomography in the early postoperative period and after a 6-month follow-up showed favourable surgical outcomes. PMID:26921885

  14. Hi-Tech Alternatives to Dissection.

    ERIC Educational Resources Information Center

    Strauss, Richard T.; Kinzie, Mable B.

    1991-01-01

    The debate on the educational value of dissection versus the value of animal life is examined. Interactive videodisc (IVD) technology is described in light of its potential for laboratory simulations. The design of the IVD-based dissection simulation, The Interactive Frog Dissection, is presented. (KR)

  15. A Dissecting Competition for Medical Students

    ERIC Educational Resources Information Center

    Samalia, Latika; Stringer, Mark D.

    2012-01-01

    After repeated requests from medical students for more cadaver dissection opportunities, a voluntary dissecting "competition" was initiated for the third year medical students in 2006. This has been held annually on five occasions since, offering up to 30 dissection stations and accommodating an average of 53 students (range 40-66) per year,…

  16. 78 FR 41070 - Notice of Single-Case Deviation from Competition Requirements: Transfer of Grantee Request for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-09

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Notice of Single-Case Deviation from... AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services...

  17. Symptomatic middle cerebral artery dissection in a young tennis player.

    PubMed

    Abe, Arata; Nishiyama, Yasuhiro; Kamiyama, Hiroyasu; Kitahara, Isao; Katsura, Ken-ichiro; Katayama, Yasuo

    2009-08-01

    No information has been available regarding middle cerebral artery (MCA) dissection occurring as a result of athletics. We describe a case of cerebral infarction in the right MCA region that occurred in young, right-handed tennis player while he was serving. Angiography with a contrast medium and a 3-dimensional rotational system revealed proximal M2 stenosis, and emergency superficial temporal artery-MCA anastomosis was performed. As a result, the patient showed a complete recovery and resumed all activities of daily life, including playing tennis. Because sports such as tennis, in which players vigorously swing their heads while serving, could lead to intracranial artery dissection, we advise that the possibility of MCA dissection should be considered in athletes with certain neurological symptoms, including headache. PMID:19755796

  18. Spontaneous coronary artery dissection: the management dilemma continues.

    PubMed

    Ahmed, Zaheer; Bajwa, Ata; Bhardwaj, Bhaskar; Laster, Steven B; Magalski, Anthony

    2015-01-01

    Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of acute coronary syndrome, particularly in women. A 36-year-old Caucasian woman presented to our hospital with sudden onset chest pain and was diagnosed with a non-ST elevation myocardial infarction. Coronary angiography revealed mid and distal left anterior descending artery (LAD) dissection with distal LAD occlusion. A short segment of apical LAD filled late with incomplete opacification (Thrombolysis In Myocardial Infarction (TIMI) 1 flow). A decision was made to treat the patient conservatively, with subsequent resolution of dissection over the next 3 months. Our patient made a good clinical recovery with healing of her affected coronary vasculature on subsequent angiogram. The case illustrates that SCAD can be managed conservatively with antiplatelet agents, β-blockers, heparin and statins, if the patient is haemodynamically stable and coronary flow is adequate. PMID:26272965

  19. NSAID-induced pyloric stenosis leading to oesophageal intramucosal dissection.

    PubMed

    Tey, Kai Rou; Kemmerly, Thomas; Banerjee, Bhaskar

    2016-01-01

    We describe a rare case of a 75-year-old woman with significant non-steroidal anti-inflammatory drug (NSAID) use who presented with haematemesis. Upper endoscopy revealed a large (9 cm) intramucosal dissection of the oesophagus without extension into the gastro-oesophageal junction and a severely narrowed pylorus. We postulate that she developed pyloric stenosis due to peptic ulcer disease from chronic NSAID use. This then led to gastro-oesophageal reflux. Undigested pills in the refluxate had contacted oesophageal mucosa, leading to pill-induced oesophageal injury. This, along with vomiting, is postulated to have led to the oesophageal intramucosal dissection. She improved with conservative medical management with a clear liquid diet and proton pump inhibitors, and a follow-up upper endoscopy 1 week later showed recovery of the previously seen intramucosal dissection. PMID:27199442

  20. Crile's neck dissection.

    PubMed

    Silver, Carl E; Rinaldo, Alessandra; Ferlito, Alfio

    2007-11-01

    George Crile, after a long experience with treatment of head and neck cancer and study of a large number of cases, appreciated that these tumors almost always drained through the lymphatic pathways of the neck, rarely metastasized distantly, and were thus theoretically curable by resection of the primary tumor and its lymphatic draining shed. After evaluation of his early failures, he found that a block resection of all of the lymph node-bearing tissue of the neck in addition to resection of the primary tumor was the most effective means of obtaining a cure, particularly in patients with clinical evidence of spread of disease to the neck. Such radical surgery, at the time, was fraught with difficulty because of the lack of blood transfusion, antibiotics, and endotracheal anesthesia, but Crile devised several strategies for combating these obstacles. Crile performed 36 such block resections with a determinate 3-year survival of 75% compared with 19% 3-year survival in patients who had not undergone block resection. The surgical precepts developed by Crile laid the foundation for the effective modern surgical treatment of head and neck cancer. PMID:17828045

  1. Spontaneous retraction of an intramyocardial dissecting hemorrhage and multiple left ventricular thrombus formations in subacute myocardial infarction and antiphospholipid syndrome: a case report with long-term follow-up.

    PubMed

    Bahlmann, Edda; Schneider, Carsten; Vitali Serdoz, Laura; Hoffmann-Riem, Martin; Broemel, Thomas; Kuck, Karl-Heinz

    2006-05-01

    This report describes a 68-year-old patient with a subacute myocardial infarction and antiphosholipid syndrome. He developed an intramyocardial dissecting hemorrhage involving the left ventricular apex and multiple left ventricular thrombus formations, documented by contrast echocardiography and magnetic resonance imaging. By use of transthoracic echocardiography, spontaneous retraction of the dissecting hemorrhage could be detected. Severe coronary 3-vessel disease was successfully treated by coronary artery bypass grafting. During follow-up of 16 months, the dissecting hematoma could not been detected. Under initiation of anticoagulant treatment with Coumadin, the patient was in stable clinical condition and improved in New York Heart Association class from III to II. The pathophysiology, diagnosis, and management of this potentially highly lethal complication is reviewed. PMID:16644445

  2. Management Strategy of Isolated Spontaneous Dissection of the Superior Mesenteric Artery

    PubMed Central

    Takase, Shinya; Seto, Yuki; Yokoyama, Hitoshi; Gotoh, Mitsukazu; Kogure, Michihiko; Midorikawa, Hirofumi; Saito, Tomiyoshi; Maehara, Kazuhira

    2014-01-01

    Objective: Isolated spontaneous dissection of the superior mesenteric artery (SMA) is very rare among of the visceral artery dissection and its treatment is not established. In this paper we present our experiences and consider the treatment of isolated SMA dissection. Methods: A retrospective review of our cases from 2005 was performed. Clinical symptoms, radiologic findings and results were evaluated. There were 14 cases of visceral artery dissection, in which all cases were with SMA dissection. There were 12 males and 2 females with a mean age of 57 years (range 41–78 years). Results: We categorized SMA dissection into the six types according to the Sakamoto’s and Zerbib’s classification. One patient with type VI underwent emergent endovascular surgery with stent. One patient with type VI received thrombectomy and intimectomy with open surgery. One patient with type II underwent aneurysmectomy due to enlarged dissected SMA 3 months later from onset. The other eleven patients were managed conservatively. At follow-up, the diameter of SMA did not enlarged and the length of the dissection significantly decreased to 20.7 ± 15.7 mm from 38.0 ± 15.1 mm at onset (p <0.01). After treatment, imaging indicated the following changes in classification: type I, one patient; type II, 4 patients; type IV, 4 patients; complete remodeling, one patient, all without any event during the follow-up period of 5–82 months. Conclusion: Most patients with isolated visceral artery dissection occurred in superior mesenteric artery and can be treated conservatively; however, endovascular or surgical procedures including laparotomy are indicated when there is suspicion of severe mesenteric ischemia. Because the dissection configuration will change, long term follow-up is necessary. (*English translation of Jpn J Vasc Surg 2013; 22: 695-701) PMID:25298823

  3. Stent-assisted coil embolization for anterior cerebral artery dissection presented with cerebral infarction

    PubMed Central

    Iwasaki, Mitsuhiro; Hattori, Itaro; Sasaki, Makoto; Ishimori, Hisatsugu; Nemoto, Akihiro; Hikita, Chiyoe; Sato, Junko; Fukuta, Shinya; Morimoto, Masafumi

    2015-01-01

    Background: Compared to those found in the vertebrobasilar system, intracranial dissection in the anterior circulation is relatively rare, especially in the anterior cerebral artery (ACA). Moreover, only several cases of ACA dissection that underwent endovascular treatment have been reported. Here we present a rare case of gradually developing ACA dissecting aneurysm causing cerebral infarction, successfully treated by stent-assisted coil embolization. Case Description: A 36-year-old man was admitted with sudden right hemiparesis. Diffusion-weighted magnetic resonance (MR) imaging showed cerebral infarction in the left ACA territory, and MR angiography showed segmental stenosis at the A2 portion of the left ACA. Three-dimensional digital subtraction angiogram showed segmental dilatation and stenosis at the left A2 portion. We diagnosed ACA dissection causing acute cerebral infarction and treated the patient conservatively. Five months after the onset, the dissecting artery at the left A2 portion formed a gradually dilating aneurysm, suggesting increased risk for aneurysmal rupture. We attempted endovascular treatment entailing coil embolization of an aneurysm while preserving the left A2 with stent assistance. The patient remained neurologically stable 6 months after the procedure. Conclusions: Although there are few reported cases of ACA dissection where endovascular treatment was attempted, we consider stent-assisted embolization for gradually developing ACA dissecting aneurysm as an alternative method to prevent bleeding and recurrent infarction. PMID:26677416

  4. A dissecting competition for medical students.

    PubMed

    Samalia, Latika; Stringer, Mark D

    2012-01-01

    After repeated requests from medical students for more cadaver dissection opportunities, a voluntary dissecting "competition" was initiated for the third year medical students in 2006. This has been held annually on five occasions since, offering up to 30 dissection stations and accommodating an average of 53 students (range 40-66) per year, representing about 20-25% of the total class. Material is standardized to distal upper or lower limb specimens, each of which is dissected by one or two students during a single weekend day. Participants are required to complete their dissection in about six hours and present an appropriately labeled display together with a 300 word abstract, emphasizing clinical relevance. Dissections are judged on presentation, accuracy of identification and labeling, and relevance to the clinical abstract, taking into account the technical difficulty of the particular dissection. Judging from successive annual uptake of places and informal feedback, this is not only a popular event allowing students to focus creatively on producing a clinically relevant dissection in a relaxed learning environment but also of educational value. An unexpected outcome has been the production of many specimens suitable as prosections for future classes. A dissecting competition may be a useful method of stimulating learning for medical students interested in undertaking further dissection but it requires appropriate staff commitment and a supply of suitable cadaver specimens. PMID:22213677

  5. Spontaneous Subclavian Artery Dissection Causing Ischemia of the Arm: Diagnosis and Endovascular Management

    SciTech Connect

    Ananthakrishnan, Ganapathy Bhat, Rajesh; Zealley, Ian

    2009-03-15

    Spontaneous subclavian artery dissections are rare, with very few cases described in the literature. We report an unusual case of a 62-year-old female who presented with ischemia of the left arm secondary to spontaneous dissection of the first part of the left subclavian artery. We describe the imaging findings on both aortic arch angiogram and CT angiogram and discuss management by endovascular means.

  6. Chemical Genetics in Dissecting Membrane Glycerolipid Functions.

    PubMed

    Chevalier, Florian; Carrera, Laura Cuyàs; Nussaume, Laurent; Maréchal, Eric

    2016-01-01

    Chemical genetics has emerged as a powerful approach to dissect biological processes, based on the utilization of small molecules disturbing the function of specific target proteins. By analogy with classical genetics, 'reverse chemical genetics' refers to the utilization of drugs acting on a known target, enabling its functional characterization at the levels of the cells, tissues and organisms. Likewise, 'direct chemical genetics' refers to the utilization of a drug of unknown mode of action, but triggering a phenotype of interest. In that case, one has to identify the target(s) possibly blocked (or possibly activated) by the small molecule. This chapter illustrates both approaches, like the analysis of the elongation of fatty acids, the biosynthesis of galactoglycerolipids or the catabolism of phosphoglycerolipids by reverse chemical genetics or the study of the membrane glycerolipid remodeling triggered upon phosphate starvation, by direct chemical genetics. PMID:27023235

  7. Endoscopic submucosal tunnel dissection salvage technique for ulcerative early gastric cancer

    PubMed Central

    Choi, Hyuk Soon; Chun, Hoon Jai; Seo, Min Ho; Kim, Eun Sun; Keum, Bora; Seo, Yeon Seok; Jeen, Yoon Tae; Lee, Hong Sik; Um, Soon Ho; Kim, Chang Duck; Ryu, Ho Sang

    2014-01-01

    Endoscopic submucosal dissection is an effective treatment modality for early gastric cancer (EGC), though the submucosal fibrosis found in ulcerative EGC is an obstacle for successful treatment. This report presents two cases of ulcerative EGC in two males, 73- and 80-year-old, with severe fibrosis. As endoscopic ultrasonography suggested that the EGCs had invaded the submucosal layer, the endoscopic submucosal tunnel dissection salvage technique was utilized for complete resection of the lesions. Although surgical gastrectomy was originally scheduled, the two patients had severe coronary heart disease, and surgeries were refused because of the risks associated with their heart conditions. The endoscopic submucosal tunnel dissection salvage technique procedures described in these cases were performed under conscious sedation, and were completed within 30 min. The complete en bloc resection of EGC using endoscopic submucosal tunnel dissection salvage technique was possible with a free resection margin, and no other complications were noted during the procedure. This is the first known report concerning the use of the endoscopic submucosal tunnel dissection salvage technique salvage technique for treatment of ulcerative EGC. We demonstrate that endoscopic submucosal tunnel dissection salvage technique it is a feasible method showing several advantages over endoscopic submucosal dissection for cases of EGC with fibrosis. PMID:25083097

  8. Evaluation of Educator & Student Use of & Attitudes toward Dissection & Dissection Alternatives

    ERIC Educational Resources Information Center

    Osenkowski, Pamela; Green, Che; Tjaden, Anne; Cunniff, Peggy

    2015-01-01

    Animal dissection has been routinely practiced in American biology classrooms for decades. With technological advancements, more states adopting student choice measures, and increased awareness about ethical concerns surrounding dissection, many useful dissection alternatives have been developed. To understand the current use of animal dissection…

  9. Delayed Intestinal Ischemia after Surgery for Type A Acute Aortic Dissection

    PubMed Central

    Kato, Yasuyuki; Motoki, Manabu; Takahashi, Yosuke; Nishimura, Shinsuke; Shibata, Toshihiko

    2015-01-01

    We report a rare case of delayed intestinal ischemia after total arch replacement for type A acute aortic dissection. At the onset of acute aortic dissection, computed tomography (CT) angiography revealed celiac trunk occlusion and progressive dissection into the superior mesenteric artery without stenosis. However, following total arch replacement, visceral malperfusion was not detected by exploratory laparotomy. On postoperative day 12, the patient developed paralytic ileus without an elevated lactate level. CT angiography revealed new superior mesenteric artery stenosis by a thrombosed false lumen with persistent celiac trunk occlusion. Endovascular treatment including stent implantation resolved intestinal ischemia. PMID:26421078

  10. Unexpected Delayed Colon Perforation after the Endoscopic Submucosal Dissection with Snaring of a Laterally Spreading Tumor

    PubMed Central

    Ko, Young Bo; Lee, Jeong-Mi; Kim, Wan Soo; Kwak, Min Seob; Lee, Ji Wan; Shin, Dong Yeol; Yang, Dong-Hoon; Byeon, Jeong-Sik

    2015-01-01

    Colonic perforation may occur as a complication of diagnostic and therapeutic colonoscopy. The risk factors for perforation after colorectal endoscopic submucosal dissection (ESD) include an inexperienced endoscopist, a large tumor size, and submucosal fibrosis. The mechanisms of perforation include unintended endoscopic resection/dissection and severe thermal injury. Here, we report a case of colon perforation that occurred after ESD with snaring of a laterally spreading tumor. The perforation was completely unexpected because there were no colorectal ESD-associated risk factors for perforation, deep dissection, or severe coagulation injury in our patient. PMID:26668808

  11. Axillary Artery Cannulation in Acute Aortic Dissection: A Word of Caution.

    PubMed

    Baek, Wan Ki; Kim, Young Sam; Lee, Mina; Yoon, Yong Han; Kim, Joung Taek; Lim, Hyun Kyung

    2016-04-01

    Arterial cannulation into the right axillary artery is a commonly adopted perfusion strategy in the treatment of acute aortic dissection. Here we describe our experience of accidentally cannulating the axillary artery in a case of acute aortic dissection with an aberrant right subclavian artery, which was missed preoperatively because its proximal segment was malperfused by the dissection and thereby not enhanced. The rapid hemodynamics collapse at the start of the bypass was reversed by prompt switching to femoral perfusion. Postoperative follow-up computed tomographic angiography revealed a well-perfused right aberrant subclavian artery. Surgeons should be aware of an aortic arch anomaly whenever performing an axillary artery cannulation. PMID:27000577

  12. Successful Aorta-osteal Stenting after Iatrogenic Acute Type-A Aortic Dissection during Primary Percutaneous Coronary Intervention

    PubMed Central

    Bekler, Adem; Özeren, Ali; Gazi, Emine; Temiz, Ahmet; Altun, Burak

    2014-01-01

    Background: Iatrogenic acute dissection of the ascending aorta following coronary angiography and percutaneous intervention is rare. This complication, if not managed urgently, can have critical results. Case Report: We present the case of a 70 year-old woman who was treated by primary percutaneous coronary intervention (PCI) of the right coronary artery (RCA) for acute inferior myocardial infarction; however, the procedure was complicated by anterograde dissection of the RCA with a simultaneous retrograde propagation to the proximal part of the ascending aorta. Successful stenting of the entry point was able to heal the RCA and restrict the retrograde propagation to the ascending aorta. The aortic dissection was monitored by means of computerised tomography and the dissection repaired itself spontaneously within a day. Conclusion: Treatment of the aorta coronary dissection (ACD) by urgent osteal stenting is a less invasive treatment compared with surgical treatment in appropriate cases. We demonstrated that immediate osteal stenting should be performed in ACD. PMID:25667792

  13. Fatal spontaneous dissection of a Contegra conduit in a child.

    PubMed

    Weldin, Joshua D; Kapur, Raj P; Lewin, Mark B; McMullan, David Michael

    2015-03-01

    The Contegra bovine jugular vein conduit (Medtronic, Minneapolis, MN) is one of the most widely used grafts for surgical reconstruction of the right ventricular outflow tract in both pediatric and adult patients with congenital heart disease. In this report, we describe a case of acute dissection of a neointimal peel in a Contegra conduit resulting in conduit stenosis and death of a child. PMID:25742831

  14. A sneeze: an unusual trigger for aortic dissection

    PubMed Central

    Upadhyaya, Subramanya G N; Large, A

    2013-01-01

    We describe a rare case of type B thoracic aortic dissection resulting from a forceful sneeze in a 57-year-old man. The presenting clinical features were not typical and consisted of pleuritic chest pain and breathlessness following a forceful sneeze. There was no haemodynamic compromise. The diagnosis was made incidentally when he underwent a CT pulmonary angiography as part of pulmonary embolism work-up. PMID:24302662

  15. Corticosteroids and Spontaneous Coronary Artery Dissection: A New Predisposing Factor?

    PubMed

    Keir, Michelle L; Dehghani, Payam

    2016-03-01

    We describe the case of a 39-year-old woman with spontaneous coronary artery dissection (SCAD) of the left circumflex artery. We postulate that her SCAD was precipitated by high-dose corticosteroid use for the treatment of optic neuritis. The epidemiology and known risk factors of SCAD are reviewed with an additional focus on the effect of corticosteroids on the cardiovascular system. PMID:26483092

  16. When does a D-dimer test help make the diagnosis of aortic dissection?

    PubMed Central

    Karagöz, Arif; Akyol, Pinar Yeşim

    2013-01-01

    We present a case of an 84-year-old woman who presented with vague abdominal discomfort and syncope secondary to a type A acute aortic dissection. In pursuit of the diagnosis, multiple tests were ordered after the history and physical exam were complete. When the D-dimer levels were reported to be high, a bedside transthoracic ultrasound was performed which showed dilated aortic root and pericardial tamponade, leading us to order a computerized tomography to confirm the diagnosis of acute aortic dissection. A diagnostic testing algorithm being used in our institution using D-dimer, ultrasound, and other tests are provided in patients presenting with possible acute aortic dissection. In this case, bedside ultrasound helped us to rapidly make the diagnosis of acute aortic dissection and arrange for further inpatient care. PMID:24381739

  17. Monotherapy with stenting in subarachnoid hemorrhage (SAH) after middle cerebral artery dissection.

    PubMed

    Puri, Ajit S; Gounis, Matthew J; Massari, Francesco; Howk, Mary; Weaver, John; Wakhloo, Ajay K

    2016-04-01

    Isolated middle cerebral artery dissection is a rare clinical entity, with descriptions limited to a few case reports and case series. Symptomatic dissection in the anterior circulation can present as an ischemic stroke in a young population; however, it is rarely associated with subarachnoid hemorrhage. We describe a young patient who presented with acute headache from a subarachnoid hemorrhage that was ultimately determined to be due to a vascular dissection in the middle cerebral artery. The initial angiogram showed vascular irregularities in this area with stenosis. Repeat imaging 4 days after presentation identified a pseudoaneurysm proximal to the stenosis. The patient was successfully treated with a self-expanding nitinol stent and followed up with serial angiography during postoperative recovery in the hospital; additional angiograms were performed approximately 1 and 6 months after treatment. Serial angiograms demonstrated incremental healing of the dissection. The patient was discharged and remains neurologically intact at the 6-month follow-up. PMID:25854687

  18. Keeping Dissection Alive for Medical Students

    ERIC Educational Resources Information Center

    Chambers, James; Emlyn-Jones, Daniel

    2009-01-01

    Traditional dissection teaching is being reduced in a number of medical schools, particularly in the United Kingdom. In response to this, 12 medical students from Warwick University, UK, traveled to the Island of Grenada for an intensive extracurricular dissection course at St. George's University. This course not only benefited the host

  19. Beyond Dissection: Innovative Tools for Biology Education.

    ERIC Educational Resources Information Center

    Larson, Sandra, Ed.

    This catalog lists resources available for classroom use in teaching about anatomy and physiology which are alternatives to dissection. The entries are provided under three main categories: (1) Whole Animal Dissection/Vivisection; (2) Animal Organ or System Anatomy and Physiology; and (3) Other, including animal behavior, biotechnology,…

  20. Biomarkers in descending thoracic aortic dissection.

    PubMed

    Shalhub, Sherene; Dua, Anahita; Brooks, Jared

    2014-12-01

    The clinical application of serum biomarkers (d-dimer, C-reactive protein) to predict the natural history of descending thoracic aortic dissection remains elusive. In this review, our current understanding of biomarkers in descending thoracic aortic dissection detection, predicting complications, and aiding in patient management is discussed. PMID:26073830

  1. Keeping Dissection Alive for Medical Students

    ERIC Educational Resources Information Center

    Chambers, James; Emlyn-Jones, Daniel

    2009-01-01

    Traditional dissection teaching is being reduced in a number of medical schools, particularly in the United Kingdom. In response to this, 12 medical students from Warwick University, UK, traveled to the Island of Grenada for an intensive extracurricular dissection course at St. George's University. This course not only benefited the host…

  2. Quick Dissection of the Segmental Bronchi

    ERIC Educational Resources Information Center

    Nakajima, Yuji

    2010-01-01

    Knowledge of the three-dimensional anatomy of the bronchopulmonary segments is essential for respiratory medicine. This report describes a quick guide for dissecting the segmental bronchi in formaldehyde-fixed human material. All segmental bronchi are easy to dissect, and thus, this exercise will help medical students to better understand the…

  3. Objecting To Dissection: A College Student's Handbook.

    ERIC Educational Resources Information Center

    National Anti-Vivisection Society, Chicago, IL.

    In a number of states, students from kindergarten through high school have won the right to refuse to dissect or kill animals and the right to substitute an alternative project. This booklet was designed to help college science students take an ethical stand by refusing to participate in dissection exercises. The booklet begins with an overview of…

  4. Quick Dissection of the Segmental Bronchi

    ERIC Educational Resources Information Center

    Nakajima, Yuji

    2010-01-01

    Knowledge of the three-dimensional anatomy of the bronchopulmonary segments is essential for respiratory medicine. This report describes a quick guide for dissecting the segmental bronchi in formaldehyde-fixed human material. All segmental bronchi are easy to dissect, and thus, this exercise will help medical students to better understand the

  5. Implantation of esophageal cancer onto post-dissection ulcer after gastric endoscopic submucosal dissection.

    PubMed

    Asai, Satoshi; Takeshita, Koutarou; Kano, Yuki; Nakao, Eisuke; Ichinona, Takumi; Fujimoto, Naoki; Akamine, Eisuke; Mori, Takuji; Ogawa, Atsuhiro

    2016-03-01

    A case in which implantation of esophageal squamous cell carcinoma onto a post-dissection gastric ulcer was strongly suspected is presented. A 72-year-old man with alcoholic liver cirrhosis underwent esophagogastroduodenoscopy (EGD). Esophageal cancer (EC) (Mt, 20 mm, 0-Is) and gastric cancer (GC) (antrum, 15 mm, 0-IIc) were identified. Biopsy specimens revealed moderately differentiated squamous cell carcinoma (SCC) and differentiated adenocarcinoma, respectively. The GC was resected by endoscopic submucosal dissection (ESD) [14 mm × 9 mm, type 0-IIc, tub1, pT1a(M), ly0, v0, HM(-), VM(-)]. Two months after ESD, radiation therapy was started for the EC, and an almost complete response was obtained. Nine months after the ESD, a follow-up EGD showed a submucosal tumor-like lesion with ulceration, located immediately under the post-ESD scar, and biopsy specimens showed moderately differentiated SCC. There were no similar lesions suggesting hematogenous or lymphatic metastasis in the stomach. PMID:26973424

  6. Implantation of esophageal cancer onto post-dissection ulcer after gastric endoscopic submucosal dissection

    PubMed Central

    Asai, Satoshi; Takeshita, Koutarou; Kano, Yuki; Nakao, Eisuke; Ichinona, Takumi; Fujimoto, Naoki; Akamine, Eisuke; Mori, Takuji; Ogawa, Atsuhiro

    2016-01-01

    A case in which implantation of esophageal squamous cell carcinoma onto a post-dissection gastric ulcer was strongly suspected is presented. A 72-year-old man with alcoholic liver cirrhosis underwent esophagogastroduodenoscopy (EGD). Esophageal cancer (EC) (Mt, 20 mm, 0-Is) and gastric cancer (GC) (antrum, 15 mm, 0-IIc) were identified. Biopsy specimens revealed moderately differentiated squamous cell carcinoma (SCC) and differentiated adenocarcinoma, respectively. The GC was resected by endoscopic submucosal dissection (ESD) [14 mm × 9 mm, type 0-IIc, tub1, pT1a(M), ly0, v0, HM(-), VM(-)]. Two months after ESD, radiation therapy was started for the EC, and an almost complete response was obtained. Nine months after the ESD, a follow-up EGD showed a submucosal tumor-like lesion with ulceration, located immediately under the post-ESD scar, and biopsy specimens showed moderately differentiated SCC. There were no similar lesions suggesting hematogenous or lymphatic metastasis in the stomach. PMID:26973424

  7. Renal Infarction Caused by Spontaneous Renal Artery Dissection: Treatment with Catheter-Directed Thrombolysis and Stenting

    SciTech Connect

    Jeon, Yong Sun Cho, Soon Gu; Hong, Ki Cheon

    2009-03-15

    Spontaneous renal artery dissection (SRAD) is rare and presents a diagnostic and therapeutic challenge. We report a case of a 36-year-old man who had an SRAD-complicated renal infarction. The patient experienced severe unilateral flank pain. Enhanced abdominal computed axial tomography scan showed renal infarction, and urinalysis showed no hematuria. Selective renal angiography was essential to evaluate the extent of dissection and suitability for repair. The patient was treated with catheter-directed thrombolysis and frenal artery stenting.

  8. Hybrid Approach to Repair Type A Aortic Dissection: Combined Endovascular Superior Mesenteric Artery Stenting and Bentall Procedure.

    PubMed

    Obied, Hamoud Y; Ghoneim, Ayman; Ibrahim, Mohamed F

    2014-08-01

    A Stanford Type A aortic dissection is a life-threatening surgical emergency that requires emergent surgery. The mortality after repair is high especially if the aortic dissection is complicated by visceral or peripheral malperfusion. We describe a case of a male patient who presented with an aortic dissection involving the ascending aorta, aortic arch, descending thoracic aorta, and the abdominal aorta down to the iliac bifurcation. The dissection also involved the visceral and renal arteries with evidence of superior mesenteric artery (SMA) occlusion. Successful outcome was achieved by endovascular stenting of the patient's SMA, followed by a Bentall procedure. To the best of our knowledge this is the first case report in the English literature of SMA stenting followed by a Bentall procedure to treat acute Type A aortic dissection complicated by SMA occlusion. PMID:26798735

  9. Hybrid Approach to Repair Type A Aortic Dissection: Combined Endovascular Superior Mesenteric Artery Stenting and Bentall Procedure

    PubMed Central

    Obied, Hamoud Y.; Ghoneim, Ayman; Ibrahim, Mohamed F.

    2014-01-01

    A Stanford Type A aortic dissection is a life-threatening surgical emergency that requires emergent surgery. The mortality after repair is high especially if the aortic dissection is complicated by visceral or peripheral malperfusion. We describe a case of a male patient who presented with an aortic dissection involving the ascending aorta, aortic arch, descending thoracic aorta, and the abdominal aorta down to the iliac bifurcation. The dissection also involved the visceral and renal arteries with evidence of superior mesenteric artery (SMA) occlusion. Successful outcome was achieved by endovascular stenting of the patient's SMA, followed by a Bentall procedure. To the best of our knowledge this is the first case report in the English literature of SMA stenting followed by a Bentall procedure to treat acute Type A aortic dissection complicated by SMA occlusion. PMID:26798735

  10. What Lies behind the Ischemic Stroke: Aortic Dissection?

    PubMed Central

    Deniz, Turgut; Dag, Ersel; Tulmac, Murat; Azapoglu, Burcu; Alp, Caglar

    2014-01-01

    Introduction. Some cases with aortic dissection (AD) could present with various complaints other than pain, especially neurological and cardiovascular manifestations. AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache. Case Report. A 71-year-old woman was admitted to emergency department with vertigo which started within the previous one hour and progressed with deterioration of consciousness following speech disorder. On arrival, she was disoriented and uncooperative. Diffusion magnetic resonance imaging (MRI) of brain was consistent with acute ischemia in the cerebral hemisphere. Fibrinolytic treatment has been planned since symptoms started within two hours. Echocardiography has shown the dilatation of ascending aorta with a suspicion of flap. Computed tomography (CT) angiography has been applied and intimal flap has been detected which was consistent with aortic dissection, intramural hematoma of which was reaching from aortic arch to bilateral common carotid artery. Thereafter, treatment strategy has completely changed and surgical invention has been done. Conclusion. In patients who are admitted to the emergency department with the loss of consciousness and stroke, inadequacy of anamnesis and carotid artery involvement of aortic dissection should be kept in mind. PMID:25544904

  11. Temporary Strecker Stent for Management of Acute Dissection in Popliteal and Crural Arteries

    SciTech Connect

    Manke, Christoph; Geissler, Angela; Seitz, Johannes; Lenhart, Markus; Kasprzak, Piotr; Gmeinwieser, Josef; Feuerbach, Stefan

    1999-03-15

    Stent placement is a widely used bail-out treatment for dissection of peripheral arteries. Below the level of the superficial femoral artery permanent stenting is complicated by a high incidence of subacute thrombosis and restenosis. We present two cases of arterial occlusion due to acute iatrogenic dissection of the popliteal and distal fibular arteries. Successful treatment was achieved with a new bail-out procedure. Strecker stents were implanted to seal off the dissection flap. Stents were retrieved easily after 24 hr using a myocardial biopsy forceps. After stent retrieval the temporarily stented segments were patent and showed a larger lumen compared with segments treated by balloon dilatation alone. Temporary stenting is a simple and safe procedure and offers the advantage of tacking up dissection membranes and preventing recoil. Persistent presence of a metallic implant as a source of continued injury and stimulus for intimal proliferation is avoided.

