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Sample records for artery resembling dissection

  1. Spontaneous Coronary Artery Dissection

    MedlinePlus

    Spontaneous coronary artery dissection (SCAD) Overview By Mayo Clinic Staff Spontaneous coronary artery dissection — sometimes referred to as SCAD — is an ... the blood vessels in the heart. Spontaneous coronary artery dissection (SCAD) can slow or block blood flow ...

  2. Spontaneous coronary artery dissection.

    PubMed

    Giacoppo, Daniele; Capodanno, Davide; Dangas, George; Tamburino, Corrado

    2014-07-15

    Spontaneous coronary artery dissection (SCAD) is a relatively rare and unexplored type of coronary disease. Although atherosclerosis, hormonal changes during pregnancy and connective tissue disorders might represent a sufficiently convincing explanation for some patients with SCAD, the many remaining cases display only a weak relationship with these causes. While on one side the clinical heterogeneity of SCAD masks a full understanding of their underlying pathophysiologic process, on the other side paucity of data and misleading presentations hamper the quick diagnosis and optimal management of this condition. A definite diagnosis of SCAD can be significantly facilitated by endovascular imaging techniques. In fact, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) overcome the limitations of coronary angiography providing detailed endovascular morphologic information. In contrast, optimal treatment strategies for SCAD still represent a burning controversial question. Herein, we review the published data examining possible causes and investigating the best therapy for SCAD in different clinical scenarios.

  3. Spontaneous Arterial Dissection.

    PubMed

    Brandt, Tobias; Caplan, Louis

    2001-09-01

    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.

  4. [Internal carotid artery dissection after Heimlich maneuver].

    PubMed

    Rakotoharinandrasana, H; Petit, E; Dumas, P; Vandermarcq, P; Gil, R; Neau, J-Ph

    2003-01-01

    We report a case of cervical artery dissection following a Heimlich maneuver. Cervical artery dissections are at the present time well known and are sometimes associated with trivial traumas. However, to our knowledge, this complication of such maneuver was never reported in the literature. Pathophysiological mechanisms are discussed.

  5. Spontaneous Coronary Artery Dissection with Cardiac Tamponade.

    PubMed

    Goh, Anne C H; Lundstrom, Robert J

    2015-10-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome.

  6. Spontaneous Coronary Artery Dissection during Cabergoline Therapy

    PubMed Central

    Mehta, Nishaki Kiran; Malkani, Samir; Ockene, Ira

    2012-01-01

    Although spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, it should be considered during the evaluation of patients who have chest pain. Coronary vasospasm can lead to spontaneous dissection. The dopamine agonist cabergoline is known to cause digital vasospasm. Herein, we report a case of spontaneous right coronary artery dissection in a 43-year-old woman who was taking cabergoline as therapy for prolactinoma. To our knowledge, this is the first report of an apparent relationship between cabergoline therapy and spontaneous coronary artery dissection. The possible association of cabergoline with coronary artery spasm and dissection should be considered in patients who present with chest pain while taking this medication. PMID:22412238

  7. Renal artery dissection following marathon running.

    PubMed

    Iqbal, Fahad M; Goparaju, Madhavi; Yemme, Soumya; Lewis, Bruce E

    2009-01-01

    A 38-year-old, previously healthy man presented with flank pain after competing in a marathon. Initial laboratory tests and urinalysis were essentially normal. Both contrast enhanced-computed tomography and magnetic resonance angiography showed an infarcted region of the left lower kidney without renal artery dissection. Thromboembolism was suspected, but further testing was negative. The diagnosis of renal artery dissection was established by angiogram, showing dissection of the segmental branch. The patient remained normotensive, maintained normal renal function, and had resolution of pain symptoms prior to discharge. On the basis of our experience and review of the literature, renal artery dissection occurs in otherwise healthy men and often goes undiagnosed. The management strategy tends to be conservative unless the patient develops progressive decline in renal function or worsening hypertension, with an excellent prognosis. This case also shows the importance of discussing the pros and cons of extreme physical exertion with all patients.

  8. Recurrent post-partum coronary artery dissection

    PubMed Central

    2010-01-01

    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. PMID:20932332

  9. Recurrent post-partum coronary artery dissection.

    PubMed

    Rajab, Taufiek K; Khalpey, Zain; Kraemer, Bernhard; Resnic, Frederic S; Gallegos, Robert P

    2010-10-09

    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.

  10. [Pregnancy and coronary artery dissection].

    PubMed

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

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

  11. Spontaneous Isolated Superior Mesenteric Artery Dissection

    PubMed Central

    Nath, Anand; Yewale, Sayali; Kousha, Mohammad

    2016-01-01

    A true isolated superior mesenteric artery (SMA) dissection is a rare occurrence. The increasing use of diagnostic imaging studies has resulted in this rare disease being more recognized. A 68-year-old Caucasian female presented with sharp upper abdominal pain. Computed tomography (CT) of the abdomen showed dissection with thrombosis in the proximal SMA. Conservative management with bowel rest, blood pressure control, and anticoagulation relieved her symptoms. Follow-up CT showed stable dissection. Physicians should consider the diagnosis of isolated spontaneous SMA dissection after excluding more common causes. The optimal management pathway has not been firmly established. Conservative management with anticoagulation appears to be a safe first-line therapy in selected patients. PMID:28203123

  12. Spontaneous Coronary Artery Dissection: The Phantom Menace

    PubMed Central

    Spinthakis, Nikolaos; Abdulkareem, Nada; Farag, Mohamed; Gorog, Diana A.

    2016-01-01

    We present a case of a 66-year-old lady with chest pain, without dynamic 12-lead electrocardiographic (ECG) changes and normal serial troponin. Coronary angiography revealed a linear filing defect in the first obtuse marginal branch of the circumflex artery indicating coronary artery dissection, with superadded thrombus. She was managed medically with dual antiplatelet therapy and has responded well. Spontaneous coronary artery dissection (SCAD) is a rare cause of cardiac chest pain, which can be missed without coronary angiography. Unlike most other lesions in patients with unstable symptoms, where coronary intervention with stenting is recommended, patients with SCAD generally fare better with conservative measures than with intervention, unless there is hemodynamic instability. PMID:28197295

  13. Spontaneous healing of spontaneous coronary artery dissection.

    PubMed

    Almafragi, Amar; Convens, Carl; Heuvel, Paul Van Den

    2010-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. It should be suspected in every healthy young woman without cardiac risk factors, especially during the peripartum or postpartum periods. It is important to check for a history of drug abuse, collagen vascular disease or blunt trauma of the chest. Coronary angiography is essential for diagnosis and early management. We wonder whether thrombolysis might aggravate coronary dissection. All types of treatment (medical therapy, percutaneous intervention or surgery) improve the prognosis without affecting survival times if used appropriately according to the clinical stability and the angiographic features of the involved coronary arteries. Prompt recognition and targeted treatment improve outcomes. We report a case of SCAD in a young female free of traditional cardiovascular risk factors, who presented six hours after thrombolysis for ST elevation myocardial infarction. Coronary angiography showed a dissection of the left anterior descending and immediate branch. She had successful coronary artery bypass grafting, with complete healing of left anterior descending dissection.

  14. Intracranial Vertebral Artery Dissections: Evolving Perspectives

    PubMed Central

    Ali, M.S.; Amenta, P.S.; Starke, R.M.; Jabbour, P.M.; Gonzalez, L.F.; Tjoumakaris, S.I.; Flanders, A.E.; Rosenwasser, R.H.; Dumont, A.S.

    2012-01-01

    Summary Intracranial vertebral artery dissection (VAD) represents the underlying etiology in a significant percentage of posterior circulation ischemic strokes and subarachnoid hemorrhages. These lesions are particularly challenging in their diagnosis, management, and in the prediction of long-term outcome. Advances in the understanding of underlying processes leading to dissection, as well as the evolution of modern imaging techniques are discussed. The data pertaining to medical management of intracranial VADs, with emphasis on anticoagulants and antiplatelet agents, is reviewed. Surgical intervention is discussed, including, the selection of operative candidates, open and endovascular procedures, and potential complications. The evolution of endovascular technology and techniques is highlighted. PMID:23217643

  15. Recurrent spontaneous coronary artery dissection: acute management and literature review

    PubMed Central

    Dana, Ali

    2012-01-01

    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. PMID:24062889

  16. Isolated Posterior Cerebral Artery Dissection: Report of Three Cases

    DTIC Science & Technology

    2005-08-31

    Dissecting intracranial aneurysms usually present with large cerebral infarcts, but may also present with subarachnoid hemorrhage or both (2, 6, 15...diagnosis of intracranial dissection and dissecting aneurysms is predominantly made by DSA, which remains the gold standard technique. There is narrowing...Anticoagulation has not been promoted in the treatment of intracranial arterial dissecting aneurysms due to the potential risk of mural hemorrhage, rupture

  17. Contemporary Review on Spontaneous Coronary Artery Dissection.

    PubMed

    Saw, Jacqueline; Mancini, G B John; Humphries, Karin H

    2016-07-19

    Spontaneous coronary artery dissection (SCAD) is gaining recognition as an important cause of myocardial infarction, especially in young women. There has been a surge in the diagnosis of SCAD in recent years, presumably due to an increased use of coronary angiography, and the clinical availability and application of high-resolution intracoronary imaging. The improved recognition and diagnosis, together with increased publications and attention through social media, have considerably raised awareness of this condition, which was once believed to be very rare. Recent publications of moderate to large contemporary case series have helped elucidate the early natural history, presenting characteristics (clinical and angiographic), underlying etiology, management, and cardiovascular outcomes with this condition, thus providing observations and important clinical insights of value to clinicians managing this challenging and perplexing patient cohort. The aim of our review is to provide a comprehensive contemporary update of SCAD to aid health care professionals in managing these patients in both the acute and chronic settings.

  18. Treatment of Ruptured Vertebral Artery Dissecting Aneurysms

    PubMed Central

    Hamasaki, Osamu; Ikawa, Fusao; Hidaka, Toshikazu; Kurokawa, Yasuharu; Yonezawa, Ushio

    2014-01-01

    Summary We evaluated the outcomes of endovascular or surgical treatment of ruptured vertebral artery dissecting aneurysms (VADAs), and investigated the relations between treatment complications and the development and location of the posterior inferior cerebellar artery (PICA). We treated 14 patients (12 men, two women; mean age, 56.2 years) with ruptured VADAs between March 1999 and June 2012 at our hospital. Six and eight patients had Hunt and Hess grades 1-3 and 4-5, respectively. Twelve patients underwent internal endovascular trapping, one underwent proximal endovascular occlusion alone, and one underwent proximal endovascular occlusion in the acute stage and occipital artery (OA)-PICA anastomosis and surgical trapping in the chronic stage. The types of VADA based on their location relative to the ipsilateral PICA were distal, PICA-involved, and non-PICA in nine, two, and three patients, respectively. The types of PICA based on their development and location were bilateral anterior inferior cerebellar artery (AICA)-PICA, ipsilateral AICA-PICA, extradural, and intradural type in one, two, two, and nine patients, respectively. Two patients with high anatomical risk developed medullary infarction, but their midterm outcomes were better than in previous reports. The modified Rankin scale indicated grades 0-2, 3-5, and 6 in eight, three, and three patients, respectively. A good outcome is often obtained in the treatment of ruptured VADA using internal endovascular trapping, except in the PICA-involved type, even with high-grade subarachnoid hemorrhage. Treatment of the PICA-involved type is controversial. The anatomical location and development of PICA may be predicted by complications with postoperative medullary infarction. PMID:24976093

  19. Dissection of the right coronary artery following blunt cardiac injury

    PubMed Central

    Vogiatzis, I; Dapcevic, I

    2015-01-01

    Background Coronary artery dissection is a rare complication of blunt thoracic trauma which can become rapidly lethal necessitating prompt diagnosis and treatment. Most reported cases of coronary artery injury, including dissection, involve the left anterior descending coronary artery, given its anatomical location in relation to the impact. Description of case A 72-year-old male, who was involved in a vehicular accident, sustained blunt thoracic trauma which resulted in isolated right coronary artery dissection and acute myocardial infarction. The culprit lesion was found in coronary angiography in the proximal right coronary artery and was successfully repaired with percutaneous coronary intervention and one drug-eluting stent placement. Conclusion Traumatic dissection of coronary arteries must be suspected in blunt thoracic trauma. It can be treated with interventional management and results in a fairly good prognosis. Hippokratia 2015; 19 (3): 278-280. PMID:27418793

  20. Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection

    PubMed Central

    Hako, René; Fedačko, Ján; Morochovič, Radoslav; Kristian, Pavol; Pekárová, Tímea; Tuomainen, Petri; Pella, Daniel

    2017-01-01

    Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR) images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension. PMID:28154579

  1. Endovascular Treatment of Huge Dissecting Aneurysms Involving the Basilar Artery

    PubMed Central

    Yang, X.; Mu, S.; Lv, M.; Li, L.; Wu, Z.

    2007-01-01

    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

  2. Spontaneous dissections of multiple visceral arteries: an extremely rare case

    PubMed Central

    Le, Trong Binh; Hong, Kee Chun; Cho, Soon Gu; Park, Keun-Myoung

    2017-01-01

    Spontaneous dissections of visceral arteries without aortic involvement are very rare. The etiologies of these entities are unclear and their clinical managements remain controversial. We report a case of spontaneous multiple dissections affecting 4 visceral arteries including the superior mesenteric artery, the celiac artery and the bilateral renal arteries. The patient was managed conservatively and endovascularly. The clinical manifestation markedly improved and laboratory tests returned to normal limits within 1 week. The regular follow-up suggested a good clinical and radiological outcome until 84 months. PMID:28382296

  3. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection.

    PubMed

    Debette, Stéphanie; Compter, Annette; Labeyrie, Marc-Antoine; Uyttenboogaart, Maarten; Metso, Tina M; Majersik, Jennifer J; Goeggel-Simonetti, Barbara; Engelter, Stefan T; Pezzini, Alessandro; Bijlenga, Philippe; Southerland, Andrew M; Naggara, Olivier; Béjot, Yannick; Cole, John W; Ducros, Anne; Giacalone, Giacomo; Schilling, Sabrina; Reiner, Peggy; Sarikaya, Hakan; Welleweerd, Janna C; Kappelle, L Jaap; de Borst, Gert Jan; Bonati, Leo H; Jung, Simon; Thijs, Vincent; Martin, Juan J; Brandt, Tobias; Grond-Ginsbach, Caspar; Kloss, Manja; Mizutani, Tohru; Minematsu, Kazuo; Meschia, James F; Pereira, Vitor M; Bersano, Anna; Touzé, Emmanuel; Lyrer, Philippe A; Leys, Didier; Chabriat, Hugues; Markus, Hugh S; Worrall, Bradford B; Chabrier, Stéphane; Baumgartner, Ralph; Stapf, Christian; Tatlisumak, Turgut; Arnold, Marcel; Bousser, Marie-Germaine

    2015-06-01

    Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defined by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass effect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be difficult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confirm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without.

  4. CrossFit-related cervical internal carotid artery dissection.

    PubMed

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

    2015-08-01

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

  5. SMAD2 Mutations Are Associated with Arterial Aneurysms and Dissections.

    PubMed

    Micha, Dimitra; Guo, Dong-Chuan; Hilhorst-Hofstee, Yvonne; van Kooten, Fop; Atmaja, Dian; Overwater, Eline; Cayami, Ferdy K; Regalado, Ellen S; van Uffelen, René; Venselaar, Hanka; Faradz, Sultana M H; Vriend, Gerrit; Weiss, Marjan M; Sistermans, Erik A; Maugeri, Alessandra; Milewicz, Dianna M; Pals, Gerard; van Dijk, Fleur S

    2015-12-01

    We report three families with arterial aneurysms and dissections in which variants predicted to be pathogenic were identified in SMAD2. Moreover, one variant occurred de novo in a proband with unaffected parents. SMAD2 is a strong candidate gene for arterial aneurysms and dissections given its role in the TGF-β signaling pathway. Furthermore, although SMAD2 and SMAD3 probably have functionally distinct roles in cell signaling, they are structurally very similar. Our findings indicate that SMAD2 mutations are associated with arterial aneurysms and dissections and are in accordance with the observation that patients with pathogenic variants in genes encoding proteins involved in the TGF-β signaling pathway exhibit arterial aneurysms and dissections as key features.

  6. Coronary Artery Dissection: Not Just a Heart Attack

    MedlinePlus

    ... Aneurysm More Coronary Artery Dissection: Not Just a Heart Attack Updated:Oct 4,2016 Sometimes a heart attack ... Disease Go Red For Women Types of aneurysms Heart Attack • Home • About Heart Attacks Acute Coronary Syndrome (ACS) ...

  7. Vertebral artery dissection related to basilar impression: case report.

    PubMed

    Dickinson, L D; Tuite, G F; Colon, G P; Papadopoulos, S M

    1995-04-01

    A 50-year-old man with myelopathy secondary to basilar impression developed bilateral vertebral artery dissection after undergoing treatment with 8 pounds of cervical traction. The vertebral artery dissection resulted in vertebrobasilar insufficiency and posterior circulation stroke. In this report, the current management philosophies in the treatment of basilar impression are discussed, and the pertinent neurovascular anatomy is illustrated. This report suggests that vertebral artery injury may result from attempted reduction of severe basilar impression. Regardless of the cause of cranial settling, the risk of vertebral artery injury with cervical traction should be considered in patients with severe basilar impression.

  8. Spontaneous Bilateral Vertebral Artery Dissection During a Basketball Game

    PubMed Central

    Mas Rodriguez, Manuel F.; Berrios, Rafael Arias; Ramos, Edwardo

    2016-01-01

    Spontaneous vertebral artery dissection accounts for 2% of all ischemic strokes and can occur as a consequence of sports events. We present an unusual case of spontaneous bilateral vertebral artery dissection in a 30-year-old male patient during a basketball game. He developed severe dysphagia, right hemiparesis, and balance dysfunction. We also present a review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this entity in sports. PMID:26733592

  9. Dissection of a non-bifurcating cervical carotid artery.

    PubMed

    Nas, Omer Fatih; Karakullukcuoglu, Zeynel; Hakyemez, Bahattin; Erdogan, Cuneyt

    2016-06-01

    A non-bifurcating cervical carotid artery is a rare anomaly in the population. Radiologic diagnosis of pathologies seen together with this anomaly can be challenging. Despite not being diagnostic all the time, digital subtraction angiography is accepted as the gold standard method for the diagnosis of dissection. We present a case of a non-bifurcating cervical carotid artery and concomitant dissection, which presented to the hospital with trauma and ischemic findings.

  10. Traumatic carotid artery dissection caused by bungee jumping.

    PubMed

    Zhou, Wei; Huynh, Tam T; Kougias, Panagiotis; El Sayed, Hosam F; Lin, Peter H

    2007-11-01

    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.

  11. [Dissecting aneurysms at the bases of the brachiocephalic artery and the left common carotid artery due to localized dissection of the aortic arch; report of a case].

    PubMed

    Higashi, Shigeki; Yoshida, Y; Mitsuoka, H

    2007-07-01

    A 43-year-old male lost consciousness immediately after archery practice, and was brought to our hospital by ambulance. Angiography showed dissecting aneurysms at the bases of the brachiocephalic artery and the left common carotid artery, causing compression of these arteries. Under cardiopulmonary bypass with selective cerebral perfusion, the blood supply to these arteries was restored with a bifurcated graft. Surgical specimen showed localized dissection of the aortic arch at the bifurcation to the brachiocephalic artery and the left common carotid artery, with the formation of dissecting aneurysms at the bases of both arteries. The aneurysms were filled with thrombi. In addition to these dissecting aneurysms, there were arterial dissections involving the brachiocephalic artery and the bilateral common carotid arteries. Histopathological examination of the vessel wall showed no evidence of atherosclerosis or vasculitis, and no abnormalities in the arrangement of elastic fibers.

  12. Propagation of dissection in a residually-stressed artery model.

    PubMed

    Wang, Lei; Roper, Steven M; Hill, Nicholas A; Luo, Xiaoyu

    2017-02-01

    This paper studies dissection propagation subject to internal pressure in a residually-stressed two-layer arterial model. The artery is assumed to be infinitely long, and the resultant plane strain problem is solved using the extended finite element method. The arterial layers are modelled using the anisotropic hyperelastic Holzapfel-Gasser-Ogden model, and the tissue damage due to tear propagation is described using a linear cohesive traction-separation law. Residual stress in the arterial wall is determined by an opening angle [Formula: see text] in a stress-free configuration. An initial tear is introduced within the artery which is subject to internal pressure. Quasi-static solutions are computed to determine the critical value of the pressure, at which the dissection starts to propagate. Our model shows that the dissection tends to propagate radially outwards. Interestingly, the critical pressure is higher for both very short and very long tears. The simulations also reveal that the inner wall buckles for longer tears, which is supported by clinical CT scans. In all simulated cases, the critical pressure is found to increase with the opening angle. In other words, residual stress acts to protect the artery against tear propagation. The effect of residual stress is more prominent when a tear is of intermediate length ([Formula: see text]90[Formula: see text] arc length). There is an intricate balance between tear length, wall buckling, fibre orientation, and residual stress that determines the tear propagation.

  13. [Spontaneous renal artery dissection with renal infarction: a case report].

    PubMed

    Oki, Takashi; Adachi, Hiroyuki; Tahara, Hideo; Kino, Sigeo

    2011-11-01

    A 58-year-old woman visited our hospital with nausea and right flank pain. At first abdominal ultrasonography was performed, suggesting a right renal infarction. Computed tomography (CT) study of the abdomen with intravenous contrast was performed to determine the cause of the symptoms. The scan revealed poor enhancement in the lower half of the right kidney. She was diagnosed with a right renal infarction. She was initially treated with anticoagulant therapy, but 5 days later, she complained of nausea. This time, CT demonstrated exacerbation of a right renal infarction with renal artery dissection. Based on this finding, we performed a right nephrectomy. The result of pathology was segmental arterial mediolysis. She was discharged 12 days after the surgery and is doing well at 6 months after discharge. Spontaneous renal artery dissection is a rare disease. It constitutes approximately 0.05% of arteriographic dissections. In addition, spontaneous renal artery dissection shows nonspecific symptoms. Together, these two factors may cause a delay in diagnosis.

  14. Case report on vertebral artery dissection in mixed martial arts.

    PubMed

    Slowey, Michael; Maw, Graeme; Furyk, Jeremy

    2012-04-01

    A 41-year-old man presented to the ED with severe vertigo 2 days after a grappling injury while training in mixed martial arts. Imaging revealed a cerebellar infarct with complete occlusion of the right vertebral artery secondary to dissection. Management options are discussed as is the ongoing controversy regarding the safety of the sport.

  15. Internal carotid artery dissection following chiropractic treatment in a pregnant woman with Systemic Lupus Erythematosus.

    PubMed

    Morton, Adam

    2012-12-19

    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.

  16. Internal carotid artery dissection following chiropractic treatment in a pregnant woman with Systemic Lupus Erythematosus

    PubMed Central

    2012-01-01

    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. PMID:23254252

  17. Vertebral Artery Dissection: Natural History, Clinical Features and Therapeutic Considerations

    PubMed Central

    Park, Kwan-Woong; Park, Jong-Sun; Hwang, Sun-Chul; Im, Soo-Bin; Shin, Won-Han

    2008-01-01

    When a tear occurs in one of the major cervicocerebral arteries and allows blood to enter the wall of the artery and split its layers, the result is either stenosis or aneurysmal dilatation of the vessel. Vertebral artery dissection (VAD) is an infrequent occurrence but is a leading cause of stroke in young and otherwise healthy patients. This article discusses recent developments in understanding of the epidemiology and pathogenesis of VAD and the various clinical manifestations, methods of diagnosis, and approaches to treatment. PMID:19096659

  18. Chiropractic Response to a Spontaneous Vertebral Artery Dissection

    PubMed Central

    Tarola, Gary; Phillips, Reed B.

    2015-01-01

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

  19. Spontaneous dissection with rupture of the superior mesenteric artery from segmental arterial mediolysis.

    PubMed

    Tameo, Michael N; Dougherty, Matthew J; Calligaro, Keith D

    2011-04-01

    Spontaneous dissection of the superior mesenteric artery (SMA) is rare. We report a case of rupture of the SMA after spontaneous dissection in a 51-year-old male who presented with acute onset of abdominal pain and hypotension. The patient was initially treated with intravenous fluid resuscitation and endovascular intervention followed by open surgery. No identifiable cause for dissection was found. The patient was diagnosed as having segmental arterial mediolysis (SAM). The patients' presentation, treatment, outcome, and all relevant imaging, pathologic, and laboratory studies were reviewed. The relevant features of the case and SAM are presented herein. In addition, a review of all available published literature on SAM to date is presented.

  20. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

    PubMed Central

    Bakoyiannis, Christos; Anastasiou, Ioannis; Koutsoumpelis, Andreas; Fragiadis, Evangelos; Felesaki, Eleni; Kafeza, Marina; Georgopoulos, Sotirios; Tsigris, Christos

    2012-01-01

    The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL. PMID:23304627

  1. Bilateral Carotid Artery Dissection after High Impact Road Traffic Accident

    PubMed Central

    Srivastava, Ankur; Bradley, Marcus; Kelly, Michael

    2008-01-01

    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. PMID:22470607

  2. Traumatic vertebral artery dissection presenting with incomplete congruous homonymous quadrantanopia

    PubMed Central

    2010-01-01

    Background To describe a rare presentation of vertebral artery dissection (VAD) as a small but congruous incomplete homonymous hemianopia demonstrating use of visual field testing in the diagnosis. Case presentation A 30 year old woman had been unwell for 4 months with difficulty focusing, vertigo, dizziness and a feeling of falling to the right. A small but congruous right inferior homonymous quadrantanopia was found on examination leading to further investigation that uncovered a vertebral artery dissection and multiple posterior circulation infarctions including a left occipital stroke matching the field defect. Conclusions We describe an atypical case of VAD presenting with a small congruous quadrantanopia. This is a rare but significant condition that predisposes to multiple thromboembolic infarction that may be easily misdiagnosed and a high index of suspicion is required to make the diagnosis. PMID:20482837

  3. Spontaneous Coronary Artery Dissection: Case Series from a Tertiary Centre.

    PubMed

    Anderson, Robert D; Jayadeva, Pavithra S; Wilson, William M; Iyer, Ravi

    2016-03-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of non-atherosclerotic acute coronary syndrome (ACS). As it is more commonly seen in young women, the diagnosis can be missed. Current evidence is based on case reports and retrospective studies with no consensus recommendations on immediate management and long-term follow-up. We present a case series of four patients to outline clinical presentation, prognosis and long-term management of this rare clinical entity.

  4. Endovascular Treatment of Iatrogenic and Traumatic Carotid Artery Dissection

    SciTech Connect

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

    2008-09-15

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

  5. The advantage of ultrasonography in the diagnosis of extracranial vertebral artery dissection

    PubMed Central

    Yang, Lijuan; Ran, Haitao

    2017-01-01

    Abstract Rationale: With the rapid development in technology of vascular imaging, the detection of artery dissection is also gradually increasing. Cervical artery dissection, including carotid artery and vertebral artery dissection, is associated in at least 20% of young adult patients with stroke. So, the diagnosis of cervical artery has become a great challenge. Patient concerns: We reported 2 patients who complained of dizziness and pain, the findings of US confirmed the presence of extracranial vertebral artery dissection. Diagnoses: The floating membrane in lumen and intramural hematoma were found in US, consistent with vertebral artery dissection, whereas DSA revealed no typical sign of artery dissection. Interventions: In order to the definite diagnosis we persuaded the patients to undergo DSA, but there was no strong evidence on the diagnosis of vertebtal artery dissection. Outcomes: The patients were diagnosed of vertebral artery dissection by US. Lessons: US show more advantages in diagnosis of extracranial vertebral artery dissection, might even be considered as the first choice. PMID:28328828

  6. A vertebral artery dissection with basilar artery occlusion in a child.

    PubMed

    Devue, Katleen; Van Ingelgem, Annemie; De Keukeleire, Katrien; De Leeuw, Marc

    2014-01-01

    This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

  7. A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

    PubMed Central

    Devue, Katleen; Van Ingelgem, Annemie; De Keukeleire, Katrien; De Leeuw, Marc

    2014-01-01

    This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services. PMID:25587466

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

    SciTech Connect

    Kutlu, Ramazan Ara, Cengiz; Sarac, Kaya

    2007-02-15

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

  9. Emergency Stenting of Unprotected Left Main Coronary Artery after Acute Catheter-Induced Occlusive Dissection

    PubMed Central

    Akgul, Ferit; Batyraliev, Talantbek; Besnili, Fikret; Karben, Zarema

    2006-01-01

    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. PMID:17215985

  10. Current Understandings of Spontaneous Isolated Superior Mesenteric Artery Dissection

    PubMed Central

    Kim, Young-Wook

    2016-01-01

    Spontaneous isolated superior mesenteric artery dissection (SISMAD) has been known as a rare vascular disease. However it is increasingly reported in these days with the development of advanced imaging technology. Underlying etiology, natural course or an optimal management strategy of SISMAD is not exactly known at the moment. During the past 10 years, we have had an interest in this rare vascular disease and collected clinical and image data in 100 or more patients with SISMAD. In this review article, I would like to describe my current understanding of SISMAD on the base of our recent publications in the major vascular surgery journals. PMID:27386450

  11. Spontaneous bilateral carotid artery dissection in a patient with bovine aortic arch.

    PubMed

    Cock, Dries De; Meuris, Bart; Benett, Johan; Desmet, Walter

    2014-08-01

    Carotid artery dissections are commonly associated with trauma or various connective tissue disorders. Dissection of the cerebrovascular arteries can result in ischemic stroke and is a frequent stroke etiology in younger patients. Anatomical variants of aortic arch branching, such as the 'bovine' aortic arch, are assumed to have little or no physiological consequence. To the best of our knowledge, we present for the first time a case of spontaneous dissection of the common origin of the innominate and left common carotid artery in a bovine aortic arch, resulting in bilateral dissection of the carotid arteries.

  12. Pulmonary artery dissection: an emerging cardiovascular complication in surviving patients with chronic pulmonary hypertension.

    PubMed

    Khattar, R S; Fox, D J; Alty, J E; Arora, A

    2005-02-01

    Pulmonary arterial dissection is an extremely rare and usually lethal complication of chronic pulmonary hypertension. The condition usually manifests as cardiogenic shock or sudden death and is therefore typically diagnosed at postmortem examination rather than during life. However, recent isolated reports have described pulmonary artery dissection in surviving patients. The first case of pulmonary artery dissection in a surviving patient with cor pulmonale caused by chronic obstructive pulmonary disease is presented. The aetiology, pathophysiology, and clinical presentation of pulmonary artery dissection are reviewed and factors that may aid diagnosis during life are discussed.

  13. Vertebral artery dissecting aneurysm treated by internal trapping via the contralateral vertebral artery: A case report

    PubMed Central

    2015-01-01

    A 42-year-old man with a history of sudden onset of severe headache followed by consciousness disturbance was brought to our hospital. Radiological examinations revealed subarachnoid hemorrhage, associated with rupture of a left vertebral artery dissecting aneurysm. Initially, internal trapping was attempted via the ipsilateral vertebral artery. However, the microcatheter could not be navigated through the true lumen to the distal side of the vertebral artery. Subsequently, therefore, the guiding catheter was placed in the right vertebral artery, and the microcatheter was retrogradely navigated successfully through the lesion to the proximal side of the left vertebral artery. Finally, the lesion was completely embolized with electrodetachable coils without complications. However, the patient died after the operation because of deterioration of the general condition. The postmortem examination revealed how an intimal flap had interfered with the antegrade navigation of the microcatheter in the lesion. The present case showed that endovascular treatment for a vertebral artery dissecting aneurysm via the contralateral vertebral artery may be a useful option in cases where antegrade navigation of the microcatheter via the ipsilateral vertebral artery is found to be difficult. PMID:26116649

  14. Vertebral artery dissecting aneurysm treated by internal trapping via the contralateral vertebral artery: A case report.

    PubMed

    Kojima, Atsuhiro

    2015-10-01

    A 42-year-old man with a history of sudden onset of severe headache followed by consciousness disturbance was brought to our hospital. Radiological examinations revealed subarachnoid hemorrhage, associated with rupture of a left vertebral artery dissecting aneurysm. Initially, internal trapping was attempted via the ipsilateral vertebral artery. However, the microcatheter could not be navigated through the true lumen to the distal side of the vertebral artery. Subsequently, therefore, the guiding catheter was placed in the right vertebral artery, and the microcatheter was retrogradely navigated successfully through the lesion to the proximal side of the left vertebral artery. Finally, the lesion was completely embolized with electrodetachable coils without complications. However, the patient died after the operation because of deterioration of the general condition. The postmortem examination revealed how an intimal flap had interfered with the antegrade navigation of the microcatheter in the lesion. The present case showed that endovascular treatment for a vertebral artery dissecting aneurysm via the contralateral vertebral artery may be a useful option in cases where antegrade navigation of the microcatheter via the ipsilateral vertebral artery is found to be difficult.

  15. Vertebral artery dissection after a chiropractor neck manipulation

    PubMed Central

    Jones, Jeremy; Nugent, Kenneth

    2015-01-01

    The differential diagnosis for ischemic central nervous system infarcts in young patients includes paradoxic emboli through cardiac shunts, vasculitis, and vascular trauma. We report a young woman who developed headache, vomiting, diplopia, dizziness, and ataxia following neck manipulation by her chiropractor. A computed tomography scan of the head revealed an infarct in the inferior half of the left cerebellar hemisphere and compression of the fourth ventricle causing moderate acute obstructive hydrocephalus. Magnetic resonance angiography revealed severe narrowing and low flow in the intracranial segment of the left distal vertebral artery. The patient was treated with mannitol and a ventriculostomy and had an excellent functional recovery. This report illustrates the potential hazards associated with neck trauma, including chiropractic manipulation. The vertebral arteries are at risk for aneurysm formation and/or dissection, which can cause acute stroke. PMID:25552813

  16. Arterial dissections during transcatheter arterial chemoembolization for hepatocellular carcinoma: a 19-year clinical experience at a single medical institution.

    PubMed

    Jung, Euichul; Shin, Ji Hoon; Kim, Jin-Hyoung; Yoon, Hyun-Ki; Ko, Gi-Young; Sung, Kyu-Bo

    2016-01-01

    Background Arterial dissections during transcatheter arterial chemoembolization (TACE) procedures are not rare and can limit the successful treatment of unresectable hepatocellular carcinoma (HCC). Purpose To evaluate the incidence of arterial dissections during TACE procedures, the rate of spontaneous lumen recovery, and the predictive factors of dissecting stenosis during follow-up. Material and Methods Based on 69,651 TACE procedures from 1997 to 2016, patients who had procedure-related arterial dissections were identified by procedure report search. More than two months after the date of dissection, dissecting stenosis was evaluated using a three-grade scale: subclinical narrowing with diameter loss under 30%, overt stenosis with diameter loss over 30%, and occlusion. Pearson Chi-square and two-sample t-test were used to assess potential prognostic markers for dissecting stenosis. Results Eighty-four arterial dissections directly related to TACE were identified in 83 patients, resulting in an incidence of 0.12% (84/69651). After more than two months, normal or subclinical narrowing, overt stenosis, occlusion, and doubling were seen in 39 (46.4%), 26 (31.0%), 13 (15.5%), and one (1.2%) patients, respectively. No follow-up images were obtained for five (6.0%) patients. On univariate analysis, the dissection ratio (the ratio of the length to the diameter of the dissection) alone was related to dissecting stenosis ( P = 0.035). Conclusion The incidence of iatrogenic dissection during TACE was approximately 0.12%. Less than 50% of the iatrogenic dissections showed normal or subclinical narrowing during follow-up of at least two months. The dissection ratio alone was the predictive factor for dissecting stenosis during follow-up.

  17. A case of spontaneous coronary artery dissection in early pregnancy managed by PCI.

    PubMed

    Magarkar, Vilas; Lathi, Pravir

    2016-09-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome in pregnant and peripartum women. This report presents a rare case of spontaneous coronary artery dissection in early pregnancy managed by coronary angioplasty and, combined obstetric and cardiac care, resulting in the delivery of a normal infant through cesarean section.

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

    SciTech Connect

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

    2004-09-15

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

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

    PubMed Central

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

    2014-01-01

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

  20. Clinical Characteristics of Symptomatic Vertebral Artery Dissection. A Systematic Review

    PubMed Central

    Gottesman, Rebecca F.; Sharma, Priti; Robinson, Karen A.; Arnan, Martinson; Tsui, Megan; Ladha, Karim; Newman-Toker, David E.

    2013-01-01

    Background Vertebral artery dissection (VAD) is an important cause of stroke in the young. It can present nonspecifically and may be misdiagnosed with adverse consequences. We assessed the frequency of head/neck pain, other neurological symptoms, and cerebrovascular events in symptomatic VAD. Methods We conducted a systematic review of observational studies, searching electronic databases (MEDLINE, EMBASE) for English-language manuscripts with >5 subjects with clinical or radiological features of VAD. Two independent reviewers selected studies for inclusion; a third adjudicated differences. Studies were assessed for methodological quality and clinical data were abstracted. Pooled proportions were calculated. Results Of 3996 citations, we screened 511manuscripts and selected 75 studies describing 1,972 VAD patients. The most common symptoms were dizziness/vertigo (58%), headache (51%) and neck pain (46%). Stroke was common (63%), especially with extracranial dissections (66% vs. 32%, p<0.0001), while TIA (14%) and subarachnoid hemorrhage (SAH) (10%) were uncommon. SAH was seen only with intracranial dissections (57% vs. 0%, p=0.003). Fewer than half of the patients had obvious trauma, and only 7.9% had a known connective tissue disease. Outcome was good (modified Rankin scale (mRS) 0-1) in 67% and poor (mRS 5-6) in 10%. Conclusion VAD is associated with nonspecific symptoms such as dizziness, vertigo, headache, or neck pain. Ischemic stroke is the most common reported cerebrovascular complication. VAD should be considered in the diagnostic assessment of patients presenting with dizziness or craniocervical pain, even in the absence of other risk factors. Future studies should compare clinical findings as predictors in well-defined, undifferentiated populations of clinical VAD suspects. PMID:22931728

  1. Outcomes of patients with spontaneous coronary artery dissection

    PubMed Central

    McGrath-Cadell, Lucy; McKenzie, Pamela; Emmanuel, Sam; Muller, David W M; Graham, Robert M; Holloway, Cameron J

    2016-01-01

    Background Spontaneous coronary artery dissection (SCAD) is an uncommon but serious condition presenting as an acute coronary syndrome (ACS) or cardiac arrest. The pathophysiology and outcomes are poorly understood. We investigated the characteristics and outcomes of patients presenting with SCAD. Methods In a retrospective study of a large cohort of patients with SCAD, data were collected regarding clinical presentation, patient characteristics, vascular screening, coronary artery involvement and clinical outcomes. Results 40 patients with SCAD (95% women, mean age 45±10 years) were included. At least 1 traditional cardiovascular risk factor was present in 40% of patients. Migraine was reported in 43% of patients. Events preceding SCAD included parturition (8%), physical stress (13%), emotional stress (10%) and vasoconstrictor substance-use (8%). 65% of patients had a non-ST elevation ACS (NSTEACS) at presentation, 30% had an ST elevation myocardial infarction (STEMI) and 13% had a cardiac arrest. The left anterior descending artery was most frequently involved (68% of patients), and 13% had involvement of multiple coronary territories. Fibromuscular dysplasia (FMD) was identified in 7 (37%) of 19 patients screened. 68% of patients were managed medically, 30% had percutaneous coronary intervention and 5% had coronary artery bypass grafting. Over a median 16-month follow-up period, 8% of patients had at least 1 recurrent SCAD event. There were no deaths. Conclusions Patients with SCAD in this study often had multiple coronary territories involved (13%) and extracardiac vascular abnormalities, suggesting a systemic vascular process, which may explain the high incidence of migraine. All patients with SCAD should be screened for FMD and followed closely due to the possibility of recurrence. PMID:27621835

  2. Successful Treatment of Isolated Spontaneous Superior Mesenteric Artery Dissection with Stent Placement

    SciTech Connect

    Yoon, Young-Won; Choi, Donghoon; Cho, Seung-Yun; Lee, Do Yun

    2003-09-15

    Isolated dissection of superior mesenteric artery is a rare condition and is usually treated surgically. We treated a patient with severe abdominal pain who was angiographically confirmed to have superior mesenteric artery thrombosis associated with isolated spontaneous dissection. He was treated initially by thrombolysis and oral anticoagulation, but recurrent symptoms developed with radiologic evidence of disease progression. We performed superior mesenteric artery stenting and recovery was uneventful.

  3. Spontaneous Dissection of Right Coronary Artery Manifested with Acute Myocardial Infarction

    PubMed Central

    Paraskevaidis, Stelios; Theofilogiannakos, Efstratios K; Chatzizisis, Yiannis S; Mantziari, Lilian; Economou, Fotis; Ziakas, Antonios; Hadjimiltiades, Stavros; Styliadis, Ioannis H

    2010-01-01

    Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention. PMID:21127744

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

    PubMed Central

    Menon, Rajeev; Kapadia, Anuj

    2014-01-01

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

  5. Bilateral vertebral artery dissection possibly precipitated in delayed fashion as a result of roller coaster rides.

    PubMed

    Schneck, Michael; Simionescu, Monica; Bijari, Armita

    2008-01-01

    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.

  6. Endovascular Treatment of Symptomatic Vertebral Artery Dissecting Aneurysms

    PubMed Central

    Han, Jinsol; Ha, Sung-Kon; Choi, Jong-Il; Jin, Sung-Won; Kim, Se-Hoon

    2016-01-01

    Objective Vertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs. Materials and Methods Between July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture. Results Clinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either. Conclusion Endovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment. PMID:27847762

  7. Vertebral artery dissection in patients with autosomal dominant polycystic kidney disease.

    PubMed

    Kuroki, Takuma; Yamashiro, Kazuo; Tanaka, Ryota; Hirano, Kazuoki; Shimada, Yoshiaki; Hattori, Nobutaka

    2014-01-01

    Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal cystic disease, and it is associated with various extrarenal manifestations, including vascular complications, such as intracranial aneurysms, and aortic root dilatation and aneurysms. However, intracranial arterial dissection has rarely been reported. We herein report the cases of 2 patients with ADPKD who developed a vertebral artery (VA) dissection. Dissection was also observed on the other side of the VA and in the internal carotid artery in the first and second patient, respectively. Both patients also had a history of hypertension, which is frequently accompanied by ADPKD, and their serum creatinine levels were normal. Our report supports the importance of considering ADPKD as one of the possible pathogenic factors in arterial dissection.

