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Spontaneous coronary dissections (SCAD) can be asymptomatic or can manifest itself as any of the clinical spectrum of the ischemic heart disease. In this report, we present a 65 year old man presented with myocardial infarction in whom coronary angiography a nonocclusive SCAD was noticed in addition to a very late stent thrombosis and make a brief overview of the treatment for SCAD.
Nine patients (six men, three women) with extracranial vertebral artery dissection are described. Their mean age was 39.1 years (range 17–66). In four casesdissection was “spontaneous”; in the other five cases there was a history of trivial trauma. Three patients had fibromuscular dysplasia, two were migraineurs, one had elastorrhexis. Treatment varied. Six received heparin, three acetylsalicylic acid or ticlopidine.
Nine patients (six men, three women) with extracranial vertebral artery dissection are described. Their mean age was 39.1 years (range 17-66). In four casesdissection was "spontaneous"; in the other five cases there was a history of trivial trauma. Three patients had fibromuscular dysplasia, two were migraineurs, one had elastorrhexis. Treatment varied. Six received heparin, three acetylsalicylic acid or ticlopidine. Eight had good recovery. Two patients experienced recurrence when stopping acetylsalicylic acid. The pathogenesis of dissections and the distinction between spontaneous dissections and those associated with minor trauma are discussed. PMID:1512608
Carotid dissection is a rare, but potentially fatal, cause of ischaemic stroke in young patients. It occurs when a small tear forms in the tunica intima of the arterial wall creating a space between the inner and outer layers of the vessel where blood can enter and form a haematoma. This can cause a stenosis or complete occlusion. Thromboembolic events are thought to be the cause of infarction in the majority of cases of stroke, rather than haemodynamic insufficiency, in patients with carotid dissection. Although traditionally thought to be most commonly caused by head or neck trauma, spontaneous carotid dissection is now an increasingly recognised cause of stroke in young patients. Clinical signs can often be subtle, with mild cerebral or cranial nerve dysfunction. Here, a case is reported of a spontaneous internal carotid artery dissection in a previously well 38-year-old man. An appropriate imaging modality is important to confirm the diagnosis before commencing anticoagulation treatment. PMID:20562155
We present eight cases of extracranial vertebral artery dissection. One of these had traumatic antecedents at the neck level while undergoing massage treatment. Of the rest, in four cases there was only a history of commonplace traumatism at neck level, consisting of twisting or stretching. Most presented pain at this level both before and during symptoms. Five had symptoms compatible with lateral bulbar infarct, two with cerebral infarct and one at the protuberance level. Angiography showed irregular stenosis of the spine on the affected side in five cases, occlusion in three cases. Nuclear magnetic resonance (NMR) was performed on five, with findings compatible with dissection. Six received anticoagulant treatment and two received platelet antiagregants with good recovery except in one patient who died twelve months later without any indication of the existence of dissection. We also carried out a review of the literature with special emphasis on the etiology of spontaneous cases, on clinical and neuroimaging findings and on treatment. PMID:8714482
Pego, R; Marey, J; López-Facal, M S; Marín-Sánchez, M
Spontaneous dissection of visceral arteries is rare in the absence of concurrent dissection of the aorta, iatrogenic injury from instrumentation, or trauma. We describe a spontaneous dissection of the celiac artery that was identified by computed tomographic scan in an otherwise healthy man with acute onset abdominal pain and no identifiable causes of dissection. The patient was successfully managed medically. Although endovascular treatment or surgical intervention is the procedure of choice for complicated cases, medical management with close observation is an acceptable management strategy for stable, uncomplicated cases of spontaneous celiac artery dissection. PMID:17543692
We report a 63-year-old case of the vertebral artery dissection with recurrent brain embolisms. She was admitted to the hospital because she suffered a visual symptom. She was examined by magnetic resonance imaging (MRI) and diagnosed a left vertebral artery (VA) dissection. Digital subtraction angiography (DSA) revealed the string sign on the left VA supporting the evidence of dissection. However, after DSA, multiple brain embolic stroke was occurred. She was treated with anti-platelet drug (sodium ozagrel), then, recanalization of the pseudo-lumen at the dissecting lesion was observed by MRI examination. Anti-platelet medicine (cilostazol) was taken for preventing reattack although the dissecting lesion was not closed. Following 4 weeks, brain embolisms were observed in the posterior circulation system. MRI revealed a dilated pseudo-lumen at the dissecting lesion with recurrent VA. This time, she was treated only with free radical scavenger (edarabone). After the occlusion of the dissected VA was observed, she started to take anti-platelet medicine again. It is generally accepted to use anti-platelet drug or anti-coagulant drug as a treatment of VA dissection causing brain ischemia. However, it should be assessed more carefully in cases showing recanalization of the pseudo-lumen as observed in this case. Surgical treatments should be taken into consideration at the early stage, especially for the cases presenting fragile dissecting lesions. Further study need to decide the effective treatment of the vertebral artery dissection. PMID:16629450
Nakase, Taizen; Suzuki, Akifumi; Okane, Kumiko; Nagata, Ken
The Temporal Bone Dissection Simulator is an ongoing research project for the construction of a synthetic environment suitable for virtual dissection of human temporal bone and related anatomy. Funded by the National Institute on Deafness and Other Communication Disorders (NIDCD), the primary goal of this project is to provide a safe, robust, and cost-effective virtual environment for learning the anatomy
Jason Bryan; Don Stredney; Gregory J. Wiet; Dennis Sessanna
Coronary artery dissection is a devastating disease, but spontaneous left main coronary artery dissection is extremely rare. We present the case of a 58-year-old diabetic man who was found to have primary spontaneous left main coronary artery dissection during a coronary angiography examination. Although the dissecting lesion persisted, he had no peri-procedural chest discomfort or electrocardiographic change. We performed urgent coronary artery bypass grafting, which was uneventful. The patient received regular cardiovascular follow-up and did not complain of any postoperative chest discomfort. He had an uneventful recovery. PMID:14604324
Three cases of extracranial vertebral artery dissections with upper limb peripheral motor deficit (C5-C6) are reported. Six similar cases were also found in the literature. Central neurological symptoms occurred in five of these nine cases, suggesting the diagnosis of dissection. The peripheral motor or sensorial deficit was strictly isolated in the four other cases, simulating radicular neuralgia due to discopathy or foraminal compression. In case of dissections, a precise analysis of pain is helpful to guide diagnosis; sharp, unbearable, continuous and extended neck pain without nocturnal paroxysms and posterior neck stiffness is typical. Analgesics or anti-inflammatory drugs are ineffective. Peripheral motor deficit is more common than sensory deficit. Recovery was complete in this series. In most cases, the radiculopathy appears to be due to cervical root compression in its extraforaminal course due to the dissection hematoma and rarely to radicular ischemia. PMID:9894290
de Bray, J M; Penisson-Besnier, I; Giroud, M; Klein, J; Tanguy, J Y; Pasco, A; Dubas, F
Spontaneous dissection of the vertebral artery is not a frequent occurrence in the vertebrobasilar system. The authors show a case with spontaneous dissection of the extracranial vertebral artery, which produced recurrent artery-to-artery embolism. The angiography revealed characteristic intimal flap. The antiplatelet and anticoagulant therapy was able to control ischemic attacks and the patient made a good clinical recovery. The angiogram performed two months later showed spontaneous resolution of the artery involved. This case shows the effectiveness of anticoagulation and antiplatelet therapy for the prevention of artery-to-artery embolism caused by the extracranial vertebral artery dissection. PMID:7816181
Ishikawa, A; Kanazawa, Y; Hikasa, T; Fujita, K; Tamaki, N
Acute aortic dissection is a rare clinical entity that mainly affects patients older than 50 years. It is unusual in younger patients and its presence has been traditionally associated with trauma, Marfan syndrome, bicuspid aortic valve and pregnancy. We present here, a case of a 30 year old pregnant female with acute aortic dissection type A (De Bakey II), without family history of connective tissue diseases and signs of Marfan syndrome. PMID:22263062
Aziz, Fahad; Penupolu, Sudheer; Alok, Anshu; Doddi, Sujatha; Abed, Mary
Acute aortic dissection is a rare clinical entity that mainly affects patients older than 50 years. It is unusual in younger patients and its presence has been traditionally associated with trauma, Marfan syndrome, bicuspid aortic valve and pregnancy. We present here, a case of a 30 year old pregnant female with acute aortic dissection type A (De Bakey II), without family history of connective tissue diseases and signs of Marfan syndrome.
Aziz, Fahad; Penupolu, Sudheer; Alok, Anshu; Doddi, Sujatha; Abed, Mary
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Recurrent spontaneous dissection is even more rare. A case of recurrent coronary artery dissection is reported and the literature is reviewed.
Emergency medicine dogma traditionally teaches that aortic dissection presents as tearing chest pain, radiating to the back. This case report describes a 55-year-old woman presenting with a left homonymous hemianopsia and resultant gait disturbance. Initial head computed tomography demonstrated a right parietal infarct, and chest radiograph demonstrated a markedly widened mediastinum. Acute Stanford type A aortic dissection was subsequently confirmed. This report provides further evidence for atypical, painless presentations of aortic dissection. Given recent literature on the increasing prevalence of painless dissection, the disease entity should be included in the differential diagnosis for stroke, and a simple portable chest x-ray should always be obtained before administering thrombolytics. PMID:22742952
Estreicher, Michael; Portale, Joseph; Lopez, Bernard
The case is presented of a 38-year-old woman who suffered multiple cerebellar infarctions as a result of emboli from a vertebral artery dissection. Surgical therapy led to a satisfactory recovery. This case emphasizes the importance of an aggressive approach to such lesions. PMID:3950750
Symptomatic spontaneous celiac artery dissection is a rare condition that is being detected more often with the use of advanced imaging techniques. There is no consensus as to whether surgical or endovascular treatment is more appropriate. We describe the case of a 41-year-old hypertensive woman who presented with the sudden onset of sharp, persistent, right-upper-quadrant abdominal and epigastric pain. Magnetic resonance angiography of the abdomen revealed celiac artery dissection, with a flap compressing the lumen approximately 17 mm from the artery's origin at the aorta. Because of the patient's persistent epigastric pain, endovascular celiac artery stent implantation was performed with the use of 2 overlapping balloon-expandable stents. Twelve months after the procedure, the patient remained asymptomatic, and the stents were patent. This case and others in the medical literature suggest that endovascular treatment can be feasible in symptomatic patients with isolated spontaneous celiac artery dissection.
Obon-Dent, Mauricio; Shabaneh, Bahaeddin; Dougherty, Kathryn G.; Strickman, Neil E.
Spontaneous coronary artery dissection is rare and usually affects younger women in the peripartum period. Here, we report an interesting case of a 34-year-old woman with spontaneous coronary artery dissection that occurred 1 month after childbirth. Emergency coronary angiography showed stenosis of the left anterior descending artery, but immediately afterwards, a new occlusion of the right coronary artery occurred. Intravascular ultrasound was used to image both right and left coronary arteries. The new occlusion of the right coronary artery was probably iatrogenic, but the left coronary artery occlusion was spontaneous. The patient underwent percutaneous coronary intervention in the right coronary artery because of her unstable hemodynamic condition. Revascularization of the left coronary artery was performed by bypass grafting. The patient was discharged on postoperative day 30. As the optimal treatment for spontaneous coronary artery dissection has not yet been established, treatments should be based on the patient's clinical presentation. PMID:23775233
With the improvement of medical imaging and surgical techniques, surgery on cervical vertebral is more frequent. Some cases of complications of this type of surgery have been described. We report a case of postoperative bilateral vertebral artery dissection. It concerns a 58 year-old woman who suffered from a left cervico-brachial C6 neuralgia with paresthesiae of the thumb. She underwent discectomy
C Manaouil; M Graser; J Delcour; D Le Gars; M. F Gontier; J Loriau; O Jardé
We herein report an unusual case of profound brain infarction of the posterior circulation due to a dolichoectatic vertebrobasilar dissecting aneurysm (DVDA) originating from atherosclerosis. On autopsy, diffuse atherosclerosis was observed with a multi-fusiform aneurysm measuring 1 to 2 cm in diameter ranging from the left vertebral artery to the basilar artery. The microscopic findings of the aneurysm revealed severe stenosis of the artery caused by intimal thickening, intimal flap formation and thrombosis, indicating the presence of a dissecting aneurysm originating from atherosclerosis. The DVDA observed in this case was considered to be slowly progressive and associated with the development of atherosclerosis. The etiology of structural destabilization in patients with DVDA involves rupture of the internal elastic lamina, which is dislodged by massive hematomas that form atheromatous lesions. PMID:23955618
The authors present the case report of a Marfan syndrome patient with aneurysm of ascending, dissecting aneurysm of descending and abdominal aorta. Ascending aorta replacement with aortic valve sparing procedure was performed at first surgery. Later on descending and abdominal aorta were replaced. The patient was reoperated because of a chylus collection in retroperitoneal space. Three months following surgery the patient is completely recovered. PMID:17879712
Santavý, P; Cermák, M; Hájek, R; Fábiková, K; Novotný, J; N?mec, P
Spontaneous coronary artery dissection (SCAD) which was first described by Pretty in 1931 is rare but significant cause of myocardial infarction and sudden cardiac death. The incidence of this condition in general population is between 0.28% and 1.1%, however in pregnant population it accounts for 27% of all MI cases.1 Mode of presentation is variable and can range from asymptomatic
|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)|
Summary: Dissecting aneurysms involving the basilar artery (BA) are lesions with significant morbidity and mortality. Their management is controversial and often difficult. There is no generally approved strategy. Two cases of huge dissections involving the BA presented with subarachnoid hemorrhage in one case and mass effect in both cases. The dissection of case 1 involved the upper two thirds of the BA distal to the anterior inferior cerebellar arteries (AICA). Another dissection of case 2 involved the bilateral vertebral arteries (VA) distal to bilateral PICA and extended to upper third of the BA. After making a basket with coils inside the pseudoaneursym, proximal dissection was totally occluded in case 1. Dissection on the bilateral VA distal to the bilateral PICA and proximal BA was occluded in case 2 with a small residual dissection on the left VA. Case 1 had an excellent recovery with a durable image and clinical result. But recanalization and regrowth occurred in case 2, which might have originated from the residual dissection on the left VA, induced acute mass effect and sudden coma six weeks after the initial treatment. The residual and regrown dissection had to be occluded in a second intervention. The patient died two days later. BA occlusion is safe and efficient for dissections involving the BA as in our case and the literature. Proximal occlusion might be enough for huge and long lesions like ours. It seems that completely dense packing of proximal dissection is the key point to prevent recanalization. PMID:20566106
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…
Background Prompt diagnosis and management of aortic dissection are key to reduce patient morbidity and mortality; hence the need to a have a high index of suspicion for this condition. We believe it's important to report this case because it underscores the relationship between cocaine abuse and aortic dissection. In addition it strongly emphasizes basic principles in medicine: patients should not be profiled, and chronic complaints may need reassessment. Case Presentation We are presenting a case of Stanford type A aortic dissection in a 46 year old patient with history of cocaine abuse. The aortic dissection presented as worsening of chronic upper abdominal pains he has had for years. He presented to us hours after using crack cocaine. Conclusion Aortic dissection associated with cocaine abuse develops at a younger age. Therefore it's crucial to have high index of suspicion for aortic dissection in this subset of patients. Furthermore as this case illustrates, serious diseases can masquerade in old complaints. Patients should never be profiled, and chronic complaints should always be revisited.
Nusair, Maen; Abuzetun, Jamil Y; Khaja, Azamuddin; Dohrmann, Mary
Ruptured vertebral artery dissecting aneurysm is more prone to re-bleeding and thus needs immediate surgical management. We present a case of 47 years old male with ruptured vertebral artery dissecting aneurysm which was immediately treated by endovascular surgery. Coil occlusion of the vertebral artery at the aneurysm site was performed. As emergency open surgery is often not possible, this case
The response of the abdominal viscera and the contraction of the intercostal muscles during the respiratory phase of sneezing increases intrathoracic pressure, which may lead to several complications. However, there are no reports in the literature concerning aortic dissection after sneezing. We report a patient in whom the development of dissection was secondary to sneezing, although hypertension was present as
A Baydin; M S Nural; H Gu?ven; T Deniz; F Bildik; A Karaduman
An elective or a prophylactic lymph node dissection is the removal of the lymph nodes that are normal on physical examination and on radiographic imaging. This type of dissection is not based on the visible disease in the targeted nodal basins, but on the potential of a radiographically occult tumour which can exist. The pathologic results of an elective lymph node dissection may help in predicting the risk of a future recurrence and, in some solid tumours, guide the delivery of the adjuvant therapy and as in this case, may contribute to a pathological diagnosis. The decision to proceed with an elective node dissection is based on the assessment of the risks and benefits of the procedure. The morbidity of the regional lymph node dissection must be balanced against the potential benefit of the procedure. A thyroid papillary microcarcinoma is defined according to the WHO criteria and Shaha as a thyroid tumour which is smaller than 1–1.5cm. Different terms are currently used to define this thyroid cancer such as small, tiny, minute, minimal or occult papillary carcinomas of the thyroid, impalpable thyroid carcinoma and incidental thyroid papillary cancer. A common clinical scenario is the incidental diagnosis of papillary thyroid microcarcinoma (PTMC) on the histology of the resected thyroid, following the surgery which was done for a presumably benign thyroid disease. PTMC was diagnosed in 7.1% of the patients with a presumably benign thyroid disease. It may be possible that this is an underestimation of the true incidence, because we did not use the serial sectioning technique and maybe because the PTMC which was present was so small that it was grossly not identified and sectioned. Herein, a case which was clinically suspicious and was radiologically and cytologically diagnosed as a case of retrosternal multinodular goitre underwent a near total thyroidectomy and a paratracheal lymphnode dissection. The node was found to have micrometastasis of the follicular variant of a papillary carcinoma and the thyroid, on a retrospective step sectioning, revealed an incidental PTMC. This case has been presented, to highlight the possibility of an incidental PTMC in the thyroid cases which were resected for benign disease and the importance of elective lymphnode dissection in contributing to the diagnosis of PTMC.
Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction and is mostly fatal. Previous studies report that it is mostly seen in middle-aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern, and its severity is related to extent and development rate of dissection. Herein we present three cases of primary spontaneous left main coronary artery dissection. Two of the patients are men and the third patient is a non-pregnant 69-year-old woman. The cases were presented and discussed with review of the pertinent literature. PMID:22917831
Primary spontaneous coronary artery dissection occurs rarely. Compared to usual acute coronary syndromes, it occurs in relatively young people, particularly in women in the peripartum or early post-partum period. The etiology of spontaneous coronary artery dissection remains unclear; there have been less than 150 cases reported in the literature, and only 28 cases documented in the left main coronary artery. This article reports the clinical course of a patient with primary spontaneous left main coronary artery dissection who was treated with coronary artery bypass grafting after clinical steadiness. PMID:19397017
Caddeo, A; Delogu, G; Cadeddu, M; Demontis, V; Meloni, M; Naccarato, S; Marchi, S M
Ischemic stroke secondary to aortic dissection is not uncommon. We present a patient with left hemiplegia secondary to Stanford type A aortic dissection extending to the supra-aortic vessels, which was precipitated by rifle butt recoil chest injury. The diagnosis of aortic dissection was delayed due to various factors. Finally, the patient underwent successful Bentall procedure with complete resolution of symptoms. This case emphasizes the need for caution in the use of firearms for recreation and to take precautions in preventing such incidents. In addition, this case illustrates the need for prompt cardiovascular physical examination in patients presenting with stroke.
Rao, Mamatha; Panduranga, Prashanth; Al-Mukhaini, Mohammed; Al-Jufaili, Mahmood; Valiath, John
Primary spontaneous coronary artery dissection is an unusual occurrence. There have been less than 150 cases reported in world literature. This process frequently occurs in relatively young women, particularly in the peripartum or early postpartum period. This article reports the clinical course of one patient with primary spontaneous left main coronary artery dissection who was treated with coronary artery bypass grafting. To our knowledge, it is the second case to be treated with the use of left internal mammary artery. PMID:8969385
Atay, Y; Ya?di, T; Türko?lu, C; Altinti?, A; Büket, S
Subclavian artery dissection is usually associated with coexisting aortic disease. Isolated and spontaneous acute subclavian artery dissection is uncommon and rarely reported. In addition, no case of left subclavian artery dissection during pregnancy and early puerperium has been described. We report the autopsy case of a 24-year-old female who died suddenly 3 days after delivery due to a spontaneous left subclavian artery dissection with rupture. PMID:22740172
Barbesier, Marie; Duncanson, Emily R; Mackey-Bojack, Shannon M; Roe, Susan J; Thomas, Lindsey C
Stroke in childhood is rare and has its own characteristic findings. Vertebrobasilar ischemia due to trauma in this age group has been described, but its specific features have not yet been clearly defined. Dissection of vertebral artery is one of the causes of vertebrobasilar ischemia that is very uncommonly detected in the intracranial portion of the posterior circulation in childhood.
Epigastralgia is a common chief compliant in the emergency department. Most of them are not fetal events, but some are life threatening such as aortic dissection or abdominal aneurysm rupture. Spontaneous visceral artery dissection is an uncommon occurrence with an unpredictable natural history and is rarely considered in the diagnosis of acute abdominal pain; however, it is as critical as aortic dissection and even easier to be ignored because of its rarity. We present a case of a 48-year-old man who presented to our emergency department with the chief concern of epigastric pain and diagnosed as having isolated spontaneous celiac artery dissection involving the hepatic artery, gastroduodenal artery, and splenic artery. Most cases required surgical intervention in previous reports; there are some, as in this case, managed well nonoperatively. PMID:23465876
Acute aortic dissection is a rare, life-threatening condition. Clinical manifestations generally include the acute onset of severe chest or back pain. Aortic dissection presenting with signs and symptoms of acute spinal cord damage is the most severe complication and is particularly rare. This paper reports a case of aortic dissection in a 50-year-old man with a 10-year history of hypertension manifesting as acute spinal cord damage (bilateral lower extremity weakness and loss of all types of sensation), acute skeletal muscle ischaemic necrosis with increased levels of creatine kinase, and acute kidney failure with increased levels of serum creatinine and decreased glomerular filtration rate. The patient refused surgical treatment. His clinical condition progressively worsened and he died 3 days later. This case indicates the importance of considering aortic dissection in patients presenting with acute spinal cord damage, acute skeletal muscle necrosis or acute kidney failure, which may allow early diagnosis and reduce the mortality rate. PMID:23206486
A 47-year-old women developed an acute vestibular syndrome with a peripheral facial palsy not associated with any trauma. Magnetic resonance imaging showed an ischemic lesion in the territory of the posterior inferior cerebellar artery. Color Doppler ultrasonography detected an occlusion of the right vertebral artery and dissection of the artery was confirmed by a subsequent angiography. During follow-up Duplex-Doppler allowed
Annamaria Casali; Stefano Gaiani; Fabio Piscaglia; Laura Gramantieri; Livia Masi; Marco Valgimigli; Luigi Bolondi
The author describes a 13-year-old Thai boy who developed stroke caused by carotid dissection and found mild elevation of plasma homocysteine (tHcy). The patient improved after anticoagulation therapy and his plasma tHcy decreased after vitamin supplement. With long-term follow-up, he is having normal neurological condition. This case proposes that the pathogenesis of carotid dissection may associate with mild hyperhomocysteinemia. PMID:21675455
BackgroundWe describe a case involving technical success with internal trapping using controllable detachable coils yet antegrade recanalization of the occluded vertebral artery, in the vertebral artery dissecting aneurysm. Possible explanations for the antegrade recanalization of the occluded vertebral artery and lessons from the case are also discussed.
Seung Kug Baik; Yong Sun Kim; Hui Jung Lee; Duk Sik Kang
Spontaneous coronary artery dissection (SCAD) is a rare condition that can result in unstable angina, acute myocardial infarction, and sudden death. This condition may occur particularly in women during late pregnancy and in the postpartum period. We present the case of a 33-year-old African American woman, who had spontaneous left anterior descending coronary artery (LAD) dissection two weeks postpartum, resulting in acute ST-segment elevation myocardial infarction with severe left ventricular dysfunction. The use of the intravascular ultrasound (IVUS) in our case confirmed the diagnosis and helped with stent sizing and implantation. On subsequent follow-up, there was marked left ventricular function recovery and clinical improvement.
Daoulah, Amin; Al Qahtani, Awad; Mazen Malak, Majed; Al Ghamdi, Saud
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
In this report the authors describe a case of internal carotid artery (ICA) dissection following a blunt posterior pharynx injury and review current literature on the identification and treatment of such disorders. An ICA dissection developed in a 6-year-old boy who had suffered blunt injury to the posterior pharynx and who was followed up via computed tomography (CT) angiography and clinic visits for 6 months. The ICA dissection healed with pseudoaneurysm development and was treated with anticoagulation therapy. The authors searched the January 1996 through March 2007 MEDLINE database by using the Ovid search engine. They requested all English-language articles with the term "carotid dissection." Reference lists from these articles were retrieved and searched for additional relevant sources. The authors found that given its availability and speed of acquisition, CT angiography typically is the preferred initial diagnostic method. Magnetic resonance angiography is usually recommended for follow-up examination especially in pediatric cases. According to the available literature, the current preferred treatment for ICA dissection is anticoagulation. PMID:18377312
Lubarsky, Michael; Helmer, Robert; Knight, Charles; Mullins, Mark E
INTRODUCTION: Acute aortic dissection is a rare clinical entity that mainly affects patients older than 50 years. It is unusual in younger patients and its presence has been traditionally associated with trauma, Marfan syndrome, bicuspid aortic valve and pregnancy. Heavy weightlifting and other fibrillinopathies have been also implicated in the literature. We present here the case of a 26 year
Spontaneous middle cerebral arterial dissection (MCAD) is a rare cause of ischemic stroke. We report two cases of isolated spontaneous MCAD causing ischemic stroke. MCAD should be considered when a young patient has a middle cerebral artery territory infarct with stenosis at the origin of the middle cerebral artery. We discuss noninvasive radiological techniques for the diagnosis of MCAD.
Jin Soo Lee; Oh Young Bang; Phil Hyu Lee; Byung Moon Kim; Seok Woo Yong
Summary: Acute vertebrobasilar dissection may cause sub- arachnoid hemorrhage by rupturing through the adventia or cerebral infarct by progressive occlusion of the true lumen. Recent reports on the endovascular management of this condition have focused on treatment of pseudoaneu- rysms. We report two cases where angioplasty or stent placement was successfully used to improve compromised blood flow secondary to vertebrobasilar
Steven J. Willing; Frank Skidmore; Jill Donaldson; Ulises Lisandro Nobo; Konstantin Chernukha
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
Nowadays, infectious aortitis has become a rare disease thanks to antibiotics, but remains life-threatening. We present a case of a patient with acupuncture-induced infectious aortitis leading to aortic dissection. Chest computed-tomogram scan revealed Stanford type A dissection with pericardial effusion. Under the impression of an impending rupture, emergent surgery was performed. During surgery, infectious aortitis was identified incidentally, so she underwent resection of the infected aorta including surrounding tissues. Then the ascending aorta and hemi-arch were replaced with a prosthetic graft as an in situ fashion. The resected tissue and blood cultures revealed Staphylococcus aureus, so prolonged antibiotherapy was prescribed.
Park, Bong Soo; Kang, Do Kyun; Jun, Hee Jae; Hwang, Youn-Ho; Jang, Eun Jeong; Jin, Kyubok; Kim, Hyun Kuk; Jang, Hang Jea; Song, Jong Woon
Blunt chest trauma is commonly encountered by surgeons and is rarely associated with cardiac injuries. The incidence of cardiac injury is rare but can be rapidly fatal, requiring prompt recognition and treatment. We review the case of a 37 year-old male who was involved in a head-on motor vehicle collision at highway speed and was found to have an isolated left main coronary artery dissection. We then review the supporting literature for evaluation of blunt cardiac injuries and the treatment options for traumatic coronary dissection.
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, particularly seen in women during pregnancy or in the puerperium. It has a high acute phase mortality. The etiology is uncertain. Hormonal changes during pregnancy, hemodynamic stress and changes in the autoimmune status have been considered as possible etiological factors. A timely diagnosis and institution of appropriate treatment is important for a successful outcome. There is no consensus of opinion for optimal treatment. Conservative management, coronary artery bypass graft surgery, and percutaneous coronary intervention, all have been described in the literature as possible therapeutic options. Spontaneous coronary artery dissection should be considered as a differential in any young woman presenting with chest pain associated with pregnancy. We report two cases of pregnancy-associated spontaneous coronary artery dissection, both successfully managed, along with a comprehensive review of the previously published literature.
Although diving with compressed air is generally safe, neurological problems resulting from infarction in SCUBA diving are well known, including arterial gas embolism and decompression sickness (caisson's disease, bends) involving the brain and spinal cord. While air gas embolism forms the overwhelming majority of causes for stroke in divers, internal carotid artery (ICA) dissection is another potential mechanism for central nervous system infarction in the setting of SCUBA diving. A 38 year-old female, who presented with complaints of headache, nausea, vomiting, and left sided hemiparesis after rapid ascent to the surface from a depth of 120 feet of seawater was initially treated for decompression illness in a hyperbaric chamber. Further neurological workup revealed a right ICA dissection. This case demonstrates the dangers of ICA dissection following rapid ascent to the surface from underwater and emphasizes an interesting presentation of stroke associated with SCUBA diving. PMID:12670119
Aortic dissection is often misdiagnosed, especially among young patients, and it is associated with a high mortality rate. We present here a case of fatal acute aortic dissection in a young man who was misdiagnosed with pericarditis. We reviewed the literature of acute aortic dissection in young people and we focused particularly on clinical presentations, outcomes and investigations of aortic dissection. We report a case of a 33-year-old man with a history of uncontrolled hypertension with acute pleuretic chest pain who was transferred to our hospital for suspected pulmonary embolism and died of acute hemorragic pericardial effusion from an ascendant aortic dissection. We should never rule out aortic dissection off our differential diagnosis on the sole basis of a patient’s young age.
Pineault, Jerome; Ouimet, Denis; Pichette, Vincent; Vallee, Michel
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.