  12. Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death.

    PubMed Central

    Basso, C.; Morgagni, G. L.; Thiene, G.

    1996-01-01

    Spontaneous coronary artery dissection is a rare cause of acute myocardial ischaemia. Eight consecutive fatal cases which occurred in women aged 34-54 years (mean 43) are described. The dissection involved the left anterior descending coronary artery in four, the left main trunk in two, the right coronary artery in one, and both left anterior descending and circumflex arteries in one. The clinical presentation was sudden death in six cases, and acute myocardial infarction in two. Diagnosis was made at necropsy in every case but one, in which coronary dissection was diagnosed during life by selective coronary angiography. The only ascertained risk factor was hypertension in one patient; none of the women was in the puerperium, and Marfan syndrome was excluded in all. Histology showed a haematoma between the coronary tunica media and adventitia, that flattened and occluded the lumen; a coronary intimal tear was detected in only two cases. Unusual histological findings were cystic medial necrosis in one case, eosinophilic inflammatory infiltrates in four, and angiomatosis of the tunica adventitia in one. Patients dying of spontaneous coronary dissection are usually middle aged women, with no coronary atherosclerosis and apparently no risk factors. Spontaneous coronary artery dissection is unpredictable, and sudden death is the usual mode of clinical presentation. Prompt diagnosis and life saving treatment is far from being achieved. Images PMID:8665336

  13. Ruptured Valsalva Sinus Aneurysm to Pericardium Simulated Aortic Root Dissection

    PubMed Central

    Davarpasand, Tahereh; Hosseinsabet, Ali; Abassi, Kumars; Arzhan, Sorya

    2014-01-01

    Ruptured valsalva sinus aneurysm to pericardium is a rare condition. Here, we described a case presented with tamponade. Initially, hemopericardium was partially drained and then, imaging evaluations were done. Transesophageal echocardiography showed limited dissection of aortic sinus and CT angiography of the ascending aorta showed deformed dilated right coronary sinus. Besides, surgery showed that windsock tract of the right coronary sinus had ruptured into the pericardium with avulsed right coronary aortic cusp. This case indicated a rare cause of cardiac tamponade and insufficiency of imaging modalities for making an accurate diagnosis. PMID:24936486

  14. Aortopulmonary artery fistula. Presenting with congestive heart failure in a patient with aortic dissection.

    PubMed Central

    Atay, Y; Can, L; Yağdi, T; Büket, S

    1998-01-01

    Although it is a rare occurrence, aortic dissections can rupture into the cardiac chambers or great vessels. A review of the English literature revealed only 3 cases of fistula between an aortic false lumen and the main pulmonary artery that were repaired successfully. In this article, we report the case of a chronic type I aortic dissection with an aortopulmonary artery fistula. The patient presented with congestive heart failure. One year earlier he had undergone aortic valve replacement. To our knowledge, this is the 4th case of a successfully repaired type I aortic dissection with rupture into the pulmonary artery and the 1st such case involving a patient who had undergone a previous cardiac operation. Images PMID:9566068

  15. Animal Rights Groups Target High School Dissection.

    ERIC Educational Resources Information Center

    Trotter, Andrew

    1992-01-01

    Two groups leading the charge against dissection are People for the Ethical Treatment of Animals (PETA) and the Student Action Corps for Animals (SACA). Protests by student and community members remain the movement's strongest weapon. (MLF)

  16. GPM Dissects Typhoon Hagupit - Duration: 38 seconds.

    NASA Video Gallery

    NASA/JAXA's GPM Dissects Typhoon Hagupit Animation revealing a swath of NASA/JAXA's Global Precipitation Measurement (GPM) mission's Core Observatory GMI precipitation rates over Typhoon Hagupit. A...

  17. A New Idea for Dissecting Tray

    ERIC Educational Resources Information Center

    Branham, Arthur

    1976-01-01

    A method of preparing a special dissecting tray to be used with transmitted light as well as reflected light is presented. It may also be used with an overhead projector to illustrate some skeletal structures in vertebrates. (Author/EB)

  18. Slowly Progressive and Painless Thoracic Aortic Dissection Presenting with a Persistent Fever in an Elderly Patient: The Usefulness of Combined Measurement of Biochemical Parameters

    PubMed Central

    Yamada, Shunsuke; Tokumoto, Masanori; Ohkuma, Toshiaki; Wakisaka, Yoshinobu; Uchizono, Yuji; Tsuruya, Kazuhiko; Kitazono, Takanari; Ooboshi, Hiroaki

    2013-01-01

    Aortic dissection is a fatal medical condition that requires urgent diagnosis and appropriate intervention. Because acute aortic dissection often manifests as sudden onset excruciating chest pain, physicians can easily reach a proper diagnosis. However, some patients with aortic dissection present with varied clinical manifestations without exhibiting typical chest pain, leading to a delayed diagnosis and possible fatality. We herein present the case of an elderly subject with a fever of unknown origin who was ultimately diagnosed with aortic dissection. In the present case, a negative procalcitonin test, increased D-dimer and serum creatinine phosphokinase-BB levels, and reelevation of the CPR level led us to the correct diagnosis. PMID:23843799

  19. 77 FR 13120 - American Midstream (Louisiana Intrastate) LLC ; Notice of Motion for Extension of Rate Case...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-05

    ... Energy Regulatory Commission American Midstream (Louisiana Intrastate) LLC ; Notice of Motion for... Intrastate) LLC (AMLI) filed a motion requesting an extension consistent with the Federal Energy Regulatory... desiring to participate in this proceeding must file a motion to intervene or to protest this filing...

  20. Endovascular Treatment of Iatrogenic and Traumatic Carotid Artery Dissection

    SciTech Connect

    Schulte, Stefan; Donas, Konstantinos P. Pitoulias, Georgios A.; Horsch, Svante

    2008-09-15

    This paper reports on the early and midterm results of endovascular treatment of acute carotid artery dissections, its specific problems, and its limitations. We encountered seven patients with symptomatic extracranial carotid artery dissection, three cases of which occurred after carotid endarterectomy, two after carotid angioplasty and stenting, and two after trauma. Balloon-expandable and self-expanding stents were placed using a transfemoral approach. Success in restoring the carotid lumen was achieved in all patients. No procedure-related complications occurred. All patients experienced significant clinical improvement while in the hospital and achieved complete long-term recovery. At follow-up (mean, 22.4 months), good luminal patency of the stented segments was observed. In conclusion, in this small series, primary stent-supported angioplasty seems to be a safe and effective strategy in the treatment of selected patients having acute traumatic extracranial carotid artery dissection, with excellent early and midterm results. Larger series and longer-term follow-up are required before definitive recommendations can be made.

  1. Robotic Salvage Lymph Node Dissection After Radical Prostatectomy

    PubMed Central

    Torricelli, Fabio C. M.; Cividanes, Arnaldo; Guglielmetti, Giuliano B.; Coelho, Rafael F.

    2015-01-01

    ABSTRACT Introduction and objective: Radical prostatectomy is a first-line treatment for localized prostate cancer. However, in some cases, biochemical recurrence associated with imaging-detected nodal metastases may happen. Herein, we aim to present the surgical technique for salvage lymph node dissection after radical prostatectomy. Materials and Methods: A 70 year-old asymptomatic man presented with a prostate-specific antigen (PSA) of 7.45ng/ mL. Digital rectal examination was normal and trans-rectal prostate biopsy revealed a prostate adenocarcinoma Gleason 7 (3+4). Pre-operative computed tomography scan and bone scintigraphy showed no metastatic disease. In other service, the patient underwent a robotic-assisted radical prostatectomy plus obturador lymphadenectomy. Pathologic examination showed a pT3aN0 tumor. After 6 months of follow-up, serum PSA was 1.45ng/mL. Further investigation with 11C–Choline PET/CT revealed only a 2-cm lymph node close to the left internal iliac artery. The patient was counseled for salvage lymph node dissection. Results: Salvage lymph node dissection was uneventfully performed. Operative time was 1.5 hour, blood loss was minimal, and there were no intra- or postoperative complications. The patient was discharged from hospital in the 1st postoperative day. After 12 months of follow-up, his PSA was undetectable with no other adjuvant therapy. Conclusion: Robotic salvage pelvic lymph node dissection is an effective option for treatment of patients with biochemical recurrence after radical prostatectomy and only pelvic lymph node metastasis detected by C11-Choline PET/CT. PMID:26401879

  2. The Effect of Animal Dissections on Student Acquisition of Knowledge of and Attitudes toward the Animals Dissected.

    ERIC Educational Resources Information Center

    McCollum, Terry L.

    A conflict exists over the use of animals in the classroom. One aspect of this use involved the dissection of animals. Animal protection advocates report that dissections constitute abuse of the animals dissected. The advocates state that what is learned by dissection could be more effectively learned by other means. Some science educators state…

  3. Calcineurin A versus NS5A-TP2/HD Domain Containing 2: A Case Study of Site-directed Low-frequency Random Mutagenesis for Dissecting Target Specificity of Peptide Aptamers*

    PubMed Central

    Dibenedetto, Silvia; Cluet, David; Stebe, Pierre-Nicolas; Baumle, Vronique; Lault, Jrmie; Terreux, Raphal; Bickle, Marc; Chassey, Benoit D. E.; Mikaelian, Ivan; Colas, Pierre; Spichty, Martin; Zoli, Michele; Rudkin, Brian B.

    2013-01-01

    We previously identified a peptide aptamer (named R5G42) via functional selection for its capacity to slow cell proliferation. A yeast two-hybrid screen of human cDNA libraries, using R5G42 as bait, allowed the identification of two binding proteins with very different functions: calcineurin A (CnA) (PP2B/PPP3CA), a protein phosphatase well characterized for its role in the immune response, and NS5A-TP2/HD domain containing 2, a much less studied protein induced subsequent to hepatitis C virus non-structural protein 5A expression in HepG2 hepatocellular carcinoma cells, with no known activity. Our objective in the present study was to dissect the dual target specificity of R5G42 in order to have tools with which to better characterize the actions of the peptide aptamers toward their individual targets. This was achieved through the selection of random mutants of the variable loop, derived from R5G42, evaluating their specificity toward CnA and NS5A-TP2 and analyzing their sequence. An interdisciplinary approach involving biomolecular computer simulations with integration of the sequence data and yeast two-hybrid binding phenotypes of these mutants yielded two structurally distinct conformers affording the potential molecular basis of the binding diversity of R5G42. Evaluation of the biological impact of CnA- versus NS5A-TP2-specific peptide aptamers indicated that although both contributed to the anti-proliferative effect of R5G42, CnA-binding was essential to stimulate the nuclear translocation of nuclear factor of activated T cells, indicative of the activation of endogenous CnA. By dissecting the target specificity of R5G42, we have generated novel tools with which to study each target individually. Apta-C8 is capable of directly activating CnA independent of binding to NS5A-TP2 and will be an important tool in studying the role of CnA activation in the regulation of different signaling pathways, whereas Apta-E1 will allow dissection of the function of NS5A-TP2, serving as an example of the usefulness of peptide aptamer technology for investigating signaling pathways. PMID:23579184

  4. Molecular Dissection of Phage Endolysin

    PubMed Central

    Pohane, Amol Arunrao; Joshi, Himanshu; Jain, Vikas

    2014-01-01

    Mycobacterium tuberculosis has always been recognized as one of the most successful pathogens. Bacteriophages that attack and kill mycobacteria offer an alternate mechanism for the curtailment of this bacterium. Upon infection, mycobacteriophages produce lysins that catalyze cell wall peptidoglycan hydrolysis and mycolic acid layer breakdown of the host resulting in bacterial cell rupture and virus release. The ability to lyse bacterial cells make lysins extremely significant. We report here a detailed molecular dissection of the function and regulation of mycobacteriophage D29 Lysin A. Several truncated versions of Lysin A were constructed, and their activities were analyzed by zymography and by expressing them in both Escherichia coli and Mycobacterium smegmatis. Our experiments establish that Lysin A harbors two catalytically active domains, both of which show E. coli cell lysis upon their expression exclusively in the periplasmic space. However, the expression of only one of these domains and the full-length Lysin A caused M. smegmatis cell lysis. Interestingly, full-length protein remained inactive in E. coli periplasm. Our data suggest that the inactivity is ensued by a C-terminal domain that interacts with the N-terminal domain. This interaction was affirmed by surface plasmon resonance. Our experiments also demonstrate that the C-terminal domain of Lysin A selectively binds to M. tuberculosis and M. smegmatis peptidoglycans. Our methodology of studying E. coli cell lysis by Lysin A and its truncations after expressing these proteins in the bacterial periplasm with the help of signal peptide paves the way for a large scale identification and analysis of such proteins obtained from other bacteriophages. PMID:24627486

  5. Dissection and dissection-associated required experiences improve student performance in gross anatomy: Differences among quartiles.

    PubMed

    Pizzimenti, Marc A; Pantazis, Nicholas; Sandra, Alexander; Hoffmann, Darren S; Lenoch, Susan; Ferguson, Kristi J

    2016-05-01

    To promote student learning, educational strategies should provide multiple levels of engagement with the subject matter. This study investigated examination data from five first year medical gross anatomy class cohorts (692 students) to determine if enhanced student performance was correlated with learning through dissection in a course that used a rotating dissection schedule coupled with peer teaching and other associated experiences. When students performed two of five weekly dissections for a given unit, their average scores on both laboratory and written examinations tended to increase as compared to when they had completed only one week of dissection (P < 0.01). However, these performance gains differed across the class strata and were related to the amount of dissection completed. Students in the upper quartile (UQS) of the class benefited when they had dissected once (92.8%) or twice (92.4%), and these scores were significantly higher than those attained when learning from peers (90.3%, P < 0.01). Students in the lower quartile (LQS) benefited most from the dissection experiences, where practical examination performance was better (77.8% and 80.5%) than when these students learned material from their peers (73.7%, P < 0.01). Although UQS benefited from dissection, LQS benefited to a greater extent in both the practical and written examinations with dissection. Although limited, these data suggest that dissection, coupled with associated educational activities, is an effective pedagogical strategy for learning. Further investigation is required to evaluate the concomitant benefits of peer teaching that are associated with the dissection experience. Anat Sci Educ 9: 238-246. © 2015 American Association of Anatomists. PMID:26536279

  6. Science Teachers and the Dissection Debate: Perspectives on Animal Dissection and Alternatives

    ERIC Educational Resources Information Center

    Oakley, Jan

    2012-01-01

    This study investigated Ontario science and biology teachers' practices and attitudes toward animal dissection and dissection alternatives. The data was collected through a mixed methods approach involving online surveys (n = 153) and subsequent telephone interviews (n = 9) with secondary school science and biology teachers. The findings indicate…

  7. Thoracic aortic dissection in an 18-year-old woman with no risk factors.

    PubMed

    Kim, Tae Eung; Smith, Dustin D

    2010-06-01

    Spontaneous aortic dissection is a rare, life-threatening cause of chest pain, and has a higher prevalence when traditional risks such as age, hypertension, dyslipidemia, or connective tissue disorders are present. However, even in the absence of risk factors, non-traumatic rupture of an aortic dissection may occur. Most are found in patients over 40 years of age. Younger victims of this disease often also suffer from other conditions such as cystic medial necrosis, connective tissue disorders such as Marfan's syndrome, or vasculitis. We present the case of an 18-year-old, previously healthy woman who was country line dancing when she began to complain of severe, cramping chest and back pain. She was hemodynamically stable on initial presentation but experienced two seizures while in the emergency department and was intubated. Subsequently, her blood pressure dropped and she developed cardiac arrest, and despite vigorous resuscitation that included blood products and emergency department thoracotomy, she was refractory to all attempts. At autopsy she was found to have a spontaneous, non-traumatic rupture of an aortic dissection. This patient had no discernable risk factors for aortic dissection or discoverable cause on necropsy. We present this case to raise awareness among physicians and review other reported cases in the literature of aortic dissection in patients under age 40 years. PMID:18296008

  8. The Relationship between Spontaneous Multi-Vessel Coronary Artery Dissection and Celiac Disease

    PubMed Central

    Çağırcı, Göksel; Üreyen, Çağın Mustafa; Kuş, Görkem; Küçükseymen, Selçuk; Arslan, Şakir

    2015-01-01

    Celiac disease (CD) is an immune-mediated enteropathy involving the small intestines. Genetic and environmental risk factors as well as autoimmunity have been linked to its etiology. Studies have shown that coronary artery disease, autoimmune myocarditis, arrhythmias and premature atherosclerosis are more prevalent in individuals with CD compared to individuals without the disease. In this case report a young male patient with CD presented with acute myocardial infarction with spontaneous coronary artery dissections of two vessels. To the best of our knowledge, this is the first case report of spontaneous multi-vessel coronary artery dissection in a patient with CD. PMID:26023313

  9. A deleterious MYH11 mutation causing familial thoracic aortic dissection

    PubMed Central

    Takeda, Norifumi; Morita, Hiroyuki; Fujita, Daishi; Inuzuka, Ryo; Taniguchi, Yuki; Nawata, Kan; Komuro, Issei

    2015-01-01

    The L1264P and R1275L heterozygous mutations of the myosin heavy chain 11 (MYH11) gene, which are on the same allele, have been reported to cause thoracic aortic aneurysms and/or dissections (TAAD) complicated with patent ductus arteriosus (PDA); however, their contributions to the pathogenesis of TAAD/PDA have not been elucidated. Here we report the first familial case of TAAD with only a MYH11 L1264P mutation, in which PDA was not observed, indicating that L1264P, not R1275L, is responsible for TAAD formation.

  10. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

    PubMed Central

    Mu, Shi-Qing; Yang, Xin-Jian; Li, You-Xiang; Jiang, Chu-Han; Wu, Zhong-Xue

    2015-01-01

    Background: The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique. Methods: We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results: All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3–6 months or 12–18 months after the endovascular treatment (median 8 months), 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions: The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis. PMID:26168833

  11. [Mediastinal dissection for patients with differentiated thyroid carcinoma: sternotomy vs VATS (video-assisted thoracoscopic surgery)].

    PubMed

    Masuda, Muneyuki; Wakasaki, Takahiro; Tamae, Akihiro; Komune, Noritaka; Hara, Takashi; Uchiyama, Akihiko

    2007-12-01

    We here present two cases of differentiated thyroid carcinoma with mediastinal lymph nodes metastases below level 106 according to the classification of the Guidelines for the Clinical and Pathologic Studies for Carcinoma of the Esophagus (9 th edition) edited by the Japanese Society for Esophageal Diseases. For Case 1, we adopted a conventional anterior approach with resection of the right half of the manubrium and sternum to the level of the second intercostal space and medial half of the right clavicule. Case 2 underwent a combined cervical approach and video-assisted thoracoscopic surgery (VATS). In Case 1, the lymph nodes around the subclavian vein, 105R, 106pre and 106recR were successfully dissected under clear view. However, through this case, the difficulty in the dissection of 106tbR was recognized, because it is quite challenging to gain an adequate surgical view in this small compartment by this approach. Conversely, in Case 2, in which mediastinal lymph nodes extended to level 107, the lymph nodes were relatively easily dissected by VATS under excellent surgical views of 106tbR and 107. Although VATS is associated with difficulty in en bloc resection, requirements of a thoracotomy, changes of body position and an intubation tube during the surgery, this approach is of great use for the dissection of 106tbR and 107. PMID:18186293

  12. Acute fatal coronary artery dissection following exercise-related blunt chest trauma.

    PubMed

    Barbesier, Marie; Boval, Catherine; Desfeux, Jacques; Lebreton, Catherine; Léonetti, Georges; Piercecchi, Marie-Dominique

    2015-01-01

    Coronary artery injury such as acute coronary dissection is an uncommon and potentially life-threatening complication after blunt chest trauma. The authors report an unusual autopsy case of a 43-year-old healthy man who suddenly collapsed after receiving a punch to the chest during the practice of kung fu. The occurrence of the punch was supported by the presence of one recent contusion on the left lateral chest area at the external examination and by areas of hemorrhage next to the left lateral intercostal spaces at the internal examination. The histological examination revealed the presence of an acute dissection of the proximal segment of the left anterior descending coronary artery. Only few cases of coronary artery dissection have been reported due to trauma during sports activities such as rugby and soccer games, but never during the practice of martial arts, sports usually considered as safe and responsible for only minor trauma. PMID:25066483

  13. Endovascular Management of Chronic Type B Dissecting Aortic Aneurysm Utilizing Aortic and Renal Stents

    SciTech Connect

    Taylor, J. D. Dunckley, M.; Thompson, M.; Morgan, R. A.

    2008-07-15

    Over the last 10 years endovascular stent-graft placement has been increasingly used to treat complicated acute Type B thoracic aortic dissections. While studies have demonstrated the use of additional aortic stent-grafts to treat continued false lumen perfusion and case reports have detailed the use of renal artery stents to treat renal ischemia related to aortic dissection, to our knowledge the adjuvant use of renal artery stents to reduce false lumen perfusion has not been reported. We present the case of a 72-year-old male who had previously undergone endovascular repair of a complicated Type B thoracic aortic dissection and presented with an expanding false lumen in the peridiaphragmatic aorta despite coverage of the entire thoracic aorta. This was treated by closure of a right renal fenestration using a renal stent.

  14. Prevention of complications in neck dissection

    PubMed Central

    Kerawala, Cyrus J; Heliotos, Manolis

    2009-01-01

    Background The neck dissection has remained a pivotal aspect of head and neck cancer management for over a century. During this time its role has expanded from a purely therapeutic option into an elective setting, in part promoted by efforts to reduce its morbidity. Objectives This review will consider the potential complications of neck dissection and on the basis of the available evidence describe both their management and prevention. Conclusion Although the neck dissection continues to provide clinicians with a method of addressing cervical disease, its reliability and safety can only be assured if surgeons remain cognisant of the potential complications and aim to minimise such morbidity by appropriate management in the peri-operative period. PMID:19822010

  15. The nature of dissection: Exploring student conceptions

    NASA Astrophysics Data System (ADS)

    York, Katharine

    The model of conceptual change in science describes the process of learning as a complete restructuring of knowledge, when learners discover or are shown more plausible, intelligent alternatives to existing conceptions. Emotions have been acknowledged as part of a learner's conceptual ecology, but the effects of emotions on learning have yet to be described. This research was conducted to examine the role that emotions have on learning for thirteen high school students, as they dissected cats in a Human Anatomy and Physiology class. The project also investigated whether a student's emotional reactions may be used to develop a sense of connectedness with the nonhuman world, which is defined as ecological literacy. This study utilized a grounded theory approach, in which student responses to interviews were the primary source of data. Interviews were transcribed, and responses were coded according to a constant comparative method of analysis. Responses were compared with the four conditions necessary for conceptual change to occur, and also to five principles of ecological literacy. Students who had negative reactions to dissection participated less in the activity, and demonstrated less conceptual change. Two female students showed the strongest emotional reactions to dissection, and also the lowest amount of conceptual change. One male student also had strong negative reactions to death, and showed no conceptual change. The dissection experiences of the students in this study did not generally reflect ecological principles. The two students whose emotional reactions to dissection were the most negative demonstrated the highest degree of ecological literacy. These results provide empirical evidence of the effects that emotions have on learning, and also supports the opinions of educators who do not favor dissection, because it does not teach students to respect all forms of life.

  16. Critical notice--defending life: a moral and legal case against abortion choice by Francis J Beckwith.

    PubMed

    Stretton, D

    2008-11-01

    Francis Beckwith's Defending life: a moral and legal case against abortion choice defends the pro-life position on moral, legal and political grounds. In this critical notice I consider three key issues and argue that Beckwith's treatment of each of them is unpersuasive. The issues are: (1) whether abortion is politically justified by the principle that we should err on the side of liberty in the face of reasonable disagreement over the moral status of the fetus; (2) whether the fetus's natural capacity or genetic propensity to develop rationality and communication is sufficient to give it a moral right to life; and (3) whether abortion is morally justified on the basis of bodily rights. I also show that Beckwith's book fails to consider several important issues and arguments. PMID:18974412

  17. Gastric cancer: Current status of lymph node dissection.

    PubMed

    Degiuli, Maurizio; De Manzoni, Giovanni; Di Leo, Alberto; D'Ugo, Domenico; Galasso, Erica; Marrelli, Daniele; Petrioli, Roberto; Polom, Karol; Roviello, Franco; Santullo, Francesco; Morino, Mario

    2016-03-14

    D2 procedure has been accepted in Far East as the standard treatment for both early (EGC) and advanced gastric cancer (AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials (RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council (MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recurrence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC. PMID:26973384

  18. Chiropractic Response to a Spontaneous Vertebral Artery Dissection

    PubMed Central

    Tarola, Gary; Phillips, Reed B.

    2015-01-01

    Objective The purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes. Clinical Features A 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1 hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient’s pain in the most severe category. Intervention and Outcome The patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately. Conclusion Recognition and rapid response by the chiropractic physician provided the optimum outcome for this particular patient. PMID:26778932

  19. Gastric cancer: Current status of lymph node dissection

    PubMed Central

    Degiuli, Maurizio; De Manzoni, Giovanni; Di Leo, Alberto; D’Ugo, Domenico; Galasso, Erica; Marrelli, Daniele; Petrioli, Roberto; Polom, Karol; Roviello, Franco; Santullo, Francesco; Morino, Mario

    2016-01-01

    D2 procedure has been accepted in Far East as the standard treatment for both early (EGC) and advanced gastric cancer (AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials (RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council (MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recurrence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC. PMID:26973384

  20. Spontaneous coronary artery dissection in puerperium.

    PubMed

    Refaie, Medhat; Alshehri, Mohammed; Gallo, Ricardo

    2016-06-01

    Spontaneous coronary artery dissection in puerperium is uncommon and most often occurs in the third trimester of pregnancy and in the early postpartum period. Two weeks after delivery, a 41-year-old woman presented with typical retrosternal chest pain and inverted T-waves in leads II, V5 and V6, and Q-waves in aVR. Her peak troponin I level was 16.39 µgċL(-1) Coronary angiography showed left main spiral dissection extending to the mid left anterior descending artery and involving the first diagonal branch. Urgent coronary artery bypass grafting was performed successfully. The mechanism and approach are discussed. PMID:25746424

  1. 76 FR 79170 - Southcross CCNG Transmission Ltd.; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-21

    ... Energy Regulatory Commission Southcross CCNG Transmission Ltd.; Notice of Motion for Extension of Rate... this rate proceeding must file a motion to intervene or to protest this filing must file in accordance... file a notice of intervention or motion to intervene, as appropriate. Such notices, motions,...

  2. 76 FR 79170 - Southcross Mississippi Pipeline, L.P.; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-21

    ... Energy Regulatory Commission Southcross Mississippi Pipeline, L.P.; Notice of Motion for Extension of... proceeding must file a motion to intervene, or to protest this filing must file in accordance with Rules 211... notice of intervention or motion to intervene, as appropriate. Such notices, motions, or protests must...

  3. Blunt Dissection: A Solution to Prevent Bile Duct Injury in Laparoscopic Cholecystectomy

    PubMed Central

    Cai, Xiu-Jun; Ying, Han-Ning; Yu, Hong; Liang, Xiao; Wang, Yi-Fan; Jiang, Wen-Bin; Li, Jian-Bo; Ji, Lin

    2015-01-01

    Background: Laparoscopic cholecystectomy (LC) has been a standard operation and replaced the open cholecystectomy (OC) rapidly because the technique resulted in less pain, smaller incision, and faster recovery. This study was to evaluate the value of blunt dissection in preventing bile duct injury (BDI) in laparoscopic cholecystectomy (LC). Methods: From 2003 to 2015, LC was performed on 21,497 patients, 7470 males and 14,027 females, age 50.3 years (14–84 years). The Calot's triangle was bluntly dissected and each duct in Calot's triangle was identified before transecting the cystic duct. Results: Two hundred and thirty-nine patients (1.1%) were converted to open procedures. The postoperative hospital stay was 2.1 (0–158) days, and cases (46%) had hospitalization days of 1 day or less, and 92.8% had hospitalization days of 3 days or less; BDI was occurred in 20 cases (0.09%) including 6 cases of common BDI, 2 cases of common hepatic duct injury, 1 case of right hepatic duct injury, 1 case of accessory right hepatic duct, 1 case of aberrant BDI 1 case of biliary stricture, 1 case of biliary duct perforation, 3 cases of hemobilia, and 4 cases of bile leakage. Conclusion: Exposing Calot's triangle by blunt dissection in laparoscopic cholecystectomy could prevent intraoperative BDI. PMID:26612288

  4. Esophageal diverticulum exposed during endoscopic submucosal dissection of superficial cancer

    PubMed Central

    Tanaka, Shinwa; Toyonaga, Takashi; Ohara, Yoshiko; Yoshizaki, Tetsuya; Kawara, Fumiaki; Ishida, Tsukasa; Hoshi, Namiko; Morita, Yoshinori; Azuma, Takeshi

    2015-01-01

    Endoscopic submucosal dissection (ESD) is now widely accepted as a strategy to treat superficial esophageal neoplasms. The rate of adverse events, such as perforation, has been decreasing with the improvement of devices and techniques. In this paper, we report a case of esophageal cancer that had a diverticulum under cancerous epithelium. The diverticulum was not detected during preoperative examination, and led to perforation during the ESD procedure. Our case shows that, although rare, some diverticula can exist underneath the mucosal surface without obvious depression. If there is any sign of hidden diverticula during ESD, surgeons should proceed with caution or, depending on the case, the procedure should be discontinued to avoid adverse events. PMID:25780314

  5. Is Planned Neck Dissection Necessary for Head and Neck Cancer After Intensity-Modulated Radiotherapy?

    SciTech Connect

    Yao Min |. E-mail: min-yao@uiowa.edu; Hoffman, Henry T.; Funk, Gerry F. |; Chang, Kristi; Smith, Russell B. |; Tan Huaming; Clamon, Gerald H.; Dornfeld, Ken |; Buatti, John M. |

    2007-07-01

    Purpose: The objective of this study was to determine regional control of local regional advanced head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiotherapy (IMRT), along with the role and selection criteria for neck dissection after IMRT. Methods and Materials: A total of 90 patients with stage N2A or greater HNSCC were treated with definitive IMRT from December 1999 to July 2005. Three clinical target volumes were defined and were treated to 70 to 74 Gy, 60 Gy, and 54 Gy, respectively. Neck dissection was performed for selected patients after IMRT. Selection criteria evolved during this period with emphasis on post-IMRT [{sup 18}F] fluorodeoxyglucose positron emission tomography in recent years. Results: Median follow-up for all patients was 29 months (range, 0.2-74 months). All living patients were followed at least 9 months after completing treatment. Thirteen patients underwent neck dissection after IMRT because of residual lymphadenopathy. Of these, 6 contained residual viable tumor. Three patients with persistent adenopathy did not undergo neck dissection: 2 refused and 1 had lung metastasis. Among the remaining 74 patients who were observed without neck dissection, there was only 1 case of regional failure. Among all 90 patients in this study, the 3-year local and regional control was 96.3% and 95.4%, respectively. Conclusions: Appropriately delivered IMRT has excellent dose coverage for cervical lymph nodes. A high radiation dose can be safely delivered to the abnormal lymph nodes. There is a high complete response rate. Routine planned neck dissection for patients with N2A and higher stage after IMRT is not necessary. Post-IMRT [{sup 18}F] fluorodeoxyglucose positron emission tomography is a useful tool in selecting patients appropriate for neck dissection.