  8. Anticoagulants versus antiplatelet drugs for cervical artery dissection: case for anticoagulants.

    PubMed

    Norris, John W

    2013-02-01

    There are no reliable data from randomised trials to decide whether anticoagulants or antiplatelet agents are better to prevent further thromboembolic events after cervical arterial dissection. Most neurologists favour anticoagulants based on the underlying pathology and the likely course of acute post-dissection thromboembolism.

  9. Stenting of a Spontaneous Dissection of the Superior Mesenteric Artery: A New Therapeutic Approach?

    SciTech Connect

    Froment, P. Alerci, M.; Vandoni, R.E.; Bogen, M.; Gertsch, P.; Galeazzi, G.

    2004-09-15

    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.

  10. Isolated Spontaneous Dissection of the Common Iliac Artery: Percutaneous Stent Placement in Two Patients

    SciTech Connect

    Kwak, Hyo-Sung; Han, Young-Min Chung, Gyung-Ho; Yu, Hee Chul; Jeong, Yeon-Jun

    2006-10-15

    Isolated spontaneous dissection of the common iliac artery (CIA) is a rare entity. Two patients with this condition were successfully treated by percutaneous stent placement. We emphasize the feasibility of nonsurgical management by percutaneous stent placement for isolated spontaneous dissection of the CIA.

  11. Traumatic dissection of the internal carotid artery: simultaneous infarct of optic nerve and brain

    PubMed Central

    Correa, Edgar; Martinez, Braulio

    2014-01-01

    Key Clinical Message Traumatic intracranial internal carotid artery dissection is a rare but significant cause of stroke in patients in their forties, leading to high morbidity and mortality. Simultaneous ischemic stroke and optic nerve infarction can occur. Clinical suspicion of dissection is determining in the acute management. PMID:25356244

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

    SciTech Connect

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

    2005-01-15

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

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

    SciTech Connect

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

    2009-03-15

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

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

    SciTech Connect

    Ananthakrishnan, Ganapathy Bhat, Rajesh; Zealley, Ian

    2009-03-15

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

  15. Spontaneous Bilateral Vertebral Artery Dissection During a Basketball Game: A Case Report.

    PubMed

    Mas Rodriguez, Manuel F; Berrios, Rafael Arias; Ramos, Edwardo

    2016-01-01

    Spontaneous vertebral artery dissection accounts for 2% of all ischemic strokes and can occur as a consequence of sports events. We present an unusual case of spontaneous bilateral vertebral artery dissection in a 30-year-old male patient during a basketball game. He developed severe dysphagia, right hemiparesis, and balance dysfunction. We also present a review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this entity in sports.

  16. Vertebral artery dissection after neck extension in an adult patient with Klippel-Feil syndrome.

    PubMed

    Dornbos, David; Ikeda, Daniel S; Slivka, Andrew; Powers, Ciaran

    2014-04-01

    The association between Klippel-Feil syndrome and vertebral artery dissection is quite rare. We report an adult patient with vertebral artery dissection and Klippel-Feil syndrome, to our knowledge only the third reported case of its kind. A 45-year-old woman with a known history of Klippel-Feil syndrome presented with occipital head and neck pain following forced neck extension. Diagnostic cerebral angiography revealed a high grade vertebral artery stenosis, consistent with vertebral artery dissection. Following 6 months of medical management, a repeat diagnostic angiogram revealed complete healing of the vessel. While cervical fusion, as seen in Klippel-Feil syndrome, has previously been shown to cause neurologic injury secondary to hypermobility, the association with vertebral artery dissection is incredibly rare. We hypothesize that this hypermobility places abnormal shear force on the vessel, causing intimal injury and dissection. Patients with seemingly spontaneous vertebral artery dissection may benefit from cervical spine radiography, and this predisposition to cerebrovascular injury strongly suggests further evaluation of vascular injury following trauma in patients with Klippel-Feil syndrome or other cervical fusion as clinically warranted.

  17. Cerebral vascular findings in PAPA syndrome: cerebral arterial vasculopathy or vasculitis and a posterior cerebral artery dissecting aneurysm.

    PubMed

    Khatibi, Kasra; Heit, Jeremy J; Telischak, Nicholas A; Elbers, Jorina M; Do, Huy M

    2015-06-24

    A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.

  18. Cerebral vascular findings in PAPA syndrome: cerebral arterial vasculopathy or vasculitis and a posterior cerebral artery dissecting aneurysm.

    PubMed

    Khatibi, Kasra; Heit, Jeremy J; Telischak, Nicholas A; Elbers, Jorina M; Do, Huy M

    2016-08-01

    A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.

  19. A Previously Unreported Arterial Variant of the Suboccipital Region Based on Cadaveric Dissection

    PubMed Central

    Fisahn, Christian; Burgess, Brittni; Iwanaga, Joe; Alonso, Fernando; Chapman, Jens R.; Oskouian, Rod J.; Tubbs, R. Shane

    2017-01-01

    Introduction Several arterial variants have been reported to occur around the posterior arch of the atlas. Understanding the various anomalies and diagnosing them preoperatively can dramatically reduce the risk of surgical insult during neurosurgical procedures. Herein we report a case of an arterial variant found just below the posterior arch of C1. Case Report During the routine dissection of the suboccipital region via a posterior approach, an unusual bulge was identified just inferior to the inferior capitis oblique muscle. With further dissection, the structure was identified as a tortuous internal carotid artery. Conclusion Arterial variants around the posterior arch of C1 are surgically significant and can result in catastrophic injuries if unappreciated. Most of these variants will be related to the vertebral artery. To our knowledge, an arterial variant of the internal carotid artery in this location, as reported herein, has not been previously reported. PMID:28299248

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

    SciTech Connect

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

    2009-03-15

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

  1. [A case of spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement].

    PubMed

    Ko, Geun Jun; Han, Ki Jun; Han, Seo Goo; Hwang, Sang Yon; Choi, Chang Hwan; Gham, Chang Woo; Cho, Hyeon Geun; Song, Soon-Young; Jung, Jin Ho

    2006-02-01

    Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.

  2. Young male survivor of a spontaneous left main coronary artery dissection treated with surgery

    PubMed Central

    Endara, Santiago A.; Ayala, Andres V.; Davalos, Gerardo A.; Moscoso, Juan; Montero, R. Alejandra

    2013-01-01

    Spontaneous dissection of the coronary arteries is a rare disease with a wide range of clinical presentations ranging from angina to myocardial infarction (MI); its pathophysiology has not yet been fully established. In this paper, we present the case of a 31-year-old male with an acute coronary syndrome. The initial results of the electrocardiogram and cardiac enzymes were consistent with MI. However, a coronary angio-tomography revealed a dissection of the left main coronary artery and the patient underwent emergent surgery with coronary artery bypass grafting. The treatment of spontaneous dissection of the coronary arteries depends on the anatomical location and the patient's clinical presentation. Coronary revascularization is associated with good results. PMID:24964467

  3. Reversible cerebral vasoconstriction syndrome with multivessel cervical artery dissections and a double aortic arch.

    PubMed

    Nouh, Amre; Ruland, Sean; Schneck, Michael J; Pasquale, David; Biller, José

    2014-02-01

    Reversible cerebral vasoconstriction syndrome (RCVS) has been associated with exposure to vasoactive substances and few reports with cervical arterial dissections (CADs). We evaluated a 32-year-old woman with history of depression, migraines without aura, and cannabis use who presented with a thunderclap headache unresponsive to triptans. She was found to have bilateral occipital infarcts, bilateral extracranial vertebral artery dissections, bilateral internal carotid artery dissecting aneurysms, and extensive distal multifocal segmental narrowing of the anterior and posterior intracranial circulation with a "sausage on a string-like appearance" suggestive of RCVS. Subsequently, she was found to have a distal thrombus of the basilar artery, was anticoagulated, and discharged home with no residual deficits. We highlight the potential association of CADs and RCVS. The association of RCVS and a double aortic arch has not been previously reported.

  4. Pediatric traumatic carotid, vertebral and cerebral artery dissections: a review.

    PubMed

    Mortazavi, Martin M; Verma, Ketan; Tubbs, R Shane; Harrigan, Mark

    2011-12-01

    Traumatic cerebral dissections are rare but potentially dangerous conditions that through improved diagnostics have recently gained increased interest. However, there is still a significant lack of knowledge on the natural history, as well as on the best treatment options. Most of the literature on this topic consists of case reports and retrospective studies with no prospective randomized controlled studies. In our review, we highlight the fact that there is no level 1 evidence for the natural history of cerebral dissections or for the best treatment. We present 26 case studies derived from 70 pediatric patients affected by dissections, occlusions, and pseudoaneurysms.

  5. Treatment of Intra- and Extracranial Arterial Dissections Using Stents and Embolization

    SciTech Connect

    Joo, Jin Yang; Ahn, Jung Yong Chung, Young Sun; Han, In Bo; Chung, Sang Sup; Yoon, Pyeong Ho; Kim, Sang Heum; Choi, Eun Wan

    2005-06-15

    Purpose. To evaluate the safety and efficacy of stent placement for extracranial and intracranial arterial dissections. Methods. Eighteen patients underwent endovascular treatment of carotid and vertebral dissections using intraluminal stent placement. Five patients with arterial dissection were treated, 2 using one insertion of a single stent and 3 using placement of two stents. Patients with a dissecting aneurysm were treated as follows: 7 patients with insertion of one stent, 4 with placement of two stents, and 2 by stent-assisted Guglielmi detachable coil embolization. In the 18 patients in whom stenting was attempted, the overall success in reaching the target lesion was 94.4%. Of the 17 patients treated with stents, stent release and positioning were considered optimal in 16 (94%) and suboptimal in one (6%). In patients who underwent a successful procedure, all parent arteries were preserved. There were no instances of postprocedural ischemic attacks, new neurologic deficits, or new minor or major strokes prior to patient discharge. In follow up, all patients were assessed, using the modified Rankin scale, as functionally improved or of stable clinical status. The reduction in dissection-induced stenosis or pseudoaneurysm, the patency rate obtained at follow-up, and the lack of strokes (ischemic or hemorrhagic) suggest that stent placement offers a viable alternative to complex surgical bypass or reconstructive procedures. The long-term efficacy and durability of stent placement for arterial dissection remain to be determined in a larger series.

  6. Connective tissue anomalies in patients with spontaneous cervical artery dissection

    PubMed Central

    Giossi, Alessia; Ritelli, Marco; Costa, Paolo; Morotti, Andrea; Poli, Loris; Del Zotto, Elisabetta; Volonghi, Irene; Chiarelli, Nicola; Gamba, Massimo; Bovi, Paolo; Tomelleri, Giampaolo; Carletti, Monica; Checcarelli, Nicoletta; Meneghetti, Giorgio; Morra, Michele; Chinaglia, Mauro; De Giuli, Valeria; Colombi, Marina; Padovani, Alessandro

    2014-01-01

    Objective: To investigate the prevalence of connective tissue abnormalities in patients with spontaneous cervical artery dissections (sCeAD). Methods: We systematically assessed clinically detectable signs of connective tissue aberration in a series of consecutive patients with sCeAD and of age- and sex-matched patients with ischemic stroke unrelated to CeAD (non-CeAD IS) by a standard examination protocol including 68 items, and performed extensive molecular investigation for hereditary connective tissue disorders in all patients with sCeAD. Results: The study group included 84 patients with sCeAD (mean age, 44.5 ± 7.8 years; 66.7% men) and 84 patients with non-CeAD IS. None of the patients with sCeAD met clinical or molecular diagnostic criteria for established hereditary connective tissue disorder. Connective tissue abnormalities were detected more frequently in the group of patients with sCeAD than in the group of those with non-CeAD IS (mean number of pathologic findings, 4.5 ± 3.5 vs 1.9 ± 2.3; p < 0.001). Eighty-one patients (96.4%) in the sCeAD group had at least one detectable sign compared with 55 patients (66.7%) in the group with non-CeAD IS (p < 0.001). Skeletal, ocular, and skin abnormalities, as well as craniofacial dysmorphisms, were the clinical signs more strongly associated with sCeAD. Signs suggesting connective tissue abnormality were also more frequently represented in patients with sCeAD than in patients with traumatic CeAD (28.6%, p < 0.001; mean number of pathologic findings, 1.7 ± 3.7, p = 0.045). Conclusions: Connective tissue abnormalities are frequent in patients with sCeAD. This reinforces the hypothesis that systemic aberrations of the connective tissue might be implicated in the pathogenesis of the disease. PMID:25355826

  7. [Dissecting aneurysm of the posterior inferior cerebellar artery--a case report].

    PubMed

    Ueki, K; Teraoka, A; Yoshida, S; Hori, T

    1987-11-01

    The authors present a case of dissecting aneurysm of the right posterior inferior cerebellar artery (PICA) in a 47-year-old female, who suffered from mild subarachnoid hemorrhage. Right vertebral angiogram showed typical "pearl and string" sign of the PICA, but we could not fully understand the condition until a surgical exposure revealed a purple sausage-like dissecting aneurysm of the PICA. The aneurysm was wrapped with muscle pieces. Postoperatively she developed Wallenberg's syndrome, but it subsided gradually. No specific disorder concerning the mural dissection was found in this patient, except for a history of mild hypertension. This case is unusual because it affected not an arterial trunk but a small branch and we could find only one other case reported in the literature. Other formerly reported cases were of arterial trunks. The intracranial dissecting aneurysm has been known as a rare cause of cerebral infarct in children and adolescents. Infants are also affected and referred to as "infantile hemiplegia". It mainly affects one of the trunk arteries and cause a severe ischemic stroke, and surgically treatable case is rare. But as the typical angiographic findings are commonly known the number of the reported cases is increasing at an accelerating rate, and some of them are being noted to need surgical treatment because they cause subarachnoid hemorrhage. We here emphasize that not only trunk arteries but also small branch arteries can develop mural dissection, leading to subarachnoid hemorrhage. Dissecting aneurysm of a smaller artery would be milder in symptom, and would give more chance for surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    PubMed

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

    2014-08-01

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

  9. Treatment of acute cervical internal carotid artery dissection using the Solitaire FR revascularization device.

    PubMed

    To, Chiu Yuen; Badr, Yaser; Richards, Boyd

    2013-11-01

    During treatment of a right internal carotid artery terminus aneurysm, an acute iatrogenic flow limiting dissection was caused in the cervical internal carotid. The true lumen was catheterized using a Mirage 0.008 microwire over an Excelsior SL-10 microcatheter, which was exchanged for a Marksman microcatheter. A 6 mm × 30 mm Solitaire FR revascularization device was then deployed across the dissection as a salvage technique.

  10. Treatment of acute cervical internal carotid artery dissection using the Solitaire FR revascularization device.

    PubMed

    To, Chiu Yuen; Badr, Yaser; Richards, Boyd

    2012-12-19

    During treatment of a right internal carotid artery terminus aneurysm, an acute iatrogenic flow limiting dissection was caused in the cervical internal carotid. The true lumen was catheterized using a Mirage 0.008 microwire over an Excelsior SL-10 microcatheter, which was exchanged for a Marksman microcatheter. A 6 mm×30 mm Solitaire FR revascularization device was then deployed across the dissection as a salvage technique.

  11. Vertebral artery dissection with compelling evidence on duplex ultrasound presenting only with neck pain

    PubMed Central

    Siepmann, Timo; Borchert, Monique; Barlinn, Kristian

    2016-01-01

    Vertebral artery dissection (VAD) is among the most common identifiable etiologies of stroke in young adults and poses a diagnostic challenge due to nonspecific symptoms and substantial variability of imaging results. Here, we present a case of unspecific neck pain as isolated symptom of VAD with unusually compelling evidence on duplex ultrasound. This observation has clinical relevance as the absence of any neurological symptoms in our patient highlights the necessity of considering cervical artery dissection in patients presenting with unspecific symptoms such as neck pain, even if isolated. Furthermore, our image of intramural hematoma on duplex ultrasound has been captured in an unusual, clear and distinct fashion and might therefore be a useful reference image in the clinical assessment of patients with a suspicion of cervical artery dissection. PMID:27843318

  12. Common carotid artery pseudoaneurysm after neck dissection: colour Doppler ultrasound and multidetector computed tomography findings.

    PubMed

    Flor, N; Sardanelli, F; Ghilardi, G; Tentori, A; Franceschelli, G; Felisati, G; Cornalba, G P

    2007-05-01

    Common carotid artery pseudoaneurysm is a rare disease, which has been previously unreported in association with neck dissection. We describe the Doppler ultrasound and multidetector computed tomography (CT) findings of a case of carotid pseudoaneurysm, one month after pharyngolaryngectomy with bilateral neck dissection. Multidetector CT confirmed the diagnosis made on the basis of Doppler ultrasound; the high image quality of axial and three-dimensional reconstructions avoided the need for pre-operative conventional angiography. In the presence of a pulsatile cervical mass after neck surgery, pseudoaneurysm of the carotid artery should be included in the differential diagnosis, and multidetector CT can be the sole pre-operative diagnostic imaging modality.

  13. The use of flow diverter stents in the management of traumatic vertebral artery dissections.

    PubMed

    Cohen, José E; Gomori, John M; Moscovici, Samuel; Bala, Miklosh; Itshayek, Eyal

    2013-05-01

    Flow diverters constitute a new generation of flexible self-expanding stent-like devices with a high metal-surface area coverage, specifically designed for the endovascular management of complex cerebral aneurysms. Recently, other potential applications for these devices in the field of occlusive cerebrovascular disease have been described. In vertebral artery dissections causing occlusion associated with a burden of extensive clots, we have found that the reduced porosity of the diverter mesh serves as an effective barrier to in-stent clot protrusion and distal embolization. We describe the novel use of a flow diverter for the management of an occlusive traumatic vertebral artery dissection. Diverter implantation allowed subsequent angioplasty.

  14. Dissecting aneurysms of the vertebral arteries following cervical manipulation: a case report.

    PubMed Central

    Dunne, J W; Conacher, G N; Khangure, M; Harper, C G

    1987-01-01

    Neck manipulation may uncommonly be associated with serious and even fatal vascular complications. Although well recognised, the nature of the vascular injury has only rarely been directly established by pathological examination. The case is reported of a 43-year-old man who died following neck manipulation, and in whom multiple dissecting aneurysms within both vertebral arteries were demonstrated radiologically and found at necropsy. Bilateral dissecting aneurysms were found both at the level of atlanto-axial articulation and close to the origins of the vertebral arteries. No predisposition was found, other than early atheroma consistent with the patient's age. Images PMID:3559616

  15. Spontaneous coronary artery dissection in a young woman with polycystic ovarian syndrome.

    PubMed

    Mirra, Marco; Kola, Nertil; Mattiello, Giacomo; Morisco, Carmine; Spinelli, Letizia

    2016-12-16

    Polycystic ovarian syndrome (PCOS) affects 4% to 12% of women in reproductive age, representing a clinical condition that could predispose to cardiovascular diseases. We report a case of a 34-year-old woman with PCOS, presenting with chest pain, onset two days before, and ST segment-elevation myocardial infarction. She was not pregnant or in a postpartum state. Subsequent cardiac angiography revealed spontaneous left anterior descending coronary artery dissections, managed by conservative approach. The patient was discharged in medical therapy after 5days. This is the first observation of spontaneous coronary artery dissection occurring in a PCOS patient.

  16. Isolated internal carotid artery dissection in a long-distance runner

    PubMed Central

    Koczewski, Paweł; Gabriel, Marcin; Kociemba, Wojciech

    2016-01-01

    We present a case of internal carotid artery dissection (ICAD) in the precranial segment, which caused binocular visual impairment in a 49-year-old man during a marathon race. The incident lasted 3 h, after which the symptoms resolved. Imaging tests showed internal carotid artery dissection. No ophthalmologic changes were identified. After 6 weeks of ineffective non-invasive treatment the patient underwent vascular surgery – stent implantation into the damaged artery. Detailed diagnostic tests and adequate treatment allowed us to achieve a good clinical result. Upon the suspicion of ICAD it is recommended to extend standard Doppler ultrasound performed with a linear transducer and evaluate the proximal segment of the internal carotid artery with a curved transducer as well. PMID:28194253

  17. Percutaneous stenting of a dissected superior mesenteric artery in a patient with previous surgical repair of Stanford type A aortic dissection.

    PubMed Central

    Hatzidakis, A; Krokidis, M; Androulakakis, Z; Rossi, M

    2015-01-01

    Background/Aim We report a case of a 54-year-old male patient with background history of hypertension, which suffered a Stanford type A thoraco-abdominal aortic dissection with extension to the visceral arteries. Description of case The patient initially underwent surgical repair with replacement of the ascending aorta and of the hemiarch in the acute phase of the dissection. Postoperatively, he developed non-specific abdominal pain that was not related to meals but led to weight loss of 20 kg within the first five post-operative months. Follow-up computerized tomography scan revealed a chronic subphrenic aortic dissection extending to the celiac axis (with involvement of the left gastric and the splenic artery), the left renal artery and the superior mesenteric artery (SMA). The hepatic artery took origin from the SMA and received blood from the true lumen of the vessel, and the right renal artery was entirely supplied from the true aortic lumen. After exclusion of other causes of abdominal pain, the patient was treated with percutaneous stent placement in the dissected SMA with significant improvement of his symptoms. Conclusion This case report emphasizes the role of visceral artery endovascular techniques in the management of patients with complicated chronic aortic dissection. Hippokratia 2015; 19 (3): 270-273. PMID:27418791

  18. Added Value of 3D Proton-Density Weighted Images in Diagnosis of Intracranial Arterial Dissection

    PubMed Central

    Kim, Jin Woo; Kim, Young Dae; Lee, Seung-Koo; Lim, Soo Mee; Oh, Se Won

    2016-01-01

    Background An early and reliable diagnosis of intracranial arterial dissection is important to reduce the risk of neurological complication. The purpose of this study was to assess the clinical usefulness of three-dimensional high-resolution MRI (3D-HR-MRI) including pre- and post-contrast T1-weighted volumetric isotropic turbo spin echo acquisition with improved motion-sensitized driven equilibrium preparation (3D-iMSDE-T1) and proton-density weighted image (3D-PD) in detecting dissection and to evaluate the added value of 3D-PD in diagnosing intracranial arterial dissection. Methods We retrospectively recruited patients who underwent 3D-HR-MRI with clinical suspicion of arterial dissection. Among them, we selected patients who were diagnosed with definite dissection according to the Spontaneous Cervicocephalic Arterial Dissections Study criteria. For each patient, the presence of intimal flap, intramural hematoma, and vessel dilatation were evaluated independently by two neuroradiologists on each sequence. Interobserver agreement was assessed. Results Seventeen patients (mean age: 41 ± 10 [SD] years; 13 men) were diagnosed with definite dissection. The intimal flaps were more frequently detected on 3D-PD (88.2%, 15/17) than on 3D-iMSDE-T1 (29.4%, 5/17), and post-contrast 3D-iMSDE-T1 (35.3%, 6/17; P = 0.006 and P = 0.004, respectively). No significant difference was found in the detection rate of intramural hematomas (59–71%) and vascular dilatations (47%) on each sequence. Interobserver agreement for detection of dissection findings showed almost perfect agreement (k = 0.84–1.00), except for detection of intimal flaps on pre-contrast 3D-iMSDE-T1 (k = 0.62). After addition of 3D-PD to pre- and post-contrast 3D-iMSDE-T1, more patients were diagnosed with definite dissection with the initial MRI (88.2% vs. 47.1%; P = 0.039). Conclusions The intimal flap might be better visualized on the 3D-PD sequence than the 3D-iMSDE-T1 sequences, allowing diagnosis of

  19. Spontaneous coronary artery dissection in a healthy adolescent following consumption of caffeinated "energy drinks".

    PubMed

    Polat, Nihat; Ardıç, Idris; Akkoyun, Murat; Vuruşkan, Ertan

    2013-12-01

    Spontaneous coronary artery dissection (SCAD) is a rare and uncommon case of sudden cardiac death and acute coronary syndrome. Herein, we present a 13-year-old boy with chest pain who was diagnosed with acute ST-segment elevation myocardial infarction associated with SCAD, possibly caused by the consumption of an energy drink, which has not been reported previously in the pediatric age group. On coronary angiography, the left anterior descending artery showed extensive dissection from the distal part of the vessel. Based on the morphology of the vessel with a dissection and TIMI flow grade III, it was decided to manage this patient conservatively with close follow-up. The aim of this report is to highlight the risks associated with the consumption of caffeinated energy drinks in children.

  20. Bilateral internal carotid artery and vertebral artery dissections with retinal artery occlusion after a roller coaster ride - case report and a review.

    PubMed

    Ozkan Arat, Yonca; Volpi, John; Arat, Anıl; Klucznik, Richard; Diaz, Orlando

    2011-01-01

    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.

  1. [Dissecting aneurysm of the posterior inferior cerebellar artery--studied by serial angiography].

    PubMed

    Yamashita, Y; Hayashi, S; Saitho, H; Teramoto, A

    2001-11-01

    We report the case of a 34-year-old male with cerebellar hemorrhagic infarction caused by a dissecting aneurysm of the left posterior inferior cerebellar artery (PICA). The patient suffered from a headache and vomiting for two days and was transferred to our hospital with sudden deterioration of consciousness. On admission, he was semicomatose. A CT scan revealed hemorrhagic infarction in the left cerebellum and upward herniation. The emergency operation for posterior fossa decompression was performed. Postoperatively, his consciousness level improved promptly and he had no neurological deficits except for slight gait disturbance. The first vertebral angiography was performed on Day 27. It showed a sausage-like dissecting aneurysm of the left distal PICA. We planned conservative therapy with careful observation because of there being no indication for an operation. Serial angiography was performed and demonstrated the regression of the dissecting aneurysm on Day 258. Dissecting aneurysms of the distal PICA are rare and their natural history is not well understood. Conservative therapy for vertebrobasilar dissecting aneurysms has often been reported. We suggest that conservative therapy with serial angiography is the treatment of choice especially for ischemic-type dissecting aneurysms. We review 17 cases of dissecting aneurysm of the distal PICA in this study.

  2. Multivessel spontaneous coronary artery dissection of left and right coronary systems

    PubMed Central

    Asrar ul Haq, Muhammad; Mutha, Vivek; van Gaal, William J

    2013-01-01

    Spontaneous coronary artery dissection (SCAD) involving multiple coronary arteries simultaneously is extremely rare. It should be considered in younger patients, especially who do not have traditional cardiac risk factors. We present a case of young male patient presenting with acute coronary syndrome associated with ST segments elevation on ECG following physical stress whose coronary angiography revealed SCAD of the left anterior descending as well as the right coronary artery and discuss the therapeutic options with a brief review of the limited evidence. PMID:24158301

  3. [Cervical cord infarction associated with unilateral vertebral artery dissection due to golf swing].

    PubMed

    Tokumoto, Kazuki; Ueda, Nobuhiko

    2014-01-01

    A-68-year-old man experienced nuchal pain and bilateral shoulder weakness that occurred suddenly after he performed a golf swing. He was conscious. His cranial nerves were normal, but bilateral deltoid and biceps muscle strengths weakened. Magnetic resonance image (MRI) showed no brain stem infarctions or cervical epidural hematoma. We tentatively diagnosed him with concussion of the spinal cord because of mild recovery of his bilateral upper limb weakness after several hours; he was later discharged. The next day, he suddenly developed serious tetraplegia and was admitted to the emergency department. His breathing was controlled by a respirator as he had expectoration difficulty and respiratory muscle paralysis. A lesion in the cervical cord became apparent on MRI; the right vertebral artery was not detected on magnetic resonance angiography. Cervical MRI showed the intimal flap and a lack of flow void in the right vertebral artery. These findings revealed a right vertebral artery dissection. Cervical cord infarction due to unilateral vertebral artery dissection is rarer than posterior cerebral infarction due to the same pathogenesis; however, some such cases have been reported. We consider the present case to be caused by cervical cord infarction associated with unilateral vertebral artery dissection resulting from golf swing.

  4. Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

    PubMed Central

    Chevli, Parag; Kelash, Fnu; Gadhvi, Pragnesh; Grandhi, Sreeram; Syed, Amer

    2014-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50) and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement. PMID:25317268

  5. Long-Term Results of Blunt Traumatic Renal Artery Dissection Treated by Endovascular Stenting

    SciTech Connect

    Memon, Sameer; Cheung, Billy Y.K.

    2005-06-15

    A 20-year-old man was admitted to the emergency department after falling 15 m onto the roof of a car and landing on his back. Imaging by computed tomography (CT) showed delayed perfusion of the right kidney and no excretion of contrast from that kidney on delayed images. Angiography confirmed a localized intimal dissection in the right main renal artery. We inserted a balloon-expandable stent using a transfemoral approach to successfully repair the dissection. At 4 year follow-up, Doppler ultrasound of the right renal artery and renal scintigraphy demonstrated preserved function of the right kidney. Our findings support endovascular stenting as a safe, effective and efficient treatment for blunt renal artery injury.

  6. [Sequential spontaneous coronary artery dissection in a female patient on oral ephedrine].

    PubMed

    Misuraca, Leonardo; Pasqualini, Paola; Baratta, Pasquale; Calabria, Paolo; Picchi, Andrea; Cresti, Alberto; Limbruno, Ugo; Severi, Silva

    2015-09-01

    Spontaneous coronary artery dissection (SCAD) is an infrequent, but not rare, cause of acute coronary syndrome. It mainly affects young women, often with few or no traditional cardiovascular risk factors. In the case described, a 57-year-old woman experienced a first episode of SCAD involving a distal branch of the circumflex coronary artery--treated conservatively--followed, after a few hours, by a second episode of SCAD involving the left anterior descending coronary artery, complicated by hemodynamic instability and treated with emergency angioplasty. During the previous months, the patient was taking a slimming drug containing ephedrine. Dual spontaneous coronary dissection of different type and involving two different vessels, which occurred in the same patient within a few hours, testifies the heterogeneity of the clinical picture of this syndrome and of the therapeutic approach.

  7. Bilateral Ophthalmic Artery Dissecting Aneurysms Presenting with Recurrent Epistaxis

    PubMed Central

    Al Balushi, Ali; Kitchener, Jacob; Edgell, Randall C.

    2017-01-01

    We present a rare case of bilateral expanding traumatic pseudoaneurysms of the ophthalmic arteries, due to a gunshot. The aneurysms presented with epistaxis. After a failure of conservative management, coil embolization of the aneurysms resulted in complete occlusion, with preservation of flow in the parent vessels. PMID:28243345

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

    PubMed

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

    2016-05-01

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

  9. Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage.

    PubMed

    Cohen, José E; Moscovici, Samuel; Rajz, Gustavo; Vargas, Andres; Itshayek, Eyal

    2016-08-01

    Basilar artery dissection (BAD) is a rare condition with a worse prognosis than a dissection limited to the vertebral artery. We report a rare case of chronic BAD with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage (SAH) in a 54-year-old woman. The diagnosis of acute BAD could only be made retrospectively, based on clinical and neuroradiological studies from a hospital admission 10months earlier. Angiography performed after her SAH showed unequivocal signs of imperfect healing; she was either post-recanalization of a complete occlusion or post-dissection. Residual multi-channel intraluminal defects led to the development of a small aneurysm, which was responsible for the massive hemorrhage. The occurrence of an associated aneurysm, and wall disease, but not an intraluminal process, reinforces the diagnosis of dissection. The patient was fully recovered at 90day follow-up. This case reinforces the need for long-term neuroradiological surveillance after non-hemorrhagic intracranial dissections to detect the development of de novo aneurysms.

  10. What are the Predictors of Death in Patients With Cranio-Cervical Artery Dissection?

    PubMed Central

    KAPLAN, Yüksel; KAMIŞLI, Özden; ALTINAYAR, Sibel; ÖZCAN, Cemal

    2015-01-01

    Introduction Few studies have reported the predictive factors related to mortality in patients with cranio-cervical artery dissections (CCAD). Our aim was to investigate the predictors related to in-hospital mortality in patients with CCAD and its subgroups. Methods Sixty-seven patients diagnosed with carotid artery dissection (CAD) or vertebral artery dissection (VAD), admitted to our clinic between 2000 and 2013, were retrospectively reviewed. Age, gender, modified Rankin Scale scores (pre-stroke and at admission), clinical presentation type, location of the dissection, risk factors, and treatments were analyzed as mortality-related prognostic factors. Of the 67 patients, 12 (17.9%) died, five (7.46%) with CAD and seven (10.44%) with VAD. We compared the prognostic characteristics of the surviving versus deceased patients with CCAD and in the subgroups with CAD and VAD. Results Age above 45 years, severe disability at admission, presentation with stroke, and intracranial VAD occurred more frequently in deceased patients and were independent variables related to mortality in patients with CCAD and its subgroup with VAD. Severe disability at admission alone was related to mortality in patients with CAD. Hypertension and hypercholesterolemia were independent variables related to mortality in patients with CCAD. Conclusion Severe disability at admission was a mortality predictor in both CAD and VAD. Although the initial severity of stroke is reportedly related to poor outcomes in patients with CCAD, it has not previously been directly identified as a predictor of mortality in patients with CAD or VAD.

  11. Ruptured Pancreaticoduodenal Artery Aneurysm Associated with Median Arcuate Ligament Compression and Aortic Dissection Successfully Treated with Embolotherapy

    PubMed Central

    Terada, Takuro; Tamaki, Masato

    2015-01-01

    A 51-year-old man with a ruptured pancreaticoduodenal artery (PDA) aneurysm caused by compression of the celiac artery by the median arcuate ligament and aortic dissection involving the celiac axis was transferred to our hospital for endovascular treatment. A 4-F catheter was advanced into the superior mesenteric artery through the narrow true lumen via the left brachial artery, and coil embolization of the aneurysm was successfully performed. In this case, rapid increase of blood flow in the superior mesenteric artery, which compensated for the decreased celiac blood flow by aortic dissection, increased hemodynamic stress on the PDA, leading to aneurysmal rupture. PMID:25848431

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-04-03

    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.

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

    PubMed Central

    2014-01-01

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

  15. Mural Dissections of Brain-Supplying Arteries in a Chimpanzee (Pan troglodytes).

    PubMed

    Baze, Wallace B; Storts, Ralph W; Wilkerson, Gregory K; Buchl, Stephanie J; Magden, Elizabeth R; Chaffee, Beth K

    2015-12-01

    We describe the pathologic features of mural arterial dissection involving brain-supplying arteries in a 31-y-old female chimpanzee (Pan troglodytes). Several hours after examination for a possible respiratory tract infection, the chimpanzee became unresponsive, developed seizures, and died within 18 h. At necropsy, the occipital cortex of the brain had a small area of congestion, and the cerebellar cortex contained a small necrotic area. Histologic evaluation confirmed the cortical lesions and revealed an additional necrotic area in the medulla oblongata characterized by mural dissection of the brain-supplying vertebral and basilar arteries and subsequent branches. Lesions in the cortices and medulla were within areas supplied by the vertebrobasilar system. Dissection of brain-supplying arteries has been described in humans but not previously in chimpanzees (or any other NHP), suggesting that these species might be useful in understanding this condition in humans. In addition, the lesion should be added to the NHP clinician's and pathologist's differential diagnosis list for similar presentations in this species.

  16. Spontaneous internal carotid artery dissection: an uncommon cause of recurrent postpartum headache.

    PubMed

    Stamboulis, Elefterios; Raptis, Georgios; Andrikopoulou, Athina; Arvaniti, Chrisa; Brountzos, Elias; Oikonomopoulos, Nikos; Stefanis, Leonidas; Voumvourakis, Konstantinos

    2011-01-01

    Postpartum spontaneous cervicocephalic artery dissection is an uncommon, poorly understood condition following pregnancy. We report a case of a 32-year-old woman with no history of trauma, chiropractic manipulation, connective tissue disorder, or previous headache who developed a mild, unilateral headache 7 days after the uneventful delivery of her third child (no general or neuraxial anesthesia was delivered). Seven days latter she presented to our emergency department complaining of recurrent episodes of right-sided headache coupled with a transient episode of sensory deficits in her left lower limb. Brain magnetic resonance imaging disclosed small infarctions in the internal watershed distribution of right internal carotid artery (ICA). Carotid artery dissection was diagnosed using DSA and T1 FAT-SAT sequences for the depiction of intramural hematoma. The patient was placed under oral anticoagulation and remained asymptomatic during a follow-up period of 6 months. The present case report highlights that cervicocephalic artery dissection is a condition that should be looked for in women with persisting or remitting unilateral headache following childbirth.

  17. A case report: spontaneous rupture of dissecting aneurysm of the middle colic artery.

    PubMed

    Chino, Osamu; Kijima, Hiroshi; Shibuya, Makoto; Yamamoto, Soichiro; Kashiwagi, Hiroyuki; Kondo, Yasumasa; Makuuchi, Hiroyasu

    2004-12-01

    Aneurysms of the superior mesenteric artery branches are rarely reported, even among them colic artery aneurysms are seldom. We report a case of 78-year-old male with ruptured dissecting aneurysm of middle colic artery. The patient complained abdominal pain and nausea during hospital stay for renal stone. The patient suddenly developed severe abdominal pain, leading to shock. He underwent emergency surgery under a preoperative diagnosis of intraperitoneal hemorrhage. At exploratory laparotomy, a large hematoma involving the mesentery root of the transverse colon was associated with a ruptured aneurysm measuring 15 x 10 mm in size, which was located to the mid-portion of middle colic artery. Right-hemicolectomy was carried out because of ischemic changes in the ascending colon. Histological examination demonstrated a ruptured dissecting aneurysm of the middle colic artery approximately 5 cm in length, associated with destruction of the tunica interna and media. The aneurysm was thought to result from idiopathic segmental arterial mediolysis, because no definitive evidence of atherosclerosis or arteritis was observed.

  18. Spontaneous rupture of a middle colic artery aneurysm arising from superior mesenteric artery dissection: Diagnosis by color Doppler ultrasonography and CT angiography.

    PubMed

    Yoo, Bo Reum; Han, Hyun Young; Cho, Young Kwon; Park, Suk Jin

    2012-05-01

    Both middle colic artery (MCA) aneurysm and spontaneous dissection of the superior mesenteric artery (SMA) are rare. We report the first case of concomitancy of both conditions, diagnosed by ultrasonography and CT angiography. A 56-year-old man with abrupt abdominal pain and hypovolemic shock was diagnosed initially with ruptured MCA aneurysm by color Doppler ultrasonography. Computed tomography and angiography confirmed MCA aneurysm and showed that it was arising from the false lumen of an SMA dissection and was probably associated with segmental arterial mediolysis. The MCA aneurysm was treated successfully by transcatheter coil embolization, and the SMA dissection was treated conservatively.

  19. Death from undetected acute myocardial infarction secondary to coronary artery dissection after blunt thoracic trauma.

    PubMed

    Puanglumyai, Supot; Thamtakerngkit, Somboon; Lekawanvijit, Suree

    2016-01-01

    Blunt thoracic trauma is a common occurrence in automobile accidents. Acute myocardial infarction (AMI) caused by coronary dissection following blunt thoracic trauma is rare. We report a case of healthy 24-year-old man with a history of blunt thoracic injury with subsequent undetected AMI who died of acute decompensated heart failure 4 days after the insult. The autopsy findings showed a 90% luminal narrowing of the left anterior descending coronary artery by dissecting hematoma, 3 cm in length. The myocardium revealed transmural myocardial infarction affecting apex, most part of left ventricular free wall, and interventricular septum. Both lungs were heavy, wet, and noncrepitant. Histological findings of the infarcted myocardium were consistent with 3-5 days post-AMI. Sections from both lungs revealed massive pulmonary edema, reflecting acute decompensated heart failure following a large AMI secondary to coronary dissection. Blunt thoracic trauma may obscure typical chest pain associated with cardiac ischemia especially in cases with a high tolerance for pain.

  20. Pulmonary artery dissection following balloon valvuloplasty in a dog with pulmonic stenosis.

    PubMed

    Grint, K A; Kellihan, H B

    2016-11-30

    A 3-month-old, 9.9 kg, male pit bull cross was referred for evaluation of collapse. A left basilar systolic heart murmur graded V/VI and a grade IV/VI right basilar systolic heart murmur were ausculted. Echocardiography showed severe pulmonic stenosis characterized by annular hypoplasia, leaflet thickening, and leaflet fusion. After 1 month of atenolol therapy, a pulmonic valve balloon valvuloplasty procedure was performed, and the intra-operative right ventricular pressure was reduced by 43%. Echocardiography, performed the following day, showed apparent rupture of a pulmonary valve leaflet and a membranous structure within the pulmonary artery consistent with a dissecting membrane. Short-term follow-up has shown no apparent progression of the pulmonary artery dissection and the patient remains free of clinical signs.

  1. Spontaneous Renal Artery Dissection Complicated by Renal Infarction: Three Case Reports

    PubMed Central

    Im, Chami; Park, Hyung Sub; Kim, Dae Hwan; Lee, Taeseung

    2016-01-01

    Spontaneous renal artery dissection (SRAD) is a rare disease entity. The diagnosis is usually delayed because clinical presentation is non-specific. We report three cases of symptomatic SRAD complicated by renal infarction which occurred in previously healthy middle-aged male patients. They visited the hospital due to acute abdominal or flank pain. They had no specific underlying disease or trauma history. The laboratory tests and physical examination were normal. They were not suspected of having SRAD initially, but computed tomography (CT) revealed dissection of the renal artery with distal hypoperfusion leading to renal infarction. They were treated conservatively with anticoagulation and/or antiplatelets for 6 months. They had a 6-month regular follow-up with CT, where resolution was confirmed in one patient and all patients remained asymptomatic. These cases emphasize the importance of clinical suspicion of SRAD in previously healthy patients who complain of abdominal pain without specific findings on initial investigation. PMID:28042561

  2. Vertebral artery dissection caused by swinging a golf club: case report and literature review.

    PubMed

    Yamada, Shoko M; Goto, Yoshiaki; Murakami, Mineko; Hoya, Katsumi; Matsuno, Akira

    2014-03-01

    Vertebral artery (VA) dissection caused by swinging a golf club is extremely rare, and the mechanism of the dissection has not been elucidated. A 39-year-old man suddenly felt sharp neck pain and dizziness when he swung a driver while playing golf and visited our clinic. Imaging studies showed acute right cerebellar infarction and complete occlusion of the right VA at the C2 (axis) level. After 1 month of 100 mg aspirin treatment, the occluded right VA was completely recanalized and the patient became totally asymptomatic. Professional golfers look at the position of the ball on the ground or tee until completion of their follow-through. However, some amateur golfers look in the direction that the ball travels at the beginning of their follow-through. It is hypothesized that this rapid disproportionate head rotation produces VA elongation and distortion, mainly at the C2 level, causing stenosis or occlusion of the artery.