Many disorders can cause aneurysm and/or dissection of the cerebral arteries, including fibromuscular dysplasia (FMD), connective tissue disorders, cerebral vasculitis, infection, and vascular malformations. Arterial fenestration is a rare congenital finding that can also cause aneurysms, and can rarely dissect and bleed. Treatment of aneurysm and dissection with subarachnoid hemorrhage can be very complicated, and requires case-by-case analysis of the risks and benefits of antithrombotic therapy. To the authors' knowledge, no case of double fenestration of the basilar artery has been reported. This report presents a case of concurring vertebral artery dissection and double fenestration of the basilar artery with aneurysm. The fenestration and FMD are considered possible main contributing causes of this presentation. A literature review of cerebrovascular fenestration and FMD is provided and the relationship between the 2 is considered. Lastly, the use of antithrombotic therapy in the setting of subarachnoid hemorrhage, dissection, and stent placement is discussed. PMID:23548267
Stark, Madeline M; Skeik, Nedaa; Delgado Almandoz, Josser E; Crandall, Benjamin M; Tubman, David E
BACKGROUNDVertebral artery dissection lesions tend to resolve spontaneously, but abnormal findings such as aneurysmal dilatation occasionally persist. However, the clinical features and pathological findings in such cases have never been verified.CASE DESCRIPTIONA 62-year-old man presented with left cerebellar infarction. Angiography showed the “pearl and string sign” in the left vertebral artery, and he was diagnosed as having left vertebral artery
Aortic dissection is a life-threatening emergency and can present neurological symptoms, mainly associated with a stroke. This represents a challenge to the neurologist because of the necessity to treat the patient with a thrombolytic in a narrow time window, which could have a fatal outcome. A 70-year-old male patient presented in emergency department with an acute stroke (right middle cerebral artery syndrome) without any other symptoms. He was considered eligible for thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA). During the thrombolysis, asymptomatic hypotension was detected which was corrected with volume and dopamine, without significant worsening of the neurologic deficits. A few minutes after the end of the perfusion, the patient complained about an unspecific dorsal discomfort. It was diagnosed a Stanford type A aortic dissection. The patient was submitted to an urgent surgery to replace the aorta. The evolution was good and 12 months later, he is independent in the activities of daily life. This case of an ischaemic stroke caused by an initial asymptomatic aortic dissection treated with rt-PA could have had a bad outcome, as in the majority of similar cases. However, the rapid diagnosis and appropriate treatment of the dissection could have been the main factors to explain the survival of our patient. PMID:21614579
Mendes, Amélia; Mendonça, Teresa; Sousa, António; Moreira, Goreti; Carvalho, Marta
Background Spontaneous coronary and vertebral artery dissections are rare events occurring most commonly in otherwise healthy women during pregnancy or the post-partum period. Case presentation This report describes a 35-year-old female who presented with an acute inferior ST elevation myocardial infarction 7 months post-partum secondary to spontaneous dissection of the left obtuse marginal coronary artery. Despite appropriate medical therapy with dual anti-platelet therapy, the patient presented four weeks later with a spontaneous dissection of the right vertebral artery. Conclusion We review the presentation, diagnosis, and management of spontaneous dissections of the vasculature in the peri-partum period.
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.
Jang, Eun Sun; Jeong, Sook-Hyang, E-mail: email@example.com; Kim, Jin Wook; Lee, Sang Hyub [Seoul National University Bundang Hospital, Department of Internal Medicine, College of Medicine (Korea, Republic of); Yoon, Chang Jin; Kang, Sung Gwon [Seoul National University Bundang Hospital, Department of Radiology (Korea, Republic of)
The Department of Pathology at the University of Pittsburgh Medical Center has compiled a wide range of pathology case studies to aid students and instructors in the medical/health science field. This case documents the neck and back pain of a 71-year-old female patient. The patient's history is provided, and includes documentation of her condition throughout the duration of her treatment. The pathologic findings include images and descriptions of the gross and microscopic evaluation. In the "Final Diagnosis" section the official conclusion of the doctor is accompanied by a discussion of the diagnosis and references. Students will find this resource especially helpful, as it provides experience with patient history, lab results, and diagnostics.
Numerous biochemical as well as electrophysiological techniques require tissue that must be retrieved very quickly following death in order to preserve the physiological integrity of the neuronal environment. Therefore, the ability to accurately predict the precise locations of brain regions of interest (ROI) and to retrieve those areas as quickly as possible following the brain harvest is critical for subsequent analyses. One way to achieve this objective is the utilization of high resolution MRI scans to guide the subsequent dissections. In the present study, individual MRI scans of the brains of rhesus and cynomolgus macaques that had chronically self-administered ethanol were employed in order to determine which blocks of dissected tissue contained specific ROIs. MRI-guided brain dissection of discrete brain regions was completely accurate in 100% of the cases. In comparison, approximately 60–70% accuracy was achieved in dissections that relied on external landmarks alone without the aid of MRI. These results clearly demonstrate that the accuracy of targeting specific brain areas can be improved with high-resolution MR imaging.
Daunais, James Bernard; Kraft, Robert Arthur; Davenport, April Teresa; Burnett, Elizabeth J; Vicki Moser Maxey, A.S.; Kendall Thomas, Szeliga; Rau, Andrew Ryan; Graham Stallard, Flory; Hemby, Scott Edwards; Christopher David, Kroenke; Grant, Kathleen Alice; Friedman, David Paul
We report a case of a middle-aged man who suffered a cerebral infarction resulting from dissection of a vertebral artery associated with morning blood pressure surge. A 56-year-old man was transferred to our hospital with dizziness and vomiting in the early morning on a cold day in winter. He reported that he had been standing in front of the sink
BackgroundVertebral artery dissecting aneurysm is now increasingly recognized as a cause of posterior circulation stroke in young adults. Here, we report a case of bilateral VADA with SAH, treated by bilateral coil occlusion using GDCs.
Although patho-physiology of spontaneous internal carotid artery dissection (sICAD) is largely unknown, an association with migraine has been suggested but not proven. Migraine is a condition which is worth considering while one is hunting a possible cause for internal carotid artery dissection (ICAD) and it may be found more often than expected. To date it remains a diagnosis of exclusion in patients with migraine. As opposed to migraine with aura, migraine without aura is significantly more frequent among patients with SICAD. It has been suggested that ICAD produces stroke in 36-68% of patients as a result of occlusion of the artery at or near the site of the dissection, or embolization occurring distally from a dislodged fragment of thrombus. We report a 31-year-old woman with headache and ptosis as initial symptoms. Magnetic resonance imaging (MRI) confirmed the diagnosis. Prompt treatment was instituted with anti-platelet agents and the patient had complete resolution of symptoms. Our case report highlights the importance of identifying the patients with ICD with history of migraine, in the absence of other risk factors and adds to the sparse literature currently available on the subject. PMID:20209702
Sharif, Muhammad; Trinick, Tom; Khan, Khurum Hayat
This paper presents the description of the author's experience with bifurcated endovascular stent graft in a patient affected by spontaneous infrarenal acute aortic dissection (SIAAD). The authors report a case of SIAAD occurring in the normal aorta of a patient who presented with severe lower back pain radiated to the abdomen, not responding to common pain-killers. A complete exclusion of the dissected aorta was accomplished with a bifurcated endovascular graft using a simple technique. SIAAD is a rare event. Endovascular therapy is a safe option and can be considered the treatment of choice even for dissection extending into one or both iliac. PMID:19202538
Tolva, V S; Bertoni, G B; Trimarchi, S; Grassi, V; Rampoldi, V
Vertebral artery dissection in two patients with traumatic brain and cervical spine injury was treated in the intensive care\\u000a unit. In both cases vertebral artery dissection was suspected solely by the presence of ischemic lesions on the cervical spine\\u000a and by magnetic resonance imaging of the brain, performed because of a failure to recover consciousness. In the intensive\\u000a care unit
Christina G. Mandila; Georgios V. Koukoulitsios; Georgios T. Stathopoulos; Ioannis Karampelas; Georgios Karydas; Andreas Karabinis
...FRL-8844-9] Clofencet; Registration Review Case Closure; Notice of Availability AGENCY: Environmental...availability of EPA's notice of registration review case closure for the pesticide clofencet, case 7015. Registration review is EPA's...
...FRL-8815-7] Difenzoquat; Registration Review Case Closure; Notice of Availability AGENCY: Environmental...availability of EPA's notice of registration review case closure for the pesticide difenzoquat, case 0223. Registration review is EPA's...
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.)
The sural nerve is a small sensory nerve innervating the lateral aspect of the ankle and foot. Clinical symptoms of pathology may present as atypical sensory changes in this region. We present the normal anatomy and ultrasound technique for examination of the sural nerve based on an anatomical dissection, as well as imaging in a normal volunteer. We also present a case series (n=10) of different conditions of the sural nerve that we encountered based on a review of interesting cases from 4 institutions. The pathological conditions included neuropathy related to stripping or venous laser surgery, compression by abscess, Lyme disease, nerve tumors, traumatic transsection, and encasement by fibrous plaque and edema. Ultrasound with its exquisite resolution is the preferred imaging method for examining the sural nerve in patients with unexplained sensory changes at the lateral aspect of the ankle and foot. PMID:23809918
Belsack, Dries; Jager, Tjeerd; Scafoglieri, Aldo; Vanderdood, Kurt; Van Hedent, Eddy; Vanhoenacker, Filip; Marcelis, Stefaan; De Maeseneer, Michel
Background. Although rare, visceral artery pseudoaneurysms often present as surgical emergencies with a specific mortality rate as high as 35% related to aneurysmal rupture. Risk factors for the development of iatrogenic pseudoaneurysms include anticoagulation, female gender, obesity, and vessel calcification. Case Report. We present a case of an elderly female who developed a dissecting pseudoaneurysm of the proper hepatic artery after undergoing routine surgery to resect a large duodenal adenoma. Surgical repair comprised of resection and primary anastomosis was employed resulting in a favourable outcome. Discussion/Conclusion. Surgical management reduces the risk of hepatic ischemia, biliary complications, and abscess formation. Although stenting, coil embolization, and thrombin injection are all plausible options for management, we propose that surgical reconstruction be considered seriously as a treatment for such spontaneous pseudoaneurysms.
Razik, Roshan; Fallah, Aria; Sandroussi, Charbel; Wei, Alice C.; McGilvray, Ian D.
Aortic dissection accompanying with preeclampsia during pregnancy can be lethal to both the mother and the fetus and carries a high mortality. Of the 2 preeclampsia patients with aortic dissection, one was Type B aortic dissection, occurring in postpartum period. The patient was treated medically and underwent catheter-based stent-graft treatment with fenestration technique. Another patient was Type A acute dissection, occurring in the third trimester. This patient was undiagnosed and both died. Although extremely rare, aortic dissection might be a possibility in preeclampsia pregnant women, the differential diagnosis of chest and/or epigastric pain in preeclampia patient should be thoroughly investigated and treated. PMID:22884082
Purpose. The aim of this study was to examine the characteristics of difficult cases and the learning curve in colorectal endoscopic submucosal dissection (ESD). Methods. We studied 518 colorectal tumors treated by ESD. Patients were divided into 2 groups such as the difficult ESD group and non-difficult ESD group in view of procedure time and procedure speed, respectively. The clinical features in each group were analyzed, and we also examined cases with severe fibrosis. Furthermore, we divided all cases into 5 periods according to experience of ESDs and investigated the rates of difficult and perforation cases. Results. In view of both procedure time and procedure speed, there were significant differences about mean tumor size, rates of severe fibrosis and perforation, and en bloc resection rate between the two groups. Severe fibrosis was detected in protruding tumors >40?mm in diameter. With respect to the learning curve, the rate of difficult and perforation cases decreased significantly in the late periods compared to the first period. Conclusions. Large tumor size, high rates of severe fibrosis and perforation, and low rate of en bloc resection are related with difficult ESD cases. The increasing of experiences can decrease the rate of difficult cases and perforation.
Background Medical management is the conventional treatment for Stanford Type B aortic dissections as surgery is associated with significant morbidity and mortality. The advent of endovascular interventional techniques has revived interest in treating end-organ complications of Type B aortic dissection. We describe a patient who benefited from endovascular repair of renal artery stenosis caused by a dissection flap, which resulted in reversal of his end-stage renal disease (ESRD). Case presentation A 69 y/o male with a Type B aortic dissection diagnosed two months earlier was found to have a serum creatinine of 15.2 mg/dL (1343.7 ?mol/L) on routine visit to his primary care physician. An MRA demonstrated a rightward spiraling aortic dissection flap involving the origins of the celiac artery, superior mesenteric artery, and both renal arteries. The right renal artery arose from the false lumen with lack of blood flow to the right kidney. The left renal artery arose from the true lumen, but an intimal dissection flap appeared to be causing an intermittent stenosis of the left renal artery with compromised blood flow to the left kidney. Endovascular reconstruction with of the left renal artery with stent placement was performed. Hemodialysis was successfully discontinued six weeks after stent placement. Conclusion Percutaneous intervention provides a promising alternative for patients with Type B aortic dissections when medical treatment will not improve the likelihood of meaningful recovery and surgery entails too great a risk. Nephrologists should therefore be aggressive in the workup of ischemic renal failure associated with aortic dissection as percutaneous intervention may reverse the effects of renal failure in this population.
Weiss, Andrew S; Ludkowski, Michael; Parikh, Chirag R
Although both coronary artery dissection and heparin-induced thrombocytopenia may provoke myocardial infarction, it is extremely rare for both conditions to develop simultaneously in a single patient. We report a case of a 69-year-old woman who sustained a head-on motor vehicle accident with associated chest trauma. During a subsequent hospitalization, she was exposed to subcutaneous heparin and developed significant thrombocytopenia. Shortly thereafter, she re-presented with an acute myocardial infarction. Coronary angiography revealed a spiral dissection with superimposed thrombosis within the right coronary artery, while laboratory testing confirmed the diagnosis of heparin induced thrombocytopenia. She was treated with catheter-based thrombectomy and adjunctive direct thrombin inhibitor therapy, followed by three months of systemic anticoagulation with warfarin. To our knowledge, this represents the first published case of a native vessel myocardial infarction due to the combination of coronary artery dissection and heparin-induced thrombocytopenia.
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
Background: Dissecting aneurysm of the posterior inferior cerebellar artery (PICA) uninvolved with the vertebral artery is rare. The exact pathohistological diagnosis might result in ‘unknown’ because the underlying pathoanatomical features are, for a variety of reasons, not always identified. Case description: We report herein two cases of dissecting aneurysm harbored in different segments of the distal posterior inferior cerebellar artery.
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.
Right-sided aortic arch is a rare anomaly, and aortic dissection involving a right-sided aortic arch is extremely rare. We report the case of a 65-year-old man with a right-sided aortic arch and a right descending aortic dissection and a stent-graft was accurately deployed without perioperative complications. There were no any complaints and complications after 18 months follow-up. The CTA demonstrated that the false lumen was largely thrombosed only with a mild type II endoleak and a mild descending aortic expansion. We feel that endovascular repair is feasible to patient of type B aortic dissection with a right-sided aortic arch. However, long-term clinical efficacy and safety have yet to be confirmed.
Introduction Basilar artery dissection is a rare occurrence, and is significantly associated with morbidity and mortality. To the best of our knowledge, we report the first case of basilar artery dissection treated with mesenchymal stem cells. Case presentation We present the case of a 17-year-old Korean man who was diagnosed with basilar artery dissection. Infarction of the bilateral pons, midbrain and right superior cerebellum due to his basilar artery dissection was partially recanalized by intrathecal injection of human umbilical cord blood-derived mesenchymal stem cells. No immunosuppressants were given to our patient, and human leukocyte antigen alloantibodies were not detected after cell therapy. Conclusions This case indicates that intrathecal injections of mesenchymal stem cells can be used in the treatment of basilar artery dissection.
Introduction Takayasu's Arteritis, formerly known as "pulseless disease", is a chronic idiopathic vasculitis which affects the large vessels in the body. First described in the 1800's, this rare condition is more commonly found in Asian women in their 40's. The aorta and its main branches are the primary vessels affected, with the most typical features reflected as ischemia or aneurysm formation. With Takayasu's Arteritis being a rare condition and its acute phase presentation often similar to other conditions, diagnosis is often difficult. Case Presentation A 48 year old Irish Caucasian female, who presented as a typical history of an aortic dissection (chest pain radiating to her back in an interscapular region and a systolic blood pressure differential of 50 mmHg between her right and left upper limbs), was investigated with a number of imaging modalities and diagnosed with Takayasu's Arteritis, involving arteries affecting a number of organs. She was treated as per protocol for Takayasu's Arteritis. A diagnosis of cervical cancer quickly followed. Conclusion This case report highlights that a differential diagnosis should never be dispelled based upon a "typical" history. The importance of modern day imaging techniques such as CT, MRI and angiography, can often be paramount to confirming a diagnosis and the extent of the pathology. A possible link between Takayasu's Arteritis and gynaecological malignancies may exist.
O'Connor, Mortimer B; Murphy, Elizabeth; O'Donovan, Neil; Murphy, Michael; Phelan, Mark J; Regan, Michael J
Giant cell arteritis may lead to catastrophic, large-vessel complications from chronic vascular wall inflammation without prompt diagnosis and treatment. We describe a rare case of acute aortic dissection without preceding aneurysm secondary to histologically confirmed giant cell arteritis (GCA) in an 85-year-old female with a four-year history of polymyalgia rheumatica and temporal arteritis diagnosed per biopsy six months prior to presentation. The literature is reviewed and the clinical implications of this case are discussed.
Nayar, Anjeli K.; Casciello, Michael; Slim, Jennifer N.; Slim, Ahmad M.
Currently in Japan, differentiated gastric submucosal invasive cancers <500 ?m (SM1) with negative lymphovascular involvement are included in expanded pathological criteria for curative endoscopic treatment. This is based on a retrospective examination of surgical resection cases in which patients suitable for such expanded criteria were determined to have a negligible risk of lymph node metastasis. We performed endoscopic submucosal dissection on a 65-year-old male with early gastric cancer in April 2005, and pathology revealed a well-differentiated adenocarcinoma, 21 × 10 mm in size, SM1 invasion depth and negative lymphovascular invasion as well as tumor-free margins, so the case was diagnosed as a curative resection. This case, however, resulted in lymph node metastasis that was diagnosed by endoscopic ultrasonography with fine-needle aspiration biopsy in May 2009. Distal gastrectomy with D2 lymph node dissection was then performed, confirming lymph node metastasis from the original gastric cancer. PMID:22083418
Aortic dissection is a life-threatening condition with a 50% mortality rate in the first 48 hours and a 3-month mortality rate of 90% in untreated patients. Aortic dissection is a rare complication of pregnancy, but there is significant morbidity and mortality for the mother and infant. A 43-year-old woman with a 37-week intrauterine pregnancy was admitted to the emergency department 6 hours after the onset of tightness in her throat and neck pain. She described the pain as similar to pain she experienced with a myocardial infarction 2 years previously. Other pertinent history included hypertension, gestational diabetes, coronary artery disease, and a family history of aortic dissection. The patient was initially misdiagnosed. Transthoracic echocardio-" gram and computed tomography scan revealed a type A thoracic aortic dissection extending into the abdominal aorta. An emergency aortic repair and cesarean section were successfully performed. Recognition of aortic dissection and an evidence-based, collaborative approach to optimize treatment and recovery are vital to the patient's survival. The purpose of this article is to highlight successful management of aortic dissection in a parturient and to broaden the body of literature on the topic. PMID:20977131
Postpartum aortic dissection is a rare but lethal event. Until now, only a limited number of cases have been reported, and a comprehensive literature review from 1988 to 2012 yielded 27 cases. Postpartum aortic dissection occurred between Day 1 and Day 42 after delivery, either vaginally or by cesarean section. Pregnancy alone without underlying contributing risk factors and Marfan syndrome were the two main risk factors for postpartum aortic dissection, accounting for 44.4% and 40.7% of cases, respectively. Late presentation and delayed diagnosis may lead to sudden death. Improving prenatal and peripartum care is, therefore, crucial in preventing the development of aortic dissection. Prompt diagnosis and timely treatment of postpartum aortic dissection may prevent patient death. PMID:24075366
Spontaneous vertebral artery dissection (VAD) has been recognized as being more common than was first thought, with the growing use of magnetic resonance imaging (MRI). However, simple MRI alone is not always satisfactory for making an accurate diagnosis. We experienced two cases of VAD in our clinic, in which three-dimensional computed tomographic angiography (3D-CTA) was performed. Our scanner has the
A subclavian artery dissection (SAD) is usually associated with coexisting aortic disease, and spontaneous SAD is extremely\\u000a rare. This report presents the case of a spontaneous SAD patient who developed atypical clinical symptoms. A 41-year-old woman\\u000a presented with bilateral ischemia of her lower limbs. An urgent bilateral femoral thrombo-embolectomy was performed using\\u000a a balloon catheter. Postoperative enhanced computed tomography (CT)
The aim of this study was to analyze the spectrum of clinical presentations of internal carotid artery dissection. Twenty-two patients with internal carotid artery dissection, mean age 39.02, were evaluated over the past ten years. Magnetic resonance imaging and magnetic resonance angiography were used to establish the diagnosis. Facial and neck pain and Horner's syndrome were the only presenting symptoms in 4 patients (without brain infarction); facial pain, Horner's syndrome and contralateral sensorimotor deficit in 6; headache and contralateral sensorimotor deficit in 2; contralateral sensorimotor deficit with or without speech impairment in 10. Internal carotid artery dissection was triggered by a trauma in 7, whereas it was spontaneous in 15. Magnetic resonance imaging revealed infarction in 18 patients. A good outcome (modified Rankin score 0-2) was seen in 20 patients. The spectrum of clinical presentations of internal carotid artery dissection is variable. Internal carotid artery dissection is not necessarily accompanied by infarction on magnetic resonance imaging. PMID:22369003
Divjak, Ivana; Slankamenac, Petar; Jovi?evi?, Mirjana; Ziki?, Tamara Rabi; Prokin, Aleksandra Luci?; Jovanovi?, Aleksandar
Neck dissection for papillary thyroid carcinoma (PTC) is the standard of care for patients with clinical evidence of regional metastases. However, the extent of neck dissection is debatable. The purpose of the current study was to develop evidence-based recommendations for when to include level V, or 1 of its sublevels, among patients with PTC undergoing neck dissection. A literature review of all studies evaluating the occurrence of metastases in level V in patients with regional metastases from PTC undergoing neck dissection was performed. Occurrence of metastases at level V is low in most series (5% to 10%), although a wide range was noticed. In cases in which metastases were found at level V, they occurred almost exclusively at sublevel VB. Sublevel VA was rarely, if ever, involved with metastatic lymph nodes. However, only recently have investigators begun to specify which sublevels of level V are at risk. Therapeutic dissection of level V is indicated when there is clinical evidence of disease involving this zone. Elective dissection of sublevel VB is indicated when there is involvement of level IV, or possibly multiple nodes at levels II and III. Under these circumstances, dissection of sublevel VB is indicated but sublevel VA may be spared. PMID:22287259
Khafif, Avi; Medina, Jesus E; Robbins, K Thomas; Silver, Carl E; Weber, Randal S; Rinaldo, Alessandra; Owen, Randall P; Shaha, Ashok R; Ferlito, Alfio
We report a 45-year-old woman whose unilateral vertebral artery (VA) was potentially occluded with head rotation at the C1–C2 level and her ischemic symptoms suddenly appeared because of contralateral VA dissection. She noticed first pain around the posterior part of her neck on the right side, and then dizziness when turning the head to the right side. The dizziness disappeared
A 47-year-old man presented with a ruptured vertebral artery dissecting aneurysm manifesting as subarachnoid hemorrhage followed by acute occlusion and early recanalization of the affected artery. Cerebral angiography 2 hours after the onset of the symptom showed pearl-and-string sign in the right vertebral artery. Serial angiography showed that the affected artery was occluded at 12 hours but was recanalized on the 4th day. The dissecting aneurysm was resected with side-to-side anastomosis between the bilateral posterior inferior cerebellar arteries. Postoperative cerebral angiography demonstrated disappearance of the lesion and patency of the right posterior inferior cerebellar artery via the anastomosis. Histological examination of the lesion showed hematoma between the media and adventitia, disrupting the internal elastica and intima. Acute occlusion and early recanalization of the affected artery may occur in ruptured vertebral artery dissecting aneurysms. Serial neurological and neuroradiological examinations are essential to decide the timing and method of treatment. PMID:16127257
Popliteal cysts are swellings in the popliteal fossa due to enlargement of the gastrocnemius semimembranous bursa. These cysts might burst, and they usually rupture posteriorly and inferiorly with severe pain in the calf. We describe a patient with popliteal cyst that dissected proximally and ruptured in the soft tissue of the thigh.
An acute aortic syndrome with simultaneous presence of a penetrating aortic ulcer, an intramural haematoma, a thoracic aortic dissection and an abdominal aortic aneurysm rupture has not previously been reported. Herein, we describe our experience with a patient treated by endovascular means with an 8-year follow-up. PMID:21738051
Pecoraro, Felice; Rancic, Zoran; Mayer, Dieter; Pfammatter, Thomas; Lachat, Mario
...Docket No. 2927] Corrected: Certain Cases For Portable Electronic Devices; Notice...has received a complaint entitled Certain Cases For Portable Electronic Devices, DN 2927...United States after importation of certain cases for portable electronic devices. The...
...INTERNATIONAL TRADE COMMISSION [DN 2927] Certain Cases for Portable Electronic Devices: Notice...has received a complaint entitled Certain Cases For Portable Electronic Devices, DN 2927...United States after importation of certain cases for portable electronic devices. The...
Vertebral artery dissection seems to be a frequent cause of stroke in young adults. We report a 34 years old female that suffered a cardiac arrest while practicing aerobics, with complete recovery and four months later developed an acute Wallenberg's syndrome. Magnetic resonance imaging showed an infarction in the right posterolateral medulla oblongata and in the right cerebellar hemisphere. Angiography revealed an occlusion of the third segment (V3) of the right vertebral artery which was hypoplastic. The patient was anticoagulated with a favorable clinical outcome. A follow up angiography, performed six months later, showed an incomplete recanalization of the vessel. Vertebral artery dissection should be suspected in every patient with ischemic symptoms or signs related to the vertebrobasilar territory, specially in young or middle aged patients with a history of trauma. Magnetic resonance imaging and ultrasound-doppler examinations are the diagnostic test of choice. PMID:7597335
Background and method The aim of this study was to assess retrospectively the clinical presentation, management and outcome of three patients with\\u000a isolated SMA dissection encountered at Okinawa Prefectural Chubu Hospital, Japan from 2005 to 2006, along with a review of\\u000a the literature. We follow up the patient's clinical symptoms and the image by using enhanced dynamic CT at 1 week,
Intracranial aneurysms in young infants are extremely rare, with few published reports on the etiology, evaluation, treatment strategies, and follow-up of this condition in this population. The authors report the case of a traumatic dissecting aneurysm at the vertebrobasilar junction (VBJ) in a 3-month-old infant caused by nonaccidental trauma. Therapeutic occlusion of the VBJ was contemplated, but coil embolization of the main aneurysm sac proved feasible, and anticoagulation and antiplatelet agents were initiated. The patient made a full neurological recovery, and follow-up studies demonstrated stable aneurysm occlusion. Management and follow-up strategies for this challenging condition are discussed. PMID:18447682
Six cases of spontaneous coronary arteries dissection are reported. In one patient, triple vessel spontaneous coronary artery dissection was identified. Another patient presented spontaneous left main coronary artery dissection. In one case we found the spontaneous dissection of the left anterior descending artery associated with distal aortic arch dissection. These conditions are very rare and may present a surgical dilemma. Causative factors and underlying pathology are clarified. Prompt diagnosis and surgical intervention is safe and effective. Early recognition of left main coronary artery dissection or three-vessel dissection is essential because urgent coronary artery bypass grafting may be life saving. PMID:11887053
Bonacchi, M; Prifti, E; Giunti, G; Frati, G; Leacche, M; Brancaccio, G; Sani, G
Traumatic carotid artery dissections are uncommon and potentially devastating injuries that often have a delayed presentation. Soldiers often engage in leisure, training, and combat activities that place them at risk for sustaining an injury that causes a carotid artery dissection. To compound matters, spontaneous dissections are being more frequently recognized as well. Clinicians must be thorough in their history taking and maintain an elevated level of suspicion for this injury when presented with neurologic symptoms suggestive of head and neck pathology. This case study illustrates the difficulties encountered in arriving at a timely, correct diagnosis and offers treatment plan options. We hope that this case study will facilitate the early recognition and treatment of carotid artery dissections in the future. PMID:23764161
The patient was a 63-year-old female who had a past history of hypertension. She suddenly complained of agonizing pain and became comatose soon thereafter. Upon admission, she was in a state of shock, with upper airway obstruction and a coma. The pupils were dilated on both sides. The laboratory data showed that D-dimer was >80µg/mL. Brain CT scan and diffusion weighted MRI of the brain showed no abnormality. On brain 2D-CT angiography, the visualization of the right internal carotid artery and the right vertebral artery was poor. She eventually was able to nod her head in response to verbal commands, but her left extremities were completely hemiplegic. Cerebral angiography showed occlusion of the right vertebral artery at the branching point from the brachiocephalic artery, and was visualized in a retrograde fashion through the left vertebral artery. The brachiocephalic artery was severely stenotic in aortography. During angiography, she became able to speak and complained of back pain. Chest CT just after angiography showed a dissection in the aortic arch. Therefore, she was directed to the cardiovascular surgeon for immediate consultation. During the operation, the aortic dissection was revealed to be Stanford type A. Laceration of the intima was found in the ascending aorta and cardiac tamponade was also found. Total arch replacement was performed. The pathological examination showed that the arterial dissection occurred in the layer of elastic fiber, and the minimum arterial thickness of the medial layer was 0.2mm. The patient improved after the operation and her neurological deficits disappeared completely 13 days after operation. Brain and spinal MRI 15 days after the operation showed no abnormality. PMID:23378388
Two patients had acute spontaneous dissection of both internal carotid arteries and of one or both vertebral arteries. One had angiographic signs suggestive of fibro-muscular dysplasia and both were on oral contraceptives. They were treated with high dose heparin and made a good clinical recovery. A digital intravenous angiography performed two to three months later showed a complete recanalization of arteries involved. These patients are similar to those reported as "idiopathic regressing arteriopathy" and "reversible angiopathy" which probably correspond to the same entity. PMID:3966257
Mas, J L; Goeau, C; Bousser, M G; Chiras, J; Verret, J M; Touboul, P J
Cotyledonoid dissecting leiomyoma (“Sternberg tumor”) is an unusual type of a benign uterine smooth-muscle tumor with a distinctive\\u000a gross appearance. A 57-year-old woman (gravida 7, para 6), in menopause for 3 years, presented with a 3–4-year history of\\u000a increased pelvic pain. The transvaginal ultrasound scan showed a 2.5 cm sized heterogenic mass in the uterus cavity and 4 × 5 cm\\u000a sized irregular contoured mass
A 46-year-old male with juvenile myoclonic epilepsy was admitted to the neurological department for convulsive seizures just after lamotrigine was discontinued. On admission he was awake but had a right-sided hemiparesis with Babinski sign and ataxic finger-nose test on the left side. An MR scan showed a left-sided pontine infarction, an infarct in the left cerebellar hemisphere and a right vertebral artery dissection (VAD). The patient was treated with heparin and an oral anticoagulant for 6 months. Recovery of neurologic function was excellent. In patients with symptoms of disturbances of posterior circulation after epileptic seizures, VAD should be considered. PMID:23904852
Single-vessel cervical arterial dissections typically occur in young adults and are a common cause of cerebral ischemia and stroke. Although the pathogenesis of multivessel dissection is unclear, it is thought to be a consequence of underlying collagen vascular disease. We present a 34-year-old previously healthy man who developed bilateral internal carotid and vertebral artery dissection following chiropractic manipulation.
R. N. Nadgir; L. A. Loevner; T. Ahmed; G. Moonis; J. Chalela; K. Slawek; S. Imbesi
A previously healthy 6-year-old boy, suddenly developed a complete right hemiparesis and dysarthria while playing at school without any history of trauma. All laboratory examinations were normal except for CT brain scan that revealed a small ischemic infarct in the left middle cerebral artery territory. Four vessel cerebral angiography demonstrated a left internal carotid artery dissective obstruction while filling of the right or left vertebral artery resulted in the simultaneous retrograde appearance of the respective middle cerebral artery possibly via the posterior communicating artery. In contrast to the literature data, the patient showed a significant recovery with conservative treatment. This uncommon stroke type in children and the possible protective role of the posterior communicating artery's collateral are further discussed. PMID:2792864
Karoutas, G; Karacostas, D; Artemis, N; Tsounis, S; Dukidis, A
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.