  6. Genetics Home Reference: familial thoracic aortic aneurysm and dissection

    MedlinePlus

    ... Genetics Home Health Conditions familial TAAD familial thoracic aortic aneurysm and dissection Enable Javascript to view the expand/ ... All Open All Close All Description Familial thoracic aortic aneurysm and dissection ( familial TAAD ) involves problems with the ...

  7. Conservative Management of Chronic Aortic Dissection with Underlying Aortic Aneurysm

    PubMed Central

    Yusuf Beebeejaun, Mohammad; Malec, Aleksandra; Gupta, Ravi

    2013-01-01

    Aortic dissection is one of the most common aortic emergencies affecting around 2000 Americans each year. It usually presents in the acute state but in a small percentage of patients aortic dissections go unnoticed and these patients survive without any adequate therapy. With recent advances in medical care and diagnostic technologies, aortic dissection can be successfully managed through surgical or medical options, consequently increasing the related survival rate. However, little is known about the optimal long-term management of patients suffering from chronic aortic dissection. The purpose of the present report is to review aortic dissection, namely its pathology and the current diagnostic tools available, and to discuss the management options for chronic aortic dissection. We report a patient in which chronic aortic dissection presented with recurring episodes of vomiting and also discuss the management plan of our patient who had a chronic aortic dissection as well as an underlying aortic aneurysm. PMID:24179638

  8. Global Distribution of Dissected Duricrust on Mars

    NASA Technical Reports Server (NTRS)

    Mustard, J. F.; Cooper, C. D.

    2000-01-01

    Evidence for dissected duricrust was identified in high resolution MOC images. Analysis of all available images was used to map the global distribution of this terrain. It is apparently restricted to two latitude bands: 30-60 deg. N and 30-60 deg. S.

  9. The etiology of cervical artery dissection

    PubMed Central

    Haneline, Michael T.; Rosner, Anthony L.

    2007-01-01

    Abstract The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation. PMID:19674705

  10. Squid Dissection: From Pen to Ink.

    ERIC Educational Resources Information Center

    Brown, Cindy; Kisiel, Jim

    2003-01-01

    Introduces students to dissection, which is an important part of scientific discovery. Students not only gain an understanding of the anatomy of a squid, but also develop a sense of responsibility and respect for the animal that they are using as a learning tool. (Author/SOE)

  11. Dissecting risk haplotypes in sporadic Alzheimer's disease.

    PubMed

    Soldner, Frank; Jaenisch, Rudolf

    2015-04-01

    Understanding how genetic risk variants contribute to complex diseases is crucial for predicting disease susceptibility and developing patient-tailored therapies. In this issue of Cell Stem Cell, Young et al. (2015) dissect the function of common non-coding risk haplotypes in the SORL1 locus in the pathogenesis of sporadic Alzheimer's disease using patient-derived induced pluripotent stem cells. PMID:25842969

  12. Cow's Eye Dissection in the Physics Lab.

    ERIC Educational Resources Information Center

    Lapp, David R.; Keenan, James E.

    1991-01-01

    Proposes the science demonstration of dissecting a cow's eye to integrate biology and physics in the study of optics and lenses. Reviews the anatomy of the eye, describes the visual process and covers topics as index of refraction of the cornea, microscopic receptors, the lens, and the retina. (MDH)

  13. Thoracoscopic left mediastinal lymph node dissection

    PubMed Central

    2016-01-01

    In Japan, the use of video-assisted thoracoscopic surgery (VATS) for primary lung cancer is increasing. However, it is not easy to perform mediastinal lymph node dissection using VATS as effectively as it is performed using thoracotomy. Herein, I have presented two techniques for subcarinal lymph node dissection from the left thoracic cavity: one involves the retraction of the lower bronchus towards the visceral and cranial side before inferior pulmonary vein resection to secure the view of the right lower portion. The other involves the separation of lymph nodes from the right main bronchus before separation from the left bronchus, to prevent the lymph nodes from falling down and interrupting the right-side view. Moreover, I have also described a technique that facilitates left upper mediastinal lymph node dissection. It involves traction of a thoracic cardiac branch from the recurrent laryngeal nerve allowing visualization of the bottom of the #4L lymph node, so that it can be dissected easily. There has been no observation of recurrent nerve paralysis using this procedure. PMID:26855946

  14. Thoracoscopic left mediastinal lymph node dissection.

    PubMed

    Nagashima, Takuya

    2016-01-01

    In Japan, the use of video-assisted thoracoscopic surgery (VATS) for primary lung cancer is increasing. However, it is not easy to perform mediastinal lymph node dissection using VATS as effectively as it is performed using thoracotomy. Herein, I have presented two techniques for subcarinal lymph node dissection from the left thoracic cavity: one involves the retraction of the lower bronchus towards the visceral and cranial side before inferior pulmonary vein resection to secure the view of the right lower portion. The other involves the separation of lymph nodes from the right main bronchus before separation from the left bronchus, to prevent the lymph nodes from falling down and interrupting the right-side view. Moreover, I have also described a technique that facilitates left upper mediastinal lymph node dissection. It involves traction of a thoracic cardiac branch from the recurrent laryngeal nerve allowing visualization of the bottom of the #4L lymph node, so that it can be dissected easily. There has been no observation of recurrent nerve paralysis using this procedure. PMID:26855946

  15. Trace Element Changes in Thoracic Aortic Dissection.

    PubMed

    Edvinsson, Marie; Ilbäck, Nils-Gunnar; Frisk, Peter; Thelin, Stefan; Nyström-Rosander, Christina

    2016-02-01

    Thoracic aortic dissection is a life-threatening condition with an incompletely understood pathogenesis. Trace elements are essential for the functioning of different processes in the body, including the immune system and associated responses to infection/inflammation. Because inflammation may be part of the pathogenesis of thoracic aortic dissection, we investigated whether trace element changes associated with inflammation occur in serum and tissue samples during the disease. The study included 21 patients undergoing surgery for thoracic aortic dissection, 10 forensic autopsy specimens for tissue controls and 23 healthy blood donors for serum controls. Levels of magnesium (Mg), calcium (Ca), vanadium (V), manganese (Mn), iron (Fe), cobalt (Co), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), cadmium (Cd) and mercury (Hg) were measured in the aortic tissue and serum by inductively coupled plasma-mass spectrometry (ICP-MS). In the serum, Ca, V, Cu and Zn decreased, whereas Fe increased. In the tissue, Cu and Zn decreased and Fe tended to increase. The Cu/Zn ratio in the serum, a marker of infection/inflammation, did not change in the patients. Concerning trace element changes in the serum and tissue, our data do not support the hypothesis that inflammation is involved in the pathogenesis of thoracic aortic dissection. PMID:26152852

  16. Use of neutral plasma coagulation in groin node dissection for vulvar malignancy: a novel technique

    PubMed Central

    Madhuri, Thumuluru Kavitha; Tailor, Anil; Butler-Manuel, Simon

    2011-01-01

    Vulvar cancer is an uncommon disease with approximately 1000 cases reported annually in the UK. Lymph node involvement is an important prognostic indicator. Vulvectomy and bilateral groin node dissection are the preferred surgical treatments for early disease and increase survival. However, significant morbidity with lymphocyst formation and wound breakdown has been reported in more than 50% of cases. We report the first case following use of the PlasmaJet® neutral argon coagulation system to reduce postoperative lymphocyst formation. PMID:21792333

  17. Use of neutral plasma coagulation in groin node dissection for vulvar malignancy: a novel technique.

    PubMed

    Madhuri, Thumuluru Kavitha; Tailor, Anil; Butler-Manuel, Simon

    2011-01-01

    Vulvar cancer is an uncommon disease with approximately 1000 cases reported annually in the UK. Lymph node involvement is an important prognostic indicator. Vulvectomy and bilateral groin node dissection are the preferred surgical treatments for early disease and increase survival. However, significant morbidity with lymphocyst formation and wound breakdown has been reported in more than 50% of cases. We report the first case following use of the PlasmaJet(®) neutral argon coagulation system to reduce postoperative lymphocyst formation. PMID:21792333

  18. Spontaneous coronary artery dissection treated with bioresorbable vascular scaffolds guided by optical coherence tomography.

    PubMed

    Cockburn, James; Yan, Warren; Bhindi, Ravinay; Hansen, Peter

    2014-11-01

    Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndromes. We report the first case, to our knowledge, of SCAD in an active fit man. We treated this patient with novel bioresorbable vascular scaffold, guided by optical coherence tomography. PMID:25442447

  19. Perceval S Valve Solution for Degenerated Freestyle Root in the Presence of Chronic Aortic Dissection.

    PubMed

    Lio, Antonio; Miceli, Antonio; Ferrarini, Matteo; Glauber, Mattia

    2016-06-01

    Aortic root replacement with porcine xenograft is a valuable treatment option in acute aortic dissection, but conduits are often prone to degeneration. Reoperation is still associated with high operative mortality, and it usually requires root removal and repetition of the Bentall procedure, or a less radical option limited to valve replacement. We describe two cases of Freestyle root degeneration in patients with chronic aortic dissection, in whom we performed a valve-in-valve procedure with the Perceval S prosthesis (Sorin Group, Saluggia, Italy). PMID:27211946

  20. Chimney technique for aortic dissection involving an aberrant right subclavian artery.

    PubMed

    Samura, Makoto; Zempo, Nobuya; Ikeda, Yoshitaka; Kaneda, Yoshikazu; Suzuki, Kazuhiro; Tsuboi, Hidetoshi; Hamano, Kimikazu

    2014-01-01

    We report a case involving a ruptured acute type B aortic dissection originating from an aberrant right subclavian artery (ARSA). A thoracic stent-graft was deployed in the distal arch close to the origin of the ARSA; the entry site at the origin of the ARSA was embolized with metallic coils. Perfusion of the left subclavian artery was preserved without a surgical bypass by using a chimney graft. This procedure is a feasible and less invasive treatment for high-risk sternotomy patients and is an effective strategy for acute aortic dissections involving an ARSA. PMID:24384181

  1. Two-stage operation for Stanford type A acute aortic dissection originating from Kommerell's diverticulum.

    PubMed

    Tanaka, Yuki; Kitamura, Tadashi; Horai, Tetsuya; Miyaji, Kagami

    2016-05-01

    We report a rare case of Stanford type A acute aortic dissection involving an aberrant right subclavian artery and originating from Kommerell's diverticulum in a 52-year old man. Initially, as an emergency measure, total arch replacement and right axillary artery reconstruction were performed. However, due to the subsequent enlargement of the false lumen, thoracic endovascular aortic repair and right subclavian artery coiling were performed successfully 5 months after the first operation. Herein, we describe surgical management approaches for the treatment of a Stanford type A acute aortic dissection with aberrant right subclavian artery. PMID:26869663

  2. Blunt traumatic internal carotid artery dissection with delayed stroke in a young skydiver.

    PubMed

    Abbo, Michael; Hussain, Kosar; Ali, Mohammad Baqer Mohammad

    2013-01-01

    We describe a case of a 33-year-old skydiver who presented to the emergency department after a traumatic landing following a parachuting episode. He initially presented with right knee pain secondary to a tibial plateau fracture. There were no neurological symptoms or signs at the initial assessment. While he was still in the emergency department, he suddenly developed headache and left-sided hemiplegia. An urgent work-up showed right middle cerebral artery thrombosis with right internal carotid thrombosis and dissection. We have discussed some possible mechanism of injury in skydiving that may have predisposed to the occurrence of cervical dissection in our patient. PMID:23559649

  3. Type A Aortic Dissection in Pregnancy: Two Operations Yielding Five Healthy Patients

    PubMed Central

    Jovic, Thomas H.; Aboelmagd, Tariq; Ramalingham, Ganesh; Jones, Nicola; Nashef, Samer A. M.

    2014-01-01

    Type A aortic dissection in pregnancy is a rare, life-threatening condition with a higher incidence in patients with connective tissue diseases. Mortality is high, reflecting the challenges of protecting both maternal and fetal well-being. We discuss two pregnancies complicated by aortic dissection, including one twin pregnancy, and describe the successful aortic repair immediately following Caesarean section. A total of three healthy neonates were delivered. The challenging management and implications of this precarious condition are explored in the context of these cases. PMID:26798726

  4. Femoral artery dissection in vascular type Ehlers-Danlos syndrome; leave well alone?

    PubMed

    Singh, M; Puppala, S; Pollitt, R C; Sobey, G J; Scott, D J A

    2012-03-01

    Vascular Ehlers-Danlos Syndrome (EDS) is a rare autosomal dominant condition resulting from a defect in type III procollagen synthesis. This causes the development of severe vascular pathologies, including arterial rupture and pseudoaneurysm formation. We present a case of a young boy previously diagnosed with vascular EDS due to a Gly975Val substitution in the collagen α1(III) chain presenting with a common femoral artery dissection secondary to minimal trauma. This was managed conservatively with serial duplex scans and gentle mobilization. At follow up the patient had returned to normal activities, with MRA and duplex scans showing complete resolution of the dissection. PMID:22226700

  5. Abdominal Aortic Dissection in a Patient With Autosomal Dominant Polycystic Kidney Disease After Starting Peritoneal Dialysis☆

    PubMed Central

    He, Yingying; Wang, Qin; Zhang, Meng; Wang, Bo; Xiong, Zuying; Luo, Qiong; Wu, Song

    2014-01-01

    Autosomal dominant polycystic kidney disease (ADPKD), one of the most common genetic disorders, is caused by mutations in the PKD1 or PKD2 gene. ADPKD primarily affects the kidneys, causing the development of multiple bilateral cysts that are characteristic of this condition. Besides renal abnormalities, other manifestations of ADPKD include hepatic, pancreatic, and splenic cysts, intracranial aneurysms, aortic aneurysms, and mitral valve prolapse. Reports of ADPKD-associated abdominal aortic dissections are not rare, but there have been no reports of an ADPKD patient developing intestinal obstruction and abdominal aortic dissection after initiating peritoneal dialysis. Herein, we present one such case. PMID:26839787

  6. Anesthetic Management in a Patient With Type A Aortic Dissection and Superior Vena Cava Syndrome

    PubMed Central

    Totonchi, Ziae; Givtaj, Nader; Sakhaei, Mozhgan; Foroutan, Afshin; Chitsazan, Mitra; Chitsazan, Mandana; Pouraliakbar, Hamidreza

    2015-01-01

    Introduction: Induction of general anesthesia in patients with superior vena cava (SVC) syndrome may cause airway obstruction and cardiovascular collapse. Case Presentation: Herein, we introduced a patient with the diagnosis of dissecting aneurysm of the ascending aorta who was candidate for emergency surgery. He also had symptoms of SVC syndrome. To maintain airway patency during anesthetic management, we decided to perform femoro-femoral cardiopulmonary bypass followed by general anesthesia and tracheal intubation. Conclusions: Femoro-femoral bypass prior to initiation of sternotomy is a safe and easy method in patients with aortic dissection and SVC syndrome in whom earlier endotracheal intubation may not be feasible. PMID:26436073

  7. Subarachnoid hemorrhage then thrombosis of posterior inferior cerebellar artery dissection: is early surgical exploration warranted?

    PubMed

    Alexiades, Nikita G; Ellis, Jason A; Meyers, Philip M; Connolly, E Sander

    2016-06-01

    The natural history of spontaneous cerebral artery dissection and thrombosis remains uncertain. Concurrent subarachnoid hemorrhage further complicates the therapeutic approach. Thus the best strategy for managing patients with acute vessel thrombosis in the setting of subarachnoid hemorrhage is unclear. Here we present a case of spontaneous posterior inferior cerebellar artery dissection presenting with subarachnoid hemorrhage and acute thrombosis. Although the patient was initially managed conservatively, angiographic follow-up demonstrated recanalization of the diseased vessel, necessitating definitive treatment. Thus we propose that angiographic follow-up is necessary in the management of patients with subarachnoid hemorrhage in association with apparent vessel thrombosis. PMID:25987592

  8. Complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection

    PubMed Central

    Chen, Fengxia; Huang, Xiuming

    2015-01-01

    We describe herein a case of complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection. The patient was a 67-year-old man. A physical examination revealed a nodule in the left lower lobe that had been present for 7 years. According to the chest computed tomography (CT) report recently, a diagnosis of lung cancer was not excluded. Due to the surgical indications, he was underwent complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection. The frozen pathology report was consistent with adenocarcinoma. He recovered smoothly, without any perioperative complications. PMID:26793364

  9. Renal Artery Stent Placement Complicated by Development of a Type B Aortic Dissection

    SciTech Connect

    Haesemeyer, Scott W.; Vedantham, Suresh Braverman, Alan

    2005-01-15

    Percutaneous renal artery angioplasty and stent placement have demonstrated safety and effectiveness in the treatment of selected patients with renovascular hypertension and ischemic nephropathy. Major complications have been predominantly confined to the affected renal artery and kidneys, including renal artery dissection and/or thrombosis, distal embolization, and contrast-related nephropathy. We report a case in which treatment of an ostial renal artery lesion with placement of a balloon-expandable stent was complicated by the development of an acute Type B aortic dissection.

  10. Blunt traumatic internal carotid artery dissection with delayed stroke in a young skydiver

    PubMed Central

    Abbo, Michael; Hussain, Kosar; Ali, Mohammad Baqer Mohammad

    2013-01-01

    We describe a case of a 33-year-old skydiver who presented to the emergency department after a traumatic landing following a parachuting episode. He initially presented with right knee pain secondary to a tibial plateau fracture. There were no neurological symptoms or signs at the initial assessment. While he was still in the emergency department, he suddenly developed headache and left-sided hemiplegia. An urgent work-up showed right middle cerebral artery thrombosis with right internal carotid thrombosis and dissection. We have discussed some possible mechanism of injury in skydiving that may have predisposed to the occurrence of cervical dissection in our patient. PMID:23559649

  11. Endovascular Treatment in Ruptured Middle Cerebral Artery Dissection Preservation of Arterial Continuity.

    PubMed

    Nam, Dong Hyuk; Park, Sang Kyu

    2015-06-01

    Rupture of spontaneous dissecting aneurysms of the middle cerebral artery (MCA) is rare and its etiology remains obscure, although the risk of rebleeding is greater than with saccular aneurysms. Most reports concerning the treatment of a ruptured dissecting aneurysm of the anterior circulation involve surgical trapping or wrapping. Here, we report on a case of an MCA dissecting rupture treated with endovascular procedures. A 22-year-old female presented with sudden stuporous mental change following severe headache and left side hemiparesis. A computed tomography scan showed a diffuse subarachnoid hemorrhage and diffusion MR showed diffusion restriction at the right putamen and internal capsule. A 3-hour follow-up digital subtraction angiography (DSA) showed a dissecting aneurysm, which was not seen on an initial DSA. A stent assisted coil embolization was performed and double stents were applied to achieve flow diversion effects. A small remnant area of the dissecting aneurysm had disappeared at 60-day and was not observed on 12-month follow-up DSA. PMID:26157690

  12. Open repair of chronic complicated type B aortic dissection using the open distal technique

    PubMed Central

    Sandhu, Harleen; Afifi, Rana O.; Azizzadeh, Ali; Charlton-Ouw, Kristofer; Miller, Charles C.; Safi, Hazim J.

    2014-01-01

    Aim The present study aimed to analyze early and late outcomes after open repair of chronic type B aortic dissection. Methods We retrospectively reviewed our cases of open descending thoracic aortic aneurysm (DTAA) with chronic dissection from 1991-2013. Long-term survival and aortic reinterventions were analyzed and patient comorbidities were evaluated in order to determine the risk of adverse outcomes. Furthermore, the technique for “distal first approach” is described. Results Between 1991 and 2013, 240 (40%) descending thoracic aortic repairs with associated chronic dissection were performed. Mean age is 59 years and 178 (74%) are men. The majority of patients (218, 91%) underwent repair using the adjunct of distal aortic perfusion with cerebral spinal fluid drainage. Early mortality was 8.3% (20/240). Permanent neurologic deficit occurred in 1.3% (3/240). Stroke occurred in 2.9% (7/240), and dialysis on discharge in 6% (12/240). 5-, 10-, 15-, and 20-year survival was 72%, 60%, 45%, and 39%, respectively. Freedom from reoperation on the operated segment was 97%, 94%, 94% and 94% at 5, 10, 15 and 20 years. Conclusions Open repairs of chronic descending thoracic dissections can be performed with respectable morbidity and mortality. Risk of neurologic deficit remains low with use of adjuncts, and risk of reintervention on the involved aortic segment is also low. These results allow comparison with endovascular repair for chronic aortic dissection. PMID:25133100

  13. Cervical Artery Dissection: A Review of the Epidemiology, Pathophysiology, Treatment, and Outcome

    PubMed Central

    Blum, Christina A.; Yaghi, Shadi

    2015-01-01

    Context Cervical artery dissection (CAD) is a common cause of stroke in young adults. There is controversy over whether anticoagulation is superior to antiplatelet therapy in preventing stroke in patients with CAD, although meta-analyses to date have not shown any difference between the two treatments. Evidence acquisition We performed a PubMed search using each of the keywords: “Cervical artery dissection”, “Dissection”, “Carotid dissection”, and “Vertebral dissection” between January 1st, 1990 and July 1st 2015. We identified evidence-based peer-reviewed articles, including randomized trials, case series and reports, and retrospective reviews that encompass the epidemiology, clinical manifestations, pathophysiology, treatment, and outcome of cervical artery dissection. Results This paper highlights the mechanisms of cervical artery dissection and stroke in patients with dissection as well as the natural history and treatment. Conclusion Given the relatively rare incidence of this disease, multicenter studies with collaborative effort among stroke centers worldwide should be considered to enroll patients with cervical artery dissection in a randomized trial comparing the two treatments. PMID:26478890

  14. Spontaneous coronary dissection associated with sleep deprivation presenting with acute myocardial infarction.

    PubMed

    Suh, Soon Yong; Kim, Jin Won; Choi, Cheol Ung; Kim, Eung Ju; Rha, Seung-Woon; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo

    2007-02-01

    Spontaneous coronary dissection is a rare cause of myocardial ischemia, myocardial infarction and sudden cardiac death. Idiopathic spontaneous coronary artery dissection (SCAD) occurs in patient without risk factors for coronary artery disease and without underlying pregnancy. We describe a case of idiopathic spontaneous coronary dissection after sleep deprivation presenting with acute myocardial infarction. A 40 year old woman presented to an emergency department with squeezing substernal chest pain lasting 1 hour following 72 h sleep deprivation due to overtime work. On admission, ECG showed no significant ST change. But the level of CK-MB and Troponin T were increased up to 77.54 ng/ml and 1.62 ng/ml, respectively. Emergent coronary angiography demonstrated a longitudinal dissection of the middle portion in the diagonal artery with TIMI III flow to the distal part of the vessel. Because the dissected vessel was too small to pass the intravascular ultrasound (IVUS) and deploy the stent, angioplasty was not performed. Under medical treatment with aspirin, clopidogrel and unfractionated heparin, conservative management was proposed; she remained free of symptom and discharged free of chest pain and in good condition. PMID:17097166

  15. Cortex-sparing infarction in triple cervical artery dissection following chiropractic neck manipulation

    PubMed Central

    Melikyan, Gayane; Kamran, Saadat; Akhtar, Naveed; Deleu, Dirk; Miyares, Francisco Ruiz

    2015-01-01

    Background: Multivessel cervical dissection with cortical sparing is exceptional in clinical practice. Case presentation: A 55-year-old man presented with acute-onset neck pain with associated sudden onset right-sided hemiparesis and dysphasia after chiropractic manipulation for chronic neck pain. Results and Discussion: Magnetic resonance imaging revealed bilateral internal carotid artery dissection and left extracranial vertebral artery dissection with bilateral anterior cerebral artery territory infarctions and large cortical-sparing left middle cerebral artery infarction. This suggests the presence of functionally patent and interconnecting leptomeningeal anastomoses between cerebral arteries, which may provide sufficient blood flow to salvage penumbral regions when a supplying artery is occluded. Conclusion: Chiropractic cervical manipulation can result in catastrophic vascular lesions preventable if these practices are limited to highly specialized personnel under very specific situations. PMID:26835412

  16. Acute cervical artery dissection after a dental procedure due to a second inferior molar infection.

    PubMed

    Delgado, Montserrat G; Riesco, Nuria; Murias, Eduardo; Calleja, Sergio

    2015-01-01

    Periodontal infections might represent one of the causative factors for cervical artery dissection. We present a case of a 49-year-old woman admitted due to headache. The patient had been suffering from a right second inferior molar infection with a cervical phlegmon for 1 week prior to admission. On 2 October 2014, the patient went to the dentist and a molar extraction was performed in the morning. In the afternoon, the patient began to experience right hemifacial pain that progressed towards an intense and bilateral headache. Neurological status at the time of admission revealed right miosis, ptosis and conjuntival hyperaemia. A CT angiography showed a right internal carotid artery dissection provoking a high-degree stenosis. The relationship between periodontal infection and vascular disease has been previously presented. Microbial agents may directly, and inflammatory and immunological host response indirectly, influence inflammatory changes in cervical arteries favouring dissections with minor traumas. PMID:26038385

  17. Use of heparin in aortic dissection: beware the misdiagnosis of acute pulmonary embolism

    PubMed Central

    Sinha, Yashashwi; Saleh, Mahdi; Weinberg, Daniel

    2013-01-01

    We present a case which highlights the diagnostic difficulties between a Stanford type A aortic dissection (AD) and a pulmonary embolism (PE) and the impact it has on subsequent management. A 75-year-old man presenting with chest pain, shortness of breath and dizziness was initially suspected of having a PE and started on low-molecular-weight-heparin (LMWH). The patient was correctly diagnosed afterwards with CT of the chest to have an aortic dissection. The detrimental use of LMWH may have caused a propagation of the dissection and delayed surgical intervention of an acutely life-threatening condition. When the diagnosis is unclear, the early use of CT can help differentiate AD from PE. This in-turn can guide the management as well as the use of LMWH, which should be avoided until the correct diagnosis is confirmed. PMID:23645649

  18. Completion of Axillary Dissection for a Positive Sentinel Node: Necessary or Not?

    PubMed Central

    Julian, Thomas B.

    2008-01-01

    Sentinel node excision has been widely accepted as the initial surgical step for evaluating the axilla for metastatic breast cancer. When the nodes are positive, the standard of care is to complete the axillary node dissection, a more extended procedure that carries an increased risk for morbidity. This article reviews data from sentinel lymph node trials, case series reports of outcomes when axillary node dissection was not performed in the setting of positive sentinel nodes, models for predicting the status of nonsentinel nodes, and the morbidity associated with axillary operations. Despite an approximate 10% false-negative rate, early results indicate that there is a much lower local recurrence rate after sentinel node excision alone and that systemic therapy may sterilize the axilla. In selected patients, it may be appropriate to forgo an axillary node dissection, although there are no randomized clinical trial data to support or refute this suggestion. PMID:19080737

  19. Emergency Coronary Artery Bypass Graft Surgery for Iatrogenic Left Main Coronary Artery Dissection

    PubMed Central

    Tarbiat, Masoud; Safarpoor, Gholamreza

    2015-01-01

    Iatrogenic coronary artery dissection during coronary angiography with or without rupture is a rare but feared complication. We herein report a case of iatrogenic left main coronary artery dissection in a 49-year-old female. Admitted to our hospital with a recent history of severe hypotension, she develpled apnea during angiography. She was intubated and resuscitated with an Epinephrine infusion in the Cath-Lab. The diagnosis was iatrogenic left main coronary artery dissection based on angiography. Immediately, the patient was transferred to the operating room in a lethargic state with an Epinephrine infusion and prepared for emergency coronary artery bypass graft surgery. In the ICU, she was completely alert with no hemodynamic complications and finally was discharged in a good overall condition. At 18 months' follow-up, the patient was in a stable situation with good daily function. PMID:26985212

  20. Which Comes First: The Use of Computer Simulation of Frog Dissection or Conventional Dissection as Academic Exercise?

    ERIC Educational Resources Information Center

    Akpan, Joseph; Strayer, Jeremy

    2010-01-01

    Science educators and school administrators are reexamining the educational value of animal dissection in the nation's schools and are focusing on simulation as an instructional alternative. One implication of the debate is that simulations can lead to equivalent learning to hands-on dissection. The second implication is whether dissection is…

  1. Application of a cervical low incision in the functional neck dissection of thyroid papillary carcinoma

    PubMed Central

    XU, JIAJIE; CHEN, CHAO; ZHENG, CHUANMING; WANG, KEJING; SHANG, JINBIAO; FANG, XIANHUA; GE, MINGHUA; TAN, ZHUO

    2016-01-01

    The present study aimed to discuss the advantage of the application of a cervical low incision for functional neck dissection in patients with thyroid papillary carcinoma. The study was a retrospective analysis of 87 thyroid papillary carcinoma patients; cervical low incision in the functional neck dissection was applied for 47 cases and the classic ‘L’ incision was applied for 40 cases. The different integrity, surgical time, blood loss and the aesthetic property of the incision were compared between the cervical low incision and the classic ‘L’ incision for lateral neck dissection of thyroid cancer. The postoperative pathological diagnosis was that the average total amount and the region II lymph nodes of the unilateral neck dissection were 33 and 10 for the cervical low incision group, and 32 and 11 for the classic ‘L’ incision group, respectively (P>0.05). The average unilateral neck dissection times were 87 and 58 min for the cervical low incision group and the classic ‘L’ incision group, respectively (P<0.05). The blood loss of the cervical low incision group was 67 ml, while the loss for the classic ‘L’ incision group was 61 ml (P>0.05). The postoperative incision of the cervical low incision group was smaller and more concealing. Additionally, the cosmetic deformities were milder for an inconspicuous cervical scar, and the sensation was improved for the patients in comparison with the classic ‘L’ incision group. These results suggest that the application of cervical low incision for functional neck dissection in thyroid papillary carcinoma patients aids in reducing postoperative complications, without increasing recurrence rates. Therefore, the classic ‘L’ incision can be replaced by the cervical low incision. PMID:27073645

  2. Spontaneous Coronary Dissection: "Live Flash" Optical Coherence Tomography Guided Angioplasty.

    PubMed

    Bento, Angela Pimenta; Fernandes, Renato Gil Dos Santos Pinto; Neves, David Cintra Henriques Silva; Patrício, Lino Manuel Ribeiro; de Aguiar, José Eduardo Chambel

    2016-01-01

    Optical Coherence tomography (OCT) is a light-based imaging modality which shows tremendous potential in the setting of coronary imaging. Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). The diagnosis of SCAD is made mainly with invasive coronary angiography, although adjunctive imaging modalities such as computed tomography angiography, IVUS, and OCT may increase the diagnostic yield. The authors describe a clinical case of a young woman admitted with the diagnosis of ACS. The ACS was caused by SCAD detected in the coronary angiography and the angioplasty was guided by OCT. OCT use in the setting of SCAD has been already described and the true innovation in this case was this unique use of OCT. The guidance of angioplasty with live and short images was very useful as it allowed clearly identifying the position of the guidewires at any given moment without the use of prohibitive amounts of contrast. PMID:26989520

  3. Aortic dissection in pregnancy in England: an incidence study using linked national databases

    PubMed Central

    Banerjee, Amitava; Begaj, Irena; Thorne, Sara

    2015-01-01

    Objectives To conduct the first population-level incidence study of aortic dissection in pregnancy using linked hospital-based data in England. Setting Hospital-based data (Hospital Episode Statistics (HES) linked with mortality data from the Office of National Statistics), national enquiries (Confidential Enquiries into Maternal Mortality) and surveys (UK Obstetric Surveillance System; UKOSS) of aortic dissection in pregnancy from 2003 to 2011 in England. Participants Between 2003 and 2011, all female patients admitted with diagnoses of aortic dissection (not necessarily as the primary cause of admission) and of pregnancy, childbirth and puerperium, were included. Outcome measures Diagnosis of aortic dissection during pregnancy, operated or not operated, with outcome of death or live patient from 2003 to 2011 in England. Results There were significant differences in characteristics of databases with respect to study population, time of study, recorded event and follow-up of outcomes. On the basis of HES, annual incidence of aortic dissection was 1.23 (95% CI 1.22 to 1.24) per 100 000 maternities. Incidence of aortic dissection with death within 1 year was 0.30 (0.29 to 0.31) per 100 000 maternities. Incidence of aortic dissection increased from 0.74 (0.73 to 0.75) per 100 000 maternities in 2003–2005 to 1.52 (1.51 to 1.53) per 100 000 maternities in 2009–2011. In the Confidential Enquiries into Maternal Deaths, incidence of deaths was highest for 2003–2005 (0.43/100 000 maternities) and lowest for 1997–1999 (0.21/100 000 maternities). In the UK Obstetric Surveillance System, national incidence of aortic dissection was 0.80 (0.50 to 1.50) per 100 000 maternities between 2009 and 2011. Conclusions The case of aortic dissection in pregnancy illustrates data limitations regarding complications in pregnancy from different sources in the UK, even for a diagnosis with seemingly few alternative coding and diagnostic possibilities. These limitations should be acknowledged when estimating incidence and outcome. PMID:26297370

  4. Dissecting mammalian immunity through mutation

    PubMed Central

    Siggs, Owen M

    2014-01-01

    Although mutation and natural selection have given rise to our immune system, a well-placed mutation can also cripple it, and within an expanding population we are recognizing more and more cases of single-gene mutations that compromise immunity. These mutations are an ideal tool for understanding human immunology, and there are more ways than ever to measure their physiological effects. There are also more ways to create mutations in the laboratory, and to use these resources to systematically define the function of every gene in our genome. This review focuses on the discovery and creation of mutations in the context of mammalian immunity, with an emphasis on the use of genome-wide chemical and CRISPR/Cas9 mutagenesis to reveal gene function. PMID:24518983

  5. Emergency thoracic aortic stent grafting for acute complicated type B aortic dissection after a previous abdominal endovascular aneurysm repair.