  3. Recurrent chest pain after treatment of spontaneous coronary artery dissection: An enigma.

    PubMed

    Bhatt, Dheeraj D; Kachru, Ranjan; Gupta, Sanjay; Kaul, Upendra

    2015-12-01

    Spontaneous coronary artery dissection (SCAD) is a rare entity. It has been described in various settings like pregnancy, collagen vascular diseases, cocaine abuse, heavy exercise, variant angina, eosinophilic arteritis, or fibro muscular dysplasia. It is also easy to miss a dissection during angiography, as the typical radiolucent lumen seen in coronary angiography may be absent in many cases. In this report, we describe the case of a 35-year-old female who presented with acute ST elevation myocardial infarction due to spontaneous coronary dissection. She had been having episodic chest pain for one year and had been seen by two different cardiologists but was thought to have non-cardiac symptoms. Even during the index hospitalization, she underwent coronary angiography three times before coronary dissection could be identified as the cause of her symptoms. She underwent coronary artery bypass graft surgery uneventfully. However, even after myocardial revascularization, she has had multiple episodes of chest pain requiring hospitalization. However, we have not been able to find a specific cause for it and the cause of her recurrent chest pain remains an enigma. This case highlights the problems, which arise while managing a case of SCAD. More research is needed to find the exact etiology and long-term prognosis of this condition.

  4. [Usefulness of pulsed water jet in dissecting sphenoid ridge meningioma while preserving arteries].

    PubMed

    Endo, Toshiki; Nakagawa, Atsuhiro; Fujimura, Miki; Sonoda, Yukihiko; Shimizu, Hiroaki; Tominaga, Teiji

    2014-11-01

    We report the utility of a pulsed water jet device in meningioma surgery. The presented case is that of a 61-year-old woman with left visual disturbance. MRI demonstrated heterogeneously enhanced mass with intratumoral hemorrhage, indicating sphenoid ridge meningioma on her left side. The tumor invaded the cavernous sinus and left optic canal, engulfing the internal carotid artery in the carotid cistern and encased middle cerebral arteries. During the operation, the pulsed water jet device was useful for dissecting the tumor away from the arteries since it was safe in light of preserving parent arteries. The jet did not cause any vascular injury and did not induce vasospasm as shown by postoperative symptomatology and MRIs. With the aid of pulsed water jet, we could achieve total resection of the tumor except for the piece within the cavernous sinus. The patient had no new neurological deficits after the operation. We consider the pulsed water jet as a useful device, especially when the need to dissect meningioma from parent arteries exists. The jet can help neurosurgeons simultaneously achieve tumor resection and preservation of blood vessels.

  5. Cocaine mediated apoptosis of vascular cells as a mechanism for carotid artery dissection leading to ischemic stroke.

    PubMed

    Dabbouseh, Noura M; Ardelt, Agnieszka

    2011-08-01

    In arterial dissection, blood may enter the arterial wall through an intimal tear, splitting the arterial wall and activating the coagulation cascade at the site of endothelial damage. Dissection of extracranial and intracranial vessels may lead to ischemic stroke through thromboembolic or hemodynamic mechanisms. Major blunt trauma or rapid acceleration-deceleration may cause dissection, but in patients with inherent arterial wall weakness, dissection can occur spontaneously or as a result of minor neck movement. Cocaine use has been associated with dissection of the aortic arch and coronary and renal arteries through cocaine-mediated hypertension. Recent preclinical studies have suggested, however, that cocaine may cause apoptosis of cells in the vascular wall. In this article, we postulate that cocaine may cause apoptosis of vascular endothelial and/or smooth muscle cells, thus weakening the vascular wall and resulting in a dissection-prone state. We review the literature and propose a biological basis for vasculopathy, vascular dissection, and ischemic stroke in the setting of cocaine use. Further research studies on vascular cells, as well as focused analysis of human pathological material, will be important in providing evidence for or against our hypotheses.

  6. Acute Pontine Infarction due to Basilar Artery Dissection from Strenuous Physical Effort: One from Sexual Intercourse and Another from Defecation

    PubMed Central

    Kim, Su-Ho; Suh, Sang-Jun; Lee, Jeong-Ho; Ryu, Kee-Young; Kang, Dong-Gee

    2016-01-01

    A basilar artery dissection (BAD) is an extremely rare disease. It can lead to hemorrhage or infarction involving the brain stem, and is often associated with grave outcome. However, little is known about the pathophysiology of BAD, and its proper managements are yet in controversy. Herein, we report on two rare cases of basilar artery dissection from strenuous physical effort; one from sexual intercourse and another from defecation. The treatment modalities and the outcomes are also discussed. PMID:27790399

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

    PubMed Central

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

    2015-01-01

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

  8. Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?

    PubMed Central

    Stamou, Sotiris C.; Gartner, Derek; Kouchoukos, Nicholas T.; Lobdell, Kevin W.; Khabbaz, Kamal; Murphy, Edward; Hagberg, Robert C.

    2016-01-01

    Background The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. Methods A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality. Results Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001). Conclusions The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles. PMID:28097193

  9. Medical and Interventional Therapy for Spontaneous Vertebral Artery Dissection in the Craniocervical Segment

    PubMed Central

    Zhang, Guiyun

    2017-01-01

    Background and Purpose. Spontaneous vertebral artery dissection (SVAD) is an important reason for posterior-circulation-ischemic stroke in the young and middle-aged population. Although some previous reports reveal a favorable outcome with conservative therapy, it is still controversial in the treatment of SVAD in some specific patients. Herein, we present our 10 years of clinical experience for SVAD at this location. Material and Methods. 20 patients with 20 SVADs in V2 and V3 segments were retrospectively studied. Clinical manifestations and imageology materials were collected and analyzed. All the patients underwent anticoagulation except for one patient because of contraindication. 14 patients underwent Wingspan stents implantation with general anesthesia. Results. In our sample, ischemia (infarction or transient ischemic attack, TIA) was found in all the patients. Angiographic stenosis and dissection aneurysm were the most common findings in the segments mentioned above. 19 of the patients (95%) got the excellent imageological and clinical outcomes. Conclusions. According to our experience in this group, although anticoagulation is effective in vertebral artery dissection, interventional therapy for SVADs in V2 and/or V3 segments is preferred in some specific patients. Stent with higher radial supporting and flexibility, such as Wingspan stent, is suggested. PMID:28321414

  10. Horner's Syndrome due to a Spontaneous Internal Carotid Artery Dissection after Deep Sea Scuba Diving

    PubMed Central

    Fernández Reyes, Jose Luis; Envid Lázaro, Blanca Mar; Fernández Letamendi, Teresa; Yeste Martín, Ryth; Jódar Morente, Francisco José

    2016-01-01

    Internal carotid artery dissection (ICAD) is a rare entity that either results from traumatic injury or can be spontaneously preceded or not by a minor trauma such as sporting activities. It represents a major cause of stroke in young patients. The diagnosis should be suspected with the combination of Horner's syndrome, headache or neck pain, and retinal or cerebral ischaemia. The confirmation is frequently made with a magnetic resonance angiography (MRA). Although anticoagulation with heparin followed by vitamin-K-antagonists is the most common treatment, there is no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid dissection. We describe a patient with ICAD following deep sea scuba diving, who presented with Horner's syndrome and neck pain and was successfully treated with anticoagulants. PMID:27525139

  11. Horner's Syndrome due to a Spontaneous Internal Carotid Artery Dissection after Deep Sea Scuba Diving.

    PubMed

    Alonso Formento, Jose Enrique; Fernández Reyes, Jose Luis; Envid Lázaro, Blanca Mar; Fernández Letamendi, Teresa; Yeste Martín, Ryth; Jódar Morente, Francisco José

    2016-01-01

    Internal carotid artery dissection (ICAD) is a rare entity that either results from traumatic injury or can be spontaneously preceded or not by a minor trauma such as sporting activities. It represents a major cause of stroke in young patients. The diagnosis should be suspected with the combination of Horner's syndrome, headache or neck pain, and retinal or cerebral ischaemia. The confirmation is frequently made with a magnetic resonance angiography (MRA). Although anticoagulation with heparin followed by vitamin-K-antagonists is the most common treatment, there is no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid dissection. We describe a patient with ICAD following deep sea scuba diving, who presented with Horner's syndrome and neck pain and was successfully treated with anticoagulants.

  12. Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography.

    PubMed

    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

    2009-04-01

    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.

  13. Conservative Management of Isolated Superior Mesenteric Artery and Celiac Trunk Dissection: A Case Report and Literature Review

    PubMed Central

    Messaoudi, Yosra; Chouchene, Adnen

    2016-01-01

    Isolated arterial dissection without aortic pathology has been rarely reported in mesenteric vessels. The natural history and appropriate treatment for this disease is uncertain because of the scarcity of literature which limits the data available to the clinician, resulting in management challenges. Herein, we report a rare case of a 42-year-old Tunisian man with spontaneous dissection and aneurysmal dilatation of the Celiac Artery (CA) and the Superior Mesenteric Artery (SMA) with partial thrombosis. This case was successfully managed conservatively with heparin infusion and blood pressure control and the patient remained symptom free at 15 months follow up. This case demonstrates that conservative management may be warranted in non-complicated isolated visceral arterial dissection. PMID:28050440

  14. Transoral carotid ultrasonography using a micro convex probe with B-flow imaging for extracranial internal carotid artery dissection.

    PubMed

    Sakima, Hirokuni; Isa, Katsunori; Anegawa, Takahiro; Kokuba, Kazuhito; Nakachi, Koh; Goya, Yoshino; Tokashiki, Takashi; Ishiuchi, Shogo; Ohya, Yusuke

    2012-11-01

    We report on transoral carotid ultrasonography using a micro convex probe with B-flow imaging for determining spontaneous extracranial internal carotid artery dissection just below the petrous portion. A 49-year-old man suffered cortical and subcortical infarction in the region of the right middle cerebral artery. Magnetic resonance angiography on the third day of admission revealed spontaneous recanalization of the right internal carotid artery associated with an intimal flap-like structure at the petrous portion. Transoral carotid ultrasonography using a micro convex probe revealed right extracranial internal carotid artery dissection, showing an increased diameter of the right extracranial internal carotid artery with double lumen formation, stenosis of the true lumen, and a mobile intimal flap in B-flow imaging. Transoral carotid ultrasonography using a micro convex probe was helpful to attempt a self-expanding stent for recanalizing right extracranial internal carotid artery dissection. The patient recovered and was discharged ambulatory. The size of the micro convex probe was optimum for transoral carotid ultrasonography in our patient. Micro convex probe is more commonly used than the standard transoral carotid ultrasonography probe, which lacks versatility. We consider that transoral carotid ultrasonography using a micro convex probe could be routinely used for ultrasonographic evaluation of extracranial internal carotid artery dissection.

  15. Pulmonary artery dissection causing haemothorax in a cat: potential role of Dirofilaria immitis infection and literature review.

    PubMed

    Biasato, I; Tursi, M; Zanet, S; Longato, E; Capucchio, M T

    2017-02-01

    A 7-year-old male castrated domestic short-haired cat suddenly died. Gross examination revealed severe right-sided haemothorax with blood clots, four adult filarial nematodes in the blood clots and the caudal vena cava and haemorrhage dissecting into the tunica media of the right pulmonary artery. Histopathological investigation showed fibrosis of the tunica intima and disorganization/fragmentation of the elastic fibres accompanied by fibrous tissue deposition in the tunica media of both branches of pulmonary artery. Degenerative vasculopathy (intimal fibromuscular hyperplasia and medial hypertrophy/hyperplasia) involving pulmonary arteries was also observed. The polymerase chain reaction amplification and sequencing confirmed the identification of the parasite as Dirofilaria immitis. A diagnosis of pulmonary artery dissection with haemothorax and concomitant heartworm disease was formulated. Degenerative processes of the tunica media have been reported to cause pulmonary artery dissection in both humans and animals. Pulmonary artery remodelling induced by heartworms may be considered the underlying cause in the first case of feline pulmonary artery dissection, herein described.

  16. Dissection of left iliac artery during anterior lumbar interspace fusion: Report of a case.

    PubMed

    Fischer, Uwe M; Davies, Mark G; El Sayed, Hosam

    2015-04-01

    Vascular injury is an uncommon complication of spine surgery. Among the different approaches, anterior lumbar interbody fusion has increased potential for vascular injuries, since the great vessels and their branches overly the disc spaces to be operated on, and retraction of these vessels is necessary to gain adequate surgical exposure. The reported incidence for anterior lumbar interbody fusion-associated vascular injuries ranges from 0% to 18.1%, with venous laceration as the most common type. We report a case of anterior lumbar interbody fusion-associated left common iliac artery dissection leading to delayed acute limb ischemia developing in early post-operative period.

  17. Clopidogrel-Associated Thrombotic Thrombocytopenic Purpura following Endovascular Treatment of Spontaneous Carotid Artery Dissection

    PubMed Central

    Rubano, Jerry A.; Chen, Kwan; Sullivan, Brianne; Vosswinkel, James A.; Jawa, Randeep S.

    2015-01-01

    Thrombotic thrombocytopenic purpura (TTP) is a life-threatening multisystem disease secondary to platelet aggregation. We present a patient who developed profound thrombocytopenia and anemia 8 days following initiation of therapy with clopidogrel after stent placement for carotid artery dissection. She did not have a disintegrin and metalloproteinase with thrombospondin domain 13 (ADAMTS 13) deficiency. Management included steroids and therapeutic plasma exchange. Clopidogrel has rarely been associated with TTP. Unlike other causes of acquired TTP, the diagnosis of early clopidogrel-associated TTP is largely clinical given the infrequent reduction in ADAMTS 13 activity. PMID:26623244

  18. Spontaneous Renal Artery Dissection in a Patient with Neurofibromatosis Type I

    PubMed Central

    Chammas, Majid Z.; Robken, Jon; Coyne, Edmund

    2016-01-01

    We present a case of spontaneous renal artery dissection (SRAD) in a 28-year-old female with history of neurofibromatosis type I (NF-1) treated successfully with endovascular stenting. The clinical presentation, diagnostic testing, and treatment options are discussed. An endovascular approach with stenting was successfully performed after failure of medical treatment with subcutaneous low molecular weight heparin. Patient's blood pressure and symptoms improved significantly. This may be the first reported case of SRAD in a patient with NF-1 successfully treated with endovascular stenting. PMID:27867667

  19. Spontaneous Dissection of the Renal Artery in Vascular Ehlers-Danlos Syndrome

    PubMed Central

    Pereira, Filipa; Cardoso, Teresa; Sá, Paula

    2015-01-01

    Ehlers-Danlos syndrome (EDS) is a rare heterogeneous group of connective tissue disorders. The vascular type (vEDS) is an autosomal dominant disorder caused by heterozygous mutations in the COL3A1 gene predisposing to premature arterial, intestinal, or uterine rupture. We report a case of a 38-year-old woman with a recent diagnosis of vEDS admitted in the Emergency Department with a suspicion of a pyelonephritis that evolved to a cardiopulmonary arrest. A fatal retroperitoneal hematoma related with a haemorrhagic dissection of the right renal artery was found after emergency surgery. This case highlights the need to be aware of the particular characteristics of vEDS, such as a severe vascular complication that can lead to a fatal outcome. PMID:26175915

  20. A rare presentation of spontaneous internal carotid artery dissection with Horner's syndrome, VIIth, Xth and XIIth nerve palsies

    PubMed Central

    Majeed, Azer; Ribeiro, Nuno Pedro Lobato; Ali, Asem; Hijazi, Mohsen; Farook, Hina

    2016-01-01

    Spontaneous internal carotid artery dissection (sICAD) is an uncommon cause of isolated cranial nerve palsies. Commonly patients present with stroke, headache, facial pain and Horner's syndrome, with upto 16% having cranial nerve palsies. We present the case of a 55-year-old man who presented with hoarseness, dysphagia and tongue swelling, mimicking a tongue base tumor. He was found to have unilateral VIIth, Xth and XIIth nerve palsies with Horner's syndrome. Magnetic resonance imaging showed high signal changes and loss of signal void in right internal carotid artery, later confirmed by Angiography as a dissection with pseudo-aneurysm. He was started on anticoagulation and made a good recovery on discharge. This case presents a unique combination of cranial nerve palsies due to internal carotid artery dissection (ICAD) and to our knowledge is the first reported case in the literature. Early recognition and institution of appropriate therapy is critical to prevention of ischemic stroke. PMID:27699055

  1. Repeat Coronary Artery Dissection in Pregnancy: A Case Report and Review of the Literature.

    PubMed

    Bitting, Casey P; Zumwalt, Ross E

    2017-02-07

    Non-atherosclerotic spontaneous coronary artery dissection (NA-SCAD) is a rare cause of morbidity and mortality with a propensity for young, healthy, and often peripartum women. NA-SCAD etiology is poorly understood, with possible hormonal and hereditary mechanisms. Current treatment strategies range from conservative management (often showing resolution on angiographic follow-up) to invasive angiographic procedures. Rarely, NA-SCAD has recurred in another coronary artery, ranging hours to years later. We report NA-SCAD of the right coronary artery (RCA) in a 30-year old, 3-month postpartum female with an additional autopsy finding of remote myocardial infarction (MI) in the left anterior descending (LAD) coronary artery territory. The remote MI is consistent with prior NA-SCAD of the LAD and, given the medical history, may have occurred in the peripartum period of the decedent first pregnancy 3 years earlier. As such, to the best of our knowledge, this may represent the first reported case of NA-SCAD recurrence in a subsequent pregnancy.

  2. Evaluation of characteristics, associations and clinical course of isolated spontaneous renal artery dissection

    PubMed Central

    Afshinnia, Farsad; Sundaram, Baskaran; Rao, Panduranga; Stanley, James; Bitzer, Markus

    2013-01-01

    Background Spontaneous renal artery dissection (SRAD) is a rare entity of unknown etiology. We aimed to study the clinical course and outcomes and compare the characteristics of patients with SRAD with those of the general population. Methods All cases of isolated renal artery dissection diagnosed at the University of Michigan Hospitals between January 2000 and July 2012 were identified by the ICD-9 code. Cases were matched by age, gender and race with individuals from the 2009–2010 National Health and Nutrition Examination Survey (NHANES). Characteristics and awareness of comorbid conditions were compared. Information about the clinical course after diagnosis was retrieved from the case group to ascertain their outcomes. Results Overall, 17 patients with SRAD with a mean age of 38.6 years (SD = 8.3) were identified. Eleven patients were male and 14 were white. The most common presenting symptom was excruciating sudden-onset flank pain ipsilateral to the site of dissection. Fibromuscular dysplasia, Ehlers–Danlos and polyarteritis nodosa were present in 4, 4 and 1 patients, respectively. After adjusting in a multivariable model, the case group was more likely to report history of hypertension, cancer and connective tissue disorders (P < 0.001), and less likely to have obesity (BMI ≥30 kg/m2) compared with the general population. Supportive medical treatment, endovascular intervention and surgery were required in 8, 5 and 4 cases, respectively. After discharge from the hospital, hypertension was adequately controlled in all the patients but one. Conclusion SRAD may be part of a syndrome having multi-organ involvement. With appropriate medical or surgical management, long-term clinical outcome appears favorable. PMID:23563282

  3. Bilateral thalamic infarct caused by spontaneous vertebral artery dissection in pre-eclampsia with HELLP syndrome: a previously unreported association.

    PubMed

    Borelli, Paolo; Baldacci, Filippo; Vergallo, Andrea; Del Dotto, Paolo; Lucetti, Claudio; Nuti, Angelo; Bonuccelli, Ubaldo

    2012-11-01

    Cerebrovascular accidents are not rare during pregnancy and the postpartum period. Pre-eclampsia is a common condition that is characterized by proteinuria and de novo hypertension that may be complicated by hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Spontaneous cervical artery dissection has been rarely reported in the postpartum period but never in association with HELLP syndrome. We describe a case of pre-eclampsia and HELLP syndrome complicated in the postpartum period by bilateral thalamic infarct as result of left vertebral artery dissection. We speculated about the possible common etiopathologic mechanisms involved in this previously unreported association.

  4. Transient ischemic jejunitis due to symptomatic isolated superior mesenteric artery dissection: case report and review of literature

    PubMed Central

    MOCAN, MIHAELA; JEICAN, IONUŢ ISAIA; MOALE, MIHAI; CHIRA, ROMEO

    2017-01-01

    Acute abdominal pain is one of the most common conditions encountered in the emergency department. The differential diagnosis of acute abdominal pain is extensive and identifying the underlying etiology can be challenging. We report a case of acute transient ischemic jejunitis due to symptomatic isolated superior mesenteric artery dissection in a patient with no cardiovascular risk factors or autoimmune diseases. Symptomatic isolated superior mesenteric artery dissection is a rare cause of acute abdominal pain usually treated in the surgical department. The patient had criteria for conservative treatment and rapidly recovered. We highlight a rare condition which should be taken into account for the differential diagnosis of acute abdominal pain. PMID:28246505

  5. Spontaneous ruptured dissection of the right common iliac artery in a patient with classic Ehlers-Danlos syndrome phenotype.

    PubMed

    Gaines, Rick; Tinkle, Brad T; Halandras, Pegge M; Al-Nouri, Omar; Crisostomo, Paul; Cho, Jae S

    2015-04-01

    Unlike vascular Ehlers-Danlos syndrome (EDS), classic EDS is rarely associated with vascular manifestation. We report the case of a 39-year-old man who presented with acute abdominal pain. At the time of presentation, the patient was in hypovolemic shock, and computed tomography angiogram demonstrated common iliac artery dissection with rupture. He underwent an attempted endovascular repair that was converted to an open repair of a ruptured right common iliac artery dissection. Subsequent genetic testing revealed a substitution of arginine for cysteine in type I collagen, COL1A1 exon 14 c.934C>T mutation, consistent with a rare variant of classic EDS.

  6. Dissecting Dissection.

    ERIC Educational Resources Information Center

    AV Magazine, 1996

    1996-01-01

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

  7. Influence of cardiac rehabilitation in Primigravida with spontaneous coronary artery dissection during postpartum

    PubMed Central

    2014-01-01

    Background The physical exercise consists of trainable physical abilities such as strength and endurance. It can be inferred that the individual cardiac patient is dependent on it as an associated therapy to the drug treatment for a rapid and lasting improvement of their overall clinical status Case presentation The patient – with Spontaneous Coronary Artery Dissection Postpartum period – was subjected to 21 sessions of cardiac rehabilitation. A physical evaluation was performed, before and after the treatment period, for data collection: anthropometric values, flexibility, aerobic capacity and strength of grip. Conclusion The patient had a positive response in aerobic capacity, flexibility and grip strength and the anthropometric values were kept in short term rehabilitation. PMID:24829614

  8. Spontaneous healing and complete disappearance of a ruptured posterior inferior cerebellar artery dissecting aneurysm.

    PubMed

    Su, Tsung-Ming; Cheng, Ching-Hsiao; Chen, Wu-Fu; Hsu, Shih-Wei

    2014-05-01

    A 7-month-old baby presented with a 4-day history of drowsiness and vomiting after a falling accident. Magnetic resonance imaging demonstrated diffuse subarachnoid hemorrhage, intraventricular hemorrhage, and variable stages of subdural hematoma in bilateral occipital and left temporal subdural spaces. A partially thrombosed aneurysm was noted in the right craniocervical junction. Ophthalmological examination revealed bilateral retinal petechial hemorrhages. Conventional cerebral angiography revealed a dissecting aneurysm in the right posterior inferior cerebellar artery (PICA). Endovascular embolization was suggested, but the family refused. After conservative treatment, follow-up MRI revealed that the PICA aneurysm had remodeled and ultimately disappeared completely at the 10th month. This case illustrates the relatively plastic nature of intracranial aneurysms in pediatric patients. More studies are necessary to clarify the natural history of spontaneously thrombosed aneurysms to assist in their overall management.

  9. Endovascular Treatment of Spontaneous Isolated Dissecting Aneurysm of the Superior Mesenteric Artery Using Stent-Assisted Coil Embolization

    SciTech Connect

    Ozaki, Toshiro Kimura, Motomasa; Yoshimura, Norihiko; Hori, Yoshiro; Takano, Toru; Kamura, Takesi; Yamamoto, Satoshi; Sasai, Keisuke

    2006-06-15

    Spontaneous isolated dissecting aneurysm of the main trunk of the superior mesenteric artery is a rare condition. We treated a patient with this condition successfully by stent-assisted coil embolization. Intravascular stent placement may widen the indications for endovascular coiling of the aneurysmal false lumen to avoid perforation.

  10. Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

    SciTech Connect

    Fang, Yi-Bin Zhao, Kai-Jun Wu, Yi-Na Zhou, Yu Li, Qiang Yang, Peng-Fei Huang, Qing-Hai Zhao, Wen-Yuan Xu, Yi Liu, Jian-Min

    2015-06-15

    PurposeThe treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.MethodsA retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.ResultsThe immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 months on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).ConclusionsOur preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.

  11. Stent-coil treatment of a distal internal carotid artery dissecting pseudoaneurysm on a redundant loop by use of a flexible, dedicated nitinol intracranial stent.

    PubMed

    Pride, G Lee; Replogle, Robert E; Rappard, George; Graybeal, Christopher L Taylor Dion; White, Jonathan; Purdy, Phillip

    2004-02-01

    Treatment of dissecting pseudoaneurysms of the distal cervical internal carotid artery with preservation of the parent artery by using stents or coils has become routine. Tortuosity remains a significant obstacle to successful endovascular treatment in some cases. We report the use of a stent-coil technique to treat a nonhealing dissecting pseudoaneurysm and associated stenosis with anatomic preservation of a redundant loop involving the stented arterial segment. This was accomplished by using a Neuroform dedicated intracranial stent.

  12. Common variation in PHACTR1 is associated with susceptibility to cervical artery dissection.

    PubMed

    Debette, Stéphanie; Kamatani, Yoichiro; Metso, Tiina M; Kloss, Manja; Chauhan, Ganesh; Engelter, Stefan T; Pezzini, Alessandro; Thijs, Vincent; Markus, Hugh S; Dichgans, Martin; Wolf, Christiane; Dittrich, Ralf; Touzé, Emmanuel; Southerland, Andrew M; Samson, Yves; Abboud, Shérine; Béjot, Yannick; Caso, Valeria; Bersano, Anna; Gschwendtner, Andreas; Sessa, Maria; Cole, John; Lamy, Chantal; Medeiros, Elisabeth; Beretta, Simone; Bonati, Leo H; Grau, Armin J; Michel, Patrik; Majersik, Jennifer J; Sharma, Pankaj; Kalashnikova, Ludmila; Nazarova, Maria; Dobrynina, Larisa; Bartels, Eva; Guillon, Benoit; van den Herik, Evita G; Fernandez-Cadenas, Israel; Jood, Katarina; Nalls, Michael A; De Leeuw, Frank-Erik; Jern, Christina; Cheng, Yu-Ching; Werner, Inge; Metso, Antti J; Lichy, Christoph; Lyrer, Philippe A; Brandt, Tobias; Boncoraglio, Giorgio B; Wichmann, Heinz-Erich; Gieger, Christian; Johnson, Andrew D; Böttcher, Thomas; Castellano, Maurizio; Arveiler, Dominique; Ikram, M Arfan; Breteler, Monique M B; Padovani, Alessandro; Meschia, James F; Kuhlenbäumer, Gregor; Rolfs, Arndt; Worrall, Bradford B; Ringelstein, Erich-Bernd; Zelenika, Diana; Tatlisumak, Turgut; Lathrop, Mark; Leys, Didier; Amouyel, Philippe; Dallongeville, Jean

    2015-01-01

    Cervical artery dissection (CeAD), a mural hematoma in a carotid or vertebral artery, is a major cause of ischemic stroke in young adults although relatively uncommon in the general population (incidence of 2.6/100,000 per year). Minor cervical traumas, infection, migraine and hypertension are putative risk factors, and inverse associations with obesity and hypercholesterolemia are described. No confirmed genetic susceptibility factors have been identified using candidate gene approaches. We performed genome-wide association studies (GWAS) in 1,393 CeAD cases and 14,416 controls. The rs9349379[G] allele (PHACTR1) was associated with lower CeAD risk (odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.69-0.82; P = 4.46 × 10(-10)), with confirmation in independent follow-up samples (659 CeAD cases and 2,648 controls; P = 3.91 × 10(-3); combined P = 1.00 × 10(-11)). The rs9349379[G] allele was previously shown to be associated with lower risk of migraine and increased risk of myocardial infarction. Deciphering the mechanisms underlying this pleiotropy might provide important information on the biological underpinnings of these disabling conditions.

  13. Retriever wire supported carotid artery revascularization (ReWiSed CARe) in acute ischemic stroke with underlying tandem occlusion caused by an internal carotid artery dissection: Technical note.

    PubMed

    Behme, Daniel; Knauth, Michael; Psychogios, Marios-Nikos

    2017-01-01

    We hereby report a novel technical approach for the treatment of acute stroke with underlying tandem occlusion. The so-called retriever wire supported carotid artery revascularization (ReWiSed CARe) technique, utilizing the wire of a stent-retriever as a guiding wire for carotid artery stenting, is technically feasible in tandem occlusions caused by an internal carotid artery (ICA) dissection or high grade ICA stenosis. This technique eliminates the need to use a long microwire in order to maintain the position inside the true lumen of a dissection. Additionally, it leads to anterograde perfusion through the released stent-retriever during the time of ICA stenting, which is favorable in all tandem occlusion cases.

  14. Cervical artery dissections and type A aortic dissection in a family with a novel missense COL3A1 mutation of vascular type Ehlers-Danlos syndrome.

    PubMed

    Makrygiannis, Georgios; Loeys, Bart; Defraigne, Jean-Olivier; Sakalihasan, Natzi

    2015-11-01

    Cervical artery dissection (CeAD) is a rare condition. One of the causes is the vascular type of Ehlers-Danlos syndrome (vEDS). A novel missense mutation in COL3A1 was found in a young patient with CeAD as the single manifestation of vEDS. This is a heterozygous c.953G > A mutation in exon 14, disrupting the normal Gly-X-Y repeats of type III procollagen, by converting glycine to aspartic acid.

  15. Spontaneous vertebral artery dissection with multiple supratentorial and infratentorial acute infarcts in the posterior circulation Case report

    PubMed Central

    Cristea, I; Popa, C

    2016-01-01

    The article represents a case of a young patient with atypical clinical and paraclinical presentation of vertebral artery dissection by multiple cerebral infarcts, localized at the supratentorial and infratentorial levels in the posterior circulation. A case of a 21-year-old man, without a history of trauma in the cervical area or at the cranial level, without recent chiropractic maneuvers or practicing a sport, which required rapid, extreme, rotational movements of the neck, was examined. He presented to the emergency room with nausea, numbness of the left limbs, dysarthria, and incoordination of walking, with multiple objective signs at the neurological examination, which revealed right vertebral artery subacute dissection after the paraclinical investigations. The case was particular due to the atypical debut symptomatology, through the installation of the clinical picture in stages, during 4 hours and by multiple infarcts through the artery-to-artery embolic mechanism in the posterior cerebral territory. Abbreviations: PICA = posterior inferior cerebellar artery, CT = computed tomography, MRI = magnetic resonance imaging, angio MRI = mangnetic resonance angiography, FLAIR = fluid attenuated inversion recovery, FS = fat suppression, ADC = apparent diffusion coefficient, DWI = diffusion weighted imaging, T1/ T2 = T1/ T2 weighted image-basic pulse sequences in MRI, VA = vertebral artery, 3D-TOF = 3D Time of Flight PMID:27974938

  16. Spontaneous vertebral artery dissection with multiple supratentorial and infratentorial acute infarcts in the posterior circulation Case report.

    PubMed

    I, Cristea; C, Popa

    2016-01-01

    The article represents a case of a young patient with atypical clinical and paraclinical presentation of vertebral artery dissection by multiple cerebral infarcts, localized at the supratentorial and infratentorial levels in the posterior circulation. A case of a 21-year-old man, without a history of trauma in the cervical area or at the cranial level, without recent chiropractic maneuvers or practicing a sport, which required rapid, extreme, rotational movements of the neck, was examined. He presented to the emergency room with nausea, numbness of the left limbs, dysarthria, and incoordination of walking, with multiple objective signs at the neurological examination, which revealed right vertebral artery subacute dissection after the paraclinical investigations. The case was particular due to the atypical debut symptomatology, through the installation of the clinical picture in stages, during 4 hours and by multiple infarcts through the artery-to-artery embolic mechanism in the posterior cerebral territory. Abbreviations: PICA = posterior inferior cerebellar artery, CT = computed tomography, MRI = magnetic resonance imaging, angio MRI = mangnetic resonance angiography, FLAIR = fluid attenuated inversion recovery, FS = fat suppression, ADC = apparent diffusion coefficient, DWI = diffusion weighted imaging, T1/ T2 = T1/ T2 weighted image-basic pulse sequences in MRI, VA = vertebral artery, 3D-TOF = 3D Time of Flight.

  17. Therapeutic Progress in Treating Vertebral Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery

    PubMed Central

    Shi, Lei; Xu, Kan; Sun, Xiaofeng; Yu, Jinlu

    2016-01-01

    Among the variations of vertebral artery dissecting aneurysms (VDAs), VDAs involving the posterior inferior cerebellar artery (PICA), especially ruptured and high-risk unruptured aneurysms, are the most difficult to treat. Because the PICA is an important structure, serious symptoms may occur after its occlusion. Retained PICAs are prone to re-bleeding because VDAs are difficult to completely occlude. There is therefore confusion regarding the appropriate treatment for VDAs involving the PICA. Here, we used the PubMed database to review recent research concerning VDAs that involve the PICA, and we found that treatments for VDAs involving the PICA include (i) endovascular treatment involving the reconstruction of blood vessels and blood flow, (ii) occluding the aneurysm using an internal coil trapping or an assisted bypass, (iii) inducing reversed blood flow by occluding the proximal VDA or forming an assisted bypass, or (iv) the reconstruction of blood flow via a craniotomy. Although the above methods effectively treat VDAs involving the PICA, each method is associated with both a high degree of risk and specific advantages and disadvantages. The core problem when treating VDAs involving the PICA is to retain the PICA while occluding the aneurysm. Therefore, the method is generally selected on a case-by-case basis according to the characteristics of the aneurysm. In this study, we summarize the various current methods that are used to treat VDAs involving the PICA and provide schematic diagrams as our conclusion. Because there is no special field of research concerning VDAs involving the PICA, these cases are hidden within many multiple-cases studies. Therefore, this study does not review all relevant documents and may have some limitations. Thus, we have focused on the mainstream treatments for VDAs that involve the PICA. PMID:27429591

  18. Long-term observation of lateral medullary infarction due to vertebral artery dissection assessed with multimodal neuroimaging.

    PubMed

    Nomura, Koichi; Mishina, Masahiro; Okubo, Seiji; Suda, Satoshi; Katsura, Ken-ichiro; Katayama, Yasuo

    2015-01-01

    A 33-year-old man presented with a lateral medullary infarction, vertigo, and nausea. At the time of hospital admission, he had Wallenberg syndrome. Although initial magnetic resonance imaging showed no abnormalities, subsequent diffusion-weighted magnetic resonance imaging showed a high-intensity area in the right lateral medulla oblongata. The right vertebral artery was shown to be dilated on basi-parallel anatomical scanning but to be stenosed on magnetic resonance angiography (MRA). Cerebral angiography 7 days after onset showed the "pearl and string sign" in the right vertebral artery. Follow-up MRA showed gradual improvement of the stenosis in the right vertebral artery. Multiple neuroimaging studies, such as MRA, basi-parallel anatomical scanning, 3-dimensional computed tomographic angiography, and cerebral angiography, should be performed soon after onset in suspected cases of cerebral artery dissection. In addition, serial imaging examinations increase diagnostic accuracy, and the medical history and neurological examination are important.

  19. Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children.

    PubMed

    Cushing, K E; Ramesh, V; Gardner-Medwin, D; Todd, N V; Gholkar, A; Baxter, P; Griffiths, P D

    2001-07-01

    Twelve children with vertebrobasilar artery stroke are reported (seven males, five females; aged 6 months to 15 years). Patient 1 showed an arcuate foramen in the posterior arch of the atlas, an anatomical variant occurring in 3 to 15% of the population. It was hypothesized that the presence of the arcuate foramen might cause tethering of the vertebral artery and lead to its dissection by repetitive trauma. Lateral plain films of the cervical spine in cases of posterior circulation stroke were taken. Eight of 11 patients showed aberrant arcuate foramina. Of the remaining three patients, one had normal cervical spine X-rays, one had an absent right posterior arch of the atlas following previous surgery for a cervical meningocele, and one patient had incomplete ossification of the vertebrae. Seven of the nine patients with arcuate foramina had vertebral angiograms. In all cases this showed the vertebral artery passing through the arcuate foramen before entering the brain and an appearance consistent with arterial dissection and occlusion at the same site below the foramen. Most documented cases of posterior circulation stroke in children follow trauma, which may be minimal or repetitive, with thrombotic occlusion of the artery at C1-C2 level. The association with an arcuate foramen and its possible causative role in the genesis of posterior circulation stroke in children has not been previously recognized. There may be a causal association between the presence of an arcuate foramen, tethering of the vertebral artery in the foramen, and dissection from repetitive trauma with movement of the neck.

  20. Comparison of Endovascular Treatments of Ruptured Dissecting Aneurysms of the Intracranial Internal Carotid Artery and Vertebral Artery with a Review of the Literature

    PubMed Central

    Byoun, Hyoung Soo; Choi, Kyu Sun; Chun, Hyoung Joon; Ko, Yong; Bak, Koang Hum

    2016-01-01

    Objective Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. Methods The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome. Results Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability. Conclusion Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances. PMID:27651862

  1. [Incidence and management of acute left main coronary artery dissection as a complication of acute transluminal coronary angioplasty].

    PubMed

    Dittel, M; Prachar, H; Spiel, R; Mlczoch, J

    1996-09-01

    Out of 1730 consecutive patients undergoing percutaneous transluminal coronary angioplasty (PTCA) of left descending coronary artery (LAD) or circumflex artery (CX) five patients (0.3%) suffered an acute dissection of left main coronary artery. In three patients dissection developed because of manipulation of the guiding catheter. In one patient retrograde dissection of the left main stem occurred because of balloon angioplasty of ostial LAD stenosis and in a second patient because of balloon rupture in the setting of stent deployment in the proximal part of the LAD. Four patients were selected for emergency operation, but one patient died before reacting the operation theatre. Out of the three remaining patients one patient died postoperatively and another patient suffered a transmural myocardial infarction. In the fifth patient three AVE Micro stents were implanted; one just at the origin of the LAD, one at the origin of the CX and the third in the left main stem. This patient was not sent for operation and was discharged without symptoms.

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

    PubMed

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

    2016-02-01

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

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

    PubMed Central

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

    2016-01-01

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

  4. Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings.

    PubMed

    Yoon, Kibo; Song, Soon Young; Lee, Chang Hwa; Ko, Byung Hee; Lee, Seunghun; Kang, Bo Kyeong; Kim, Mi Mi

    2017-04-01

    The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate < 60 mL/min/1.73 m² or to end-stage renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR.

  5. Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings

    PubMed Central

    2017-01-01

    The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate < 60 mL/min/1.73 m2 or to end-stage renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR. PMID:28244286

  6. Medevac from a cruise ship of a patient with spontaneous coronary artery dissection who presented with epigastralgia.

    PubMed

    Garcia-Castaneda, Jenny; Harb-De la Rosa, Alfredo

    2014-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome that has been associated with peripartum and postpartum periods. It results from the separation of the layers of the arterial wall of the coronary artery with the subsequent formation of a false lumen. We report a case of a 54-year-old female who presented to the cruise ship's medical facility complaining of epigastralgia and dizziness. Work up including an electrocardiography and cardiac profile was ordered. Results yielded a diagnosis of non-ST segment elevation myocardial infarction (NSTEMI). Treatment following American Heart Association recommendations including nitrates, clopidogrel and enoxaparin was given. After debarkation at sea and referral to a reference hospital, the patient was diagnosed with SCAD. Patient's outcome was favorable and she was discharged home a few days after, despite being managed as a NSTEMI.

  7. Use of Three-Dimensional Curved-Multiplanar Reconstruction Images for Sylvian Dissection in Microsurgery of Middle Cerebral Artery Aneurysms

    PubMed Central

    Nam, Taek-Kyun; Byun, Jun-Soo; Park, Seung-Won; Kwon, Jeong-Taik

    2017-01-01

    Purpose The purpose of this study was to introduce a method of using three-dimensional (3D) curved-multiplanar reconstruction (MPR) images for sylvian dissection during microsurgical treatment of middle cerebral artery (MCA) aneurysms. Materials and Methods Forty-nine patients who had undergone surgery for MCA aneurysms were enrolled. We obtained the 3D curved-MPR images along the sphenoid ridge using OsiriX MD™ imaging software, compared sylvian dissection time according to several 3D MPR image factors, and investigated the correlations between these images and intraoperative findings. Results Utilizing preoperative information of the sylvian fissure (SF) and peri-aneurysmal space on 3D curved-MPR images, we could predict the feasibility of sylvian dissection for a safe surgery. 3D curved-MPR images showed several features: first, perpendicular images to the sylvian surface in the same orientation as the surgeon's view; second, simultaneous visualization of the brain cortex, vessels, and cisternal space; and third, more accurate measurement of various parameters, such as depth of the MCA from the sylvian surface and the location and width of the SFs. Conclusion In addition to conventional image studies, 3D curved-MPR images seem to provide useful information for Sylvian dissection in the microsurgical treatment of MCA aneurysms. PMID:27873519

  8. Percutaneous Cervical Sympathetic Block for Pain Control after Internal Carotid Artery Dissection. A Report of Two Cases

    PubMed Central

    Saeed, Omar; Khan, Asif A.; Herial, Nabeel A.; Aytac, Emrah; Qureshi, Adnan I.