Al-Raweshidy, Y H; Sinha, D M; Coward, L J; Guyler, P C; O'Brien, A
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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
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Summary: Vertebral artery dissection after neck manipulation has been well described. A case of bilateral vertebral artery dissection diagnosed with dynamic CT scanning of the neck is reported. The CT appearances and correlative angiographic and MR findings are presented.
The natural history of atraumatic idiopathic dissection of the distal anterior cerebral artery is still unclear. We present a 38-year-old man who had dissection of the left A2 segment of this vessel associated with subintimal hematoma and infarction. Because of complete stroke in acute stage, he did not undergo surgery. About three months later, administration of aspirin (100 mg/day) was started. At nine months, magnetic resonance angiography revealed complete recanalization of the A2 dissection. To assess the outcome of dissection, we should observe the patient for at least one year.
Students are provided with a dinosaur article from a popular magazine (e.g. Discover or Natural History) or the journal Science. Their task is to dissect the article distinguishing evidence from interpretation. They need to recognize the various hypotheses presented and also evaluate the strength of these ideas. Then during classroom discussion, they explore the implications of their dissections. For example they would address some of the following questions: Are other interpretations possible? Where have the authors over interpreted the evidence? What are the strongest interpretations? How could the ideas be further tested? What type of evidence would be sufficient to falsify or further support the interpretations of the papers?
|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…
White light is composed of the entire visible light spectrum, but how do you teach this to students in a hands-on way? The answer is simple: by using a spectroscope. This easy-to-make tool allows students to dissect light and in the process, develop an un
One thousand two hundred and thirty-two women with invasive breast cancer lesions measuring less than 2 cm in diameter, clinically assessed as T1N0-1M0, were treated from 1970 to 1983 at the National Cancer Institute of Milan with quadrantectomy, axillary dissection, and radiotherapy (QUART). Pathologic evidence of lymph-nodes metastases was found in 32% of the patients. Overall survival at 5 and 10 years from surgery was 91% and 78%, respectively. The cumulative probability of survival tends to decrease with increasing tumor size: the 7-year survival rate was 84% in cases in which lesions measured from 1.6 to 2.0 cm, and 94% in cases in which the lesions were less than 0.5 cm. Tumor site in the treated breast did not affect distant outcome. No difference was found between the patients without node metastases and patients with one node involved, whereas the patients with more than one node showed a lower probability of survival. The survival curves of 352 cases treated inside a randomized trial and that of 880 cases routinely treated appear to be superimposable. Local recurrences and new primary ipsilateral tumors were, respectively, 35 (2.8%) and 19 (1.6%); 56 women with local recurrences or second tumors underwent second surgery (total mastectomy, 43; wide resection, 11). Five of them died from distant spread of breast cancer, while 49 are alive and well. In the contralateral breasts 45 carcinomas were recorded during the follow-up time. The results of the present analysis of a large number of T1 cases reconfirm the safety of integrated radiosurgical conservative treatments.
Veronesi, U; Salvadori, B; Luini, A; Banfi, A; Zucali, R; Del Vecchio, M; Saccozzi, R; Beretta, E; Boracchi, P; Farante, G
Spontaneous dissection of the superior mesenteric artery (SMA) is a rare occurrence, especially when not associated with aortic dissection . Currently, only 28 cases appear to have been reported. Due to the scarcity of cases in the literature, the natural history of isolated, spontaneous SMA dissection is unclear. CT has been reported to be useful for the initial diagnosis of SMA dissection [2-5]. We present two recent cases of spontaneous SMA dissection in which enhanced spiral CT was instrumental in following the disease process and guiding clinical decision making.
Sheldon, Patrick J. [Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103 (United States); Esther, James B. [Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, West Campus, CC308E, One Deaconess Road, Boston, MA 02215 (United States); Sheldon, Elana L. [Department of Medicine, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103 (United States); Sparks, Steven R. [Department of Surgery, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103 (United States); Brophy, David P. [Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, West Campus, CC308E, One Deaconess Road, Boston, MA 02215 (United States); Oglevie, Steven B. [Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103 (United States)
Blunt chest trauma is commonly encountered by surgeons and is rarely associated with cardiac injuries. The incidence of cardiac injury is rare but can be rapidly fatal, requiring prompt recognition and treatment. We review the case of a 37 year-old male who was involved in a head-on motor vehicle collision at highway speed and was found to have an isolated
Mollie M James; Marnix Verhofste; Cass Franklin; Greg Beilman; Charles Goldman
Students observe clams (Mercenaria) in a salt water aquarium, paying attention to siphons and any burrowing. They then remove the clams and describe the external morphology. The clams are then dissected, with special attention made to features (siphons, muscles) that leave observable marks on the shells. They are then provided the shells of a different genus (Mya) and asked to predict the soft tissue morphology and life mode.
We review the angiographic and CT findings, precipitating factors and clinical features in nine patients with ten intracranial\\u000a arterial dissections. The internal carotid artery was involved in five cases, the vertebral artery in four and the posterior\\u000a inferior cerebellar artery in one. Angiography revealed irregular stenosis in four cases, irregular stenosis and a pseudoaneurysm\\u000a in two, irregular stenosis and irregular
O. Pelkonen; T. Tikkakoski; S. Leinonen; J. Pyhtinen; K. Sotaniemi
Cervical artery dissection is an important cause of stroke in young patients and accounts of 10%–20% of stroke or TIA in patients\\u000a aged less than 50 years. Basilar artery occlusion (BAO) is an infrequent cause of acute stroke, which invariably leads to\\u000a death or long-term disability if not recanalized. We describe three patients with BAO caused by vertebral dissection, successfully
Paolo Cerrato; Maurizio Berardino; Edo Bottacchi; Giovanni Corso; Alessandra Lentini; Giovanni Bosco; Eleonora Destefanis; Mariagiovanna Caprioli; Dino Daniele; Gianni Boris Bradac; Mauro Bergui
We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides. PMID:21341139
We experienced a rare case of isolated lateral lymph node (LLN) recurrence after laparoscopic intersphincteric resection with total mesorectal excision for T1 lower rectal cancer that was successfully treated using LLN dissection with en bloc resection of the left superior vesical artery, the left ovary and the left obturator nerve, artery and vein. There are no guidelines for treating patients with isolated LLN recurrence because isolated LLN recurrence is rare, especially in patients with T1 rectal cancer. However, in patients with pT1N0 lower rectal cancer, follow-up examinations of the pelvis should be performed periodically. Patients with isolated LLN recurrence treated with surgery might have good long-term prognoses. Therefore, for such patients, surgical resection should be considered as a curative treatment only. PMID:22832928
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.
Spontaneous coronary artery dissection and vertebral artery dissection are rare, life-threatening conditions. The pathophysiology of spontaneous coronary artery dissection during the peripartum period is poorly understood. We present a case of spontaneous multivessel dissection in a 32-year-old postpartum woman who presented with neck and chest pain. The patient's coronary and vertebral artery dissections were diagnosed with use of multiple imaging methods, and dissection of the internal mammary artery was discovered during surgery. The patient underwent successful coronary artery bypass grafting and remained asymptomatic 2 years later. To our knowledge, this is the first report of simultaneous coronary, vertebral, and internal mammary artery dissection in a postpartum woman. Early recognition and treatment is crucial, given the high mortality rate associated with spontaneous dissection. PMID:23109768
Brantley, Hutton P; Cabarrus, Brian R; Movahed, Assad
Spontaneous coronary artery dissection and vertebral artery dissection are rare, life-threatening conditions. The pathophysiology of spontaneous coronary artery dissection during the peripartum period is poorly understood. We present a case of spontaneous multivessel dissection in a 32-year-old postpartum woman who presented with neck and chest pain. The patient's coronary and vertebral artery dissections were diagnosed with use of multiple imaging methods, and dissection of the internal mammary artery was discovered during surgery. The patient underwent successful coronary artery bypass grafting and remained asymptomatic 2 years later. To our knowledge, this is the first report of simultaneous coronary, vertebral, and internal mammary artery dissection in a postpartum woman. Early recognition and treatment is crucial, given the high mortality rate associated with spontaneous dissection.
Brantley, Hutton P.; Cabarrus, Brian R.; Movahed, Assad
Traumatic cervical artery dissection (TCAD) is a complication of severe blunt head or neck trauma, the main cause being motor vehicle accidents. TCAD are increasingly recognized, and incidences of up to 0.86% for internal carotid and 0.53% for traumatic vertebral artery dissections (TVAD) among blunt trauma victims are reported. Diagnostic evaluation for TCAD is mandatory in the presence of (1) hemorrhage of potential arterial origin originating from the nose, ears, mouth, or a wound; (2) expanding cervical hematoma; (3) cervical bruit in a patient >50 years of age; (4) evidence of acute infarct at brain imaging; (5) unexplained central or lateralizing neurological deficit or transient ischemic attack, or (6) Horner syndrome, neck or head pain. In addition, a number of centers screen asymptomatic patients with blunt trauma for TCAD. Catheter angiography is the standard of reference for diagnosis of TCAD. Color duplex ultrasound, computed tomographic, and magnetic resonance angiography are noninvasive screening alternatives, but each method has its diagnostic limitations compared to catheter angiography. Anticoagulants and antiplatelet drugs may prevent ischemic stroke, but bleeding from traumatized tissues may offset the benefits of antithrombotic treatment. Endovascular therapy of dissected vessels, thrombarterectomy, direct suture of intimal tears, and extracranial-intracranial bypass should be considered in exceptional cases. Neurological outcome is probably worse in TCAD compared to spontaneous CAD, although it is unclear whether this is due to dissection-induced ischemic stroke or associated traumatic lesions. PMID:17290111
Introduction Cerebrovascular disease is a major cause of mortality and morbidity worldwide. Ischemic stroke is the most common manifestation, encompassing a wide variety of causative mechanisms. We present the case of a middle-aged male patient with spontaneous coronary artery dissection in the presence of anti-cardiolipin antibodies, leading to left ventricular thrombus and presenting with stroke. Case presentation A 56-year-old Caucasian man presented with dysarthria and right-sided weakness. There was a history of chest pain with autonomic symptoms four days earlier. Examination revealed right-sided hemiparesis. Electrocardiogram showed sinus rhythm with anterior Q waves. Magnetic resonance imaging of the brain showed large left parietal and smaller multiple cerebral infarcts. Echocardiogram showed anterior wall and apical akinesis with a large mural thrombus. Anti-cardiolipin antibodies immunoglobulin G and immunoglobulin M were strongly positive. Coronary angiography showed dissection of the mid left anterior descending artery with normal flow down the distal vessel. He was treated conservatively with anticoagulation and secondary prevention. He was in good health when seen in clinic four months later. Conclusion We highlight the importance of a comprehensive approach at obtaining the correct diagnosis, input of different specialities and the fact that the presence of anti-cardiolipin antibodies is associated with coronary artery dissection in a middle-aged male patient whose presentation was stroke.
Aortic dissections can be challenging to diagnose in the emergency department (ED) because patients can present with a variety of complaints. We present a case involving a woman with multiple comorbidities, who had experienced intermittent abdominal pain for several months, which worsened in the days leading up to her ED visit. She was diagnosed with pancreatitis based on her history and blood work but, incidentally, on computed tomographic scan, also was found to have a Stanford type B aortic dissection. Her dissection and pancreatitis were managed medically with tight blood pressure control without the need for surgical intervention. Several case studies associating acute aortic dissection with acute pancreatitis have been published, but it remains unclear whether these 2 conditions have a causal relationship. PMID:23602744
Most of the cocaine - deaths are said to be related to cardiovascular complications. This paper addresses a rather infrequent complication of chronic cocaine use, represented by the aortic dissection. The case in point pertains to a 45-year-old, caucasian male, substance abuser who suffered an aortic dissection following the use of cocaine. Blood concentrations of cocaine and benzoylecgonine were considered not to be within a potentially toxic range. PMID:21907939
Marella, Gian Luca; Furnari, Carmelo; Perfetti, Emilio; Arcudi, Giovanni
Sternoclavicular joint hypertrophy is anecdotally reported as a common sequela to radical neck dissection. It is postulated\\u000a that sternoclavicular joint hypertrophy is a result of a combination of spinal accessory nerve division and sternocleidomastoid\\u000a muscle resection during radical neck dissection. However, we noticed that sternoclavicular joint hypertrophy can occur following\\u000a functional neck dissection with preservation of the spinal accessory nerve,
Mohamed A. Ellabban; Greg O’Neill; Stephen Morley; David S. Soutar
The effective management of aortic dissection relies heavily on a high index of suspicion followed by timely definitive diagnosis. Young adults without a history of blunt trauma who are not at risk for atherosclerotic disease may lower this suspicion. We present a 24-year-old patient with complaints of chest pain who presented in multiple urgent care clinics and emergency departments. With
Spinal manifestations of vertebral artery dissection (VAD) are rare events and are typically symptomatic with neck pain and ischemic brain injury. We report a patient presenting with unusual peripheral paresis of the right upper limb due to an intramural hematoma of the right vertebral artery with local compression of C5 and C6 as the cause of cervical radiculopathy. These symptoms
Ghazaleh Tabatabai; Wolfgang Schöber; Ulrike Ernemann; Michael Weller; Rejko Krüger
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.
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Five cases of vertebral arterial dissection occurring in sport are presented. These cases emphasise the diagnostic and management difficulties in this setting. Stroke in sport, although uncommon, is predominantly due to arterial dissection in either the vertebral or carotid arteries. Physicians involved in athlete care need to be aware of this diagnosis.
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Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48h later with acute right hemiparesis, decreasing level of consciousness,
Ignasi Galtés; Juan Carlos Borondo; Mònica Cos; Mercè Subirana; Carles Martín; Josep Castellà; Jordi Medallo
Spontaneous coronary artery dissection (SCAD) is an uncommon condition with a variety of clinical presentations. Our knowledge base for SCAD is limited and derives from case reports and retrospective reviews. Several aspects of this disorder, including its rarity, heterogeneity of its presentation, and lack of identification during initial assessment, propose obstacles to reliably secure an accurate diagnosis and consequently we believe that the incidence of this disorder is likely underestimated in the literature. We present a case series of 5 patients with SCAD who exhibit features of this disorder that pose diagnostic challenges and outline the aspects of their history, presentation, and work-up. We propose that this condition is more than rare and may be underestimated; improved awareness of this disorder and associated trends might improve a clinician's index of suspicion and lead to a better diagnostic approach. Case reports and reviews remain vital to our understanding of this disorder and its true prevalence. PMID:23813076
A 47-year-old women developed an acute vestibular syndrome with a peripheral facial palsy not associated with any trauma. Magnetic resonance imaging showed an ischemic lesion in the territory of the posterior inferior cerebellar artery. Color Doppler ultrasonography detected an occlusion of the right vertebral artery and dissection of the artery was confirmed by a subsequent angiography. During follow-up Duplex-Doppler allowed a non-invasive monitoring of recanalization of the occluded artery. Copyright 1997 Elsevier Science Ireland Ltd. PMID:9795057
We report an autopsy case of a bilateral carotid artery dissection, following cervical manipulation by a chiropractor. To establish the etiology of a cervical artery dissection is important in view of possible legal implications and to exclude hereditary disorders, since cervical artery dissection has been linked to several arteriopathies. The underlying arteriopathy in the presented case was an idiopathic cystic medial degeneration. This report emphasizes the role of the pathologist in defining the underlying arteriopathy in carotid artery dissection. PMID:22633562
Carprieaux, Marilyn; Michotte, Alex; Van Varenbergh, Dirk; Marichal, Miriam Pipeleers
Vertebral artery dissection is an important cause of disabling stroke in young adults, recognition of its presenting features and risk factors is paramount for expeditious diagnosis and preventive treatment. Numerous risk factors for vertebral artery dissection have been reported; trauma is the most common. This case report describes a patient with amphetamine abuse, who had posterior circulation stroke from vertebral
This website provides information regarding Marquette University' Neuroanatomical Dissection Summer Course. The focus of the course is an intensive review of the brain and spinal cord. Participants will spend a portion of the course dissecting a cadaver.
This report describes 2 cases of spontaneous aortic dissecting hematoma in young Border Collie and Border Collie crossbred dogs. Histology was performed in one of the cases involving an unusual splitting of the elastin present within the wall of the aorta, consistent with elastin dysplasia as described in Marfan syndrome in humans. The first case involved a young purebred Border Collie that died suddenly and the second case involved a Border Collie crossbred dog that died after a 1-month history of seizures. Gross lesions included pericardial tamponade with dissection of the ascending aorta in the former case and thoracic cavity hemorrhage, mediastinal hematoma, and aortic dissection in the latter. Histologic lesions in the case of the Border Collie crossbred dog included a dissecting hematoma of the ascending aorta with elastin dysplasia and right axillary arterial intimal proliferation. PMID:16312247
Boulineau, Theresa Marie; Andrews-Jones, Lydia; Van Alstine, William
Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48 h later with acute right hemiparesis, decreasing level of consciousness, and unsteadiness. CT revealed massive cerebellar infarction. CT angiography was normal. The patient died in coma 7 days after injury and autopsy revealed bilateral edematous cerebellar infarction and bilateral vertebral artery dissection. Rotational neck injury and mural tear in the wall of the Atlantic parts of both vertebral arteries is suggested as the possible mechanism of the arterial injury. Head and neck injuries are reported as a precipitating cause of vertebral artery injury. The possible influence of trauma may be further underestimated if longer intervals between vessel dissection and ischemia occur. The current case illustrates that "talk-and-die" syndrome may be due to occult vertebral artery dissection, possibly bilateral. In forensic cases of delayed death after mild trauma to the head and neck, the vertebral arteries should be examined for the cause of death. PMID:21798679
Thoracic aortic dissection (TAD) is estimated to occur at a rate of 3–4 cases per 100,000 persons per year and is associated with a high mortality. Reported rates are probably underestimates of the true incidence of TAD because of difficulties in diagnosis. The incidence of TAD appears to have been increasing over time. TAD is most common in men and
|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…
This overview of Federal cases points out that the refusal of the US Supreme Court on April 29, 1996, to hear the South Dakota case of Janklow v. Planned Parenthood leaves confusion about which standard (Salerno or Casey) is appropriate to apply to abortion cases. The South Dakota case involved an attempt to reverse an appellate ruling that changed the 1993 law requiring parental notification within 48 hours of the abortion procedure for an adolescent. The 1987 decision in United States v. Salerno established that plaintiffs who challenge an abortion law must meet the strict standard of proving that there was no set of circumstances under which the statute could be applied in a constitutional manner. The 1992 ruling in Planned Parenthood v. Casey required federal courts to eliminate abortions laws that placed an undue burden on a large number of women. Justices Scalia, Rehnquist, and Thomas considered it the duty of the high court to resolve the conflict between appellate courts over the legal standard for reviewing suits against abortion restrictions that was presented in a 1995 appellate decision. Justice Stevens issued a rare statement of agreement with the decision to reject the South Dakota case. The appeals court for South Dakota had invalidated the one-parent notification provision, because it did not permit a young adolescent to seek a judicial by-pass to avoid the mandate. This appellate ruling was based on a Supreme Court ruling involving two-parent consent and two-parent notification requirements that required states to provide a confidential and expeditious alternative to women who could not tell their parents. The lower appellate courts assumed that the two-parent notification alternatives would apply to one-parent notification alternatives. PMID:12291324
Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitation and chronic descending aortic dissection immediately after Cesarean section. Regular follow-up will be needed to monitor the descending aortic dissection.
Colorectal endoscopic submucosal dissection (ESD) still remains a technically difficult procedure. The maintenance of tissue tension and good submucosal exposure during dissection is one of the most important factors for an effective and safe dissection. Although various traction methods have been developed, traction by gravity is one of the most useful method for colorectal ESD. Traction using adjunctive devices can thus be reserved for extremely difficult cases or for endoscopists in their learning periods for colorectal ESD.
BackgroundThe surgical management of type A dissection with the intimal tear in the descending aorta—retrograde dissection—has some challenging aspects because the standard approach through a median sternotomy for ascending aortic dissection is difficult in these cases in which the intimal tear is located in the descending aorta.
Left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of mitral valve is not only limited to patients with hypertrophic cardiomyopathy. A diagnosis of LVOT obstruction with SAM is important because conventional inotropic support may potentially aggravate hemodynamic deterioration. We present a case of LVOT obstruction with SAM in a patient who underwent an emergent surgery for ascending aortic dissection with pericardial effusion. The patient showed refractory hypotension after standard pharmacologic interventions during induction of anesthesia. Transesophageal echocardiography (TEE) revealed LVOT obstruction with SAM and it was managed appropriately under the guidance of TEE. Intraoperative TEE can play an important role in diagnosis and management of LVOT obstruction with SAM caused by pericardial effusion.
Park, Keun Suk; Kim, Hyerim; Jung, Yoo Sun; Kim, Hyun Joo; Lee, Jung-Man; Hong, Deok Man; Jeon, Yunseok
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.
Melvin, Thuy-Anh N.; Eliades, Steven J.; Ha, Patrick K.; Fakhry, Carole; Saunders, John M.; Califano, Joseph A.; Blanco, Ray G. F.
A lingering issue in the area of protein engineering is the optimal design of ? motifs. In this regard, the framework provided by intestinal fatty acid binding protein (IFABP) was successfully chosen to explore the consequences on structure and function of the redesign of natural motifs. A truncated form of IFABP (?98?) served to illustrate the nonintuitive notion that the integrity of the ?-barrel can indeed be compromised with no effect on the ability to attain a native-like fold. This is most likely the outcome of the key role played by the preservation of essential core residues. In the search for the minimal structural determinants of this fold, ?98? offered room for further intervention. A dissection of this protein leads to a new abridged variant, ?78?, containing 60% of the amino acids of IFABP. Spectroscopic analyses indicate that ?78? retains substantial ?-sheet content and preserves tertiary interactions, displaying cooperative unfolding and binding activity. Most strikingly, this construct adopts a remarkably stable dimeric structure in solution. This phenomenon takes advantage of the inherent structural plasticity of this motif, likely profitting from edge-to-edge interactions between ?-sheets, whereas avoiding the most commonly occurring outcome represented by aggregation.
Franchini, Gisela R; Curto, Lucrecia M; Caramelo, Julio J; Maria Delfino, Jose
The dissecting aortic aneurysm (DAA) is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively. PMID:19861869
Ounissi, M; Goucha, R; Hedri, H; Hamida, F Ben; Abderrahim, E; El Younsi, F; Abdallah, T Ben; Maiz, H Ben; Kheder, A
Spontaneous coronary artery dissection, which causes acute coronary syndrome and can result in sudden death, is rare; but its true incidence is underestimated, since most patients die suddenly, without diagnosis. The aim of this study was to show the importance of prompt diagnosis and treatment. In reviewing the records of 5,000 consecutive patients who underwent coronary angiography between January 2001 and August 2006, we found 6 cases of spontaneous coronary artery dissection (an incidence rate of 0.12%). Five patients presented with left main coronary artery dissection and 1 patient, with right coronary artery dissection. Angioplasty with stenting failed in the patient with right coronary artery dissection. Coronary artery bypass surgery was performed in all patients. The patient with right coronary artery dissection died of sepsis on the 30th postoperative day. The other 5 patients (83.3%) are still free of symptoms, and they had negative results on stress tests at the 6- and 12-month follow-up visits after coronary artery bypass surgery. The clinical presentation of spontaneous left main coronary artery dissection was similar to that of atherosclerotic disease. However, early diagnosis of spontaneous coronary artery dissection by means of coronary angiography is of paramount importance, because urgent coronary artery bypass grafting can be lifesaving.
Spontaneous coronary artery dissection, which causes acute coronary syndrome and can result in sudden death, is rare; but its true incidence is underestimated, since most patients die suddenly, without diagnosis. The aim of this study was to show the importance of prompt diagnosis and treatment. In reviewing the records of 5,000 consecutive patients who underwent coronary angiography between January 2001 and August 2006, we found 6 cases of spontaneous coronary artery dissection (an incidence rate of 0.12%). Five patients presented with left main coronary artery dissection and 1 patient, with right coronary artery dissection. Angioplasty with stenting failed in the patient with right coronary artery dissection. Coronary artery bypass surgery was performed in all patients. The patient with right coronary artery dissection died of sepsis on the 30th postoperative day. The other 5 patients (83.3%) are still free of symptoms, and they had negative results on stress tests at the 6- and 12-month follow-up visits after coronary artery bypass surgery. The clinical presentation of spontaneous left main coronary artery dissection was similar to that of atherosclerotic disease. However, early diagnosis of spontaneous coronary artery dissection by means of coronary angiography is of paramount importance, because urgent coronary artery bypass grafting can be lifesaving. PMID:19156232
Aortic dissection is a rare, potentially catastrophic vascular emergency. Early recognition of the clinical manifestations, rapid confirmation using imaging modalities, urgent administration of appropriate medication and expedient selection of definitive long-term therapy are key to preserving life and reducing morbidity. In recent years it has become increasingly clear that there is a relation between cocaine and aortic dissection. Cocaine serves as both a predisposing factor to aortic dissection due to its effect on aortic connective tissue and as a precipitating factor due to its propensity to produce abrupt and severe hypertension. While similarities exist in the clinical features and diagnostic methods between cocaine-related aortic dissection and aortic dissection unrelated to cocaine use, there are important differences in management between these two syndromes which are rooted in the pharmacology and physiology of cocaine. An understanding of these differences is key to effective early and long-term management of cocaine-related aortic dissection. PMID:20233907
Background and Purpose Emphasizing the therapeutic and diagnostic implications of concomitant inadequate collaterals from the circle of Willis in a rare case of spontaneous acute bilateral internal carotid artery dissection (BICAD) following 5 days of isolated rigorous cough (pertussis like). Case Description A 45-year-old male has been referred to our department with rapid neurological deterioration consisting of dysarthria and severe left hemiparesis following 5 days of isolated rigorous cough. CTA demonstrated BICAD, a tiny anterior communicating artery and no bilateral posterior communicating artery. The patient had no personal or familial risk factors. Infectious, traumatic, vascular and connective tissue diseases were ruled out. Results Neurological deterioration persisted despite immediate provision of continuous ‘full-heparinization’ with concomitant rigorous control of blood pressure. Endovascular treatment consisting of bilateral stenting was undertaken. Ten days later, the patient was discharged with mild hemiparesis and resuming normal activity after 3 months. Conclusions BICAD with concomitant inadequate collaterals from the circle of Willis may predispose to hypoperfusion which might not respond to the usual conservative treatment prompting for flow reestablishment. Moreover, isolated rigorous cough can cause acute spontaneous BICAD even among patients without any risk factors.
Dissection of a renal artery is rare and is usually associated with underlying arterial disease. Bilateral renal artery dissection following extreme exertion is exceptionally uncommon, and thus presents a diagnostic challenge. We report a case of a middle-aged, otherwise healthy man who presented to the hospital with left flank pain after a long bicycling trip. Initial laboratory tests and urinalysis were normal. Careful review of a contrast-enhanced computed tomography angiogram (CTA) with 3D reconstruction revealed bilateral segmental renal artery dissection and thrombosis with corresponding renal infarcts. He was treated medically and rapidly recovered. PMID:21955870
Baroudi, S; Bastani, B; Balci, N; Bieneman, B K; Sobti, P; Kudva, G C
Aortic dissections remain complicated management issues both in the acute setting and in the chronic setting. Acute problems revolve around malperfusion syndromes or rupture, whereas chronic issues progress from the development of aneurysms in the residual dissected aorta. Endovascular approaches to dealing with these difficult situations are being used more frequently to treat acute issues in type B dissections and prevent secondary complications in type A dissections that may require significant intervention in the future. This article discusses the endovascular approaches employed in the care of acute dissections with particular attention toward the anesthetic considerations involved in these challenging cases. PMID:22194281
Jazaeri, Omid; Gupta, Rajan; Rochon, Paul J; Reece, T Brett
From Fairchild Tropical Botanic Garden, this site presents a simple Flower Dissection Lab using orchids and composite flowers. This pdf document contains the materials needed and instructions for the lab, as well as a worksheet for students to complete as they dissect their flower.
Pulmonary artery dissection is a rare but life-threatening event, predisposing to sudden cardiac death or cardiogenic shock. It is often associated with underlying congenital disorders predisposing to pulmonary hypertension. Rarely, it is diagnosed by echocardiography or other image techniques. We present a case report of a pulmonary artery dissection, diagnosed primarily by echocardiography. The patient died soon after refusing any interventional approach after a short period under medication. PMID:12848882
Renal artery dissections are stenotic or occlusive lesions most often observed in hypertensive patients with underlying atherosclerosis or fibromuscular disease. Acute dissections may present spontaneously, as a complication of diagnostic or therapeutic angiography or as an agonal event associated with overwhelming systemic illness. Chronic dissections may produce renovascular hypertension or be entirely asymptomatic. Fourteen renal artery dissections have been encountered in nine patients treated at Vanderbilt University Medical Center during the past decade. Eleven dissections have been found in seven patients with renovascular hypertension. Seven of these dissections were chronic (six functional, one silent) and four acute (two spontaneous, two secondary to angiography). Three agonal dissections were found in two additional patients postmortem: one at autopsy and bilateral dissections found at the time of cadaveric donor nephrectomy. Ten bypass procedures, including five complex branch reconstructions of which three were performed ex vivo, have been performed with 100% immediate patency and maintenance or improvement of renal function. Long-term follow-up of these patients has shown sustained patency of the reconstructed renal arteries, excellent blood pressure control, and normal renal function in all. Nephrectomy has not been required and there have been no associated deaths. Seventy-seven additional renal artery dissections in 72 patients collected from previous reports have been analyzed. Patient survival (55/72, 76.4%) and preservation of the involved kidney in surviving patients (26/55, 47.3%) were low in these earlier series. In addition, renal failure was associated with 59% of the deaths. The lethality of renal artery dissections and the ease and success of revascularization, which preserves renal function and ameliorates associated renovascular hypertension, emphasize the need for an aggressive approach to the recognition and treatment of this entity. Therapy should be directed toward arterial reconstructions and the preservation of functioning renal tissue. Images FIG. 1A. FIG. 2A. FIG. 5. FIG. 6. FIG. 7. FIG. 9. FIG. 10. FIG. 11.
There is no controlled study for the best treatment or management of cervico-cerebral artery dissection (CAD). Rationale initial empiric treatment in acute CAD to prevent secondary embolism is partial thromboplastin time (PTT)-guided anticoagulation by intravenous heparin followed by anticoagulation with warfarin. Carotid surgery for treatment of CAD is not recommended anymore with the possible exception of persisting severe stenosis of the proximal internal carotid artery (ICA). There could be use of carotid angioplasty by balloon dilatation and stenting in selected cases of severe cerebral hemodynamic impairment by bilateral CAD. Duration of secondary prophylaxis by anticoagulation is best guided by Doppler sonography follow-up, and should be continued until normalization of blood flow or until at least 1 year after the vessel is occluded. There is no evidence that pseudoaneurysms increase the risk for embolic complication, and there is no evidence for surgery or continuation of anticoagulation in patients with pseudoaneurysms. Caution should be recommended for exercises that involve excessive head movements (eg, bungee jumping, trampoline jumping, and chiropractic maneuvers). The patient should be informed that recurrent rate is low in nonfamilial cases. Doppler sonography is a low-cost and high-sensitivity method for patients at risk. PMID:11487460
...Calpine Texas Pipeline, L.P.; Notice of Motion for Extension of Rate Case Filing Deadline...Pipeline, L.P. (Calpine Texas) filed a motion to extend the date for filing its next...participate in this rate proceeding must file a motion to intervene or to protest this...