    PubMed

    Yoshiga, Ryosuke; Morisaki, Koichi; Matsubara, Yutaka; Yoshiya, Keiji; Inoue, Kentaro; Matsuda, Daisuke; Aoyagi, Yukihiko; Tanaka, Shinichi; Okadome, Jun; Matsumoto, Takuya; Maehara, Yoshihiko

    2015-12-01

    We report a case of acute type B aortic dissection with the complication of bowel ischemia and abdominal stent graft compression treated by emergency thoracic aortic stent grafting after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). A 69-year-old male was admitted to our hospital for sudden thoraco-abdominal pain. He had past treatment history of EVAR for AAA half a year ago. A computed tomography (CT) showed acute type B aortic dissection, and conservative treatment was initially performed. Three days after occurrence of aortic dissection, worsened abdominal pain and melena were observed. CT showed that the true lumen and abdominal stent graft was compressed by the false lumen. Emergency thoracic endovascular repair (TEVAR) was performed to close the entry tear. After the operation, the image views and the symptoms were improved. The state was still stable 6 months later. TEVAR for acute type B aortic dissection can become one of the effective treatments. PMID:26943423

  6. Simultaneous Surgical Treatment of Type B Dissection Complicated With Visceral Malperfusion and Abdominal Aortic Aneurysm: Role of Aortic Fenestration

    PubMed Central

    Filippone, Gianfranco; Ferro, Gabriele; Duranti, Cristiana; La Barbera, Gaetano; Talarico, Francesco

    2013-01-01

    Aortic dissection occurs in about 5% of patients with coexistent abdominal aortic aneurysm (AAA); combined type B dissection complicated with visceral malperfusion and AAA is an uncommon aortic emergency and patients presenting with complications of thoracic aortic dissection have a dismal prognosis related to difficulties in treatment strategies. Despite tremendous improvement of endovascular techniques, surgical aortic fenestration represents a quick, safe, and effective procedure able to restore flow in an otherwise malperfused aorta. This procedure has to be kept in mind because subsets of patients cannot be treated conventionally due to either prohibitive risk of aortic replacement, anatomic contraindication, or limitations of percutaneous procedures. Herein we report a case of a patient presenting with type B aortic dissection complicated by visceral malperfusion and AAA which was successfully treated simultaneously by open AAA repair and surgical fenestration. We focus on the mechanism of malperfusion and on the role of surgical fenestration. PMID:26798685

  7. Intramyocardial Dissection following Postinfarction Ventricular Wall Rupture Contained by Surrounding Postoperative Adhesions

    PubMed Central

    Ercan, Abdulkadir; Gurbuz, Orcun; Kumtepe, Gencehan; Ozkan, Hakan; Karal, Ilker Hasan; Velioglu, Yusuf; Ener, Serdar

    2015-01-01

    Introduction. Dissection of the myocardium is a rare form of cardiac rupture, caused by a hemorrhagic dissection among the spiral myocardial fibers, its diagnosis is rarely established before the operation or death, and extremely few cases have been reported in the literature and none of these cases seem to have a history of previous cardiac surgery which makes our report unique. Case Presentation. A 61-year-old female patient was admitted into the emergency room with complaints of progressive chest pain for 2 days. She had a history of second time prosthetic aortic valve replacement and was under anticoagulation therapy. She was diagnosed with an acute inferoposterior myocardial infarction and underwent emergency coronary angiography revealing spontaneous recanalization of the right coronary artery. During the follow-up, she developed cardiogenic shock and a new occurring systolic ejection murmur. Transthoracic echocardiography showed a left ventricular free wall rupture; then, she was taken in for emergency surgery. During the operation, a rupture zone and a wide intramyocardial dissecting area were detected. Intraventricular patch repair technic with autologous pericardial patch was used to exclude the ruptured area. Following the warming period, despite adequate hemostasis, hemorrhage around suture lines progressively increased, leading to the patient's death. Conclusion. Pericardial adhesions might contain left ventricular rupture leading to intramyocardial dissection. PMID:25874153

  8. Intramyocardial Dissection following Postinfarction Ventricular Wall Rupture Contained by Surrounding Postoperative Adhesions.

    PubMed

    Ercan, Abdulkadir; Gurbuz, Orcun; Kumtepe, Gencehan; Ozkan, Hakan; Karal, Ilker Hasan; Velioglu, Yusuf; Ener, Serdar

    2015-01-01

    Introduction. Dissection of the myocardium is a rare form of cardiac rupture, caused by a hemorrhagic dissection among the spiral myocardial fibers, its diagnosis is rarely established before the operation or death, and extremely few cases have been reported in the literature and none of these cases seem to have a history of previous cardiac surgery which makes our report unique. Case Presentation. A 61-year-old female patient was admitted into the emergency room with complaints of progressive chest pain for 2 days. She had a history of second time prosthetic aortic valve replacement and was under anticoagulation therapy. She was diagnosed with an acute inferoposterior myocardial infarction and underwent emergency coronary angiography revealing spontaneous recanalization of the right coronary artery. During the follow-up, she developed cardiogenic shock and a new occurring systolic ejection murmur. Transthoracic echocardiography showed a left ventricular free wall rupture; then, she was taken in for emergency surgery. During the operation, a rupture zone and a wide intramyocardial dissecting area were detected. Intraventricular patch repair technic with autologous pericardial patch was used to exclude the ruptured area. Following the warming period, despite adequate hemostasis, hemorrhage around suture lines progressively increased, leading to the patient's death. Conclusion. Pericardial adhesions might contain left ventricular rupture leading to intramyocardial dissection. PMID:25874153

  9. Towards a fast implementation of spectral nested dissection

    NASA Technical Reports Server (NTRS)

    Pothen, Alex; Simon, Horst D.; Wang, Lie; Barnard, Stephen T.

    1992-01-01

    We describe the spectral nested dissection (SND) algorithm, a new algorithm for computing orderings appropriate for parallel factorization of sparse, symmetric matrices. The algorithm makes use of spectral properties of the Laplacian matrix associated with the given matrix to compute separators. We evaluate the quality of the spectral orderings with respect to several measures: fill, elimination tree height, height and weight balances of elimination trees, and clique tree heights. We use some very large structural analysis problems as test cases and demonstrate on these real applications (such as the Space Shuttle Solid Rocket Booster) that spectral orderings compare quite favorably with commonly used orderings, outperforming them by a wide margin for some of these measures. The only disadvantage of SND is its relatively long execution time. We will present some recent efforts to improve the execution time using both a multilevel and a hybrid approach. We use SND in computing a multifrontal numerical factorization with the different orderings on an eight processor Cray Y-MP and show its effectiveness. We believe that spectral nested dissection is a major breakthrough in terms of generating efficient sparse orderings for parallel machines.

  10. Anesthesia Management in Aortic Dissection in Patients Undergoing Kidney Transplant.

    PubMed

    Ucar, Muharrem; Erdil, Feray; Sanlı, Mukadder; Aydogan, Mustafa Said; Durmus, Mahmut

    2016-04-01

    Kidney transplant is a last resort to increase the life expectancy and quality of life in patients with renal failure. Aortic dissection is a disease that requires emergency intervention; it is characterized by sudden life-threatening back or abdominal pain. In the case described, constant chest pain that increased with respiration was present on exam-ination of a 28-year-old man (85 kg, 173 cm) who presented at our emergency department complaining of severe back pain. He had undergone a kidney transplant in 2004 from his mother (live donor). He was diagnosed with acute Type II aortic dissection and was scheduled for emergent surgery. Because there were no surgical or anesthetic complications, the patient with 79 and 89 minutes aortic cross-clamping and cardiopulmonary bypass durations was sent, intubated, to intensive care unit. When nephrotoxic agents are avoided and blood flow is stabilized, cardiovascular surgery with cardio-pulmonary bypass may be performed seamlessly in patients who have undergone a kidney transplant. PMID:25375956

  11. Dissecting immunity by germline mutagenesis.

    PubMed

    Choi, Onjee; Rutschmann, Sophie

    2012-10-01

    The last decades have seen numerous approaches being used to decipher biological phenomena, notably the strategies we employ to defend ourselves against pathogenic attacks. From microarrays to genetics to computing technologies, all have supported a better but not yet comprehensive understanding of the pathways regulating our immune system. Limitations are notably exemplified by cases of immune deficiencies in humans that often result in high susceptibility to infections or even death, without the genetic cause being evident. To provide further insight into the mechanisms by which pathogen detection and eradication occur, several in vivo strategies can be used. The current review focuses on one of them, namely germline mutagenesis in the mouse. After describing the main technical aspects of this forward genetic approach, we will discuss particular germline mutants that have all been instrumental in deciphering innate or adaptive immune responses. Mutations in previously uncharacterized genes in the mouse, like Unc93B or Themis, have demonstrated the impartiality of forward genetics and led to the identification of new crucial immunity actors. Some mutants, like PanR1, have informed us on particular protein domains and their specific functions. Finally, certain mutations identified by this non-hypothesis-driven method have revealed previously unknown gene functions, as recently illustrated by memi, which links a particular nucleoside salvage enzyme to cell proliferation and apoptosis. PMID:22681445

  12. Dissecting immunity by germline mutagenesis

    PubMed Central

    Choi, Onjee; Rutschmann, Sophie

    2012-01-01

    The last decades have seen numerous approaches being used to decipher biological phenomena, notably the strategies we employ to defend ourselves against pathogenic attacks. From microarrays to genetics to computing technologies, all have supported a better but not yet comprehensive understanding of the pathways regulating our immune system. Limitations are notably exemplified by cases of immune deficiencies in humans that often result in high susceptibility to infections or even death, without the genetic cause being evident. To provide further insight into the mechanisms by which pathogen detection and eradication occur, several in vivo strategies can be used. The current review focuses on one of them, namely germline mutagenesis in the mouse. After describing the main technical aspects of this forward genetic approach, we will discuss particular germline mutants that have all been instrumental in deciphering innate or adaptive immune responses. Mutations in previously uncharacterized genes in the mouse, like Unc93B or Themis, have demonstrated the impartiality of forward genetics and led to the identification of new crucial immunity actors. Some mutants, like PanR1, have informed us on particular protein domains and their specific functions. Finally, certain mutations identified by this non-hypothesis-driven method have revealed previously unknown gene functions, as recently illustrated by memi, which links a particular nucleoside salvage enzyme to cell proliferation and apoptosis. PMID:22681445

  13. Recurrent tamponade and aortic dissection in syphilis.

    PubMed

    Stansal, Audrey; Mirault, Tristan; Rossi, Aude; Dupin, Nicolas; Bruneval, Patrick; Bel, Alain; Azarine, Arshid; Minozzi, Catherine; Deman, Anne Laure; Messas, Emmanuel

    2013-11-01

    Syphilitic cardiovascular disease has been described since the 19th century, mainly on autopsy series. Major clinical manifestations are aortic aneurysm, aortic insufficiency, and coronary ostial stenosis. The diagnosis of syphilitic cardiovascular disease is based mainly on positive serologic tests and overt clinical manifestations. We present here a rare and unusual clinical presentation of a tertiary syphilis with recurrent tamponade and type B aortic dissection, whose positive diagnosis was made by polymerase chain reaction on pericardial fluid analysis. PMID:24182507

  14. Block data distribution for parallel nested dissection

    SciTech Connect

    Charrier, P.; Facq, L.; Roman, J.

    1995-12-01

    In this paper, we consider the problem of data partitioning for block sparse Cholesky factorization on distributed memory MIMD computers. We propose a preprocessing algorithm which computes and distributes a column block partition based on an initial partition induced by a nested dissection ordering. This preprocessing algorithm works by optimizing load balancing under precedence constraints and communication traffic. It can be performed in linear time and space complexities.

  15. Building mental models by dissecting physical models.

    PubMed

    Srivastava, Anveshna

    2016-01-01

    When students build physical models from prefabricated components to learn about model systems, there is an implicit trade-off between the physical degrees of freedom in building the model and the intensity of instructor supervision needed. Models that are too flexible, permitting multiple possible constructions require greater supervision to ensure focused learning; models that are too constrained require less supervision, but can be constructed mechanically, with little to no conceptual engagement. We propose "model-dissection" as an alternative to "model-building," whereby instructors could make efficient use of supervisory resources, while simultaneously promoting focused learning. We report empirical results from a study conducted with biology undergraduate students, where we demonstrate that asking them to "dissect" out specific conceptual structures from an already built 3D physical model leads to a significant improvement in performance than asking them to build the 3D model from simpler components. Using questionnaires to measure understanding both before and after model-based interventions for two cohorts of students, we find that both the "builders" and the "dissectors" improve in the post-test, but it is the latter group who show statistically significant improvement. These results, in addition to the intrinsic time-efficiency of "model dissection," suggest that it could be a valuable pedagogical tool. © 2015 by The International Union of Biochemistry and Molecular Biology, 44:7-11, 2016. PMID:26712513

  16. Advanced endoscopic submucosal dissection with traction

    PubMed Central

    Imaeda, Hiroyuki; Hosoe, Naoki; Kashiwagi, Kazuhiro; Ohmori, Tai; Yahagi, Naohisa; Kanai, Takanori; Ogata, Haruhiko

    2014-01-01

    Endoscopic submucosal dissection (ESD) has been established as a standard treatment for early stage gastric cancer (EGC) in Japan and has spread worldwide. ESD has been used not only for EGC but also for early esophageal and colonic cancers. However, ESD is associated with several adverse events, such as bleeding and perforation, which requires more skill. Adequate tissue tension and clear visibility of the tissue to be dissected are important for effective and safe dissection. Many ESD methods using traction have been developed, such as clip-with-line method, percutaneous traction method, sinker-assisted method, magnetic anchor method, external forceps method, internal-traction method, double-channel-scope method, outerroute method, double-scope method, endoscopic-surgical-platform, and robot-assisted method. Each method has both advantages and disadvantages. Robotic endoscopy, enabling ESD with a traction method, will become more common due to advances in technology. In the near future, simple, noninvasive, and effective ESD using traction is expected to be developed and become established as a worldwide standard treatment for superficial gastrointestinal neoplasias. PMID:25031787

  17. 78 FR 116 - Certain Cases for Portable Electronic Devices: Notice of Receipt of Complaint; Solicitation of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-02

    ... official business hours (8:45 a.m. to 5:15 p.m.) in the Office of the Secretary, U.S. International Trade... impact United States consumers. Written submissions must be filed no later than by close of business... importation of certain cases for portable electronic devices. The complaint names as respondents...

  18. 76 FR 1152 - Crosstex North Texas Pipeline, L.P.; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-07

    ... Energy Regulatory Commission Crosstex North Texas Pipeline, L.P.; Notice of Motion for Extension of Rate... desiring to participate in this rate proceeding must file a motion to intervene or to protest this filing... to become a party must file a notice of intervention or motion to intervene, as appropriate....

  19. 76 FR 76711 - Overland Trail Transmission, LLC; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-08

    ... Energy Regulatory Commission Overland Trail Transmission, LLC; Notice of Motion for Extension of Rate... ] 61,150 (May 20, 2010). Any person desiring to participate in this rate proceeding must file a motion... to the proceeding. Any person wishing to become a party must file a notice of intervention or...

  20. 75 FR 70752 - ONEOK WesTex Transmission, LLC; Notice of Motion for Extension of Rate Case Filing Deadline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-18

    ... Federal Energy Regulatory Commission ONEOK WesTex Transmission, LLC; Notice of Motion for Extension of... 20, 2010). Any person desiring to participate in this rate proceeding must file a motion to intervene... proceeding. Any person wishing to become a party must file a notice of intervention or motion to...

  1. Spontaneous coronary artery dissection: a rare cause of acute coronary syndrome

    PubMed Central

    Junpaparp, Parichart; Romero-Corral, Abel; Lee, Seung Yoon Celine; Witzke, Christian

    2014-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction, which should always be included in differential diagnoses of acute coronary syndrome among young patients without known atherosclerotic risk. Although, it is commonly observed in young women during postpartum period, there were cases reported in connective tissue disorders, eosinophilic arteritis, contraception use, cocaine abuse and repetitive chest trauma. We report a case of SCAD, presenting with acute ST-elevation myocardial infarction, which was successfully treated conservatively. PMID:24632904

  2. Acute Myocardial Infarction Due to Coronary Artery Dissection in the Postpartum Period

    PubMed Central

    Moussa, Hind N.; Movahedian, Malahat; Leon, Mateo G.; Sibai, Baha M.

    2015-01-01

    Background?Though rare, myocardial infarction secondary to coronary artery dissection is a life-threatening event. In reproductive age women, it commonly occurs during pregnancy or the postpartum period. Case?We present a case of pregnancy-related acute myocardial infarction due to spontaneous coronary artery dissection in a 37-year-old woman who presented to the emergency room with shortness of breath and sudden onset of retrosternal chest pain 8 days after delivery of premature twins. Coronary artery catheterization showed 75 to 90% stenosis in the left main coronary artery (LMCA), extending into the proximal and mid left anterior descending (LAD) branch. The LMCA appearance in the heart catheterization was consistent with vasospasm, but it was not responsive to medical management. Subsequently, she underwent a second coronary artery catheterization and was found to have dissection requiring emergent coronary artery bypass graft??3 in the LMCA, circumflex, and LAD that was followed by an uneventful recovery. Conclusion?Early diagnosis and management of myocardial infarction due to coronary artery dissection in the peripartum period is crucial. This condition should be suspected in young reproductive age women, even in the setting of minimal risk factors. Angiography is required for diagnosis. Management should be individualized as it may include both invasive and noninvasive measures. PMID:26495161

  3. Peer-Assisted Learning in a Gross Anatomy Dissection Course

    PubMed Central

    Han, Eui-Ryoung; Chung, Eun-Kyung; Nam, Kwang-Il

    2015-01-01

    Peer-assisted learning encourages students to participate more actively in the dissection process and promotes thoughtful dissection. We implemented peer-assisted dissection in 2012 and compared its effects on students’ self-assessments of learning and their academic achievement with those of faculty-led dissection. All subjects performed dissections after a lecture about upper-limb gross anatomy. Experimental group (n = 134) dissected a cadaver while guided by peer tutors who had prepared for the dissection in advance, and control group (n = 71) dissected a cadaver after the introduction by a faculty via prosection. Self-assessment scores regarding the learning objectives related to upper limbs were significantly higher in experimental group than in control group. Additionally, experimental group received significantly higher academic scores than did control group. The students in peer-assisted learning perceived themselves as having a better understanding of course content and achieved better academic results compared with those who participated in faculty-led dissection. Peer-assisted dissection contributed to self-perception and to the ability to retain and explain anatomical knowledge. PMID:26565616

  4. Background music in the dissection laboratory: impact on stress associated with the dissection experience.

    PubMed

    Anyanwu, Emeka G

    2015-06-01

    Notable challenges, such as mental distress, boredom, negative moods, and attitudes, have been associated with learning in the cadaver dissection laboratory (CDL). The ability of background music (BM) to enhance the cognitive abilities of students is well documented. The present study was designed to investigate the impact of BM in the CDL and on stress associated with the dissection experience. After 8 wk of normal dissection without BM, various genres of BM were introduced into the cadaver dissection sessions of 260 medical and dental students for 3 wk. Feedback on the impact of BM on students in the CDL and students' attitude were accessed using a questionnaire. Psychological stress assessment was done using Psychological Stress Measure 9. Two batches of 30 students each were made to dissect same areas of the body for 2 h, one batch with BM playing and the other batch without. The same examination was given to both groups at the end. Over 90% of the participants expressed a desire to incorporate BM into the CDL; 87% of the sampled population that expressed love for music also reported BM to be a very useful tool that could be used to enhance learning conditions in the CDL. A strong positive relationship was established between love for music and its perception as a tool for learning in the CDL (P < 0.001). Students that studied under the influence of BM had significantly higher scores (P < 0.001) in the overall examination result. BM reduced the level of stress associated with the dissection experience by ∼33%. PMID:26031725

  5. Incidence of branching patterns variations of the arch in aortic dissection in Chinese patients.

    PubMed

    Tapia, G Pullas; Zhu, Xiaohua; Xu, Jing; Liang, Pan; Su, Gang; Liu, Hai; Liu, Yang; Shu, Liliang; Liu, Shuiqi; Huang, Chen

    2015-05-01

    Several authors have described anatomic variations of the aortic arch in 13% to 20% of the patients who do not have aortic disease. However, few studies have evaluated these patterns in the thoracic aortic dissection (TAD). In the authors' knowledge, this is the first survey that specifically investigates the frequency of these variations in a broad, nonselected group of Chinese patients with aortic dissection. Furthermore, it compares this group with a group of patients without aortic disease.The objective of this study was to define the variation frequency of the aortic arch branches pattern using the tomographic studies of 525 Chinese patients with a diagnosis of TAD. The Stanford classification was used to set the site of the initial tear of the dissection. In addition, we performed an epidemiological analysis of the aortic arch anatomic variations in TAD, and its possible implications for surgical or endovascular treatment. The general hypothesis proposal asserted that Chinese patients with dissection of the aorta have a similar incidence of variations of the aortic arch to the patients without aortic disease.A retrospective study of cases and controls was carried out using the tomographic studies (CT) of all patients admitted to the First Affiliated Hospital of Zhengzhou University, located at Henan-China, with a confirmed diagnosis of aortic dissection from January 2012 until December 2014. The group of cases consisted of 525 patients: 374 men and 151 women, with a mean age of 52.27 years (range, 20-89). The average age of the patients with Stanford A and B aortic dissection was 49.46 and 53.67, respectively. The control group consisted of 525 unselected patients without TAD who underwent a CT scan of the chest due to other indications. This group consisted of 286 men and 239 women, with a mean age of 53.60 years (range, 18-89). All the patients with aneurysm or dissection were excluded from the control group. We performed a statistical analysis of demographic data.The study found 7 different patterns of the aortic arch on both groups of cases and controls. Within the 525 patients with TAD were observed 85 (16.19%) anatomical variations, while the control group showed 112 variations (21.33%); P = 0.033. The most common anatomical variant was the bovine arch, found in 62 (11.80%) cases of TAD compared with 77 (14.66%) in the control group; P = 0.172. Anatomical variations were observed in 14.32% of the patients with Stanford A dissection and 17.09% of the patients with Stanford B dissection; P = 0.425. Patients with Stanford A dissection showed the pattern of bovine arch in 23 (13.21%) of 174 cases. In contrast, the patients with Stanford B dissection showed it in 39 (11.11%) of 351 cases; P = 0.481. The anatomical variant defined as vertebral artery of direct origin of the aortic arch was more frequent in the patients with Stanford B dissection (5.12%). The patients with Stanford A dissection presented this pattern in 1.14% of the cases; P = 0.025. This study observed an increased frequency of aortic dissection in the subgroup from 41 to 60 years old. In the subgroup from 41 to 60 years old without TAD, a greater frequency of anatomical variations were found than in the patients with TAD (20.81% vs 14.23%; P = 0.050). The same fashion was seen in patients older than 80 years (27.27% vs 0%; P = 0.030). The anatomical variations of the aortic arch with TAD occurred in 14.97% of the male patients and 19.20% of the female patients compared to 21.67% to 20.92% in the control group; P = 0.026 and P = 0.681, respectively.The aortic arch variations were found less frequently in the TAD group than in the control group in the present Chinese series. The bovine arch was considered the variant pattern of the major frequency in the patients with TAD and the control group. The anatomical variant of 4 branches, defined as vertebral artery of direct origin of the aortic arch, was more frequent in patients with Stanford B aortic dissection than in the patients with Stanford A.This finding might show an association between the geometry of the aortic arch and the site of onset of first intimal tear of dissection. PMID:25929931

  6. Incidence of Branching Patterns Variations of the Arch in Aortic Dissection in Chinese Patients

    PubMed Central

    Tapia, G. Pullas; Zhu, Xiaohua; Xu, Jing; Liang, Pan; Su, Gang; Liu, Hai; Liu, Yang; Shu, Liliang; Liu, Shuiqi; Huang, Chen

    2015-01-01

    Abstract Several authors have described anatomic variations of the aortic arch in 13% to 20% of the patients who do not have aortic disease. However, few studies have evaluated these patterns in the thoracic aortic dissection (TAD). In the authors’ knowledge, this is the first survey that specifically investigates the frequency of these variations in a broad, nonselected group of Chinese patients with aortic dissection. Furthermore, it compares this group with a group of patients without aortic disease. The objective of this study was to define the variation frequency of the aortic arch branches pattern using the tomographic studies of 525 Chinese patients with a diagnosis of TAD. The Stanford classification was used to set the site of the initial tear of the dissection. In addition, we performed an epidemiological analysis of the aortic arch anatomic variations in TAD, and its possible implications for surgical or endovascular treatment. The general hypothesis proposal asserted that Chinese patients with dissection of the aorta have a similar incidence of variations of the aortic arch to the patients without aortic disease. A retrospective study of cases and controls was carried out using the tomographic studies (CT) of all patients admitted to the First Affiliated Hospital of Zhengzhou University, located at Henan-China, with a confirmed diagnosis of aortic dissection from January 2012 until December 2014. The group of cases consisted of 525 patients: 374 men and 151 women, with a mean age of 52.27 years (range, 20–89). The average age of the patients with Stanford A and B aortic dissection was 49.46 and 53.67, respectively. The control group consisted of 525 unselected patients without TAD who underwent a CT scan of the chest due to other indications. This group consisted of 286 men and 239 women, with a mean age of 53.60 years (range, 18–89). All the patients with aneurysm or dissection were excluded from the control group. We performed a statistical analysis of demographic data. The study found 7 different patterns of the aortic arch on both groups of cases and controls. Within the 525 patients with TAD were observed 85 (16.19%) anatomical variations, while the control group showed 112 variations (21.33%); P = 0.033. The most common anatomical variant was the bovine arch, found in 62 (11.80%) cases of TAD compared with 77 (14.66%) in the control group; P = 0.172. Anatomical variations were observed in 14.32% of the patients with Stanford A dissection and 17.09% of the patients with Stanford B dissection; P = 0.425. Patients with Stanford A dissection showed the pattern of bovine arch in 23 (13.21%) of 174 cases. In contrast, the patients with Stanford B dissection showed it in 39 (11.11%) of 351 cases; P = 0.481. The anatomical variant defined as vertebral artery of direct origin of the aortic arch was more frequent in the patients with Stanford B dissection (5.12%). The patients with Stanford A dissection presented this pattern in 1.14% of the cases; P = 0.025. This study observed an increased frequency of aortic dissection in the subgroup from 41 to 60 years old. In the subgroup from 41 to 60 years old without TAD, a greater frequency of anatomical variations were found than in the patients with TAD (20.81% vs 14.23%; P = 0.050). The same fashion was seen in patients older than 80 years (27.27% vs 0%; P = 0.030). The anatomical variations of the aortic arch with TAD occurred in 14.97% of the male patients and 19.20% of the female patients compared to 21.67% to 20.92% in the control group; P = 0.026 and P = 0.681, respectively. The aortic arch variations were found less frequently in the TAD group than in the control group in the present Chinese series. The bovine arch was considered the variant pattern of the major frequency in the patients with TAD and the control group. The anatomical variant of 4 branches, defined as vertebral artery of direct origin of the aortic arch, was more frequent in patients with Stanford B aortic dissection than in the patients with Stanford A. This finding might show an association between the geometry of the aortic arch and the site of onset of first intimal tear of dissection. PMID:25929931

  7. Spontaneous coronary artery dissection as a cause of myocardial infarction.

    PubMed

    Aksakal, Aytekin; Arslan, Uğur; Yaman, Mehmet; Urumdaş, Mehmet; Ateş, Ahmet Hakan

    2014-12-26

    Spontaneous coronary artery dissection (SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 70-year-old man was admitted to the emergency department with chest pain which started 1 h ago during a relative's funeral. The initial electrocardiography demonstrated 2 mm ST-segment depression in leads V1-V3 and the patient underwent emergent coronary angiography. SCAD simultaneously in two different coronary arteries [left anterior descending (LAD) artery and left circumflex (LCx)] artery was detected and SCAD in LCx artery was causing total occlusion which resulted in acute myocardial infarction. Successful stenting was performed thereafter for both lesions. In addition to the existence of SCAD simultaneously in two different coronary arteries, the presence of muscular bridge and SCAD together at the same site of the LAD artery was another interesting point which made us report this case. PMID:25548620

  8. JAK2-Centered Interactome Hotspot Identified by an Integrative Network Algorithm in Acute Stanford Type A Aortic Dissection

    PubMed Central

    Teschendorff, Andrew E.; Hong, Tao; Wang, Linyan; Qian, Mengjia; Wang, Chunsheng; Wang, Xiangdong

    2014-01-01

    The precise mechanisms underlying dissections, especially those without connective tissue diseases or congenital vascular diseases, are incompletely understood. This study attempted to identify both the expression profile of the dissected ascending aorta and the interactome hotspots associated with the disease, using microarray technology and gene regulatory network analysis. There were 2,737 genes differentially expressed between patients with acute Stanford type A aortic dissection and controls. Eight interactome hotspots significantly associated with aortic dissection were identified by an integrative network algorithm. In particular, we identified a JAK2-centered expression module, which was validated in an independent gene expression microarray data set, and which was characterized by over-expressed cytokines and receptors in acute aortic dissection cases, indicating that JAK2 may play a key role in the inflammatory process, which potentially contributes to the occurrence of acute aortic dissection. Overall, the analytical strategy used in this study offered the possibility to identify functional relevant network modules and subsequently facilitated the biological interpretation in the complicated disease. PMID:24586754

  9. Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

    PubMed Central

    Omar, Sabry; Moore, Tyler; Payne, Drew; Momeni, Parastoo; Mulkey, Zachary; Nugent, Kenneth

    2014-01-01

    We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary. PMID:25104961

  10. Molecular Dissection Using Array Comparative Genomic Hybridization and Clinical Evaluation of An Infertile Male Carrier of An Unbalanced Y;21 Translocation: A Case Report and Review of The Literature

    PubMed Central

    Orrico, Alfredo; Marseglia, Giuseppina; Pescucci, Chiara; Cortesi, Ambra; Piomboni, Paola; Giansanti, Andrea; Gerundino, Francesca; Ponchietti, Roberto

    2016-01-01

    Chromosomal defects are relatively frequent in infertile men however, translocations between the Y chromosome and autosomes are rare and less than 40 cases of Y-autosome translocation have been reported. In particular, only three individuals has been described with a Y;21 translocation, up to now. We report on an additional case of an infertile man in whom a Y;21 translocation was associated with the deletion of a large part of the Y chromosome long arm. Applying various techniques, including conventional cytogenetic procedures, fluorescence in situ hybridisation (FISH) analysis and array comparative genomic hybridization (array-CGH) studies, we identified a derivative chromosome originating from a fragment of the short arm of the chromosome Y translocated on the short arm of the 21 chromosome. The Y chromosome structural rearrangement resulted in the intactness of the entire short arm, including the sex-determining region Y (SRY) and the short stature homeobox (SHOX) loci, although translocated on the 21 chromosome, and the loss of a large part of the long arm of the Y chromosome, including azoospermia factor-a (AZFa), AZFb, AZFc and Yq heterochromatin regions. This is the first case in which a (Yp;21p) translocation has been ascertained using an array-CGH approach, thus reporting details of such a rearrangement at higher resolution. PMID:26985348

  11. Atrial septal dissection late after congenital heart surgery.

    PubMed

    Knecht, Kenneth R; Imamura, Michiaki

    2011-10-01

    Atrial septal dissection is a rare entity usually seen after surgical mitral valve repair, myocardial infarction, or endocarditis. This is a report of an atrial dissection in a young girl found on routine follow-up echocardiography after repair of atrial and ventricular septal defects. No identifiable predisposing risk was found prior to or at the time of surgical repair. Considerable risk of significant morbidity and even mortality attends atrial dissection due to the risk of rupture. PMID:21958812

  12. Left Atrial Wall Dissection after Mitral Valve Replacement

    PubMed Central

    Kim, Kyung Woo; Park, Se Hyeok; Lee, Sang-Il; Kim, Ji Yeon; Kim, Kyung-Tae; Choe, Won Joo; Park, Jang Su; Kim, Jung Won

    2013-01-01

    Left atrial dissection does occur, though rarely, after mitral valve surgery. A 68-year-old Korean female presented with moderate mitral stenosis, mild mitral regurgitation, moderate tricuspid regurgitation and mild aortic regurgitation. She was scheduled for mitral valve replacement and tricuspid annuloplasty. We experienced a left atrial dissection after weaning from cardiopulmonary bypass and decided not to repair it. The patient recovered uneventfully. We suggest that a specific type of left atrial dissection can be treated conservatively. PMID:24198922

  13. Serial Dissection of Parasite Gene Families.

    PubMed

    Bzik, David J

    2016-05-01

    Calcium ion signaling regulates central aspects of the biology controlling stage and life cycle transitions of apicomplexan parasites. In the current issue of Infection and Immunity, Long and coworkers (S. Long, Q. Wang, and L. D. Sibley, Infect Immun 84:1262-1273, 2016, http://dx.doi.org/10.1128/IAI.01173-15) describe a powerful genetic system enabling reliable serial genetic dissection of a large gene family encoding novel calcium-dependent protein kinases (CDPKs) that provides new insights into the roles of CDPKs during Toxoplasma gondii infection. PMID:26953326

  14. [Coronary artery dissection following blunt chest trauma].