    2017-01-01

    Background Medical treatment of cranio-cervical pain can be suboptimal in patients with internal carotid artery (ICA) dissection. We report the use of cervical sympathetic block for treatment of pain in two patients with ICA dissection. Case Reports A 58-year-old man and a 43-year-old woman presented with severe cranio-cervical pain associated with left and right ICA dissection confirmed by magnetic resonance imaging and cerebral angiography. Due to suboptimal control of pain with medical treatment, cervical sympathetic block was performed under fluoroscopic guidance using 20 ml of bupivacaine injected lateral to the posterior aspect of sixth vertebral body in both patients. On self-reported pain scale, the 58-year-old man reported improvement in pain intensity from 8/10 pain to 0/10 within 1 h of blockade. The patient remained relatively pain free for the 24-h post blockade. Mild recurrence of pain was noted on Day 2. The 43-year-old woman reported improvement in pain intensity from 6/10 pain to 0/10 within 1 h of blockade. The patient remained pain free for five days with recurrence to previous intensity. Conclusion Cervical sympathetic blockade in patients with ICA dissection may be an effective option in the event of suboptimal pain control with medical treatment; however, the technique may be limited due to relatively short duration of action. PMID:28243349

  9. Bilateral dissection of the internal carotid artery at the base of the skull due to blunt trauma: incidence and severity.

    PubMed

    Alimi, Y; Di Mauro, P; Tomachot, L; Albanese, J; Martin, C; Alliez, B; Juhan, C

    1998-11-01

    Between January 1, 1992 and December 31, 1996, a total of 1095 head trauma vicims were admitted in our intensive care unit. If CT scans demonstrated ischemic brain lesions, arteriography to visualize supraaortic vessels was performed. Carotid artery dissection was observed in ten patients (0.91%) and was bilateral in eight patients (0.73%). In the bilateral carotid artery dissection (BCAD) group, there were five women and three men, with a mean age of 35.2 years (range: 17 to 54 years). Injuries resulted from traffic accidents in seven patients and a fall in one patient. Upon admission, six patients presented with alteration of consciousness and three with hemiplegia or hemiparesia, associated with aphasia in two cases. In two other cases, hemiplegia occurred 24 hr and 13 days after the accident. All patients had brain infarction, which was unilateral in five cases and bilateral in three cases. The severity of lesions was graded on the basis of arteriographic findings as follows: Type I, wall involvement without significant stenosis or dilation; Type II, arterial dissection with stenosis >70% (Type IIA) or dilatation >50% (Type IIB) and the normal diameter of the proximal or distal internal carotid artery; and Type III, thrombosis of the internal carotid artery. Lesions were asymmetrical in six patients, including two with Type II and III lesions and four with Type I and II lesions, and symmetrical in two patients, including one with bilateral Type III lesions and one with bilateral Type II lesions. Surgery was performed in two patients with Type II lesions, including one case associated with contralateral carotid thrombosis. The intrapetrous carotid artery was exposed by an ear-nose-throat (ENT) surgeon and repaired by interposition grafting. Follow-up in these two surgical cases was 28 and 31 months. In the remaining six cases, medical treatment was performed. Outcome in nonsurgical cases was variable: death in two cases at 31 and 43 days after the accident

  10. Open triple-branched stent graft applied to patient of acute type a aortic dissection with Aberrant Right Subclavian Artery

    PubMed Central

    2013-01-01

    A 57-year-old Chinese male patient presented with Standford type A aortic dissection with an aberrant right subclavian artery (ARSA). At operation, the ascending aorta was replaced by a mono–branch vascular prosthesis with the branch bypassing to the ARSA; the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta (covering the origin of the ARSA) with each sidearm graft being positioned into the aortic branches; and then its proximal end was sutured to mono–branched vascular prosthesis. Follow-up computed tomography angiography showed false lumen of the dissection disappeared with satisfactory position of the triple-branched stent graft. PMID:23587108

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

    PubMed

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

    2013-07-01

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

  12. Right coronary artery dissection and aneurysm presented as acute inferior myocardial infarction from an automobile airbag trauma.

    PubMed

    Zeng, Chunlai; Hu, Wuming; Zhu, Ning; Zhao, Xuyong; Xu, Jian; Ye, Shiyong; Xiang, Yijia; Lv, Linchun

    2015-10-01

    Coronary artery dissection and aneurysm culminating in acute myocardial infarction are rare after blunt chest trauma. We are reporting a case of a previously healthy 52-year-old man who presented with right inferior lobe contusion, pleural effusion, right interlobar fissure effusion, bone fracture of right fourth rib, and acute inferior wall myocardial infarction and who experienced blunt trauma in his right chest wall by an airbag deployment in a car accident. Coronary angiography showed an aneurysm in the middle of right coronary artery with 70% afferent narrowing just distal to the aneurysm with no visible atherosclerotic lesion. A 4.0×20 mm TEXUS Liberté stent in the lesion was deployed, and a good coronary flow was obtained without residual stenosis and the aneurysm vanished.

  13. Gross anatomy of the arterial supply of the stomach of the North American beaver (Castor canadensis).

    PubMed

    Bisaillon, A; Bhérer, J

    1979-01-01

    The arterial pattern of the stomach of the North American beaver is studied by dissection of height specimens. The arrangement of the arteries resembles the typical mammalian pattern, although some variations are described. For example, the celiac artery gives off two large vessels, the cardiac and fundic arteries, which supply the corresponding regions of the stomach. Also, the right gastric artery originates from the gastroduodenal vessel instead of the hepatic artery.

  14. Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

    SciTech Connect

    Zelenak, Kamil; Zelenakova, Jana; DeRiggo, Julius; Kurca, Egon; Kantorova, Ema; Polacek, Hubert

    2013-08-01

    Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet-Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX-XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits.

  15. Uncomplicated moderate coronary artery dissections after balloon angioplasty: good outcome without stenting

    PubMed Central

    Albertal, M; Van Langenhove, G; Regar, E; Kay, I; Foley, D; Sianos, G; Kozuma, K; Beijsterveldt, T; Carlier, S; Belardi, J; Boersma, E; Sousa, J; de Bruyne, B; Serruys, P

    2001-01-01

    OBJECTIVE—To study the relation between moderate coronary dissections, coronary flow velocity reserve (CFVR), and long term outcome.
METHODS—523 patients undergoing balloon angioplasty and sequential intracoronary Doppler measurements were examined as part of the DEBATE II trial (Doppler endpoints balloon angioplasty trial Europe). After successful balloon angioplasty, patients were randomised to stenting or no further treatment. Dissections were graded at the core laboratory by two observers and divided into four categories: none, mild (type A-B), moderate (type C), severe (types D to F). Patients with severe dissections (n = 128) or without available reference vessel CFVR (n = 139) were excluded. The remaining 256 patients were divided into two groups according to the presence (group A, n = 45) or absence (group B, n = 211) of moderate dissection.
RESULTS—Following balloon angioplasty, there was no difference in CFVR between the two groups. At 12 months follow up, a higher rate of major adverse cardiac events was observed overall in group A than in group B (10 (22%) v 23 (11%), p = 0.041). However, the risk of major adverse events was similar in the subgroups receiving balloon angioplasty (group A, 6 (19%) v group B, 16 (16%), NS). Among group A patients, the adverse events risk was greater in those randomised to stenting (odds ratios 6.603 v 1.197, p = 0.046), whereas there was no difference in risk if the group was analysed according to whether the CFVR was < 2.5 or ⩾ 2.5 after balloon angioplasty.
CONCLUSIONS—Moderate dissections left untreated result in no increased risk of major adverse cardiac events. Additional stenting does not improve the long term outcome.


Keywords: coronary dissection; intracoronary Doppler; angioplasty PMID:11454840

  16. When life-threatening conditions appear clinically silent: an atypical presentation of spontaneous coronary artery dissection in a 60-year-old female

    PubMed Central

    Harper, Yenal; Agarwal, Manyoo; Gannamraj, Krishna; Parmar, Sneha; Hwang, Inyong; Alsafwah, Shadwan

    2016-01-01

    Spontaneous coronary artery dissection is a poorly understood phenomenon that usually affects women during pregnancy or the immediate post-partum period. We present the case of a 60-year-old female with chronic obstructive pulmonary disease who presented with vague complaints of shortness of breath, dizziness, and weakness with a mildly elevated troponin. She denied any anginal symptoms. As part of her initial workup, a nuclear stress test revealed inferior wall reversible changes. Coronary angiography revealed spontaneous right coronary artery dissection which was treated with a drug-eluting stent. PMID:27802856

  17. A case of posterior cerebral artery dissection presenting with migraine-like headache and visual field defect: usefulness of fast imaging employing steady-state acquisition (FIESTA) for diagnosis.

    PubMed

    Haraguchi, Koichi; Toyama, Kentaro; Ito, Takeo; Hasunuma, Masahiro; Sakamoto, Yasuo

    2012-11-01

    We report a 34-year-old woman with sudden onset of unilateral migraine-like headache and right homonymous hemianopsia. Fast imaging employing steady-state acquisition (FIESTA) of the posterior cerebral artery captured an intimal flap and a pseudolumen, leading to a diagnosis of posterior cerebral artery dissection. This case was considered a spontaneous posterior cerebral artery dissection causing migraine-like headache. The treatment of migraine-like headache hinges on correct diagnosis. In this case, FIESTA was very useful in diagnosing an intracranial artery dissection.

  18. Renal infarction due to spontaneous dissection of the renal artery: an unusual cause of non-visceral type abdominal pain

    PubMed Central

    Kang, James H-E; Kang, Jin-Yong; Morgan, Robert

    2013-01-01

    A 44-year-old man presented with very severe right upper quadrant pain of sudden onset. This was exacerbated by movement but unaffected by food or defaecation. It was continuous—day and night —but resolved over a 1-week period. The physical examination was normal at presentation, by which time the pain had resolved. His white cell count, alanine transaminase and C reactive protein were elevated but normalised after 10 days. An abdominal CT showed low density lesions in the right kidney consistent with segmental infarcts. CT angiogram showed a dissection of the right renal artery. The patient remained asymptomatic and normotensive when reviewed 1 month later. PMID:24049091

  19. Relief of Mesenteric Ischemia by Z-Stent Placement into the Superior Mesenteric Artery Compressed by the False Lumen of an Aortic Dissection

    SciTech Connect

    Yamakado, Koichiro; Takeda, Kan; Nomura, Yoshiyuki; Kato, Noriyuki; Hirano, Tadanori; Matsumura, Kaname; Nakagawa, Tsuyoshi; Yuasa, Hiroshi; Yada, Isao

    1998-01-15

    In a 58-year-old man acute aortic dissection compromised the origin of the superior mesenteric artery (SMA), resulting in mesenteric ischemia. After failed balloon angioplasty a Gianturco Z-stent was placed. The stenosis improved immediately, followed by resolution of the clinical signs of mesenteric ischemia. SMA flow was well preserved 1 year after stenting.

  20. Retreatment and Outcomes of Recurrent Intracranial Vertebral Artery Dissecting Aneurysms after Stent Assisted Coiling: A Single Center Experience

    PubMed Central

    Song, Ying; Wang, Yang; Li, Chuanhui; Wang, Yanmin; Mu, Shiqing; Yang, Xinjian

    2014-01-01

    Background and purpose The retreatment of recurrent intracranial vertebral artery dissecting aneurysms (VADAs) after stent assisted coiling (SAC) has not yet been studied. The purpose of this study was to evaluate the strategies and outcomes for retreatment of recurrent VADAs after SAC. Methods Between September 2009 and November 2013, six consecutive patients presenting with recurrent intracranial VADAs after SAC were enrolled in this study. They were all male with age ranging from 29 to 54 years (mean age, 46.2 years). The procedures of treatments and angiographic and clinical follow-up were reviewed retrospectively. Retreatment modalities were selected individually according to the characteristics of recurrence. The outcomes of retreatment were evaluated by angiographic and clinical follow-up. Results Six patients with recurrent intracranial VADAs after SAC were retreated, with second SAC in three patients, coil embolization, double overlapping stents placement and endovascular occlusion with aneurysm trapping in one patient, respectively. Immediate angiographic outcomes of retreatment were: complete occlusion in three patients, nearly complete occlusion in two patients, and contrast medium retention in dissecting aneurysm in one patient. All cases were technically successful. No complications related to endovascular procedures occurred. Angiographic follow-up was available in all five patients treated with second SAC or double overlapping stents, which was complete occlusion in four patients, obliteration of parent artery in one patient, showing no recurrence at 4–11 months (mean: 8.6 months). Clinical follow-up was performed in all six patients at 11–51 months after initial endovascular treatment and at 9–43 months after retreatment. The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient. Conclusions Endovascular retreatment is feasible and effective for recurrent intracranial VADAs after SAC

  1. Endovascular Treatment of Vertebral Artery Dissecting Aneurysms That Cause Subarachnoid Hemorrhage : Consideration of Therapeutic Approaches Relevant to the Angioarchitecture

    PubMed Central

    Lim, Seung Hoon; Lee, Seung Hwan; Koh, Jun Seok

    2015-01-01

    Objective Intracranial ruptured vertebral artery dissecting aneurysms (VADAns) are associated with high morbidity and mortality when left untreated due to the high likelihood of rebleeding. The present study aimed to establish an endovascular therapeutic strategy that focuses specifically on the angioarchitecture of ruptured VADAns. Methods Twenty-three patients with ruptured VADAn received endovascular treatment (EVT) over 7 years. The patient group included 14 women (60.9%) and 9 men (39.1%) between the ages of 39 and 72 years (mean age 54.2 years). Clinical data and radiologic findings were retrospectively analyzed. Results Four patients had aneurysms on the dominant vertebral artery. Fourteen (61%) aneurysms were located distal to the posterior inferior cerebellar artery (PICA). Six (26%) patients had an extracranial origin of the PICA on the ruptured VA, and 2 patients (9%) had bilateral VADAns. Eighteen patients (78%) were treated with internal coil trapping. Two patients (9%) required an adjunctive bypass procedure. Seven patients (30%) required stent-supported endovascular procedures. Two patients experienced intra-procedural rupture during EVT, one of which was associated with a focal medullary infarction. Two patients (9%) exhibited recanalization of the VADAn during follow-up, which required additional coiling. No recurrent hemorrhage was observed during the follow-up period. Conclusion EVT of ruptured VADAns based on angioarchitecture is a feasible and effective armamentarium to prevent fatal hemorrhage recurrence with an acceptable low risk of procedural complications. Clinical outcomes depend mainly on the pre-procedural clinical state of the patient. Radiologic follow-up is necessary to prevent hemorrhage recurrence after EVT. PMID:26539258

  2. Direct reperfusion of the right common carotid artery prior to cardiopulmonary bypass in patients with brain malperfusion complicated with acute aortic dissection.

    PubMed

    Okita, Yutaka; Matsumori, Masamichi; Kano, Hiroya

    2016-04-01

    The cases of 3 patients with brain malperfusion secondary to acute aortic dissection who underwent preoperative perfusion of the right common carotid artery are presented. The patients were 64, 65 and 72 years old and 2 were female. All were in a comatose or semi-comatose state with left hemiplegia. The right common carotid artery was exposed and directly cannulated, using a 12-Fr paediatric arterial cannula. The right common femoral artery was chosen for arterial drainage, using a 14-Fr double-lumen cannula. The circuit contained a small roller pump and heat exchanger coil. Target flow was set at 90 ml/min and blood temperature at 30 °C. Durations of right carotid perfusion were 120, 100 and 45 min, respectively. All underwent partial arch replacement and survived. Postoperative neurological sequelae were minimal in all cases.

  3. Spontaneous Coronary Artery Dissection/Intramural Haematoma in Young Women with ST-Elevation Myocardial Infarction: "It Is Not Always a Plaque Rupture Event".

    PubMed

    Kassimis, George; Manolis, Athanasios; Townend, Jonathan N

    2015-01-01

    Spontaneous coronary artery dissection (SCAD) is an unusual, but increasingly recognized, cause of ST-elevation myocardial infarction (STEMI), especially among younger patients without conventional risk factors for coronary artery disease (CAD). Although dissection of the coronary intima or media is a hallmark finding, hematoma formation within the vessel wall is often present. It remains unclear whether dissection or hematoma is the primary event, but both may cause luminal stenosis and occlusion. The diagnosis of SCAD is made principally with invasive coronary angiography, although adjunctive intracoronary imaging modalities may increase the diagnostic yield. In STEMI patients, the decision whether to pursue primary percutaneous coronary intervention (PCI) or appropriate conservative medical therapy is based on clinical presentation, the extent of the dissection, the critical anatomy involvement, and the amount of ischaemic myocardium at risk. In this case report, we present two cases of young women with SCAD and STEMI, successfully treated with primary PCI. We briefly illustrate the characteristic aspects of the angiographic presentation and intravascular ultrasound-guided treatment. SCAD should always be considered in young STEMI patients without conventional risk factors for CAD with primary angioplasty to be required in patients with ongoing myocardial ischemia.

  4. Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer

    PubMed Central

    Yeon, Jihee; Jung, Ye Won; Yang, Shin Seok; Kang, Byung Hun; Lee, Mina; Ko, Young Bok; Yang, Jung Bo; Lee, Ki Hwan

    2017-01-01

    Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications. PMID:28344966

  5. Radical Dissection of Greater Palatine Artery and Dynamic Reconstruction of Cleft Palate

    PubMed Central

    Gill, Nauman Ahmad; Chaudry, Ayesha; Ishaq, Irfan; Aslam, Muhammad; Shamim, Romaisa; Kafeel, Mirza Muhammad; Aazam, Muhammad; Sailer, Hermann; Ganatra, Muhammad Ashraf

    2017-01-01

    Background: Restoration of proper anatomy and physiology is an integral part of cleft palate repair. The senior author has devised a new technique of radical release of greater palatine vessels, which helps in achieving tension-free closure of palatal cleft. In addition, release and transposition of palatal muscles is performed without the use of operative microscope, resulting in improved palatal function. This technique is applicable to all types of clefts of the palate and can be performed on adult patients as well. Materials and Methods: This is a retrospective case series of cleft palate repairs performed over a period of 3 years. Single-stage repair with modified Bardach’s technique for complete cleft palate and von Langenbeck’s technique for incomplete cleft palate with radical release of greater palatine vessels and levator complex retropositioning was performed. The outcome measures were closure of palatal defect and speech production. A follow-up of at least 6 months was completed in each patient. Results: A total of 1568 patients were included in the study. Their age ranged from 9 months to 54 years. The overall fistula rate was 6.1%. Improvement of speech was observed even in adult patients. Conclusions: Radical release of greater palatine artery and levator complex transposition can dramatically improve results of cleft palate repair. This technique helps in dynamic reconstruction of cleft palate and can be effectively applied in all age groups. PMID:28280675

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

    PubMed Central

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

    2015-01-01

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

  7. Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

    PubMed Central

    Mattox, Ross; Smith, Linda W.; Kettner, Norman W.

    2014-01-01

    Objective The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache. Clinical features A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated. Intervention and outcome Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital. Conclusion This case highlights the potential for patients with vertebral artery dissection to present with nonspecific musculoskeletal complaints. Neurological symptoms may not manifest initially, but their sudden onset indicates the possibility of an ischemic cerebrovascular event. We suggest that early recognition and emergent referral for this patient avoided potential exacerbation of an evolving pre-existing condition and resulted in timely anticoagulation treatment. PMID:25685116

  8. Progressed Multivessel Spontaneous Coronary Artery Dissection That Naturally Healed in a Male Patient with Non-ST Segment Elevation Myocardial Infarction.

    PubMed

    Haraki, Tatsuo; Uemura, Ryota; Masuda, Shin-Ichiro; Lee, Takeshi

    2016-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare condition that may have a serious outcome because of acute coronary syndrome. The condition especially affects young women. We evaluated a middle-aged male patient with a non-ST segment elevation myocardial infarction caused by multivessel SCAD. The SCAD had occurred in the distal right coronary artery (RCA), the mid left anterior descending artery (LAD), and the distal LAD at the same time. His culprit lesion was in the distal RCA, but the SCAD had progressed more proximally within the RCA 12 days later with no clinical symptoms. We treated the mid LAD with implantation of a drug-eluting stent on admission and the SCAD had not progressed 12 days later. Moreover, the SCAD in the distal RCA and distal LAD healed spontaneously 12 days later. He had no recurrent attack, and all SCAD lesions of the RCA and LAD had completely healed 6 months later. Given that SCAD appears in various forms over the clinical course, a strategy of intervention needs careful consideration.

  9. [Spontaneous dissection of the anterior cerebral artery that simultaneously presented with cerebral infarction and subarachnoid hemorrhage, successfully treated with conservative management: a case report].

    PubMed

    Nanbara, Sho; Tsutsumi, Keisuke; Takahata, Hideaki; Fujimoto, Takashi; Kawahara, Ichiro; Ono, Tomonori; Toda, Keisuke; Baba, Hiroshi; Yonekura, Masahiro

    2012-07-01

    We recently encountered a rare case of anterior cerebral artery dissection (ACAD) that accompanied fresh cerebral infarction (CI) and subarachnoid hemorrhage (SAH). An initial head CT showed a thin SAH in the interhemispheric cistern and cortical sulcus of the left frontal surface. Subsequent MRI performed 10 min after head CT scan revealed a fresh infarction in the left ACA region. MR-and digital subtraction angiograms demonstrated a dissection in the A2 portion of the left ACA with a leak of contrast media around the left A3 portion, suggesting that the bleeding occurred in a distal portion of the main dilation. Without anti-thrombotic therapy, the patient recovered without complications by blood pressure control and administration of brain-function protection therapies. We found 11 cases similar to the present case in the literature. All cases presented with lower-extremity dominant hemiparesis; however, sudden onset headache was rare. Blood pressure was not well-controlled in 4 out of the 6 known hypertensive cases. Main sites of dissection were located at the A2 portion in all cases except one A3 lesion, and extended to A3 in 2 cases. Conservative therapy led to favorable outcome in 8 cases, while 4 cases underwent surgical interventions for increasing risk of aneurysm rupture after initial observational therapies. Re-bleeding did not occur in any of the 12 cases reviewed. These data suggest that conservative treatment can be considered for an initial management of ACAD with simultaneous CI and SAH. More evidence needs to be accumulated to establish the optimal therapeutic approach for ACAD associated with CI and SAH.

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

    PubMed

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

    2014-02-01

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

  11. Subclavian artery cannulation provides better myocardial protection in conventional repair of acute type A aortic dissection: experience from a single medical centre in Taiwan

    PubMed Central

    Hsu, Po-Shun; Tsai, Chien-Sung; Tsai, Yi-Ting; Lin, Chih-Yuan; Lee, Chung-Yi; Ke, Hong-Yan; Lin, Yi-Chang; Tsai, Chien-Suang; Chen, Jia-Lin

    2016-01-01

    Summary Background Although many reports have detailed the advantages and disadvantages between femoral and subclavian arterial cannulations for acute aortic dissection type A (AADA), the confounding factors caused by disease severity and surgical procedures could not be completely eliminated. We compared femoral and subclavian artery cannulation and report the results for reconstruction of only the ascending aorta. Methods From January 2003 to December 2010, 51 AADA cases involving reconstruction of only the ascending aorta were retrospectively reviewed and categorised on the basis of femoral (n = 26, 51%) or subclavian (n = 25, 49%) arterycannulation. Bentall’s procedures, arch reconstruction and hybrid operations with stent-grafts were all excluded to avoid confounding factors due to dissection severity. Surgical results, postoperative mortality, and short- and mid-term outcomes were compared between the groups. Results Subclavian cannulation had a lower incidence of cerebral and myocardial injury and lower hospital mortality than femoral cannulation (8 vs 34%, p = 0.04). Ventilation duration as well as intensive care unit (ICU) and hospital stay were also shorter with subclavian cannulation. Risk factors for hospital mortality included pre-operative respiratory failure (odds ratio: 12.84), peri-operative cardiopulmonary bypass (CPB) time > 200 minutes (odds ratio: 13.49), postoperative acidosis (pH < 7.2, odds ratio: 88.63), and troponin I > 2.0 ng/ml (odds ratio: 20.08). The overall hospital mortality rate was 21%. The 40 survivors were followed up for three years with survival of 75% at one year and 70% at three years. Conclusions Our results show that subclavian cannulation had a lower incidence of cerebral and myocardial injury as well as better postoperative recovery and lower hospital mortality rates for reconstruction of only the ascending aorta. PMID:27841900

  12. Neck dissection

    MedlinePlus

    ... There are three main types of neck dissection surgery: Radical neck dissection: All the tissue on the side of ... Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap ...

  13. [Aortic dissection].

    PubMed

    Ogino, Hitoshi

    2011-07-01

    Acute aortic dissection suddenly occurrs and results in a variety of catastrophic sequelae including cardiac tamponade, rupture, and organ malperfusion. In acute stage (< 2 weeks), according to the classifications on the region of aortic dissection, the condition of the false channel and the onset, appropriate medical, surgical, or endovascular treatments including endovascular aneurysm repair followed by the rapid and accurate diagnosis of aortic dissection using computed tomography and ultrasound should be performed without delay. In the chronic stage (> 2 weeks), the behavior of the chronic dissection or residual distal dissection after the initial treatment should be followed-up carefully with best medical treatment at the regular intervals. If necessary, appropriate surgical and endovascular treatment should be carried out in the proper timing before rupture.

  14. Does Facial Resemblance Enhance Cooperation?

    PubMed Central

    Giang, Trang; Bell, Raoul; Buchner, Axel

    2012-01-01

    Facial self-resemblance has been proposed to serve as a kinship cue that facilitates cooperation between kin. In the present study, facial resemblance was manipulated by morphing stimulus faces with the participants' own faces or control faces (resulting in self-resemblant or other-resemblant composite faces). A norming study showed that the perceived degree of kinship was higher for the participants and the self-resemblant composite faces than for actual first-degree relatives. Effects of facial self-resemblance on trust and cooperation were tested in a paradigm that has proven to be sensitive to facial trustworthiness, facial likability, and facial expression. First, participants played a cooperation game in which the composite faces were shown. Then, likability ratings were assessed. In a source memory test, participants were required to identify old and new faces, and were asked to remember whether the faces belonged to cooperators or cheaters in the cooperation game. Old-new recognition was enhanced for self-resemblant faces in comparison to other-resemblant faces. However, facial self-resemblance had no effects on the degree of cooperation in the cooperation game, on the emotional evaluation of the faces as reflected in the likability judgments, and on the expectation that a face belonged to a cooperator rather than to a cheater. Therefore, the present results are clearly inconsistent with the assumption of an evolved kin recognition module built into the human face recognition system. PMID:23094095

  15. Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review.

    PubMed

    Anichini, G; Passacantilli, E; Lenzi, J; Guidetti, G; Santoro, A

    2012-04-01

    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.

  16. Spontaneous Coronary Dissection Masquerading as Benign Fascicular Ventricular Tachycardia.

    PubMed

    Ho, Sara Wei-Fen; Lin, Weiqin; Chan, Koo Hui; Seow, Swee-Chong

    2016-01-01

    Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome. Diagnosis of coronary artery dissection is made on coronary angiogram and prompt revascularisation is the key in management. We present a case of coronary artery dissection with an atypical presentation of cardiac arrhythmia mimicking benign fascicular ventricular tachycardia. A high index of suspicion and early coronary angiogram allowed us to diagnose and treat this potentially life-threatening disease.

  17. Aortic dissection

    MedlinePlus

    ... to reduce your risk include: Treating and controlling hardening of the arteries (atherosclerosis) Keeping high blood pressure ... Blood clots Cardiac tamponade Coarctation of the aorta Hardening of the arteries High blood pressure Magnetic resonance ...

  18. Polyomino Dissections

    ERIC Educational Resources Information Center

    Hohn, Tiina; Liu, Andy

    2012-01-01

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

  19. Children's Explanations of Family Resemblances.

    ERIC Educational Resources Information Center

    Horobin, Karen D.

    Four studies investigated children's explanations for family resemblance and species-typical characteristics, under different conditions of biological parentage and rearing environment. Participating were 226 children between 3 and 11 years. Children Children were presented with a number of different tasks, some involving people and some domestic…

  20. [Dissecting emphysema].

    PubMed

    Gurtner, B

    1991-10-29

    We report six observations of pneumomediastinum, due to dental extraction and use of high speed air turbine drill, aspiration of a nut with air trapping, labor in delivery, status asthmaticus, mechanical ventilation, and rectal perforation. Some patients showed widespread extension of dissecting air presenting as subcutaneous emphysema, pneumopericardium or pneumoretroperitoneum. The mediastinum is thought to be a central pump, the diaphragm and the lung acting like bellows, which distribute interstitial air from and into communicating layers on both sides of the diaphragm. Pneumomediastinum does not prove an air leak in the thoracic cage nor does pneumoretroperitoneum absolutely indicate bowel rupture. Review of the literature.

  1. Segmental arterial mediolysis and fibromuscular dysplasia: what comes first, the chicken or the egg?

    PubMed

    Hall, E Tyler; Gibson, Blake A; Hennemeyer, Charles T; Devis, Paola; Black, Stacey; Larsen, Brandon T

    2016-01-01

    Segmental arterial mediolysis (SAM) is a rare vasculopathy characterized by lysis of the outer media in splanchnic arteries and formation of dissecting pseudoaneurysms that may spontaneously rupture, leading to massive and often fatal intraabdominal hemorrhage. The pathogenesis of SAM is poorly understood. Healed SAM lesions closely resemble fibromuscular dysplasia (FMD), leading some authors to postulate that SAM represents a precursor to FMD despite distinct clinical differences between these two disorders. Herein, we present a 61-year-old woman with fatal SAM who showed histologic features in her aorta suggesting the opposite pathogenetic relationship, with an unclassified "FMD-like" arteriopathy preceding development of SAM.

  2. Painless aortic dissection presenting as paraplegia.

    PubMed

    Colak, Necmettin; Nazli, Yunus; Alpay, Mehmet Fatih; Akkaya, Ismail Olgun; Cakir, Omer

    2012-01-01

    Acute dissection of the aorta can be life-threatening. As a presenting manifestation of aortic dissection, neurologic complications such as paraplegia are rare. Herein, we report the case of a 51-year-old man who presented with sudden-onset paraplegia and ischemia of the legs, with no chest or back pain. His medical history included coronary artery bypass grafting. Physical examination revealed pulseless lower extremities, and computed tomography showed aortic dissection from the ascending aorta to the common iliac arteries bilaterally. A lumbar catheter was inserted for cerebrospinal fluid drainage, and axillary arterial cannulation was established. With the use of cardiopulmonary bypass, the aortic dissection was corrected, and the previous coronary artery grafts were reattached. The surgery restored spinal and lower-extremity perfusion, and the patient walked unaided from the hospital upon his discharge 5 days later. Although acute aortic dissection presenting as paraplegia is rare, it should be considered in patients who have pulseless femoral arteries bilaterally and sudden-onset paraplegia, despite no pain in the chest or back. Prompt diagnosis and intervention can prevent morbidity and death.

  3. Segmental arterial mediolysis: a precursor to fibromuscular dysplasia?

    PubMed

    Slavin, R E; Saeki, K; Bhagavan, B; Maas, A E

    1995-04-01

    We describe five cases of segmental arterial mediolysis (SAM), formerly known as segmental mediolytic arteritis. SAM occurs in epicardial coronary arteries and in the abdominal splanchnic arteries. Patients with abdominal SAM are generally elderly, whereas coronary SAM presents in neonates, children, and young adults. SAM is initiated by mediolysis of the outer media, which can expand to involve the mid- and inner media. Accompanying alterations include fibrinous linear deposits at the medial adventitial junction and replacement of the lysed muscle fibers by fibrin, erythrocytes, and granulation tissue. Transmural mediolysis results in arterial wall gaps frequently complicated by dissecting hematomas and aneurysms. Abdominal hemorrhages stem from these complications. SAM involving abdominal splanchnic arteries clinically presents with abdominal pain and distension, falling hematocrit, and shock. Simultaneous involvement of more than one abdominal artery is frequent, and branches of the celiac axis are most commonly affected. Various disease states that provoke pathologic stimuli for endothelial mediated vasoconstriction occur in the immediate clinical background of patients with SAM. Certain morphologic features of SAM suggest that this arterial lesion is due to vasospasm, which we putatively ascribe to focal endothelial paracrine dysfunction. Organization of uncomplicated SAM lesions could resemble certain types of fibromuscular dysplasia, suggesting that the genesis of such arterial lesions is related to vasospasm.

  4. Arteriovenous shunts resembling patent ductus arteriosus in dogs: 3 cases.

    PubMed

    Fujii, Yoko; Aoki, Takuma; Takano, Hiroshi; Ishikawa, Ryokichi; Wakao, Yoshito

    2009-12-01

    Three dogs presented for the evaluation of cardiac murmurs were diagnosed with aberrant arteriovenous shunts. All cases demonstrated the following findings: 1) relatively soft continuous murmur loudest at the left heart base resembling patent ductus arteriosus (PDA); 2) shunt flow signals in the pulmonary artery on echocardiography; and 3) no PDA on selective angiography, but evidence of anomalous shunting vessels from thoracic aorta to pulmonary vasculature. An aberrant arteriovenous shunt should be considered when a continuous murmur of relatively small intensity is heard.

  5. Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis

    PubMed Central

    de Bray, J M; Penisson-Besnier, I; Dubas, F; Emile, J

    1997-01-01

    OBJECTIVES—To compare the diagnosis and prognosis of extracranial versus intracranial vertebral artery dissections without intracerebral haemorrhage.
METHODS—Twenty two vertebral artery dissections were defined by intra-arterial angiography and classified in two groups: group 1,nine extracranial dissections (seven patients) and group 2, 13intracranial dissections (nine patients), involving the basilar artery in five cases. Bilateral dissections were found in 38% of the population. Before angiography, all the patients had been investigated by continuous wave Doppler, colour coded Doppler, and transcranial Doppler. Mean follow up was 44months.
RESULTS—The two most important symptoms of both dissections (81% of patients) were unbearable pain preceding stroke and progressive onset of stroke within a few hours. Severe ultrasonic abnormalities were present in 94% of the patients whereas specific ultrasonic signs (segmental dilation with eccentric channel) were rare (19%) in both groups. Major strokes and brainstem strokes represented respectively 67% and 78% in intracranial versus 43% and 29% in extracranial dissections. Severe sequelae (permanent disabling motor or cerebellar deficit) were more often associated with intracranial (44%) than with extracranial dissections (14%). No recurrence of dissection and no cerebral haemorrhage were found under heparin. Significant factors of poor outcome (P< 0.05) were the initial severity of the stroke and the bilateral location of dissections.
CONCLUSION—The combination of a pain and a progressive onset of the stroke, corroborated by ultrasonic findings, could have helped to recognise most of these types of dissections. Intracranial dissections have a poorer prognosis than extracranial dissections.

 PMID:9221967

  6. [A case report of segmental arterial mediolysis].

    PubMed

    Takahashi, Yuko; Moriguchi, Masato; Suminaga, Yoshihisa; Nagashio, Chiaki; Kano, Toshikazu; Suzuki, Akitake; Kunimatsu, Jyunwa; Asao, Rin; Yamashita, Hiroyuki; Itoh, Kenji; Mimori, Akio

    2007-06-01

    We report a case of 58-year-old woman with a ruptured dissecting aneurysm of the middle colic artery (MCA). Her initial manifestation was sudden and severe right-sided abdominal pain, followed by hemorrhagic shock and acute anemia. Abdominal CT showed a right retroperitoneal hemorrhage. Emergency catheter angiography and therapeutic coil embolization of the middle colic artery were performed and micro aneurysms were enhanced in the jejunal branch. Immunological tests showed nothing abnormal. Follow-up angiography after 3 months showed that the micro aneurysms had disappeared. The patient was diagnosed as having segmental arterial mediolysis (SAM), because no definitive evidence of atherosclerosis and polyarteritis nodosa were observed. SAM is a rare disease of unknown etiology. The arterial lesions developing in elderly patients are characterized by segmental lysis of the abdominal splanchnic arteries resulting in aneurysms, and acute bleeding in a skip pattern. Multiple aneurysms and abdominal pain due to the rupture of these lesions in SAM resemble the clinical findings in polyarteritis nodosa. Differential diagnosis of the two diseases is important because steroid therapy is not beneficial for SAM.

  7. Aortic arch dissection: a controversy of classification.

    PubMed

    Lempel, Jason K; Frazier, Aletta Ann; Jeudy, Jean; Kligerman, Seth J; Schultz, Randall; Ninalowo, Hammed A; Gozansky, Elliott K; Griffith, Bartley; White, Charles S

    2014-06-01

    Aortic dissections originating in the ascending aorta and descending aorta have been classified as type A and type B dissections, respectively. However, dissections with intimal flap extension into the aortic arch between the innominate and left subclavian arteries are not accounted for adequately in the widely used Stanford classification. This gap has been the subject of controversy in the medical and surgical literature, and there is a tendency among many radiologists to categorize such arch dissections as type A lesions, thus making them an indication for surgery. However, the radiologic perspective is not supported by either standard dissection classification or current clinical management. In this special report, the origin of dissection classification and its evolution into current radiologic interpretation and surgical practice are reviewed. The cause for the widespread misconception about classification and treatment algorithms is identified. Institutional review board approval and waiver of informed consent were obtained as part of this HIPAA-compliant retrospective study to assess all aortic dissection studies performed at the University of Maryland Medical Center, Baltimore between 2010 and 2012 to determine the prevalence of arch dissections. Finally, a unified classification system that reconciles imaging interpretation and management implementation is proposed.

  8. Treatment of Vertebro-Basilar Dissecting Aneurysms Using Intravascular Stents

    PubMed Central

    Yamasaki, S.; Hashimoto, K.; Kawano, Y.; Yoshimura, M.; Yamamoto, T.; Hara, M.

    2006-01-01

    Summary Endovascular surgery is an established primary therapeutic modality for dissecting aneurysms at vertebro-basilar arteries. Intravascular stents can be used to treat the dissecting aneurysms for which simple obliteration procedures cannot be used. In such cases, stent implantation alone or a combination of stents and coils need to be selected properly by taking into consideration the site and shape of dissections. In this report, three patterns of stent application are described and their method of selection is discussed. PMID:20569619

  9. Exome Sequencing Identifies SMAD3 Mutations as a Cause of Familial Thoracic Aortic Aneurysm and Dissection with Intracranial and Other Arterial Aneurysms

    PubMed Central

    Regalado, Ellen S.; Guo, Dong-chuan; Villamizar, Carlos; Avidan, Nili; Gilchrist, Dawna; McGillivray, Barbara; Clarke, Lorne; Bernier, Francois; Santos-Cortez, Regie L.; Leal, Suzanne M.; Bertoli-Avella, Aida M.; Shendure, Jay; Rieder, Mark J.; Nickerson, Deborah A; Milewicz, Dianna M.

    2014-01-01

    Rationale Thoracic aortic aneurysms leading to acute aortic dissections (TAAD) can be inherited in families in an autosomal dominant manner. As part of the spectrum of clinical heterogeneity of familial TAAD, we recently described families with multiple members that had TAAD and intracranial aneurysms or TAAD and intracranial and abdominal aortic aneurysms inherited in an autosomal dominant manner. Objective To identify the causative mutation in a large family with autosomal dominant inheritance of TAAD with intracranial and abdominal aortic aneurysms by performing exome sequencing of two distantly related individuals with TAAD and identifying shared rare variants. Methods and Results A novel frame shift mutation, p. N218fs (c.652delA), was identified in the SMAD3 gene and segregated with the vascular diseases in this family with a LOD score of 2.52. Sequencing of 181 probands with familial TAAD identified three additional SMAD3 mutations in 4 families, p.R279K (c.836G>A), p.E239K (c.715G>A), and p.A112V (c.235C>T) resulting in a combined LOD score of 5.21. These four mutations were notably absent in 2300 control exomes. SMAD3 mutations were recently described in patients with Aneurysms Osteoarthritis Syndrome and some of the features of this syndrome were identified in individuals in our cohort, but these features were notably absent in many SMAD3 mutation carriers. Conclusions SMAD3 mutations are responsible for 2% of familial TAAD. Mutations are found in families with TAAD alone, along with families with TAAD, intracranial aneurysms, aortic and bilateral iliac aneurysms segregating in an autosomal dominant manner. PMID:21778426

  10. Dissecting Classroom Ethics.

    ERIC Educational Resources Information Center

    Allchin, Douglas

    1991-01-01

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

  11. The Problems of Dissection.

    ERIC Educational Resources Information Center

    Davis, Pat

    1997-01-01

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

  12. Non-traumatic rupture of the intracranial vertebral artery of a man found dead in a severe car accident - histopathological differentiation by step-serial sections.

    PubMed

    Ro, Ayako; Kageyama, Norimasa; Hayashi, Kino; Shigeta, Akio; Fukunaga, Tatsushige

    2008-03-01

    A 58-year-old male with untreated hypertension was found dead in his car after a traffic accident on his way to the office. Emergency head CT showed diffuse subarachnoid hemorrhage at cerebral base. On autopsy examination, traumatic injuries were seen on his face and lower extremities. The skull was not fractured and there were no brain contusions except subscalp bleeding at the frontal head. The brain weighed 1510g and showed diffuse subarachnoid hemorrhage due to a rupture of the left vertebral artery (VA). Histopathological examination using serial step sections of every 0.1mm of the whole VA revealed multiple arterial dissections (AD) with fresh and old states at bilateral VA. Previous dissections at the basilar artery and internal carotid artery were also observed. The symptoms that he reported a week before the accident, left sided headache and shoulder pains, could have come from previous dissections. We concluded that the AD occurred while driving and was the cause of death, with the car accident then being caused by the stroke. Other specific histopathological findings were medial degeneration and serrate changes of the internal elastic lamina which resembled lesion of the segmental arterial mediolysis. These would suggest a pathogenesis of intracranial AD. Differential diagnosis of subarachnoid hemorrhage from the ruptured VA, distinguishing between idiopathic AD and traumatic trilaminar rupture, is still a difficult matter in forensic autopsy. However, this serial step sections procedure could be useful for the morphological differentiation.

  13. Segmental arterial mediolysis of varying phases affecting both the intra-abdominal and intracranial vertebral arteries: an autopsy case report.

    PubMed

    Ro, Ayako; Kageyama, Norimasa; Takatsu, Akihiro; Fukunaga, Tatsushige

    2010-01-01

    We report an autopsy case of segmental arterial mediolysis (SAM) of various phases occurring in both the intracranial vertebral artery (IVA) and intra-abdominal arteries. The patient was a 70-year-old male found dead in his house. The cause of death was massive intra-abdominal hemorrhage owing to a ruptured right gastroepiploic artery. Histopathological examination revealed that there was a broad arterial dissection as long as 20 cm in the right gastroepiploic artery associated with SAM in the injurious phase. In addition, SAM in the reparative phase was observed as organized arterial dissections in the left gastric artery. Furthermore, SAM in the reparative phase was detected as an arterial dissection in the right IVA undergoing an organizing process. These three lesions were considered to have developed at different times. SAM occurring in both the intra-abdominal and intracranial vertebral arteries is extremely rare. This coincidence may provide a clue to the relationship between SAM and spontaneous IVA dissection.