Summary While so-called twin or mirror aneurysms constitute an established subgroup of multiple aneurysms, simultaneous spontaneous mirror dissections of cervicocephalic artery have not yet been reported as a particular entity. Among the patients treated at our institution since 1989, we identified 74 patients with spontaneous, nontraumatic dissections. Six of these cases presented with simultaneous bilateral dissections and four of the six patients had mirror dissections. Acute or chronic headache was present in all four cases. Additional clinical presentations consisted of impaired consciousness, cranial nerve palsy, and tinnitus. Angiography revealed irregular stenosis, dilatation or aneurysms located in the cervical ICA (internal carotid artery), VA (vertebral artery), or MCA (middle cerebral artery) without evident location bias. Although mirror dissections seems to be an exceptional finding, they may shed light on the vulnerability of different arterial segments to specific diseases. Similar to arterial aneurysm formation, pathogenesis of mirror dissection may involve an underlying "shared defect" in the endothelial cells, since these cells demonstrate a bilateral distribution during embryological development. This particular distribution therefore also provides a chronicle trail of the first trigger striking during embryonic development and demonstrates the segmental vulnerability to highly specific triggers.
We report a case of internal carotid artery dissection (ICAD) associated with contralateral vertebral artery dissection (VAD). The interest of this case is to discuss an unusual Doppler pattern manifesting by a spectrum of an alternating vertebral artery flow suggesting a hemodynamic contribution from the contralateral vertebral artery (VA) and a clear depiction of both antegrade (red) and retrograde (blue)
N Cals; G Devuyst; D. K Jung; N Afsar; G De Freitas; P-A Despland; J Bogousslavsky
Introduction Subarachnoid hemorrhages caused by intracranial dissections are rare. The management of dissections in these cases not clear.\\u000a \\u000a \\u000a \\u000a Methods Case report.\\u000a \\u000a \\u000a \\u000a Results An 82-year-old woman presented with acute drowsiness and vomiting. CT scan demonstrated extensive subarachnoid hemorrhage\\u000a and hydrocephalus that subsequently required placement of ventriculoperitoneal shunt. Angiography revealed extensive basilar\\u000a artery dissection and no aneurysms. The dissection did not produce a critical stenosis
Alexander Y. Zubkov; Amit N. Sanghvi; Harry J. Cloft; Eelco F. M. Wijdicks; Alejandro A. Rabinstein
... obstruction, or leak in the lining of the carotid. This leaking of blood into the artery wall ( ... to the neck, which means stroke secondary to carotid dissection may occur in young people as well ...
A 50-year-old woman presented a sudden left occipital headache and a posterior circulation stroke after cervical manipulation\\u000a for neck pain. Magnetic resonance imaging documented a left intracranial vertebral artery occlusive dissection associated\\u000a with an ipsilateral internal carotid artery dissection with vessel stenosis in its prepetrous tract. This is the first reported\\u000a case showing an associate vertebral and carotid artery dissection
Giuliano Parenti; Giovanni Orlandi; Mariacristina Bianchi; Maria Renna; Antonio Martini; Luigi Murri
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.
Namazi, Mohammad Hassan; Rostami, Reza Tajik; Mohammadi, Afsaneh; Amini, Abdol Latifi; Safi, Morteza; Saadat, Habibollah; Vakili, Hosein; Motamedi, Mohammad Reza; Movahed, Mohammad Reza
Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD) dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA) dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.
Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction that occurs particularly in women during the pregnancy and in the postpartum period. We describe a dramatic case of pregnancy-related spontaneous left main coronary artery dissection that resulted in acute myocardial infarction with severe left ventricular dysfunction and was complicated by acute heart failure and cardiogenic shock. Urgent revascularization and restoration of myocardial perfusion that were performed in this case resulted in marked left ventricular function recovery and clinical improvement. PMID:18060935
Goland, Sorel; Schwarz, Ernst R; Siegel, Robert J; Czer, Lawrence S C
Craniocervical arterial dissection is an important cause of childhood arterial ischemic stroke, accounting for 7.5% to 20% of cases. Significant neurologic morbidity and mortality may result and recurrence risk may be higher than in adults. However, the natural history and long-term outcome of pediatric dissection are poorly studied. We report 3 cases of extracranial vertebral artery dissection with complications including
Marilyn A. Tan; Derek Armstrong; Daune L. MacGregor; Adam Kirton
Cerebral oximetry is a noninvasive bedside monitor for cerebral oxygen saturation (rSO2). A patient with a thoracic aneurysm underwent combined surgical and endovascular repair. A sudden decrease in right rSO2 led to the finding of acute innominate artery dissection. Immediate repair was instituted. Sudden asymmetry of rSO2 may be a warning sign of underlying pathology.
A case of internal carotid artery dissection in a pregnant woman with Systemic Lupus Erythematosus (SLE) immediately following chiropractic treatment is presented. The literature regarding complications of neck manipulation during pregnancy, spontaneous dissection of craniocervical arteries in pregnancy and the postpartum period, and dissection of craniocervical arteries in SLE are reviewed. To the best of the author’s knowledge, this is the first case of carotid artery dissection following chiropractic treatment in a pregnant woman published in the literature.
Acute aortic dissection is rare but potentially catastrophic complication of pregnancy. Aortic root enlargement, congenital bicuspid aortic valve disease, and Marfan syndrome have been identified as critical risk factors for peripartum aortic dissection. Most of the aortic dissections reported to date involve the ascending aorta and occur before delivery, but only a few cases of postpartum aortic dissection have been
Sweeta D. Gandhi; Zafar Iqbal; Sandeep Markan; G. Hossein Almassi; Paul S. Pagel
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
We describe a 43-year-old man who developed a spontaneous dissection of a right iliac artery aneurysm after performing vigorous physical exercise. Additionally, during peripheral intervention, the patient developed iatrogenic dissection of the left iliac artery. The patient had the characteristic physical findings of Ehlers–Danlos syndrome (EDS), classic type. Genetic testing revealed a mutation in the COL5A1 gene associated with EDS, classic type. Vascular aneurysms and dissections are characteristics of EDS vascular type, but not the classic type. Only one previous case with EDS, classic type with spontaneous iliac artery dissection has been described.
We describe a 43-year-old man who developed a spontaneous dissection of a right iliac artery aneurysm after performing vigorous physical exercise. Additionally, during peripheral intervention, the patient developed iatrogenic dissection of the left iliac artery. The patient had the characteristic physical findings of Ehlers-Danlos syndrome (EDS), classic type. Genetic testing revealed a mutation in the COL5A1 gene associated with EDS, classic type. Vascular aneurysms and dissections are characteristics of EDS vascular type, but not the classic type. Only one previous case with EDS, classic type with spontaneous iliac artery dissection has been described. PMID:23997563
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.
Chung, Hwan-Hoon; Cha, Sang Hoon, E-mail: firstname.lastname@example.org; Cho, Sung Bum; Kim, Jung Hyuck; Lee, Seung Hwa [Ansan Hospital, Korea University College of Medicine, Department of Radiology (Korea, Republic of); Shin, Jae Seung [Ansan Hospital, Korea University College of Medicine, Department of Thoracic and Cardiovascular Surgery (Korea, Republic of); Park, Sang Woo [KonKuk University Hospital, Department of Radiology (Korea, Republic of)
The authors report a case of internal carotid artery dissection in a young woman with Behçet's syndrome. The authors postulate that a vasculitis of the vasa vasorum already suspected as the basis of aneurysm formation in course of Behçet's syndrome can account for occurrence of arterial dissection in this inflammatory condition. PMID:9732425
Pannone, A; Lucchetti, G; Stazi, G; Corvi, F; Ferguson, T L; Massucci, M; Zaccaria, A
Two cases of spontaneous left main coronary artery dissection are reported. This condition is rare and may present as an urgent surgical dilemma. The presentation, diagnosis, and management of primary left main coronary artery dissection are reviewed. Causative factors and underlying pathology are clarified. Prompt diagnosis and surgical intervention with temporary ventricular support is safe and effective. PMID:9692481
Thistlethwaite, P A; Tarazi, R Y; Giordano, F J; Jamieson, S W
Spontaneous coronary artery dissection is a rare cause of acute presentations to the catheter laboratory. Often, the angiographic findings are subtle and may be mistaken for a plaque rupture. We descibe a case where repeat presentation revealed the diagnosis of recurrent spontaneous coronary artery dissection.
Strokes of the posterior circulation are uncommon in childhood. In vertebrobasilar insults, vertebral artery dissection remains a rare diagnosis. We report the case of an 8-year-old boy with a history of migraine headaches who presented with acute cerebellar signs and agitation following multiple infarctions of bilateral cerebellar hemispheres. Vertebral angiography demonstrated dissection of the left vertebral artery with occlusion of
Postgraduate cadaver dissection is an unsurpassed method of maintaining and improving one's knowledge of anatomy. Since fresh cadavers are not always available, some form of preservation is often required especially for courses or workshops. A technique using glutaraldehyde is described and its pros and cons compared with the time honored formaldehyde-phenol technique. The method is particularly suitable for cadaver preservation
|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…
This video gallery is from the Museum's Seminars on Science, a series of distance-learning courses designed to help educators meet the new national science standards. There are 16 videos each covering dissection of a different part of the dogfish shark. There is a downloadable pdf for each video.
|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)|
Spontaneous coronary artery dissection (SCAD) is an infrequent condition that is underdiagnosed. There is a predilection for young women without traditional cardiovascular risk factors, and it is increasingly diagnosed in women who are not peripartum. We discovered an association between SCAD and fibromuscular dysplasia (FMD), in which most women with nonatherosclerotic SCAD were found to have FMD in another vascular territory. We suspect that these seemingly healthy patients have underlying coronary FMD that predisposed them to coronary dissection. Medical treatment of SCAD includes antiplatelet therapy and ?-blockade. Revascularization of SCAD patients might be challenging, and the recommendation for stenting or surgery depends on their clinical status and the dissected coronary anatomy. The long-term outcome of patients who survived their SCAD event is generally good, however, they are at risk for recurrent dissection and major cardiovascular events, and thus should be closely monitored by cardiovascular specialists. This review summarizes the epidemiology, associated etiology, diagnosis, management, and outcome of patients with SCAD. PMID:23498840
A 75-year-old female was admitted to our hospital with sudden back pain and right leg ischemia. Computed tomography showed acute type A aortic dissection with the occlusion of the right common iliac artery. The patient was treated with ascending aorta replacement and femoro-femoral bypass. Three hours after the operation, the patient went into a sudden shock. Electrocardiogram showed ventricular tachycardia and ventricular fibrillation. Percutaneous cardio-pulmonary support was administered and coronary arteriogram (CAG) was proceeded for evaluation of the coronary arteries. Although CAG revealed normal coronary arteries, intravascular ultrasound showed mobile intimal flap at left main coronary artery trunk, suggesting dissection of the coronary artery. Percutaneous coronary intervention of the left main coronary artery trunk was performed. The patient recovered from shock and was discharged from the hospital without any major complication. PMID:22566246
Hori, Daijiro; Noguchi, Kenichiro; Yamaguchi, Atsushi; Adachi, Hideo
Background: Along with the ongoing modifications in treatment of primary breast cancer, the purpose and extent of lymph-node dissection\\u000a has changed. The following is an overview of the current knowledge and practice of lymph-node dissection in breast cancer,\\u000a with special regard to expected developments in the near future. Axillary dissection is described as a ten-step procedure,\\u000a including dissection of level-I
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
Spontaneous coronary artery dissection is a rare and generally fatal disease. A review of the literature demonstrates that the aetiopathogenesis of the disease is unknown and that the histology is rarely described. It usually occurs in young women during the post-partum period or while taking oral contraceptives. The treatment depends on the clinical presentation and the results of the angiography. We report here a case of spontaneous dissection of the left main stem coronary artery, with extension into the left coronary territory which which occurred in a 43-year-old woman. PMID:18614552
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Spontaneous coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death. The clinical presentation is highly variable and prognosis varies widely, depending mainly on how rapidly it is diagnosed. Prompt treatment is also essential, and includes medical management, percutaneous coronary intervention and surgical revascularization. We describe the case of a young woman presenting with spontaneous coronary artery dissection of the left main coronary artery, first diagnosed as coronary thrombus, who underwent successful percutaneous coronary stenting. This report highlights the need to include spontaneous coronary artery dissection in differential diagnosis of chest pain in young women and that distinguishing between coronary thrombus and coronary artery dissection is not always straightforward. To our knowledge this is the fourth case of left main stenting in a patient with spontaneous coronary artery dissection described in the literature. PMID:23809628
Sousa, Alexandra; Lopes, Ricardo; Silva, João Carlos; Maciel, M Júlia
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.
View this Webcast dissection of four shark species conducted last August at the Birch Aquarium and narrated by Dr. Jeffrey Graham of the Scripps Institution of Oceanography. This is a rare opportunity to learn from a marine biologist as he examines the internal organs of these sharks for the audience. The site also has several short text sections offering life history and behavioral information for those users interested in learning more about sharks in general.
A sheep brain is used to teach about memory and where it takes place because its brain structure and functions are similar to the human brain. Students will be exposed briefly to the fact that electrochemical connections made between brain cells help us remember the thoughts, skills, experiences, and knowledge that make each of us unique. Through dissections, students will learn about the cortex, brain cells, and where the three main subdivisions of memory (working, long-term, and skill memory) take place.
Science NetLinks (The museum of science, art and human perception at the Palace of Fine Arts;)
A 54-year-old hypertensive woman was admitted with severe interscapular back pain. A chest radiograph showed marked widening of the mediastinum. Aortography demonstrated a DeBakey type III, a thoracic aortic dissection and an anomalous right subclavian artery which was associated with an isolated left vertebral artery. The patient underwent aortic arch replacement with 5 branches and made an uneventful recovery. As far as we can determine, this is the first reported occurrence of these anomalies together with acquired disease of the aorta. PMID:9972891
Spontaneous coronary artery dissection is rare and previously was associated with a high mortality rate. Spontaneous dissection of the internal carotid artery is a cause of ischemic stroke, especially in young patients. Medical therapy allows healing of the carotid dissection in most patients, although endovascular stent placement has been reported for the treatment of selected cases. A case is reported of a patient in their late 30s who presented with a symptomatic occlusive cervical carotid artery dissection and, 7 days later, developed an acute coronary syndrome due to an occlusive dissection of the intermediate artery. Both lesions were treated with stent placement. PMID:22131438
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.
Kutlu, Ramazan [Inonu University School of Medicine, Department of Radiology (Turkey)], E-mail: email@example.com; Ara, Cengiz [Inonu University School of Medicine, Department of General Surgery (Turkey); Sarac, Kaya [Inonu University School of Medicine, Department of Radiology (Turkey)
Acute aortic dissection is a life-threatening disease that requires immediate surgical intervention. Although aortic dissection is a rare condition during pregnancy, it is of high risk for both mother and foetus. Most cases of aortic dissection during pregnancy have certain risk factors, including Marfan syndrome and congenital heart diseases. In this study, we report on a case of acute aortic dissection developing spontaneously at 32 weeks of gestation. The patient delivered a baby through cesarean section, and medical management of the dissection was commenced. Both mother and neonate survived and recovered well. PMID:23192290
Two patients had isolated unilateral cranial nerve palsies due to spontaneous internal carotid artery (ICA) dissection without ischaemic cerebral involvement. One had acute glossopharyngeal and vagal, the other isolated hypoglossal nerve palsy. Reviewing all reported cases of angiographically confirmed ICA dissection in the literature, 36 additional cases with unequivocal ipsilateral cranial nerve palsies were analysed. While an isolated palsy of the IXth and Xth has not been reported previously, palsies of the XIIth nerve or the IXth to XIIth nerves were most frequently found. In these patients, lower cranial nerve palsies are probably the result of compression by an enlarging ICA due to mural haematoma. Symptoms and signs indicative of carotid dissection were concurrently present only in some reported cases. This raises the question of unrecognised carotid dissection as a cause of isolated cranial nerve palsies. When the dissection occurs in the subadventitial layer without relevant narrowing of the arterial lumen and when an aneurysm is thrombosed, angiography does not reliably yield the diagnosis. Therefore, carotid dissection might have been underestimated as a cause of isolated lower cranial nerve palsies before the advent of MRI. MRI demonstrates directly the extension of the wall haematoma in the axial and longitudinal planes. Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Images
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
Mahenthiran, J.; Revankar, R.; Koka, V.; Hoo, J.; Shenoy, M.
INTRODUCTIONCarotid and vertebral artery dissections are potentially disabling and yet probably under-diagnosed, and mainly seem to affect young and middle-aged people (Bogousslavsky et al. 1987). Our review focuses on the mechanisms, possible underlying causes, clinical manifestations, diagnostic tools, treatment and prognosis of both carotid and vertebral dissection.EPIDEMIOLOGYCervical artery dissection accounts for up to 20% of strokes in patients under 30
Aneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery. PMID:21766201
Anichini, G; Passacantilli, E; Lenzi, J; Guidetti, G; Santoro, A
Objective?With the increasing use of the endoscope in neurosurgery, transsphenoidal surgery has undergone a considerable technical evolution. However, most recently reported advances relate to the approach to the sella turcica or to extended transsphenoidal approaches, whereas the dissection technique for pituitary tumor removal itself has received more limited attention. A notable exception is Oldfield's elegant description of an extracapsular dissection of functional pituitary microadenomas. Our objective is to describe and illustrate our technique for endoscopic extracapsular resection of pituitary macroadenomas.Methods?Influenced by Oldfield's description, we have adopted an extracapsular dissection technique in the endoscopic resection of pituitary macroadenomas. After carefully opening the dura without disrupting the macroadenoma pseudocapsule, the pseudocapsule is dissected inferiorly and laterally. The tumor is then internally debulked and the extracapsular dissection is extended circumferentially; the resection is then complete.Results?The enhanced visualization and illumination afforded by the endoscope enables the identification and surgical dissection of the pseudocapsule at the periphery of the macroadenomas under direct vision in most cases. As demonstrated in the illustrative case, working around the macroadenoma pseudocapsule allows for a definitive and complete macroadenoma resection with direct visual confirmation and with preservation of the normal gland and diaphragma.Conclusion?The endoscopic transsphenoidal approach permits an extracapsular dissection of many pituitary macroadenomas. In our preliminary experience, this technique appears to result in a high rate of complete resection without an increase in complications. PMID:23034885
Chamoun, Roukoz; Takashima, Masayoshi; Yoshor, Daniel
We report 4 cases of ascending aortic dissection in patients with long histories of weight lifting. In 2 of the patients, the initial symptoms of dissection developed while they were lifting weights. Two patients had a history of hypertension and 2 had previously used anabolic steroids. All 4 were successfully treated surgically. Histopathology showed aortic medial changes in all 4. We believe that the hemodynamic stresses of weight lifting, namely, a rapid increase in systemic arterial blood pressure without a decrease in total peripheral vascular resistance, in combination with aortic medial degeneration may have contributed to the development of the aortic dissection. PMID:2322060
de Virgilio, C; Nelson, R J; Milliken, J; Snyder, R; Chiang, F; MacDonald, W D; Robertson, J M
Bungee jumping is a popular recreational activity in which participant experiences transient freefall while connected to a bungee cord. The rapid freefall and the resultant rebound force created by the bungee cord can result in a variety of bodily injuries. We report herein a case of traumatic carotid artery dissection caused by bungee jumping. The symptoms related to carotid artery dissection were successfully treated with anticoagulation. The etiology of carotid dissection related to bungee jumping is discussed. Physicians should be cognizant of this potential injury due to the force created by the freefall and rebound motion associated in this recreational sport. PMID:17980290
Zhou, Wei; Huynh, Tam T; Kougias, Panagiotis; El Sayed, Hosam F; Lin, Peter H
Spontaneous dissection of the left main coronary artery is the least common of all dissections involving the coronary arteries. It usually occurs in young women, especially in the peripartum or early postpartum period. We describe the case of a 59-year-old man with no previous history of atherosclerotic heart disease who presented in cardiac tamponade and was found to have a spontaneous left main stem coronary artery dissection at cardiac catheterization. Emergency revascularization was carried out with the patient remaining symptom-free 4 months after surgery. PMID:11996290
Badmanaban, Balaji; McCarty, David; Mole, Damian J; McKeown, Pascal P; Sarsam, Mazin A I
Dissections of the cervical arteries cause about 20% of total juvenile strokes. Approximately 4% of the carotid artery dissections are due to a (poly)trauma such as car accidents. Despite improved diagnostic facilities, traumatic dissections are often underdiagnosed or diagnosed too late due to a lack of awareness of potential initial signs and symptoms. We report here a case of a delayed embolic stroke after a car accident caused by a dissection of the carotid artery and subsequent pseudoaneurysm. To reduce the long-term morbidity or mortality of multiple trauma patients, an early detection of cervical carotid and vertebral dissections is strictly necessary.
Dissections of the cervical arteries cause about 20% of total juvenile strokes. Approximately 4% of the carotid artery dissections are due to a (poly)trauma such as car accidents. Despite improved diagnostic facilities, traumatic dissections are often underdiagnosed or diagnosed too late due to a lack of awareness of potential initial signs and symptoms. We report here a case of a delayed embolic stroke after a car accident caused by a dissection of the carotid artery and subsequent pseudoaneurysm. To reduce the long-term morbidity or mortality of multiple trauma patients, an early detection of cervical carotid and vertebral dissections is strictly necessary. PMID:23466599
Traumatic thoracic aortic injury is typically fatal. However, recent improvements in pre-hospital care and diagnostic modalities have resulted in an increased number of patients with traumatic aortic injury arriving alive at the hospital. Also, the morbidity and mortality associated with endovascular repair are significantly lower than with conventional open surgery in traumatic thoracic aorta injury. We experienced two cases of successful management of traumatic thoracic aortic dissection with endovascular stents caused by traffic accidents.
Jang, Mi Ok; Kim, Ju Han; Oh, Sang Ki; Lee, Min Goo; Park, Keun Ho; Sim, Doo Sun; Hong, Young Joon; Ahn, Youngkeun
Arteriography is thought to be mandatory for the diagnosis of internal carotid artery (ICA) dissection. With the introduction of transcranial Doppler sonography (TCD) and magnetic resonance imaging (MRI), however, this is no longer the case. In 13 consecutive patients with ICA dissections the diagnosis was made by means of non-invasive tests including extracranial and transcranial Doppler sonography, contrast enhanced computed tomography (ceCT), and, in five patients, MRI. Intra-arterial digital subtraction angiography used as the gold standard in all cases was confirmative. Extracranial and transcranial ultrasound findings indicative of the diagnosis could be identified. MRI directly demonstrated the intramural haematoma and the false lumen of the dissected artery. These non-invasive techniques also allowed for repetitive follow up examinations. They were, however, unable to demonstrate false aneurysms in the chronic state. Results show that the diagnosis of carotid dissection can be made by means of cerebrovascular ultrasound and MRI. Images
We recently observed a case of vertebral artery (VA) dissection following chiropractic neck manipulations. The first manifestation was unusual; in the form of vertigo. Therefore, the patient was referred to the otoneurologist. A VA dissection should be suspected in a case of vertigo following chiropractic neck manipulations, and vestibular tests should be done carefully, avoiding Rose’s positions. In our case,
|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…
Forty-nine cases of dissection of the internal carotid and vertebral arteries are reported in our prospective multicenter study of 35 men and 14 women, with a mean age of 46.77 years. (range 17–60 years). We evaluated etiology, clinical manifestations, investigative techniques, and treatment. Thirty-one patients had so-called spontaneous dissections, although in the remaining 18 minimal or obvious trauma was considered
Summary ¶?Dissecting aneurysms of intracranial posterior circulation have recently been shown to be less uncommon than previously\\u000a thought. However, those involving the posterior inferior cerebellar artery (PICA) and not vertebral artery at all are extremely\\u000a rare. We report here a case of a patient with a dissecting aneurysm of the lateral medullary segment of PICA which presented\\u000a as subarachnoid haemorrhage. The
Y. Kanou; K. Arita; K. Kurisu; F. Ikawa; K. Eguchi; S. Monden; K. Watanabe
This paper reports on the early and midterm results of endovascular treatment of acute carotid artery dissections, its specific\\u000a problems, and its limitations. We encountered seven patients with symptomatic extracranial carotid artery dissection, three\\u000a cases of which occurred after carotid endarterectomy, two after carotid angioplasty and stenting, and two after trauma. Balloon-expandable\\u000a and self-expanding stents were placed using a transfemoral
Stefan Schulte; Konstantinos P. Donas; Georgios A. Pitoulias; Svante Horsch
Opinion statement \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a There is no controlled study for the best treatment or management of cervicocerebral artery dissection (CAD).\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Rationale initial empiric treatment in acute CAD to prevent secondary embolism is partial thromboplastin time (PTT)-guided\\u000a anticoagulation by intravenous heparin followed by anticoagulation with warfarin.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Carotid surgery for treatment of CAD is not recommended anymore with the possible exception
We report 2 cases of congenital pericardial defect with ruptured acute type A aortic dissection. Case 1: An 83-year old man presented with sudden chest and back pain, and computed tomography (CT) showed acute aortic dissection with left pleural massive effusion. Because of his unstable haemodynamic condition with low blood pressure, an emergency operation was performed. We observed small amounts of bloody pericardial effusion, massive left-sided bloody pleural effusion and a partial left-sided pericardial defect of the pulmonary artery. The ascending aorta was replaced. The postoperative course was uneventful. Case 2: A 79-year old man presented with fainting followed by cardiac arrest and was resuscitated. Chest CT showed acute aortic dissection and massive haemothorax. Emergency operation was attempted, but was given up. We observed partial left-sided pericardial defect of the pulmonary artery. Further, we reviewed 6 cases of congenital pericardial defect with ruptured acute aortic dissection, including our 2 cases. In all the cases, the patients did not develop cardiac tamponade but had massive haemothorax due to congenital pericardial defects leading to confusion in diagnoses and surgical strategies. Therefore, it may be necessary to consider congenital pericardial defects before performing an operation in case of acute type A aortic dissection with massive haemothorax. PMID:22843655
Isolated dissection of visceral arteries without associated aortic pathology is very rare. Risk factors, etiology, and natural history of this pathology continue to be unclear, and the guidelines for clinical management remain to be defined. We present a case not described previously, with sequential dissections of the celiac trunk, superior mesenteric artery, and renal arteries without aortic involvement. The patient presented with severe back thoracic and abdominal pain and without evidence of peritonitis. An abdominal angio-CT scan showed dissection of the superior mesenteric artery (SMA), with partial thrombosis of the false lumen and subsequent stenosis of around 60%. Conservative treatment with anticoagulants seemed to be appropriate in the beginning, because the patient became asymptomatic spontaneously within a few hours and angio-CT showed dissection but no ischemic lesions. On day 10 after onset, however, he again indicated severe back thoracic and abdominal pain. Emergent CT was performed. The prior SMA dissection appeared to be worse due to increased size of the false lumen, followed by SMA stenosis (about 75?80%). In addition, dissection of the celiac artery and both renal arteries could be seen. The patient underwent angiography and stenting of the main trunk of the SMA, with good clinical and radiologic outcome. Double oral antiplatelet therapy was then introduced. An angio-MRI scan 6 months later showed stability of the multiple dissections. PMID:23522441
Though a rare cause of stroke in the general population, in almost one quarter of young patients affected by stroke cervical\\u000a artery dissection (CAD) is the underlying cause. Among these cases “spontaneous” dissections, intended as non-traumatic, represent\\u000a about 34% of posterior circulation arterial dissection in patients aged less than 18 years. We here describe the case of a\\u000a seven-year-old boy
S. Bacigaluppi; R. Rusconi; P. Rampini; F. Annoni; M. L. Zavanone; V. Carnelli; S. M. Gaini
Vertebral artery dissection and arteriovenous fistulas are uncommon complications of vascular access and angiographic procedures.\\u000a There are several cases of iatrogenic vertebral artery dissection secondary to central line placement reported in the literature.\\u000a Only a few iatrogenic arteriovenous fistulae have been reported, but none also involving the dissection of the vertebral artery.\\u000a In each of these cases, the fistulae were
David J. Finlay; Luis A. Sanchez; Gregorio A. Sicard
Background. Previously, we reported that the Flushknife (electrosurgical endoknife with a water-jet function) could reduce the operation time of colorectal endoscopic submucosal dissection (ESD) however, suitable situation for the Flushknife was obscure. This subgroup analysis of a prospective randomized controlled trial was aimed to investigate the suitable situation for the Flushknife. Methods. A total of 48 superficial colorectal neoplasms that underwent ESD using either the Flexknife or the Flushknife in a referral center were enrolled. The differences of operation time between the Flexknife and the Flushknife groups in each subgroup (tumor size, location, and macroscopic type) were analyzed. Results. Median (95% CI) operation time calculated using survival curves was significantly shorter in the Flushknife group than in the Flexknife group (55.5?min [41, 78] versus 74.0 [57, 90]?min; P = 0.039, Hazard Ratio HR: 0.53; 95% CI (0.29–0.97)). In particular, the HR in patients with laterally spreading tumors-nongranular type (LST-NG) in the Flushknife group was significantly smaller than in the Flexknife group (HR: 0.165?0.17; 95% CI (0.04–0.66)). There was a trend of decreasing HRs according to larger lesion size. Conclusions. The Flushknife proved its merits in colorectal ESD especially for the lesions which should be removed en bloc (LST-NG and large lesion).
A lingering issue in the area of protein engineering is the optimal design of beta motifs. In this regard, the framework provided by intestinal fatty acid binding protein (IFABP) was successfully chosen to explore the consequences on structure and function of the redesign of natural motifs. A truncated form of IFABP (Delta 98 Delta) served to illustrate the nonintuitive notion that the integrity of the beta-barrel can indeed be compromised with no effect on the ability to attain a native-like fold. This is most likely the outcome of the key role played by the preservation of essential core residues. In the search for the minimal structural determinants of this fold, Delta 98 Delta offered room for further intervention. A dissection of this protein leads to a new abridged variant, Delta 78 Delta, containing 60% of the amino acids of IFABP. Spectroscopic analyses indicate that Delta 78 Delta retains substantial beta-sheet content and preserves tertiary interactions, displaying cooperative unfolding and binding activity. Most strikingly, this construct adopts a remarkably stable dimeric structure in solution. This phenomenon takes advantage of the inherent structural plasticity of this motif, likely profitting from edge-to-edge interactions between beta-sheets, whereas avoiding the most commonly occurring outcome represented by aggregation. PMID:19844951
Franchini, Gisela R; Curto, Lucrecia M; Caramelo, Julio J; Delfino, José María
Background and aims. To introduce a special dissection technique named “Curettage and Aspiration Dissection Technique” (CADT) using a versatile instrument called Peng's Multifunction Operative Dissector (PMOD) for liver resection. PMOD is an electrosurgical pencil with an inline suction, bearing four functions: electric cutting, coagulation, aspiration and dissection, The above-mentioned functions can be achieved simultaneously or sequentially during liver resection. The purpose of this study was to evaluate this technique and the special electrosurgical device in hepatic surgery. Patients and methods. From June 2005 to December 2006, 70 consecutive patients with segmentectomy or major hepatectomy were performed with this dissection technique by the same surgeon. Peri-operative data and the technical aspect of this device and dissection technique for various types of liver resection were summarised. Results. Forty-nine of 70 cases with various degrees of cirrhosis. Median blood loss were 470 ml (100–2400 ml), the bleeding and mortality within one month postoperatively was zero. There were postoperative complications in 20 patients: bile leak occurred in five cases, nine cases with right pleural effusion and six with ascites. No relative complications with this method were found. Conclusion. The CADT and PMOD can achieve better dissection and hemostasis. It possible is a much more valuable alternative to other devices currently used for liver surgery.