    PubMed

    Seven, Ekim; Henningsen, Kristoffer; Abildgaard, Ulrik

    2015-03-16

    A previously healthy 38-year-old man was admitted to hospital with chest pain. The day before the patient had been to a karate session and had received multiple punches and kicks to the chest region. An ECG showed Q-waves in V1 and V2 and flattening of the T-waves in V1-V6. Levels of cardiac enzyme markers were elevated. The patient subsequently underwent coronary angiography with supplemental optical coherence tomography that revealed a bifurcate dissection involving the proximal parts of left ramus interventricularis anterior and circumflex coronary artery. Two drug-eluting stents were implanted with good angiographic result. PMID:25786846

  15. Spontaneous coronary artery dissection in a 35 year-old woman with systemic lupus erythematosus successfully treated by angioplasty.

    PubMed

    Rekik, Sofiene; Lanfranchi, Philippe; Jacq, Laurent; Bernasconi, François

    2013-11-01

    Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischaemia with complex pathophysiology; it has been associated with several conditions such as atherosclerosis, connective tissue disorders and the peripartum period. SCAD has exceptionally been reported (three published cases) in patients with systemic lupus erythematosus (SLE). In this work, we report the original case of a 35 year-old woman with a known history of SLE who presented with an acute coronary syndrome caused by an extensive dissection of the left anterior descending artery (LAD) and the diagonal and who was successfully treated by an intravascular ultrasound (IVUS)-guided percutaneous angioplasty. PMID:23465651

  16. Vessel wall MRI for suspected isolated basilar artery dissection.

    PubMed

    Obusez, Emmanuel C; Jones, Stephen E; Hui, Ferdinand

    2016-05-01

    Isolated basilar artery dissection is an uncommon intracranial vasculopathy with a poor prognosis. Digital subtraction angiography is considered the definitive modality for diagnosis. Vessel wall MRI (VW-MRI) is an emerging non-invasive technique for assessing the structural integrity of intracranial vessel walls and lumina. Recently, a small number of studies have described the vessel wall patterns of intracranial artery dissection. However, studies on vessel wall imaging of isolated basilar artery dissection remain limited. We describe a patient with suspected isolated spontaneous basilar artery dissection diagnosed using VW-MRI. PMID:26765755

  17. Doing Dissections Differently: A Structured, Peer-Assisted Learning Approach to Maximizing Learning in Dissections

    ERIC Educational Resources Information Center

    Hall, Emma R.; Davis, Rachel C.; Weller, Renate; Powney, Sonya; Williams, Sarah B.

    2013-01-01

    Areas of difficulty faced by our veterinary medicine students, with respect to their learning in dissection classes, were identified. These challenges were both general adult-learning related and specific to the discipline of anatomy. Our aim was to design, implement, and evaluate a modified reciprocal peer-assisted/team-based learning

  18. Doing Dissections Differently: A Structured, Peer-Assisted Learning Approach to Maximizing Learning in Dissections

    ERIC Educational Resources Information Center

    Hall, Emma R.; Davis, Rachel C.; Weller, Renate; Powney, Sonya; Williams, Sarah B.

    2013-01-01

    Areas of difficulty faced by our veterinary medicine students, with respect to their learning in dissection classes, were identified. These challenges were both general adult-learning related and specific to the discipline of anatomy. Our aim was to design, implement, and evaluate a modified reciprocal peer-assisted/team-based learning…

  19. Background Music in the Dissection Laboratory: Impact on Stress Associated with the Dissection Experience

    ERIC Educational Resources Information Center

    Anyanwu, Emeka G.

    2015-01-01

    Notable challenges, such as mental distress, boredom, negative moods, and attitudes, have been associated with learning in the cadaver dissection laboratory (CDL). The ability of background music (BM) to enhance the cognitive abilities of students is well documented. The present study was designed to investigate the impact of BM in the CDL and on…

  20. The Effect of a Prior Dissection Simulation on Middle School Students' Dissection Performance and Understanding of the Anatomy and Morphology of the Frog

    NASA Astrophysics Data System (ADS)

    Akpan, Joseph Paul; Andre, Thomas

    1999-06-01

    Science teachers, school administrators, educators, and the scientific community are faced with ethical controversies over animal dissection in classrooms. Simulation has been proposed as a way of dealing with this issue. One intriguing previous finding was that use of an interactive videodisc dissection facilitated performance on a subsequent actual dissection. This study examined the prior use of simulation of frog dissection in improving students' actual dissection performance and learning of frog anatomy and morphology. There were three experimental conditions: simulation before dissection (SBD); dissection before simulation (DBS); or dissection-only (DO). Results of the study indicated that students receiving SBD performed significantly better than students receiving DBS or DO on both actual dissection and knowledge of the anatomy and morphology. Students' attitudes toward the use of animals for dissection did not change significantly from pretest to posttest and did not interact with treatment. The genders did not differ in achievement, but males were more favorable towards dissection and computers than were females.

  1. Biology teachers' dissection practices and the influences that lead to their adoption: An exploratory research

    NASA Astrophysics Data System (ADS)

    Milano, Regina Nicole

    The lack of resolution in the on-going animal dissection debate inspired this mixed methods study to identify Connecticut secondary biology teachers' dissection practices and the influences that lead to their adoption. Qualitative findings indicate past experiences, managing objections to dissection, school culture, goals of biology teaching and ethics as major influences on dissection practices with 58.4% (n=7) of the sample dissecting and 41.6% not dissecting (n=5). Quantitative findings reveal gender, standards and curriculum, advantages of dissection and experiences as a student as major influences on dissection practices with 71.9% (n=92) of the sample dissecting and 28.1% (n=36) not dissecting. The study concludes that dissection policies are necessary and imminent in Connecticut school districts. Furthermore, it advises teacher-initiated, qualitative and quantitative assessments to expose disparities between student dissection perspectives and their own, prior to conducting dissection. Finally, it provides suggestions for addressing potential differences including administrative involvement.

  2. Effects on seventh-grade students' achievement and science anxiety of alternatives to conventional frog dissection

    NASA Astrophysics Data System (ADS)

    Marszalek, Christine Susan

    1998-12-01

    The purpose of this study in a suburban school district was to investigate and compare the level of learning and long-term retention of frog internal anatomy between seventh-grade students using an interactive CD tutorial, a desktop microworld, and conventional frog dissection. Students' anxiety toward science was also compared across the three treatment groups and between genders. Additional data on the students' preferred learning style were used to explore possible interaction effects with their respective instructional activity. Subjects participating in the study were all seventh-grade students in one junior-high school, numbering 280 in total. Classes were randomly assigned to the three modes of instruction for the dissection of a frog: a CD-tutorial dissection, a desktop microworld dissection, and a conventional dissection. The Conventional treatment was the traditional physical dissection using a preserved frog specimen and lab dissection tools. The CD-Tutorial treatment was the interactive tutorial Digital Frog from Digital Frog International. The Microworld treatment was a desktop microworld environment composed of Operation Frog on CD supplemented with other programs to provide additional avenues for learning. Data collection and testing occurred prior to treatment, one day after treatment, and three months after treatment. Data collected showed mixed results for all measures taken. The differences in achievement gained favoring the conventional treatment from pretest to both posttests appear to have leveled out somewhat over time. Although anxiety levels declined for both genders after treatment, females continued to report significantly higher science anxiety than males. There appears to be a relationship between treatment and gender in terms of effect on science anxiety. For all three measures taken--pretest, immediate posttest and delayed posttest--no significant difference in achievement by learning style was observed. Learning style alone does not appear to be related to achievement in this study. However, the interaction between learning style and treatment was significant in some cases. In looking at achievement defined as gain scores among the three achievement measures, only some cases within the microworld treatment proved to be significant.

  3. Evaluation of the hemodynamic effectiveness of aortic dissection treatments via virtual stenting.

    PubMed

    Alimohammadi, Mona; Bhattacharya-Ghosh, Benjamin; Seshadhri, Santhosh; Penrose, Justin; Agu, Obiekezie; Balabani, Stavroula; Díaz-Zuccarini, Vanessa

    2014-10-01

    Aortic dissection treatment varies for each patient and stenting is one of a number of approaches that are utilized to Stabilize the condition. Information regarding the hemodynamic forces in the aorta in dissected and virtually stented cases could support clinicians in their choices of treatment prior to medical intervention. Computational fluid dynamics coupled with lumped parameter models have shown promise in providing detailed information that could be used in the clinic; for this, it is necessary to develop personalized workflows in order to produce patient-specific simulations. In the present study, a case of pre- and post-stenting (virtual stent-graft) of an aortic dissection is investigated with a particular focus on the role of personalized boundary conditions. For each virtual case, velocity, pressure, energy loss, and wall shear stress values are evaluated and compared. The simulated single stent-graft only marginally reduced the pulse pressure and systemic energy loss. The double stent-graft results showed a larger reduction in pulse pressure and a 40% reduction in energy loss as well as a more physiological wall shear stress distribution.Regions of potential risk were highlighted. The methodology applied in the present study revealed detailed information about two possible surgical outcome cases and shows promise as both a diagnostic and an interventional tool. PMID:24811307

  4. Molecular Mechanisms of Thoracic Aortic Dissection

    PubMed Central

    Wu, Darrell; Shen, Ying H.; Russell, Ludivine; Coselli, Joseph S.; LeMaire, Scott A.

    2013-01-01

    Thoracic aortic dissection (TAD) is a highly lethal vascular disease. In many patients with TAD, the aorta progressively dilates and ultimately ruptures. Dissection formation, progression, and rupture cannot be reliably prevented pharmacologically because the molecular mechanisms of aortic wall degeneration are poorly understood. The key histopathologic feature of TAD is medial degeneration, a process characterized by smooth muscle cell depletion and extracellular matrix degradation. These structural changes have a profound impact on the functional properties of the aortic wall and can result from excessive protease-mediated destruction of the extracellular matrix, altered signaling pathways, and altered gene expression. Review of the literature reveals differences in the processes that lead to ascending versus descending and sporadic versus hereditary TAD. These differences add to the complexity of this disease. Although tremendous progress has been made in diagnosing and treating TAD, a better understanding of the molecular, cellular, and genetic mechanisms that cause this disease is necessary to developing more effective preventative and therapeutic treatment strategies. PMID:23856125

  5. Right ventricular free wall dissection as a rupture tract in left ventricular rupture during acute myocardial infarction.

    PubMed

    Takada, Aya; Saito, Kazuyuki; Murai, Tatsuya; Kurosaki, Kunihiko; Kurihara, Katsuyoshi; Hamamatsu, Akihiko

    2015-11-01

    Three rare cases of cardiac rupture with right ventricular wall dissection during acute myocardial infarction (AMI) were reported. The cases comprised 2% among our 148 previously reported postinfarction cardiac ruptures with sudden death. The dissections occurred in hearts with biventricular inferior wall AMI and developed between the superficial layers and the deeper layers of inferior wall of the right ventricle. All had an endocardial tear at the basal septum where it meets the inferior free wall of the left ventricle, and had an epicardial tear on the middle inferior wall of the right ventricle. Based on the evidence of the ages of the thrombi of the rupture tracts, delayed epicardial rupture was found besides that soon after the right ventricular dissection. PMID:26594003

  6. Spontaneous coronary artery dissection in a middle-age woman: percutaneous treatment guided by intracoronary imaging techniques.

    PubMed

    Fineschi, Massimo; D'Ascenzi, Flavio; Sirbu, Vasile; Mondillo, Sergio; Pierli, Carlo

    2014-07-01

    Angiographic diagnosis and treatment of spontaneous coronary artery dissection is challenging. Complementary use of intracoronary imaging can provide information to guide percutaneous treatments, particularly in these challenging settings. Here we report a case of a 52-year-old woman presenting with an anterior ST-segment elevation myocardial infarction caused by a spontaneous, long, and spiral dissection of the left anterior descending artery. Intracoronary imaging allowed us to visualize the entry port of the coronary dissection which was not sealed by the first angio-guided stenting. This case demonstrates that, beyond merely diagnostic information, the intracoronary imaging is able to provide information to guide percutaneous treatments, particularly in challenging settings in which coronary angiography reveals its limitations. PMID:25004000

  7. Early recognition of acute thoracic aortic dissection and aneurysm

    PubMed Central

    2013-01-01

    Background Thoracic aortic dissection (TAD) and aneurysm (TAA) are rare but catastrophic. Prompt recognition of TAD/TAA and differentiation from acute coronary syndrome (ACS) is difficult yet crucial. Earlier identification of TAA/TAD based upon routine emergency department screening is necessary. Methods A retrospective analysis of patients that presented with acute thoracic complaints to the ED from January 2007 through June 2012 was performed. Cases of TAA/TAD were compared to an equal number of controls which consisted of patients with the diagnosis of ACS. Demographics, physical findings, EKG, and the results of laboratory and radiological imaging were compared. P-value of > 0.05 was considered statistically significant. Results In total, 136 patients were identified with TAA/TAD, 0.36% of patients that presented with chest complaints. Compared to ACS patients, TAA/TAD group was older (68.9 vs. 63.2 years), less likely to be diabetic (13% vs 32%), less likely to complain of chest pain (47% vs 85%) and head and neck pain (4% vs 17%). The pain for the TAA/TAD group was less likely characterized as tight/heavy in nature (5% vs 37%). TAA/TAD patients were also less likely to experience shortness of breath (42% vs. 51%), palpitations (2% vs 9%) and dizziness (2% vs 13%) and had a greater incidence of focal lower extremity neurological deficits (6% vs 1%), bradycardia (15% vs. 5%) and tachypnea (53% vs. 22%). On multivariate analysis, increasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction were independent predictors of ACS. Conclusions Increasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction can be used to differentiate acute coronary syndromes from thoracic aortic dissections/aneurysms. PMID:24499618

  8. Diagnosis of Aortic Dissection in Emergency Department Patients is Rare

    PubMed Central

    Alter, Scott M.; Eskin, Barnet; Allegra, John R.

    2015-01-01

    Introduction Aortic dissection is a rare event. While the most frequent symptom is chest pain, that is a common emergency department (ED) chief complaint and other diseases causing chest pain occur much more often. Furthermore, 20% of dissections are without chest pain and 6% are painless. For these reasons, diagnosing dissections may be challenging. Our goal was to determine the number of total ED and atraumatic chest pain patients for every aortic dissection diagnosed by emergency physicians. Methods Design: Retrospective cohort. Setting: 33 suburban and urban New York and New Jersey EDs with annual visits between 8,000 and 80,000. Participants: Consecutive patients seen by emergency physicians from 1-1-1996 through 12-31-2010. Observations: We identified aortic dissection and atraumatic chest pain patients using the International Classification of Diseases 9th Revision and Clinical Modification codes. We then calculated the number of total ED and atraumatic chest pain patients for every aortic dissection, along with 95% confidence intervals (CIs). Results From a database of 9.5 million ED visits, we identified 782 aortic dissections or one for every 12,200 (95% CI [11,400–13,100]) visits. The mean age of dissection patients was 66±16 years and 38% were female. There were 763,000 (8%) with atraumatic chest pain diagnoses. Thus, there is one dissection for every 980 (95% CI [910–1,050]) atraumatic chest pain patients. Conclusion The diagnosis of aortic dissections by emergency physicians is rare and challenging. An emergency physician seeing 3,000 to 4,000 patients a year would diagnose an aortic dissection approximately every three to four years. PMID:26587083

  9. The Effect of a Prior Dissection Simulation on Middle School Students' Dissection Performance and Understanding of the Anatomy and Morphology of the Frog.

    ERIC Educational Resources Information Center

    Akpan, Joseph Paul; Andre, Thomas

    1999-01-01

    Reports on a study that examined the prior use of simulation on frog dissection in improving students' actual dissection performance and learning of frog anatomy and morphology. Finds that students who performed the simulation before dissection performed significantly better than students who performed dissection before using the simulation or…

  10. Delayed perforation after endoscopic submucosal dissection for early gastric cancer: Clinical features and treatment

    PubMed Central

    Yano, Takafumi; Tanabe, Satoshi; Ishido, Kenji; Azuma, Mizutomo; Wada, Takuya; Suzuki, Mizuto; Kawanishi, Natsuko; Yamane, Sakiko; Sasaki, Tohru; Katada, Chikatoshi; Mikami, Tetsuo; Katada, Natsuya; Koizumi, Wasaburo

    2016-01-01

    Perforation is an important procedural complication of endoscopic submucosal dissection (ESD) for early gastric cancer. Although the incidence of delayed perforation after ESD is low, extreme caution is necessary because many cases require surgical intervention. Among 1984 lesions of early gastric cancer treated in our hospital by ESD in 1588 patients from September 2002 through March 2015, delayed perforation developed in 4 patients (4 lesions, 0.25%). A diagnosis of delayed perforation requires prompt action, including surgical intervention when required. PMID:27114751

  11. IVC filter limb penetration of the caval wall during retroperitoneal surgery/lymph node dissection.

    PubMed

    Goh, Gerard S; Slattery, Michael M; Given, Mark F; Little, David; Lee, Michael J

    2012-12-01

    Optional inferior vena cava (IVC) filters are being increasingly used for protection against pulmonary embolism in patients with deep vein thrombosis where anticoagulation is contraindicated. We describe two cases during retroperitoneal surgery where the IVC filters were found to have perforated the cava wall and were subsequently removed intra-operatively. Cava wall penetration by filter limbs poses a significant danger during retroperitoneal lymph node dissection and filters should be removed preoperatively. PMID:23210584

  12. Outcomes of a Rotational Dissection System in Gross Anatomy

    ERIC Educational Resources Information Center

    Marshak, David W.; Oakes, Joanne; Hsieh, Pei-Hsuan; Chuang, Alice Z.; Cleary, Leonard J.

    2015-01-01

    At the University of Texas Houston Medical School, a rotational dissection system was introduced to improve coordination between the Gross Anatomy and the Introduction to Clinical Medicine (ICM) courses. Six students were assigned to each cadaver and divided into two teams. For each laboratory, one team was assigned to dissect and the other to…

  13. Alternatives To Animal Dissection in School Science Classes. ERIC Digest.

    ERIC Educational Resources Information Center

    Haury, David L.

    Until recently, one of the most expected and accepted experiences among students in biology classrooms of the United States has been the dissection of vertebrate animals, from frogs and mice to cats and fetal pigs. However, resistance to animal dissection has grown during the past decade with concerns ranging from inhumane treatment of animals by…

  14. Dissection Videos Do Not Improve Anatomy Examination Scores

    ERIC Educational Resources Information Center

    Mahmud, Waqas; Hyder, Omar; Butt, Jamaal; Aftab, Arsalan

    2011-01-01

    In this quasi-experimental study, we describe the effect of showing dissection videos on first-year medical students' performance in terms of test scores during a gross anatomy course. We also surveyed students' perception regarding the showing of dissection videos. Two hundred eighty-seven first-year medical students at Rawalpindi Medical College…

  15. Intracranial dissecting and saccular aneurysms in polycystic kidney disease.

    PubMed

    Kulla, L; Deymeer, F; Smith, T W; Weiner, M; Mullins, T F

    1982-12-01

    A young man with polycystic kidney disease was seen initially with an brain-stem infarction. Postmortem examination disclosed a dissecting aneurysm of the basilar artery and a saccular aneurysm of the right vertebral artery. Dissecting intracranial aneurysms rarely are associated with saccular aneurysms and, to our knowledge, have not been reported in association with polycystic kidney disease. PMID:7138321

  16. Student Attitudes toward Cadaveric Dissection at a UK Medical School

    ERIC Educational Resources Information Center

    Quince, Thelma A.; Barclay, Stephen I. G.; Spear, Michelle; Parker, Richard A.; Wood, Diana F.

    2011-01-01

    A more humanistic approach toward dissection has emerged. However, student attitudes toward this approach are unknown and the influences on such attitudes are little understood. One hundred and fifty-six first-year medical students participated in a study examining firstly, attitudes toward the process of dissection and the personhood of the…

  17. A Modified Dissection Method to Preserve Neck Structures

    ERIC Educational Resources Information Center

    Hankin, Mark H.; Stoller, Jeremy L.

    2009-01-01

    The neck is not only one of the more challenging anatomical regions to dissect but also has important application to clinical conditions, diseases, and procedures. In this study, we describe two simple modifications for dissection of the neck that (1) aid in the identification and preservation of the cutaneous branches of the cervical plexus and…

  18. Justifying the Dissection of Animals in Biology Teaching.

    ERIC Educational Resources Information Center

    Wheeler, Anthony G.

    1993-01-01

    Presents the idea that several points should be considered in animal dissection: (1) ethics; (2) the animal's position; (3) the law; and (4) the actual benefits to society. Recommends that students be carefully prepared for animal dissection. Contains 21 references. (DDR)

  19. Traditional versus Computer-Based Dissections in Enhancing Learning in a Tertiary Setting: A Student Perspective.

    ERIC Educational Resources Information Center

    Franklin, Sue; Peat, Mary; Lewis, Alison

    2002-01-01

    Describes a study that investigates both the use and usefulness of laboratory dissections and computer-based dissections in a tertiary, first-year human biology course. Explores attitudes toward dissection. (DDR)

  20. Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis.

    PubMed

    Kanaroglou, Savas; Nair, Vidhya; Fernandes, John R

    2015-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), cardiac tamponade and sudden cardiac death that typically affects young women in the postpartum period. Rarely, it can be caused by systemic inflammatory conditions such as sarcoidosis. Sarcoidosis is an inflammatory disease most often affecting the lung and lymph nodes that can sometimes affect the heart. The authors report a case of sudden cardiac death caused by SCAD in the context of undiagnosed and subclinical cardiac sarcoidosis. The decedent was a 47-year-old male with a relatively innocuous past medical history. He was found dead in bed. At autopsy, there was a lethal hemopericardium resulting in cardiac tamponade. Gross examination of the heart revealed dissection of the posterior descending coronary branch of the right coronary artery. Histologically, the coronary artery showed acute and organizing dissection with evidence of vasculitis. A chronic inflammatory infiltrate consisting of lymphocytes, histiocytes, eosinophils and giant cells was seen. Sections of the myocardium showed myocarditis with a nonnecrotizing granuloma. The death was attributed to cardiac tamponade secondary to SCAD in the context of systemic sarcoidosis. The presented case demonstrates two concurrent rare pathologies and highlights the importance of considering SCAD in cases of sudden cardiac death at autopsy. PMID:25638512

  1. Lymph node dissection for gastric cancer: a critical review

    PubMed Central

    Batista, Thales Paulo; Martins, Mário Rino

    2012-01-01

    Gastric cancer is one of the most common neoplasms and an important cause of cancer-related death worldwide. Efforts to reduce its high mortality rates are currently focused on multidisciplinary management. However, surgery remains a cornerstone in the management of patients with resectable disease. There is still some controversy as to the extent of lymph node dissection for potentially curable stomach cancer. Surgeons in eastern countries favor more extensive lymph node dissection, whereas those in the West favor less extensive dissection. Thus, extent of lymph node dissection remains one of the most hotly discussed aspects of gastric surgery, particularly because most stomach cancers are now often comprehensively treated by adding some perioperative chemotherapy or chemo-radiation. We provide a critical review of lymph nodes dissection for gastric cancer with a particular focus on its benefits in a multimodal approach. PMID:25992202

  2. Dissecting aortic aneurysms: accuracy of computed tomographic diagnosis

    SciTech Connect

    Thorsen, M.K.; San Dretto, M.A.; Lawson, T.L.; Foley, W.D.; Smith, D.F.; Berland, L.L.

    1983-09-01

    During a three-year period, fifty patients were evaluated for the possibility of dissecting aortic aneurysm using high-resolution computed tomography (CT). The diagnosis of dissection was made if two contrast-medium-filled channels were identified within the aortic lumen. Eighteen patients were diagnosed with CT as having dissecting aortic aneurysms. Eight patients were evaluated postoperatively and five of these patients had persistence of the double channel. Twenty-four patients had no evidence on CT of aortic dissection. Follow-up was obtained in all patients. There were no known false-negative diagnoses and one false-positive diagnosis. High-resolution CT offers an accurate, noninvasive means to evaluate patients for suspected dissecting aortic aneurysms.

  3. Aortic Dissections Type A during Sexual Intercourse in Male Patients: Accident or Systematic Coincidence? Examination of 365 Patients with Acute Aortic Dissection within 20 Years.

    PubMed

    Gansera, Laura; Deutsch, Oliver; Szameitat, Larissa; Eichinger, Walter; Gansera, Brigitte

    2016-03-01

    Objectives Physical exercise accompanied by arterial hypertension is known to trigger acute aortic dissections. As a booster effect, mental stress leads to aggravation of hypertensive crisis. The aim of the study was to evaluate whether stress factors during sexual intercourse play any role as a catalyst in patients with acute type A aortic dissections. Concerning this subject, only two case reports have been published. Methods A total of 365 patients with acute type A aortic dissections, operated between January 1993 and July 2014, were analyzed retrospectively. The main focus was to identify the provoking situation before onset of symptoms. A total of 247 patients were males and mean age was 60.2 years (range, 17.0-91.9 years). Of the total cohort, 86 patients (24%) were younger than 50 years (68 males) and 184 patients (50%) were younger than 60 years (149 males). Results The explicit trigger could not be determined in 24% of the patients. In majority of the patients, onset of symptoms occurred during physical exercises, such as sports or lifting of heavy weights (68%), without a significant difference between males and females. In only 8% of the patients, symptoms occurred at rest. In 0.9%, Marfan syndrome was evident. Eleven of 68 males < 50 years (16%) and 17 of 149 males < 60 years (11%) but none among females (p = 0.03) experienced sudden onset of symptoms during sexual intercourse. Conclusion Combined physical and emotional stress during sexual intercourse seems to present a meaningful promoter effect for acute aortic dissections, especially in younger males, but not in females. Despite self-evidence of this phenomenon, frequency of this sensitive issue appears to be surprisingly high. PMID:25785767

  4. Treatment of a Chronic Aneurysmal Aortic Dissection in a Patient with Marfan Syndrome Using a Staged Hybrid Procedure and a Fenestrated Endograft

    SciTech Connect

    Walkden, R. Miles Morgan, Rob A.; Loftus, Ian; Thompson, Matt

    2008-07-15

    Patients with aneurysmal dissections involving both the thoracic and the abdominal aorta are particularly challenging to treat with endovascular techniques because of the natural communications at the level of the visceral arteries. We present the case of a patient with Marfan syndrome with an aneurysmal aortic dissection involving the thoracic and abdominal aorta who was treated by a combination of endografts, surgical bypass, and a fenestrated tube graft.

  5. Dissecting Japan's Dengue Outbreak in 2014

    PubMed Central

    Quam, Mikkel B.; Sessions, October; Kamaraj, Uma Sangumathi; Rocklöv, Joacim; Wilder-Smith, Annelies

    2016-01-01

    Despite Japan's temperate climate, a dengue outbreak occurred in Tokyo for the first time in over 70 years in 2014. We dissected this dengue outbreak based on phylogenetic analysis, travel interconnectivity, and environmental drivers for dengue epidemics. Comparing the available dengue virus 1 (DENV1) E gene sequence from this outbreak with 3,282 unique DENV1 sequences in National Center for Biotechnology Information suggested that the DENV might have been imported from China, Indonesia, Singapore, or Vietnam. With travelers arriving into Japan, Guangzhou (China) may have been the source of DENV introduction, given that Guangzhou also reported a large-scale dengue outbreak in 2014. Coinciding with the 2014 outbreak, Tokyo's climate conditions permitted the amplification of Aedes vectors and the annual peak of vectorial capacity. Given suitable vectors and climate conditions in addition to increasing interconnectivity with endemic areas of Asia, Tokyo's 2014 outbreak did not come as a surprise and may foretell more to come. PMID:26711518

  6. Dissecting Japan's Dengue Outbreak in 2014.

    PubMed

    Quam, Mikkel B; Sessions, October; Kamaraj, Uma Sangumathi; Rocklöv, Joacim; Wilder-Smith, Annelies

    2016-02-01

    Despite Japan's temperate climate, a dengue outbreak occurred in Tokyo for the first time in over 70 years in 2014. We dissected this dengue outbreak based on phylogenetic analysis, travel interconnectivity, and environmental drivers for dengue epidemics. Comparing the available dengue virus 1 (DENV1) E gene sequence from this outbreak with 3,282 unique DENV1 sequences in National Center for Biotechnology Information suggested that the DENV might have been imported from China, Indonesia, Singapore, or Vietnam. With travelers arriving into Japan, Guangzhou (China) may have been the source of DENV introduction, given that Guangzhou also reported a large-scale dengue outbreak in 2014. Coinciding with the 2014 outbreak, Tokyo's climate conditions permitted the amplification of Aedes vectors and the annual peak of vectorial capacity. Given suitable vectors and climate conditions in addition to increasing interconnectivity with endemic areas of Asia, Tokyo's 2014 outbreak did not come as a surprise and may foretell more to come. PMID:26711518

  7. Cervical artery dissection: emerging risk factors.

    PubMed

    Micheli, S; Paciaroni, M; Corea, F; Agnelli, G; Zampolini, M; Caso, V

    2010-01-01

    Cervical artery dissection (CAD) represents an increasingly recognized cause of stroke and the most common cause of ischemic stroke in young adults. Many factors have been identified in association with CAD such as primary disease of arterial wall (fibrodysplasia) and other non-specific diseases related to CAD like Ehlers Danlos-syndrome IV, Marfan's syndrome, vessel tortuosity. Moreover, an underlying arteriopathy which could be in part genetically determined, has been suspected. The rule of emerging risk factors for CAD such as recent respiratory tract infection, migraine and hyperhomocysteinemia are still a matter of research. Other known risks factors for CAD are major head/neck trauma like chiropractic maneuver, coughing or hyperextension injury associated to car. We examined emerging risks factors for CAD detected in the last years, as CAD pathogenesis is still not completely understood and needs further investigations. PMID:21270941

  8. Proto-professionalism and the dissecting laboratory.

    PubMed

    Slotnick, Henry B; Hilton, Sean R

    2006-07-01

    This essay argues for medical students' dissection of cadavers because this activity offers medical students opportunities to have certain experiences and reflect on them in ways facilitating their development of mature medical professionalism at the time they enter clinical practice. Issues central to professionalism as we envision it are (1) cognitive abilities identified as reflective judgment and principled ethical reasoning as they are exercised in four practice domains and (2) learning to learn in medical settings. We argue further that a key feature of such setting is practitioners' having to deal with ill-structured problems, and so we identify their features and relate their management to the sophisticated cognitive and learning abilities required of medical professionals. PMID:16583422

  9. A variant of nested dissection for solving n by n grid problems

    NASA Technical Reports Server (NTRS)

    George, A.; Poole, W. G., Jr.; Voigt, R. G.