  14. Laparoscopic dissecting instruments.

    PubMed

    Park, A E; Mastrangelo, M J; Gandsas, A; Chu, U; Quick, N E

    2001-03-01

    The authors provide an overview of laparoscopic dissecting instruments and discuss early development, surgical options, and special features. End effectors of different shapes and functions are described. A comparison of available energy sources for laparoscopic instruments includes discussion of thermal dissection, ultrasonic dissection, and water-jet dissection. The ergonomic risks and challenges inherent in the use of current laparoscopic instruments are outlined, as well as ergonomic issues for the design of future instruments. New directions that laparoscopic instrumentation may take are considered in connection with developing technology in robotics, haptic feedback, and MicroElectroMechanical Systems.

  15. Hemodynamic Impact of a Spontaneous Cervical Dissection on an Ipsilateral Saccular Aneurysm

    PubMed Central

    See, Alfred P.; Penn, David L.; Du, Rose; Frerichs, Kai U

    2016-01-01

    The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach. PMID:27790401

  16. Spontaneous vertebral dissection: Clinical, conventional angiographic, CT, and MR findings

    SciTech Connect

    Provenzale, J.M.; Morgenlander, J.C.; Gress, D.

    1996-03-01

    The purpose of this study was to determine if typical clinical and neuroradiologic patterns exist in patients with spontaneous vertebral artery (VA) dissection. The medical records and neuroradiologic examinations of 14 patients with spontaneous VA dissection were reviewed. The medical records were examined to exclude patients with a history of trauma and to record evidence of a nontratimatic precipitating event ({open_quotes}trivial trauma{close_quotes}) and presence of possible risk factors such as hypertension. All patients under-went conventional angiography, 13 either CT or MRI (II both CT and MRI), and 3 MRA. Conventional arteriograrris were evaluated for dissection site, evidence of fibromuscular dysplasia, luminal stenosis or occlusion, and pseudoaneurysm formation, CT examinations for the presence of infarction or subarachnoid hemorrhage, MR examinations for the presence of infarction or arterial signal abnormality, and MR angiograms for abnormality of the arterial signal column. Seven patients had precipitating events within 24 h of onset of symptoms that may have been causative of dissection and five had hypertension. At catheter angiography, two patients had dissections in two arteries (both VAs in one patient, VA and internal carotid artery in one patient), giving a total of 15 VAs with dissection. Dissection sites included V1 in four patients, V2 in one patient, V3 in three patients, V4 in six patients, and both V3 and V4 in one patient. Luminal stenosis was present in 13 VAs, occlusion in 2, pseudoaneurysm in 1, and evidence of fibromuscular dysplasia in 1. Posterior circulation infarcts were found on CT or MR in five patients. Subarachnoid hemorrhage was found on CT in two patients and by lumbar puncture alone in two patients. Abnormal periarterial signal on MRI was seen in three patients. MRA demonstrated absent VA signal in one patient, pseudoaneurysm in one, and a false-negative examination in one.

  17. Visceral ischemia: could it be segmental arterial mediolysis.

    PubMed

    Agarwal, Sunil; Stephen, Edwin; Selvaraj, Dheepak; Mathur, Kapil; Keshava, Shyamkumar; Chandy, Sunil Thomas

    2009-01-01

    We present two cases of segmental arterial mediolysis, which can present with dissecting aneurysms or thrombosis of the visceral branches of the abdominal aorta. Segmental arterial mediolysis (SAM) causes ischemic bowel disease and has characteristic CT and angiographic features.

  18. GPM Dissects Typhoon Hagupit

    NASA Video Gallery

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

  19. Growing Evidence about the Relationship between Vessel Dissection and Scuba Diving.

    PubMed

    Brajkovic, Simona; Riboldi, Giulietta; Govoni, Alessandra; Corti, Stefania; Bresolin, Nereo; Comi, Giacomo Pietro

    2013-01-01

    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.

  20. Ruptured pseudoaneurysm of the pulmonary artery--rare manifestation of a primary pulmonary artery sarcoma.

    PubMed

    Koch, Achim; Mechtersheimer, Gunhild; Tochtermann, Ursula; Karck, Matthias

    2010-01-01

    A 64-year-old male developed chest pain while gardening. Aortic dissection and coronary artery disease were excluded but chest computed tomography (CT) scan showed an aneurysmic enlargement of the pulmonary artery and a fluttering structure within. He underwent immediate sternotomy for replacement of the pulmonary artery. Histology showed an intimal sarcoma of both branches of the pulmonary artery. The pulmonary artery was replaced by a T-shaped Gore-Tex-prosthesis.

  1. Lymphoplasmacytic aortitis and acute aortic dissection. An uncommon association.

    PubMed

    Faye-Petersen, O M; Arnold, M M; Grizzle, W E; Lie, J T

    1996-04-01

    A 43-year-old white man with a history of cigarette smoking, hypertension, nephrolithiasis, and cervical degenerative arthritis was hospitalized for sudden-onset severe, substernal, and pleuritic chest pain with epigastric radiation. Despite evaluation, the cause remained unclear and the patient expired on hospital day 5. Autopsy revealed acute Stanford type A aortic dissection, hemopericardium, and hemothorax. Grossly, the aorta and its branches, including uninvolved medium-sized arteries, displayed extreme mural fragility. Microscopic examination showed a primary lymphoplasmacytic aortitis-periaortitis without giant cells. Rents within the tunica media, medial-adventitial inflammation, and elastic fiber disruption were limited to sites of gross aortic dissection. Muscular arteries showed patchy, chronic arteritis-periarteritis without giant cell infiltrate or aneurysm formation. This case documents an unusual association of primary lymphoplasmacytic aortitis and aortic dissection.

  2. Arterial anatomy of the thumb.

    PubMed

    Ames, E L; Bissonnette, M; Acland, R; Lister, G; Firrell, J

    1993-08-01

    The anatomical literature has indicated that the arterial supply to the thumb comes from the princeps pollicis artery. However, this simplified description does not often correlate with intraoperative findings. The purpose of this study was to investigate and clarify this important area of anatomy by dissection of fresh cadaver hands. 40 dissections were completed on 35 intravascularly injected and five non-injected hands. Five patterns were identified. The most common pattern showed both a superficial and deep vessel to the first web space in 54% of specimens. Dominant vessels included the superficial palmar branch of the radial artery in 8%, first palmar metacarpal artery in 18% and dorsal metacarpal artery in 8%. Only three specimens correlated with the textbook description. We conclude that the term "princeps pollicis" is actually a misnomer.

  3. Dissection of the interventricular septum

    PubMed Central

    Gu, Xiaoyan; He, Yihua; Luan, Shurong; Zhao, Ying; Sun, Lin; Zhang, Hongjia; Nixon, J.V. Ian

    2017-01-01

    Abstract Dissection of the interventricular septum (IVS) is an extremely rare entity. An institutional echocardiographic database was retrospectively reviewed; 13 patients with a diagnosis of IVS dissection were found and confirmed by cardiac surgery. The purposes of the study were: to determine the value of transthoracic echocardiography (TTE) in establishing the diagnosis of IVS dissection, and to detail the TTE features of IVS dissection. Thirteen patients with IVS dissection diagnosed by TTE, 8 males and 5 females were taken from 789,114 TTE studies performed between 1985 and 2014. All underwent cardiac surgery during which their diagnosis was confirmed. The etiology, location, 2-dimensional morphology, and color Doppler findings of IVS dissection were noted. The right sinus of Valsalva (SOV) was involved in 11 of the 13 patients. In 5 patients, a single aneurysm of the right SOV was seen dissecting into the IVS. One patient with a combination of a bicuspid aortic valve and a right SOV aneurysm dissected into the IVS. In 4 patients, aortic valve infective endocarditis resulted in IVS dissection. In 1 patient, mechanical aortic valve prosthetic replacement was complicated by annular detachment and a severe paravalvular leak causing IVS dissection. In all 11 patients, TTE showed a dissecting cystic-like mass in the IVS from the base to the mid-septum or confined to the septal base. The path of the dissection in these 11 patients was traced to the right SOV and communications between the IVS dissection and the aortic root were identified. In the remaining 2 patients, IVS dissection followed septal rupture due to a myocardial infarction, and communication was seen between the IVS dissection and the right ventricle. The study showed that most of the dissections of the IVS commence in the right SOV, due to either congenital anomalies or infective endocarditis, or following aortic valve replacement or myocardial infarction. The TTE characteristic of IVS dissection is

  4. Gait analysis in a mouse model resembling Leigh disease.

    PubMed

    de Haas, Ria; Russel, Frans G; Smeitink, Jan A

    2016-01-01

    Leigh disease (LD) is one of the clinical phenotypes of mitochondrial OXPHOS disorders and also known as sub-acute necrotizing encephalomyelopathy. The disease has an incidence of 1 in 77,000 live births. Symptoms typically begin early in life and prognosis for LD patients is poor. Currently, no clinically effective treatments are available. Suitable animal and cellular models are necessary for the understanding of the neuropathology and the development of successful new therapeutic strategies. In this study we used the Ndufs4 knockout (Ndufs4(-/-)) mouse, a model of mitochondrial complex I deficiency. Ndusf4(-/-) mice exhibit progressive neurodegeneration, which closely resemble the human LD phenotype. When dissecting behavioral abnormalities in animal models it is of great importance to apply translational tools that are clinically relevant. To distinguish gait abnormalities in patients, simple walking tests can be assessed, but in animals this is not easy. This study is the first to demonstrate automated CatWalk gait analysis in the Ndufs4(-/-) mouse model. Marked differences were noted between Ndufs4(-/-) and control mice in dynamic, static, coordination and support parameters. Variation of walking speed was significantly increased in Ndufs4(-/-) mice, suggesting hampered and uncoordinated gait. Furthermore, decreased regularity index, increased base of support and changes in support were noted in the Ndufs4(-/-) mice. Here, we report the ability of the CatWalk system to sensitively assess gait abnormalities in Ndufs4(-/-) mice. This objective gait analysis can be of great value for intervention and drug efficacy studies in animal models for mitochondrial disease.

  5. Dissecting Diversity Part II

    ERIC Educational Resources Information Center

    Matthews, Frank

    2005-01-01

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

  6. Alternatives To Dissection. Second Edition.

    ERIC Educational Resources Information Center

    DeRosa, Bill, Ed.; Winiarskyj, Lesia, Ed.

    This packet attempts to provide educationally sound alternatives to dissection in the classroom, thereby making it possible for teachers to eliminate dissection from the curriculum. This packet can also be used by educators who include dissection in their curricula but consider it important to respect the expression of students' ethical, moral, or…

  7. Postpartum Stanford Type A Aortic Dissection: A Case Report and Review of the Literature

    PubMed Central

    Balbay, Esra; Basci, Semih; Bozkurt, Irem; Ozkok, Abdullah; Dogruyol, Sinem; Sirkeci, Emel Erkus; Oguz, Aytekin

    2013-01-01

    Acute aortic dissection is a life-threatening disease. Approximately half of the aortic dissection observed in women under 45 years old has been reported to be related to pregnancy. Herein, we present a case of type A aortic dissection diagnosed in postpartum period. A 37-year-old woman admitted to the emergency department with the complaint of sudden onset of dyspnea. Arterial blood pressure was measured as 170/100 mmHg in left arm and 90/60 mmHg in right arm. With a prediagnosis of aortic dissection, thoracic and abdominal computed tomograpy was performed and type A aortic dissection extending form carotid artery to renal arterial level was detected. Operation of aortic dissection together with coronary arterial repairment and aortic valve replacement were successfully performed. Aortic dissection is not uncommon in pregnancy and furthermore it is potentially life-threatening for both mother and fetus. A high level of suspicion is required for prompt diagnosis and treatment in the peripartum period.

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

    PubMed Central

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

    2002-01-01

    Although not common, acute leg ischemia is an important element in the clinical presentation of a patient with aortic dissection. This report describes a case of aortic dissection in which the main feature at presentation was acute right leg ischemia. The angiography showed right common iliac artery and external iliac artery occlusion. Diagnosis was made by clinical evaluation and angiography. Embolectomy was then attempted immediately but failed. Aortic dissection was highly suspected and confirmed by emergency computed tomography. Fortunately, the patient had good recovery. Aortic dissection is potentially lethal if misdiagnosed or if recognition is delayed. As such, aortic dissection should be considered in the differential diagnosis. Images Figure 1 Figure 2 PMID:12784971

  9. Arterial Abnormalities Leading to Tinnitus.

    PubMed

    Miller, Timothy R; Serulle, Yafell; Gandhi, Dheeraj

    2016-05-01

    Tinnitus is a common symptom that usually originates in the middle ear. Vascular causes of pulsatile tinnitus are categorized by the location of the source of the noise within the cerebral-cervical vasculature: arterial, arteriovenous, and venous. Arterial stenosis secondary to atherosclerotic disease or dissection, arterial anatomic variants at the skull base, and vascular skull base tumors are some of the more common causes of arterial and arteriovenous pulsatile tinnitus. Noninvasive imaging is indicated to evaluate for possible causes of pulsatile tinnitus, and should be followed by catheter angiography if there is a strong clinical suspicion for a dural arteriovenous fistula.

  10. Body elimination attitude family resemblance in Kuwait.

    PubMed

    Al-Fayez, Ghenaim; Awadalla, Abdelwahid; Arikawa, Hiroko; Templer, Donald I; Hutton, Shane

    2009-12-01

    The purpose of the present study was to determine the family resemblance of attitude toward body elimination in Kuwaiti participants. This study was conceptualized in the context of the theories of moral development, importance of cleanliness in the Muslim religion, cross-cultural differences in personal hygiene practices, previous research reporting an association between family attitudes and body elimination attitude, and health implications. The 24-item Likert-type format Body Elimination Attitude Scale-Revised was administered to 277 Kuwaiti high school students and 437 of their parents. Females scored higher, indicating greater disgust, than the males. Moreover, sons' body elimination attitude correlated more strongly with fathers' attitude (r = .85) than with that of the mothers (r = .64). Daughters' attitude was similarly associated with the fathers' (r = .89) and the mothers' attitude (r = .86). The high correlations were discussed within the context of Kuwait having a collectivistic culture with authoritarian parenting style. The higher adolescent correlations, and in particular the boys' correlation with fathers than with mothers, was explained in terms of the more dominant role of the Muslim father in the family. Public health and future research implications were suggested. A theoretical formulation was advanced in which "ideal" body elimination attitude is relative rather than absolute, and is a function of one's life circumstances, one's occupation, one's culture and subculture, and the society that one lives in.

  11. Repair of type A dissection-benefits of dissection rota

    PubMed Central

    Bashir, Mohamad; Shaw, Matthew; Field, Mark; Kuduvalli, Manoj; Harrington, Deborah; Fok, Mathew

    2016-01-01

    Background Acute type A aortic dissection repair is a surgical emergency associated with high mortality. In 2007, Liverpool Heart & Chest Hospital was the first institution in the United Kingdom to implement a thoracic aortic on-call dissection rota. We set out to investigate whether the dissection rota improved hospital quality outcomes and long-term survival. Methods Data from a prospectively collected database was analysed following case note validation. Two hundred patients underwent acute type A aortic dissection repair between October 1998 and November 2015. To assess the effect of the post-dissection rota on operative and postoperative outcomes, propensity matching of pre- and post-dissection rota patients was used. Results Eighty patients were identified from the pre-dissection rota era and 120 from the post-dissection rota era. Sixty patients from each era were then propensity matched. Comparative analyses showed that patients who underwent acute type A dissection repair in the post-dissection rota period were less likely to suffer in-hospital mortality in both the matched and unmatched groups (30% vs. 13.3%; P=0.004 and 28.3% vs. 11.7%; P=0.055, respectively). A similar improvement was shown in acute renal failure (26.3% vs. 14.2%; P=0.033 and 31.7% vs. 15.0%; P=0.044, respectively). However, cardiopulmonary bypass times and aortic cross clamp times were still significantly longer in the matched post–dissection rota cohort. There was a significant improvement in 5-year survival for the pre- and post-dissection rota in both the matched and unmatched patients (P=0.004 and P=0.034). Conclusions Reorganization of surgical expertise, activity and implementation of a dissection rota within our hospital have resulted in lower in-hospital mortality and better survival outcomes in this group of patients. PMID:27386408

  12. Segmental arterial mediolysis.

    PubMed

    Chao, Christine P

    2009-09-01

    Segmental arterial mediolysis (SAM) is a nonatherosclerotic, noninflammatory arteriopathy, which is characterized by dissecting aneurysms resulting from lysis of the outer media of the arterial wall. The most common presentation is abdominal pain and hemorrhage in the elderly. Computed tomography (CT) and angiography imaging findings overlap with various vasculitides and include segmental changes of aneurysm and stenosis. A key distinguishing feature is the presence of dissections, the principle morphologic expression of SAM. Differentiation and exclusion of an inflammatory arteritis is crucial in appropriate management, as immunosuppressants generally used for treatment of vasculitis may be ineffective or even worsen the vasculopathy. Although the disease can be self-limiting without treatment or with conservative medical therapy, the acute process carries a 50% mortality rate and may necessitate urgent surgical and/or endovascular therapy. Prompt recognition and diagnosis are therefore of utmost importance in appropriate management of this rare entity.

  13. Extensive Iatrogenic Aortic Dissection During Renal Angioplasty: Successful Treatment with a Covered Stent-Graft

    SciTech Connect

    Rasmus, M.; Huegli, R.; Jacob, A.L.; Aschwanden, M.; Bilecen, D.

    2007-06-15

    An extensive iatrogenic aortic type B dissection during percutaneous transluminal renal angioplasty (PTRA) for bilateral renal artery stenosis was treated with a covered stent placed in the right renal artery. Control angiography confirmed closure of the entry. Postprocedural CT demonstrated a thick intramural hematoma (IMH) up to the left subclavian artery. CT follow-up at 8 months showed an almost complete resorption of the IMH. While medical treatment is the standard therapy for type B dissections, closure of the intimal tear with a covered stent may be an additional option in extensive cases during PTRA.

  14. SURGICAL EMBOLECTOMY FOR FOVEA-THREATENING ACUTE RETINAL ARTERY OCCLUSION

    PubMed Central

    Almeida, David R.P.; Mammo, Zaid; Chin, Eric K.

    2016-01-01

    Purpose: To describe a technique of surgical intraocular embolectomy in patients with acute fovea-threatening branch retinal artery occlusion. Methods: Pars plana vitrectomy with embolectomy involving embolus isolation, dissection, and removal in patients with an acute fovea-threatening arterial occlusion without a patent cilioretinal artery. Results: The surgical technique involves a core vitrectomy. The blocked artery is incised using a microvitreoretinal blade, and microsurgical forceps are used to retrieve the embolus. No significant complications were noted. The study technique offers an excellent safety profile and minimizes the risk of vitreous hemorrhage by carefully dissecting the vascular adventitial sheath and isolating the embolus. Conclusion: Surgical embolectomy is a viable technique for patients with acute fovea-threatening arterial occlusions without patent cilioretinal artery. Careful dissection and retrieval of the embolus minimizes the risk of vitreous hemorrhage, which is an important improvement in previous techniques for management of acute retinal arterial occlusions. PMID:26674278

  15. Acute aortic dissections with pregnancy in women with ACTA2 mutations.

    PubMed

    Regalado, Ellen S; Guo, Dong-chuan; Estrera, Anthony L; Buja, L Maximilian; Milewicz, Dianna M

    2014-01-01

    Mutations in ACTA2 predispose to thoracic aortic aneurysms and dissection as well as coronary artery and cerebrovascular disease. Here we examined the risk of aortic dissections, stroke and myocardial infarct with pregnancy in women with ACTA2 mutations. Of the 53 women who had a total of 137 pregnancies, eight had aortic dissections in the third trimester or the postpartum period (6% of pregnancies). One woman also had a myocardial infarct that occurred during pregnancy that was independent of her aortic dissection. Compared to the population-based frequency of peripartum aortic dissections of 0.6%, the rate of peripartum aortic dissections in women with ACTA2 mutations is much higher (8 out of 39; 20%). Six of these dissections initiated in the ascending aorta (Stanford type A), three were fatal. Three women had ascending aortic dissections at diameters less that 5.0 cm (range 3.8-4.7 cm). Aortic pathology showed mild to moderate medial degeneration of the aorta in three women. Of note, five of the women had hypertension either during or before the pregnancy. In summary, the majority of women with ACTA2 mutations did not have aortic or other vascular complications with pregnancy. However, these findings show that pregnancy is associated with significant risk for aortic dissection in women with ACTA2 mutations. Women with ACTA2 mutations who are planning to get pregnant should be counseled about this risk of aortic dissection, and proper clinical management should be initiated to reduce this risk.

  16. A Case of Acute Aortic Dissection Type B Associated with Cushing's Syndrome

    PubMed Central

    Petramala, Luigi; Cotesta, Dario; Sapienza, Paolo; Zinnamosca, Laura; Moroni, Enrico; di Marzio, Luca; De Toma, Giorgio; Letizia, Claudio

    2009-01-01

    We report a case of a 63-year-old man, with a previous history of hypertension and glucose intolerance associated troncular obesity that was emergently admitted to our Institution for evaluation of a severe, constant posterior chest pain which radiated anteriorly and dyspnoea with a suspected diagnosis of acute aortic dissection. A CT scan of thorax and abdomen demonstrated a dissection starting just below left succlavian artery and extending downward to the left renal artery, involving the celiac tripod and superior mesenteric artery. The dissection was classified as Stanford B, De Bakey III. Moreover, CT scan of abdomen revealed incidentally a left adrenal tumor of 25 mm of diameter. An emergent prosthetic graft was placed just below the origin of the left succlavian artery up-to the diaphragmatic hiatus. Furthermore, a diagnostic evaluation of the mass revealed an increase of cortisol production, and a diagnosis of Cushing's syndrome was done and the patient underwent an adrenalectomy via laparotomic approach. We report an association of acute aortic dissection of acute aortic dissection type B associated to Cushing's syndrome. Keywords Cushing's syndrome; Adrenocortical adenoma; Aortic dissection type B PMID:22505966

  17. Popliteal lymph node dissection.

    PubMed

    Sholar, Alina; Martin, Robert C G; McMasters, Kelly M

    2005-02-01

    Most sentinel nodes are located in the cervical, axillary, and inguinal nodal basins. Sometimes, however, sentinel nodes exist outside these traditional nodal basins. Popliteal nodal metastasis is relatively uncommon, and popliteal lymph node dissection is infrequently necessary. However, with lymphoscintigraphic identification of popliteal sentinel nodes, surgeons are more frequently called on to address the popliteal nodal basin. Therefore, knowledge of the anatomy and surgical technique for popliteal lymphadenectomy is essential. This case study illustrates the importance of considering the approach to the popliteal lymph node basin for patients with melanoma.

  18. Coronary Artery Manifestations of Fibromuscular Dysplasia

    PubMed Central

    Michelis, Katherine C.; Olin, Jeffrey W.; Kadian-Dodov, Daniella; d’Escamard, Valentina; Kovacic, Jason C.

    2015-01-01

    Fibromuscular dysplasia (FMD) involving the coronary arteries is an uncommon but important condition that can present as acute coronary syndrome, left ventricular dysfunction, or potentially sudden cardiac death. Although the classic angiographic “string of beads” that may be observed in renal artery FMD does not occur in coronary arteries, potential manifestations include spontaneous coronary artery dissection, distal tapering or long, smooth narrowing that may represent dissection, intramural hematoma, spasm, or tortuosity. Importantly, FMD must be identified in at least one other noncoronary arterial territory to attribute any coronary findings to FMD. Although there is limited evidence to guide treatment, many lesions heal spontaneously; thus, a conservative approach is generally preferred. The etiology is poorly understood, but there are ongoing efforts to better characterize FMD and define its genetic and molecular basis. This report reviews the clinical course of FMD involving the coronary arteries and provides guidance for diagnosis and treatment strategies. PMID:25190240

  19. Coronary artery manifestations of fibromuscular dysplasia.

    PubMed

    Michelis, Katherine C; Olin, Jeffrey W; Kadian-Dodov, Daniella; d'Escamard, Valentina; Kovacic, Jason C

    2014-09-09

    Fibromuscular dysplasia (FMD) involving the coronary arteries is an uncommon but important condition that can present as acute coronary syndrome, left ventricular dysfunction, or potentially sudden cardiac death. Although the classic angiographic "string of beads" that may be observed in renal artery FMD does not occur in coronary arteries, potential manifestations include spontaneous coronary artery dissection, distal tapering or long, smooth narrowing that may represent dissection, intramural hematoma, spasm, or tortuosity. Importantly, FMD must be identified in at least one other noncoronary arterial territory to attribute any coronary findings to FMD. Although there is limited evidence to guide treatment, many lesions heal spontaneously; thus, a conservative approach is generally preferred. The etiology is poorly understood, but there are ongoing efforts to better characterize FMD and define its genetic and molecular basis. This report reviews the clinical course of FMD involving the coronary arteries and provides guidance for diagnosis and treatment strategies.

  20. Ventricular Tachycardia and Resembling Acute Coronary Syndrome During Pheochromocytoma Crisis

    PubMed Central

    Li, Shi-jun; Wang, Tao; Wang, Lin; Pang, Zhan-qi; Ma, Ben; Li, Ya-wen; Yang, Jian; Dong, He

    2016-01-01

    Abstract Pheochromocytomas are neuroendocrine tumors, and its cardiac involvement may include transient myocardial dysfunction, acute coronary syndrome (ACS), and even ventricular arrhythmias. A patient was referred for evaluation of stuttering chest pain, and his electrocardiogram showed T-wave inversion over leads V1 to V4. Coronary angiography showed 90% stenosis in the mid-left anterior descending coronary artery (LAD), which was stented. Five days later, the patient had ventricular tachycardia, and severe hypertension, remarkable blood pressure fluctuation between 224/76 and 70/50 mm Hg. The patient felt abdominal pain and his abdominal ultrasound showed suspicious right adrenal gland tumor. Enhanced computed tomography of adrenal gland conformed that there was a tumor in right adrenal gland accompanied by an upset level of aldosterone. The tumor was removed by laparoscope, and the pathological examination showed pheochromocytoma. After the surgery, the blood pressure turned normal gradually. There was no T-wave inversion in lead V1-V4. Our case illustrates a rare pheochromocytoma presentation with a VT and resembling ACS. In our case, the serious stenosis in the mid of LAD could be explained by worsen the clinical course of myocardial ischemia or severe coronary vasospasm by the excessive amounts of catecholamines released from the tumor. Coronary vasospasm was possible because he had no classic coronary risk factors (e.g. family history and smoking habit, essential hypertension, hyperglycemia and abnormal serum lipoprotein, high body mass index). Thus, pheochromocytoma was missed until he revealed the association of his symptoms with abdominalgia. As phaeochromocytomas that present with cardiovascular complications can be fatal, it is necessary to screen for the disease when patients present with symptoms indicating catecholamine excess. PMID:27057898

  1. Neurovascular Bundle Decompression without Excessive Dissection for Tarsal Tunnel Syndrome

    PubMed Central

    KIM, Kyongsong; ISU, Toyohiko; MORIMOTO, Daijiro; SASAMORI, Toru; SUGAWARA, Atsushi; CHIBA, Yasuhiro; ISOBE, Masahiro; KOBAYASHI, Shiro; MORITA, Akio

    2014-01-01

    Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. In self-assessments, 47 patients (68%) reported the treatment outcome as satisfactory, 15 (22%) as acceptable, and 7 (10%) were dissatisfied. Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. Our method is simple, safe, and without detailed nerve dissection and it prevents postoperative adhesion. PMID:25367582

  2. Neurovascular bundle decompression without excessive dissection for tarsal tunnel syndrome.

    PubMed

    Kim, Kyongsong; Isu, Toyohiko; Morimoto, Daijiro; Sasamori, Toru; Sugawara, Atsushi; Chiba, Yasuhiro; Isobe, Masahiro; Kobayashi, Shiro; Morita, Akio

    2014-01-01

    Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. In self-assessments, 47 patients (68%) reported the treatment outcome as satisfactory, 15 (22%) as acceptable, and 7 (10%) were dissatisfied. Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. Our method is simple, safe, and without detailed nerve dissection and it prevents postoperative adhesion.

  3. [Anatomy of the pancreatic nerve plexuses and significance of their dissection].

    PubMed

    Kimura, Wataru; Watanabe, Toshihiro

    2011-05-01

    Although various therapeutic modalities for carcinoma of the pancreas are available, curative resection is the most important. Thus, the aim of surgery for carcinoma of the pancreas is local complete resection of the carcinoma. All of the important pancreaticoduodenal arcades of arteries, veins, and nerves are situated on the fusion fascia of Treits. The pancreatic parenchyma, extrapancreatic nerve plexuses, superior mesenteric artery (SMA), and portal vein are also covered within the fusion fascia and exist in the same area. Carcinoma of the head of the pancreas invades through the pancreatic parenchyma, following the arteries, veins, and especially nerves between the parenchyma and fusion fascia, and then spreads horizontally toward the SMA or celiac axis. The entire dissected end of the nerve plexus should be investigated during surgery using frozen specimens and confirmed to be negative for cancer. If the dissected end is positive for cancer, additional resection of the nerve plexus should be performed to achieve curative resection. It is not possible to investigate thoroughly whether the dissected end of the nerve plexus is positive or negative for carcinoma after surgery, since the end may be long and some specimens may be deformed by formalin fixation; thus it is difficult to identify the true surgically dissected end. The pancreaticoduodenal artery arises from the left side of the SMA and divides into two arteries: jejunal artery 1; and the inferior pancreaticoduodenal artery (IPDA), which runs behind and transversely to the right of both the anterior and posterior IPDA. A common origin of the anterior and posterior IPDA is found in 80% of cases. The postoperative course of patients with pancreatic head carcinoma with invasion of the perineural plexuses immediately behind the SMA is not as good as in that of patients without cancerous invasion, even if additional resection is performed so that the dissected end is confirmed to be negative during surgery

  4. Modeling plaque fissuring and dissection during balloon angioplasty intervention.

    PubMed

    Gasser, T Christian; Holzapfel, Gerhard A

    2007-05-01

    Balloon angioplasty intervention is traumatic to arterial tissue. Fracture mechanisms such as plaque fissuring and/or dissection occur and constitute major contributions to the lumen enlargement. However, these types of mechanically-based traumatization of arterial tissue are also contributing factors to both acute procedural complications and chronic restenosis of the treatment site. We propose physical and finite element models, which are generally useable to trace fissuring and/or dissection in atherosclerotic plaques during balloon angioplasty interventions. The arterial wall is described as an anisotropic, heterogeneous, highly deformable, nearly incompressible body, whereas tissue failure is captured by a strong discontinuity kinematics and a novel cohesive zone model. The numerical implementation is based on the partition of unity finite element method and the interface element method. The later is used to link together meshes of the different tissue components. The balloon angioplasty-based failure mechanisms are numerically studied in 3D by means of an atherosclerotic-prone human external iliac artery, with a type V lesion. Image-based 3D geometry is generated and tissue-specific material properties are considered. Numerical results show that in a primary phase the plaque fissures at both shoulders of the fibrous cap and stops at the lamina elastica interna. In a secondary phase, local dissections between the intima and the media develop at the fibrous cap location with the smallest thickness. The predicted results indicate that plaque fissuring and dissection cause localized mechanical trauma, but prevent the main portion of the stenosis from high stress, and hence from continuous tissue damage.

  5. Ventricular Septal Dissection Complicating Inferior Wall Myocardial Infarction

    PubMed Central

    Kalvin, Lindsey; Yousefzai, Rayan; Khandheria, Bijoy K.; Paterick, Timothy E.

    2017-01-01

    Postmyocardial infarction ventricular septal defect is an increasingly rare mechanical complication of acute myocardial infarction. We present a case of acute myocardial infarction from right coronary artery occlusion that developed hypotension and systolic murmur 12 hours after successful percutaneous coronary intervention. Although preoperative imaging suggested a large ventricular septal defect and a pseudoaneurysm, intraoperative findings concluded a serpiginous dissection of the ventricular septum. The imaging technicalities are discussed.

  6. "Dissection" of a Hair Dryer

    ERIC Educational Resources Information Center

    Eisenstein, Stan; Simpson, Jeff

    2008-01-01

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

  7. [Stent Grafting for Aortic Dissection].

    PubMed

    Uchida, Naomichi

    2016-07-01

    The purpose of stent graft for aortic dissection is to terminate antegrade blood flow into the false lumen through primary entry. Early intervention for primary entry makes excellent aortic remodeling and emergent stent grafting for complicated acute type B aortic dissection is supported as a class I. On the other hand stent grafting for chronic aortic dissection is controversial. Early stent grafting is considered with in 6 months after on-set if the diameter of the descending aorta is more than 40 mm. Additional interventions for residual false lumen on the downstream aorta are still required. Stent graft for re-entry, candy-plug technique, and double stenting, other effective re-interventions were reported. Best treatment on the basis of each anatomical and physical characteristics should be selected in each institution. Frozen elephant trunk is alternative procedure for aortic dissection without the need to take account of proximal anatomical limitation and effective for acute type A aortic dissection.

  8. Coronary Arteries

    MedlinePlus

    ... and animations for grades K-6. The Coronary Arteries Coronary Circulation The heart muscle, like every other ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...

  9. Multidetector CT of hepatic artery pathologies.

    PubMed

    Karaosmanoglu, D; Erol, B; Karcaaltincaba, M

    2012-01-01

    The hepatic artery can be involved by a variety of pathology and diseases.Today MDCT enables high quality imaging of the hepatic artery using axial, MIP and volume rendered images. We illustrate MDCT findings of anatomical variations, aneurysm, dilatation, dissection, arteriovenous fistula, thrombosis and stenosis. Aneurysms can be saccular, fusiform and multiple and may develop due to atherosclerosis, vasculitis, trauma and biopsy. Dilatation of hepatic artery can be seen in portal hypertension, Osler-Weber-Rendu disease and hemangiomatosis. Hepatic artery can be occluded after trauma and transplantation. Dissection develops due to atherosclerosis, Marfan and Ehler Danlos syndromes and during pregnancy. Arteriovenous fistula can be congenital and acquired. We conclude that various hepatic artery pathologies can be confidently diagnosed by MDCT.

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

    PubMed Central

    Avadhani, Sriya A.; Marmur, Jonathan D.

    2015-01-01

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

  11. Anatomic variation of the common palmar digital nerves and arteries.

    PubMed

    Tian, Dong; Fu, Maoyong

    2015-03-01

    Variations in the course and distribution of common palmar digital nerves and arteries are rare. A classic common palmar digital nerves and arteries are defined as concomitant. During routine dissection classes to undergraduate medical students we observed formation of each common palmar digital nerve divided into 2 or 3 branches and formed a ring enclosing the corresponding common palmar digital artery. Knowledge of the anatomical variations of the common palmar digital nerves and arteries is crucial for safe and successful hand surgery.

  12. Endovascular repair for abdominal aortic aneurysm followed by type B dissection.

    PubMed

    Shingaki, Masami; Kato, Masaaki; Motoki, Manabu; Kubo, Yoji; Isaji, Toshihiko; Okubo, Nobukazu

    2016-10-01

    An 86-year-old man with an abdominal aortic aneurysm was diagnosed with type B aortic dissection accompanied by a patent false lumen that started at the distal arch of the thoracic aorta and terminated at the left common iliac artery. Meticulous preoperative assessment detected 3 large intimal tears in the descending aorta, abdominal aortic aneurysm, and left common iliac artery. We performed single-stage thoracic and abdominal endovascular aneurysm repair and concomitant axillary-axillary bypass. The abdominal aortic aneurysm with type B aortic dissection was successfully treated using a single-stage endovascular stent graft, without any complications due to the careful preoperative examinations.

  13. Biomedicine: an ontological dissection.

    PubMed

    Baronov, David

    2008-01-01

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

  14. Experience with parametric binary dissection

    NASA Technical Reports Server (NTRS)

    Bokhari, Shahid H.

    1993-01-01

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

  15. Segmental arterial mediolysis.

    PubMed

    Pillai, Anil Kumar; Iqbal, Shams I; Liu, Raymond W; Rachamreddy, Niranjan; Kalva, Sanjeeva P

    2014-06-01

    Segmental arterial mediolysis (SAM) is an uncommon, nonatherosclerotic, noninflammatory, large- to medium-sized arteriopathy first described in 1976. It is characterized histologically by vacuolization and lysis of the outer arterial media leading to dissecting aneurysms and vessel rupture presenting clinically with self-limiting abdominal pain or catastrophic hemorrhages in the abdomen. Patients of all ages are affected with a greater incidence at the fifth and sixth decades. There is a slight male predominance. Imaging findings overlap with inflammatory vasculitis, collagen vascular disease, and fibromuscular dysplasia. The presence of segmental dissections involving the celiac, mesenteric, and/or renal arteries is the key distinguishing features of SAM. Inflammatory markers, genetic tests for collagen vascular disorders, and hypercoagulable studies are negative. Anti-inflammatory agents and immunosuppressants are not effective. A mortality rate of 50 % has been attributed to the acute presentation with aneurysmal rupture necessitating urgent surgical or endovascular treatments; in the absence of the acute presentation, SAM is a self-limiting disease and is treated conservatively. There are no established guidelines on medical therapy, although optimal control of blood pressure is considered the main cornerstone of medical therapy. The long-term prognosis is not known.

  16. A Case of the Inferior Mesenteric Artery Arising from the Superior Mesenteric Artery in a Korean Woman

    PubMed Central

    Yoo, Seung Jin; Ku, Min Jung; Cho, Sa Sun

    2011-01-01

    Anatomical variations of the inferior mesenteric artery are extremely uncommon, since the inferior mesenteric artery is regularly diverged at the level of the third lumbar vertebra. We found a rare case in which the inferior mesenteric artery arose from the superior mesenteric artery. The findings were made during a routine dissection of the cadaver of an 82-yr-old Korean woman. This is the tenth report on this anomaly, the second female and the first Korean. The superior mesenteric artery normally arising from abdominal aorta sent the inferior mesenteric artery as the second branch. The longitudinal anastomosis vessels between the superior mesenteric artery and inferior mesenteric artery survived to form the common mesenteric artery. This anatomical variation concerning the common mesenteric artery is of clinical importance, performing procedures containing the superior mesenteric artery. PMID:22022194

  17. Lymph node dissection for Siewert II esophagogastric junction adenocarcinoma

    PubMed Central

    Duan, Xiao-Feng; Yue, Jie; Tang, Peng; Shang, Xiao-Bin; Jiang, Hong-Jing; Yu, Zhen-Tao

    2017-01-01

    Abstract The present study was aimed to investigate the application of right thansthoracic Ivor–Lewis (IL), left transthoracic (LTT), and left thoracoabdominal (LTA) approach in Siewert type II adenocarcinoma of esophagogastric junction (AEG). The data of 196 patients with Siewert type II AEG received surgical resection in our cancer center between January 2014 and April 2016 was retrospectively analyzed. Finally, 136 patients met the inclusion criteria were enrolled in the study and divided into the IL (47 cases), LTT (51 cases), and LTA group (38 cases). Clinical and short-term treatment effects were compared among the 3 groups. The patients with weight loss, diabetes, and heart disease increased in the LTT group (P = 0.054, P = 0.075, and P = 0.063, respectively). Operation time was significantly longest in the IL group (P < 0.001), but the amount of bleeding and tumor size did not significantly differ among the 3 groups (P = 0.176 and P = 0.228, respectively). The IL group had the significantly longest proximal surgical margin (P < 0.001) and most number of total (P < 0.001) and thoracic lymph nodes (P < 0.001) dissected. Both the IL and LTA groups had more abdominal lymph nodes dissected than the LTT group (P < 0.001). In general, the IL and LTT groups had the highest dissection rates of every station of thoracic (P < 0.05) and lower mediastinal lymph nodes (P < 0.05), respectively. The dissection rate of the paracardial, left gastric artery, and gastric lesser curvature lymph nodes did not differ significantly among the 3 groups (P > 0.05), but the dissection rate of the hepatic artery, splenic artery, and celiac trunk lymph nodes was significantly highest in the IL group (P < 0.05). Postoperative hospital stay, perioperative complications, and mortality did not differ significantly among the 3 groups (P > 0.05). Compared with the traditional left transthoracic approach, the Ivor–Lewis approach

  18. Variant branching pattern of axillary artery: a case report.

    PubMed

    Shantakumar, Swamy Ravindra; Mohandas Rao, K G

    2012-01-01

    During routine dissection of an approximately 50-year-old male cadaver for the undergraduate medical students at Melaka Manipal Medical College, Manipal University, Manipal, we came across a variation in branching pattern of right axillary artery. The second part of axillary artery gave rise to a common trunk which divided into the subscapular and lateral thoracic arteries. The third part of right axillary artery gave rise to anterior and posterior circumflex humeral arteries. Variations in the branching pattern of axillary artery are important for the surgeons performing interventional or diagnostic procedures in cardiovascular diseases.

  19. Early history of neck dissection.

    PubMed

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

    2008-12-01

    With the exception of distant metastases, the presence of lymph node metastasis in the neck is accepted as the single most important adverse independent prognostic factor and an indicator of survival in squamous carcinoma of the head and neck. Neck dissection in its various forms is the standard surgical treatment for clinical, subclinical and subpathologic metastatic cancer to the neck. The pertinent literature from the beginning of the nineteenth century to the middle of the twentieth century was reviewed. The four giants of late nineteenth century surgery: von Langenbeck, Billroth, von Volkmann and Kocher developed and reported the early cases of different types of neck dissection. Butlin, in England, conceived and developed the concept of elective neck dissection. In 1888, the Polish surgeon Jawdyńsky reported and described in detail the first successful extended en bloc neck dissection. Crile, in 1905 and 1906, reported the first significant series of radical en bloc neck dissections, bringing this procedure to the attention of the medical world as an effective operation with reproducible technique and results. The greatest impetus to the status of this surgical procedure came from Martin and colleagues, who published a monumental report in 1951 of 1,450 cases that established the place and technique of radical neck dissection in the modern treatment of head and neck cancer. Neck dissection, for treatment of cervical lymph node metastases in head and neck cancer, was conceived and attempted in the nineteenth century, with some limited success reported by the end of that era. An effective operation was described and reported in the early twentieth century and evolved by the mid century into a fundamental tool in the management of patients with head and neck cancer.