A rare case of bilateral coronary artery dissection with rupture of aortic valve commissure following type A aortic dissection is described. 64-slice multidetector computed tomography (MDCT) was able to demonstrate both this findings along with involvement of other neck vessels. TEE demonstrated the severity and mechanisms of aortic valve damage and assisted the surgeon in valve repair. MDCT has played an invaluable role in the diagnosis of the abnormal details of such life-threatening vascular complications. PMID:18384568
Das, K M; Abdou, Sayed M; El-Menyar, Ayman; Ayman, El Menyar; Khulaifi, A A; Nabti, A L
Summary Treatment and prognosis of 14 patients of posterior fossa arterial dissections (AD) and dissecting aneurysms (DA) in one institution was reviewed. Internal trapping of aneurysm was performed for six patients presenting with SAH (three Vertebral, one posterior cerebral, one posterior inferior cerebellar, one anterior inferior cerebellar DA). The patency of the parent arteries was preserved in four DA patients with SAH (two Vertebral, two Basilar DA), 1 incidental vertebral DA, and one DA patient with brainstem infarction using stents and coils (four patients) or coils only (two patient). Proximal occlusion of parent artery was performed in a vertebral DA with SAH. One patient with a superior cerebellar DA presented with a midbrain infarct developed SAH with spontaneous occlusion of the aneurysm two weeks later. Of the 14 cases, ten were angiographically stable or cured during a follow up period of four to 70 months. one spontaneously resolved and two recurred. There was one death.
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
The case of a 21-year-old female patient with neck pain and brain stem symptomatology after appendectomy is reported. Duplex sonographic findings were compatible with right vertebral artery dissection and occlusion of the vessel. Angiography confirmed the diagnosis. The patient recovered within weeks and was free of symptoms 6 months after the acute episode. Dissection of the vertebral artery can occur with or without minor trauma. Associations with fibromuscular dysplasia, arterial hypertension and the use of oral contraceptives have been reported. As in our own patient, dissection can appear without any vessel pathology or risk situation. The most dangerous complication of the disease is rupture of the adventitia with subarachnoid hemorrhage. Without this complication, prognosis of vertebral artery dissection is favourable with complete recovery within weeks. Clinical findings, diagnostic procedure and therapy are discussed. PMID:1925454
Endoscopic submucosal dissection (ESD) was developed in Japan but has now also become permanently established in various centers in Europe. ESD is an endoscopic en bloc mucosal resection technique for the treatment of early cancers with a diameter >1 cm and also superficial precancerous lesions, which could only be removed unsatisfactorily in several fragments or with uncertain lateral safety margins using previous loop excision procedures. Using ESD a lesion is excised after circular marking and generous submucosal injection with a safety margin of approximately 5 mm and subsequently resected at the level of the submucosa with a 1-3 mm short diathermic knife. ESD requires high technical skills in interventional endoscopy and is more time-consuming than snare resection techniques. However, numerous studies have shown a clear superiority for ESD with respect to the R0 resection rate and the local recurrence rate. The present article gives a current review of the use of ESD in the upper and lower gastrointestinal tract and demonstrates perspectives of the procedure. PMID:23455659
Hochberger, J; Köhler, P; Kruse, E; Hûppertz, J; Delvaux, M; Gay, G; Wedi, E
Summary: A case of traumatic extracranial vertebral arte- rial dissection leading to vertebrobasilar thrombosis and respiratory compromise requiring mechanical ventilation was managed with intraarterial thrombolysis and stenting of the vertebral intimal dissection. In contrast to similar, previously reported cases, this critically ill patient made a full recovery, returning to his job as a secondary school teacher.
Rupert F. Price; Robin Sellar; Clarence Leung; Michael J. O'Sullivan
A case of traumatic extracranial vertebral arterial dissection leading to vertebrobasilar thrombosis and respiratory compromise requiring mechanical ventilation was managed with intraarterial thrombolysis and stenting of the vertebral intimal dissection. In contrast to similar, previously reported cases, this critically ill patient made a full recovery, returning to his job as a secondary school teacher. PMID:9802490
The major diseases affecting the aorta are aortic aneurysms and dissections, with patients with acute dissections often presenting in the emergency department (ED). Recent studies demonstrate a strong genetic predisposition to thoracic aortic aneurysms and dissections, independent of syndromes traditionally considered to predispose to aortic disease (such as Marfan syndrome). Nonsyndromic familial thoracic aortic aneurysms and dissections are inherited in
Sumera N Hasham; Matthew R Lewin; Van T Tran; Hariyadarshi Pannu; Ann Muilenburg; Marcia Willing; Dianna M Milewicz
Dissection of craniocervical arteries internal carotid artery (ICA), or vertebral artery (VA) is an increasingly recognized entity and infrequent cause of stroke. We investigated 8 patients (4 women and 4 men) with dissections of the craniocervical arteries. Diagnostic procedures for detection of craniocervical dissection included: extracranial ultrasound-color Doppler flow imaging (CDFI) of carotid and vertebral arteries, transcranial Doppler sonography (TCD) and radiological computed tomography (CT) and digital subtractive angiography (DSA) examinations. Ultrasound findings (CDFI of carotid and vertebral arteries) were positive for vessel dissection in seven patients (or 87.5 per cent) and negative in one patient. DSA was consistent with dissection in five patients (or 62.5 per cent), negative in one, while in two patients the examination was not performed due to known allergy to contrast media. Five patients (62.5 per cent) were treated with anticoagulants, one with suppressors of platelet aggregation, and two patients were operated. Six patients (75 per cent) after the treatment showed partial recovery of neurological defects, and an improvement of ultrasound finding of dissected arteries. In one patient, following operation, stroke developed with deterioration of motor deficit, and one patient was readmitted three months later due to a newly developed stroke and soon died. The diagnosis should be suspected in any young or middle-age patient with new onset of otherwise unexplained unremitting headache or neck ache, especially in association with transient or permanent focal neurological deficits. PMID:16417172
Pasi?, Marija Bosnjak; Solter, Vesna Vargek; Seri?, Vesna; Uremovi?, Melita; Vidrih, Branka; Lisak, Marijana; Demarin, Vida
A survey of 5000 American middle and high school level biology teachers was completed to assess attitudes and classroom practice relating to dissection and alternative teaching methods. A preliminary sample of 494 respondents revealed that 79% of teachers used dissection to teach biology. While 72% believed that dissection was an important part of the curriculum, 17% disagreed; 69% considered dissection to be an essential hands-on activity. While 31% believed that alternatives were as good as dissection for teaching anatomy and physiology, 55% disagreed. The primary reason given for continuing dissection, rather than exclusively using alternatives, was the hands-on aspect of dissection (69%). While the majority (66%) of biology teachers favoured student choice between dissection and other learning methods, 20% disagreed. Although the effectiveness of alternative methods has been documented, and ethical arguments against dissection have been advanced, the mainstream introduction of humane alternatives to dissection requires a transformation of the beliefs, experience and practice of biology teachers. PMID:23581121
King, Lesley A; Ross, Cheryl L; Stephens, Martin L; Rowan, Andrew N
We present the case of a young male with severe head injury, cervico-thoracic fractures, and an initially unrecognized brainstem infarct due to unilateral dissection of vertebral artery, who made an unusually excellent recovery. This report stresses the importance of prompt clinico-imaging diagnosis and prophylactic anticoagulant treatment in such cases. PMID:15702842
Stranjalis, G; Papavlassopoulos, F; Kouyialis, A T; Korfias, S; Bontozoglou, N; Sakas, D E
Vertebral artery dissection (VAD) has been infrequently recognized in children. The authors have reviewed 68 reported cases of VAD in children in the existing literature. An association between routine types of neck movement in sports and the evolution of VAD was recognized in half of the reported cases. Boys outnumbered girls by a ratio of 6.6 to 1, in contrast
Izhar Hasan; Simon Wapnick; Michael S. Tenner; William T. Couldwell
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.
Papadopoulos, Dimitris P., E-mail: firstname.lastname@example.org; Moyssakis, Ioannis; Perakis, Alexandros; Athanasiou, Andreas [Department of Cardiology (Greece); Anagnostopoulou, Sophia [University of Athens Medical School, Department of Anatomy (Greece); Benos, Ioannis; Votteas, Vassilios E. [Department of Cardiology (Greece)
A 34-year-old woman presented with a 5-month history of persistent vertigo after multiple roller coaster rides, followed by neck pain for 1 month and then 2 weeks of blurred vision related to diplopia. She was ultimately found to have bilateral cervical vertebral artery dissection. The images are described and the literature is reviewed regarding late diagnosis of vertebral dissection and prior cases of roller coaster-associated dissection. PMID:18190821
Left main coronary artery dissection occurs very rarely during selective coronary angiography, but it generally progresses to complete coronary occlusion. The traditional treatment of occlusive dissection of the unprotected left main coronary artery has been surgical. Percutaneous treatment has been sporadic and controversial. We report a case of iatrogenic occlusive dissection of the unprotected left main coronary artery during diagnostic coronary angiography, followed by successful stenting of the lesion.
Our classification system of acute dissection of the aorta is based on the site of the main intimal tear: Type A: on the ascending aorta; type B: on the transverse aortic arch; type C: on the descending aorta. The extension of the dissecting process is classified as "antegrade" or "retrograde". Acute dissection involving the ascending aorta is an absolute surgical urgency. Any delay in referring the patient to a proper surgical institution or to the operating room increases the risk of death. Fifty per cent of patients, indeed, either untreated or medically supported, die within 48 hours after the onset of symptoms. Surgical therapy is mainly aimed at preventing the patient from dying from intrapericardial rupture of the aorta or from acute massive aortic regurgitation. In type A, it is necessary to replace the ascending aorta with a bloodtight Dacron prosthesis after resecting the entry site, if possible. Downstream, joining the two dissected cylinders by two running sutures and the aid of GRF glue, seals the false lumen. Upstream, the reconstruction of the aortic root and the resuspension of the aortic valve, also by means of running sutures and GRF glue, suppress the aortic valve insufficiency in 90% patients. However, in case of pre-existing annulo-aortic ectasia, the ascending aorta must be replaced by a composite tube according to the Bentail technique. The use of GRF glue since the beginning of 1977, has dramatically improved the immediate and long-term results, accounting for a hospital mortality rate of 10%, in patients less than 65 years old. In type B, resecting the entry site requires that the transverse arch be partially or totally replaced. It is, therefore, mandatory to protect the Central Nervous System. In our experience this is best achieved by perfusing the carotid arteries with cold blood (6 degrees C) during circulatory arrest at moderate core hypothermia (28 degrees C). With this technique of "Cerebroplegia", the hospital mortality rate has been lowered to 28%, higher, though, than in patients undergoing isolated replacement of the ascending aorta. In type C, only the dissections demonstrating symptoms of major complications (rupture or deleterious ischemia) require urgent surgical treatment. In the remaining cases, medical treatment, based on permanent and accurate control of the patient's blood pressure, lead to a good long-term survival rate. Close survey at regular intervals, by means of CT scan or MNR is mandatory to detect any aneurysmal evolution, which may require surgery.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8482700
Guilmet, D; Bachet, J; Goudot, B; Dreyfus, G; Martinelli, G L
A 77-year-old woman with right aortic arch was diagnosed as aortic dissection (De Bakey IIIb) and hospitalized for conservative treatment. But, her respiratory condition deteriorated due to tracheal stenosis with aortic dissection. Surgical graft replacement of the descending aorta was performed to release tracheal stenosis. Six days after surgery, tracheoesophageal fistula (TEF) was noticed. The size of the fistula was 3 cm in diameter, located 3cm to the oral side from the carina and 23 cm from the incisors. Nineteen days after surgery, an esophageal stent was placed leading to temporary improvement of the respiratory status, but it aggravated again. Unfortunately, she died due to ventricular fibrillation 26 days after surgery. The case is extremely rare with dissection of the right aortic arch. Such a case is considered to be a high risk of TEF, and it is necessary to perform early preventive measures. PMID:23984573
. \\u000a Isolated dissections of the posterior inferior cerebellar artery (PICA) are rare. Thus, no large series of cases have been\\u000a reported in the literature. Due to limited knowledge regarding the natural history of these lesions and the lack of high-quality\\u000a evidence supporting various treatment options, management is controversial and practice parameters are ill defined. In order\\u000a to offer a comprehensive
Rabih G. Tawk; Bernard R. Bendok; Adnan I. Qureshi; Christopher C. Getch; Jayashree Srinivasan; Mark Alberts; Eric J. Russell; H. Hunt Batjer
Background: Pneumococcal meningitis in adults is widely associated with intracranial complications, which occur in up to 74.7% of the patients. Method: Case report. Results: We report the case of a 40-year-old white female with pneumococcal meningitis after a sinus surgery, who developed a concomitant cerebral venous thrombosis and multiple cervical artery dissections. Following treatment with antibiotics and intravenous heparin, she had complete neurological recovery. Conclusions: Vascular complications should always be remembered and adequately treated in patients with bacterial meningitis. Cervical arterial dissections should be investigated as potential embolic sources of intracranial ischemic lesions.
Spontaneous coronary artery dissection is a rare but morbid event. We present the case of a previously healthy 38-year-old man who experienced severe chest discomfort while vigorously exercising. An acute anterolateral myocardial infarction was diagnosed. The patient underwent coronary angiography, demonstrating acute thrombosis of the left main coronary artery. The patient was referred for immediate bypass surgery. Examination of the left main coronary artery in the operating room revealed a dissection flap with thrombosis. With successful surgical intervention, the patient made an uneventful recovery. This case is discussed and the literature reviewed. PMID:16106188
Justice, L Todd; Dauterman, Kent; Smedira, Nicholas G; Moliterno, David J
Vertebral artery dissection\\u000a (VAD) has been observed\\u000a in association with chirotherapy of\\u000a the neck. However, most publications\\u000a describe only single case reports\\u000a or a small number of cases.\\u000a We analyzed data from neurological\\u000a departments at university hospitals\\u000a in Germany over a three year\\u000a period of time of subjects with vertebral\\u000a artery dissections associated\\u000a with chiropractic neck manipulation.\\u000a We conducted a
U. Reuter; M. Hämling; I. Kavuk; K. M. Einhäupl; E. Schielke
Aortic dissection involving the arch can be complicated by extension to the supra-aortic branches. Carotid dissection may be symptomatic or asymptomatic at the time of surgery. Dissection or re-dissection of repaired carotid may happen later, with symptoms occurring days after the surgical repair, increasing the morbidity and mortality of those patients. We report a case of a patient with type A aortic dissection involving the aortic arch and extending to the supra-aortic branches. During surgery the dissection was seen extending to the distal carotid arteries with tears in the inner wall. After use of surgical glue as a sealant, seeing the persistent fragility and the presence of spiral form tears in the internal wall of the carotid arteries, intraoperative stenting of the common carotid arteries was performed using two stents to prevent carotid re-dissection and ischemic stroke in the postoperative period. In patients with aortic dissection and extension into the carotid arteries, especially with presence of tears of the inner wall, after use of a glue as a sealant of the two dissected layers, if the repaired artery wall results are still fragile, use of intraoperative carotid stenting may be of help in preventing late re-dissection. PMID:18940833
A case of dissecting aortic aneurysm in a 4-year-old male thoroughbred horse is reported. The horse had a history of inflammation in the right thigh and a fever 2 weeks before sudden death. At necropsy, aortic aneurysms were observed from the aortic valve to the aortic arch, spreading over a distance of 40 cm. An irregular rupture of the intima of the ascending aorta was located in the cardiac side of a ramification to the tunica branchiocephalicus communis. An intramural haematoma, apparent on the cut surface and in the pericardium, had caused cardiac tamponade and sudden death. PMID:10213675
Endovascular stent-graft repair is emerging as the treatment of choice for complicated type B aortic dissection. In this report we describe a patient who presented with type B aortic dissection involving a right-sided aortic arch (RAA), a rare congenital vascular anomaly. The initial aggressive medical treatment proved unsuccessful due to false aneurysm expansion. Given the greater complexity of conventional surgical repair and the limited experience with this rare malformation, endovascular repair was preferred and successfully performed. We report the first case of endovascular repair of type B dissection involving RAA, confirming that endovascular treatment is technically feasible also when the dissection involves this unusual vascular malformation.
Croccia, Maria Grazia; Levantino, Maurizio; Cioni, Roberto; Bortolotti, Uberto
The dissecting aortic aneurysm (DAA) is an emergency, and because of that it requires urgent diagnosis and treatment. Many methods may by used to diagnose dissection, including aortography, CT, MRI, traditional and transesophageal ultrasonography. The computed tomography is often used in diagnostic of DAA, thus the knowledge of morphological characteristic of dissection is very important. The most important features of dissection in CT are presence of dissection of intima and two lumens, true and false. Nevertheless, the CT pictures of dissection not always appears like this, and sometimes the two lumens are identified only by their different rates of opacification with contrast material. PMID:15314960
Pas?awski, Marek; Z?omaniec, Janusz; Ruci?ska, Eulalia; Horbaczewska, Anna
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.
Diagnostic imaging for aortic dissection has dramatically changed in recent years. Previously, imaging consisted of conventional X-ray radiography, followed by invasive catheter angiography. Now imaging of dissection is performed primarily with multidetector CT, and to a lesser extent, with ultrasound and MRI. Catheter angiography is used primarily as a means of treating complications. Which modality to choose depends on patient factors, physician preference, and differences in availability of state-of-the-art equipment. All three modalities are highly accurate in experienced hands and have revolutionized the detection and evaluation of this condition. PMID:16253826
A 63-year-old Japanese man with no significant medical or family history was admitted for sudden consciousness disturbance, left hemiparesis and shock. Physical examination showed internal carotid artery asymmetry on palpation and significant differential blood pressure in both upper arms. A thoracic CT scan showed classic aortic dissection from the ascending aorta through the common iliac artery, classic dissection of the left common carotid artery and an intramural haematoma in the right common carotid artery. The patient's consciousness level gradually improved, and he underwent emergency surgery involving aortic rebuilding with a synthetic graft. Subsequently, he had a good clinical course. PMID:22783009
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 discover how engineers solve problems such as how to vary between low and high heat and fan speed by simply moving the position of a single switch. Principles of alternating versus direct current, series and parallel circuits, electrical safety, voltage dividing, ac rectification, power, and measurement of resistance and continuity all come in to play.
Carotid and vertebral artery dissection are relatively frequent and risky conditions. In the last decade, different patients with extracranial (and in 1 case also intracranial) dissections associated with the practice of scuba diving were reported. The connection between the two conditions has not been fully explained so far. In the present article, we report the case of a patient presenting with Claude Bernard-Horner syndrome and homolateral XII cranial nerve palsy, manifesting a few days after diving in the cold water of a lake. The patient ended up having internal carotid artery dissection associated with the formation of a pseudoaneurysm. Here, we offer a summary of all cases reported in the literature about scuba diving and arterial dissection, and provide a critical discussion about which scuba diving-related factors can trigger the dissection of cervical vessels.
Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart transplantation. We report the second case of successful surgical treatment of aortic dissection confined to the donor aorta in a recipient of an orthotopic cardiac allograft. A 68-year-old patient was admitted with chest pain and shortness of breath 7 years after orthotopic heart transplantation. He
Ali Kubilay Korkut; Francis Wellens; Luc Foubert; Marc Goethals
Spontaneous dissection of the vertebral artery (VA) is usually managed medically. The objective of this report was to describe 10 patients treated surgically for spontaneous dissection of the VA. Seven men and three women with a mean age of 52.5±11.3 years were treated between December 1978 and January 2001. In eight cases the presenting symptom was neck pain. Transient ischemic
Laurent Chiche; Barbara Praquin; Fabien Koskas; Edouard Kieffer
Spontaneous dissection of the superior mesenteric artery (SMA) is rare and has been reported only sporadically. Therapeutic options are either a surgical approach, which is the more frequently adopted, or a simple observation. We report a case of spontaneous dissection of the SMA with a review of the literature and present a new therapeutic approach.
Froment, P. [Ospedale San Giovanni, Department of Surgery (Switzerland)], E-mail: email@example.com; Alerci, M. [Ospedale San Giovanni, Department of Radiology (Switzerland); Vandoni, R.E.; Bogen, M.; Gertsch, P. [Ospedale San Giovanni, Department of Surgery (Switzerland); Galeazzi, G. [Ospedale San Giovanni, Department of Radiology (Switzerland)
We present a case of 44 year-old female who was admitted to the hospital due to performed radio frequency ablation because of VF during WPW syndrome, which was complicated by dissection of left main. The dissection was treated with success by primary percutaneous coronary intervention with two metal stents. PMID:22427091
Kulawik, Tomasz; Ka?u?a, Bernadetta; Ku?nierz, Jacek
Background. Extensive aortic replacement in acute dissection is currently not a widely accepted method of treatment.Methods. We developed a safe method for extended aortic repair including the aortic arch in type A acute dissection, and describe here its application in 5 cases. This method was based on a modification of the elephant trunk method and several other strategies. Most of
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.
Heye, Sam, E-mail: firstname.lastname@example.org; Maleux, Geert [University Hospitals Gasthuisberg, Department of Radiology (Belgium); Vandenberghe, Rik [University Hospitals Gasthuisberg, Department of Neurology (Belgium); Wilms, Guido [University Hospitals Gasthuisberg, Department of Radiology (Belgium)
A case of spontaneous isolated dissecting aneurysm of the left main and anterior descending branches of the left coronary artery in a 42-year-old woman is described. The patient survived the dissection, and resultant myocardial infarct with cardiogenic shock was treated with an orthotopic cardiac transplant. She died from a bilateral pneumonia caused by Candida tropicalis 3 weeks later. Spontaneous isolated
J. Fernando Val-Bernal; Concepción Alvarez-Cañas; José L. Vega; Juan J. Olalla
Traumatic vertebral artery dissection is an unusual event in children, but early recognition and treatment are important to prevent neurological deficits. The authors present a case of a 4-year-old boy with a traumatic extracranial vertebral artery dissection, who suffers from left arm monoplegia due to brachial plexus injury.
We present a case of a 32 year-old right-hand dominant woman who sustained a right brachial plexus injury, ipsilateral fractures of the cervical spine transverse processes, and vertebral artery dissection. She presented to us four days following the initiating accident. Magnetic Resonance Imaging showed normal brachial plexus along with vertebral artery dissection with intramural thrombus and vascular lumen occlusion. The
Spontaneous coronary artery dissection is a rare but potentially life-threatening event associated with the peripartum period. We present a case of postpartum multivessel spontaneous coronary artery dissection diagnosed by conventional angiography and monitored with computed tomographic coronary angiography. The patient was initially managed medically and later received a coronary stent.
Schroder, Catherine; Stoler, Robert C.; Branning, George B.
Many studies have reported on the perceptions of medical students toward dissection. It is important to understand the feelings and symptoms experienced during dissection so that they can be adequately handled. Prior to dissection, first year students are given lectures on aspects of dissection, death and dying, and death rituals in various cultures. Two separate questionnaires, one given during the first week of dissection and another given one month into the program were then completed anonymously by dissection groups. The questions were designed to be open-ended, thereby encouraging group discussion amongst students. The questionnaires were used to determine the perception of students to dissection and to discover if these perceptions change during the dissection program. The first questionnaire revealed that students do experience fears and anxiety prior to and at the beginning of dissection; however, most of these fears dissipated by the time of the second questionnaire. One month into dissection students cited talking to peers as their main coping mechanism and fewer students mentioned emotional detachment from their cadaver as a coping mechanism, as was the case in the first questionnaire. Dissection was perceived as a positive experience by our student cohort and most students cited the main advantage of dissection as the ability to visualize organs in three dimensions. The comprehensive answers received from the students indicated that thorough discussion of feelings amongst peers occurred, introducing students to an important coping mechanism at an early stage of their learning. PMID:23208957
In our previous study, the healing effect of proton pump inhibitor plus rebamipide for endoscopic submucosal dissection-related artificial ulcer smaller than 40 mm showed statistical significance. However, such effect of the combination was not yet clear for ulcers with dissected diameter more than 40 mm. The aim of this present study was to resolve this problem under sufficient statistical power, with adequate sample size. We conducted a randomized controlled study. Either the proton pump inhibitor mono-therapy or the combination therapy was prescribed for 28 days after endoscopic submucosal dissection. Eighty-seven patients were eligible for outcome evaluation. Combination therapy was significantly superior to mono-therapy, 27.8% vs 0% reached healing stage (scar stage) in cases with ulcers of dissection diameter more than 40 mm. In conclusion, the combination therapy with rebamipide was favorable regimen in patients with larger artificial ulcer after endoscopic submucosal dissection.
In our previous study, the healing effect of proton pump inhibitor plus rebamipide for endoscopic submucosal dissection-related artificial ulcer smaller than 40 mm showed statistical significance. However, such effect of the combination was not yet clear for ulcers with dissected diameter more than 40 mm. The aim of this present study was to resolve this problem under sufficient statistical power, with adequate sample size. We conducted a randomized controlled study. Either the proton pump inhibitor mono-therapy or the combination therapy was prescribed for 28 days after endoscopic submucosal dissection. Eighty-seven patients were eligible for outcome evaluation. Combination therapy was significantly superior to mono-therapy, 27.8% vs 0% reached healing stage (scar stage) in cases with ulcers of dissection diameter more than 40 mm. In conclusion, the combination therapy with rebamipide was favorable regimen in patients with larger artificial ulcer after endoscopic submucosal dissection. PMID:23170045
This article describes an experiential course with the goal of immersing medical students in a cadaver dissection course abroad. The course was developed because of a reduction in cadaver opportunities and a desire by medical students to gain dissection skills.
|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,…
|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)|
Ilioinguinal block dissections have been traditionally associated with a high incidence of complications. Wound complication rates are in the range of 50 to 70% and lymphedema is seen in a majority of cases. A variety of incisions and reconstructive techniques have been experimented with in an effort to reduce the morbidity. We have used the tensor fasciae lata (TFL) myocutaneous
D. N. Savant; A. V. Dalal; S. G. Patel; H. M. Bhathena; N. M. Kavarana
Penile cancer with inguinal lymph node metastasis is a common cancer in India. Open inguinal lymphadenectomy is the gold standard treatment of metastatic inguinal lymph nodes. We report our experience and technique of robotic assisted inguinal lymph node dissection in two patients presented with palpable inguinal lymph nodes, which to our knowledge is the first reported case series from India.
Dogra, P. N.; Saini, Ashish Kumar; Singh, Prabhjot
Cardiac complications associated with type A aortic dissections are relatively common before and during the surgical repair. A cardiac event occurring a few days after routine recovery is rare though. We describe a case of acute occlusion of the left anterior descending artery by thrombus, 4 days after surgical repair, salvaged by emergency angioplasty and stenting. A possible explanation for
J. Andreas Hoschtitzky; Louise Crawford; Mick Brack; John Au
Summary: Vertebral artery injury may occur at the time of cer- vical fracture or dislocation. Congenital vertebral artery varia- tions, especially a double vertebral artery origin, may be respon- sible for angiographic findings that mimic vertebral artery dissection. Two cases of cervical spine fracture with ipsilateral double vertebral artery are presented. Conventional cerebral an- giography is the easiest and best
Thomas E. Nogueira; A. Alan Chambers; Mary T. Brueggemeyer; Timothy J. Miller
The goal of this study was to evaluate the results of endovascular and surgical treatments for ruptured vertebral artery dissecting aneurysms (VADAs) to determine which treatment is preferable. We evaluated the cases of 25 consecutive patients with ruptured VADAs treated in our institution. From 1992 to 1997, five patients were treated surgically. Since 1998, 20 patients with VADAs have been
K. Sugiu; K. Tokunaga; K. Watanabe; W. Sasahara; S. Ono; T. Tamiya; I. Date
The authors report the case of a 37-year-old man who presented with subarachnoid haemorrhage (SAH) after rupture of an extradural vertebral artery dissecting aneurysm. The patient underwent a left lateral suboccipital craniotomy with removal of the medial part of the occipital condyle and the fusiform dilatation was coated. The angiograms 3 months after surgery showed aneurysm resolution and normal vessel
Javier Fandino; Yasuhiro Yonekawa; Werner W Wichmann; Peter Roth
The logical depth of a graph $G$ is the minimum quantifier depth of a first order sentence defining $G$ up to isomorphism in the language of the adjacency and the equality relations. We consider the case that $G$ is a dissection of a convex polygon or, equivalently, a biconnected outerplanar graph. We bound the logical depth of a such $G$
Carotid artery dissections (CAD) are uncommon, but not rare, and are increasingly recognized as a cause of morbidity. A case of CAD following minimal sustained postural trauma is described. The causes and outcomes of CAD are discussed, with particular reference to risks that might be found in the workplace.
Cervicocephalic arterial dissection CCAD is an important, but rarely recognized, cause of stroke in children. We describe 3 cases of CCAD who were diagnosed during a study on childhood stroke which included 104 patients. A high index of suspicion and targeted investigations are needed for the diagnosis and management of CCAD in childhood. PMID:16532124
Salih, Mustafa A; Al-Jarallah, Ahmed A; Al-Salman, Mussaad M; Alorainy, Ibrahim A; Hassan, Hamdy H
...and Cease and Desist Orders; Termination of the...issued a general exclusion order prohibiting importation...issued cease and desist orders direct to domestic respondents...FOR FURTHER INFORMATION CONTACT: Panyin A. Hughes...SmileCase''); Suntel Global Investment Ltd. of...
OBJECTIVES: To stratify the rate and prediction of lymph node involvement in prostate cancer patients undergoing sentinel-lymphadenectomy depending on preoperative tumor characteristics, and to compare the outcome with the European Association of Urology Guideline indication for lymphadenectomy. METHODS: A total of 1229 patients (median age 66 years) were treated with open sentinel-lymphadenectomy and prostatectomy between 2005 and 2009. Median preoperative prostate-specific antigen was 7.4?ng/mL. The rate of lymph node involvement was analyzed for D'Amico risk groups. Multivariable logistic regression was used to estimate the probability of lymph node involvement. Predictor variables included preoperative prostate-specific antigen, clinical T-category and biopsy Gleason sum. Predictive accuracy has been quantified (area under the curve) and lymph node positive patients were verified under consideration of the recommended European threshold for lymphadenectomy (nomogram-predicted lymph node invasion risk of >7%). RESULTS: The median number of lymph nodes removed was 10 (interquartile range 7-13). Overall, 17.1% of patients had lymph node involvement; 3.2% in low-, 14.8% in intermediate- and 37.4% in high-risk disease. The predicted risk for lymph node involvement ranged from 2% (prostate-specific antigen ?4?ng/mL, T1, Gleason sum ?6) to 87% (prostate-specific antigen >20?ng/mL, T3, Gleason sum ?8). The predictive accuracy was 82.1%. According to the European guidelines, 15.9% of all lymph node involved cases would not have been detected. CONCLUSIONS: The rate of lymph node involvement seems to be higher in the examined sentinel collective than expected according to the European Guideline nomogram. The first sentinel-based lymph node involvement prediction model can assist in deciding on the indication for sentinel-lymphadenectomy. The validation of a corresponding sentinel-based nomogram is still missing. PMID:23659488
A 63-year-old male patient with a type B aortic dissection after the use of tadalafil, a phosphodiesterase type 5 inhibitor, is presented. The possible role of a novel predisposing factor--sexual activity combined with tadalafil--is reviewed. This report and three other cases add a new dimension to the known predisposing factors such as chronic systemic hypertension, hereditary connective tissue diseases- and congenital aortic valve diseases. However, the precise role of phosphodiesterase type 5 inhibitors in the pathophysiology of aortic dissection remains unknown. PMID:22269733
Lameijer, Charlotte M; Tielliu, Ignace F J; van Driel, Mels F; Zeebregts, Clark J
Acute aortic dissection is a life-threatening condition associated with high morbidity and mortality. In this article, the authors review basic biology of the aorta and aortic dissection, epidemiology, clinical presentation, diagnostic approach, emergency stabilization measures, and the latest surgical approach for type B dissection.