    1976-01-01

    Nested dissection orderings are known to be very effective for solving the sparse positive definite linear systems which arise from n by n grid problems. In this paper nested dissection is shown to be the final step of incomplete nested dissection, an ordering which corresponds to the premature termination of dissection. Analyses of the arithmetic and storage requirements for incomplete nested dissection are given, and the ordering is shown to be competitive with nested dissection under certain conditions.

  10. Immunostaining of dissected zebrafish embryonic heart.

    PubMed

    Yang, Jingchun; Xu, Xiaolei

    2012-01-01

    Zebrafish embryo becomes a popular in vivo vertebrate model for studying cardiac development and human heart diseases due to its advantageous embryology and genetics. About 100-200 embryos are readily available every week from a single pair of adult fish. The transparent embryos that develop ex utero make them ideal for assessing cardiac defects. The expression of any gene can be manipulated via morpholino technology or RNA injection. Moreover, forward genetic screens have already generated a list of mutants that affect different perspectives of cardiogenesis. Whole mount immunostaining is an important technique in this animal model to reveal the expression pattern of the targeted protein to a particular tissue. However, high resolution images that can reveal cellular or subcellular structures have been difficult, mainly due to the physical location of the heart and the poor penetration of the antibodies. Here, we present a method to address these bottlenecks by dissecting heart first and then conducting the staining process on the surface of a microscope slide. To prevent the loss of small heart samples and to facilitate solution handling, we restricted the heart samples within a circle on the surface of the microscope slides drawn by an immEdge pen. After the staining, the fluorescence signals can be directly observed by a compound microscope. Our new method significantly improves the penetration for antibodies, since a heart from an embryonic fish only consists of few cell layers. High quality images from intact hearts can be obtained within a much reduced procession time for zebrafish embryos aged from day 2 to day 6. Our method can be potentially extended to stain other organs dissected from either zebrafish or other small animals. PMID:22258109

  11. Diamondiferous Peridotite Tomography: Precursor to Xenolith Dissections.

    NASA Astrophysics Data System (ADS)

    Taylor, L. A.; Taylor, D. S.; Anand, M.; Ketcham, R.; Carlson, W.; Sobolev, N. V.; Pokhilenko, N.

    2003-12-01

    Three-dimensional, high-resolution computed X-ray tomography (HRCXT) of diamondiferous peridotite xenoliths from Siberia has successfully imaged diamonds and their textural relationships with co-existing minerals. This is an extension to the tomography and xenolith dissections performed previously on diamondiferous eclogites (e.g., Taylor et al., 2000, Int'l Geol Rev 42; Anand et al., 2003, 8th Int'l Kimb Conf). Spatial relationships between diamonds and their surroundings provide clues to the processes that control diamond crystallization. These relationships can be determined by rotating and viewing the 3-D model at different perspectives and orientations to look for specific associations/alignments. It is possible to render some of the phases transparent and display only one or two minerals at a time. Then by rotating the model, it is possible to look for spatial relationships between different crystals of the same mineral or different minerals. The maps obtained from the tomography form the basis for the delicate dissections of the xenoliths, revealing the diamonds as they formed in their mantle host rocks. Diamondiferous peridotites appear to be sparse carriers of diamonds compared to eclogites, where one unusual eclogite of 65 g contained 74 macro-diamonds. Although kimberlites always contain considerably more peridotite xenoliths than eclogites, the diamond population may actually be more indicative of eclogitic origin. The diamonds appear to be preferentially located in zones with a prominent sub-planar fabric of secondary mineralization - i.e., zones of increased permeability. Diamond was never observed in direct contact with any fresh, primary minerals. Also, there is insufficient sulfide mineralization to call upon an immiscible-sulfide melt as the diamond-forming medium. The association of the diamonds with secondary minerals strongly suggests that the diamonds formed after the initial host peridotite or eclogite, perhaps in conjunction with introduction of metasomatic fluids.

  12. Influence of a Dissection Video Clip on Anxiety, Affect, and Self-Efficacy in Educational Dissection: A Treatment Study

    ERIC Educational Resources Information Center

    Randler, Christoph; Demirhan, Eda; Wüst-Ackermann, Peter; Desch, Inga H.

    2016-01-01

    In science education, dissections of animals are an integral part of teaching, but they often evoke negative emotions. We aimed at reducing negative emotions (anxiety, negative affect [NA]) and increasing positive affect (PA) and self-efficacy by an experimental intervention using a predissection video to instruct students about fish dissection.…

  13. The Effects of Computer Animated Dissection versus Preserved Animal Dissection on the Student Achievement in a High School Biology Class.

    ERIC Educational Resources Information Center

    Kariuki, Patrick; Paulson, Ronda

    The purpose of this study was to examine the effectiveness of computer-animated dissection techniques versus the effectiveness of traditional dissection techniques as related to student achievement. The sample used was 104 general biology students from a small, rural high school in Northeast Tennessee. Random selection was used to separate the…

  14. Influence of a Dissection Video Clip on Anxiety, Affect, and Self-Efficacy in Educational Dissection: A Treatment Study

    ERIC Educational Resources Information Center

    Randler, Christoph; Demirhan, Eda; Wst-Ackermann, Peter; Desch, Inga H.

    2016-01-01

    In science education, dissections of animals are an integral part of teaching, but they often evoke negative emotions. We aimed at reducing negative emotions (anxiety, negative affect [NA]) and increasing positive affect (PA) and self-efficacy by an experimental intervention using a predissection video to instruct students about fish dissection.

  15. Influence of a Dissection Video Clip on Anxiety, Affect, and Self-Efficacy in Educational Dissection: A Treatment Study

    PubMed Central

    Randler, Christoph; Demirhan, Eda; Wüst-Ackermann, Peter; Desch, Inga H.

    2016-01-01

    In science education, dissections of animals are an integral part of teaching, but they often evoke negative emotions. We aimed at reducing negative emotions (anxiety, negative affect [NA]) and increasing positive affect (PA) and self-efficacy by an experimental intervention using a predissection video to instruct students about fish dissection. We compared this treatment with another group that watched a life history video about the fish. The participants were 135 students studying to become biology teachers. Seventy received the treatment with the dissection video, and 65 viewed the life history video. We applied a pre/posttest treatment-comparison design and used the Positive and Negative Affect Schedule (PANAS), the State–Trait–Anxiety Inventory for State (STAI-S), and a self-efficacy measure three times: before the lesson (pretest), after the film treatment (posttest 1), and after the dissection (posttest 2). The dissection film group scored higher in PA, NA, and state anxiety (STAI-S) after the dissection video treatment and higher in self-efficacy after the dissection. The life history group showed no differences between the pretest and posttest 1. The dissection film has clear benefits—increasing PA and self-efficacy—that come at the cost of higher NA and higher STAI-S.

  16. A Novel 'Cheese Wire' Technique for Stent Positioning Following Difficult Iliac Artery Subintimal Dissection and Aortic Re-Entry

    SciTech Connect

    Watkinson, A. F.

    2009-07-15

    Subintimal wire dissection is a well-established method for traversing difficult vascular occlusions. This technique relies on re-entry of the true lumen distal to the occlusion, which may be difficult in diseased vessels with significant calcification. This case report describes a novel 'cheese wire' technique to allow stent positioning without the use of proprietary re-entry devices.

  17. Detection of coronary artery disease in acute aortic dissection: the efficacy of 64-row multidetector computed tomography.

    PubMed

    Yoshikai, Masaru; Ikeda, Kazuyuki; Itoh, Manabu; Noguchi, Ryou

    2008-01-01

    We herein describe a case with an acute aortic dissection, whose atherosclerotic coronary artery disease (CAD) could be accurately detected using a preoperative 64-row multidetector computed tomography (MDCT). Emergency surgery including a coronary artery bypass grafting and a total arch replacement were successfully performed without causing perioperative myocardial infarction. MDCT coronary angiography is a safe and noninvasive examination, therefore, we believe that MDCT coronary angiography should become a routine preoperative examination for patients with an acute aortic dissection in order to detect the presence of CAD. PMID:18435650

  18. Endovascular Treatment of a Carotid Dissecting Pseudoaneurysm in a Patient with Ehlers-Danlos Syndrome Type IV with Fatal Outcome

    SciTech Connect

    Lim, Siok Ping Duddy, Martin J.

    2008-01-15

    We present a patient with Ehlers-Danlos syndrome type IV (EDS IV) with a carotid dissecting pseudoaneurysm causing severe carotid stenosis. This lesion was treated endovascularly. Unfortunately, the patient died of remote vascular catastrophes (intracranial hemorrhage and abdominal aortic rupture). This unique case illustrates the perils of endovascular treatment of EDS IV patients and the need for preoperative screening for concomitant lesions. It also shows that a dissecting pseudoaneurysm can feasibly be treated with a covered stent and that closure is effective using Angioseal in patients with EDS IV.

  19. Spontaneous ruptured dissection of the right common iliac artery in a patient with classic Ehlers-Danlos syndrome phenotype.

    PubMed

    Gaines, Rick; Tinkle, Brad T; Halandras, Pegge M; Al-Nouri, Omar; Crisostomo, Paul; Cho, Jae S

    2015-04-01

    Unlike vascular Ehlers-Danlos syndrome (EDS), classic EDS is rarely associated with vascular manifestation. We report the case of a 39-year-old man who presented with acute abdominal pain. At the time of presentation, the patient was in hypovolemic shock, and computed tomography angiogram demonstrated common iliac artery dissection with rupture. He underwent an attempted endovascular repair that was converted to an open repair of a ruptured right common iliac artery dissection. Subsequent genetic testing revealed a substitution of arginine for cysteine in type I collagen, COL1A1 exon 14 c.934C>T mutation, consistent with a rare variant of classic EDS. PMID:25597651

  20. Prevention of esophageal strictures after endoscopic submucosal dissection

    PubMed Central

    Kobayashi, Shinichiro; Kanai, Nobuo; Ohki, Takeshi; Takagi, Ryo; Yamaguchi, Naoyuki; Isomoto, Hajime; Kasai, Yoshiyuki; Hosoi, Takahiro; Nakao, Kazuhiko; Eguchi, Susumu; Yamamoto, Masakazu; Yamato, Masayuki; Okano, Teruo

    2014-01-01

    Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have recently been accepted as less invasive methods for treating patients with early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett’s esophagus. However, the large defects in the esophageal mucosa often cause severe esophageal strictures, which dramatically reduce the patient’s quality of life. Although preventive endoscopic balloon dilatation can reduce dysphagia and the frequency of dilatation, other approaches are necessary to prevent esophageal strictures after ESD. This review describes several strategies for preventing esophageal strictures after ESD, with a particular focus on anti-inflammatory and tissue engineering approaches. The local injection of triamcinolone acetonide and other systemic steroid therapies are frequently used to prevent esophageal strictures after ESD. Tissue engineering approaches for preventing esophageal strictures have recently been applied in basic research studies. Scaffolds with temporary stents have been applied in five cases, and this technique has been shown to be safe and is anticipated to prevent esophageal strictures. Fabricated autologous oral mucosal epithelial cell sheets to cover the defective mucosa similarly to how commercially available skin products fabricated from epidermal cells are used for skin defects or in cases of intractable ulcers. Fabricated autologous oral-mucosal-epithelial cell sheets have already been shown to be safe. PMID:25386058

  1. Training methods and models for colonoscopic insertion, endoscopic mucosal resection, and endoscopic submucosal dissection.

    PubMed

    Yoshida, Naohisa; Fernandopulle, Nilesh; Inada, Yutaka; Naito, Yuji; Itoh, Yoshito

    2014-09-01

    Colonoscopic examination is considered an effective examination for the detection of colorectal cancers. Additionally, early colorectal cancers can be resected using endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection. However, those examinations and treatments need special techniques. Various training methods are practiced to acquire such endoscopic techniques throughout the world. In clinical cases, magnetic positioning devices help endoscopic insertion by less experienced endoscopists. There is a physical model made by polyvinyl chloride and a virtual simulator for training of colonoscopic insertion. Various techniques including a method to apply pressure to the abdomen and consideration for patient's pain can be trained using these models. In view of extensive training of endoscopic mucosal resection and endoscopic submucosal dissection, animal models are useful and actually used. Live animal models of minipig, which entails blood flow, are ideal and used frequently, but are cumbersome to prepare. On the other hand, ex vivo animal models using intestine of porcine and bovine are convenient for preparation and less expensive. Unique ex vivo animal models with blood flow have been developed recently and techniques for hemostasis can be practiced. With respect to a method of training for colorectal endoscopic submucosal dissection, a stepwise system has been adopted throughout the world. Thus, first they observe the expert's technique, then practice training of animal models, and finally, they perform clinical rectal cases. The system is useful for a safe and definite procedure. In this review, we reveal various training methods for colonoscopic examinations and treatments. PMID:25102984

  2. Death from undetected acute myocardial infarction secondary to coronary artery dissection after blunt thoracic trauma.

    PubMed

    Puanglumyai, Supot; Thamtakerngkit, Somboon; Lekawanvijit, Suree

    2016-01-01

    Blunt thoracic trauma is a common occurrence in automobile accidents. Acute myocardial infarction (AMI) caused by coronary dissection following blunt thoracic trauma is rare. We report a case of healthy 24-year-old man with a history of blunt thoracic injury with subsequent undetected AMI who died of acute decompensated heart failure 4days after the insult. The autopsy findings showed a 90% luminal narrowing of the left anterior descending coronary artery by dissecting hematoma, 3cm in length. The myocardium revealed transmural myocardial infarction affecting apex, most part of left ventricular free wall, and interventricular septum. Both lungs were heavy, wet, and noncrepitant. Histological findings of the infarcted myocardium were consistent with 3-5days post-AMI. Sections from both lungs revealed massive pulmonary edema, reflecting acute decompensated heart failure following a large AMI secondary to coronary dissection. Blunt thoracic trauma may obscure typical chest pain associated with cardiac ischemia especially in cases with a high tolerance for pain. PMID:26454807

  3. [Sequential spontaneous coronary artery dissection in a female patient on oral ephedrine].

    PubMed

    Misuraca, Leonardo; Pasqualini, Paola; Baratta, Pasquale; Calabria, Paolo; Picchi, Andrea; Cresti, Alberto; Limbruno, Ugo; Severi, Silva

    2015-09-01

    Spontaneous coronary artery dissection (SCAD) is an infrequent, but not rare, cause of acute coronary syndrome. It mainly affects young women, often with few or no traditional cardiovascular risk factors. In the case described, a 57-year-old woman experienced a first episode of SCAD involving a distal branch of the circumflex coronary artery--treated conservatively--followed, after a few hours, by a second episode of SCAD involving the left anterior descending coronary artery, complicated by hemodynamic instability and treated with emergency angioplasty. During the previous months, the patient was taking a slimming drug containing ephedrine. Dual spontaneous coronary dissection of different type and involving two different vessels, which occurred in the same patient within a few hours, testifies the heterogeneity of the clinical picture of this syndrome and of the therapeutic approach. PMID:26418392

  4. Raising the thinker: new concept for dissecting the cystic pedicle during laparoscopic cholecystectomy.

    PubMed

    Neychev, Vladimir; Saldinger, Pierre F

    2011-12-01

    Imprecise dissection due to poor visualization of anatomic structures is among the major causes of biliary injuries during laparoscopic cholecystectomy. Developing new illustrational and rendering techniques represents an important part in decreasing visual deception and subsequent bile duct injuries. We use the model of one of the most well-known pieces of art, Rodin's The Thinker, to visualize the gallbladder and cystic pedicle structures. This minimizes visual deception before dissection, especially in cases with obscured structures. Our method, raising The Thinker, is based on the remarkable similarity between the sculpture and the topographic anatomy of the gallbladder. The method can be used not only for better orientation and visualization during laparoscopic cholecystectomy but also as a tool to complement the teaching of laparoscopic biliary anatomy to surgical residents and medical students. PMID:22184309

  5. Spontaneous coronary artery dissection with multiple coronary artery aneurysms in a patient with diabetic ketoacidosis.

    PubMed

    Tashtoush, Basheer; Balagadde, Angela; Bhatt, Mahesh

    2014-02-01

    Spontaneous coronary artery dissection (SCAD) is a very rare and commonly fatal condition that typically presents with signs and symptoms of an acute myocardial infarction and cardiogenic shock. We herein present a case of a 54-year-old woman who was diagnosed with diabetic ketoacidosis (DKA) as the first manifestation of her underlying diabetes mellitus, while being hospitalized for treatment, she was found to have a non ST-elevation myocardial infarction (NSTEMI), an urgent cardiac catheterization revealed a complete dissection of the right coronary artery (RCA) with an intraluminal thrombus formation and multiple aneurismal dilatations in the left anterior descending (LAD) and left circumflex (LC) arteries. The patient underwent coronary artery bypass grafting with a favorable outcome. PMID:24605245

  6. Cotyledonoid dissecting leiomyoma as a possible cause of chronic lower back pain.

    PubMed

    Onu, David O; Fiorentino, Lisa M; Bunting, Michael W

    2013-01-01

    Uterine fibroids having the distinct pathological and immunohistochemical features of cotyledonoid dissecting leiomyoma have been reported infrequently. We describe a postmenopausal woman with an incidental finding of an abdominopelvic mass arising from the uterine fundus on routine radiological imaging of the lumbar spine. The imaging was performed for the investigation of chronic radicular lower back pain refractory to usual pain management. However, the woman did not manifest any gynaecological symptoms. Intraoperatively, the pelvic mass appeared malignant and a frozen section suggested uterine sarcoma. As such, the mass was radically resected, resulting in significant resolution of the back pain. To the authors' knowledge, this is the first report of cotyledonoid dissecting leiomyoma presenting solely as chronic lower back pain, and also the first report of this fibroid variant in Australasia. We discuss the diagnostic and operative challenges, emphasising the role of radiological imaging and immunohistopathology in such cases and review current literature. PMID:24121815

  7. Cotyledonoid dissecting leiomyoma as a possible cause of chronic lower back pain

    PubMed Central

    Onu, David O; Fiorentino, Lisa M; Bunting, Michael W

    2013-01-01

    Uterine fibroids having the distinct pathological and immunohistochemical features of cotyledonoid dissecting leiomyoma have been reported infrequently. We describe a postmenopausal woman with an incidental finding of an abdominopelvic mass arising from the uterine fundus on routine radiological imaging of the lumbar spine. The imaging was performed for the investigation of chronic radicular lower back pain refractory to usual pain management. However, the woman did not manifest any gynaecological symptoms. Intraoperatively, the pelvic mass appeared malignant and a frozen section suggested uterine sarcoma. As such, the mass was radically resected, resulting in significant resolution of the back pain. To the authors’ knowledge, this is the first report of cotyledonoid dissecting leiomyoma presenting solely as chronic lower back pain, and also the first report of this fibroid variant in Australasia. We discuss the diagnostic and operative challenges, emphasising the role of radiological imaging and immunohistopathology in such cases and review current literature. PMID:24121815

  8. Chronic type B aortic dissection: indications and strategies for treatment.

    PubMed

    Rohlffs, F; Tsilimparis, N; Diener, H; Larena-Avellaneda, A; Von Kodolitsch, Y; Wipper, S; Debus, E S; Kölbel, T

    2015-04-01

    Chronic type B aortic dissection is a distinctive condition that needs individual treatment strategies and different considerations than in therapy of acute or subacute type B aortic dissection. The most common indication for treatment of this complex disease is aneurysmal dilatation of the dissected aortic segment. While open repair of the enlarged dissected aorta remains the best option for good-risk patients and patients with connective tissue disorders in high-volume centers with respective expertise, endovascular management of chronic type B aortic dissection with postdissection aneurysms has significantly gained ground in the past years. But the concept of TEVAR with implantation of a tubular stent-graft into the thoracic aorta to seal the proximal entry tear and reroute the blood flow into the true lumen alone, is not associated with satisfactory results. This is mainly due to the sparse remodeling capacity of the aortic tissue compared to earlier stages of the disease as the aortic wall and the dissection membrane are thickened and more rigid. On the other hand, it is restricted by the most limiting factor for endovascular success in chronic type B aortic dissection: persistent false lumen perfusion. This problem also affects patients with residual dissection after surgical repair of a DeBakey type I aortic dissection or dissection after ascending aortic repair for other pathologies. Hence, it is evident that strategies to achieve endovascular false lumen occlusion are of increasing importance and novel techniques have been introduced to solve the problem of persisting false lumen flow. Thus, the evolution of a large variety of techniques to address the false lumen perfusion issue indicates that complicated chronic type B dissection involves a high diversity in clinical presentation and morphology. A large armamentarium of catheter skills as well as critical individualized treatment strategies are required to address the heterogenous morphological disease pattern for each individual patient. The rapid development in endovascular techniques gives new directions for treatment indications and strategies in chronic aortic dissection and enables new insights into this old disease. PMID:25604323

  9. Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results

    PubMed Central

    Haji Zeinali, Ali Mohammad; Marzban, Mehrab; Zafarghandi, Mohammadreza; Shirzad, Mahmood; Shirani, Shapour; Mahmoodian, Roshanak; Sheikhvatan, Mehrdad; Lotfi-Tokaldany, Masoumeh

    2016-01-01

    Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. Patients and Methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients. PMID:27110330

  10. A Novel Fenestration Technique for Abdominal Aortic Dissection Membranes Using a Combination of a Needle Re-entry Catheter and the 'Cheese-wire' Technique

    SciTech Connect

    Kos, Sebastian; Guerke, Lorenz; Jacob, Augustinus L.

    2011-12-15

    Purpose: This study was designed to demonstrate the applicability of a combined needle-based re-entry catheter and 'cheese-wire' technique for fenestration of abdominal aortic dissection membranes. Methods: Four male patients (mean age: 65 years) with acute complicated aortic type B dissections were treated at our institution by fenestrating the abdominal aortic dissection membrane using a hybrid technique. This technique combined an initial membrane puncture with a needle-based re-entry catheter using a transfemoral approach. A guidewire was passed through the re-entry catheter and across the membrane. Using a contralateral transfemoral access, this guidewire was then snared, creating a through-and-through wire access. The membrane was then fenestrated using the cheese-wire maneuver. Results: We successfully performed: (a) membrane puncture; (b) guidewire passage; (c) guidewire snaring; and (d) cheese-wire maneuver in all four cases. After this maneuver, decompression of the false lumen and acceptable arterial inflow into the true lumen was observed in all cases. The dependent visceral arteries were reperfused. In one case, portions of the fenestrated membrane occluded the common iliac artery, which was immediately and successfully stented. In another case, long-standing intestinal hypoperfusion before the fenestration resulted in reperfusion-related shock and intraoperative death of the patient. Conclusions: The described hybrid approach for fenestration of dissection membranes is technically feasible and may be established as a therapeutic method in cases with a complicated type B dissection.

  11. [Spontaneous coronary artery dissection and ST-segment elevation myocardial infarction (STEMI)].

    PubMed

    Malcles, G; Combaret, N; Motreff, P

    2015-12-01

    Spontaneous coronary artery dissection (SCAD) is a poorly understood and under-diagnosed entity of acute coronary syndrome, affecting predominantly young women. On coronary angiography, the diagnosis remains challenging, particularly in case of intramural hematoma without intimal rupture. Intracoronary imaging, especially by optical coherence tomography (OCT), provides an incremental value in terms of diagnosis and management. We report the case of a 49-year-old woman admitted for STEMI caused by an intramural hematoma. In the discussion part, we aim to review the epidemiology, physiopathology, diagnosis, management and long-term prognosis of SCAD. PMID:26601736

  12. Surgical Management and Reconstruction of Hoffman's Disease (Dissecting Cellulitis of the Scalp)

    PubMed Central

    Hintze, Justin M.; Howard, Brittany E.; Donald, Carrlene B.; Hayden, Richard E.

    2016-01-01

    Dissecting cellulitis of the scalp, or Hoffman's disease, is a rare dermatologic condition characterized by recurrent pustules and sinus tract formation leading to scarring and alopecia. Medical management includes the use of corticosteroids, antibiotics, isotretinoin, and adalimumab. In cases where the disease is severe, refractory, and intractable, surgery is an option. We report two cases of Hoffman's disease, where medical management failed to achieve remission. Surgical treatment was undertaken with complete resection of the affected scalp in staged procedures with subsequent split-thickness skin grafting for reconstruction. Surgery achieved both disease remission and excellent aesthetic outcomes in both patients. PMID:26966606

  13. Dissecting innate immunity by germline mutagenesis.

    PubMed

    Rutschmann, Sophie; Hoebe, Kasper

    2008-04-01

    The innate arm of our immune system is the first line of defence against infections. In addition, it is believed to drive adaptive immune responses, which help fight pathogens and provide long-term memory. As such, the innate immune system is instrumental for protection against pathogens that would otherwise destroy their host. Although our understanding of the innate immune components involved in pathogen sensing and fighting is improving, it is still limited. This is particularly exemplified by increased documentation of innate immune deficiencies in humans that often result in high and recurrent susceptibility to infections or even death, without the genetic cause being evident. To provide further insight into the mechanisms by which pathogen sensing and eradication occur, several strategies can be used. The current review focuses on the forward genetic approaches that have been used to dissect innate immunity in the fruit fly and the mouse. For both animal models, forward genetics has been instrumental in the deciphering of innate immunity and has greatly improved our understanding of how we respond to invading pathogens. PMID:18205789

  14. Dissecting innate immunity by germline mutagenesis

    PubMed Central

    Rutschmann, Sophie; Hoebe, Kasper

    2008-01-01

    The innate arm of our immune system is the first line of defence against infections. In addition, it is believed to drive adaptive immune responses, which help fight pathogens and provide long-term memory. As such, the innate immune system is instrumental for protection against pathogens that would otherwise destroy their host. Although our understanding of the innate immune components involved in pathogen sensing and fighting is improving, it is still limited. This is particularly exemplified by increased documentation of innate immune deficiencies in humans that often result in high and recurrent susceptibility to infections or even death, without the genetic cause being evident. To provide further insight into the mechanisms by which pathogen sensing and eradication occur, several strategies can be used. The current review focuses on the forward genetic approaches that have been used to dissect innate immunity in the fruit fly and the mouse. For both animal models, forward genetics has been instrumental in the deciphering of innate immunity and has greatly improved our understanding of how we respond to invading pathogens. PMID:18205789

  15. Optogenetic dissection of medial prefrontal cortex circuitry

    PubMed Central

    Riga, Danai; Matos, Mariana R.; Glas, Annet; Smit, August B.; Spijker, Sabine; Van den Oever, Michel C.

    2014-01-01

    The medial prefrontal cortex (mPFC) is critically involved in numerous cognitive functions, including attention, inhibitory control, habit formation, working memory and long-term memory. Moreover, through its dense interconnectivity with subcortical regions (e.g., thalamus, striatum, amygdala and hippocampus), the mPFC is thought to exert top-down executive control over the processing of aversive and appetitive stimuli. Because the mPFC has been implicated in the processing of a wide range of cognitive and emotional stimuli, it is thought to function as a central hub in the brain circuitry mediating symptoms of psychiatric disorders. New optogenetics technology enables anatomical and functional dissection of mPFC circuitry with unprecedented spatial and temporal resolution. This provides important novel insights in the contribution of specific neuronal subpopulations and their connectivity to mPFC function in health and disease states. In this review, we present the current knowledge obtained with optogenetic methods concerning mPFC function and dysfunction and integrate this with findings from traditional intervention approaches used to investigate the mPFC circuitry in animal models of cognitive processing and psychiatric disorders. PMID:25538574

  16. [Esophagectomy after endoscopic submucosal dissection (ESD)].