  20. Professional parachuting: the risk of acute aortic dissection.

    PubMed

    Buchholz, Stefan; Quaden, René Bombien; Schmitz, Christoph; Überfuhr, Peter

    2011-09-01

    Acute aortic dissection is a rare disease, but if it occurs rapid diagnosis and therapy are needed. It is usually seen in elderly patients with long-term persistent arterial hypertension. In younger patients, it is mainly caused by congenital connective tissue disorders, such as Marfan syndrome, or by trauma. We present here a 34-year-old male patient with an acute type A aortic dissection. This patient was a professional parachutist and had carried out a large number of parachute jumps during his lifetime. He was admitted to the emergency department with acute chest pain. The symptoms were not related in time to a parachute jump. During a computed tomography scan, an aortic dissection was diagnosed. The patient was immediately referred to the operating room, and the ascending aorta was replaced by a conduit. After a regular postoperative course, the patient was discharged and recovered completely. Although acute aortic dissection is rare in young patients, it has to be considered in cases of acute chest pain. An immediate diagnosis and adequate therapy are essential to offer the patient a good clinical outcome and long-term survival.

  1. Triple-barrel aorta: dissection of a healed aortic dissection.

    PubMed

    Lie, J T

    1982-08-01

    An unusual case of a triple-barrel aorta in a 51-year-old woman is described. The patient first had a spontaneous type I dissection of the aorta and acute aortic insufficiency, for which she underwent aortic valve replacement and Dacron graft replacement of the ascending aorta. She remained asymptomatic for five years with a healed aortic dissection (double-barrel aorta) distal to the graft. She then underwent a second operation for repair and poppet replacement of the malfunctioned prosthesis. Postoperative cardiac failure necessitated the use of a counterpulsation intra-aortic balloon catheter, which entered and dissected the wall of the false lumen, thus creating a triple-lumen aorta.

  2. Arterial insufficiency

    MedlinePlus

    ... the most common causes of arterial insufficiency is atherosclerosis or "hardening of the arteries." Fatty material (called ... Images Arteries of the brain Developmental process of atherosclerosis References Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and ...

  3. Intentions vs. resemblance: understanding pictures in typical development and autism.

    PubMed

    Hartley, Calum; Allen, Melissa L

    2014-04-01

    Research has debated whether children reflect on artists' intentions when comprehending pictures, or instead derive meaning entirely from resemblance. We explore these hypotheses by comparing how typically developing toddlers and low-functioning children with autism (a population impaired in intentional reasoning) interpret abstract pictures. In Experiment 1, both groups mapped familiar object names onto abstract pictures, however, they related the same representations to different 3-D referents. Toddlers linked abstract pictures with intended referents they did not resemble, while children with autism mapped picture-referent relations based on resemblance. Experiment 2 showed that toddlers do not rely upon linguistic cues to determine intended referential relations. Experiment 3 confirmed that the responding of children with autism was not due to perseveration or associative word learning, and also provided independent evidence of their intention-reading difficulties. We argue that typically developing children derive meaning from the social-communicative intentions underlying pictures when resemblance is an inadequate cue to meaning. By contrast, children with autism do not reflect on artists' intentions and simply relate pictures to whatever they happen to resemble.

  4. The aberrant retroesophageal right subclavian artery.

    PubMed

    Seres-Sturm, M; Maros, T N; Seres-Sturm, L

    1985-01-01

    Two cases with arteria lusoria were found at 278 routine dissections. These arteria arise as the last branches of the aortic arch and have a retroesophageal position. At the crossing point, the esophagus narrows due to the groove caused by the artery. The appearance of this malposition is the consequence of the perturbation in the organo-genesis of the right dorsal aorta and fourth branchial artery. The aberration can lead to disphagia lusoria.

  5. Pulmonary artery rupture in pregnancy complicating patent ductus arteriosus

    PubMed Central

    Green, Nicholas J; Rollason, Terence P

    1992-01-01

    Fatal haemopericardium in a 27 year old pregnant woman was caused by rupture of a dissecting aneurysm of the pulmonary artery. She had an uncorrected patent ductus arteriosus and severe pulmonary hypertension. The wall of the pulmonary artery showed atherosclerosis and cystic medionecrosis. PMID:1467058

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

    SciTech Connect

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

    2008-07-15

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

  7. A Simple Dissection Method for the Conduction System of the Human Heart

    ERIC Educational Resources Information Center

    Yanagawa, Nariaki; Nakajima, Yuji

    2009-01-01

    A simple dissection guide for the conduction system of the human heart is shown. The atrioventricular (AV) node, AV bundle, and right bundle branch were identified in a formaldehyde-fixed human heart. The sinu-atrial (SA) node could not be found, but the region in which SA node was contained was identified using the SA nodal artery. Gross…

  8. Early Coronary Thrombosis without ST-Segment Elevation Following Repair of Acute Aortic Dissection

    PubMed Central

    Carino, Davide; Nicolini, Francesco; Romano, Giorgio; Ricci, Matteo; Gherli, Tiziano

    2016-01-01

    Acute coronary thrombosis after emergent surgery for acute Type A aortic dissection is a rare event that can remain undiagnosed in absence of typical electrocardiogram readings. We report a case of left anterior descending artery thrombosis without ST-segment elevation three days after surgical repair, which was successfully treated with angioplasty and stenting. PMID:28097197

  9. Percutaneous fenestration of aortic dissection: Salvage of an ischemic solitary left kidney

    SciTech Connect

    Park, Jae Hyung; Chung, Jin Wook; Cho, Yoon Koo; Kim, Sun Ho; Ahn, Hyuk; Oh, Byung Hee

    1997-03-15

    The false channel of a type III aortic dissection caused acute renal ischemia by compression of the origin of the left renal artery in a patient with status post-right nephrectomy. To relieve the ischemia and restore renal function, percutaneous balloon fenestration was performed successfully.

  10. A hypothesis to explain accuracy of wasp resemblances.

    PubMed

    Boppré, Michael; Vane-Wright, Richard I; Wickler, Wolfgang

    2017-01-01

    Mimicry is one of the oldest concepts in biology, but it still presents many puzzles and continues to be widely debated. Simulation of wasps with a yellow-black abdominal pattern by other insects (commonly called "wasp mimicry") is traditionally considered a case of resemblance of unprofitable by profitable prey causing educated predators to avoid models and mimics to the advantage of both (Figure 1a). However, as wasps themselves are predators of insects, wasp mimicry can also be seen as a case of resemblance to one's own potential antagonist. We here propose an additional hypothesis to Batesian and Müllerian mimicry (both typically involving selection by learning vertebrate predators; cf. Table 1) that reflects another possible scenario for the evolution of multifold and in particular very accurate resemblances to wasps: an innate, visual inhibition of aggression among look-alike wasps, based on their social organization and high abundance. We argue that wasp species resembling each other need not only be Müllerian mutualists and that other insects resembling wasps need not only be Batesian mimics, but an innate ability of wasps to recognize each other during hunting is the driver in the evolution of a distinct kind of masquerade, in which model, mimic, and selecting agent belong to one or several species (Figure  1b). Wasp mimics resemble wasps not (only) to be mistaken by educated predators but rather, or in addition, to escape attack from their wasp models. Within a given ecosystem, there will be selection pressures leading to masquerade driven by wasps and/or to mimicry driven by other predators that have to learn to avoid them. Different pressures by guilds of these two types of selective agents could explain the widely differing fidelity with respect to the models in assemblages of yellow jackets and yellow jacket look-alikes.

  11. Acute Aortic Dissections with Pregnancy in Women with ACTA2 Mutations

    PubMed Central

    Regalado, Ellen S.; Guo, Dong-chuan; Estrera, Anthony L.; Buja, L. Maximilian; Milewicz, Dianna M.

    2014-01-01

    Mutations in ACTA2 predispose to thoracic aortic aneurysms and dissections as well as coronary artery and cerebrovascular disease. Here we examined the risk of aortic dissections, stroke and myocardial infarct with pregnancy in women with ACTA2 mutations. Of the 53 women who had a total of 137 pregnancies, eight had aortic dissections in the third trimester or the postpartum period (6% of pregnancies). One woman also had a myocardial infarct that occurred during pregnancy that was independent of her aortic dissection. Compared to the population-based frequency of peripartum aortic dissections of 0.6%, the rate of peripartum aortic dissections in women with ACTA2 mutations is much higher (8 out of 39; 20%). Six of these dissections initiated in the ascending aorta (Stanford type A), three of which were fatal. Three women had ascending aortic dissections at diameters less that 5.0 cm (range 3.8 to 4.7 cm). Aortic pathology showed mild to moderate medial degeneration of the aorta in three women. Of note, five of the women had hypertension either during or before the pregnancy. In summary, the majority of women with ACTA2 mutations did not have aortic or other vascular complications with pregnancy. However, these findings show that pregnancy is associated with significant risk for aortic dissections in women in whom diagnosis of ACTA2 mutation has not been made. Women with ACTA2 mutations who are planning to get pregnant should be counseled about this risk of aortic dissections, and proper clinical management should be initiated to reduce this risk. PMID:24243736

  12. ``Dissection'' of a Hair Dryer

    NASA Astrophysics Data System (ADS)

    Eisenstein, Stan; Simpson, Jeff

    2008-12-01

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

  13. Diagnostic imaging for aortic dissection.

    PubMed

    Kapustin, Andrew J; Litt, Harold I

    2005-01-01

    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.

  14. [Chronic type A aortic dissection associated with Turner syndrome; report of a case].

    PubMed

    Tanaka, Hideyuki; Kozaki, Tomofumi; Kume, Masazumi; Miyamoto, Shinji

    2014-12-01

    Aortic dissection is a critical but rare complication of Turner syndrome. This report describes a case of chronic aortic dissection in a patient with Turner syndrome. A 54-year-old woman, suffering from mild back pain for 1 month, was referred to our hospital with a diagnosis of Stanford type A chronic aortic dissection and a bicuspid aortic valve with moderate regurgitation. Computed tomography revealed aortic dissection, involving all arch branches, extending from the ascending to the abdominal aorta. The true lumen of the brachial artery was nearly obstructed by the thrombosed false lumen. Elective aortic arch repair and aortic valve replacement were successfully performed. The patient was diagnosed with 45, XO Turner syndrome after surgery. Taking aortopathy of Turner syndrome into consideration, surveillance of the residual aorta was performed. No rapidly progressive dilatation of the residual aorta was detected during the 6 years' follow-up.

  15. Unusual presentation of aortic dissection: post-coital acute paraplegia with renal failure.

    PubMed

    Galabada, Dinith P; Nazar, Abdul L M

    2014-09-01

    We report the case of a 45-year-old chronic smoker who presented with acute paraplegia occurring during coitus and subsequently developed acute renal failure (ARF) requiring dialysis. He had absent peripheral pulses in the lower limbs with evidence of acute ischemia. Doppler study showed dissecting aneurysm of thoracic aorta, thrombotic occlusion of the distal aorta from L1 level up to bifurcation and occlusion of the right renal artery by a thrombus that was confirmed by magnetic resonance imaging of the spine. He was not subjected to any vascular intervention as his lower limbs were not salvageable due to delay in the diagnosis. Post-coital aortic dissection and aortic dissection presenting with acute paraplegia and ARF are very rare. This is probably the first case report with post-coital acute aortic dissection presenting with paraplegia and ARF. This case emphasizes the importance of a careful examination of peripheral pulses in patients presenting with ARF and paraplegia.

  16. Pancreaticoduodenal Artery Pseudoaneurysm Caused by Segmental Arterial Mediolysis: A Case Report of Surgical Treatment

    PubMed Central

    2013-01-01

    A 64-year-old woman underwent surgical resection of a posterior inferior pancreaticoduodenal arterial aneurysm in the subacute phase of acute aortic dissection (AAD). Concomitantly, a distal pancreatectomy was also required. The aneurysm was approximately 20 mm in diameter. Surgical resection of the aneurysm was performed because endovascular treatment was considered to be technically difficult due to dissecting lesions that had remained at the abdominal aorta. Histopathological findings suggested this aneurysm to be a pseudoaneurysm, which had arisen as a result of segmental arterial mediolysis. Approximately 1 year after surgery, no recurrence of the aneurysms was detected. PMID:23825502

  17. Pancreaticoduodenal artery pseudoaneurysm caused by segmental arterial mediolysis: a case report of surgical treatment.

    PubMed

    Ushijima, Tomoki; Izumo, Akihiko; Matsumoto, Takashi; Taniguchi, Kenichiro; Uchida, Takayuki

    2013-01-01

    A 64-year-old woman underwent surgical resection of a posterior inferior pancreaticoduodenal arterial aneurysm in the subacute phase of acute aortic dissection (AAD). Concomitantly, a distal pancreatectomy was also required. The aneurysm was approximately 20 mm in diameter. Surgical resection of the aneurysm was performed because endovascular treatment was considered to be technically difficult due to dissecting lesions that had remained at the abdominal aorta. Histopathological findings suggested this aneurysm to be a pseudoaneurysm, which had arisen as a result of segmental arterial mediolysis. Approximately 1 year after surgery, no recurrence of the aneurysms was detected.

  18. Two Rare Variants of Left Vertebral Artery.

    PubMed

    Singh, Rajani

    2017-02-15

    Though the variations of vertebral artery are clinically asymptomatic yet abnormalities are of diagnostic importance either prior to vascular surgery in the neck region or in patients of intravascular diseases such as arteriovenous malformations or cerebral aneurysms. Therefore, the aim of the study is to bring out 2 variations in the configuration of vertebral artery and their clinical implication. During dissection of thorax of 2 female cadavers, 2 different variants of configurations of left vertebral arteries were observed. In 1 patient, the left vertebral artery arose aberrantly from arch of aorta between left common carotid artery and left subclavian artery. This artery then, following oblique course, abnormally entered into foramen transversarium of C4 vertebra. In the second patient, the left common stump emerged from arch of aorta in the left side of left common carotid artery and then instantly bifurcated into vertebral artery and subclavian artery. Then following the usual oblique course, the left vertebral artery anomalously entered into foramen transversarium of C3 vertebra at the level of upper border of thyroid cartilage. The knowledge of these rare variations in the origin of vertebral artery is of paramount importance to surgeons performing surgery in neck region, radiologist performing angiography to avoid misinterpretation of radiographs and to anatomists for rare variations in academics and research.

  19. Traumatic aorta to pulmonary artery fistula

    PubMed Central

    Zajtchuk, Rustik; Resnekov, Leon; Ranniger, Klaus; Gonzalez-Lavin, Lorenzo

    1971-01-01

    A case of chronic aortic to pulmonary artery traumatic fistula is presented and the surgical repair is detailed. Closure through the aorta is recommended; this approach provides a dry operative field and avoids the need for dissection of adhesions around the fistulous tract. Fistulae of this type are not common and the pertinent literature is reviewed. Images PMID:5576540

  20. ASL Nominal Constructions Involving Signs That Resemble Pronouns

    ERIC Educational Resources Information Center

    Sloan, Vivion Smith

    2013-01-01

    This dissertation examines six different types of noun phrases that commonly occur in American Sign Language. These noun phrases all include at least a head noun and one of four signs resembling a pronoun. Videos of natural ASL discourses are gathered, multiple instances of the six types of noun phrases are identified, and their meanings are…

  1. Differential grandparental investment - the impact of phenotypic resemblance.

    PubMed

    Schlee, Juliane; Kirchengast, Sylvia

    2015-01-01

    Differential grandparental investment is mainly explained as a result of paternity uncertainty. Phenotypic resemblance may be interpreted as an indicator of genetically relatedness. Consequently the present study focused on the impact of phenotypic resemblance on grandparental investment, i.e. solicitude, contact frequency and quality of relationship. 213 adults persons between the age 19 and 32 years (x = 25.5; SD = 3.4) were enrolled in the study. Data concerning grandparental investment during childhood were collected retrospectively using a 30 item questionnaire. Grandparental investment patterns differed significantly according grandparent category. In detail maternal grandmothers showed the highest contact frequency and the highest solicitude while - as to be expected - the paternal grandfather exhibited the lowest degree of investment. Grandparental investment was independent of grandparent category mainly influenced by residential distance. Phenotypic resemblance had an impact on grandparental investment independent of residential distance. This was first of all true of paternal grandfathers. An impact of phenotypic resemblance on grandparental investment patters can be assumed.

  2. Allergic Contact Dermatitis to Benzoyl Peroxide Resembling Impetigo.

    PubMed

    Kim, Changhyun; Craiglow, Brittany G; Watsky, Kalman L; Antaya, Richard J

    2015-01-01

    A 17-year-old boy presented with recurring severe dermatitis of the face of 5-months duration that resembled impetigo. He had been treated with several courses of antibiotics without improvement. Biopsy showed changes consistent with allergic contact dermatitis and patch testing later revealed sensitization to benzoyl peroxide, which the patient had been using for the treatment of acne vulgaris.

  3. Dissect Your Squid and Eat It Too!

    ERIC Educational Resources Information Center

    McGinnis, Patricia

    2001-01-01

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

  4. [Dissection is still important when learning anatomy].

    PubMed

    Knudsen, Britt Mejer; Søe, Niels H; Jensen, Nina Vendel; Langebæk, Rikke; Dahlin, Lars B

    2013-05-20

    Dissection and prosection require a donation programme of cadavers for education and research. The importance of maintaining the donation programme and the significance of dissection as a teaching method when learning anatomic structures and obtaining surgical skills are evaluated.

  5. Dissection & Science Fairs. [Information Packet.

    ERIC Educational Resources Information Center

    National Anti-Vivisection Society, Chicago, IL.

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

  6. Animal Rights Activism Threatens Dissection.

    ERIC Educational Resources Information Center

    Holden, Constance

    1990-01-01

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

  7. [Resistant arterial hypertension and coarctation of the aorta].

    PubMed

    Martínez-Quintana, Efrén; Rossique-Delmas, Pilar; Rodríguez-González, Fayna

    2014-01-01

    Coarctation of the aorta accounts for around 5 percent of all congenital heart defects. Many of these patients develop arterial hypertension, and occasionally resistant arterial hypertension, despite adequate correction. This may lead to potentially fatal complications such as heart failure, aortic dissection, cerebrovascular events, or myocardial infarction. Therefore, a correct diagnosis must be made and an appropriate treatment started to reduce arterial hypertension, arteriosclerotic vascular disease, as well as the increased risk of cardiovascular morbidity and mortality.

  8. A Dissecting Competition for Medical Students

    ERIC Educational Resources Information Center

    Samalia, Latika; Stringer, Mark D.

    2012-01-01

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

  9. Staged total exclusion of the aorta for chronic type B aortic dissection.

    PubMed

    Dias Perera, Anton; Willis, Alan K; Fernandez, Joss D; Garrett, H Edward; Wolf, Bradley A

    2010-11-01

    Hybrid techniques using extra-anatomic bypass of critical aortic branches to enable endovascular treatment of complex aortic pathology have been previously described. A staged endograft repair of a complex, chronic Stanford type B aortic dissection with aneurysmal degeneration is reported in a 50-year-old man. The aneurysmal portion of the dissection extended from the distal arch to both common iliac arteries and was covered with an endograft from the ascending aorta to both external iliac arteries. Aortic arch branches, visceral, and renal arteries were bypassed using open technique. The patient had no neurologic complications. This case report illustrates the feasibility of the hybrid technique in selected high-risk patients when confronted with complex aortic pathology.

  10. Splenic artery transposition graft usage for the supply of the right hepatic artery: a case report.

    PubMed

    Odabasi, Mehmet; Eris, Cengiz; Yildiz, Mehmet Kamil; Abuoglu, Hasan; Akbulut, Sami; Saglam, Abdullah

    2013-01-01

    Hepatic artery aneurysms are responsible for 12% to 20% of all visceral arterial aneurysms. Because most patients are asymptomatic, this disease is generally diagnosed incidentally during radiologic examination. Aneurysm rupture develops in 14% to 80% of cases, depending on the aneurysmatic segment's diameter and location, as well as other etiologic factors. Mortality rates associated with rupture range between 20% and 70%. Thus, early diagnosis and timely initiation of medical interventions are critical to improve survival rates. Here, we present a male patient, age 69 years, with a hepatic artery aneurysm that was detected incidentally. The 3-cm aneurysm was detected on contrast-enhanced computed tomography and extended from the common hepatic artery to the hepatic trifurcation. A laparotomy was performed using a right subcostal incision. After dissection of the hepatoduodenal ligament, the common, right, and left hepatic arteries, as well as the gastroduodenal artery, were suspended separately. Then, the aneurysmatic hepatic artery segment was resected, and the gastroduodenal artery stump was ligated. An end-to-end anastomosis was formed between the left and common hepatic arteries, followed by an end-to-end anastomosis formed between the right hepatic artery and splenic artery using a splenic artery transposition graft. Postoperative follow-up examinations showed that both hepatic arterial circulations were good, and no splenic infraction had developed.

  11. Splenic Artery Transposition Graft Usage for the Supply of the Right Hepatic Artery: A Case Report

    PubMed Central

    Odabasi, Mehmet; Eris, Cengiz; Yildiz, Mehmet Kamil; Abuoglu, Hasan; Akbulut, Sami; Saglam, Abdullah

    2013-01-01

    Hepatic artery aneurysms are responsible for 12% to 20% of all visceral arterial aneurysms. Because most patients are asymptomatic, this disease is generally diagnosed incidentally during radiologic examination. Aneurysm rupture develops in 14% to 80% of cases, depending on the aneurysmatic segment's diameter and location, as well as other etiologic factors. Mortality rates associated with rupture range between 20% and 70%. Thus, early diagnosis and timely initiation of medical interventions are critical to improve survival rates. Here, we present a male patient, age 69 years, with a hepatic artery aneurysm that was detected incidentally. The 3-cm aneurysm was detected on contrast-enhanced computed tomography and extended from the common hepatic artery to the hepatic trifurcation. A laparotomy was performed using a right subcostal incision. After dissection of the hepatoduodenal ligament, the common, right, and left hepatic arteries, as well as the gastroduodenal artery, were suspended separately. Then, the aneurysmatic hepatic artery segment was resected, and the gastroduodenal artery stump was ligated. An end-to-end anastomosis was formed between the left and common hepatic arteries, followed by an end-to-end anastomosis formed between the right hepatic artery and splenic artery using a splenic artery transposition graft. Postoperative follow-up examinations showed that both hepatic arterial circulations were good, and no splenic infraction had developed. PMID:23971784

  12. Treatment of Acute Aortic Type B Dissection with Stent-Grafts

    SciTech Connect

    Hausegger, K.A.; Tiesenhausen, K.; Schedlbauer, P.; Oberwalder, P.; Tauss, J.; Rigler, B.

    2001-09-15

    Purpose: To evaluate the feasibility of endoluminal stent-grafts in the treatment of acute type B aortic dissections.Methods: In five patients with acute aortic type B dissections, sealing of the primary intimal tear with an endoluminal stent-graft was attempted. Indication for treatment was aneurysm formation in two patients and persistent pain in three patients. One of the latter also had an unstable dissection flap compromising the ostium of the superior mesenteric artery. The distance from the intimal tear to the left subclavian artery was <0.5 cm in four patients, who had typical type B dissections. In one patient with an atypical dissection the distance from the primary tear to the left subclavian artery was 4 cm. This patient had no re-entry tear. Talent tube grafts (World Medical Manufacturing Cooperation, Sunrise, FL, USA) were used in all patients.Results: Stent-graft insertion with sealing of the primary tear was successful in all patients. The proximal covered portion of the stent-graft was placed across the left subclavian artery in four patients (1x transposition of the left subclavian artery). Left arm perfusion was preserved via a subclavian steal phenomenon in the patients in whom the stent-graft covered the orifice of the left subclavian artery. The only procedural complication we observed was an asymptomatic segmental renal infarction in one patient. In the thoracic aorta thrombosis of the false aortic lumen occurred in all patients. In one patient the false lumen of the abdominal aorta thrombosed after 4 weeks; in the other three patients the status of the abdominal aorta remained unchanged compared with the situation prior to stent-graft insertion. As a late complication formation of a secondary aneurysm of the thoracic aorta was observed at the distal end of the stent-graft 3 months after the primary intervention. This aneurysm was treated by coaxial insertion of an additional stent-graft without complications.Conclusion: Endoluminal treatment

  13. Aneurysms of medium-sized arteries in Marfan syndrome.

    PubMed

    Awais, Mazen; Williams, David M; Deeb, G Michael; Shea, Michael J

    2013-11-01

    Marfan syndrome is a relatively common connective tissue disorder that causes skin, ocular, skeletal, and cardiovascular abnormalities. High morbidity and mortality occur with aortic aneurysm and dissection. Other large-artery aneurysms, including carotid, subclavian, and iliac artery aneurysms, have also been associated with Marfan syndrome. It is not clear whether small- to medium-sized artery aneurysms are associated with Marfan syndrome. This report describes 4 patients with Marfan syndrome who have associated small- to medium-sized artery aneurysms with several complications. Additional investigations are needed to determine whether Marfan syndrome can cause small- to medium-sized artery aneurysms and how patients with these aneurysms should be treated.

  14. Segmental arterial mediolysis: angioplasty of bilateral renal artery stenoses with 2-year imaging follow-up.

    PubMed

    Soulen, Michael C; Cohen, Debbie L; Itkin, Maxim; Townsend, Raymond R; Roberts, David A

    2004-07-01

    Segmental arterial mediolysis (SAM) is a rare condition caused by loss of muscular elements in the walls of medium-sized, usually visceral, arteries. This causes dissection, occlusion, aneurysm formation, and rupture. The clinical presentation is usually catastrophic as a result of vascular occlusion or rupture. Herein an unusual case of renovascular hypertension resulting from SAM is reported, which was successfully treated with balloon angioplasty.

  15. Successful treatment tailored to each splanchnic arterial lesion due to segmental arterial mediolysis (SAM): report of a case.

    PubMed

    Hashimoto, Takuya; Deguchi, Juno; Endo, Hisako; Miyata, Tetsuro

    2008-11-01

    Segmental arterial mediolysis (SAM) is a rare condition characterized by splanchnic arterial catastrophe caused by mediolysis. We report a 59-year-old man with a ruptured splenic arterial aneurysm who was successfully treated by coil embolization. He underwent additional resection of large gastroepiploic and residual splenic aneurysms. Pathological examination showed mediolysis and tearing, compatible with SAM. Furthermore, he developed acute dissection of the superior mesenteric artery (SMA) one and a half years later, demonstrated by computed tomography. This report demonstrates that SAM is characterized by multiple lesions of the splanchnic arteries at different times, and requires treatment suited to the lesions, including careful long-term observation.

  16. Analysis of dissection algorithms for vector computers

    NASA Technical Reports Server (NTRS)

    George, A.; Poole, W. G., Jr.; Voigt, R. G.

    1978-01-01

    Recently two dissection algorithms (one-way and incomplete nested dissection) have been developed for solving the sparse positive definite linear systems arising from n by n grid problems. Concurrently, vector computers (such as the CDC STAR-100 and TI ASC) have been developed for large scientific applications. An analysis of the use of dissection algorithms on vector computers dictates that vectors of maximum length be utilized thereby implying little or no dissection; on the other hand, minimizing operation counts suggest that considerable dissection be performed. In this paper we discuss the resolution of this conflict by minimizing the total time required by vectorized versions of the two algorithms.

  17. Superficial ulnar artery perforator flap.

    PubMed

    Schonauer, Fabrizio; Marlino, Sergio; Turrà, Francesco; Graziano, Pasquale; Dell'Aversana Orabona, Giovanni

    2014-09-01

    Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions.

  18. Arterial Catheterization

    MedlinePlus

    ... The arterial catheter allows accurate, second-to-second measurement of the blood pressure; repeated meas- urement is ... pressure must be lowered gradually in steps, and measurements with an arterial catheter help guide the treatment. ■ ...

  19. Superficial brachioradial artery (radial artery originating from the axillary artery): a case-report and its embryological background.

    PubMed

    Konarik, M; Knize, J; Baca, V; Kachlik, D

    2009-08-01

    A case of anomalous terminal branching of the axillary artery, concerning the variant called superficial brachioradial artery (arteria brachioradialis superficialis) was described, with special regard to its embryological origin. The left upper limb of a male cadaver was dissected in successive steps from the axillary fossa distally to the palmar region. A variant artery, stemming from the end of the third segment of the axillary artery, followed a superficial course distally. It skipped the cubital fossa, ran on the lateral side of the forearm, crossed ventrally to the palm, and terminated in the deep palmar arch. This vessel is a case of so-called "brachioradial artery" (inexactly called a "radial artery with a high origin"). The origin of the brachioradial artery directly from the axillary artery belongs to the rare variants of the arterial pattern of the upper limb. Its incidence is approximately 3%. Moreover, this vascular variant was associated with another one concerning the brachial plexus. The medial cutaneous nerve of the forearm joined the median nerve in the middle third of the arm and ran further distally as a common trunk, as the normal median nerve does. Anatomical knowledge of the axillary region is crucial for radiodiagnostic and surgical procedures, especially in cases of trauma. The superficially located artery brings an elevated risk of bleeding complications in unexpected situations.

  20. Triple-branched stent graft for arch repair in a pregnant woman with acute DeBakey type I aortic dissection.

    PubMed

    Zhang, Qian; Ma, Xiaochun; Wang, Zhengjun; Zou, Chengwei

    2017-03-12

    A woman aged 36 years at 36 weeks of pregnancy sought medical attention at the Shandong Provincial Hospital affiliated to Shandong University, Shandong, China, after experiencing acute chest pain. The patient was diagnosed with chronic hypertension, severe pre-eclampsia, acute aortic dissection, aortic regurgitation, and heart failure. Computed tomography examination demonstrated a DeBakey type I aortic dissection that involved the origin of the innominate artery, the left common carotid artery, and the left subclavian artery. This article is protected by copyright. All rights reserved.

  1. Spontaneous rupture of an intrahepatic aneurysm of the right hepatic artery caused by segmental arterial mediolysis.

    PubMed

    Beerle, Corinne; Soll, Christopher; Breitenstein, Stefan; Grieder, Felix

    2016-03-18

    Segmental arterial mediolysis (SAM) is a non-arteriosclerotic, non-inflammatory arteriopathy characterised by dissecting aneurysms and most commonly found in abdominal arteries. A rupture of a visceral artery aneurysm is generally associated with high mortality. We present the case of a 57-year-old woman with a rupture of an intrahepatic aneurysm that led to intra-abdominal haemorrhage. The patient was surgically treated by evacuating the abdominal haematoma and ligature of the right hepatic artery. Histology of the right hepatic artery revealed the diagnosis of SAM. Six months postoperatively, the patient was in excellent physical condition with normal liver function and arterial blood flow of the right hepatic sections over collateral circulation.

  2. Anatomy of the medial femoral circumflex artery with respect to the vascularity of the femoral head.

    PubMed

    Zlotorowicz, M; Szczodry, M; Czubak, J; Ciszek, B

    2011-11-01

    We performed a series of 16 anatomical dissections on Caucasian cadaver material to determine the surgical anatomy of the medial femoral circumflex artery (MFCA) and its anastomoses. These confirmed that the femoral head receives its blood supply primarily from the MFCA via a group of posterior superior nutrient arteries and the posterior inferior nutrient artery. In terms of anastomoses that may also contribute to the blood supply, the anastomosis with the inferior gluteal artery, via the piriformis branch, is the most important. These dissections provide a base of knowledge for further radiological studies on the vascularity of the normal femoral head and its vascularity after dislocation of the hip.

  3. Pathophysiology and Surgical Treatment of Type A Acute Aortic Dissection

    PubMed Central

    Karube, Norihisa; Yasuda, Shota; Miyamoto, Takuma; Matsuki, Yusuke; Isoda, Susumu; Goda, Motohiko; Suzuki, Shinichi; Masuda, Munetaka; Imoto, Kiyotaka

    2016-01-01

    Objectives: We report the pathophysiology and treatment results of type A acute aortic dissection from our 20-year experience. Methods: We studied 673 patients with type A acute aortic dissection who underwent initial treatment from 1994 through July 2014. We divided these patients into two groups. The former group comprised 448 patients from 1994 through 2008, and the latter group comprised 225 patients from 2009 onward, when the current strategy of initial treatment and surgical technique including the early organ reperfusion therapies were established. Results: Women were significantly often presented than men in patients over 60 years of age. Thrombosed-type dissection accounted for more than half in patients over 70 years, and significantly often complicated pericardial effusion and cardiac tamponade than patent type. Malperfusion occurred in 26% of patients. Central repair operations were performed in 579 patients. In-hospital mortality for all patients was 15%, and for the patients who underwent central repair operations was 10%. Former period of operation, malperfusion, and preoperative cardiopulmonary arrest were significant risk factor of in-hospital death. Preoperative left main trunk (LMT) stents were placed in eight patients and superior mesenteric artery (SMA) intervention was performed in five, they were effective to improve the outcome. From 2009 onward, in-hospital mortality was 5.0% and there was no significant risk factor. Conclusion: Surgical results of type A acute aortic dissection were dramatically improved in the past 20 years. Early reperfusion strategy for the patients with malperfusion improved the outcomes. (This article is a translation of Jpn J Vasc Surg 2015; 24: 127–134.) PMID:27738456

  4. Basilar artery of the capybara (Hydrochaeris hydrochaeris): an ultrastructural study.

    PubMed

    Islam, S; Ribeiro, A A C M; Loesch, A

    2004-04-01

    The present study investigated the ultrastructural features of the basilar artery of the largest rodent species, the capybara. The study suggests that the general ultrastructural morphological organization of the basilar artery of the capybara is similar to that of small rodents. However, there are some exceptions. The basilar artery of the capybara contains a subpopulation of 'granular' vascular smooth muscle cells resembling monocytes and/or macrophages. The possibility cannot be excluded that the presence of these cells reflects the remodelling processes of the artery due to animal maturation and the regression of the internal carotid artery. To clarify this issue, more systemic studies are required involving capybaras of various ages.

  5. Extending disorder: essentialism, family resemblance and secondary sense.

    PubMed

    Pickering, Neil

    2013-05-01

    It is commonly thought that mental disorder is a valid concept only in so far as it is an extension of or continuous with the concept of physical disorder. A valid extension has to meet two criteria: determination and coherence. Essentialists meet these criteria through necessary and sufficient conditions for being a disorder. Two Wittgensteinian alternatives to essentialism are considered and assessed against the two criteria. These are the family resemblance approach and the secondary sense approach. Where the focus is solely on the characteristics or attributes of things, both these approaches seem to fail to meet the criteria for valid extension. However, this focus on attributes is mistaken. The criteria for valid extension are met in the case of family resemblance by the pattern of characteristics associated with a concept, and by the limits of intelligibility of applying a concept. Secondary sense, though it may have some claims to be a good account of the relation between physical and mental disorder, cannot claim to meet the two criteria of valid extension.

  6. Ritodrine-induced pustular eruptions distinctly resembling impetigo herpetiformis.

    PubMed

    Kuwabara, Yoshimitsu; Sato, Atsuki; Abe, Hiroko; Abe, Sumino; Kawai, Naoki; Takeshita, Toshiyuki

    2011-01-01

    A 27-year-old nulligravida woman without a history of dermatosis was hospitalized for threatened preterm labor at 29 weeks' gestation; therefore, continuous infusion of ritodrine hydrochloride was started. At 31 weeks' gestation, erythematous plaques appeared and spread over the body surface; therefore, a topical steroid preparation was applied. At 32 weeks' gestation, the eruptions developed into irregular annular areas of erythema with multiple pustules accompanied by severe itching, and oral prednisolone treatment was started. Bacterial cultures of the pustules were negative, and a crural cutaneous biopsy revealed Kogoj's spongiform pustules. Based on the clinicopathological findings, the most likely diagnosis was impetigo herpetiformis, which causes cutaneous symptoms closely resembling pustular psoriasis in pregnant females without a history of psoriasis. To rule out ritodrine-induced pustular eruptions, the ritodrine infusion was stopped and treatment with an MgSO(4) preparation was started at 33 weeks' 3 days' gestation; however, the uterine contractions could not be suppressed. Because of the patient's highly edematous, severely painful feet, a cesarean section was performed the same day. Within several days of delivery, the eruptions began to resolve, and no recurrence was observed after treatment with oral prednisolone was stopped 31 days after delivery. On the basis of a positive patch test for ritodrine, we diagnosed pustular drug eruptions caused by ritodrine hydrochloride. Although ritodrine-induced pathognomonic cutaneous eruptions are rare, we would like to emphasize that ritodrine can cause drug-induced pustular eruptions distinctly resembling life-threatening impetigo herpetiformis.

  7. Acute arterial occlusion - kidney

    MedlinePlus

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidneys need a good blood supply. The main artery to the kidney is called the renal artery. ...

  8. Applied anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery

    PubMed Central

    de Araujo Netto, Belmino Corrêa; Ferreira, Lydia Masako; de Oliveira Santos, Ivan Dunshee Abranches

    2003-01-01

    A study of the anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery was performed to help the elaboration of a fasciocutaneous flap for the reconstruction of skin and subcutaneous and deep fascia of the knee and popliteal region. Forty thighs in 27 fresh cadavers were dissected. In all of the thighs, the third perforator artery was found to arise from the deep femoral artery and reach the posterior aspect of the thigh after perforating the adductor magnus muscle. At that point it was also found that the third perforator artery gives off a branch that emerges through the intermuscular septum between the vast lateral muscle and the long head of the biceps femoral muscle, then crosses the posterior cutaneous nerve and moves directly on to perforate the deep fascia and then to bifurcate into two other branches: one ascending and one descending. The cutaneous area of the flap of the thigh’s posterior region, nourished by the fasciocutaneous branch, was evaluated through the injection of dye. Dying of the upper medial, middle medial, lower medial and lower lateral areas of the flap was not successful in all of the dissected thighs. Nevertheless, the upper lateral and the middle lateral areas were dyed successfully in all 40 dissected thighs of the 27 cadavers. PMID:24115846

  9. Successful treatment for acute aortic dissection in pregnancy---bentall procedure concomitant with cesarean section

    PubMed Central

    2011-01-01

    Acute aortic type A dissection is a life-threatening disease that requires immediate surgical intervention. When dissection occurs during pregnancy, it is of high risk for both the mother and the fetus. In this study, we reported two cases of acute aortic dissection in late pregnancy at 28 weeks and 32 weeks of gestation respectively. After the two patients underwent a cesarean section and delivered a baby, we performed composite graft replacement of the aortic valve, aortic root and ascending aorta, with re-implantation of the coronary arteries into the graft (Bentall procedure) instead of repairing the arch with deep hypothermia and circulation arrest. Both mothers and children survived and recovered well. PMID:21999207

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  11. A survival case of painless chronic type A aortic dissection with a history of stroke and anticoagulant use.

    PubMed

    Tugcu, Aylin; Yildirimturk, Ozlem; Demiroglu, I C Cemsid; Aytekin, Saide

    2010-10-01

    We report the case of a patient with completely painless chronic aortic dissection, who presented to another hospital with a left hemiparesia 3 months ago and received anticoagulation therapy with a diagnosis of ischemic stroke. Most of her symptoms had resolved when she presented to our outpatient clinic except for numbness of her left hand and dysphasia. Physical examination found a diastolic murmur at the left sternal border and a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection with extension into the internal right carotid artery and severe aortic regurgitation. Surgery was performed successfully and the patient was discharged. This case emphasizes that the diagnosis of a completely painless aortic dissection with only neurologic symptoms at presentation can be extremely difficult and should always be considered as a cause of ischemic stroke to avoid catastrophic antithrombolytic or anticoagulation therapy.

  12. The new indication of TEVAR for uncomplicated type B aortic dissection

    PubMed Central

    Song, Chao; Lu, Qingsheng; Zhou, Jian; Yu, Guanyu; Feng, Xiang; Zhao, Zhiqing; Bao, Junmin; Feng, Rui; Jing, Zaiping

    2016-01-01

    Abstract The classical therapeutic indication for type B aortic dissection is based on either medication or open surgery; medication therapy is recommended for relatively stable uncomplicated type B aortic dissection. With improvements in endovascular repair and the potential risk of disease progression, it is now necessary to evaluate the requirement for revision of the therapeutic choice of uncomplicated type B aortic dissection based on morphological features and time window. Data from 252 patients diagnosed as uncomplicated type B aortic dissection from 1992 to 2015 were analyzed retrospectively. Among these cases, 117 patients received medication therapy and 135 patients underwent endovascular repair. The 60-month survival rate in the endovascular group was higher than that in the medication group (92.3% vs 67.6%). According to the morphological evaluation, visceral artery involvement and false/true lumen ratios over 0.7 were strong risk factors for medical treatment alone. Increased surgical time and blood loss were found in patients treated in the chronic phase, compared with those who underwent endovascular repair within 14 days of the onset of symptoms. With improvements in aortic remodeling techniques, endovascular repair has been shown to improve long-term survival rates of patients with uncomplicated aortic dissection. Considering the potential risk of death, we recommend that patients with visceral artery involvement and a false/true lumen ratio over 0.7 should receive endovascular repair aggressively. Furthermore, delayed endovascular repair in the chronic phase does not improve the long-term outcome of uncomplicated type B aortic dissection. PMID:27336881

  13. Uterine Tumour Resembling Ovarian Sex Cord Tumour- A Rare Entity

    PubMed Central

    Ilhan, Tolgay Tuyan; Gül, Ayhan; Ugurluoglu, Ceyhan; Çelik, Çetin

    2016-01-01

    Uterine Tumour Resembling Ovarian Sex-Cord Tumours (UTROSCTs) are an extremely rare type of uterine body tumours arising from the endometrial stroma. Epidemiology, aetiology, pathogenesis, management and natural history of UTROSCTs are still a question of debate, as there is little available data in the literature. Although rare, the possibility of UTROSCTs should be kept in mind, when a patient presents with abnormal bleeding and an enlarged uterus. UTROSCTs appear dirty white/cream-coloured, gelatinous, well-circumscribed mass with smooth surface on macroscopic examination. We present a rare case of endometrial stromal tumour with sex-cord-like differentiation which was successfully treated by hysterectomy with bilateral salpingo-oophorectomy. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here. PMID:28208949

  14. Adenomyomatosis of the gallbladder resembling honeycomb in a child.

    PubMed

    Akçam, Mustafa; Buyukyavuz, Ilker; Ciriş, Metin; Eriş, Naim

    2008-09-01

    Adenomyomatosis of the gallbladder is believed to be an uncommon pathologic condition of the gallbladder in childhood. Only three pediatric cases have been described in the literature up to now. Honeycomb gallbladder has been described in two adult patients; no patients have been reported in childhood until now. To the best of our knowledge, we report here the first case of adenomyomatosis of the gallbladder which resembled honeycomb, in a 9-year-old girl presented with recurrent abdominal pain. The diagnosis was made by ultrasound, and confirmed by magnetic resonance cholangiopancreatography and finally cholecystectomy. In conclusion, ultrasound scanning performed more generally in children presenting with recurrent abdominal pain might lead to accurate diagnosis of adenomyomotosis of the gallbladder during childhood.