Although radioguided surgery has been used for the excision of sentinel nodes in breast cancer and melanoma, sparse literature exists describing its use in thyroid cancer. We report a 69-year-old patient with a previous total thyroidectomy and lymph node dissection for papillary carcinoma who was subsequently found to have recurrent metastatic disease. After a therapeutic dose of radioactive iodine, a hand-held gamma-probe was used to selectively dissect the neck. The patient was offered radioguided revision neck dissection to remove the disease using residual radioactivity of the original therapeutic iodine 131 dose. Our case report seeks to demonstrate a recent example of our use of the gamma-probe in radioguided surgical excision of recurrent metastatic papillary thyroid carcinoma. PMID:16360827
The authors report an unusual manifestation of extracranial vertebral artery dissection (VAD), presenting with a predominantly motor radicular manifestation. Cervical magnetic resonance imaging (MRI) revealed the intramural hematoma in the dissected vessel wall, compressing mainly the segmental motor root and, to a lesser degree, the sensory ganglion. In the digital subtraction angiography (DSA), a circumscribed narrowing of the incriminated vessel was demonstrated. Color-coded Duplex imaging (CDDI) revealed complete recanalization after a few days of anticoagulation treatment. Complete neurologic recovery was seen after 3 months. Considering the MRI data, the likely pathogenetic mechanism was compression of the nerve root by the intramural hematoma. The synopsis with similar cases in the literature points to the characteristic features, i.e., the association of neck pain with radicular motor deficit and the absence of degenerative disk disease. The respective syndrome should raise the suspicion of vertebral artery dissection, especially in young individuals. PMID:10800269
In the emergency setting, a cold, clammy, dyspnoeic patient presenting with interscapular chest pain and unequal blood pressures suggests an acute aortic dissection until proven otherwise. By means of a case report, the authors detail one such patient who presented identically to one having an acute aortic dissection. Initial assessment showed unequal blood pressures in left and right arms, a resting tachycardia and indistinct heart sounds. Fluid resuscitation failed to improve the patient's physiological parameters and they rapidly deteriorated. The medical history included mesothelioma and atrial fibrillation. Existing investigations were reviewed and after thorough consideration of the patient's premorbid state and likely prognosis, the decision was made to palliate. The patient died shortly after being transferred to the oncology ward. Imaging is therefore integral to the assessment and management of a patient in whom an aortic dissection is feared.
Cranial nerve palsy in internal carotid artery (ICA) dissection occurs in 3--12% of all patients, but in 3% of these a syndrome of hemicranias and ipsilateral cranial nerve palsy is the sole manifestation of ICA dissection, and in 0.5% of cases there is only cranial nerve palsy without headache. We present two cases of lower cranial nerve palsy. The first patient, a 49-year-old woman, developed left eleventh and twelfth cranial nerve palsies and ipsilateral neck pain. The angio-RM showed an ICA dissection with stenosis of 50%, beginning about 2 cm before the carotid channel. The patient was treated with oral anticoagulant therapy and gradually improved, until complete clinical recovery. The second patient, a 38-year-old woman, presented right hemiparesis and neck pain. The left ICA dissection, beginning 2 cm distal to the bulb, was shown by ultrasound scanning of the carotid and confirmed by MR angiogram and angiography with lumen stenosis of 90%. Following hospitalisation, 20 days from the onset of symptoms, paresis of the left trapezius and sternocleidomastoideus muscles became evident. The patient was treated with oral anticoagulant therapy and only a slight right arm paresis was present at 10 months follow-up. Cranial nerve palsy is not rare in ICA dissection, and the lower cranial nerve palsies in various combinations constitute the main syndrome, but in most cases these are present with the motor or sensory deficit due to cerebral ischemia, along with headache or Horner's syndrome. In the diagnosis of the first case, there was further difficulty because the cranial nerve palsy was isolated without hemiparesis, and the second case presented a rare association of hemiparesis and palsy of the eleventh cranial nerve alone. Compression or stretching of the nerve by the expanded artery may explain the palsies, but an alternative cause is also possible, namely the interruption of the nutrient vessels supplying the nerve, which in our patients is more likely. PMID:11239957
We experienced a rare case of congenital pericardial defect incidentally found during off-pump coronary artery bypass grafting (CABG)[OPCAB]. We performed off-pump for a 61-year-old man. He was asymptomatic but was noted to have an abnormal chest X-ray showing the enlarged heart. He had right ventricule lifting upward and apex shifting far to left side. Partial absence of the left pericardium was found. The surgery was technically more demanding than usual, because of heart rotation and inadequate pericardial stitch. PMID:23445654
Thoracic aortic dissection, one of the major diseases affecting the aorta, carries a very high mortality rate. Improving our understanding of the pathobiology of this disease may help us develop medical treatments to prevent dissection and subsequent aneurysm formation and rupture. Dissection is associated with degeneration of the aortic media. Recent studies have shown increased expression and activation of a family of proteolytic enzymes—called matrix metalloproteinases (MMPs)—in dissected aortic tissue, suggesting that MMPs may play a major role in this disease. Inhibition of MMPs may be beneficial in reducing MMP-mediated aortic damage associated with dissection. This article reviews the recent literature and summarizes our current understanding of the role of MMPs in the pathobiology of thoracic aortic dissection. The potential importance of MMP inhibition as a future treatment of aortic dissection is also discussed.
Background. High-pressure water-jet dissection was originally developed for industry where ultra-precise cutting and engraving were desirable. This technology has been adapted for medical applications with favorable results, but little is understood about its performance in hepatic resections. Blood loss may be limited by the thin laminar liquid-jet effect that provides precise, controllable, tissue-selective dissection with excellent visualization and minimal trauma to surrounding fibrous structures. Patients and methods. The efficacy of the Water-jet system for hepatic parenchymal dissection was examined in a consecutive case series of 101 hepatic resections (including 22 living donor transplantation resections) performed over 11 months. Perioperative outcomes, including blood loss, transfusion requirements, complications, and length of stay (LOS), were assessed. Results. Three-quarters of the cases were major hepatectomies and 22% were cirrhotic. Malignancy was the most common indication (77%). Median operative time was 289 min. Median estimated blood loss (EBL) was 900 ml for all cases, and only 14% of patients had >2000 ml EBL. Furthermore, EBL was 1000 ml for major resections, 775 ml for living donor resections, 600 ml in cirrhotic patients, and 1950 ml for steatotic livers. In all, 14% of patients received heterologous packed red blood cell (PRBC) transfusions for an average of 0.59 units per case. Median LOS was 7 days. EBL, transfusion requirements, and LOS were slightly increased in the major resection cohort. There was one mortality (1%) overall. These results are equivalent to, or better than, those from our contemporary series of resections performed with ultrasonic dissection. Conclusion. Water-jet dissection minimizes large blood volume loss, requirements for transfusion, and complications. This initial experience suggests that this precision tool is safe and effective for hepatic division, and compares favorably to other established methods for hepatic parenchymal transection.
Dixon, Elijah; Sahajpal, Ajay; Cattral, Mark S.; Grant, David R.; Gallinger, Steven; Taylor, Bryce R.; Greig, Paul D.
This tutorial on frog dissection contains an introduction and sections on preparation, skin incisions, muscle incisions, and internal organs. The purpose of this lab activity is to help students learn the anatomy of a frog and provide them with a better understanding of the anatomy of vertebrate animals in general, including humans. This site provides still and motion visuals of preserved and pithed (severed spinal cord) frogs to demonstrate incisions, in addition to text.
Yeast is a highly tractable model system that is used to study many different cellular processes. The common laboratory strain Saccharomyces cerevisiae exists in either a haploid or diploid state. The ability to combine alleles from two haploids and the ability to introduce modifications to the genome requires the production and dissection of asci. Asci production from haploid cells begins with the mating of two yeast haploid strains with compatible mating types to produce a diploid strain. This can be accomplished in a number of ways either on solid medium or in liquid. It is advantageous to select for the diploids in medium that selectively promotes their growth compared to either of the haploid strains. The diploids are then allowed to sporulate on nutrient-poor medium to form asci, a bundle of four haploid daughter cells resulting from meiotic reproduction of the diploid. A mixture of vegetative cells and asci is then treated with the enzyme zymolyase to digest away the membrane sac surrounding the ascospores of the asci. Using micromanipulation with a microneedle under a dissection microscope one can pick up individual asci and separate and relocate the four ascopores. Dissected asci are grown for several days and tested for the markers or alleles of interest by replica plating onto appropriate selective media. PMID:19455096
Here we report a case of a 79-year-old woman with inferior myocardial infarction, transferred to our cath lab to perform a primary percutaneous coronary intervention (PPCI). During the procedure, a massive dissection complicated the thrombotic lesion of the right coronary artery (RCA). In this case, we decided to use the MGuard stent to treat both the large dissection and the thrombotic lesion. MGuard stent is a combination of a coronary stent merged with an embolic protection device. After multiple MGuard stent implantation we obtained a complete resolution of the coronary dissection obtaining a patent RCA with normal antegrade flow. PMID:20093945
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset thunderclap headache and focal neurologic deficits. Once thought to be a rare syndrome, more advanced non-invasive imaging has led to an increase in RCVS diagnosis. Unilateral vertebral artery dissection has been described in fewer than 40% of cases of RCVS. Bilateral vertebral artery dissection has rarely been reported. We describe the case of a patient with RCVS and bilateral vertebral artery dissection presenting with an intramedullary infarct treated successfully with medical management and careful close follow-up. This rare coexistence should be recognized as the treatment differs. PMID:23354867
ObjectiveThe purpose of this case report is to describe a patient who regularly practiced self-manipulation of her neck who presented with shoulder and neck pain and was undergoing a vertebral artery dissection.
...2012-10-01 2012-10-01 false Content of notice. 431.210 Section 431...Beneficiaries Notice Â§ 431.210 Content of notice. A notice required under...hearing; or (2) In cases of an action based on a change in law, the...
We report a case of acute aortic dissection in a lady of 28 weeks of gestation with undiagnosed Marfan syndrome. The patient had been seen in our antenatal clinics. Her history documented in her pregnancy record was negative for genetic/congenital abnormalities. There was no family history documented. Subsequently, at 28 weeks of gestation, the patient presented with sudden onset chest, jaw, and back pain. Further history revealed that her father had died at the age of 27 of an aortic dissection. Echocardiography showed aortic root dissection with occlusion of aortic branches. She subsequently underwent an emergency lower segment caesarean section followed by surgical repair of type A dissection. A simultaneous type B dissection was managed conservatively. On later examination, our patient fulfilled the diagnostic criteria for phenotypic expression of Marfan syndrome. Genetic testing also confirmed that she has a mutation of the fibrillin (FBN 1) gene associated with the disease. PMID:23304584
We report a patient with a ruptured vertebral artery (VA) dissecting aneurysm that was treated by internal trapping of the aneurysm and parent artery using detachable coils with subsequent antegrade recanalization of occluded vertebral artery during the follow-up period. A 38-year-old man was admitted with a ruptured right VA dissecting aneurysm just distal to origin of right posterior inferior cerebellar artery. The dissected segment of the VA was occluded by coil embolization. The 14 months follow-up angiography showed that dissected aneurysm was completely occluded, but the parent artery was recanalized in an antegrade fashion. Based on this unique case, the authors suggest that careful angiographic follow-up of dissecting aneurysm is required, even in patients successfully treated with endovascular occlusion of the affected artery and aneurysm.
Spontaneous coronary artery dissection (SCAD) is an uncommon condition that may lead to sudden coronary artery occlusion resulting in a fatal acute myocardial infarction. It usually affects young to middle age women. A Medline search from 1966 to 2001 (using keywords: coronary artery dissection and systemic lupus erythematosis) revealed no prior reports of coronary dissection in a patient with systemic lupus erythematosis (SLE). We describe a 48-year old woman with SLE who sustained a fatal spontaneous left main coronary artery dissection. Coronary angiogram was notable for marked variability in the size of coronary lumen from systole to diastole. This case demonstrates the need to consider SCAD in the evaluation of chest pain and myocardial infarction in patients with SLE. Furthermore, in the absence of classical angiographic findings of coronary dissection, a detailed review of phasic changes in coronary lumen during a cardiac cycle could help reach this diagnosis. PMID:14702766
Sharma, Arvind K; Farb, Andrew; Maniar, Parimal; Ajani, Andrew E; Castagna, Marco; Virmani, Renu; Suddath, William; Lindsay, Joseph
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
Although many surgical or endovascular treatments for ruptured vertebral artery dissection have been reported, the best treatment\\u000a is controversial. We treated five cases of ruptured vertebral artery dissection distal to the origin of the posterior inferior\\u000a cerebellar artery (PICA), using retrievable platinum coils packed in the dissection site and the immediately proximal vertebral\\u000a artery. All patients had a contralateral vertebral
H. Manabe; T. Hatayama; S. Hasegawa; S. M. D. Islam; S. Suzuki
Summary Dissection aneurysms of the vertebral artery represent 3.2% of all cerebral aneurysms and 28% of intracranial dissection aneurysms. Dissection of the vertebral artery in its intracranial segment (V4) usually causes a subarachnoid hemorrhage (SAH) from subadventiatial extension of the vessel wall hematoma. Rarely (one case in seven), the symptomatology is characterized by brain stem ischemia from the vertebral artery and/or postero-inferior cerebellar artery occlusive dissection. The high rebleeding (18-33% with a 10+/-5 day interval between the first and the second bleeding) and mortality (>45%) rates 1,13 of this disease prompt emergency treatment usually consisting in endovascular coiling of the dissection aneurysm and/or the dissected segment of the parent vessel. Herein we report our experience in endovascular coiling of acutely ruptured dissecting aneurysms of the vertebral artery dissection in V4 segment. We focus the discussion on the risk of rebleeding and the ischemic complications that my occur after endovascular or surgical treatment
Mangiafico, S.; Padolecchia, R.; Cellerini, M.; Puglioli, M.; Villa, G.; Nistri, M.
The purpose of this study was to examine the effectiveness of computer-simulated dissection versus the effectiveness of true dissection related to student achievement and attitude. Student achievement was measured by post-dissection and delayed post-dissection tests which measured students' knowledge on frog anatomy. Students' attitudes were measured by pre-dissection and post-dissection attitude surveys. The sample used consisted of 115 high school
We present a 49-year-old male who suffered a cerebellar infarction due to a vertebral artery dissection. The patient had taken sildenafil daily for at least 2 years for sexual enhancement. There was no sexual intercourse or traumatic event prior to symptom onset. Sildenafil intake has been associated with aortic dissection and, in the light of this report, we suggest that chronic sildenafil intake could be a risk factor for arterial dissection. PMID:23454143
Dersch, Rick; Anastasopoulos, Constantin; Hader, Claudia; Stich, Oliver
Genetic study can provide important insight into the etiology of aortic dissection. To explore the pathogenesis and natural history of aortic dissection, a number of genes have been identified through microarray chip screening and undergone testing of polymorphisms to find mutations strongly associated with the disease. The results suggested aortic dissection to be a multi-gene disorder. Multiple genes probably work together to promote its development. Several diseases with a genetic predisposition are closely connected with aortic dissection, which also implied a role of genetic changes and malfunction in this disease. PMID:23926011
Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality. The most important recognized acquired cause that leads to dissection is chronic arterial hypertension. With respect to the anuria and renal failure, aortic dissection is not something that is always considered and is still not a very common presentation unless both renal arteries come off the false lumen of the dissection. However, when present, preoperative renal failure in patients with acute type B dissection has been noted to be an independent predictor of mortality. Early recognition and diagnosis is the key and as noted by previous studies as well, almost a third of these patients are initially worked up for other causes until later when they are diagnosed with aortic dissection. Here we present a case of a patient presenting with severe hypothyroidism, long-standing hypertension, and anuria. Through the case, we highlight the importance of having aortic dissection as an important differential in patients presenting with anuria who have a long standing history of uncontrolled hypertension. Pathophysiology relating to severe hypothyroidism-induced renal dysfunction is also discussed.
In a prospective study of 76 children aged between 18 months and 13 years, 40 children underwent tonsillectomy using the traditional blunt dissection technique with bipolar diathermy to establish haemostasis while 36 children underwent tonsillectomy where bipolar diathermy alone was used to dissect out the tonsils. Blood loss was significantly reduced in the diathermy dissection group (10.5 ml ± 2.05,
F. B. MacGregor; D. M. Albert; A. K. Bhattacharyya
Fibromuscular dysplasia is a rare, nonatherosclerotic, noninflammatory vascular disease that typically affects women between the ages of 20 and 60 years. Although any artery can be affected, fibromuscular dysplasia most commonly affects the renal and carotid arteries. Fibromuscular dysplasia of the renal arteries usually presents with hypertension, while carotid or vertebral artery disease causes transient ischemic attacks, strokes, or dissection. Fibromuscular dysplasia of the brachial arteries is extremely uncommon. It can induce extremity ischemia, nerve compression, or both—causing coldness, discoloration, pain, ulceration or gangrene of the fingers, paresthesias, or paralysis. We report a rare case of multivessel fibromuscular dysplasia manifested by acute stroke in association with type I aortic dissection, which progressed rapidly to ascending aortic false aneurysmal development that necessitated arch replacement. Outcomes of aortic arch replacement in this setting are currently unknown. Therefore, our case might well offer some insight.
Mitral regurgitation due to 'floppy' valves is frequently associated with areas of medical necrosis in the ascending aorta. Application of the aortic clamp to such an area during valve replacement may produce an intimal tear followed by acute dissection. This complication occurred in three patients and was treated successfully by repair of the tear in the two cases where the dissection was observed at the time of operation. Is is suggested that infrequent clamping of the aorta and careful control of the pefusion pressure may decrease the risk of intimal trauma and acute dissection. Images
We present a case of a 34-year-old male who presented to the emergency ward with fever and abdominal pain. The diagnosis of Takayasu's arteritis and also antiphospholipid syndrome was made during an imaging workup of deep-vein thrombosis. A spontaneous coronary artery dissection was revealed in coronary CT angiography requested for chest pain and dyspnea. The patient was treated medically and discharged on close followup. The concurrence of spontaneous coronary artery dissection with antiphospholipid syndrome and Takayasu's arteritis has not been reported in the previous literature. The possibility of a spontaneous coronary artery dissection should be considered in patients presenting with both diseases.
Background and Purpose: The pathogenesis of spontaneous cervical artery dissections (sCAD) and its best medical treatment are debated. This may be due to a lack of clear classification of sCAD. We propose the new Borgess classification of sCAD, based on the presence or absence of intimal tear as depicted on imaging studies and effect on blood flow. Materials and Methods: This is a single-center investigator-initiated registry on consecutive patients treated for sCAD. In the Borgess classification, type I dissections have intact intima and type II dissections have an intimal tear. Results: Forty-four patients and 52 dissected arteries were found. Forty-nine of 52 dissections (93%) were treated with dual anti-platelet therapy. Twenty-one of 52 dissections were type I; 31 were type II. Type I dissections were more likely to present with ischemic symptoms [stroke, transient ischemic attack (TIA)] (p?=?0.001). More type I dissections occurred in the vertebral artery, while more type II dissections occurred in the internal carotid artery (p?0.001). Follow-up averaged 18.1?months (range: 3–108?months) with no recurrent ischemic events (stroke, TIA), deaths, or hemorrhage. Forty-six vessels had 6?month follow-up on medical treatment; 19/46 (41%) healed. Type I dissections were more likely to heal than type II (p?0.001). Conclusion: The two dissection types in the Borgess classification appear to relate to clinical presentation and rate of healing, making the classification useful in clinical management. Dual anti-platelet therapy for sCAD seems to have a very low risk of subsequent stroke; however, a large prospective study is needed to investigate the best treatment.
A case of vertebral artery dissection and consequent basilar artery thrombosis in a 6-year-old patient is reported. The patient was treated with subcutaneous low-molecular-weight heparin at therapeutic doses (enoxaparin, 100 IU\\/kg twice daily) for 3 weeks, then reduced to 2,000 IU\\/day for 3 more weeks. After this time a magnetic resonance angiogram was obtained that showed complete recanalization of the
Marco Marietta; Marcello Bertesi; Nino Rozzi; Maria Carmen Cano; Stefano Vallone; Cinzia Cappi; Samantha Pozzi; Giuseppe Torelli
Traumatic cerebral dissections are rare but potentially dangerous conditions that through improved diagnostics have recently\\u000a gained increased interest. However, there is still a significant lack of knowledge on the natural history, as well as on the\\u000a best treatment options. Most of the literature on this topic consists of case reports and retrospective studies with no prospective\\u000a randomized controlled studies. In
Martin M. Mortazavi; Ketan Verma; R. Shane Tubbs; Mark Harrigan
A 31-year-old female with a history of toxic oil syndrome in childhood, presented with spontaneous left main coronary dissection 4 weeks after an uncomplicated delivery. She had an extensive myocardial infarction, severe left ventricular dysfunction and cardiogenic shock which did not resolve following urgent surgical revascularization. Temporary left ventricular support and heart transplantation were necessary. We analyze the etiology and treatment sequence in what to our knowledge is the first case with these characteristics to be reported. PMID:15487278
Hinojal, Yolanda Carrascal; Di Stefano, Salvatore; Florez, Santiago; Martínez, Gerardo; de la Fuente, Luis; Casquero, Elena; Gualis, Javier
Child abuse is often suspected based on particular patterns of injury. We report a case of intracranial vertebral artery dissection with subarachnoid hemorrhage (SAH) in a 3-month-old boy following child abuse. The mechanisms of injury and the clinical and imaging findings are discussed. This particular pattern of injury has rarely been reported in association with child abuse. We hope to raise physician awareness of child abuse when faced with these imaging findings. PMID:17453187
Nguyen, Pamela H; Burrowes, Delilah M; Ali, Saad; Bowman, Robin M; Shaibani, Ali
Child abuse is often suspected based on particular patterns of injury. We report a case of intracranial vertebral artery dissection\\u000a with subarachnoid hemorrhage (SAH) in a 3-month-old boy following child abuse. The mechanisms of injury and the clinical and\\u000a imaging findings are discussed. This particular pattern of injury has rarely been reported in association with child abuse.\\u000a We hope to
Pamela H. Nguyen; Delilah M. Burrowes; Saad Ali; Robin M. Bowman; Ali Shaibani
Summary: Management of arterial dissections can be par- ticularly challenging. We report a case of vertebral artery dissection in which perfusion- and diffusion-weighted MR imaging findings suggested the presence of salvageable tissue, despite that the patient had symptoms for more than 40 hours. Direct access to the distal vascular territory was unattainable, and the presence of collateral circulation through an
Lucas Restrepo; Gustavo Pradilla; Rafael Llinas; Norman J. Beauchamp
Autosomal dominant polycystic kidney disease (ADPKD) is primarily associated with renal failure, but it also causes systemic diseases, including cysts of other systemic organs and cerebral or visceral aneurysm. To make matters worse, life-threatening aortic diseases are associated with ADPKD in some cases. However, only a few reports of ADPKD-associated with thoracic aortic dissection have been published. Herein, we present a case of dissecting aneurysm in a patient with hypertension and ADPKD. He had been followed up for type B aortic dissection for six years. Preoperative creatinine level ranged from 2.1 to 2.4 mg/dl. We performed replacement of the thoracic aorta with prosthetic graft successfully, and postoperatively, dialysis was not required.It is very important for us to recognize the relationship between ADPKD and thoracic aortic dissection, which can cause high mortality and morbidity rates. PMID:22293308
We presented six cases we have encountered of vertebral artery dissection without subarachnoid hemorrhage followed by serial angiography. All six patients suffered from severe headache and/or nuchal pain at onset. Pain was acute at onset, with severe intensity and sharp quality and was located unilaterally on the dissection side. Only two patients showed neurological deficits. CT scan disclosed no abnormalities in any of the cases and angiography performed at the acute stage showed varied findings. The so-called pearl and string sign, which has been considered the most common finding of this disorder, was observed in only two cases. The definite diagnosis was able to be finally made by serial angiography. During the first few months after onset, dynamic changes of angiographical findings were demonstrated in all cases. During these periods, although transient deterioration of the angiographical findings was shown in four cases, spontaneous healing or improvement was finally recognized in all cases except one which progressed to total occlusion. In contrast to this, in the chronic stage, no changes of angiographical findings occurred in any of the cases. All six patients were treated non-surgically. All showed almost total recovery from symptoms and returned to their previous life styles. There were no cases of recurrent deterioration of symptoms in spite of the changes indicated by the angiographical findings. Our experience with these patients suggests that the actual incidence of vertebral artery dissection without subarachnoid hemorrhage may be much higher than is usually thought, and that the natural course of this disorder seems to be usually favorable. However, longer follow-up study and an analysis of a larger number of cases are required to identify the true incidence and the natural course of this disorder. In addition, we would like to emphasize that accurate diagnosis is most important. If it is clinically suspected, careful investigations including serial angiography should be carried out for the diagnosis of this disorder. PMID:8692370
|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…
Arterial dissections are frequently observed in clinical practice and during road traffic accidents. In particular, the lamellarly arrangement of elastin, collagen, in addition to smooth muscle cells in the middle arterial layer, the media, favors dissection failure. Experimental studies and related biomechanical models are rare in the literature. Finite strain kinematics is employed, and the discontinuity in the displacement field
|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…
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…
|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,…
It has been established that an appropriately indicated selective neck dissection can achieve the same oncologic results as more extensive dissections. An even more modified selective neck dissection, termed superselective neck dissection, involves the compartmental removal of the fibrofatty tissue contents within the defined boundaries of two or fewer contiguous neck levels. Evidence from retrospective studies suggests that superselective neck dissection (SSND) is oncologically sound for two indications: elective treatment of the clinically N0 neck and salvage treatment of persistent lymph node disease after chemoradiotherapy. While there is broader support for the former scenario, evidence that SSND may constitute optimal treatment in the latter is in conformity with the trend toward developing surgical techniques that provide better functional outcomes without compromising efficacy. PMID:23321797
Suárez, Carlos; Rodrigo, Juan P; Robbins, K Thomas; Paleri, Vinidh; Silver, Carl E; Rinaldo, Alessandra; Medina, Jesus E; Hamoir, Marc; Sanabria, Alvaro; Mondin, Vanni; Takes, Robert P; Ferlito, Alfio
Background: Vertebral artery dissection is a well-recognized cause of posterior circulation stroke for which there is relatively little information on long-term outcomes. Quality of life (QOL) is an important patient-centred outcome measure. Methods: Stroke due to vertebral artery dissection was conservatively defined by neuroimaging documentation. Thirty sequential cases were identified based on a retrospective database and chart review with prospective
Traumatic coronary artery dissection is a very rare cause of myocardial infarction. Occurrence of this condition late in the posttraumatic period is extremely uncommon. We present a case of a young patient with acute myocardial infarction 4 weeks after blunt chest trauma. Coronary angiography showed left anterior descending artery dissection as well as thrombus formation, and multiple small infarctions were shown by cardiovascular magnetic resonance. PMID:20686414
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome occurring during pregnancy and the first weeks after delivery. Left main stem coronary artery (LMS) involvement is very rare and usually discovered after autopsy. We present the case of a young woman with cardiogenic shock due to LMS dissection. The patient was successfully treated by coronary angioplasty with implantation of multiple drug-eluting stents. PMID:23407042
Neck dissection is an important part of the surgical treatment of head and neck squamous cell carcinoma (HNSCC). The historical concept of neck dissection implied the removal of all lymph node-bearing tissue in the neck, which began in the late nineteenth century. However, more conservative variations of neck dissection have been performed and promoted as well. Anatomic, pathologic, clinical investigations, and prospective studies have demonstrated that the lymphatic dissemination of HNSCC occurs in predictable patterns. Supported by these studies, selective neck dissection (SND), which consists of the removal of select levels of lymph nodes in the neck that have the highest risk of harboring undetected metastases, has become widely accepted in the treatment of the clinically uninvolved neck. More recently, evidence supports using SND in a therapeutic setting in selected cases of HNSCC with limited metastatic disease. Additionally, even more targeted dissections referred to as super-selective neck dissection have been explored for selected patients undergoing elective node dissection for supraglottic cancer and as an adjuvant therapy for salvage of residual lymphadenopathy confined to a single neck level following chemoradiation. In the future, the trend to tailor treatment to individual patients and to limit toxicity and morbidity may further increase the use of SND. The indications have to be guided by further research, in relation with non-surgical treatment options while optimizing oncological effectiveness. PMID:22903756
Robbins, K Thomas; Ferlito, Alfio; Shah, Jatin P; Hamoir, Marc; Takes, Robert P; Strojan, Primož; Khafif, Avi; Silver, Carl E; Rinaldo, Alessandra; Medina, Jesus E
...the case of notification directly to affected employees, insertion of notice into pay envelopes is another viable option. A ticketed...preprinted notice regularly included in each employee's pay check or pay envelope, does not meet the...
...2013-07-01 false Notice of publication. 2.155 Section 2.155 ...RULES OF PRACTICE IN TRADEMARK CASES Publication of Marks Registered Under 1905 Act Â§ 2.155 Notice of publication. The Office will send the...
The management of blunt carotid artery dissections caused by hanging remains controversial, especially with regard to diagnostic work-up and treatment options. We present 2 men, 49 and 41 years of age, who were treated for bilateral common carotid artery dissection caused by strangulation. In the first patient, additional cricotracheal separation and blunt thyroid gland trauma was observed. Bilateral saphenous vein graft interposition was accomplished in both patients. In the first patient, tracheal repair and suture of the thyroid gland completed the procedure. At 1 year of follow-up, both patients were capable of managing their lives independently. A systematic review of the literature on managing near-hanging and nonfatal strangulation victims is included in this report to allow this case series to be put into perspective. PMID:23972634
Aspalter, Manuela; Linni, Klaus; Domenig, Christoph M; Mader, Nina; Klupp, Nikolaus; Hölzenbein, Thomas J
A 58 year old man was involved in a high impact road traffic incident and was admitted for observation. Asymptomatic for the first 24 hours, he collapsed with symptoms and signs consistent with a cerebrovascular accident. Computed tomography angiogram (CTA) and Magnetic resonance angiogram (MRA) demonstrated bilateral internal carotid artery dissections and a left middle cerebral artery infarct. It was not considered appropriate to attempt stenting or other revascularistation. The patient was treated with heparin prior to starting warfarin. He made a partial recovery and was discharged to a rehabilitation facility. This case is a reminder of carotid dissection as an uncommon but serious complication of high speed motor vehicle accident, which may be silent initially. Literature Review suggests risk stratification before relevant radiological screening at risk patients. Significant advances in CTA have made it the diagnostic tool of choice, but ultrasound is an important screening tool.