    PubMed

    Nako, Yoshito; Shiozaki, Atushi; Fujiwara, Hitoshi; Konishi, Hirotaka; Kosuga, Toshiyuki; Morimura, Ryo; Murayama, Yasutoshi; Komatsu, Shuhei; Ikoma, Hisashi; Kuriu, Yoshiaki; Nakanishi, Masayoshi; Ichikawa, Daisuke; Okamoto, Kazuma; Sakakura, Chouhei; Otsuji, Eigo

    2014-11-01

    Herein, we report 9 patients who underwent esophagectomy after endoscopic submucosal dissection (ESD) between April 2003 and December 2013. All patients were men, with a mean age of 65 years. En bloc ESD was performed, and no complications arose in any patient. The mean surgical time of esophagectomy was 323 minutes, and mean blood loss was 295 mL. Postoperative complications were present in 5 patients(anastomotic leakage in 3, pulmonary complications in 2, and recurrent laryngeal nerve palsy in 1). In a patient diagnosed with pT1b-SM1 disease after ESD, a residual tumor(pT1a-MM, N0) was detected after esophagectomy. In another patient diagnosed with pT1b-SM2 disease, lymph node metastasis was detected after esophagectomy. In all patients, curative resection was performed, and no recurrences have been observed to date. This highlights the importance of additional esophagectomy after ESD for patients with pT1b disease. Esophagectomy after ESD can be considered a valid treatment because it provides high curative rates with acceptable safety. PMID:25731401

  17. Mesenteric ischemia in acute aortic dissection.

    PubMed

    Orihashi, Kazumasa

    2016-05-01

    Mesenteric ischemia complicated by acute aortic dissection (AAD) is uncommon, but serious, as there is no established treatment strategy and it can progress rapidly to multi-organ failure. Diagnosing mesenteric ischemia before necrotic change is difficult, not only for primary care physicians, but even for gastrointestinal or cardiovascular surgeons as it can occur at any time during surgery. Thus, measures need to be in place at the bedside to enable us to obtain information on visceral perfusion. It is often difficult to decide which of laparotomy or aortic repair should be performed first, especially when there is associated shock or malperfusion of other vital organs. The standard surgical procedures for mesenteric ischemia are prompt revascularization of the mesenteric artery and, if needed, resection of necrotic intestine. However, the development of endovascular treatment and the introduction of hybrid ORs have improved the treatment strategies for mesenteric ischemia. This article reviews the issues of "diagnosis" in relation to the mechanism of mesenteric ischemia, and discusses the current "treatment strategies". PMID:26024781

  18. Dissecting Antibodies with Regards to Linear and Conformational Epitopes

    PubMed Central

    Forsstrm, Bjrn; Bis?awska Axns, Barbara; Rockberg, Johan; Danielsson, Hanna; Bohlin, Anna; Uhlen, Mathias

    2015-01-01

    An important issue for the performance and specificity of an antibody is the nature of the binding to its protein target, including if the recognition involves linear or conformational epitopes. Here, we dissect polyclonal sera by creating epitope-specific antibody fractions using a combination of epitope mapping and an affinity capture approach involving both synthesized peptides and recombinant protein fragments. This allowed us to study the relative amounts of antibodies to linear and conformational epitopes in the polyclonal sera as well as the ability of each antibody-fraction to detect its target protein in Western blot assays. The majority of the analyzed polyclonal sera were found to have most of the target-specific antibodies directed towards linear epitopes and these were in many cases giving Western blot bands of correct molecular weight. In contrast, many of the antibodies towards conformational epitopes did not bind their target proteins in the Western blot assays. The results from this work have given us insights regarding the nature of the antibody response generated by immunization with recombinant protein fragments and has demonstrated the advantage of using antibodies recognizing linear epitopes for immunoassay involving wholly or partially denatured protein targets. PMID:25816293

  19. Dissecting antibodies with regards to linear and conformational epitopes.

    PubMed

    Forsstrm, Bjrn; Axns, Barbara Bis?awska; Rockberg, Johan; Danielsson, Hanna; Bohlin, Anna; Uhlen, Mathias

    2015-01-01

    An important issue for the performance and specificity of an antibody is the nature of the binding to its protein target, including if the recognition involves linear or conformational epitopes. Here, we dissect polyclonal sera by creating epitope-specific antibody fractions using a combination of epitope mapping and an affinity capture approach involving both synthesized peptides and recombinant protein fragments. This allowed us to study the relative amounts of antibodies to linear and conformational epitopes in the polyclonal sera as well as the ability of each antibody-fraction to detect its target protein in Western blot assays. The majority of the analyzed polyclonal sera were found to have most of the target-specific antibodies directed towards linear epitopes and these were in many cases giving Western blot bands of correct molecular weight. In contrast, many of the antibodies towards conformational epitopes did not bind their target proteins in the Western blot assays. The results from this work have given us insights regarding the nature of the antibody response generated by immunization with recombinant protein fragments and has demonstrated the advantage of using antibodies recognizing linear epitopes for immunoassay involving wholly or partially denatured protein targets. PMID:25816293

  20. Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

    PubMed

    Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

    2015-12-01

    Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to the head and neck induced by a sudden braking event in a commonly experienced non-collision traffic incident. The likely mechanism of injury resulted from interaction between the occupant and the 3-point seat belt. These findings indicate that ICA dissections are substantially more likely to be associated with SAH following head and neck trauma, regardless of the magnitude of the traumatic event or whether an impact was involved. PMID:26499790

  1. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection.

    PubMed

    Debette, Stéphanie; Compter, Annette; Labeyrie, Marc-Antoine; Uyttenboogaart, Maarten; Metso, Tina M; Majersik, Jennifer J; Goeggel-Simonetti, Barbara; Engelter, Stefan T; Pezzini, Alessandro; Bijlenga, Philippe; Southerland, Andrew M; Naggara, Olivier; Béjot, Yannick; Cole, John W; Ducros, Anne; Giacalone, Giacomo; Schilling, Sabrina; Reiner, Peggy; Sarikaya, Hakan; Welleweerd, Janna C; Kappelle, L Jaap; de Borst, Gert Jan; Bonati, Leo H; Jung, Simon; Thijs, Vincent; Martin, Juan J; Brandt, Tobias; Grond-Ginsbach, Caspar; Kloss, Manja; Mizutani, Tohru; Minematsu, Kazuo; Meschia, James F; Pereira, Vitor M; Bersano, Anna; Touzé, Emmanuel; Lyrer, Philippe A; Leys, Didier; Chabriat, Hugues; Markus, Hugh S; Worrall, Bradford B; Chabrier, Stéphane; Baumgartner, Ralph; Stapf, Christian; Tatlisumak, Turgut; Arnold, Marcel; Bousser, Marie-Germaine

    2015-06-01

    Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defined by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass effect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be difficult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confirm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without. PMID:25987283

  2. Spontaneous coronary artery dissection mimicking coronary spasm diagnosed by intravascular ultrasonography.

    PubMed

    Chung, Hyemoon; Lee, Sung-Joo; Park, Jong-Kwan; Choi, In Suk; Won, Ho Yeon; Kim, Sohee; Cha, Jung-Joon; Lee, Byoung Kwon

    2013-07-01

    Spontaneous coronary artery dissection (SCAD) is a rare and occasionally life-threatening cause of acute coronary syndrome. Patients may present with clinical scenarios ranging from angina pectoris to cardiogenic shock to sudden cardiac death, and it may be a potentially life-threatening condition if not recognized. However, its etiology, pathophysiology and optimal therapeutic strategies have not been well understood. SCAD is diagnosed on the basis of coronary angiography, but complementary techniques as such intravascular ultrasound (IVUS) and optical coherence tomography should be considered for diagnostic clarification where appropriate. Likewise, the selection of treatment strategy depends upon the clinical manifestation, location and the extent of dissection and amount of ischemic myocardium at risk. Herein, we present the case of a 35-year-old woman who presented with acute myocardial infarction. She was diagnosed by IVUS with spontaneous diffuse dissection of the left anterior descending artery without atheroma, treated with percutaneous coronary stenting, and had a favorable clinical course and was discharged on medical therapy. PMID:23964297

  3. A successful treatment of cardiac tamponade due to an aortic dissection using open-chest massage.

    PubMed

    Keiko, Terasumi; Yanagawa, Youichi; Isoda, Susumu

    2012-05-01

    An 81-year-old woman became unconsciousness after complaining of a backache, and then, an ambulance was called. She was suspected to have an aortic dissection by the emergency medical technicians and was transferred to our department. On arrival, she was in shock. Emergency cardiac ultrasound disclosed good wall motion with cardiac tamponade but no complication of aortic regurgitation. Computed tomography of the trunk revealed a type A aortic dissection with cardiac tamponade. During performance of pericardial drainage, she lapsed into cardiopulmonary arrest. Immediately after sterilization of the patient's upper body with compression of the chest wall, we performed a thoracotomy and dissolved the cardiac tamponade by pericardiotomy and obtained her spontaneous circulation. Fortunately, blood discharge was ceased immediately after controlling her blood pressure aggressively. As she complicated pneumonitis, conservative therapy was performed. Her physical condition gradually improved, and she finally could feed herself and communicate. In cases of acute cardiac tamponade, simple pericardiocentesis often is not effective due to the presence of the clot, and a cardiac tamponade by a Stanford type A aortic dissection is highly possible to complicate cardiac arrest, so emergency physicians should be ready to provide immediate open cardiac massage to treat such patients. PMID:21406318

  4. Dissecting aneurysm of vertebral artery manifestating as contralateral abducens nerve palsy.

    PubMed

    Jeon, Jin Sue; Lee, Sang Hyung; Son, Young-Je; Chung, Young Seob

    2013-03-01

    Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern. PMID:23634273

  5. Propofol-Based Sedation Versus General Anesthesia for Endoscopic Submucosal Dissection.

    PubMed

    Yurtlu, Derya Arslan; Aslan, Fatih; Ayvat, Pinar; Isik, Yasemin; Karakus, Nesli; Ünsal, Belkis; Kizilkaya, Mehmet

    2016-05-01

    The main objective of this study is to evaluate general anesthesia or propofol-based sedation methods at gastric endoscopic submucosal dissection (ESD) procedures.The anesthetic method administered to cases undergoing upper gastrointestinal ESD between 2013 and 2015 was retrospectively investigated. Procedure time, lesion size, dissection speed, anesthesia time, adverse effects such as gag reflex, nausea, vomiting, cough, number of desaturation episodes (SpO2 < 90%), oropharyngeal suctioning requirements, hemorrhage, perforation, and amount of anesthetic medications were recorded.There were 54 and 37 patients who were administered sedation (group S) and general anesthesia (group G), respectively. The demographics of the groups were similar. The calculated dissection speed was significantly high in group G (36.02 ± 20.96 mm/min) compared with group S (26.04 ± 17.56 mm/min; P = 0.010). The incidence of nausea, cough, number of oropharyngeal suctioning, and desaturation episodes were significantly high in group S compared with that in group G (P < 0.5). While there was no difference between the groups in terms of hemodynamic parameters, in group S the use of propofol and in group G the use of midazolam and fentanyl were significantly higher (P < 0.05). Anesthesia time, postoperative anesthesia care unit, and hospital stay durations were not significantly different between the groups.General anesthesia increased dissection speed and enhanced endoscopist performance when compared with propofol-based sedation technique. PMID:27196474

  6. External iliac artery polytetrafluoroethylene graft interposition: An effective rescuer for kidney transplant in progressive intimal dissection of external iliac artery

    PubMed Central

    Dar, Tanveer Iqbal; Tyagi, Vipin; Khawaja, Abdul Rouf; Chadha, Sudhir; Jauhari, Harsha

    2016-01-01

    Aims and Objective: The aim of this study is to highlight the use of polytetrafluoroethylene (PTFE) interposition graft as an important salvage procedure in case of irreparable intimal injury of external iliac artery during renal transplant recipient surgery. Materials and Methods: Since 1987, we encountered irreparable intimal dissection of external iliac artery in five cases just after opening the clamp. It was successfully managed by PTFE interposition graft with subsequent end to side anastomosis of donor renal artery to the vascular graft. Results: No patient had bleeding or infective complications related to the graft and three patients had immediate diuresis. Normal immediate graft function was present in three patients while the other two had delayed graft function. Conclusion: Polytetrafluoroethylene interposition graft is a successful procedure to salvage the kidney and lower limb in case of progressive intimal dissection of external iliac artery during renal transplant surgery.

  7. A comparison of retention of anatomical knowledge in an introductory college biology course: Traditional dissection vs. virtual dissection

    NASA Astrophysics Data System (ADS)

    Taeger, Kelli Rae

    Dissection has always played a crucial role in biology and anatomy courses at all levels of education. However, in recent years, ethical concerns, as well as improved technology, have brought to the forefront the issue of whether virtual dissection is as effective or whether it is more effective than traditional dissection. Most prior research indicated the two methods produced equal results. However, none of those studies examined retention of information past the initial test of knowledge. Two groups of college students currently enrolled in an introductory level college biology course were given one hour to complete a frog dissection. One group performed a traditional frog dissection, making cuts in an actual preserved frog specimen with scalpels and scissors. The other group performed a virtual frog dissection, using "The Digital Frog 2" software. Immediately after the dissections were completed, each group was given an examination consisting of questions on actual specimens, pictures generated from the computer software, and illustrations that neither group had seen. Two weeks later, unannounced, the groups took the same exam in order to test retention. The traditional dissection group scored significantly higher on two of the three sections, as well as the total score on the initial exam. However, with the exception of specimen questions (on which the traditional group retained significantly more information), there was no significant difference in the retention from exam 1 to exam 2 between the two groups. These results, along with the majority of prior studies, show that the two methods produce, for the most part, the same end results. Therefore, the decision of which method to employ should be based on the goals and preferences of the instructor(s) and the department. If that department's goals include: Being at the forefront of new technology, increasing time management, increasing student: teacher ratio for economic reasons, and/or ethical issues, then the choice should be the use of computer software. If the goals include: Students gaining a 3-dimensional feel for the location and relationship of parts to one another, students being able to see various naturally occurring anomalies, and increased experience with manipulation of dissection tools, then the choice should be dissection of actual specimens. It is important to note, however, that regardless of which method is chosen, the effectiveness of that method is very much dependent on the skill and enthusiasm of the instructor.

  8. A patient-specific study of type-B aortic dissection: evaluation of true-false lumen blood exchange

    PubMed Central

    2013-01-01

    Background Aortic dissection is a severe pathological condition in which blood penetrates between layers of the aortic wall and creates a duplicate channel – the false lumen. This considerable change on the aortic morphology alters hemodynamic features dramatically and, in the case of rupture, induces markedly high rates of morbidity and mortality. Methods In this study, we establish a patient-specific computational model and simulate the pulsatile blood flow within the dissected aorta. The k-ω SST turbulence model is employed to represent the flow and finite volume method is applied for numerical solutions. Our emphasis is on flow exchange between true and false lumen during the cardiac cycle and on quantifying the flow across specific passages. Loading distributions including pressure and wall shear stress have also been investigated and results of direct simulations are compared with solutions employing appropriate turbulence models. Results Our results indicate that (i) high velocities occur at the periphery of the entries; (ii) for the case studied, approximately 40% of the blood flow passes the false lumen during a heartbeat cycle; (iii) higher pressures are found at the outer wall of the dissection, which may induce further dilation of the pseudo-lumen; (iv) highest wall shear stresses occur around the entries, perhaps indicating the vulnerability of this region to further splitting; and (v) laminar simulations with adequately fine mesh resolutions, especially refined near the walls, can capture similar flow patterns to the (coarser mesh) turbulent results, although the absolute magnitudes computed are in general smaller. Conclusions The patient-specific model of aortic dissection provides detailed flow information of blood transport within the true and false lumen and quantifies the loading distributions over the aorta and dissection walls. This contributes to evaluating potential thrombotic behavior in the false lumen and is pivotal in guiding endovascular intervention. Moreover, as a computational study, mesh requirements to successfully evaluate the hemodynamic parameters have been proposed. PMID:23829346

  9. A Simple Emergency Prediction Tool for Acute Aortic Dissection

    PubMed Central

    Peng, Wen; Zhu, Qing-yi; Zhou, Xiang-hong; Chai, Xiang-ping

    2013-01-01

    Abstract Background A simple emergency risk prediction tool should be developed for clinicians to quickly identify the prognosis of patients with acute aortic dissection. Methods We enrolled 280 patients with acute aortic dissection admitted to emergency department between May 2010 and February 2013. Multivariate logistic regression analysis was performed to identify independent predictors of in-hospital death. Results The in-hospital mortality of our patients with acute aortic dissection was 32.5%, in-hospital deaths with surgery less than the survived (34.1% VS 54.5%). Multivariate analysis identified that age (≥65 years old), Type A, blood pressure (mean systolic blood pressure ≤ 90 mmHg), neutrophil percentage (≥ 80%) and serum D-dimer (≥ 5.0 mg/L) were significant predictors of death. With the simple emergency risk prediction tool, scores of all in-hospital deaths were ≥ 3, whereas almost all of the survivors (97.9%) had scores < 15. A score of 10 offered the best threshold value, with the highest sensitivity (81.3%) and specificity (86.8%). Conclusions The in-hospital mortality rate of patients with acute aortic dissection is high and can be predicted. Early surgery would be beneficial for in-hospital survive. This tool should be available for clinicians in the emergency department to quickly identify the prognosis of patients with acute aortic dissection. PMID:26060615

  10. Surgical repair of aortic dissection 16 years post-Ross procedure.

    PubMed

    Myers, Mollie R; Magruder, J Trent; Crawford, Todd C; Grimm, Joshua C; Halushka, Marc K; Baumgartner, William A; Cameron, Duke E

    2016-01-01

    The Ross procedure is an excellent choice for younger patients in need of aortic valve replacement. While patients have benefited from superior survival rates associated with this procedure, complications related to aortic root dilatation and degeneration of the autograft may be encountered later in life. These challenges may be exacerbated in those with underlying connective tissue abnormalities, a phenomenon commonly observed in the bicuspid aortic valve population. In this report, we present the case of a patient who presented with an aortic dissection 16 years after a Ross procedure for aortic insufficiency in the setting of a bicuspid aortic valve, and review the existing literature related to this adverse event. PMID:27141044

  11. Surgical repair of aortic dissection 16 years post-Ross procedure

    PubMed Central

    Myers, Mollie R.; Magruder, J. Trent; Crawford, Todd C.; Grimm, Joshua C.; Halushka, Marc K.; Baumgartner, William A.; Cameron, Duke E.

    2016-01-01

    The Ross procedure is an excellent choice for younger patients in need of aortic valve replacement. While patients have benefited from superior survival rates associated with this procedure, complications related to aortic root dilatation and degeneration of the autograft may be encountered later in life. These challenges may be exacerbated in those with underlying connective tissue abnormalities, a phenomenon commonly observed in the bicuspid aortic valve population. In this report, we present the case of a patient who presented with an aortic dissection 16 years after a Ross procedure for aortic insufficiency in the setting of a bicuspid aortic valve, and review the existing literature related to this adverse event. PMID:27141044

  12. Dissecting Cellulitis of the Scalp Responding to Intravenous Tumor Necrosis Factor-alpha Antagonist

    PubMed Central

    Wollina, Uwe; Gemmeke, Astrid; Koch, Andr

    2012-01-01

    The authors present the case of a 30-year-old male patient with a severe and long-standing dissecting cellulitis of the scalp. The disease did not respond to conventional treatment, including oral antibiotics, isotretinoin, and prednisolone. Quality of life was significantly impaired. After introduction of anti-tumor necrosis factor-alpha treatment (infliximab), the malodorous discharge stopped, inflammation was reduced significantly, nodules became flat, and pain decreased. The treatment was well tolerated although he developed a temporary psoriasiform rash after the second intravenous infusion. In conclusion, anti-tumor necrosis factor-alpha treatment is a new therapeutic option in this severe and recalcitrant disorder. PMID:22708007

  13. Spontaneous coronary artery dissection in a 22-year-old man on lisdexamfetamine

    PubMed Central

    Afzal, Aasim M.; Sarmast, Syed A.; Weber, Nicholas A.

    2015-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of coronary events and sudden cardiac death. SCAD can present with a wide spectrum of clinical presentations and as an entity remains underrecognized. Several risk factors, such as female gender, peripartum and early postpartum state, and atherosclerotic disease, have been attributed to SCAD. Amphetamine use has been attributed to an increased risk for coronary artery events. We present a case of a 22-year-old man on lisdexamfetamine and no other significant medical history who presented with SCAD and was successfully treated with medical management. PMID:26130892

  14. Coronary accordion effect mimicking coronary dissection

    PubMed Central

    Balli, Mehmet; Akilli, Rabia Eker; Tekin, Kamuran; Cayli, Murat

    2013-01-01

    The coronary “accordion” effect is a rare pseudo-complication of percutaneous coronary intervention (PCI). It is usually observed due to straightening and shortening of tortuous vessels with stiff guidewires during PCI. In this case report, we present an interesting case of the coronary accordion effect observed in a 52-year-old woman undergoing PCI. PMID:24570759

  15. On the necessity of dissecting sequence similarity scores into segment-specific contributions for inferring protein homology, function prediction and annotation

    PubMed Central

    2014-01-01

    Background Protein sequence similarities to any types of non-globular segments (coiled coils, low complexity regions, transmembrane regions, long loops, etc. where either positional sequence conservation is the result of a very simple, physically induced pattern or rather integral sequence properties are critical) are pertinent sources for mistaken homologies. Regretfully, these considerations regularly escape attention in large-scale annotation studies since, often, there is no substitute to manual handling of these cases. Quantitative criteria are required to suppress events of function annotation transfer as a result of false homology assignments. Results The sequence homology concept is based on the similarity comparison between the structural elements, the basic building blocks for conferring the overall fold of a protein. We propose to dissect the total similarity score into fold-critical and other, remaining contributions and suggest that, for a valid homology statement, the fold-relevant score contribution should at least be significant on its own. As part of the article, we provide the DissectHMMER software program for dissecting HMMER2/3 scores into segment-specific contributions. We show that DissectHMMER reproduces HMMER2/3 scores with sufficient accuracy and that it is useful in automated decisions about homology for instructive sequence examples. To generalize the dissection concept for cases without 3D structural information, we find that a dissection based on alignment quality is an appropriate surrogate. The approach was applied to a large-scale study of SMART and PFAM domains in the space of seed sequences and in the space of UniProt/SwissProt. Conclusions Sequence similarity core dissection with regard to fold-critical and other contributions systematically suppresses false hits and, additionally, recovers previously obscured homology relationships such as the one between aquaporins and formate/nitrite transporters that, so far, was only supported by structure comparison. PMID:24890864

  16. Dissecting through barriers: A mixed-methods study on the effect of interprofessional education in a dissection course with healthcare professional students.

    PubMed

    Fernandes, Alisha Rebecca; Palombella, Andrew; Salfi, Jenn; Wainman, Bruce

    2015-01-01

    Healthcare delivery is reliant on a team-based approach, and interprofessional education (IPE) provides a means by which such collaboration skills can be fostered prior to entering the workplace. IPE within healthcare programs has been associated with improved collaborative behavior, patient care and satisfaction, reduced clinical error, and diminished negative professional stereotypes. An intensive interprofessional gross anatomy dissection course was created in 2009 to facilitate IPE at McMaster University. Data were collected from five cohorts over five years to determine the influence of this IPE format on the attitudes and perceptions of students towards other health professions. Each year, 28 students from the medicine, midwifery, nursing, physician's assistant, physiotherapy, and occupational therapy programs were randomly assigned into interprofessional teams for 10 weeks. Sessions involved an anatomy and scope-of-practice presentation, a small-group case-based session, and a dissection. A before/after design measured changes in attitudes and perceptions, while focus group data elaborated on the student experience with the course. Pre- and postmatched data revealed significant improvements in positive professional identity, competency and autonomy, role clarity and attitudes toward other health professions. Qualitative analysis of intraprofessional focus group interviews revealed meaningful improvements in a number of areas including learning anatomy, role clarity, and attitudes towards other health professions. PMID:25641912

  17. Spontaneous coronary artery dissection in men presenting with acute coronary syndrome, successfully managed by intravascular ultrasound-guided percutaneous coronary intervention

    PubMed Central

    Thomas, Bethan Nia; Aslam, Sajid; Cullen, James; Anantharaman, Rajaram

    2014-01-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It is most commonly seen in young women, without atherosclerosis, in the peripartum period. Management options include conservative medical treatment, percutaneous coronary intervention or a surgical approach depending on the presentation, extent of dissection and luminal stenosis. We describe three unusual cases of spontaneous coronary artery dissection occurring in young/middle-aged men—the first in association with heavy mechanical work, the second in association with high levels of anxiety and emotional distress and the third in association with intense physical exercise. In each case we report the use of coronary angiography and intravascular ultrasound in the diagnosis of the condition, and their successful management using percutaneous coronary intervention. PMID:24717852

  18. Free manual of cadaver dissection modifiable by other anatomists.

    PubMed

    Chung, Beom Sun; Chung, Min Suk

    2015-06-01

    Even in the rapidly changing field of cadaver dissection, published guide books still play an important role in the anatomy lab. However, commercial manuals with lengthy volumes and inflexible copyrights have several limitations which can be complemented by open-source manuals. Recently, the authors have manufactured and distributed a free electronic dissection manual (anatomy.co.kr), where descriptions are written concisely and images are drawn schematically. Moreover, simplified signs are employed to represent the cadaver viewing angles and manner of dissection. Based on the original files of this manual, other anatomists can revise and utilize the descriptions and figures. We expect many updated versions of our manual to be shared between students all over the world. PMID:25577205

  19. Proteomic approaches to dissect platelet function: half the story

    PubMed Central

    Gnatenko, Dmitri V.; Perrotta, Peter L.; Bahou, Wadie F.

    2006-01-01

    Platelets play critical roles in diverse hemostatic and pathologic disorders and are broadly implicated in various biological processes that include inflammation, wound healing, and thrombosis. Recent progress in high-throughput mRNA and protein profiling techniques has advanced our understanding of the biological functions of platelets. Platelet proteomics has been adopted to decode the complex processes that underlie platelet function by identifying novel platelet-expressed proteins, dissecting mechanisms of signal or metabolic pathways, and analyzing functional changes of the platelet proteome in normal and pathologic states. The integration of transcriptomics and proteomics, coupled with progress in bioinformatics, provides novel tools for dissecting platelet biology. In this review, we focus on current advances in platelet proteomic studies, with emphasis on the importance of parallel transcriptomic studies to optimally dissect platelet function. Applications of these global profiling approaches to investigate platelet genetic diseases and platelet-related disorders are also addressed. PMID:16926286

  20. Digital dissection system for medical school anatomy training

    NASA Astrophysics Data System (ADS)

    Augustine, Kurt E.; Pawlina, Wojciech; Carmichael, Stephen W.; Korinek, Mark J.; Schroeder, Kathryn K.; Segovis, Colin M.; Robb, Richard A.

    2003-05-01

    As technology advances, new and innovative ways of viewing and visualizing the human body are developed. Medicine has benefited greatly from imaging modalities that provide ways for us to visualize anatomy that cannot be seen without invasive procedures. As long as medical procedures include invasive operations, students of anatomy will benefit from the cadaveric dissection experience. Teaching proper technique for dissection of human cadavers is a challenging task for anatomy educators. Traditional methods, which have not changed significantly for centuries, include the use of textbooks and pictures to show students what a particular dissection specimen should look like. The ability to properly carry out such highly visual and interactive procedures is significantly constrained by these methods. The student receives a single view and has no idea how the procedure was carried out. The Department of Anatomy at Mayo Medical School recently built a new, state-of-the-art teaching laboratory, including data ports and power sources above each dissection table. This feature allows students to access the Mayo intranet from a computer mounted on each table. The vision of the Department of Anatomy is to replace all paper-based resources in the laboratory (dissection manuals, anatomic atlases, etc.) with a more dynamic medium that will direct students in dissection and in learning human anatomy. Part of that vision includes the use of interactive 3-D visualization technology. The Biomedical Imaging Resource (BIR) at Mayo Clinic has developed, in collaboration with the Department of Anatomy, a system for the control and capture of high resolution digital photographic sequences which can be used to create 3-D interactive visualizations of specimen dissections. The primary components of the system include a Kodak DC290 digital camera, a motorized controller rig from Kaidan, a PC, and custom software to synchronize and control the components. For each dissection procedure, the images are captured automatically, and then processed to generate a Quicktime VR sequence, which permits users to view an object from multiple angles by rotating it on the screen. This provides 3-D visualizations of anatomy for students without the need for special '3-D glasses' that would be impractical to use in a laboratory setting. In addition, a digital video camera may be mounted on the rig for capturing video recordings of selected dissection procedures being carried out by expert anatomists for playback by the students. Anatomists from the Department of Anatomy at Mayo have captured several sets of dissection sequences and processed them into Quicktime VR sequences. The students are able to look at these specimens from multiple angles using this VR technology. In addition, the student may zoom in to obtain high-resolution close-up views of the specimen. They may interactively view the specimen at varying stages of dissection, providing a way to quickly and intuitively navigate through the layers of tissue. Electronic media has begun to impact all areas of education, but a 3-D interactive visualization of specimen dissections in the laboratory environment is a unique and powerful means of teaching anatomy. When fully implemented, anatomy education will be enhanced significantly by comparison to traditional methods.

  1. Expression microdissection adapted to commercial laser dissection instruments

    PubMed Central

    Hanson, Jeffrey C; Tangrea, Michael A; Kim, Skye; Armani, Michael D; Pohida, Thomas J; Bonner, Robert F; Rodriguez-Canales, Jaime; Emmert-Buck, Michael R

    2016-01-01

    Laser-based microdissection facilitates the isolation of specific cell populations from clinical or animal model tissue specimens for molecular analysis. Expression microdissection (xMD) is a second-generation technology that offers considerable advantages in dissection capabilities; however, until recently the method has not been accessible to investigators. This protocol describes the adaptation of xMD to commonly used laser microdissection instruments and to a commercially available handheld laser device in order to make the technique widely available to the biomedical research community. The method improves dissection speed for many applications by using a targeting probe for cell procurement in place of an operator-based, cell-by-cell selection process. Moreover, xMD can provide improved dissection precision because of the unique characteristics of film activation. The time to complete the protocol is highly dependent on the target cell population and the number of cells needed for subsequent molecular analysis. PMID:21412274

  2. The birth and evolution of neuroscience through cadaveric dissection.

    PubMed

    Moon, Karam; Filis, Andreas K; Cohen, Alan R

    2010-09-01

    Although interest in the art of dissection and vivisection has waxed and waned throughout the ages, the past century has seen it accepted as commonplace in medical schools across the country. No other practice in medicine has contributed more to the understanding of neuroanatomy and the neurosciences as dissection of the human cadaver, the origins of which are widely documented to have been in Alexandrian Greece. This article chronicles the fascinating and often controversial use of dissection and vivisection in these fields through the ages, beginning with Herophilus of Alexandria, among the first systematic dissectors in the history of Western medicine. The authors comment on its role in the development of modern neurosurgery and conclude with remarks about use of this educational tool today in the United States. PMID:20657312

  3. Successful Endovascular Stent-Graft Repair for Complicated Type B Aortic Dissection Developed in a Patient with Polycystic Kidney Disease

    PubMed Central

    Jung, Chan Sung; Park, Byoung-Won; Bang, Duk Won; Jang, Won Ho; Kim, Hyo Shik; Oh, Ji Hyun

    2015-01-01

    Polycystic kidney disease (PCKD) is rarely associated with aortic dissection (AD), which is a life-threatening disease. Although endovascular stent-graft repair tends to show better outcomes than conventional therapies in complicated type B AD (TBAD), successful endovascular intervention of TBAD with malperfusion in a patient with PCKD has not been reported. This case shows a 37-year-old male who had sudden onset of sharply stabbing epigastric pain with severe hypertension, who was diagnosed with TBAD and PCKD by a computed tomography and initially underwent medical treatment. Four days after discharge, he was rehospitalized with left leg pain and paresthesia due to left lower leg malperfusion. Thoracic endovascular stent-graft repair covering the primary tear site of dissection was performed successfully, leading to a decrease in false lumen and improvement of symptoms. We report the case of complicated TBAD in a patient with PCKD treated with endovascular stent-graft repair. PMID:26217646

  4. Heavy Lifting Causing Spontaneous Coronary Artery Dissection with Anterior Myocardial Infarction in a 54-Year-Old Woman.