  15. Differentiated human stem cells resemble fetal, not adult, β cells.

    PubMed

    Hrvatin, Sinisa; O'Donnell, Charles W; Deng, Francis; Millman, Jeffrey R; Pagliuca, Felicia Walton; DiIorio, Philip; Rezania, Alireza; Gifford, David K; Melton, Douglas A

    2014-02-25

    Human pluripotent stem cells (hPSCs) have the potential to generate any human cell type, and one widely recognized goal is to make pancreatic β cells. To this end, comparisons between differentiated cell types produced in vitro and their in vivo counterparts are essential to validate hPSC-derived cells. Genome-wide transcriptional analysis of sorted insulin-expressing (INS(+)) cells derived from three independent hPSC lines, human fetal pancreata, and adult human islets points to two major conclusions: (i) Different hPSC lines produce highly similar INS(+) cells and (ii) hPSC-derived INS(+) (hPSC-INS(+)) cells more closely resemble human fetal β cells than adult β cells. This study provides a direct comparison of transcriptional programs between pure hPSC-INS(+) cells and true β cells and provides a catalog of genes whose manipulation may convert hPSC-INS(+) cells into functional β cells.

  16. Imperfect Batesian mimicry and the conspicuousness costs of mimetic resemblance.

    PubMed

    Speed, Michael P; Ruxton, Graeme D

    2010-07-01

    We apply signal detection methodology to make predictions about the evolution of Batesian mimicry. Our approach is novel in three ways. First, we applied a deterministic evolutionary modeling system that allows a large number of alternative mimetic morphs to coexist and compete. Second, we considered that there may be natural boundaries to phenotypic expression. Finally, we allowed increasing conspicuousness to impose an increasing detection cost on mimics. In some instances, the model predicts widespread variation in mimetic forms at evolutionary stability. In other situations, rather than a polymorphism the model predicts dimorphisms in which some prey were maximally cryptic and had minimal resemblance to the model, whereas many others were more conspicuous than the model. The biological implications of these results, particularly for our understanding of imperfect mimicry, are discussed.

  17. Muscular dystrophy in a dog resembling human becker muscular dystrophy.

    PubMed

    Baroncelli, A B; Abellonio, F; Pagano, T B; Esposito, I; Peirone, B; Papparella, S; Paciello, O

    2014-05-01

    A 3-year-old, male Labrador retriever dog was presented with clinical signs of progressive exercise intolerance, bilateral elbow extension, rigidity of the forelimbs, hindlimb flexion and kyphosis. Microscopical examination of muscle tissue showed marked variability in myofibre size, replacement of muscle with mature adipose tissue and degeneration/regeneration of muscle fibres, consistent with muscular dystrophy. Immunohistochemical examination for dystrophin showed markedly reduced labelling with monoclonal antibodies specific for the rod domain and the carboxy-terminal of dystrophin, while expression of β-sarcoglycan, γ-sarcoglycan and β-dystroglycan was normal. Immunoblotting revealed a truncated dystrophin protein of approximately 135 kDa. These findings supported a diagnosis of congenital canine muscular dystrophy resembling Becker muscular dystrophy in man.

  18. Transposition of Great Arteries with Intramural Coronary Artery: Experience with a Modified Surgical Technique

    PubMed Central

    Mishra, Amit; Jain, Anil; Hinduja, Manish; Wadhawa, Vivek; Patel, Ramesh; Vaidhya, Nikunj; Rodricks, Dayesh; Patel, Hardik

    2016-01-01

    Objective: Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries in arterial switch operation. Methods: This prospective study involves 450 patients undergoing arterial switch operation at our institute from April 2006 to December 2013 (7.6 years). Eighteen patients underwent arterial switch operation with intramural coronary artery. The coronary patterns and technique used are detailed in the text. Results: The overall mortality found in the subgroup of 18 patients having intramural coronary artery was 16% (n=3). Our first patient had an accidental injury to the left coronary artery and died in the operating room. A seven-day old newborn died from intractable ventricular arrhythmia fifteen hours after surgery. Another patient who had multiple ventricular septal defects with type B arch interruption died from residual apical ventricular septal defect and sepsis on the eleventh postoperative day. The remainder of the patients are doing well, showing a median follow-up duration of 1235.34±815.26 days (range 369 - 2730). Conclusion: Transposition of the great arteries with intramural coronary artery is demanding in a subset of patients undergoing arterial switch operation. We believe our technique of coronary button dissection in the presence of intramural coronary arteries using coronary shunt is simple and can be a good addition to the surgeons' armamentarium. PMID:27074270

  19. Computational Biomechanics in Thoracic Aortic Dissection: Today's Approaches and Tomorrow's Opportunities.

    PubMed

    Doyle, Barry J; Norman, Paul E

    2016-01-01

    Dissection of an artery is characterised by the separation of the layers of the arterial wall causing blood to flow within the wall. The incidence rates of thoracic aortic dissection (AoD) are increasing, despite falls in virtually all other manifestations of cardiovascular disease, including abdominal aortic aneurysm (AAA). Dissections involving the ascending aorta (Type A) are a medical emergency and require urgent surgical repair. However, dissections of the descending aorta (Type B) are less lethal and require different clinical management whereby the patient may not be offered surgery unless complicating factors are present. But how do we tell if a patient will develop a complication later on? Currently, there is no consensus and the evidence base is limited. There is an opportunity for computational biomechanics to help clinicians decide as to which cases to repair and which to manage with blood pressure control. In this review article, we look at AoD from both the clinical and biomechanical perspective and discuss some of the recent computational studies of both Type A and B AoD. We then focus more on Type B where the real opportunity for patient-specific modelling exists. Finally, we look ahead at some of the promising areas of research that may help clinicians improve the decision-making process surrounding Type B AoD.

  20. Brachioradial arteries with anastomotic arteries connecting to brachial arteries bilaterally.

    PubMed

    Hong, Tong; Qiuhong, Dan; Haipeng, Cai

    2010-01-01

    We present a patient with a failed radial coronary angioplasty as a result of bilateral brachioradial arteries, the radial arteries anomalously originating from the axillary arteries. We review the literature concerning abnormal origins of the radial artery and propose the left ulnar artery as optimal access of choice in cases with a right brachioradial artery of relatively small size in its proximal part.

  1. Successful staged operation for acute type A aortic dissection with paraplegia.

    PubMed

    Ando, Takashi; Abe, Hiroyuki; Nagata, Tokuichiro; Makuuchi, Haruo

    2013-06-01

    A 75-year-old man presented with both paraplegia and acute occlusion of the abdominal aorta at onset. Extraanatomical bypass was performed following spinal drainage. After 3 days, the ascending aorta replaced under cardiopulmonary bypass using the extraanatomical bypass graft for arterial cannulation. The abdominal aorta was replaced after 6 months. A staged operation is one of the options for acute aortic dissection with paraplegia and acute occlusion of the abdominal aorta.

  2. Keeping Dissection Alive for Medical Students

    ERIC Educational Resources Information Center

    Chambers, James; Emlyn-Jones, Daniel

    2009-01-01

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

  3. Quick Dissection of the Segmental Bronchi

    ERIC Educational Resources Information Center

    Nakajima, Yuji

    2010-01-01

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

  4. Arterial Vascularization of the Gastrointestinal Tract of the Pampas Deer (Ozotoceros bezoarticus, Linnaeus, 1758).

    PubMed

    Pérez, W; Vazquez, N; Ungerfeld, R

    2016-06-01

    Based on gross dissection of fifteen adult animals (11 females, 4 males), we described the arterial supply of the stomach and intestines of the pampas deer (Ozotoceros bezoarticus), a South American endangered species. The coeliac artery emitted the splenic, left gastric and hepatic arteries. The splenic artery directed towards the spleen, and the right ruminal artery, which is its only collateral directed towards the stomach, being the main artery of the rumen. The left gastric artery gave origin to the left ruminal, the reticular and the left gastroepiploic arteries. The left gastroepiploic artery originated the reticular accessory artery. Both arteries, gastric and left gastroepiploic, anastomosed their right counterparts derived from the hepatic artery on the curvatures of the abomasum. The cranial mesenteric artery irrigated the second half of the duodenum until the beginning of the descending colon. The thickest branch emitted by the cranial mesenteric artery was the ileocolic artery, which was destined to the ascending colon, caecum and ileum. The colic branches and the right colic arteries were irradiated on the right surface of the spiral loop of the ascending colon and distributed to both centripetal and centrifugal coils of the ascending colon; the colic branches were also anastomosed with the last jejunals and ileals and with the right colic arteries. There were no variations in the origin of any of the main branches derived from the coeliac and cranial mesenteric arteries. This species had a basic pattern of arterial distribution similar to small domestic ruminants.

  5. Spontaneous hepatic artery dissection—a rare presentation of fibromuscular dysplasia

    PubMed Central

    Su, Kevin Y.C.; Stanhope, Melanie L.; Kaufman, Brendan P.W.

    2016-01-01

    Fibromuscular dysplasia (FMD) is a rare condition that causes structural compromise of the blood vessel presenting either as an incidental radiological finding, dissection or stenosis usually of the renal or craniocervical arteries. Seldom, patients present with spontaneous dissection in visceral arteries and there are few reports of hepatic involvement. This report outlines the case of a 43-year-old female who presented with severe right upper quadrant pain with a subsequent diagnosis of FMD manifesting as spontaneous hepatic artery dissection. The patient was treated with conservative antiplatelet therapy and regular radiographic follow-up, decided by the treating team as no clear guidelines exist for management of this particular presentation of FMD. Surgical management is not currently recommended to this patient due to the risk of further dissection, but may be considered if there is severe haemodynamic compromise or refractory pain. PMID:28031848

  6. Arterial calcifications

    PubMed Central

    Rennenberg, Roger J M W; Schurgers, Leon J; Kroon, Abraham A; Stehouwer, Coen D A

    2010-01-01

    Abstract Arterial calcifications as found with various imaging techniques, like plain X-ray, computed tomography or ultrasound are associated with increased cardiovascular risk. The prevalence of arterial calcification increases with age and is stimulated by several common cardiovascular risk factors. In this review, the clinical importance of arterial calcification and the currently known proteins involved are discussed. Arterial calcification is the result of a complex interplay between stimulating (bone morphogenetic protein type 2 [BMP-2], RANKL) and inhibitory (matrix Gla protein, BMP-7, osteoprotegerin, fetuin-A, osteopontin) proteins. Vascular calcification is especially prevalent and related to adverse outcome in patients with renal insufficiency and diabetes mellitus. We address the special circumstances and mechanisms in these patient groups. Treatment and prevention of arterial calcification is possible by the use of specific drugs. However, it remains to be proven that reduction of vascular calcification in itself leads to a reduced cardiovascular risk. PMID:20716128

  7. Segmental arterial mediolysis studied by repeated angiography.

    PubMed

    Sakano, T; Morita, K; Imaki, M; Ueno, H

    1997-06-01

    Segmental arterial mediolysis (SAM) is a rare disease of unknown aetiology. We report the fourteenth case of SAM, but the first to demonstrate serial changes on arteriography. A 65-year-old woman with abdominal pain underwent laparotomy with resection of an abnormally beaded and narrowed segment of the right branch of the middle colic artery. Characteristic pathological findings of lysis of the arterial media with dissecting haematomas were present. Other than some post-prandial pain, the patient's post-operative course was uneventful. Serial arteriography showed various abnormalities in the trunk and branches of the superior mesenteric artery. Changes in the vessels consisted of three phases, i.e. dilatation, beading with narrowing and restoration of the smooth wall, with various modifications such as aneurysmal enlargement and occlusion.

  8. Treatment of a Chronic Aneurysmal Aortic Dissection in a Patient with Marfan Syndrome Using a Staged Hybrid Procedure and a Fenestrated Endograft

    SciTech Connect

    Walkden, R. Miles Morgan, Rob A.; Loftus, Ian; Thompson, Matt

    2008-07-15

    Patients with aneurysmal dissections involving both the thoracic and the abdominal aorta are particularly challenging to treat with endovascular techniques because of the natural communications at the level of the visceral arteries. We present the case of a patient with Marfan syndrome with an aneurysmal aortic dissection involving the thoracic and abdominal aorta who was treated by a combination of endografts, surgical bypass, and a fenestrated tube graft.

  9. Nicotine Delivery to Rats via Lung Alveolar Region-Targeted Aerosol Technology Produces Blood Pharmacokinetics Resembling Human Smoking

    PubMed Central

    2013-01-01

    Introduction: Nicotine is a heavily used addictive drug acquired through smoking tobacco. Nicotine in cigarette smoke is deposited and absorbed in the lungs, which results in a rapidly peaked slowly declining arterial concentration. This pattern plays an important role in initiation of nicotine addiction. Methods: A method and device were developed for delivering nicotine to rodents with lung alveolar region-targeted aerosol technology. The dose of delivery can be controlled by the nicotine aerosol concentration and duration of exposure. Results: Our data showed that, in the breathing zone of the nose-only exposure chamber, the aerosol droplet size distribution was within the respirable diameter range. Rats were exposed to nicotine aerosol for 2min. The arterial blood nicotine concentration reached 43.2±15.7ng/ml (mean ± SD) within 1–4min and declined over the next 20min, closely resembling the magnitude and early pharmacokinetics of a human smoking a cigarette. The acute inhalation toxicity of nicotine: LC50 = 2.3mg/L was determined; it was affected by pH, suggesting that acidification decreases nicotine absorption and/or bioavailability. Conclusions: A noninvasive method and toolkit were developed for delivering nicotine to rodents that enable rapid delivery of a controllable amount of nicotine into the systemic circulation and brain-inducing dose-dependent pharmacological effects, even a lethal dose. Aerosol inhalation can produce nicotine kinetics in both arterial and venous blood resembling human smoking. This method can be applied to studies of the effects of chronic intermittent nicotine exposure, nicotine addiction, toxicology, tobacco-related diseases, teratogenicity, and for discovery of pharmacological therapeutics. PMID:23239844

  10. Identification of the Bony Canal of the Posterior Superior Alveolar Nerve and Artery in the Maxillary Sinus: Tomographic, Radiographic, and Macroscopic Analyses

    PubMed Central

    German, Iris Jasmin Santos; Buchaim, Daniela Vieira; Andreo, Jesus Carlos; Shinohara, Elio Hitoshi; Capelozza, Ana Lúcia Alvares; Shinohara, Andre Luis; Pereira, Mizael; Buchaim, Rogerio Leone

    2015-01-01

    The aim of this study was to identify the shape and route of the bony canal of the posterior superior alveolar artery (PSAA) and posterior superior alveolar nerve (PSAN) using different identification methods, including computed tomography (CT), panoramic radiograph, and macroscopic evaluation (corpse and dry skull). Twenty-four patients were analyzed by CT and panoramic and posterior anterior (PA) radiographs; additionally, 90 dry skulls and 21 dissected anatomical specimens were examined. Three-dimensional-CT revealed that the lateral wall of the maxillary sinus resembled a tunnel format in 60% of the treated patients. Out of all 24 patients, the panoramic radiograph identified the bony canal in only one patient; whereas the PA radiograph identified it in 80% of the patients. The dry skulls showed tunnellike routes of the PSAA and PSAN in 65% of the cases. Moreover, the pathway was also visibly observed in the dissected anatomical specimens as a straight shape in 85% of the cases. Thus, our results demonstrated that the most common shape of the bony canal of the PSAA and PSAN is the tunnel format with a straight route by 3D-CT, posterior anterior radiography, and macroscopic evaluation. However, in the panoramic radiographs, it was difficult to identify this canal. PMID:25861685

  11. Segmental mediolytic arteritis involving hepatic arteries.

    PubMed

    Armas, O A; Donovan, D C

    1992-05-01

    Segmental mediolytic arteritis is a rare, noninflammatory arteriopathy that involves the splanchnic arteries of adults with shock and the coronary arteries of neonates with hypoxemia. We report the first case (to our knowledge) of segmental mediolytic arteritis involving the hepatic arteries. The lesion begins with cytoplasmic vacuolar degeneration of the arterial smooth-muscle cells, which then progresses to coalescence of vacuoles, leading to disruption of the media, intramural hemorrhage, and periadventitial fibrin deposition. Segmental mediolysis results in arterial wall defects, which can lead to dissecting aneurysms or hemorrhage due to arterial rupture. The intima and internal elastica are spared from the lytic process, and there is minimal periadventitial inflammation. Segmental mediolytic arteritis is not a true arteritis; therefore, segmental mediolytic arteriopathy may be a preferable term. Morphological similarities exist between segmental mediolytic arteritis and arterial fibromuscular dysplasia. In our case, hepatic ischemia correlated with mediolysis involving the hepatic arterial branches. Segmental mediolytic arteritis is thought to be due to an inappropriate vasospastic response, developing in the setting of hypoperfusion and hypoxemia.

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

    PubMed

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

    2016-01-01

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

  13. A neural network dynamics that resembles protein evolution

    NASA Astrophysics Data System (ADS)

    Ferrán, Edgardo A.; Ferrara, Pascual

    1992-06-01

    We use neutral networks to classify proteins according to their sequence similarities. A network composed by 7 × 7 neurons, was trained with the Kohonen unsupervised learning algorithm using, as inputs, matrix patterns derived from the bipeptide composition of cytochrome c proteins belonging to 76 different species. As a result of the training, the network self-organized the activation of its neurons into topologically ordered maps, wherein phylogenetically related sequences were positioned close to each other. The evolution of the topological map during learning, in a representative computational experiment, roughly resembles the way in which one species evolves into several others. For instance, sequences corresponding to vertebrates, initially grouped together into one neuron, were placed in a contiguous zone of the final neural map, with sequences of fishes, amphibia, reptiles, birds and mammals associated to different neurons. Some apparent wrong classifications are due to the fact that some proteins have a greater degree of sequence identity than the one expected by phylogenetics. In the final neural map, each synaptic vector may be considered as the pattern corresponding to the ancestor of all the proteins that are attached to that neuron. Although it may be also tempting to link real time with learning epochs and to use this relationship to calibrate the molecular evolutionary clock, this is not correct because the evolutionary time schedule obtained with the neural network depends highly on the discrete way in which the winner neighborhood is decreased during learning.

  14. [Crohn's disease with the onset resembling systemic lupus erythematosus].

    PubMed

    Shimizu, T; Nishinarita, S; Son, K; Tomita, Y; Yoshihiro; Matsukawa; Kitamura, N; Horie, T; Baba, M; Hiranuma, M

    1999-06-01

    We described a 37-year-old man with Crohn's disease (CD) resembling systemic lupus erythematosus (SLE) at his disease onset. He was admitted to the municiple Akiru Hospital in October 1986 by fever, aphtous oral ulcerations, sore throat and polyarthralgia. Hematologic examination showed leukocytopenia, lymphocytopenia, positive tests for antinuclear antibody, anti-DNA antibody and LE cell phenomenon. He has had episodes of convulsion and conciousness loss of unknown etiology when he was 17 years old. The diagnosis of SLE was made, and oral medication of prednisolone was started. Several weeks later, most of symptoms and autoantibodies disappeared, although the oral aphtous ulcerations and leukocytopenia remained. In May 1987, he admitted to the other hospital because of bloody vomiting. Endoscopic examination showed the esophagial ulceration, and histology of biopsied-specimen was nonspecific esophagitis. The combination of prednisolone and oral cyclophosphamide or methotrexate was employed thereafter. However, the leukocytopenia, oral aphtous ulceration and esophagial ulceration continued in spite of these treatments. All the immunosuppressive treatment was stopped at March 1992. In October 1995, he admitted to our hospital because of body weight loss and continuous diarrhea with occasional bloody stool. Barium enema and endoscopic examination of the colon revealed the findings compatible with CD. The patient responded favorably to methylprednisolone pulse therapy followed by oral sulphasalazine. This case indicated that cases with inflammatory bowel diseases like CD could show similar clinical signs and symptoms to SLE, and in some cases of CD might satisfied the classification of criteria for SLE.

  15. Extended lymph node dissection in robotic radical prostatectomy: Current status

    PubMed Central

    Chopra, Sameer; Alemozaffar, Mehrdad; Gill, Inderbir; Aron, Monish

    2016-01-01

    Introduction: The role and extent of extended pelvic lymph node dissection (ePLND) during radical prostatectomy (RP) for prostate cancer patients remains unclear. Materials and Methods: A PubMed literature search was performed for studies reporting on treatment regimens and outcomes in patients with prostate cancer treated by RP and extended lymph node dissection between 1999 and 2013. Results: Studies have shown that RP can improve progression-free and overall survival in patients with lymph node-positive prostate cancer. While this finding requires further validation, it does allow urologists to question the former treatment paradigm of aborting surgery when lymph node invasion from prostate cancer occurred, especially in patients with limited lymph node tumor infiltration. Studies show that intermediate- and high-risk patients should undergo ePLND up to the common iliac arteries in order to improve nodal staging. Conclusions: Evidence from the literature suggests that RP with ePLND improves survival in lymph node-positive prostate cancer. While studies have shown promising results, further improvements and understanding of the surgical technique and post-operative treatment are required to improve treatment for prostate cancer patients with lymph node involvement. PMID:27127352

  16. Preliminary Experience with Vascular Plugs for Parent Artery Occlusion of the Carotid or Vertebral Arteries

    PubMed Central

    Lee, Woosung; Shin, Yong Sam; Kim, Kyung Hyun; Kim, Yong Bae; Hong, Chang-Ki

    2016-01-01

    Objective The purpose of this study was to report the authors' preliminary experience using the Amplatzer Vascular Plug (AVP) (St. Jude Medical, Plymouth, MN, USA) for parent artery occlusion of the internal carotid artery (ICA) or vertebral artery (VA). Materials and Methods Between September 2008 and December 2015, we performed 52 therapeutic parent artery occlusions (PAOs) by an endovascular technique. Among them, 10 patients underwent PAO of the carotid or vertebral arteries using AVPs. Clinical and radiographic data of these patients were retrospectively reviewed. Results The devices were used for VA dissection that presented with subarachnoid hemorrhage (SAH) in five patients, traumatic arteriovenous fistula (AVF) in two patients, spontaneous AVF in one patient, recurrence of carotid-cavernous fistula (CCF) in one patient, and symptomatic unruptured giant ICA aneurysm in one patient. The devices were used in conjunction with detachable and/or pushable coils and in the extracranial segments of the ICA or VA. Complete occlusion of the parent artery was achieved in all patients. There was one intra-procedural rupture of the VA dissection during coiling prior to using the device. Conclusion Results from the current series suggest that the AVP might be used for therapeutic PAO in the extracranial segments of the ICA or VA. PMID:27847763

  17. Peripheral Artery Disease

    MedlinePlus

    ... Physician Resources Professions Site Index A-Z Peripheral Artery Disease (PAD) Peripheral artery disease (PAD) refers to ... is peripheral artery disease treated? What is peripheral artery disease (PAD)? Peripheral artery disease, or PAD, refers ...

  18. Mesenteric artery ischemia

    MedlinePlus

    ... bowel - mesenteric; Dead gut - mesenteric; Atherosclerosis - mesenteric artery; Hardening of the arteries - mesenteric artery ... the aorta, the main artery from the heart. Hardening of the arteries occurs when fat, cholesterol, and ...

  19. Acute aortic dissection at two extreme ages.

    PubMed

    Ramzisham, A R M; Arief, H; Ngoo, K S; Zamrin, D M; Joanna, O S M

    2011-01-01

    Acute aortic dissection is a life-threatening condition, warranting prompt diagnosis and treatment. Management of which incorporates multidisciplinary expertise from the medical, surgical and intensive care. If left untreated, the mortality rate of acute aortic disease exceeds 50% within 48 hours and 80% within two weeks, with a 5-year survival rate of 19%. The most common cause of death in untreated acute aortic dissection, regardless of aetiology, is aortic rupture. We would like to share our successful experience of cases at the two extreme ages of acute aortic dissection. Literature review with their pathogenesis are discussed.

  20. Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

    PubMed Central

    Omar, Sabry; Moore, Tyler; Payne, Drew; Momeni, Parastoo; Mulkey, Zachary; Nugent, Kenneth

    2014-01-01

    We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary. PMID:25104961

  1. Variations in the origin of superior laryngeal artery

    PubMed Central

    Devadas, Deepa; Sukumaran, Tintu Thottiyil

    2016-01-01

    The superior laryngeal artery is the principal artery supplying the laryngeal mucosa, musculature, and glands. Knowledge of variations in the origin of superior laryngeal artery could prove to be very useful during reconstructive surgeries of the larynx, partial laryngectomy, laryngeal transplantation, and also during procedures like super-selective intra-arterial chemotherapy for laryngeal and hypolaryngeal cancers. However, relatively few studies have been done on the superior laryngeal artery in comparison to its clinical importance. The present study was aimed at documenting the prevalence of variable origin of the superior laryngeal artery within the carotid triangle. Sixty hemi-necks obtained from 30 South Indian cadavers were dissected and studied for variations in the origin of superior laryngeal artery. It was observed that the superior laryngeal artery took origin from superior thyroid in 91.7% cases. Variable origin from the external carotid artery was noted in 5% cases. The superior laryngeal artery was found to arise from the lingual artery in one case alone (1.7%). In addition to the above findings, a very rare variation of superior laryngeal artery arising from the ascending pharyngeal (1.7%) was also observed in the hemi-neck of one cadaver. All the variations that were observed were unilateral and on the left side. These findings may help provide further insight to the anatomists, radiologists and surgeons and can help improve performances during surgical manipulations of the larynx. PMID:28127500

  2. Familial resemblance for body composition measures: the HERITAGE Family Study.

    PubMed

    Rice, T; Daw, E W; Gagnon, J; Bouchard, C; Leon, A S; Skinner, J S; Wilmore, J H; Rao, D C

    1997-11-01

    A sex-specific familial correlation model was used to assess the heritable contributions to several measures of body composition in 86 sedentary white families participating in the HERITAGE Family Study. For this study, sedentary families were recruited, tested for a battery of measures, endurance exercise trained for 20 weeks, and remeasured. This sample is unique in that activity level was controlled for in these families at baseline measurement. In this report, three body composition variables measured at baseline were analyzed, two indexing adiposity (total subcutaneous fat based on eight skinfold measurements [SF8] and percent body fat measured by underwater weighing techniques [%BF]) and one assessing fat free mass ([FFM] derived from underwater weighing). The maximal heritabilities for SF8 (34%) and %BF (62%) were consistent with those reported in previous studies. There were no sex nor generation differences in the familial correlations, and the spouse correlation was significant, consistent with the hypothesis that the familial aggregation reflects genetic and familial environmental factors. However, the results for FFM were very different. The most parsimonious pattern of familial resemblance was consistent with mitochondrial inheritance (i.e., mother-offspring and sibling correlations were equal and were larger than those for spouse and father-offspring pairs). Under the mitochondrial hypothesis, 39% of the variance was accounted for by familial/genetic effects. However, under a nonmitochondrial hypothesis, which could not be ruled out, 65% of the FFM phenotypic variance was accounted for by familial/genetic factors. This high heritability level, as compared with results from previous studies, is consistent with the hypothesis that activity may constitute an important environmental determinant of FFM. These alternative hypotheses for FFM warrant further investigation using complex multilocus-multitrait segregation models, which allow for major genetic

  3. Bilateral extensive cerebral infarction and mesenteric ischemia associated with segmental arterial mediolysis in two young women.

    PubMed

    Basso, Monique Camila; Flores, Patrícia Carrasco; de Azevedo Marques, Ary; de Souza, Guilherme Leme; D'Elboux Guimarães Brescia, Marília; Campos, Cynthia Resende; de Cleva, Roberto; Saldiva, Paulo Hilario Nascimento; Mauad, Thais

    2005-10-01

    Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic non-inflammatory vascular disease that affects mainly muscular arteries of the splanchnic and cerebral territories. Reported herein are two cases of SAM in young women with fatal outcome. One of the patients had an atypical form of the disease, which primarily affected small intestinal submucosal and subserosal arteries, and resulted in acute mesenteric ischemia. The other had bilateral brain infarction with SAM of internal carotid arteries (ICA). Pathological examination of both cases did not reveal the cause of blood flow disturbance: large mesenteric branches of the former and ICA of the latter were free of either dissection or thrombosis; in addition, small intestinal arteries of the first patient did not show signs of vasculitis. These findings suggest that unusual pathways of arterial occlusion and dissection may occur in the context of SAM.

  4. Animal Rights Groups Target High School Dissection.

    ERIC Educational Resources Information Center

    Trotter, Andrew

    1992-01-01

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

  5. Neck dissection: current concepts and future directions.

    PubMed

    Rigual, Nestor R; Wiseman, Sam M

    2004-01-01

    For individuals diagnosed with head and neck cancer, neck dissection may be performed for therapy or disease staging. The classification of neck dissection and the definition of precise anatomic landmarks have allowed for this operation, and its many variations, to become standardized world-wide. SLNBX shows promise in its ability to accurately stage NO head and neck cancer and may allow patients with no micro metastatic disease to avoid neck dissection. Before this technique becomes adopted into routine clinical practice, however, it must first be prospectively scrutinized in large patient populations. Regardless of the future role of SLNBX in the management of head and neck cancer, currently it is only through a complete understanding of the clinical, theoretic, and technical aspects of neck dis-section that surgeons may benefit individual patients and the head and neck cancer patient population as a whole.

  6. A New Idea for Dissecting Tray

    ERIC Educational Resources Information Center

    Branham, Arthur

    1976-01-01

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

  7. [Gross anatomy dissection and the legal control].

    PubMed

    Yamashina, Shohei; Shibata, Yosaburo

    2010-12-01

    In Japan, dissection of human body is generally prohibited by the Penal Code, i.e. the criminal law. However, the Postmortem Examination and Corpse Preservation Act allows for the dissection of the body in very limited situations, that include gross anatomy dissection and pathological and forensic autopsy in medical and dental schools. Growing numbers of co-medical schools have been founded more recently in Japan, and not a small number of co-medical schools try to adopt human body dissection in the course of anatomy education. The present short communication reminds us of the ways of thinking of the Postmortem Examination and Corpse Preservation Act and the Act on Body Donation for Medical and Dental Education in order that anatomy education in medical as well as co-medical schools takes place under the regulation by these two laws.

  8. Managing Dissections of the Thoracic Aorta

    PubMed Central

    WONG, DANIEL R.; LEMAIRE, SCOTT A.; COSELLI, JOSEPH S.

    2010-01-01

    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. PMID:18481490

  9. Localizing intramyocardially embedded left anterior descending artery during coronary bypass surgery: literature review

    PubMed Central

    2013-01-01

    Proper detection of the deeply embedded left anterior descending artery remains a challenge. Many authors proposed different methods for artery identification, such as ultrasound Doppler, cineangiography, retrograde dissection overlying tissues, and exposure over the probe. Choice of the technique often depends on the surgeon's acquaintance and experience. The article compares and summarizes different procedures for the detection of intramyocardially located left anterior descending artery. PMID:24172140

  10. Stent recanalization of carotid tonsillar loop dissection using the Enterprise vascular reconstruction device

    PubMed Central

    Rahal, Jason P.; Gao, Bulang; Safain, Mina G.; Malek, Adel M.

    2014-01-01

    Although advances in endovascular techniques have permitted reconstruction of intimal dissections and related pseudoaneurysms of the extracranial cervical internal carotid artery, highly tortuous tonsillar loop anatomic variants still pose an obstacle to conventional extracranial self-expanding carotid stents. During a 12 year period, nine of 48 cases with cervical carotid dissections were associated with a tonsillar loop. Five patients required endovascular treatment, which was performed using a microcatheter-based technique with the low-profile Enterprise vascular reconstruction device (Codman Neurovascular, Raynham, MA, USA). Technical, radiographic, and clinical outcomes were analyzed for each patient. Dissection etiology was spontaneous in three patients, iatrogenic in one, and traumatic in one. Four near-occlusive tonsillar loop dissections were successfully recanalized during the acute phase. Dissection-related stenosis improved from 90 ± 22% to 31 ± 13%, with tandem stents needed in three instances to seal the inflow zone. There were no procedure-related transient ischemic attacks (TIA), minor/major strokes, or deaths. Angiographic follow-up with a mean of 28.0 ± 21.6 months showed all stents were patent, with average stenosis of 25.2 ± 12.2%. Focal ovalization and kinking of the closed-cell design was noted at the sharpest curve in one patient. Clinical outcome (follow-up of 28.1 ± 21.5 months) demonstrated overall improvement with no clinical worsening, new TIA, or stroke. Tonsillar loop-associated carotid dissections can be successfully and durably recanalized using the low-profile Enterprise stent with excellent long-term patency rate and low procedural risk. The possibility of stent kinking and low radial force should be considered when planning reconstruction with this device. PMID:24642024

  11. Investigation of hemodynamics in the development of dissecting aneurysm within patient-specific dissecting aneurismal aortas using computational fluid dynamics (CFD) simulations.

    PubMed

    Tse, Kwong Ming; Chiu, Peixuan; Lee, Heow Pueh; Ho, Pei

    2011-03-15

    Aortic dissecting aneurysm is one of the most catastrophic cardiovascular emergencies that carries high mortality. It was pointed out from clinical observations that the aneurysm development is likely to be related to the hemodynamics condition of the dissected aorta. In order to gain more insight on the formation and progression of dissecting aneurysm, hemodynamic parameters including flow pattern, velocity distribution, aortic wall pressure and shear stress, which are difficult to measure in vivo, are evaluated using numerical simulations. Pulsatile blood flow in patient-specific dissecting aneurismal aortas before and after the formation of lumenal aneurysm (pre-aneurysm and post-aneurysm) is investigated by computational fluid dynamics (CFD) simulations. Realistic time-dependent boundary conditions are prescribed at various arteries of the complete aorta models. This study suggests the helical development of false lumen around true lumen may be related to the helical nature of hemodynamic flow in aorta. Narrowing of the aorta is responsible for the massive recirculation in the poststenosis region in the lumenal aneurysm development. High pressure difference of 0.21 kPa between true and false lumens in the pre-aneurismal aorta infers the possible lumenal aneurysm site in the descending aorta. It is also found that relatively high time-averaged wall shear stress (in the range of 4-8 kPa) may be associated with tear initiation and propagation. CFD modeling assists in medical planning by providing blood flow patterns, wall pressure and wall shear stress. This helps to understand various phenomena in the development of dissecting aneurysm.

  12. [A case of hepatic artery aneurysm that had formed asymptomatically and penetrated into the duodenum].

    PubMed

    Hatogai, Ken; Nakazawa, Atsushi; Takita, Maiko; Kishino, Ryouhei; Seki, Eri; Iwasaki, Eisuke; Izumiya, Motoko; Maeda, Norio; Motegi, Katsuhiko; Mukai, Kiyoshi; Tsukada, Nobuhiro

    2012-02-01

    A 41-year-old man was admitted to our hospital with gastrointestinal bleeding. Esophagogastroduodenoscopy revealed a submucosal protrusion with erosion in the duodenal bulb which was thought to be the bleeding source. Dynamic CT scan, ultrasonography and angiography of the abdomen revealed a hepatic artery aneurysm and a dilated celiac artery that dissected from its origin. Although we considered percutaneous transcatheter arterial embolization with metallic coils, we chose surgical resection and vascular reconstruction to prevent hepatic ischemia resulting from interruption of collateral circulation. On the 8(th) day, hepatic artery aneurysmectomy and revascularization with a great saphenous vein was carried out without any severe complication. The pathological specimen demonstrated segmental arterial mediolysis.

  13. [Radio-anatomical study of the main trunk of the middle cerebral artery (author's transl)].

    PubMed

    Grellier, P; Roche, J L; Duplay, J

    1978-01-01

    This work corroborates anatomical data well known since G. Lazorthes about the main trunk of the middle cerebral artery. The data are interesting in various fields: Sylvian aneurysms, big sphenoïd ridge meningiomas, extra-intra cranial micro neurosurgical anastomoses. This work is based upon 280 angiographic pictures, 20 dissections of brain arteries and 12 plastic injections of the brain arterial vascular tree. The most important data to point out are variations of length and of division (no division, simple bifurcation, trifurcation or multiple divisions), variability in the central arteries and some rare anomalies like accessory middle cerebral arteries and duplication.

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

    ERIC Educational Resources Information Center

    McCollum, Terry L.

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

  15. Lymph node dissection for Siewert II esophagogastric junction adenocarcinoma: A retrospective study of 3 surgical procedures.

    PubMed

    Duan, Xiao-Feng; Yue, Jie; Tang, Peng; Shang, Xiao-Bin; Jiang, Hong-Jing; Yu, Zhen-Tao

    2017-02-01

    The present study was aimed to investigate the application of right thansthoracic Ivor-Lewis (IL), left transthoracic (LTT), and left thoracoabdominal (LTA) approach in Siewert type II adenocarcinoma of esophagogastric junction (AEG).The data of 196 patients with Siewert type II AEG received surgical resection in our cancer center between January 2014 and April 2016 was retrospectively analyzed. Finally, 136 patients met the inclusion criteria were enrolled in the study and divided into the IL (47 cases), LTT (51 cases), and LTA group (38 cases). Clinical and short-term treatment effects were compared among the 3 groups.The patients with weight loss, diabetes, and heart disease increased in the LTT group (P = 0.054, P = 0.075, and P = 0.063, respectively). Operation time was significantly longest in the IL group (P < 0.001), but the amount of bleeding and tumor size did not significantly differ among the 3 groups (P = 0.176 and P = 0.228, respectively). The IL group had the significantly longest proximal surgical margin (P < 0.001) and most number of total (P < 0.001) and thoracic lymph nodes (P < 0.001) dissected. Both the IL and LTA groups had more abdominal lymph nodes dissected than the LTT group (P < 0.001). In general, the IL and LTT groups had the highest dissection rates of every station of thoracic (P < 0.05) and lower mediastinal lymph nodes (P < 0.05), respectively. The dissection rate of the paracardial, left gastric artery, and gastric lesser curvature lymph nodes did not differ significantly among the 3 groups (P > 0.05), but the dissection rate of the hepatic artery, splenic artery, and celiac trunk lymph nodes was significantly highest in the IL group (P < 0.05). Postoperative hospital stay, perioperative complications, and mortality did not differ significantly among the 3 groups (P > 0.05).Compared with the traditional left transthoracic approach, the Ivor-Lewis approach did not increase

  16. Evaluating dissection in the gross anatomy course: Correlation between quality of laboratory dissection and students outcomes.

    PubMed

    Nwachukwu, Chika; Lachman, Nirusha; Pawlina, Wojciech

    2015-01-01

    Anatomy learned by active exploration through dissection has many proven benefits including improvement of anatomic knowledge. Decreased laboratory time may affect the quality of dissection and ultimately lower student performance in anatomy translating to lower knowledge acquisition. The aim of this study was to determine whether the quality of students' dissection in teams correlates with their performance in the gross anatomy course. Quality of dissections for each team enrolled in a gross anatomy course at Mayo Medical School was evaluated biweekly using a five-point rubric based on course learning objectives. Assessment of anatomic knowledge was based on sequential laboratory practice practical examination scores, achievements on daily audience response system (ARS) quizzes, and final practical, written, and National Board of Medical Examiners(®) (NBME(®) ) Gross Anatomy and Embryology Subject Examinations. Twelve teams comprising 48 students were included in the study. There was a positive correlation between dissection quality and practice practical examination score (R = 0.83) and a negative correlation between dissection quality and ARS quizzes (R = -0.985). Dissection teams with a passing score on their dissection evaluations (>70%) performed better on their final examinations. Based on an end of course survey, students agreed that dissection evaluations should continue to be a part of the course. This study showed that better quality of dissection was associated with higher scores on practice practical examinations, final practical, written, and NBME examinations. The study demonstrated a positive correlation between dissection evaluations, accompanied by formative feedback during the course, and higher scores on final course assessments.

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

    PubMed

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

    2016-05-06

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

  18. Angiographic Anatomy of External Iliac Arteries in the Sheep.

    PubMed

    Joscht, M; Martin, M; Henin, M; Nisolle, J F; Kirschvink, N; Dugdale, A; Godart, B; Coulon, H; Simon, V; Hontoir, F; Graffin, R; De Raeve, Y; Vandeweerd, J M

    2016-12-01

    External iliac artery atherosclerotic disease and aneurism occur in man. For treatment, imaging is required to facilitate minimally invasive introduction and advancement of stents within the intended vessels. Sheep are commonly used to test and improve stents. However, little information is published regarding the angiographic anatomy of the iliac arteries in the ovine species. The objective of this study was to describe the angiographic anatomy of the iliac arteries in the sheep. Computed tomography (CT) angiography and gross anatomical dissection were performed in, respectively, 10 and 43 adult ewes. Diameters and lengths of the arteries were measured. In comparison with man, salient anatomical differences were identified in the sheep: (1) the absence of common iliac arteries, (2) the common trunk at the origin of internal iliac arteries and (3) the location of the bifurcation of the external iliac arteries into femoral arteries in the pelvis (not in the limb). External iliac arteries in this series of sheep were 86 mm long in average and had a mean diameter of 7.5 mm. Lengths of arteries are only slightly different between man and sheep, while diameters are rather similar. Therefore, the sheep model appears to be sufficiently similar to man to test stent properties. This study provides useful reference images and measures of lengths and diameters of relevant arteries that could be applied to research with ovine models.

  19. Ventricular Tachycardia and Resembling Acute Coronary Syndrome During Pheochromocytoma Crisis: A Case Report.

    PubMed

    Li, Shi-Jun; Wang, Tao; Wang, Lin; Pang, Zhan-Qi; Ma, Ben; Li, Ya-Wen; Yang, Jian; Dong, He

    2016-04-01

    Pheochromocytomas are neuroendocrine tumors, and its cardiac involvement may include transient myocardial dysfunction, acute coronary syndrome (ACS), and even ventricular arrhythmias.A patient was referred for evaluation of stuttering chest pain, and his electrocardiogram showed T-wave inversion over leads V1 to V4. Coronary angiography showed 90% stenosis in the mid-left anterior descending coronary artery (LAD), which was stented. Five days later, the patient had ventricular tachycardia, and severe hypertension, remarkable blood pressure fluctuation between 224/76 and 70/50 mm Hg. The patient felt abdominal pain and his abdominal ultrasound showed suspicious right adrenal gland tumor. Enhanced computed tomography of adrenal gland conformed that there was a tumor in right adrenal gland accompanied by an upset level of aldosterone.The tumor was removed by laparoscope, and the pathological examination showed pheochromocytoma. After the surgery, the blood pressure turned normal gradually. There was no T-wave inversion in lead V1-V4. Our case illustrates a rare pheochromocytoma presentation with a VT and resembling ACS. In our case, the serious stenosis in the mid of LAD could be explained by worsen the clinical course of myocardial ischemia or severe coronary vasospasm by the excessive amounts of catecholamines released from the tumor. Coronary vasospasm was possible because he had no classic coronary risk factors (e.g. family history and smoking habit, essential hypertension, hyperglycemia and abnormal serum lipoprotein, high body mass index). Thus, pheochromocytoma was missed until he revealed the association of his symptoms with abdominalgia.As phaeochromocytomas that present with cardiovascular complications can be fatal, it is necessary to screen for the disease when patients present with symptoms indicating catecholamine excess.