Srivastava, Ankur; Bradley, Marcus; Kelly, Michael
A case of atypical movement of the intimal flap (tear) during aortic aneurysm dissection is reported. Aortic dissection is caused by the sudden development of a tear in the aortic intima, opening the way for a column of blood driven by the force of the arterial pressure to enter the aortic wall, destroying the media and stripping the intima from the adventitia for variable distance along the length of the aorta. Echocardiographically, aortic dissection is characterized by separation of the normal single dominant echo from the aortic wall in the region of the dissection into two discrete echoes. The inner echo arises from the tunica intima, whereas the outer echo arises from the medial and adventitial structures external to the tear and it is possible to identify two lumens separated by an intimal flap within the aorta. The two echoes generally move in unison with one another, i.e. movement of the flap away from the true lumen during systole and recoil during diastole as the blood flows from true to false lumen. The dissection flap can also move inward during systole owing to the suction caused by high-velocity flow (Venturi effect), as shown in this case report. In any instances, motion of the intimal flap during the cardiac cycle is strong evidence of dissecting aneurysm. PMID:9466104
Background Conventional radical neck dissection often causes a variety of complications. Although the dissection method has been improved by retaining some tissues to reduce complications, the incomplete dissection may cause recurrence of disease. In the present study, we developed a novel radical neck dissection, which preserves the external jugular vein, the greater auricular nerve, and the deep branches of the cervical nerve, to effectively reduce complications and subsequently, to promote the postoperative survival quality. Methods A total of 100 cases of radical neck dissection were retrospectively analyzed to evaluate the efficacy, rate of complication, and postoperative dysfunction of patients treated with the novel radical neck dissection. Data analysis was performed using the Chi-square test. Results Compared with conventional radical neck dissection, the novel radical neck dissection could significantly reduce complications and promote postoperative survival quality. Particularly, the preservation of the external jugular vein reduced the surgical risk (ie, intracranial hypertension) and complications (eg, facial edema, dizziness, headache). Preservation of the deep branches of the cervical nerve and greater auricular nerve resulted in relatively ideal postoperative functions of the shoulders and ear skin sensory function (P < 0.05), while the two types of dissection procedures showed no differences in the recurrence rate (P > 0.05). Conclusion Our novel radical neck dissection procedure could effectively reduce the complications of intracranial hypertension, shoulder dysfunction, and ear sensory disturbances. It can be used as a regular surgical approach for oral carcinoma radical neck dissection.
Controversy remains about management of the neck in squamous cell carcinoma (SCC) of the maxillary sinus and we know of no reports of the use of elective selective neck dissection for management in this site. We retrospectively reviewed 18 consecutive patients with SCC of the maxillary sinus who were managed by primary operation with curative intent. A total of 13 patients had an elective selective neck dissection, which was invaded in one case 8%. Four patients had regional metastases, two with positive nodal disease confirmed after elective selective neck dissection, and two who developed regional recurrence (both after elective selective neck dissections which were negative (pN0)). A review of other published articles in the English language showed no cases of elective selective neck dissections reported. The mean regional recurrence rate was 12% (range 0-26%) and total mean regional metastases rate 21% (range 5-36%). Elective selective neck dissection did not contribute to an improved rate of neck control with regional recurrence of 11% (2/18) compared with 12% in the review. There is no evidence in this report to indicate that elective selective neck dissections for maxillary sinus SCC will result in better disease control. Future research may indicate fewer radiotherapy fields for necks with pathologically clear nodes after elective selective neck dissection. PMID:22578881
Brown, James S; Bekiroglu, Fazilet; Shaw, Richard J; Woolgar, Julia A; Triantafyllou, Asterios; Rogers, Simon N
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
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
Endoscopic submucosal dissection (ESD) represents an important advancement in the therapy of early neoplastic gastrointestinal lesions by providing higher en-bloc curative resection rate with lower recurrence compared to endoscopic mucosal resection (EMR) and by sparing the involved organ and protecting patient's quality of life. Despite these advantages ESD is associated with long procedure times and a higher rate of complications, making ESD a challenging procedure which requires advanced endoscopic skills. Thus, there has been a recognized need for structured training system for ESD to enhance trainee experience and, to reduce the risks of complications and inadequate treatment. ESD has a very flat learning curve. However, we do not have uniformly accepted benchmarks for competency. Nevertheless, it appears that, in Japan, more than 30 supervised gastric ESD procedures are required to achieve technical proficiency and minimize complications. A number of training algorithms have been proposed in Japan with the aim to standardize ESD training. These algorithms cannot be directly applied in the West due to substantial differences including the availability of highly qualified mentors, the type of pathology seen, choice of devices, and trainee's background. We propose a training algorithm for Western physicians which integrates both hands-on training courses, animal model work as well as visits to expert centers. No specific preceptor training programs have been yet developed but there is a consensus that these programs are important for permeation of ESD worldwide. PMID:23951392
Coman, Roxana M; Gotoda, Takuji; Draganov, Peter V
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.
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
The authors' method for uniting the dissected aortic wall layers with the help of gelatine-resorcinol adhesive is described focusing on special instruments used in this conjunction. (Eur J Cardio-thorac Surg (1994) 8:160-1611
|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)|
A previously healthy 35-year-old man suddenly developed vertebrobasilar ischaemia while playing tennis. Cerebral arteriography revealed a dissecting aneurysm of the cervical portion of both vertebral arteries. The neurological deficit and the angiographic features resolved with anticoagulant treatment alone. Only 15 patients with non-traumatic extracranial vertebral artery dissection have been previously reported. It is necessary to recognize the condition very quickly,
D. Leys; F. Lesoin; J. P. Pruvo; G. Gozet; M. Jomin; H. Petit
Thoracic aortic dissection is associated with substantial morbidity and mortality, and it requires timely and accurate diagnosis and treatment. Long-term antihypertensive therapy remains critical for the treatment of this disease. Surgical intervention, although still a formidable undertaking, has evolved to better address both acute and chronic dissection, and the results have improved. Basic and clinical research, as well as technological advances, have increased our understanding of this challenging disease state.
WONG, DANIEL R.; LEMAIRE, SCOTT A.; COSELLI, JOSEPH S.
Twelve patients (mean age 36,0+/-10,4 years) with a vertebral artery dissection (VAD) were followed-up during 2,5 months - 5 years. All patients underwent magnetic resonance (MR) imaging of the head, MR-angiography (11 patients - repeated studies), 5 patients - conventional cerebral angiography. VAD was located on extracranial (7), intracranial (1), extra-intracranial levels (4), the extension of dissection to the basilar artery was found in 2 patients. Dissection involving both vertebral arteries was observed in 6 patients, recurrent VAD after 4-15 months - in 3 patients. A total number of VAD was 22, a total number of cerebrovascular events - 15. The latter included ischemic strokes (13), transient ischemic attacks (1) and isolated headache (1). Ischemic cerebrovascular events were characterized by the combination of cerebral ischemic symptoms with occipital headache and/or posterior neck pain (79%) which usually preceded ischemic cerebral symptoms by the interval of several hours - 3 weeks as well as a goof recovery of neurological deficit (92%). In a half of patients, cerebral ischemic symptoms developed after neck movements or manual therapy. Angiography revealed the stenosis of vertebral arteries, usually elongated, irregular or tapered (64%), more often located at the level of V3-V4 segments, vertebral artery occlusion (36%) and pseudoaneurisms (19%). The repeated angiography performed in 2-3 months or more showed positive changes in 82%, the complete (86%) or partial (14%) resolution of all stenoses and the complete or partial recanalization of the half of vertebral artery occlusions, the regress of all pseudoaneurisms. An intramural hematoma on MR imaging (the axial plane) was found in 85% dissections analyzed, the increased vertebral artery outer diameter - in 69%. Atherosclerotic plaques were absent in all cases. VAD is one of unknown causes of ischemic stroke in vertebrobasilar circulation. Diagnosis is based on characteristic clinical and angiography data. PMID:18379492
Kalashnikova, L A; Krotenkova, M V; Knovalov, R N; Protski?, S V; Kadykov, A S
The clinical profiles and outcomes of acute aortic dissection (AAD) have not been evaluated in China. We retrospectively analyzed, from January 1, 2008 to December 31, 2011, the data from 1,812 patients (mean age 51.1 ± 10.9 years; 77.5% men) with AAD (726 with type A and 1,086 with type B) from 19 large hospitals. Most patients had hypertension and presented with an abrupt onset of chest and/or back pain. Patients with type A AAD were more likely to present with typical symptoms and signs. Computed tomography was the most common initial imaging modality, used in 76.3% of patients with an AAD. The overall in-hospital mortality rate was 17.7%, with most of the deaths occurring within the first week. Surgery was used in 75.3% of patients with type A AAD. The mortality in this cohort was 33.8%. Endovascular treatment was performed in 76.1% of patients with type B AAD. The mortality rate was 2.2%. Multivariate analysis showed that hypertension (odds ratio 2.80, p <0.001), Marfan syndrome (odds ratio 1.76, p = 0.017), anterior chest pain (odds ratio 1.62, p = 0.004), abdominal pain (odds ratio 1.51, p = 0.041), migrating pain (odds ratio 1.56, p = 0.04), and arch vessel involvement (odds ratio 1.70, p <0.001) were predictive factors for increased in-hospital mortality in patients with an AAD. In conclusion, our study has provided insight into the current profiles and outcomes of AAD in China. This knowledge might be useful for clinicians when diagnosing and treating these patients. PMID:22762721
|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…
Intracranial arterial dissections of the vertebrobasilar system are recognized as a cause of stroke. Although the pathogenic mechanism underlying this phenomenon is unknown, in some cases the stroke originates from subarachnoid hemorrhage, while in others ischemia is the cause. In cases where hemorrhage occurs, occlusion of the lesion is effective in reducing the risk of re-bleeding. However, deciding on treatment
Retropharyngeal lymph node (RPLN) metastases can occur from advanced head and neck malignancies. Surgical access to RPLNs can be challenging. Considering the more aggressive conventional approach methods, there is an increasing need for minimally invasive techniques. Applying transoral robotic surgery (TORS) to access the RPLN has never been reported in the literature. The purpose of this study was to describe our experience with transoral robotic RPLN dissection for oropharyngeal and hypopharyngeal squamous cell carcinomas. We conducted a retrospective review of TORS cases performed at Severance Hospital, a tertiary care medical center from December 2011 to July 2012. Demographic, clinicopathologic, and treatment characteristics were abstracted from the medical record as well as complications and were analyzed descriptively. A total of 5 TORS procedures with transoral robotic RPLN dissection have been performed at Severance Hospital. Of these, 4 patients were treated for oropharyngeal squamous cell carcinoma and 1 for hypopharyngeal squamous cell carcinoma. The mean operation time for TORS including the robotic RPLN dissection was 84 ± 18.5 minutes. The operation time included time for docking of the robotic arms (4.8 ± 1.3 minutes), console working time for primary tumor removal (50 ± 8.9 minutes), and console working time for RPLN dissection (29.2 ± 9.4 minutes). No patients experienced complications related to the transoral robotic RPLN dissection. Transoral robotic RPLN dissection is a feasible approach for accessing retropharyngeal lymph nodes. This particular operative technique can serve as a minimal invasive surgery in removing pathologic RPLNs. PMID:23851761
Byeon, Hyung Kwon; Duvvuri, Umamaheswar; Kim, Won Shik; Park, Young Min; Hong, Hyun Jun; Koh, Yoon Woo; Choi, Eun Chang
Background. Intracranial artery dissections are rare and many controversies exist about treatment options. The aim of this study was to evaluate the efficacy and safety of the endovascular approach in patients with an intracranial dissection presenting with different symptoms. Methods. We prospectively evaluated the clinical features and treatment outcomes of 30 patients who had angiographically confirmed nontraumatic intracranial dissections over 4 years. Patients were followed up for 17 months, and their final outcomes were assessed by the modified Rankin Score (mRS) and angiography. Results. Sixteen (53.3%) patients had a dissection of the anterior circulation, whereas 14 (46.7%) had a posterior circulation dissection. Overall, 83.3% of the patients suffered a subarachnoid hemorrhage (SAH). Grade IV Hunt and Hess score was seen in 32% of the SAH presenting cases. Parent artery occlusion (PAO) with coil embolization was used in 70% of the cases. The prevalence of overall procedural complications was 23.3%, and all were completely resolved at the end of follow-up. No evidence of in-stent occlusion/stenosis or rebleeding was observed in our cases during follow-up. Angiography results improved more frequently in the PAO with coil embolization group (100%) than in the stent-only-treated group (88.9%) (P = 0.310) and the unruptured dissection group (5/5, 100%) in comparison with the group that presented with SAH (95.8%) (P = 0.833). Conclusion. Favorable outcomes were achieved following an endovascular approach for symptomatic ruptured or unruptured dissecting aneurysms. However, the long-term efficacy and durability of these procedures remain to be determined in a larger series.
Taheraghdam, Ali Akbar; Sharifipour, Ehsan; Mansourizadeh, Reza; Pashapour, Ali; Shimia, Mohammad; Shokouhi, Ghaffar; shakeri, Moslem; Hashemzadeh, Ali
An expert multidisciplinary panel in the treatment of type B aortic dissection reviewed available literature to develop treatment algorithms using a consensus method. Data from 63 studies published from 2006 to 2012 were retrieved for a total of 1,548 patients treated medically, 1,706 patients who underwent open surgery, and 3,457 patients who underwent thoracic endovascular repair (TEVAR). For acute (first 2 weeks) type B aortic dissection, the pooled early mortality rate was 6.4% with medical treatment and increased to 10.2% with TEVAR and 17.5% with open surgery, mostly for complicated cases. Limited data for treatment of subacute (2 to 6 weeks after onset) type B aortic dissection showed an early mortality rate of 2.8% with TEVAR. In chronic (after 6 weeks) type B aortic dissection, 5-year survival of 60% to 80% was expected with medical therapy because complications were likely. If interventional treatment was applied, the pooled early mortality rate was 6.6% with TEVAR and 8.0% with open surgery. Medical treatment of uncomplicated acute, subacute, and chronic type B aortic dissection is managed with close image monitoring. Hemodynamic instability, organ malperfusion, increasing periaortic hematoma, and hemorrhagic pleural effusion on imaging identify patients with complicated acute type B aortic dissection requiring urgent aortic repair. Recurrence of symptoms, aortic aneurysmal dilation (>55 mm), or a yearly increase of >4 mm after the acute phase are predictors of adverse outcome and need for delayed aortic repair ("complicated chronic aortic dissections"). The expert panel is aware that this consensus document provides proposal for strategies based on nonrobust evidence for management of type B aortic dissection, and that literature results were largely heterogeneous and should be interpreted cautiously. PMID:23500232
Fattori, Rossella; Cao, Piergiorgio; De Rango, Paola; Czerny, Martin; Evangelista, Arturo; Nienaber, Christoph; Rousseau, Hervé; Schepens, Marc
|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…
We report a case of lower limb ischemia secondary to type B aortic dissection, which was successfully treated with endovascular aortic fenestration and stent placement. In this case, we were not able to restore adequate flow to the ischemic limb by means of aortic balloon fenestration alone, so additional stent placement was required to buttress the true lumen and fenestra. There was no recurrence of lower limb ischemia complications during the follow-up period. Aortic balloon fenestration with stent placement seems to be a safe and effective technique to salvage an ischemic lower limb complicated by acute aortic dissection. PMID:16875314
Female phenotype, sexual infantilism, small stature and stigmatization are typical for patients with Turner's syndrome (TS). The most frequent cardiovascular manifestations in these patients are a bicuspidal aortal valve and coarctation of the aorta. In 5% patients dilatation of the aorta is found which can develop into a dissecting aneurysm. In the submitted case-history the authors describe a 34-year-old patient where the diagnosis of TS was proved only in adult age at the time when a dissecting aneurysm of the aorta was detected. The submitted case-history supports the recommendation of regular echocardiographic check-up examinations of patients with TS. PMID:10953662
Carotid artery redundancies are common findings on routine imaging studies and are usually considered to be benign variants. We present a case of a 40-year-old man, with a history of cocaine abuse, who was diagnosed with dissection of the right internal carotid artery and looping of the bilateral internal carotid arteries. This report attempts to highlight the possible association between carotid artery redundancy and dissection, especially in the context of vascular injury such as cocaine abuse, as in our case. PMID:23539068
Meghani, M; Siddique, M N; Bhat, T; Samarneh, M; Elsayegh, S
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and sudden cardiac death. Involvement of the left main coronary artery is uncommon accounting for 9% of all cases. The condition commonly affects premenopausal females with about one third of the cases occurring during pregnancy and the peripartum period. The diagnosis may occasionally be overlooked as the patients are often young and have no risk factors for coronary artery disease. The clinical presentation and interesting angiographic findings of a 42-year-old female patient with left main coronary artery dissection are described along with a brief discussion of the pathogenesis and management of the condition. PMID:19882065
|Appropriately timed Focus on Form can help in raising the learners' language awareness. In this paper we argue that the learner's own text composition progression can indicate when a learner is ready to notice a particular language form. Stimulated recall induced discussion was used to provoke explicit writer comments relating to noticing and…
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.
Taylor, J. D., E-mail: email@example.com; Dunckley, M.; Thompson, M.; Morgan, R. A. [St. George's Vascular Institute, St. George's Hospital (United Kingdom)
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.
Cervicocerebral arterial dissections (CAD) are an important cause of strokes in younger patients accounting for nearly 20% of strokes in patients under the age of 45 years. Extracranial internal carotid artery dissections comprise 70%–80% and extracranial vertebral dissections account for about 15% of all CAD. Aetiopathogenesis of CAD is incompletely understood, though trauma, respiratory infections, and underlying arteriopathy are considered important. A typical picture of local pain, headache, and ipsilateral Horner's syndrome followed after several hours by cerebral or retinal ischaemia is rare. Doppler ultrasound, MRI/MRA, and CT angiography are useful non-invasive diagnostic tests. The treatment of extracranial CAD is mainly medical using anticoagulants or antiplatelet agents although controlled studies to show their effectiveness are lacking. The prognosis of extracranial CAD is generally much better than that of the intracranial CAD. Recurrences are rare in CAD.
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.
Two hundred fifty years have passed since Frank Nicholls' history-making, accurate observations on the anatomic findings and cause of death of King George II were published. Several decades later, the disease was named, using--for the first time--the terms dissection and dissecting attached to an aortic disease process. Another century went by before effective surgical treatment was developed. In sharp contrast, the evolution of the last 20 years has been nothing short of amazing. Our understanding of AD, while not yet complete, has improved dramatically. In addition, the introduction of nonsurgical endovascular therapy has had a profoundly transformative impact--and we are just at the beginning! It would not be unreasonable to predict that stent-graft repair will likely replace (or nearly replace) open surgery in the treatment of complicated type B dissection in the near future, especially as technologies continue to improve and indication-specific designs are developed and tested in the clinical setting. Moreover, it is predictable that endovascular solutions for some patients with type A aortic dissection will become available in the years to come as surgical results continue to be suboptimal. Finally, and amidst this plethora of “good news,” it is appropriate to reflect on the formidable challenge that endovascular therapies face as they gear to “compete” with optimal medical therapy in the management of patients with acute uncomplicated type B dissection, because it will obviously be difficult (if not impossible) to improve on the already-achieved 30-day mortality rate of less than 10%. Long-term gains may well become the winning card when and if the late results of TEVAR can be shown to improve on the rather compromised outlook of medically treated dissection patients. Stay tuned. PMID:22199439
In the acute stage (less than two weeks), surgery is indicated for Stanford type A aortic dissections. With respect to the initial work-up, surgery consists in replacing the ascending aorta, sometimes the aortic arch (with supra aortic vessels reimplantation), and aortic valve replacement (valve replacement, Bentall valved tube or valve sparing Tyron David technique). Ischemic visceral complications must be searched for and treated by endovascular techniques or surgery. Aneurismal evolution of chronic dissections must be treated surgically. Replacement can encompass the entire aorta. PMID:21146353
...China First'') and Shanghai Three Star Stationery Industry Corp. (``Three Star'') and separate rate company Orient International...30, 2007 with respect to China First, Three Star, and SFTC. See Certain Cased Pencils from...
Spontaneous coronary artery dissection is a rare cause of myocardial infarction and the role of thrombolytic therapy in this setting is not known. A case of acute ST elevation myocardial infarction is presented, with initial positive response to thrombolytic therapy and subsequent marked worsening of ST elevation due to extensive dissection, possibly triggered by thrombolytic therapy, which was successfully treated with percutaneous coronary intervention.
Saadat, Habib; Taherkhani, Maryam; Safi, Morteza; Vakili, Hosein; Namazi, Mohammad Hassan; Poorhoseini, Hamid Reza; Movahed, Mohammad Reza
Several endovascular approaches have been used in the treatment of dissecting aneurysms of the vertebrobasilar system. We present a case of a bilateral spontaneous vertebral artery (VA) dissecting aneurysms presenting with a subarachnoid haemorrhage. The dominant left VA aneurysm was treated with a stent- within-a-stent construct and the contralateral VA aneurysm was proximally occluded, with no complications, by an unintentional
Patients with Turner syndrome are prompt to develop spontaneous acute aortic dissection following insidious aortic dilatation, with abnormal cardiovascular anatomy and consequently require specific guidelines for regular surveillance since they represent a subset of high-risk young patients. We report a rare and uncommon case of spontaneous acute aortic dissection in a 48-year old female patient with Turner syndrome who was not apparently eligible for a prophylactic surgery. A CT scan showed a Stanford type A aortic dissection and was urgently referred for surgical management. We operated on the patient under deep hypothermia (18°C) and circulatory arrest with a retrograde cerebroplegia as the primary entry tear was located in the arch. The postoperative course was uneventful and the patient was discharged at the eighth postoperative day. Following description of this case, special attention was paid to determine predisposing risk factors for aortic dissection to be specifically adjusted to TS patients.
Objective : To describe management challenges and follow-up data for three years in a case with spontaneous carotid artery dis- section (SCAD). Case Report : We present a case of SCAD that presented with Horner's syn- drome and headache. The patient developed the SCAD, Horner's syndrome and headache one month after a lumbar epidural steroid in- jection for radicular pain.
A 78-year-old woman who presented with chest pain, on a background of hypertension and varicose veins, was found to have a non-ST segment elevation myocardial infarction with coronary angiography demonstrating dissections of all three major arteries distally. She was treated medically, with anticoagulation and risk factor management as the primary therapies. This is the first reported case of triple spontaneous coronary artery dissection treated medically, along with angiographic follow-up demonstrating complete resolution. PMID:23880400
A best evidence topic was written according to a structured protocol. The question addressed was whether dissection of the pulmonary ligament during an upper lobectomy would result in improved outcomes. A total of 85 articles were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Reported measures were complications associated with dissection (atelectasis, bronchial stenosis, bronchial obstruction and bronchial deformation) and preservation (insufficient lung expansion, pooling of effusion and atelectasis) of the pulmonary ligament, ratio (%) of dead space in longitudinal axis (movement of nonoperated lobes), change in the angle (degrees) of main bronchus on the operated side, overall morbidity and mortality, overall survival and conversion rates. In a randomized control trial, the dissection of the pulmonary ligament revealed no significant difference in the dead space ratio or change in the angle of the main bronchus when compared with preservation. Dissection of the ligament, in theory, reduces the free space in the upper thorax by increasing the mobility of the residual lobes. Dissection of the ligament may lead to bronchial deformation, stenosis, obstruction or lobar torsion. Preservation of the ligament may prevent this complication by suppressing the upward movement of residual lobes. However, this may result in pleural effusion in the free thoracic space that may potentially become infected resulting in an empyema or bronchial fistula. Five large case series were analysed; three routinely dissected the pulmonary ligament and two did not. There was no observed difference in clinical outcomes between the two groups. There is no convincing evidence that dissection of the pulmonary ligament in an upper lobectomy significantly improves outcomes and reduces complications. PMID:23628653
Khanbhai, Mustafa; Dunning, Joel; Yap, Kok Hooi; Rammohan, Kandadai S
BACKGROUND: Acute aortic dissection (AAD) is a life-threatening condition requiring immediate assessment and therapy. A patient suffering from AAD often presents with an insignificant or irrelevant medical history, giving rise to possible misdiagnosis. The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used. METHODS: From January 2000 to December 2004,
The purpose of this chapter is to present ultrasound and, in particular, color duplex sonography (CDS) assessment of spontaneous dissection of the cervical internal carotid (sICAD) and vertebral (sVAD) arteries. The examination, typical ultrasound findings and pitfalls in the acute sICAD and sVAD, detection of microembolic signals, and recanalization will be discussed. PMID:17290115
Arteriovenous dissection (AVD) is a surgical maneuver to separate the retinal artery and vein at the crossing site in patients with branch retinal vein occlusion (BRVO). The published studies showed an evidence level 3. AVD seems to be maintainable in patients with recent onset of BRVO and decimal visual acuity < or =0.4. PMID:18317778
Feltgen, N; Hattenbach, L-O; Mirshahi, A; Hansen, L
|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)|
INTRODUCTIONThe spider Cupiennius salei, commonly known as the American wandering spider, is a particularly useful laboratory model for embryological studies because of the availability of tools to study and manipulate its embryonic development. Cupiennius is used to study axis formation, segmentation, appendage development, neurogenesis, and silk production. These studies contribute to our understanding of the evolution of these processes, but they also help us to understand the origin and diversification of evolutionary novelties. Comparisons between spiders and insects can show the degree of conservation and divergence of developmental mechanisms during arthropod evolution. Any embryological feature conserved between spiders and insects is likely to represent an ancestral feature for arthropods. Comparative molecular embryological work in insects and spiders should eventually allow us to define a molecular archetype for the phylum Arthropoda. This in itself will be a necessary cornerstone for comparing the different metazoan phyla, including chordates. Spider embryos can be studied as whole mounts under the dissection microscope. Alternatively, the embryos can be dissected and observed under the compound microscope. Preparing and dissecting spider embryos for compound microscopy is difficult due to the high amount of yolk, which makes the embryos very fragile. The following protocol describes how to make the necessary tools, then use them to obtain good preparations. Not all embryonic stages can be dissected and prepared; very young stages can only be examined as whole mounts. PMID:21356703
Prpic, Nikola-Michael; Schoppmeier, Michael; Damen, Wim G M
Gastric hyperplastic polyps are generally considered benign lesions, although rare cases of adenocarcinoma have been reported. Although, the underlying mechanism of carcinogenesis in gastric hyperplastic polyps is still uncertain, most malignant polyps are seen to originate from dysplastic epithelium rather than from hyperplastic epithelium. Herein, we report the case of a woman diagnosed with adenocarcinoma that originated from a hyperplastic gastric polyp that was successfully removed by endoscopic submucosal dissection. In this case, we observed adenomatous changes around the cancerous component.
Jang, Hye Won; Jeong, Hyun Yong; Kim, Seok Hyun; Kang, Sun Hyung; Seong, Jae Kyu; Song, Kyu Sang
We implanted stents in three patients who had traumatic abdominal aortic dissections, complicated by right limb ischemia\\u000a in one case. The circulating false channel extended to the left iliac artery in one case and to both iliac arteries in the\\u000a last case. Diagnosis and radiological follow-up included ultrasound, computed tomography, and arteriography. Two patients\\u000a were treated with Wallstents, one with
Hélène Vernhet; Charles-Henri Marty-Ané; Alvian Lesnik; Régis Chircop; Olivier Serres-Cousiné; Eric Picard; Henry Mary; Jean Paul Senac
Summary \\u000a The case of a 49-year-old busdriver is referred, who died 6 days after heavy neck-ache in course of a Wallenberg's syndrome.\\u000a Although neurological examination gave all the signs of a brain-stem-vessel-disease, the definite verification by ultrasound\\u000a and x-rays (CT and MRI) took several days and was not out of doubts until the infarction and the occlusion of the basilar
Traditional, hands-on dissection of an animal is common practice in many classrooms to aid in the study of anatomy and biology.\\u000a More specifically, virtual dissection environments have been developed making it possible to study the inner workings of animals\\u000a without cutting them up. In this paper, we present a novel virtual reality dissection simulator, where a user can dissect\\u000a an
Objective: To assess the outcome, tissue trauma, clinical improvement and the reduction in size of fibroid following laparoscopic dissection of uterine vessels (LDUV). Setting: Department of Obstetrics and Gynaecology, Endoscopic Training Centre, Baby Friendly Hospital, Kladno, Czech Republic. Design: An uncontrolled case series of 17 consecutive women who underwent LDUV using ultrasonically activated shears for the treatment of fibroids over
BACKGROUND: Thoracic aortic aneurysms and dissections (TAAD) is a critical condition that often goes undiagnosed with fatal consequences. While majority of the cases are sporadic, more than 20% are inherited as a single gene disorder. The most common familial TAA is Marfan syndrome (MFS), which is primarily caused by mutations in fibrillin-1 (FBN1) gene. Patients with FBN1 mutations are at
Ali R Keramati; Anita Sadeghpour; Maryam M Farahani; Gurangad Chandok; Arya Mani
Background context: The growing recognition of cervical manipulation as a treatment of neck pain and cervicogenic headaches has lead to increased interest in potential complications that may result from this treatment approach. Recent surveys have reported that many neurologists will encounter cases of vertebral artery dissection that occur at various times after cervical manipulation, whereas most practitioners of spinal manipulation
Scott Haldeman; Paul Carey; Murray Townsend; Costa Papadopoulos
Summary Carotid and vertebral artery dissections from blunt cervical trauma are uncommon injuries that in recent years are becoming increasingly recognized as a result of angiographic screening protocols in trauma patients. Traumatic carotid cavernous fistulas are even less common events, but represent the most common intracranial vascular anomaly after head injury. The present report details the unique case of a
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.
Haesemeyer, Scott W.; Vedantham, Suresh [Washington University in St. Louis, Mallinckrodt Institute of Radiology (United States)], E-mail: firstname.lastname@example.org; Braverman, Alan [Washington University in St. Louis, Section of Cardiology (United States)
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
Abbo, Michael; Hussain, Kosar; Ali, Mohammad Baqer Mohammad
Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, nowadays poorly understood yet. The lack of firm recommendations about this issue is a great limitation which makes any therapeutic decision controversial. The case described is that of a young, otherwise healthy woman, who presented with an ostial dissection of the left anterior descending (LAD) artery. Due to patient's stable clinical and hemodynamic parameters, we used a cautious approach based on watchful waiting and medical therapy, postponing stenting in order to achieve a partial vessel reopening with a more comfortable access to PCI.
Arrivi, A.; Bazzucchi, M.; De Paolis, M.; Placanica, A.; Bock, C.; Milici, C.; Boschetti, E.; Dominici, M.