    PubMed

    Yiangou, Kyriakos; Papadopoulos, Kyriacos; Azina, Chara

    2016-04-01

    Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis and treatment of this rare condition is a challenge, but prompt recognition and appropriate early choice of angioplasty or surgery can lead to a good outcome. We report the case of a postmenopausal 54-year-old woman who presented with anterior myocardial infarction caused by spontaneous dissection of the left anterior descending coronary artery after she had lifted a heavy weight while gardening. The patient was treated successfully by means of angioplasty and the implantation of 3 drug-eluting stents. In addition to presenting the patient's case, we review the topical medical literature. PMID:27127443

  5. Heavy Lifting Causing Spontaneous Coronary Artery Dissection with Anterior Myocardial Infarction in a 54-Year-Old Woman

    PubMed Central

    Papadopoulos, Kyriacos; Azina, Chara

    2016-01-01

    Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis and treatment of this rare condition is a challenge, but prompt recognition and appropriate early choice of angioplasty or surgery can lead to a good outcome. We report the case of a postmenopausal 54-year-old woman who presented with anterior myocardial infarction caused by spontaneous dissection of the left anterior descending coronary artery after she had lifted a heavy weight while gardening. The patient was treated successfully by means of angioplasty and the implantation of 3 drug-eluting stents. In addition to presenting the patient's case, we review the topical medical literature. PMID:27127443

  6. Basic dissecting techniques in ultrasound-guided surgery.

    PubMed

    Pilecki, Zbigniew; Koczy, Bogdan; Mielnik, Michał; Pilecki, Grzegorz; Dzielicki, Józef; Jakubowski, Wiesław

    2014-06-01

    Ultrasound-guided surgery is an area of minimally-invasive surgery where surgical procedures are performed with the aid of ultrasound imaging throghout the operation. This requires the operator to posses a certain degree of experience in endoscopic procedures, and to be adeptly skillfull in conducting US examinations. It is combining and finely tuning together these two elements that allows to perform efficiently an ultrasound-guided surgical procedure. Accessing an affected site correctly is of utmost importance in surgery, being oftentimes decisive in terms of the procedure's final outcome. In ultrasound-guided procedures, the operative site is accessed percutaneously, with a single point incision, yet tissues situated deeper within are dissected with dissecting techniques in a fluid evironment, typical for this area of surgery. Dissecting techniques in ultrasound-guided surgery are currently divided into basic ones which employ either a hydrodissection needle, surgical instruments, electrosurgical instruments, a thread, or a combination thereof, and advanced ones where either a balloon, a hook dissection technique, or a hybrid one is used. Hydrodissection with a needle was devised based on the rule of complementarity, and is the most frequently applied technique in ultrasound-guided surgery. The immense possibilities that go along with this modality will be of huge benefit to any surgeon, regardless of their field. Dissection with a variety of surgical instruments and electrosurgery instruments is a standard practice in all surgery areas, yet the method of imaging we employ in ultrasound-guided surgery results in certain modifications of these techniques. It is, however, learning the thread technique that facilitates a precise and oftentimes extensive dissection. This technique is successfully applied for dissecting muscle, ligament, tendon, vascular and other structures. Having mastered dissecting techniques allows to perform any minimally-invasive procedure efficiently, be they ultrasound-guided, artroscopic, or endoscopic ones. Various surgical techniques are bridged, resulting in applying the so-called hybrid ones. Their strength lies in excellent imaging results allowing to conduct a surgical procedure both in a body cavity and within a parenchymal organ. PMID:26674391

  7. Basic dissecting techniques in ultrasound-guided surgery

    PubMed Central

    Koczy, Bogdan; Mielnik, Micha?; Pilecki, Grzegorz; Dzielicki, Jzef; Jakubowski, Wies?aw

    2014-01-01

    Ultrasound-guided surgery is an area of minimally-invasive surgery where surgical procedures are performed with the aid of ultrasound imaging throghout the operation. This requires the operator to posses a certain degree of experience in endoscopic procedures, and to be adeptly skillfull in conducting US examinations. It is combining and finely tuning together these two elements that allows to perform efficiently an ultrasound-guided surgical procedure. Accessing an affected site correctly is of utmost importance in surgery, being oftentimes decisive in terms of the procedure's final outcome. In ultrasound-guided procedures, the operative site is accessed percutaneously, with a single point incision, yet tissues situated deeper within are dissected with dissecting techniques in a fluid evironment, typical for this area of surgery. Dissecting techniques in ultrasound-guided surgery are currently divided into basic ones which employ either a hydrodissection needle, surgical instruments, electrosurgical instruments, a thread, or a combination thereof, and advanced ones where either a balloon, a hook dissection technique, or a hybrid one is used. Hydrodissection with a needle was devised based on the rule of complementarity, and is the most frequently applied technique in ultrasound-guided surgery. The immense possibilities that go along with this modality will be of huge benefit to any surgeon, regardless of their field. Dissection with a variety of surgical instruments and electrosurgery instruments is a standard practice in all surgery areas, yet the method of imaging we employ in ultrasound-guided surgery results in certain modifications of these techniques. It is, however, learning the thread technique that facilitates a precise and oftentimes extensive dissection. This technique is successfully applied for dissecting muscle, ligament, tendon, vascular and other structures. Having mastered dissecting techniques allows to perform any minimally-invasive procedure efficiently, be they ultrasound-guided, artroscopic, or endoscopic ones. Various surgical techniques are bridged, resulting in applying the so-called hybrid ones. Their strength lies in excellent imaging results allowing to conduct a surgical procedure both in a body cavity and within a parenchymal organ. PMID:26674391

  8. Computational Fluid Dynamics Analysis of Thoracic Aortic Dissection

    NASA Astrophysics Data System (ADS)

    Tang, Yik; Fan, Yi; Cheng, Stephen; Chow, Kwok

    2011-11-01

    Thoracic Aortic Dissection (TAD) is a cardiovascular disease with high mortality. An aortic dissection is formed when blood infiltrates the layers of the vascular wall, and a new artificial channel, the false lumen, is created. The expansion of the blood vessel due to the weakened wall enhances the risk of rupture. Computational fluid dynamics analysis is performed to study the hemodynamics of this pathological condition. Both idealized geometry and realistic patient configurations from computed tomography (CT) images are investigated. Physiological boundary conditions from in vivo measurements are employed. Flow configuration and biomechanical forces are studied. Quantitative analysis allows clinicians to assess the risk of rupture in making decision regarding surgical intervention.

  9. Elective neck dissection in oral carcinoma: a critical review of the evidence

    PubMed Central

    Kowalski, LP; Sanabria, A

    2007-01-01

    Summary More than 50% of patients with squamous cell carcinoma of the oral cavity have lymph node metastases and histological confirmation of metastatic disease is the most important prognostic factor. Among patients with a clinically negative neck, the incidence of occult metastases varies with the site, size and thickness of the primary tumour. The high incidence rate of occult cervical metastases (> 20%) in tumours of the lower part of the oral cavity is the main argument in favour of elective treatment of the neck. The usual treatment of patients with clinically palpable metastatic lymph nodes has been radical neck dissection. This classical surgical procedure involves not only resection of level I to V lymph nodes of the neck but also the tail of the parotid, submandibular gland, sternocleidomastoid muscle, internal jugular vein and spinal accessory nerve. It is a safe oncological surgical procedure that significantly reduces the risk of regional recurrences, however it produces significant post-operative morbidity, mainly shoulder dysfunction. Aiming to reduce morbidity, Ward and Roben described a modification of the procedure sparing the spinal accessory nerve to prevent post-operative shoulder morbidity. Several clinical and pathological studies have demonstrated that the pattern of metastatic lymph node metastases occurs in a predictable fashion in patients with oral and oropharyngeal carcinoma. The use of selective supraomohyoid neck dissection as the elective treatment of the neck, in oral cancer patients, is now well established. However, its role in the treatment of clinically positive neck patients is controversial. Some Authors advocate this type of selective neck dissection in patients with limited neck disease at the upper levels of the neck, without jeopardizing neck control. The main factors supporting this approach are the usually good prognosis in patients with single levels I or II metastasis independent of the extent of neck dissection, and the low rates of level V involvement in oral cavity tumours. Furthermore, the high incidence of clinically false-positive lymph nodes in oral cavity cancer patients is well recognized. In selected cases, supraomohyoid dissection could be extended to level IV, and followed by radiotherapy when indicated. Several reports have confirmed the usefulness of minimally invasive sentinel lymph node biopsy in melanoma and breast tumours. However, only preliminary data testing the feasibility of the method exist regarding the management of oral and oropharyngeal squamous cell carcinoma. The complexity of lymphatic drainage and the presence of deep lymphatics of the neck make application of this method difficult. This attractive concept has recently been explored by several investigators who examined the feasibility of identifying the sentinel lymph node in primary echelons of drainage from oral cavity squamous carcinoma. The current knowledge of sentinel lymph node biopsy does not allow avoiding the indication of elective neck dissection in clinical practice. Sentinel lymph node biopsy cannot be considered the standard of care at this time. However, there are multi-institutional clinical trials testing this approach. Management of occult neck node metastasis continues to be a matter of debate. The role of imaging methods such as ultrasound-guided needle biopsy, sentinel node biopsy and positron emission tomography-computed tomography are still being evaluated as alternatives to elective neck dissections. Whether one of these techniques will change the current management of cervical node metastasis remains to be proved in prospective multi-institutional trials. PMID:17883186

  10. Retraction: notice.

    PubMed

    2014-10-01

    Ping Gao, Shun-Chang Jiao, Li Bai, et al. 'Detection of circulating tumour cells in gastric and hepatocellular carcinoma: A systematic review' Journal of International Medical Research August 2013 vol. 41 no. 4 923-933. DOI: 10.1177/0300060513489789 has been retracted. This is because it contains unattributed overlap with material from the following article: FC Bidard, FR Ferrand, F Huguet, et al. 'Disseminated and circulating tumor cells in gastrointestinal oncology' Critical Reviews in Oncology / Hematology, Volume 82, Issue 2, Pages 103-115, May 2012. DOI: 10.1016/j.critrevonc.2011.05.008 NOTICE: Yongsheng Zhao, Yuxin Liu and Yanping Zheng, 'Osteoporosis and related factors in older females with skeletal pain or numbness: A retrospective study in East China', Journal of International Medical Research June 2013 vol. 41 no. 3 859-866. DOI: 10.1177/0300060513483414 has been retracted. This is because it contains unattributed overlap with material from the following article: Shasha Li, Hongchen He, Mingfu Ding et al. 'The correlation of osteoporosis to clinical features: a study of 4382 Female Cases of a Hospital Cohort with musculoskeletal symptoms in Southwest China' BMC Musculoskeletal Disorders 2010, 11:183. DOI: 10.1186/1471-2474-11-183 NOTICE: Ao Qiang Guo, Lei Sheng, Xu Lei et al. 'Pharmacological and physical prevention and treatment of no-reflow after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction' Journal of International Medical Research June 2013 vol. 41 no. 3 537-547. DOI: 10.1177/0300060513479859 has been retracted. This is because it contains unattributed overlap with material from the following article: Giampaolo Niccoli, Rajesh K Kharbanda, Filippo Crea, et al. 'No-reflow: again prevention is better than treatment' European Heart Journal (2010) 31(20): 2449-2455. DOI: 10.1093/eurheartj/ehq299. PMID:25239877

  11. Contrast layering artefact mimicking aortic dissection in a patient on veno-arterial extracorporeal membrane oxygenation undergoing computed tomography scan.

    PubMed

    Goslar, Tomaz; Stankovic, Milenko; Ksela, Jus

    2016-04-01

    Interpretation and evaluation of images obtained by different contrast-enhanced diagnostic tools in patients on extracorporeal membrane oxygenation (ECMO) support can be extremely challenging due to profound pump-related alterations in haemodynamics and contrast media enhancement patterns. We present a case of a 65-year old patient on veno-arterial ECMO with a pseudo-filling defect of the arterial system on contrast-enhanced computed tomography scan, resembling aortic dissection. PMID:26721943

  12. Role of cadaveric dissections in modern medical curricula: a study on student perceptions

    PubMed Central

    Nirthanan, Selvanayagam N.; Khoo, Tien K.; Tedman, Raymond

    2015-01-01

    The shift from traditional medical curricula to newer teaching and learning approaches such as problem-based learning has often resulted in omission or significant reduction of cadaveric dissections as a method of learning anatomy. The objective of this study was to evaluate students' perception of dissection in a graduate-entry, problem-based learning-based medical curriculum. At the end of the musculoskeletal dissection program in second year, a Likert-type questionnaire was used to explore medical student perceptions of the perceived advantages and challenges of cadaveric dissections in comparison with other anatomy teaching methods. Overall, a majority of students had a positive perception of dissections. Students who attended dissections regularly had significantly more positive perceptions about their experience and were in agreement with statements such as "dissections make learning more interesting" and "I would be disadvantaged if I did not attend dissection classes." Non-regular attendance was associated with statements about dissections such as "I do not like the smell," "time consuming," and "bored with the way it is carried-out." A follow-up study after completion of the medical program revealed a significant improvement of positive perception about dissection. Student perceptions appear to favour a role for cadaveric dissection in learning anatomy in modern medical curricula. However, optimal and effective integration of dissections is important, with consideration given to its structure and extent of content weighed against logistics and availability of resources; while addressing negative perceptions of dissection-based teaching. PMID:26417481

  13. Extent of lymph node dissection: common hepatic artery lymph node dissection can be omitted for esophageal squamous cell carcinoma

    PubMed Central

    Ma, Xiao; Li, Bin; Yang, Su; Guo, Wei; Zhu, Xiaoli; Xiang, Jiaqing; Zhang, Yawei

    2014-01-01

    Objectives Controversy persists regarding the adequate extent of lymph node (LN) dissection in thoracic esophageal cancer (EC) surgery. Oncologic efficacy should be balanced with the increased risk of postoperative complications after aggressive radical LN dissection. Here, we evaluate the effectiveness of common hepatic artery LN dissection in surgery for thoracic esophageal squamous cell carcinoma. Patients and methods Among a total of 1,563 EC patients who underwent surgery from May 2005 to December 2012 at the Fudan University Shanghai Cancer Center, 1,248 thoracic esophageal squamous cell carcinoma were selected for this study, including 682 patients who underwent esophagectomy with common hepatic artery LN dissection and 566 patients who underwent esophagectomy without common hepatic artery LN dissection. The clinical data of patients were retrospectively analyzed. In addition, the locoregional LN metastasis, relationship between metastatic rates of common hepatic artery LN and clinicopathological factors were analyzed. A propensity score match analysis were performed to control for potential differences in the characteristics of patients with EC cell carcinoma, and postoperative complications were analyzed after propensity score-matching. Results The metastatic rate of common hepatic LN was 3.5%. Logistic regression analysis revealed tumor diameter, N classification and pTNM stage were risk factors for common hepatic LN metastasis. Matching based on propensity scores produced 361 patients in each group. The overall incidence of postoperative complications was 32.70% and 35.45%, respectively, no significant difference was found (P=0.432). Conclusions The metastatic rate of common hepatic artery LN is low. For patients who undergo resection for Stage I thoracic esophageal squamous cell carcinoma, the dissection of common hepatic artery LN may be safely omitted. PMID:24876938

  14. Dissections of regional lymph nodes for treatment of skin cancer: predicting annual caseloads that will optimise outcomes

    PubMed Central

    Davies, A; Rahman, S; Sethu, C; Smith, JRO; Orlando, A; Ayers, D

    2015-01-01

    Introduction Dissection of regional lymph nodes (RLNs) can lead to significant morbidity and a high prevalence of complications. Published guidance states that these procedures should be carried out by surgeons who are members of a specialist skin multidisciplinary team who carry out a combined minimum of 15 axillary/groin dissections per year. However, there is little evidence to guide this minimum figure of procedures. We report on the burden of service provision and prevalence of complications across the South West of England and Wales. Methods A 12-month review of dissections of RLNs for skin cancer was undertaken covering five Plastic Surgery Units with a collective catchment of 8.4 million people. Detailed data were collected on patient demographics, pathology, timing of surgery, and prevalence of complications. Results A total of 163 dissections were carried out. Forty-three per cent of patients experienced one or more complication. In that 12-month period, an average of 8 axillary/groin dissections was carried out per surgeon. A funnel plot demonstrated that the prevalence of complications for individual surgeons was within the limit of the plot but, in many cases, this was based only on a relatively small number of procedures per consultant. If surgeons carried out 10 procedures per year, the upper and lower limits on the plot were 73% and 11%, respectively. Conclusions Funnel plots can provide a useful guide as to whether the prevalence of complications for procedures for individual surgeons lies within acceptable limits. Based on these results, 10 procedures per consultant per year should be sufficient to enable meaningful assessment of the prevalence of complications. PMID:25519267

  15. How Klingler's dissection permits exploration of brain structural connectivity? An electron microscopy study of human white matter.

    PubMed

    Zemmoura, Ilyess; Blanchard, Emmanuelle; Raynal, Pierre-Ivan; Rousselot-Denis, Cécilia; Destrieux, Christophe; Velut, Stéphane

    2016-06-01

    The objective of this study is to explore histological and ultrastructural changes induced by Klingler's method. Five human brains were prepared. First, the effects of freezing-defrosting on white matter were explored with optical microscopy on corpus callosum samples of two brains; one prepared in accordance with the description of Klingler (1956) and the other without freezing-defrosting. Then, the combined effect of formalin fixation and freezing-defrosting was explored with transmission electron microscopy (EM) on samples of cingulum from one brain: samples from one hemisphere were fixed in paraformaldehyde-glutaraldehyde (para/gluta), other samples from the other hemisphere were fixed in formalin; once fixed, half of the samples were frozen-defrosted. Finally, the effect of dissection was explored from three formalin-fixed brains: one hemisphere of each brain was frozen-defrosted; samples of the corpus callosum were dissected before preparation for scanning EM. Optical microscopy showed enlarged extracellular space on frozen samples. Transmission EM showed no significant alteration of white matter ultrastructure after formalin or para/gluta fixation. Freezing-defrosting created extra-axonal lacunas, larger on formalin-fixed than on para/gluta-fixed samples. In all cases, myelin sheaths were preserved, allowing maintenance of axonal integrity. Scanning EM showed the destruction of most of the extra-axonal structures after freezing-defrosting and the preservation of most of the axons after dissection. Our results are the first to highlight the effects of Klingler's preparation and dissection on white matter ultrastructure. Preservation of myelinated axons is a strong argument to support the reliability of Klingler's dissection to explore the structure of human white matter. PMID:25905864

  16. Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer: is it an adequate treatment?

    PubMed Central

    2014-01-01

    Background Cervical lymph node metastases in papillary thyroid cancer are common. Although central neck dissection is indicated in clinically nodal-positive disease, it remains controversial in patients with no clinical evidence of nodal metastasis. The aim of this retrospective study was to determine the outcomes of clinically lymph node-negative patients with papillary thyroid cancer who underwent total thyroidectomy without a central neck dissection, in order to determine the rates of recurrence and reoperation in these patients compared with a group of patients submitted to total thyroidectomy with central neck dissection. Methods Two-hundred and eighty-five patients undergoing total thyroidectomy with preoperative diagnosis of papillary thyroid cancer, in the absence of suspicious nodes, were divided in two groups: those who underwent a thyroidectomy only (group A; n = 220) and those who also received a central neck dissection (group B; n = 65). Results Six cases (2.1%) of nodal recurrence were observed: 4 in group A and 2 in group B. Tumor histology was associated with risk of recurrence: Hürthle cell-variant and tall cell-variant carcinomas were associated with a high risk of recurrence. Multifocality and extrathyroidal invasion also presented a higher risk, while smaller tumors were at lower risk. Conclusions The role of prophylactic central lymph node dissection in the management of papillary thyroid cancer remains controversial. Total thyroidectomy appears to be an adequate treatment for clinically node-negative papillary thyroid cancer. Prophylactic central neck dissection could be considered for the more appropriate selection of patients for radioiodine treatment and should be reserved for high-risk patients only. No clinical or pathological factors are able to predict with any certainty the presence of nodal metastasis. In our experience, tumor size, some histological types, multifocality, and locoregional infiltration are related to an increased risk of recurrence. The potential use of molecular markers will hopefully offer a further strategy to stratify the risk of recurrence in patients with papillary thyroid cancer and allow a more tailored approach to offer prophylactic central neck dissection to patients with the greatest benefit. Multi-institutional larger studies with longer follow-up periods are necessary to draw definitive conclusions. PMID:24885654

  17. Dissecting Thoracic Aortic Hematoma Masquerading as Blunt Force Injury of the Neck.

    PubMed

    Wiens, Andrea L; Felo, Joseph A

    2015-07-01

    Discoloration of the skin of the anterior and lateral neck may raise suspicion for blunt force injury, particularly cervical compression, in an unwitnessed death. We present a case of an elderly woman with an unwitnessed death at home which highlights an external examination finding of blue/purple discoloration of the skin of the neck and links this finding with those from internal examination at autopsy. Pertinent negatives include absence of conjunctival and mucosal petechiae, absence of cutaneous abrasions of the neck, and absence of contusions of the anterior neck musculature. This case illustrates a natural disease entity, spontaneous dissection of a thoracic aortic hematoma, masquerading as blunt force injury externally and highlights the importance of having an appropriate index of suspicion when triaging jurisdictional cases for postmortem examination to accurately determine cause and manner of death. PMID:25800076

  18. [Familial thoracic aortic aneurysms and dissections can be divided into three different main categories].

    PubMed

    Hannuksela, Matias; Stattin, Eva-Lena; Nyberg, Peter; Carlberg, Bo

    Thoracic aortic aneurysms and dissections (TAAD) can be divided into three different main categories. 1. Inherited syndromes predisposing to TAAD such as Marfan syndrome, Ehlers-Danlos syndrome type IV and Loeys-Dietz syndrome (less than 5% of all TAAD). 2. Familial TAAD (FTAAD) with more than one affected family member (20 % of all TAAD). Inheritance shows an autosomal dominant pattern and there are no features of known syndromes. 3. Sporadic forms of TAAD with no family history or features of syndromic forms. FTAAD present earlier in life and dissections occur in smaller diameter than in sporadic cases. The underlying genetic cause can be found in about 20 % of the inherited cases. The pathogenesis seems to be an involvement of the transforming growth factor β (TGFβ) signaling pathway or a dysfunction of the smooth muscle cell contraction. The role of β-blockers for aneurysm prevention is uncertain and there are on-going studies comparing angiotensin receptor blockers and β-blockers. PMID:24570135

  19. A Novel Approach to the Dissection of the Human Knee

    ERIC Educational Resources Information Center

    Clemente, F. Richard; Fabrizio, Philip A.; Shumaker, Michael

    2009-01-01

    The knee is one of the most frequently injured joints of the human body with injuries affecting the general population and the athletic population of many age groups. Dissection procedures for the knee joint typically do not allow unobstructed visualization of the anterior cruciate or posterior cruciate ligaments without sacrificing the collateral…

  20. DISSECT: Data-Intensive Socially Similar Evolving Community Tracker

    NASA Astrophysics Data System (ADS)

    Chin, Alvin; Chignell, Mark

    This chapter examines the problem of tracking community in social networks inferred from online interactions by tracking evolution of known subgroups over time. Finding subgroups within social networks is important for understanding and possibly influencing the formation and evolution of online communities. A variety of approaches have been suggested to address this problem and the corresponding research literature on centrality, clustering, and optimization methods for finding subgroupings is reviewed. This review will include a critical analysis of the limitations of past approaches. The focus of the chapter will then turn to novel methods for tracking online community interaction. First, the method proposed by Chin and Chignell called SCAN will be briefly introduced, where a combination of heuristic methods is used to identify subgroups in a manner that can potentially scale up to very large social networks. Then, we present the DISSECT method where multiple known subgroups within a social network are tracked in terms of similarity-based cohesiveness over time. The DISSECT method relies on cluster analysis of snapshots of network activity at different points in time followed by similarity analysis of subgroup evolution over successive time periods. The DISSECT method can be supplemented with behavioral measures of sense of community where administration of a questionnaire is feasible. Finally, we conclude the chapter with a discussion on possible applications and use of the DISSECT method.

  1. General Dissection of Female Ant Reproductive System and Brain

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Dissection of the reproductive system of ant workers and queens can be useful for answering many questions. Observations of ovarian status in both female castes can be used to identify relationships between other factors and the ovaries, determine whether an individual has laid eggs, and, with more ...

  2. Using a Dissecting Microscope in Teaching Introductory Chemistry.

    ERIC Educational Resources Information Center

    Winokur, Robert; Monroe, Manus

    1985-01-01

    To have students develop observational skills and acquire an excitement about chemistry, stereoscopic dissecting microscopes are used to observe the physical characteristics and chemical reactions of various substances. Several of these reactions (including dissolving potassium permanganate in deionized water and reactions between copper metal and

  3. Using a Dissecting Microscope in Teaching Introductory Chemistry.

    ERIC Educational Resources Information Center

    Winokur, Robert; Monroe, Manus

    1985-01-01

    To have students develop observational skills and acquire an excitement about chemistry, stereoscopic dissecting microscopes are used to observe the physical characteristics and chemical reactions of various substances. Several of these reactions (including dissolving potassium permanganate in deionized water and reactions between copper metal and…

  4. There Is More to the Dissection of a Pig's Heart

    ERIC Educational Resources Information Center

    Lee, Yeung Chung

    2004-01-01

    The dissection of the mammalian heart in secondary biology classes need not be restricted to revealing the internal structure of the heart and its function. It could also be used to demonstrate other important aspects of blood circulation, including the blood supply to the heart itself as well as the causes and effects of coronary heart disease.

  5. The Influence of Emotion on Students' Performance in Dissection Exercises

    ERIC Educational Resources Information Center

    Holstermann, Nina; Grube, Dietmar; Bogeholz, Susanne

    2009-01-01

    This paper investigates the issue of how emotions such as disgust influence students' self-efficacy belief in terms of mastering a dissection task and also how these affect their interest in the biology of the heart. Following models of intrinsic motivation and the development of motivation, we expected disgust to negatively impact on students'…

  6. The Influence of Emotion on Students' Performance in Dissection Exercises

    ERIC Educational Resources Information Center

    Holstermann, Nina; Grube, Dietmar; Bogeholz, Susanne

    2009-01-01

    This paper investigates the issue of how emotions such as disgust influence students' self-efficacy belief in terms of mastering a dissection task and also how these affect their interest in the biology of the heart. Following models of intrinsic motivation and the development of motivation, we expected disgust to negatively impact on students'

  7. Gastric Wall Dissection as a Complication of Percutaneous Gastrostomy

    SciTech Connect

    Reimer, Wolfgang; Farres, Maria Teresa; Lammer, Johannes

    1996-04-15

    A percutaneous gastrostomy (PG) was complicated by gastric wall dissection and partial tube malposition. It occurred after tangential puncture along the greater curvature of the stomach which was performed in order to avoid an enlarged left lobe of the liver. To prevent this complication we recommend not using hydrophilic guidewires during PG.

  8. A Novel Approach to the Dissection of the Human Knee

    ERIC Educational Resources Information Center

    Clemente, F. Richard; Fabrizio, Philip A.; Shumaker, Michael

    2009-01-01

    The knee is one of the most frequently injured joints of the human body with injuries affecting the general population and the athletic population of many age groups. Dissection procedures for the knee joint typically do not allow unobstructed visualization of the anterior cruciate or posterior cruciate ligaments without sacrificing the collateral

  9. There Is More to the Dissection of a Pig's Heart

    ERIC Educational Resources Information Center

    Lee, Yeung Chung

    2004-01-01

    The dissection of the mammalian heart in secondary biology classes need not be restricted to revealing the internal structure of the heart and its function. It could also be used to demonstrate other important aspects of blood circulation, including the blood supply to the heart itself as well as the causes and effects of coronary heart disease.…

  10. Exploring Dissections of Rectangles into Right-Angled Triangles

    ERIC Educational Resources Information Center

    Griffiths, Martin

    2013-01-01

    In this article we highlight how a simple classroom activity associated with the dissection of rectangles into right-angled triangles can lead on to a number of interesting explorations for students following a post-16 mathematics course. Several results connected with this construction are obtained, and some of the educational benefits of…

  11. Standard methods for Apis mellifera anatomy and dissection

    Technology Transfer Automated Retrieval System (TEKTRAN)

    An understanding of the anatomy and functions of internal and external structures are fundamental to many studies on the honey bee Apis mellifera. Similarly, proficiency in dissection techniques is vital for many more complex procedures. In this paper, which is a prelude to the other papers of the C...

  12. Student Attitudes to Whole Body Donation Are Influenced by Dissection

    ERIC Educational Resources Information Center

    Cahill, Kevin C.; Ettarh, Raj R.

    2008-01-01

    Given the important role that anatomical dissection plays in the shaping of medical student attitudes to life and death, these attitudes have not been evaluated in the context of whole body donation for medical science. First year students of anatomy in an Irish university medical school were surveyed by questionnaire before and after the initial…

  13. 12 CFR 1511.8 - Notice of attachment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 9 2013-01-01 2013-01-01 false Notice of attachment. 1511.8 Section 1511.8....8 Notice of attachment. The interest of a debtor in a Security Entitlement may be reached by a... or other notice of attachment in any particular case or class of cases....

  14. 12 CFR 1511.8 - Notice of attachment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Notice of attachment. 1511.8 Section 1511.8....8 Notice of attachment. The interest of a debtor in a Security Entitlement may be reached by a... or other notice of attachment in any particular case or class of cases....

  15. 12 CFR 1511.8 - Notice of attachment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Notice of attachment. 1511.8 Section 1511.8....8 Notice of attachment. The interest of a debtor in a Security Entitlement may be reached by a... or other notice of attachment in any particular case or class of cases....

  16. 12 CFR 1511.8 - Notice of attachment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Notice of attachment. 1511.8 Section 1511.8....8 Notice of attachment. The interest of a debtor in a Security Entitlement may be reached by a... or other notice of attachment in any particular case or class of cases....

  17. 12 CFR 1511.8 - Notice of attachment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Notice of attachment. 1511.8 Section 1511.8....8 Notice of attachment. The interest of a debtor in a Security Entitlement may be reached by a... or other notice of attachment in any particular case or class of cases....

  18. 77 FR 77091 - Notice of Receipt of Complaint; Solicitation of Comments Relating to the Public Interest

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-31

    ...Notice is hereby given that the U.S. International Trade Commission has received a complaint entitled Certain Balloon Dissection Devices and Products Containing Same, DN 2925; the Commission is soliciting comments on any public interest issues raised by the complaint or complainant's filing under section 210.8(b) of the Commission's Rules of Practice and Procedure (19 CFR...

  19. Possible extracardiac predictors of aortic dissection in Marfan syndrome

    PubMed Central

    2014-01-01

    Background According to previous studies, aortic diameter alone seems to be insufficient to predict the event of aortic dissection in Marfan syndrome (MFS). Determining the optimal schedule for preventive aortic root replacement (ARR) aortic growth rate is of importance, as well as family history, however, none of them appear to be decisive. Thus, the aim of this study was to search for potential predictors of aortic dissection in MFS. Methods A Marfan Biobank consisting of 79 MFS patients was established. Thirty-nine MFS patients who underwent ARR were assigned into three groups based on the indication for surgery (dissection, annuloaortic ectasia and prophylactic surgery). The prophylactic surgery group was excluded from the study. Transforming growth factor-β (TGF-β) serum levels were measured by ELISA, relative expression of c-Fos, matrix metalloproteinase 3 and 9 (MMP-3 and −9) were assessed by RT-PCR. Clinical parameters, including anthropometric variables - based on the original Ghent criteria were also analyzed. Results Among patients with aortic dissection, TGF-β serum level was elevated (43.78 ± 6.51 vs. 31.64 ± 4.99 ng/l, p < 0.0001), MMP-3 was up-regulated (Ln2α = 1.87, p = 0.062) and striae atrophicae were more common (92% vs. 41% p = 0.027) compared to the annuloaortic ectasia group. Conclusions We found three easily measurable parameters (striae atrophicae, TGF-β serum level, MMP-3) that may help to predict the risk of aortic dissection in MFS. Based on these findings a new classification of MFS, that is benign or malignant is also proposed, which could be taken into consideration in determining the timing of prophylactic ARR. PMID:24720641

  20. Mediastinal micro-vessels clipping during lymph node dissection may contribute to reduce postoperative pleural drainage

    PubMed Central

    Yan, Shi; Wang, Xing; Lv, Chao; Phan, Kevin; Wang, Yuzhao; Wang, Jia; Yang, Yue

    2016-01-01

    Background Postoperative pleural drainage markedly influences the length of postoperative stay and financial costs of medical care. The aim of this study is to retrospectively investigate potentially predisposing factors related to pleural drainage after curative thoracic surgery and to explore the impact of mediastinal micro-vessels clipping on pleural drainage control after lymph node dissection. Methods From February 2012 to November 2013, 322 consecutive cases of operable non-small cell lung cancers (NSCLC) undergoing lobectomy and mediastinal lymph node dissection with or without application of clipping were collected. Total and daily postoperative pleural drainage were recorded. Propensity score matching (1:2) was applied to balance variables potentially impacting pleural drainage between group clip and group control. Analyses were performed to compare drainage volume, duration of chest tube and postoperative hospital stay between the two groups. Variables linked with pleural drainage in whole cohort were assessed using multivariable logistic regression analysis. Results Propensity score matching resulted in 197 patients (matched cohort). Baseline patient characteristics were matched between two groups. Group clip showed less cumulative drainage volume (P=0.020), shorter duration of chest tube (P=0.031) and postoperative hospital stay (P=0.022) compared with group control. Risk factors significantly associated with high-output drainage in multivariable logistic regression analysis were being male, age >60 years, bilobectomy/sleeve lobectomy, pleural adhesion, the application of clip applier, duration of operation ≥220 minutes and chylothorax (P<0.05). Conclusions This study suggests that mediastinal micro-vessels clipping during lymph node dissection may reduce postoperative pleural drainage and thus shorten hospital stay. PMID:27076936