The BioValsalva (Vascutek Terumo, Renfrewshire, Scotland, UK) conduit is the first commercially available prefabricated bioprosthetic aortic valved conduit. We present a case of chronic dissection of a BioValsalva valved conduit presenting as a 7.5-cm aortic root aneurysm 1 year after a Bentall operation. Intraoperatively, the conduit was found to have dissected from the annulus upward, and the coronary buttons were avulsed from the inner layers while remaining attached to the outer layer. Both the outer layer and the coronary buttons were grossly dilatated. PMID:23816079
The "Guideliner," a child catheter, aims to deliver stents in tortuous coronary lesions by deep engagement and providing better support. Coronary artery spiral dissection, which may be caused by deep-seated coronary catheters or noncoaxial engagement is one of the most seen percutaneous coronary intervention-related complications. In this case, Guideliner-related left main dissection occurred after successful revascularization of a chronic total occlusion at the left anterior descending artery and the left circumflex, which has not been previously reported. The Guideliner catheter is efficient in treating complex coronary lesions, but one should be aware of its related complications. PMID:23413132
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 ?1(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
Singh, M; Puppala, S; Pollitt, R C; Sobey, G J; Scott, D J A
Spontaneous dissection of the external iliac artery in the absence of aortic disease is extremely uncommon. We report the conservative treatment of a 46-year-old male patient who presented with acute left lower limb ischemia due to an isolated dissection of the external iliac artery secondary to repetitive swinging movements during golf club manufacturing. Although syndromes of nonatherosclerotic vascular disease secondary to repetitive movements in high-level athletic activity have been previously described in cyclists, long distance runners, and rugby players, we believe this to be the first occupational case associated with golf. PMID:23203597
Yoong, S; Heyes, G; Davison, G W; Hannon, R; O'Donnell, M E
A prospective single-blinded study was conducted to compare pediatric tonsillectomy using the traditional cold sharp dissection with ligation for securing hemostasis (CSDL) versus microsurgical bipolar dissection technique (MBCT). Sixty children aged between 2 and 14 years were sequentially assigned to each group. Blood loss and postoperative pain in the first hour were markedly decreased in the MBCT group (P<0.0001 and
Luis Lassaletta; Gonzalo Mart??n; Miguel Angel Villafruela; Caridad Bolaños; Juan José Álvarez-Vicent
Aim to report duplex scan findings in patients with spontaneous internal carotid artery (ICA) or vertebral artery (VA) dissection. Material and methods the records of 24 patients (13 males and 11 females, median age 48 years [range 25–68 years]) with spontaneous extracranial ICA dissection (n=20) or VA dissection (n=4), identified between January 1995 and December 1999, were retrospectively analysed. Results
K. Logason; H.-G. Hårdemark; T. Bärlin; D. Bergqvist; H. Ahlstöm; S. Karacagil
Carotid and vertebral artery dissection is a rarely reported cause of stroke in childhood and adolescence, especially if there is not a direct trauma to the neck. Four patients, under 15 years of age, presented with an internal carotid artery dissection, and one patient presented with a vertebral artery dissection. They were all making a physical effort when the event
Ana Camacho; Alberto Villarejo; Ana Mart??nez de Aragón; Rogelio Simón; Fernando Mateos
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
Vertebral artery dissection may lead to stroke. Medical therapy is usually the first line of treatment. The endovascular approach of medically refractory vertebral artery dissection may include numerous techniques, including coil occlusion of the parent vessel. Two cases are presented of medically refractory symptomatic vertebral artery dissections in which vessel coil occlusion was successfully achieved with a single long oversized coil. There were no periprocedural complications and both patients had excellent clinical and angiographic outcome and remained asymptomatic on follow-up. The use of a single long oversized coil in vessel sacrifice has not been described previously. It represents a safe, rapid and cost effective alternative to the current existing techniques for vessel sacrifice. PMID:22326905
Grigoryan, Mikayel; Cordina, Steve M; Khatri, Rakesh; Hassan, Ameer E; Rodriguez, Gustavo J
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.
Spontaneous dissection of the vertebral artery (VA) is usually managed medically. The objective of this report was to describe 10 patients treated surgically for spontaneous dissection of the VA. Seven men and three women with a mean age of 52.5 +/- 11.3 years were treated between December 1978 and January 2001. In eight cases the presenting symptom was neck pain. Transient ischemic attack or completed stroke in the vertebrobasilar distribution followed in nine cases. In the remaining case, symptoms resulted from irritation of the superior roots of the brachial plexus. Dissection was located in one segment of the VA in seven cases and two contiguous segments in three cases. Lesions involved aneurysm in seven cases, tight stenosis in two, and occlusion in one. The decision to perform surgery was made because of either continued symptoms despite maximal anticoagulation therapy or the presence of an aneurysm causing recurrent thromboembolism or threatening rupture. In eight cases the revascularization procedure consisted of bypass from the carotid artery to the distal VA. In the remaining two cases revascularization was achieved by transposition of the VA directly onto the common or internal carotid artery. Postoperative recovery was uneventful in all cases. No further neurological events were observed in any patient at a mean follow-up of 96.9 +/- 66 months (range, 12-216 months). Long-term resolution of vertebrobasilar symptoms was achieved in all cases, including one patient whose bypass occluded at 6 months. From these results we conclude that surgical treatment is the method of choice for spontaneous dissection of the extracranial VA associated with continued vertebrobasilar symptoms despite maximal medical therapy or with an expanding aneurysm. The most useful technique is bypass to the distal VA. Morbidity is low and long-term outcome is excellent. PMID:15714360
|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…
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
Supraclavicular lymph node metastasis from endometrial carcinoma is considerably rarer than metastasis from uterine cervical cancer. To date, there have been no reported cases regarding systematic neck dissection as a salvage treatment. In this report, we describe the neck dissection procedure carried out on a 74-year-old woman with supraclavicular lymph node metastasis. Our objective was to histologically determine the origin of the metastasis while simultaneously providing appropriate treatment. The patient’s past medical history included two prior cases of cancer: rectal cancer 7?years earlier and endometrial adenocarcinoma 4?years earlier. We determined that middle and lower jugular neck dissection was appropriate in treating this case based on the results of our preoperative FDG-PET and tumor markers. This surgery provided histological evidence that metastasis occurred from endometrial carcinoma. Middle and lower jugular neck dissection was expected to improve the patient’s prognosis without impacting the patient’s active daily life. We have continued to monitor the patient closely over an extended period.
Objective The purpose of this case report is to describe a patient who regularly practiced self-manipulation of her neck who presented with shoulder and neck pain and was undergoing a vertebral artery dissection. Clinical Features A 42-year-old female patient sought care for left shoulder pain with a secondary complaint of left lower neck pain. Twelve days prior, she had had “the worst headache of her life,” which began in her left lower cervical spine and extended to her left temporal region. The pain was sudden and severe, was described as sharp and burning, and lasted 3 hours. She reported nausea, vomiting, and blurred vision. Intervention and Outcome Initial history and examination suggested that the patient's head and neck pain was not musculoskeletal in origin, but vascular. She repeatedly requested that an adjustment be performed, but instead was referred to the local emergency department for further evaluation. Magnetic resonance angiogram revealed a dissection of the left vertebral artery from C6 to the C2-C3 interspace and a 3-mm dissecting pseudoaneurysm at the C3 level. She underwent stent-assisted percutaneous transluminal angioplasty combined with antiplatelet therapy (clopidogrel) and experienced a good outcome. Conclusion This case suggests that careful history taking and awareness of the symptoms of VAD are necessary in cases of sudden head and neck pain. More research is needed on the relationship between vertebral artery dissection and self-manipulation of the neck.
Traumatic internal carotid artery dissection may result from a direct blow to anterolateral aspect of the neck, or an extreme extension and rotation of the neck. Traumas involved are variable ranging from high speed motor vehicle accident to trivial traumas. The most frequent presentations of carotid artery dissection are stroke, Hörner syndrome, and paralysis of a cranial nerve. Time of ischemic signs onset is very variable too, diverging from immediate to several months delay. We report the case of a 60-year-old woman, who was assaulted by a young man. Immediately, she complained of headache and posterior cervical pain. Three months later she developed a left hemifacial paralysis. MRI and MRA showed a dissection of the left internal carotid artery. The causal relationship between the trauma and the carotid artery dissection as well as forensic issues are discussed. PMID:24112338
Makhlouf, F; Scolan, V; Detante, O; Barret, L; Paysant, F
We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.
Forty-nine cases of dissection of the internal carotid and vertebral arteries are reported in our prospective multicenter study of 35 men and 14 women, with a mean age of 46.77 years. (range 17-60 years). We evaluated etiology, clinical manifestations, investigative techniques, and treatment. Thirty-one patients had so-called spontaneous dissections, although in the remaining 18 minimal or obvious trauma was considered as the etiological factor. Headache and neck pain occurred in 32 patients (65.3%). Local neurological manifestations were present in 15 patients (30.6%) and ischemic cerebral symptoms were present in 41 patients (83.6%). The most-relevant of the diagnostic tools are duplex sonography, magnetic resonance angiography, and angiography. Anticoagulation with heparin followed by warfarin was the treatment of choice in most of our patients. Complete recovery is reported in 14 patients (28.5%); 41 patients showed cerebral ischemic symptoms, of which 13 (26.5%) had good functional recovery. In 28 (57.1%), the NIHSS score decreased from 6.68 to 3.31 during hospitalization. PMID:12774200
Mutations in the genes encoding transforming growth factor ? receptors 1 and 2 (TGFBR1 and TGFBR2) have recently been associated with hereditary connective tissue disorders with widespread vascular involvement, including arterial dissection. To determine whether mutations in these genes cause spontaneous cervical artery dissection (sCAD), all coding exons of TGFBR1 and TGFBR2 were sequenced in 56 consecutive patients with sCAD. Novel TGFBR2 disease causing mutations were found in two patients. The two mutations were the pK327R substitution affecting the kinase domain of TGFBR2 and the pC138R substitution falling in the extracellular domain of the protein, involved in TGF? binding and signalling. No TGFBR1 mutation was found. The findings indicate that TGFBR2 gene mutations are responsible for sCAD in 3.6% (95% CI 0.0 to 8.4) of cases, have implications in understanding the role of TGF? signalling in the pathogenesis of sCAD and emphasise the importance of considering molecular characterisation of the TGFBR2 gene in these patients, regardless of the presence of clinical features suggestive of hereditary connective tissue disorders. PMID:21270064
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.
Among 60 patients with oral squamous cell carcinoma, 30 were treated by the modified functional neck dissection (preserve 8 functional tissues), 30 were treated by functional neck dissection (preserve 3 functional tissues). The recurrent rate of cervical lymph node and the sense of skin were assessed. The recurrence rates in cervical nodes was 6.67% and 10%, respectively (p > 0.05) in patients who accepted modified functional neck dissection and functional neck dissection. The sensation in skin in patients who accepted modified functional neck dissection was better than those who accepted functional neck dissection (p < 0.01). Modified functional neck dissection is helpful to decrease postoperative complications, without increasing recurrent rates of cervical lymph node. PMID:16139562
We review our early experience with laparoscopic retroperitoneal lymph node dissection (RPLND) via extraperitoneal approach\\u000a to assess the precise pathological status of retroperitoneal lymph nodes in early-stage testicular cancer. A total of 32 patients\\u000a (23 with stage I, 4 with stage IIa, and 5 with stage IIb) with testicular cancer underwent extraperitoneal laparoscopic RPLND\\u000a in the supine position. After developing
Lateral lymph node metastases occur in 9% of rectal cancer patients. For cancers localized in the lower rectum below peritoneal\\u000a reflection, the frequency increases to 13% of all cases and to 25.5% in those of Dukes' stage C. The most important technique\\u000a in colorectal surgery for decreasing local failure in the pelvis is lateral lymph node dissection. Today, however, it
Aim: To evaluate the efficacy of elective neck dissection versus the “wait and watch” policy in the treatment of early squamous cell carcinoma of tongue. Materials and Methods: This is a retrospective study of 21 patients with surgical treatment between April 2009 and July 2011. The patients were divided into two groups, with Group 1 consisting of patients who underwent wide excision glossectomy with elective neck dissection and Group 2 consisting of patients who underwent glossectomy without the neck being surgically addressed. The selection of patients was done by the random double-blinded method and the review was done by a single reviewer. All patients were examined for an average period of 1 year postoperatively. Results: Twenty-one cases were treated, among which there were 17 T1 and 4 T2 carcinomas. All the patients had primary carcinoma involving only the tongue with no clinical neck palpable neck nodes. Eleven patients underwent wide excision of primary tumor with elective neck dissection (Group 1) and 10 patients underwent only resection of primary tumor without the neck being surgically addressed (Group 2). In Group 1, there were no recurrences, and in Group 2, there were two patients who developed subsequent cervical node metastasis with one patient undergoing further surgery to address the positive neck and the other patient was lost to follow-up. Conclusions: Regional recurrence was the most common cause of failure after surgical treatment of oral tongue carcinoma. Elective neck dissection significantly reduced mortality due to regional recurrence and also increased the overall survival. Our study suggests that elective neck dissection is a treatment strategy of choice for stages I and II carcinoma of the oral tongue. A prospective, randomized study is worthwhile to further evaluate the benefit of elective neck dissection in the treatment of early carcinoma of the tongue with a larger pool of patients and a lengthier follow-up period.
Since the adoption of off-pump coronary artery bypass surgery (OPCAB), numerous investigators have compared its short- and long-term results with those of on-pump coronary bypass surgery. Some reports of OPCAB were quite favorable, whereas others were critical, claiming that it resulted in incomplete revascularization and reduced venous graft patency. A potentially serious complication of OPCAB, not heretofore sufficiently confronted, is the increased incidence of early postoperative acute aortic dissection, in comparison with the more familiar intraoperative and late-occurring aortic dissection after conventional on-pump bypass surgery.Early postoperative acute aortic dissection after OPCAB appears to be more frequent than was initially thought. Its clinical manifestations can be unusual and often neurologic in nature-rendering diagnosis difficult, causing delays in surgical intervention, and resulting in a high mortality rate.When the physician notes unusual developments in patients after OPCAB that lead to the suspicion of aortic dissection, immediate computed tomography of the chest and surgery should occur if dissection is confirmed. If not detected early, this sequela almost certainly leads to rapid death from aortic rupture. Prevention lies in the strict control of systolic blood pressure during the performance of proximal anastomoses; avoidance of aortic clamping through the use of sequential all-arterial grafts or new-generation mechanical connectors; and, at times, aggressive replacement of the aorta with a prosthetic graft.Herein, we present the cases of 4 patients who sustained acute aortic dissection early after OPCAB. We review the pertinent medical literature. PMID:19876430
We describe a rare case of acute Stanford type A dissection with “intimo-intimal intussusception.” A 38-year-old male with sudden back pain and unconsciousness was admitted to the hospital. A computed tomography (CT) scan revealed the presence of an intimal flap in the aortic root and the aortic arch, absence of an intimal flap in the ascending aorta along with dilatation and occlusion of the brachiocephalic artery. Surgical treatment consisted of ascending aorta replacement under circulatory arrest. During the operation, complete circumferential detachment of the intima at the level of the sinotubular junction with an inverted flap intruding into the brachiocephalic artery was visualized. The surgery was successful with an uneventful postoperative recovery.
Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal complication that can cause strokes in both adults and children. Traumatic vertebral artery dissection (VAD) is one of the most common causes of ABAO in young patients. We present a case of an 11-year-old boy with VAD complicated by basilar artery occlusion 2 days after a fight with classmates that caused severe neurological deficits. He did not have any direct head trauma or concomitant risk factors. Clinical symptoms included nausea, vomiting, and rapid alteration of consciousness. Magnetic resonance imaging showed total occlusion of the basilar artery, and angiography confirmed VAD from the third to the fourth segments. A history of such subtle precipitating events should be noted when diagnosing young patients with brainstem strokes. A delay in the diagnosis of ABAO is frequently due to misleading symptoms and signs and the lack of awareness of this rare condition. PMID:23597537
miRNAs are small molecules involved in gene regulation. Each tissue shows a characteristic miRNAs epression profile that could be altered during neoplastic transformation. Glioblastoma is the most aggressive brain tumour of the adult with a high rate of mortality. Recognizing a specific pattern of miRNAs for GBM could provide further boost for target therapy. The availability of fresh tissue for brain specimens is often limited and for this reason the possibility of starting from formalin fixed and paraffin embedded tissue (FFPE) could very helpful even in miRNAs expression analysis. We analysed a panel of 19 miRNAs in 30 paired samples starting both from FFPE and Fresh/Frozen material. Our data revealed that there is a good correlation in results obtained from FFPE in comparison with those obtained analysing miRNAs extracted from Fresh/Frozen specimen. In the few cases with a not good correlation value we noticed that the discrepancy could be due to dissection performed in FFPE samples. To the best of our knowledge this is the first paper demonstrating that the results obtained in miRNAs analysis using Real-Time PCR starting from FFPE specimens of glioblastoma are comparable with those obtained in Fresh/Frozen samples. PMID:22530056
Background and Aims High frequency electrosurgery has a key role in the broadening application of liver surgery. Its molecular signature, i.e. the metabolites evolving from electrocauterization which may inhibit hepatic wound healing, have not been systematically studied. Methods Human liver samples were thus obtained during surgery before and after electrosurgical dissection and subjected to a two-stage metabolomic screening experiment (discovery sample: N?=?18, replication sample: N?=?20) using gas chromatography/mass spectrometry. Results In a set of 208 chemically defined metabolites, electrosurgical dissection lead to a distinct metabolic signature resulting in a separation in the first two dimensions of a principal components analysis. Six metabolites including glycolic acid, azelaic acid, 2-n-pentylfuran, dihydroactinidiolide, 2-butenal and n-pentanal were consistently increased after electrosurgery meeting the discovery (p<2.0×10?4) and the replication thresholds (p<3.5×10?3). Azelaic acid, a lipid peroxidation product from the fragmentation of abundant sn-2 linoleoyl residues, was most abundant and increased 8.1-fold after electrosurgical liver dissection (preplication?=?1.6×10?4). The corresponding phospholipid hexadecyl azelaoyl glycerophosphocholine inhibited wound healing and tissue remodelling in scratch- and proliferation assays of hepatic stellate cells and cholangiocytes, and caused apoptosis dose-dependently in vitro, which may explain in part the tissue damage due to electrosurgery. Conclusion Hepatic electrosurgery generates a metabolic signature with characteristic lipid peroxidation products. Among these, azelaic acid shows a dose-dependent toxicity in liver cells and inhibits wound healing. These observations potentially pave the way for pharmacological intervention prior liver surgery to modify the metabolic response and prevent postoperative complications.
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Knowledge of this condition is scarce and, at present, no consensus exists with regards to the aetiology, prognosis, and treatment. Among patients with SCAD, cases involving the left main (LM) and the left anterior descending (LAD) and circumflex (Cx) arteries bifurcation are even more exceptional. Furthermore, the treatment of asymptomatic patients with involvement of these major vessels poses a major challenge for the cardiologists and cardiac surgeons. We report a case of complicated spontaneous left main coronary artery dissection in which we question what is the best initial treatment in these asymptomatic patients: conservative or early aggressive. PMID:23084325
Jurado-Román, Alfonso; Andreu, Javier; Tejada, Julio García; Velázquez, Maite; Albarrán, Agustín; Hernández, Felipe; Unzué, Leire; Tascón, Juan
We report the case of a 70-year-old man who presented with a large dissection of the ascending aorta related to coronary artery bypass grafting 3 years earlier. One graft was patent; however, a reverse venous graft to the right coronary artery was occluded, and that artery was substantially stenotic. The patient was a high-risk surgical candidate, so we treated a large dissection successfully by endovascular means with a thoracic endograft. This case suggests that this approach can be applied safely and effectively to other high-surgical-risk patients who have complex ascending aortic disease.
Shabaneh, Bahaeddin; Gregoric, Igor D.; Loyalka, Pranav; Krajcer, Zvonimir
Primary spontaneous coronary artery dissection may appear in young women during the peripartum period or as a result of atherosclerosis. We present a patient with familial hypercholesterolemia who developed a giant aneurysm of the right coronary artery in the setting of atherosclerotic spontaneous coronary dissection over an 8 year period. This report illustrates the association between spontaneous coronary artery dissection and subsequent coronary aneurysm formation. PMID:20014206
Treating dissections and dissecting aneurysms requires maintenance of flow through the true lumen and exclusion of the false lumen from the circulation. A dissecting aneurysm of the vertebral artery presented with both a true and false lumen within the aneurysmal sac. Stenting of the true lumen followed by coil embolization of both lumens was performed. Management options and decision-making are discussed for this unique situation. PMID:23761478
Johnson, Andrew Kelly; Gerard, Carter S; Lopes, Demetrius Klee
Treating dissections and dissecting aneurysms requires maintenance of flow through the true lumen and exclusion of the false lumen from the circulation. A dissecting aneurysm of the vertebral artery presented with both a true and false lumen within the aneurysmal sac. Stenting of the true lumen followed by coil embolization of both lumens was performed. Management options and decision-making are discussed for this unique situation. PMID:23737597
Johnson, Andrew Kelly; Gerard, Carter S; Lopes, Demetrius Klee
A review of 4,500 angiograms yielded 11 patients with dissection of the vertebral arteries who had MRI and (in 4 patients)\\u000a MR angiography (MRA) in the acute phase of stroke. One patient with incidental discovery at arteriography of asymptomatic\\u000a vertebral artery dissection and two patients with acute strokes with MRI and MRA findings consistent with vertebral artery\\u000a dissection were included.
M. Mascalchi; M. C. Bianchi; S. Mangiafico; G. Ferrito; M. Puglioli; E. Marin; S. Mugnai; R. Canapicchi; N. Quilici; D. Inzitari
Eleven patients were studied after aortic dissection repair, using a technique of intravenous angiography with a line-scanned projection radiography prototype. A computed tomographic scanner was modified to produce line-scanned projection images of the aorta, using temporal or dual energy subtraction in combination with intravenous injection of diatrizoate. Excellent visualization of the Dacron graft, persistent intimal flaps, and aneurysmal dilation of the aorta were obtained in nine patients. Patient respiration when temporal subtraction was used and prolonged circulation time contributed to the two inadequate studies.
Arterial dissections of head and neck arteries were first identified pathologically in the 1950s, but not until the 1970s and the 1980s did they begin to be widely recognized as a clinical entity. Carotid and vertebral artery dissections account for only 2% of all ischemic strokes, but they account for approximately 20% of thromboembolic strokes in patients younger than 45 years. The cause of supra-aortic dissections can be either spontaneous or traumatic. This article addresses spontaneous cervical and cerebral artery dissections. PMID:24156857
Rahme, Rudy J; Aoun, Salah G; McClendon, Jamal; El Ahmadieh, Tarek Y; Bendok, Bernard R
The treatment of dissecting aneurysms of the vertebral artery (VA) involving the posterior inferior cerebellar artery (PICA) or presenting with hypoplasia of the contralateral VA is controversial. We describe our experience with 4 ruptured and 2 unruptured VA dissecting aneurysms and discuss the efficacy of endovascular surgery using stents. All patients were male; their mean age was 50.7 years. According to World Federation of Neurological Surgeons (WFNS) grading, 3 of the ruptured aneurysms were grade V, the other was grade I. All patients were successfully treated using stents; in 5 we also coil-embolized the aneurysmal lumen. One aneurysm was treated by the placement of 2 stents covering the dissection site; there was a danger of aneurysmal rupture during coil embolization. No technical complications were encountered although one patient suffered minor rebleeding 5 days post-treatment. Delayed vasospasm occurred in 4 cases. According to the Glasgow Outcome Scale (GOS), at 3 months after treatment 2 patients had made a good recovery, one was moderately disabled, one suffered severe disability, and 2 had died. One death each was due to acute myocardial and brain stem infarction. Endovascular surgery using stents may be a useful treatment in patients in poor condition who manifest dissecting VA aneurysms involving the PICA or hypoplasia of the contralateral VA, especially in the acute period after rupture. PMID:18683108
Suzuki, S; Kurata, A; Iwamoto, K; Sato, K; Niki, J; Miyazaki, T; Yamada, M; Oka, H; Fujii, K; Kan, S
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.
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.
Traumatic coronary artery dissection is an uncommon cause of acute myocardial infarction (AMI). We report a case of blunt chest trauma resulting from a motorcycle collision causing ostial dissection of the left anterior descending (LAD) artery in a 31-year-old previously healthy male. The patient also suffered from compound comminuted fractures of the humerus and ulna and severe liver laceration, which hampered both percutaneous and surgical acute revasularization. After a stormy hospital course, a bare metal stent was implanted to seal the LAD artery dissection. The patient was discharged in a stable condition and was followed-up for rehabilitation. This case report underscores the multidisciplinary approach in facing challenges encountered after rare sequelae of chest trauma. PMID:22121464
We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures.
Rahman, Shahid; Abdul-Waheed, Mohammed; Helmy, Tarek; Huffman, Lynn C; Koshal, Vipin; Guitron, Julian; Merrill, Walter H; Lewis, David F; Dunlap, Stephanie; Shizukuda, Yukitaka; Weintraub, Neal L; Meyer, Cristopher; Cilingiroglu, Mehmet
We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures. PMID:19338659
Rahman, Shahid; Abdul-Waheed, Mohammed; Helmy, Tarek; Huffman, Lynn C; Koshal, Vipin; Guitron, Julian; Merrill, Walter H; Lewis, David F; Dunlap, Stephanie; Shizukuda, Yukitaka; Weintraub, Neal L; Meyer, Christopher; Cilingiroglu, Mehmet
The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair was first described 15 years ago. Currently, there is a diverse array of endografts that are commercially available to treat the thoracic aorta. Multiple studies, including industry-sponsored and single-institution reports, have demonstrated excellent outcomes of thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms, with less reported perioperative morbidity and mortality in comparison with conventional open repair. Additionally, similar outcomes have been demonstrated for the treatment of type B dissections. However, the technology remains relatively novel, and larger studies with longer term outcomes are necessary to more fully evaluate the role of endovascular therapy for the treatment of thoracic aortic disease. This review examines the currently available thoracic endografts, preoperative planning for thoracic endovascular aortic repair, and outcomes of thoracic endovascular aortic repair for the treatment of both thoracic aortic aneurysms and type B aortic dissections. Mt Sinai J Med 77:256-269, 2010. (c) 2010 Mount Sinai School of Medicine. PMID:20506451
Baril, Donald T; Cho, Jae S; Chaer, Rabih A; Makaroun, Michel S
With the goal of understanding how nervous systems produce activity and respond to the environment, neuroscientists turn to model systems that exhibit the activity of interest and are accessible and amenable to experimental methods. The stomatogastric nervous system (STNS) of the American lobster (Homarus americanus; also know was the Atlantic or Maine lobster) has been established as a model system for studying rhythm generating networks and neuromodulation of networks. The STNS consists of 3 anterior ganglia (2 commissural ganglia and an oesophageal ganglion), containing modulatory neurons that project centrally to the stomatogastric ganglion (STG). The STG contains approximately 30 neurons that comprise two central pattern generating networks, the pyloric and gastric networks that underlie feeding behaviors in crustaceans1,2. While it is possible to study this system in vivo3, the STNS continues to produce its rhythmic activity when isolated in vitro. Physical isolation of the STNS in a dish allows for easy access to the somata in the ganglia for intracellular electrophysiological recordings and to the nerves of the STNS for extracellular recordings. Isolating the STNS is a two-part process. The first part, dissecting the stomach from the animal, is described in an accompanying video article4. In this video article, fine dissection techniques are used to isolate the STNS from the stomach. This procedure results in a nervous system preparation that is available for electrophysiological recordings.
We reported simple partial root remodeling using a graft trimmed twin “U” shape for extensive dissection into the right/non-coronary sinuses with acute type A aortic dissection with cardiac tamponade, acute myocardial infarction on the right coronary artery and aortic regurgitation. After total arch replacement with frozen elephant trunk technique for distal dissection, partial root remodeling on the non and right coronary sinuses was performed. Postoperative computed tomography (CT) showed well shaped Valsalva sinuses and aortic regurgitation completely disappeared. This technique might become an alternative procedure for aortic dissection severely involving Valsalva sinuses without dilatation on the aortic root.
Spontaneous coronary artery dissection (SCAD) is a rare cause of chest pain and cardiomyopathy. This phenomenon usually occurs during the peripartum period. SCAD associated with exercise and heavy weight lifting is even rarer and has been reported in less than 10 cases in the literature. We describe a case of SCAD associated with heavy weight lifting and exercise in a 29-year-old male who presented with exertional chest pain. The patient subsequently underwent a cardiac catheterization that showed a left ventricular ejection fraction of 40% and a dissection in the left anterior descending (LAD) coronary artery after the first diagonal/septal branch with extension to the distal LAD that wrapped around the apex. He was effectively managed with the combination of medical therapy followed by a few days later with stenting. In summary, diagnosis and treatment of this rare phenomenon is a challenge, but early diagnosis and appropriate management can lead to a successful outcome. PMID:21413128
We report a case of multiple flat adenomas and cancer of the rectum that occurred 15 years after pelvic irradiation following surgery for uterine cancer. Adenoma borders were diagnosed accurately by magnifying chromoendoscopy, leading to their adequate excision using endoscopic submucosal dissection. This enabled minimal dissection of the irradiated pelvis that would have otherwise been difficult. Furthermore, our approach probably helped minimize loss of bowel function, thereby preserving the patient's quality of life as much as possible. Pathology of the resected specimens revealed thickened walls of the submucosal layer vessels, indicating chronic radiation proctitis. Pelvic irradiation of the bowel carries a high risk of causing flat adenomas and cancer. Close and long-term surveillance may be useful in such cases, using not only conventional colonoscopy but also chromoendoscopy with indigo carmine dye spray and magnifying endoscopy. PMID:23515559
Summary Background Chyle fistula is one of the rare complications of neck dissections. Even though no consented algorithm for the management of this entity has been established yet, conservative treatment options including somatostatin analogues have been suggested as an adequate modality for low output fistulas. Case Report Here we present a patient with a right-sided neck fistula which was resistant to conventional treatment, and was finally treated by surgery. The neck dissection was performed for a malignant right neck mass that was accepted as the lymph node metastasis of formerly treated papillary thyroid carcinoma. The pathology of the specimen revealed a contralateral neck metastasis of previously treated breast carcinoma. Conclusion We assume that consecutive surgeries on axillary and neck lymph pathways resulted in such a complicated and exceptional case.
Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI) in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. Stanford type A aortic dissection, rarely may mimic myocardial infarction. We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. Prognostic implications of early diagnosis applying transthoracic echocardiography (TTE) are described.
Purpose The rationale for this pilot study was to add arterio-venous dissection (AVD) after unsuccessful medical treatment in a well-defined group of patients with branch retinal vein occlusion (BRVO).Methods In this prospective, interventional case series 35 consecutive patients with a visual acuity (VA) of 0.4 (logMar) or worse were scheduled for surgery within the first 3 months of the onset of BRVO. The
Nicolas Feltgen; Julia Herrmann; Hansjuergen Agostini; Adel Sammain; Lutz L. Hansen
Study design:Case reportObjective:To describe the clinical and imaging findings of a patient with painless aortic dissection.Setting:University Neurology Department, Thessaloniki, GreecePatient, Methods, Results:A 46-year-old man was transferred to our Department for emergent evaluation of paraplegia, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, bilateral leg weakness, 24 h earlier. He presented complete flaccid
D Karacostas; G Anthomelides; P Ioannides; K Psaroulis; D Psaroulis
We present a case of aortic dissection with shock due to cardiac tamponade in a previously healthy 15-year-old male. The diagnosis was suspected and confirmed by transthoracic echocardiography before transfer to the cardiothoracic unit for successful surgical intervention. Because it is a rare life-threatening condition with a high mortality rate in the pediatric population, a very high index of suspicion is required to reach the clinical diagnosis in a timely manner and institute appropriate surgical management. PMID:16944331
Purpose: We conducted a randomized trial to investigate whether systematic nodal dissection (SND) is superior to mediastinal lymph nodal sampling (MLS) in surgical treatment of non-small cell lung cancer (NSCLC). Methods: The patients resectable clinical Stage I–IIIA NSCLC were randomly assigned to lung resection combined with SND or lung resection combined with MLS. After postoperative pathological re-staging, eligible cases were
Yi-long Wu; Zhi-fan Huang; Si-yu Wang; Xue-ning Yang; Wei Ou
Sentinel node excision has been widely accepted as the initial surgical step for evaluating the axilla for metastatic breast\\u000a cancer. When the nodes are positive, the standard of care is to complete the axillary node dissection, a more extended procedure\\u000a that carries an increased risk for morbidity. This article reviews data from sentinel lymph node trials, case series reports\\u000a of