  20. Evolution of a chronic dissecting aneurysm on magnetic resonance imaging in a pediatric patient.

    PubMed

    Chen, Long; Yau, Ivanna; deVeber, Gabrielle; Dirks, Peter; Armstrong, Derek; Krings, Timo

    2015-02-01

    Clinical and imaging manifestations of the so-called partially thrombosed aneurysm (PTA) are different from those of the classic intracranial saccular aneurysm. Given some of their peculiar imaging features, it had been hypothesized that some PTAs occur due to repeated intramural hemorrhages. The authors present a case of PTA that evolved from an acute dissecting aneurysm as shown by serial imaging. A previously healthy 5-year-old boy had a sudden onset of left hemiparesis. Initial MRI sequences showed a perforating vessel infarction in the right basal ganglia area secondary to an acute distal middle cerebral artery (MCA) dissection as demonstrated on conventional angiography. Conservative management with close observation of this dissection was chosen, and serial MRI studies revealed layering of blood of various ages within the wall of an aneurysmal outpouching of the MCA, thereby leading to the imaging appearance of a PTA. The findings in this case indicate that some PTAs may be caused by repeated or chronic dissections, with blood entering the wall through an endothelial defect. Understanding the pathological mechanism underlying the formation of these aneurysms will help inform appropriate treatment strategies.

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

    ERIC Educational Resources Information Center

    Oakley, Jan

    2012-01-01

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

  2. Exertional leg pain: teasing out arterial entrapments.

    PubMed

    Pham, Thomas T; Kapur, Rahul; Harwood, Marc I

    2007-12-01

    Vascular causes of exertional lower extremity pain are relatively rare, but may be the answer in athletes refractory to treatment for the more common overuse syndromes of the lower extremities. It is important to differentiate these vascular causes from chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), and stress fractures in order to develop appropriate treatment plans, avoid complications, and return athletes to play expeditiously. Important vascular etiologies to be considered are popliteal artery entrapment syndrome (PAES), endofibrotic disease, popliteal artery aneurysm, cystic adventitial disease, and peripheral arterial dissections. The diagnostic workup involves angiography or noninvasive vascular studies such as Doppler ultrasound or magnetic resonance angiography in both the neutral and provocative positions. Treatment of these vascular abnormalities typically involves surgical correction of the vascular anomaly.

  3. Coronary Artery Bypass Grafting

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...

  4. Management of type A dissection with malperfusion

    PubMed Central

    Yang, Bo; Patel, Himanshu J.; Williams, David M.; Dasika, Narasimham L.

    2016-01-01

    Malperfusion is a common lethal complication of acute aortic dissection following rupture, for which the optimal management strategy has yet to be clearly established. The objective of this study was to reassess the management of acute type A aortic dissection (Type A-AAD) with malperfusion. We retrospectively analyzed the outcomes of all patients with Type A-AAD with malperfusion at the University of Michigan and compared the results from patients that directly underwent open surgical repair versus those who had percutaneous reperfusion prior to open surgical repair. Based on the results, we developed a patient care protocol for the treatment of all patients with acute type A dissection. We later re-analyzed the long-term outcomes for patients using the protocol. The present study demonstrated that, although the outcomes for patients with acute type A aortic dissection with malperfusion syndrome treated with initial percutaneous reperfusion and delayed open surgical intervention are not as good as the results for patients with uncomplicated Type A-AAD that undergo immediate surgical repair, their outcomes continue the long-term outcomes of the former group are superior. To outdo patients with acute type A aortic dissection with malperfusion syndrome treated with immediate open surgical intervention. In conclusion, at the University of Michigan we continue to use our patient care protocol to treat patients with Type A-AAD. PMID:27563540

  5. Arterial embolism

    MedlinePlus

    ... for embolization (especially to the brain) is mitral stenosis . Endocarditis (infection of the inside of the heart) can also cause arterial emboli. A common source for an embolus is from areas of hardening (atherosclerosis) in the aorta and other large blood vessels. These clots can ...

  6. Arterial endofibrosis in professional cyclists

    PubMed Central

    VERALDI, G.F.; MACRÌ, M.; CRISCENTI, P.; SCORSONE, L.; ZINGARETTI, C.C.; GNONI, M.; MEZZETTO, L.

    2015-01-01

    External Iliac Artery Endofibrosis (EIAE) is an uncommon disease usually affecting young, otherwise healthy, patients. It usually involves cyclists but cases have been reported in other groups of endurance athletes. The external iliac artery is the most affected anatomical site but other locations are described too. The precise pathophysiology and long-term evolution of the disease still remain unknown. The diagnosis may be challenging and delayed as the patients usually present symptoms only in extreme conditions and physical and instrumental examinations may be normal at rest. We present two cases of young professional cyclists who suffered of exercise-induced leg pain which led them to reduce running. Both patients were firstly treated with balloon angioplasty that rapidly failed to improve their symptoms. The successive open surgery with endofibrosectomy and autologous saphenous vein closure patch completely resolved physical limitations. EIAE is a rare disease that can induce arterial stenosis, thrombosis, dissection and secondary atheroma. After-exercise ankle-brachial index represents a useful diagnostic criterion. Careful observation of angio-CT may strengthen the suspect. Knowledge of the these features allows a better pre-operative assessment and an early effective treatment. Surgical revascularization remains the gold standard approach. PMID:26888703

  7. Complex Reoperation for Late Complications After Acute Type A Aortic Dissection Surgery

    PubMed Central

    Stöger, Guillermo; Ríos, Matías; Battellini, Roberto; Bracco, Daniel; Kotowicz, Vadim

    2015-01-01

    The correct management of acute Type A dissection continues to be a challenge. The primary goal is to save the patient´s life. However, the decision regarding the surgical approach determines possible later complications. We present the case of a 59-year-old female patient with a past history of emergent surgery for acute Type A dissection treated by supracoronary ascending and aortic valve replacement 19 years previously. Later, in a second endovascular approach, the descending aorta was treated by a thoracic endoprosthesis. During follow-up a dilated aortic root and a Type I endoleak were observed, and complex reoperation was required. We performed a total aortic arch replacement with a 4-branched graft and a complete aortic root replacement using the Cabrol technique for the reinsertion of the coronary arteries. The mechanical aortic normally functioning valve was preserved. The patient was discharged 30 days postoperatively. PMID:27390749

  8. Dissection of the aorta in Turner's syndrome.

    PubMed Central

    Price, W H; Wilson, J

    1983-01-01

    Three deaths from dissection of the aorta in a series of 157 adult women with Turner's syndrome are reported. These are greatly in excess of the numbers expected. None of the three patients had a coarctation of the aorta. One had aortic regurgitation but there was no reason to believe that the aorta in the other two patients had been subjected to unusual haemodynamic stresses. Cystic medial necrosis of the aorta was described in two patients on whom necropsies were carried out. It is concluded that there is probably a greatly increased risk of dissection of the aorta in Turner's syndrome even in the absence of any other abnormality of the aorta and aortic valve. Previously reported cases of aortic dissection in Turner's syndrome are discussed. PMID:6842536

  9. The nature of dissection: Exploring student conceptions

    NASA Astrophysics Data System (ADS)

    York, Katharine

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

  10. A coincidental variation of the axillary artery: the brachioradial artery and the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle

    PubMed Central

    Konarik, Marek; Kachlik, David; Baca, Vaclav

    2014-01-01

    A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the “radial artery with high origin”). Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus. PMID:25428677

  11. A coincidental variation of the axillary artery: the brachioradial artery and the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle.

    PubMed

    Konarik, Marek; Kachlik, David; Baca, Vaclav

    2014-09-11

    A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the "radial artery with high origin"). Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus.

  12. Emotional Family Resemblances? Darwin's Contributions to a Theory of Emotions and Emotional Development.

    ERIC Educational Resources Information Center

    Hesse, Petra

    A family resemblance model of emotions is proposed which uses Darwin's discussion of emotions and Eleanor Rosch's and the philosopher Ludwig Wittgenstein's work on family resemblances. In Darwin's discussion of emotions, certain core features are thought to be widely shared by the members of the respective families of emotions, and more marginal…

  13. Wrapping procedure for stanford type a acute aortic dissection: is there an indication for surgery without a cardiopulmonary bypass?

    PubMed

    Lopez, Stéphane; Roux, Daniel; Cazavet, Alexandre; Tapia, Michel; Teboul, Jacques; Leobon, Bertrand; Glock, Yves

    2012-09-01

    A wrapping procedure for acute type A aortic dissection was performed on six elderly patients at high risk for conventional surgery. Aortic valve insufficiency was mild, with no malperfusion syndrome. A Teflon plaque or Dacron vascular prosthesis was passed around the aorta and tightened from the coronary ostia to the innominate artery. No severe neurologic complications or deaths occurred in the postoperative period. Computed tomography and magnetic resonance imaging imaging during follow-up showed aortic diameters had stabilized in all patients.

  14. Independent risk factors for hypoxemia after surgery for acute aortic dissection

    PubMed Central

    Sheng, Wei; Yang, Hai-Qin; Chi, Yi-Fan; Niu, Zhao-Zhuo; Lin, Ming-Shan; Long, Sun

    2015-01-01

    Objectives: To determine risk factors associated with postoperative hypoxemia after surgery for acute type A aortic dissection. Methods: We retrospectively analyzed the clinical data of 192 patients with acute type A aortic dissection who underwent surgery in Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, China between January 2007 and December 2013. Patients were divided into hypoxemia group (n=55) [arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤200 mm Hg] and non-hypoxemia group (n=137) [PaO2/FiO2 >200 mm Hg]. Perioperative clinical data were analyzed and compared between the 2 groups. Results: The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.6% (55/192). Perioperative death occurred in 13 patients (6.8%). Multivariate regression identified body mass index (BMI) >25 kg/m2 (OR=21.929, p=0.000), deep hypothermic circulatory arrest (DHCA) (OR=11.551, p=0.000), preoperative PaO2/FiO2 ≤300 mm Hg (OR=7.830, p=0.000) and blood transfusion >6U in 24 hours postoperatively (OR=12.037, p=0.000) as independent predictors of postoperative hypoxemia for patients undergoing Stanford A aortic dissection surgery. Conclusion: Our study demonstrated that BMI >25 kg/m2, DHCA, preoperative PaO2/FiO2 ≤300 mm Hg, and blood transfusion in 24 hours postoperatively >6U were independent risk factors of the hypoxemia after acute type A aortic dissection aneurysm surgery. PMID:26219444

  15. The medial sural artery perforator free flap.

    PubMed

    Cavadas, P C; Sanz-Giménez-Rico, J R; Gutierrez-de la Cámara, A; Navarro-Monzonís, A; Soler-Nomdedeu, S; Martínez-Soriano, F

    2001-11-01

    The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. The possible use of these musculocutaneous perforators as the source of a perforator-based free flap was investigated in cadavers. Ten legs were dissected, and the topography of significant perforating musculocutaneous vessels on both the medial and the lateral gastrocnemius muscles was recorded. A mean of 2.2 perforators (range, 1 to 4) was noted over the medial gastrocnemius muscle, whereas in only 20 percent of the specimens was a perforator of moderate size noted over the lateral gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease. When two perforators were present (the most frequent case), the perforators were located at a mean of 11.8 cm (range, 8.5 to 15 cm) and 17 cm (range, 15 to 19 cm) from the popliteal crease. A series of six successful clinical cases is reported, including five free flaps and one pedicled flap for ipsilateral lower-leg and foot reconstruction. The dissection is somewhat tedious, but the vascular pedicle can be considerably long and of suitable caliber. Donor-site morbidity was minimal because the muscle was not included in the flap. Although the present series is short, it seems that the medial sural artery perforator flap can be a useful flap for free and pedicled transfer in lower-limb reconstruction.

  16. Acute thoracic aortic dissection: how to defuse a time bomb.

    PubMed

    McClarren-Curry, C; Shaughnessy, K

    1999-01-01

    Acute thoracic aortic dissection is frequently misdiagnosed, and even with surgical intervention, the mortality rate is 50%. This article focuses on assessment, interventions, and postoperative care of patients with aortic dissection.

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

    ERIC Educational Resources Information Center

    Lapp, David R.; Keenan, James E.

    1991-01-01

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

  18. Squid Dissection: From Pen to Ink.

    ERIC Educational Resources Information Center

    Brown, Cindy; Kisiel, Jim

    2003-01-01

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

  19. Nested Dissection Interface Reconstruction in Pececillo

    SciTech Connect

    Jibben, Zechariah Joel

    2016-08-31

    A nested dissection method for interface reconstruction in a volume tracking framework has been implemented in Pececillo. This method provides a significant improvement over the traditional onion-skin method, which does not appropriately handle T-shaped multimaterial intersections and dynamic contact lines present in additive manufacturing simulations. The resulting implementation lays the groundwork for further re- search in numerical contact angle estimates.

  20. Alpha-1 Antitrypsin Deficiency Presenting with MPO-ANCA Associated Vasculitis and Aortic Dissection

    PubMed Central

    van Schaik, Jan; Crobach, Stijn L. P.; van Rijswijk, Catharina S. P.; Rotmans, Joris I.

    2017-01-01

    The combination of alpha-1 antitrypsin (AAT) deficiency, ANCA-vasculitis, and aortic aneurysm has been rarely described in literature. We report an eventually fatal case in a 70-year-old patient who initially presented with giant cell arteritis and ANCA associated glomerulonephritis. Several years later, he presented with aortic dissection due to large vessel vasculitis, raising the suspicion of AAT deficiency, as two first-line relatives had chronic obstructive pulmonary disease, while they never smoked. This diagnosis was confirmed by AAT electrophoresis and immunohistochemistry on a temporal artery biopsy. Considering AAT deficiency in these cases might lead to a more timely diagnosis. PMID:28367219

  1. Glomus tumor of the stomach: a case treated by endoscopic submucosal dissection.

    PubMed

    Xu, Min; Jiang, Xiao-Meng; He, Ya-Long; Zhang, You-Li; Xu, Mei-Dong; Yao, Li-Qing

    2011-04-01

    Glomus tumors, as a type of quite rare neoplasms, originate from modified smooth muscle cells of the glomus body whose function is to regulate blood flow within arteries according to the body temperature. Although these tumors most commonly occur in the peripheral soft tissues, especially in the distal parts of extremities, there have been rare reports of visceral involvement (Lorber et al., 2005) [1]. We report a case of gastric glomus tumor, which was preoperatively diagnosed by ultrasonic endoscopy as a gastric stromal tumor and treated by endoscopic submucosal dissection (ESD).

  2. Vascular patterns of upper limb: an anatomical study with accent on superficial brachial artery

    PubMed Central

    Kachlik, David; Konarik, Marek; Baca, Vaclav

    2011-01-01

    The aim of the study was to evaluate the terminal segmentation of the axillary artery and to present four cases of anomalous branching of the axillary artery, the superficial brachial artery (arteria brachialis superficialis), which is defined as the brachial artery that runs superficially to the median nerve. Totally, 130 cadaveric upper arms embalmed by classical formaldehyde technique from collections of the Department of Anatomy, Third Faculty of Medicine, Charles University in Prague, were macroscopically dissected with special focus on the branching arrangement of the axillary artery. The most distal part of the axillary artery (infrapectoral part) terminated in four cases as a bifurcation into two terminal branches: the superficial brachial artery and profunda brachii artery, denominated according to their relation to the median nerve. The profunda brachii artery primarily gave rise to the main branches of the infrapectoral part of the axillary artery. The superficial brachial artery descended to the cubital fossa where it assumed the usual course of the brachial artery in two cases and in the other two cases its branches (the radial and ulnar arteries) passed superficially to the flexors. The incidence of the superficial brachial artery in our study was 5% of cases. The reported incidence is a bit contradictory, from 0.12% to 25% of cases. The anatomical knowledge of the axillary region is of crucial importance for neurosurgeons and specialists using the radiodiagnostic techniques, particularly in cases involving traumatic injuries. The improved knowledge would allow more accurate diagnostic interpretations and surgical treatment. PMID:21342134

  3. Segmental Arterial Mediolysis in Pigs Presenting With Renal Infarcts.

    PubMed

    Leifsson, P S; Slavin, R E

    2015-11-01

    Segmental arterial mediolysis, a rare arteriopathy first reported in humans, is described in the kidneys of 36 pigs slaughtered in an abattoir in Jutland, Denmark. The kidney changes presented themselves macroscopically as one or more cortical wedge-shaped hemorrhagic or pale lesions. The arterial lesions involved the interlobar and arcuate arteries and exhibited injurious and reparative phases of development. Two types of injurious lesions occurred: (1) a tearing separation of the outer media from the adventitia with fibrin, erythrocytes, and edema fluid filling the formed space, causing collapse of the arterial wall, and (2) outer and mid-medial foci showing irregularly bordered cytoplasmic vacuolar change containing membranous and organelle debris or smooth muscle shrinkage with nuclear loss. In the reparative phase, granulation tissue filled and expanded tear sites and zones of arterial medial muscle loss and extended into the adventitia and through the intima into the arterial lumen. Sequelae, including dissecting hematomas and arterial occlusions causing renal infarcts, were found. Although repartitioning agents widely used in animal husbandry in many countries may potentially cause segmental arterial mediolysis, no such link could be identified. The causation of segmental arterial mediolysis in these pigs is currently unknown but is being further investigated.

  4. Anomalous supratendinous course of the fifth extensor compartment artery: a case report.

    PubMed

    Tracy, C Alan

    2007-12-01

    Vascularized bone grafts have been successfully used in the treatment of carpal bone nonunion and avascular necrosis. The 4 + 5 extensor compartmental vascularized bone graft based on the fourth extensor compartment artery with retrograde blood flow through the fifth extensor compartment artery is the pedicle of choice for vascularized bone grafting of the lunate. This case report describes an anomalous supratendinous course of the fifth extensor compartment artery. The recognition of this anatomic variant is important for the safe dissection of the fifth extensor compartment artery.

  5. Conspicuousness, color resemblance, and toxicity in geographically diverging mimicry: The pan-Amazonian frog Allobates femoralis.

    PubMed

    Amézquita, Adolfo; Ramos, Óscar; González, Mabel Cristina; Rodríguez, Camilo; Medina, Iliana; Simões, Pedro Ivo; Lima, Albertina Pimentel

    2017-01-09

    Predation risk is allegedly reduced in Batesian and Müllerian mimics, because their coloration resembles the conspicuous coloration of unpalatable prey. The efficacy of mimicry is thought to be affected by variation in the unpalatability of prey, the conspicuousness of the signals, and the visual system of predators that see them. Many frog species exhibit small colorful patches contrasting against an otherwise dark body. By measuring toxicity and color reflectance in a geographically variable frog species and the syntopic toxic species, we tested whether unpalatability was correlated with between-species color resemblance and whether resemblance was highest for the most conspicuous components of coloration pattern. Heterospecific resemblance in colorful patches was highest between species at the same locality, but unrelated to concomitant variation in toxicity. Surprisingly, resemblance was lower for the conspicuous femoral patches compared to the inconspicuous dorsum. By building visual models, we further tested whether resemblance was affected by the visual system of model predators. As predicted, mimic-model resemblance was higher under the visual system of simulated predators compared to no visual system at all. Our results indicate that femoral patches are aposematic signals and support a role of mimicry in driving phenotypic divergence or mimetic radiation between localities.

  6. Variation in the Branching Pattern of Third Part of Axillary Artery- A Case Report

    PubMed Central

    Banerjee, Aritra; Kumari, Chiman

    2017-01-01

    Anatomical variation of the branching pattern of axillary artery is very common. The knowledge of this variation is often useful during different surgical and interventional procedures. Variations include typically of Lateral Thoracic Artery (LTA) and Posterior Circumflex Humeral Artery (PCHA). The present case has been reported to document the variation of LTA and PCHA. The axilla of a 65-year-old embalmed female cadaver was routinely dissected for educational purpose in the Department of Anatomy, AIIMS, New Delhi, India. Cunnighams Manual of Dissection was followed during the whole dissection procedure. We found that the third part of axillary artery gave rise to a common trunk which divided into PCHA and LTA. The PCHA curved backwards around the humeral neck and made anastomosis with the anterior circumflex humeral artery. The LTA supplied serratus anterior and the pectoral muscles and made anastomosis with intercostal arteries. The axillary nerve accompanied PCHA while the thoracodorsal nerve accompanied LTA. The rare anatomical variation of the branching pattern of axillary artery is assumed to be helpful in the surgical procedures and various therapeutic interventions of the upper limb. PMID:28384847

  7. Spontaneous coronary artery dissection—A review

    PubMed Central

    Yip, Amelia

    2015-01-01

    Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). Unfortunately, SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Lack of angiographic recognition from clinicians is a major factor of under-diagnosis. With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved diagnosis of SCAD. The aim of this paper is to review the epidemiology, etiology, presentation, diagnosis and management of SCAD. PMID:25774346

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

    ERIC Educational Resources Information Center

    Akpan, Joseph; Strayer, Jeremy

    2010-01-01

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

  9. Variant Branching Pattern of Superior Thyroid Artery and Its Clinical Relevance: A Case Report

    PubMed Central

    Motwani, Rohini

    2015-01-01

    Thyroid surgeries are most common neck surgeries; hence thorough knowledge of the blood supply of this gland to the surgeons is of immense importance to prevent any alarming haemorrhage. We report a rare unilateral branching pattern of superior thyroid artery (STA) on right side during routine dissection on an adult male cadaver in the Department of Anatomy, A.I.I.M.S, New Delhi. Left superior thyroid artery was normal. The common trunk (CT) arose from anterior surface of right external carotid artery (ECA) just above the bifurcation of common carotid artery (CCA) soon dividing into five branches i.e., infrahyoid, superior laryngeal, superior thyroid, cricothyroid and sternocleidomastoid artery. This variant branching pattern of STA is very rare. The inferior thyroid arteries did not show any unusual distribution. Knowledge of such arterial variations related to the thyroid gland is immensely helpful to the surgeons to avoid damage of the vital organs in this region. PMID:26266110

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

    PubMed Central

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

    1986-01-01

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

  11. Carotid Artery Disease

    MedlinePlus

    ... brain with blood. If you have carotid artery disease, the arteries become narrow, usually because of atherosclerosis. ... one of the causes of stroke. Carotid artery disease often does not cause symptoms, but there are ...

  12. Coronary artery fistula

    MedlinePlus

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the ...

  13. A method to quantify and visualize femoral head intraosseous arteries by micro-CT.

    PubMed

    Qiu, Xing; Shi, Xiaotian; Ouyang, Jun; Xu, Dachuan; Zhao, Dewei

    2016-08-01

    dissection and thus significantly shortens the time required to quantify and display intraosseous arteries. This method provides a simple and rapid technique for quantifying and visualizing human intraosseous arteries.

  14. RESEMBLANCES BETWEEN THE ELECTROMOTOR VARIATIONS OF RHYTHMICALLY REACTING LIVING AND NON-LIVING SYSTEMS.

    PubMed

    Lillie, R S

    1929-09-20

    1. The electromotor variations of pure iron wires, arranged to react rhythmically with nitric acid, are recorded and described. 2. Resemblances between these variations and those of rhythmically reacting living tissues (especially the heart) are pointed out and discussed.

  15. Lymph Node Dissection for Differentiated Thyroid Cancer

    PubMed Central

    Mizrachi, Aviram; Shaha, Ashok R.

    2017-01-01

    Lymph node metastases in differentiated thyroid cancer (DTC) have a wide spectrum of clinical significance. Several variables are taken under consideration when trying to decide on the optimal management of patients with DTC. Routine prophylactic central and/or lateral lymph node dissection is not advocated with exception of central neck dissection for locally advanced tumors. When regarding recurrent disease, foundations have been laid for clinicians to make accurate decisions as to when to perform surgery and when to continue maintaining the patient’s disease under observation. These complex decisions are determined based upon multiple factors, not only regarding the patient’s disease but also the patient’s comprehension of the procedure and apprehension levels. Nevertheless if the patient and/or clinician are emotionally keen to surgically remove the disease then the procedure should be considered. PMID:28117285

  16. Counter traction makes endoscopic submucosal dissection easier.

    PubMed

    Oyama, Tsuneo

    2012-11-01

    Poor counter traction and poor field of vision make endoscopic submucosal dissection (ESD) difficult. Good counter traction allows dissections to be performed more quickly and safely. Position change, which utilizes gravity, is the simplest method to create a clear field of vision. It is useful especially for esophageal and colon ESD. The second easiest method is clip with line method. Counter traction made by clip with line accomplishes the creation of a clear field of vision and suitable counter traction thereby making ESD more efficient and safe. The author published this method in 2002. The name ESD was not established in those days; the name cutting endoscopic mucosal resection (EMR) or EMR with hook knife was used. The other traction methods such as external grasping forceps, internal traction, double channel scope, and double scopes method are introduced in this paper. A good strategy for creating counter traction makes ESD easier.

  17. [Open submucosal dissection: first case described].

    PubMed

    Portanova, Michel; Vesco, Eduardo; Morales, Domingo

    2007-01-01

    Endoscopic submucosal dissection is a new treatment, basically for the management of early gastric cancer, it is also a good option for large benign lesions if a "una pieza" resection needs to be performed. However this technique requires not only gastroenterologist with proven technical skill, but also some special devices not necessarily disposables in our country. The present paper describes the case of a patient with a large hyperplastic polyp located in the upper third of the stomach who underwent an open endoscopic submucosal dissection to resect the lesion owing to its size and characteristics. According our knowledge this is the first case in the medical literature describing the use of this technique during an open surgery.

  18. Donors' attitudes towards body donation for dissection.

    PubMed

    Richardson, R; Hurwitz, B

    1995-07-29

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

  19. Nested Dissection Interface Reconstruction in Pececillo

    SciTech Connect

    Jibben, Zechariah Joel; Carlson, Neil N.; Francois, Marianne M.

    2016-09-13

    A nested dissection method for interface reconstruction in a volume tracking framework has been implemented in Pececillo, a mini-app for Truchas, which is the ASC code for casting and additive manufacturing. This method provides a significant improvement over the traditional onion-skin method, which does not appropriately handle T-shaped multimaterial intersections and dynamic contact lines present in additive manufacturing simulations. The resulting implementation lays the groundwork for further research in contact angle estimates and surface tension calculations.

  20. Hardening of the arteries

    MedlinePlus

    Atherosclerosis; Arteriosclerosis; Plaque buildup - arteries; Hyperlipidemia - atherosclerosis; Cholesterol - atherosclerosis ... cause of heart attack and stroke. High blood cholesterol levels can cause hardening of the arteries at ...

  1. Who Resembles Whom? Mimetic and Coincidental Look-Alikes among Tropical Reef Fishes

    PubMed Central

    Robertson, D. Ross

    2013-01-01

    Studies of mimicry among tropical reef-fishes usually give little or no consideration to alternative explanations for behavioral associations between unrelated, look-alike species that benefit the supposed mimic. I propose and assess such an alternative explanation. With mimicry the mimic resembles its model, evolved to do so in response to selection by the mimicry target, and gains evolved benefits from that resemblance. In the alternative, the social-trap hypothesis, a coincidental resemblance of the model to the “mimic” inadvertently attracts the latter to it, and reinforcement of this social trapping by learned benefits leads to the “mimic” regularly associating with the model. I examine three well known cases of supposed aggressive mimicry among reef-fishes in relation to nine predictions from these hypotheses, and assess which hypothesis offers a better explanation for each. One case, involving precise and complex morphological and behavioral resemblance, is strongly consistent with mimicry, one is inconclusive, and one is more consistent with a social-trap based on coincidental, imprecise resemblance. Few cases of supposed interspecific mimicry among tropical reef fishes have been examined in depth, and many such associations may involve social traps arising from generalized, coincidental resemblance. Mimicry may be much less common among these fishes than is generally thought. PMID:23372795

  2. Building mental models by dissecting physical models.

    PubMed

    Srivastava, Anveshna

    2016-01-01

    When students build physical models from prefabricated components to learn about model systems, there is an implicit trade-off between the physical degrees of freedom in building the model and the intensity of instructor supervision needed. Models that are too flexible, permitting multiple possible constructions require greater supervision to ensure focused learning; models that are too constrained require less supervision, but can be constructed mechanically, with little to no conceptual engagement. We propose "model-dissection" as an alternative to "model-building," whereby instructors could make efficient use of supervisory resources, while simultaneously promoting focused learning. We report empirical results from a study conducted with biology undergraduate students, where we demonstrate that asking them to "dissect" out specific conceptual structures from an already built 3D physical model leads to a significant improvement in performance than asking them to build the 3D model from simpler components. Using questionnaires to measure understanding both before and after model-based interventions for two cohorts of students, we find that both the "builders" and the "dissectors" improve in the post-test, but it is the latter group who show statistically significant improvement. These results, in addition to the intrinsic time-efficiency of "model dissection," suggest that it could be a valuable pedagogical tool.

  3. Future directions of duodenal endoscopic submucosal dissection

    PubMed Central

    Matsumoto, Satohiro; Miyatani, Hiroyuki; Yoshida, Yukio

    2015-01-01

    Endoscopic therapies for lesions of the duodenum are technically more difficult than those for lesions of the other parts of the gastrointestinal tract due to the anatomical features of the duodenum, and the incidence rate of complications such as perforation and bleeding is also higher. These aforementioned trends were especially noticeable for the case of duodenal endoscopic submucosal dissection (ESD). The indication for ESD of duodenal tumors should be determined by assessment of the histopathology, macroscopic morphology, and diameter of the tumors. The three types of candidate lesions for endoscopic therapy are adenoma, carcinoma, and neuroendocrine tumors. For applying endoscopic therapies to duodenal lesions, accurate preoperative histopathological diagnosis is necessary. The most important technical issue in duodenal ESD is the submucosal dissection process. In duodenal ESD, a short needle-type knife is suitable for the mucosal incision and submucosal dissection processes, and the Small-caliber-tip Transparent hood is an important tool. After endoscopic therapies, the wound should be closed by clipping in order to prevent complications such as secondary hemorrhage and delayed perforation. At present, the criteria for selection between ESD and EMR vary among institutions. The indications for ESD should be carefully considered. Duodenal ESD should have limitations, such as the need for its being performed by experts with abundant experience in performing the procedure. PMID:25901218

  4. Whole vitreous humor dissection for vitreodynamic analysis.

    PubMed

    Murali, Karthik; Kashani, Amir H; Humayun, Mark S

    2015-05-24

    The authors propose an effective technique to isolate whole, intact vitreous core and cortex from post mortem enucleated porcine eyes. While previous studies have shown the results of such dissections, the detailed steps have not been described, precluding researchers outside the field from replicating their methods. Other studies harvest vitreous either through aspiration, which does not maintain the vitreous structure anatomy, or through partial dissection, which only isolates the vitreous core. The proposed method isolates the whole vitreous body, with the vitreous core and cortex intact, while maintaining vitreous anatomy and structural integrity. In this method, a full thickness scleral flap in an enucleated porcine eye is first created and through this, the choroid tissue can be separated from the sclera. The scleral flap is then expanded and the choroid is completely separated from the sclera. Finally the choroid-retina tissue is peeled off the vitreous to leave an isolated intact vitreous body. The proposed vitreous dissection technique can be used to study physical properties of the vitreous humor. In particular, this method has significance for experimental studies involving drug delivery, vitreo-retinal oxygen transport, and intraocular convection.

  5. Supravital morphology of small branches of lateral striate arteries as observed with Nomarski optics.

    PubMed

    Gouveia, C J

    1996-01-01

    Lateral striate arteries were dissected from the fixed brains of 6 patients of increasing age. Small branches of arteries were observed--unprocessed and unstained--by Nomarski optics. Among the findings there was fibrous intimal proliferation, replacement of medial muscle by collagen, tortuosity, twisting or coiling. The severity of changes seemed to progress with aging. The advantages of the used methodology that aims at avoiding artifacts of processing are discussed briefly.

  6. Arterial vascularization patterns of the splenium: An anatomical study.

    PubMed

    Kahilogullari, G; Comert, A; Ozdemir, M; Brohi, R A; Ozgural, O; Esmer, A F; Egemen, N; Karahan, S T

    2013-09-01

    The aim of this study was to provide detailed information about the arterial vascularization of the splenium of the corpus callosum (CC). The splenium is unique in that it is part of the largest commissural tract in the brain and a region in which pathologies are seen frequently. An exact description of the arterial vascularization of this part of the CC remains under debate. Thirty adult human brains (60 hemispheres) were obtained from routine autopsies. Cerebral arteries were separately cannulated and injected with colored latex. Then, the brains were fixed in formaldehyde, and dissections were performed using a surgical microscope. The diameter of the arterial branches supplying the splenium of the CC at their origin was investigated, and the vascularization patterns of these branches were observed. Vascular supply to the splenium was provided by the anterior pericallosal artery (40%) from the anterior circulation and by the posterior pericallosal artery (88%) and posterior accessory pericallosal artery (50%) from the posterior circulation. The vascularization pattern of the splenium differs in each hemisphere and is usually supplied by multiple branches. The arterial vascularization of the splenium of the CC was studied comprehensively considering the ongoing debate and the inadequacy of the studies on this issue currently available in the literature. This anatomical knowledge is essential during the treatment of pathologies in this region and especially for splenial arteriovenous malformations.

  7. Segmental arterial mediolysis: unrecognized cases culled from cases of ruptured aneurysm of abdominal visceral arteries reported in the Japanese literature.

    PubMed

    Inada, Kiyoshi; Maeda, Matsuyoshi; Ikeda, Tsuneko

    2007-01-01

    Segmental arterial mediolysis (SAM) is a rare nonatherosclerotic and noninflammatory arteriopathy that was proposed by Slavin et al. [Segmental mediolytic arteritis. A clinical pathologic study, Lab. Invest. 35 (1976) 23-29]. It mainly involves abdominal visceral arteries and is characterized by lytic degeneration of the media, resulting in intraabdominal bleeding. We collected 27 unrecognized cases of SAM by reviewing microscopic slides of cases of ruptured aneurysms of visceral arteries, except splenic and hepatic aneurysms, reported in the Japanese literature. This paper describes the pathological and clinical features of these cases. The symptom at onset was abdominal pain associated with intraabdominal bleeding in all cases. The most involved artery was the middle colic artery, accounting for 14 (50%), followed by gastric and gastroepiploic arteries, (6 and 5, respectively). Seventy-eight percent of aneurysms were of dissecting type and the rest of pseudoaneurysm type, except for one. Multiple aneurysms were found in 9 cases (33.3%). Pathological lesions were acute in all. The outcome of those who had surgery was good, even in those who had surgery for 1 ruptured aneurysm, leaving the others unmanaged. The relationship of SAM to fibromuscular dysplasia is discussed. Secondary changes in the wall of the accompanying vein to the affected artery are briefly described. It is emphasized that the majority of aneurysms of abdominal visceral arteries are gathered together as SAM as a definite clinical and pathological entity.

  8. Combined Interventional and Surgical Treatment for Acute Aortic Type A Dissection

    SciTech Connect

    Liu Jincheng; Zhang Jinzhou Yang Jian; Zuo Jian; Zhang Jinbao; Yu Shiqiang; Chen Tao; Xu Xuezeng; Wei Xufeng; Yi Dinghua

    2008-07-15

    Surgical repair and endovascular stent-graft placement are both therapies for thoracic aortic dissection. A combination of these two approaches may be effective in patients with type A dissection. In this study, we evaluated the prognosis of this combined technique. From December 2003 to December 2006, 15 patients with type A dissection were admitted to our institute; clinical data were retrospectively reviewed. Follow-up was performed at discharge and approximately 12 months after operation. Endovascular stent-graft placement by interventional radiology and surgical repair for reconstruction of aortic arch was performed in all patients. Total arch replacement for distal arch aneurysm was carried out under deep hypothermia with circulatory arrest; antegrade-selected cerebral perfusion was used for brain protection. Four patients concomitantly received a coronary artery bypass graft. Hospital mortality rate was 6.7%; the patient died of cerebral infarction. Neurological complications developed in two patients. Multi-detector-row computed tomography scans performed before discharge revealed complete thrombosis of the false lumen in six patients and partial thrombosis in eight patients. At the follow-up examination, complete thrombosis was found in another three patients, aortic rupture, endoleaks, or migration of the stent-graft was not observed and injuries of peripheral organs or anastomotic endoleaks did not occur. For patients with aortic type A dissection, combining intervention and surgical procedures is feasible, and complete or at least partial thrombosis of the false lumen in the descending aorta can be achieved. This combined approach simplified the surgical procedures and shortened the circulatory arrest time, minimizing the necessity for further aortic operation.

  9. Student attitudes to whole body donation are influenced by dissection.

    PubMed

    Cahill, Kevin C; Ettarh, Raj R

    2008-01-01

    Given the important role that anatomical dissection plays in the shaping of medical student attitudes to life and death, these attitudes have not been evaluated in the context of whole body donation for medical science. First year students of anatomy in an Irish university medical school were surveyed by questionnaire before and after the initial dissection and again after 9 weeks of anatomical dissection. Analysis of student responses to the idea of whole body donation by an unrelated stranger, a family member, or by the respondent showed that a priori attitudes to donation by a stranger did not change with exposure to dissection. However, student opposition to donation by a family member was evident immediately after the initial dissection and was sustained throughout the duration of this study. Support for the idea of donating their bodies to medical science decreased significantly among respondents after exposure to dissection (31.5% before dissection, 19.6% after dissecting for 9 weeks) but not to levels reported in the general population in other studies. This study demonstrates that where dissection forms a part of anatomy teaching, students expect to learn anatomy by dissecting donors whom they do not know. As a potential donor population, students are reluctant to become emotionally involved in the donation process and are unwilling to become donors themselves.

  10. Peer-Assisted Learning in a Gross Anatomy Dissection Course.

    PubMed

    Han, Eui-Ryoung; Chung, Eun-Kyung; Nam, Kwang-Il

    2015-01-01

    Peer-assisted learning encourages students to participate more actively in the dissection process and promotes thoughtful dissection. We implemented peer-assisted dissection in 2012 and compared its effects on students' self-assessments of learning and their academic achievement with those of faculty-led dissection. All subjects performed dissections after a lecture about upper-limb gross anatomy. Experimental group (n = 134) dissected a cadaver while guided by peer tutors who had prepared for the dissection in advance, and control group (n = 71) dissected a cadaver after the introduction by a faculty via prosection. Self-assessment scores regarding the learning objectives related to upper limbs were significantly higher in experimental group than in control group. Additionally, experimental group received significantly higher academic scores than did control group. The students in peer-assisted learning perceived themselves as having a better understanding of course content and achieved better academic results compared with those who participated in faculty-led dissection. Peer-assisted dissection contributed to self-perception and to the ability to retain and explain anatomical knowledge.

  11. Endoscopic Submucosal Dissection of an Inverted Early Gastric Cancer-Forming False Gastric Diverticulum

    PubMed Central

    Lee, Yong-il; Lee, Sang-kil

    2016-01-01

    Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer (EGC) that does not have any risk of lymph node or distant metastases. Here, we report a case of EGC resembling a diverticulum. Diverticular formation makes it difficult for endoscopists to determine the depth of invasion and to subsequently perform ESD. Because the false diverticulum does not have a muscular layer, this lesion can be treated with ESD. Our case was successfully treated with ESD. After ESD, the EGC was confined to the submucosal layer without vertical and lateral margin involvement. This is the first case in which ESD was successfully performed for a case of EGC that coexisted with a false gastric diverticulum. An additional, larger study is needed to determine the efficacy of ESD in various types of EGC, such as a false gastric diverticulum. PMID:26855930

  12. Background music in the dissection laboratory: impact on stress associated with the dissection experience.

    PubMed

    Anyanwu, Emeka G

    2015-06-01

    Notable challenges, such as mental distress, boredom, negative moods, and attitudes, have been associated with learning in the cadaver dissection laboratory (CDL). The ability of background music (BM) to enhance the cognitive abilities of students is well documented. The present study was designed to investigate the impact of BM in the CDL and on stress associated with the dissection experience. After 8 wk of normal dissection without BM, various genres of BM were introduced into the cadaver dissection sessions of 260 medical and dental students for 3 wk. Feedback on the impact of BM on students in the CDL and students' attitude were accessed using a questionnaire. Psychological stress assessment was done using Psychological Stress Measure 9. Two batches of 30 students each were made to dissect same areas of the body for 2 h, one batch with BM playing and the other batch without. The same examination was given to both groups at the end. Over 90% of the participants expressed a desire to incorporate BM into the CDL; 87% of the sampled population that expressed love for music also reported BM to be a very useful tool that could be used to enhance learning conditions in the CDL. A strong positive relationship was established between love for music and its perception as a tool for learning in the CDL (P < 0.001). Students that studied under the influence of BM had significantly higher scores (P < 0.001) in the overall examination result. BM reduced the level of stress associated with the dissection experience by ∼33%.

  13. Calpain 1 inhibitor BDA-410 ameliorates α-klotho-deficiency phenotypes resembling human aging-related syndromes

    PubMed Central

    Nabeshima, Yoko; Washida, Miwa; Tamura, Masaru; Maeno, Akiteru; Ohnishi, Mutsuko; Shiroishi, Toshihiko; Imura, Akihiro; Razzaque, M. Shawkat; Nabeshima, Yo-ichi

    2014-01-01

    Taking good care of elderly is a major challenge of our society, and thus identification of potential drug targets to reduce age-associated disease burden is desirable. α-klotho-/- (α-kl) is a short-lived mouse model that displays multiple phenotypes resembling human aging-related syndromes. Such ageing phenotype of α-kl-/- mice is associated with activation of a proteolytic enzyme, Calpain-1. We hypothesized that uncontrolled activation of calpain-1 might be causing age-related phenotypes in α-kl-deficient mice. We found that daily administration of BDA-410, a calpain-1 inhibitor, strikingly ameliorated multiple aging-related phenotypes. Treated mice showed recovery of reproductive ability, increased body weight, reduced organ atrophy, and suppression of ectopic calcifications, bone mineral density reduction, pulmonary emphysema and senile atrophy of skin. We also observed ectopic expression of FGF23 in calcified arteries of α-kl-/- mice, which might account for the clinically observed association of increased FGF23 level with increased risk of cardiovascular mortality. These findings allow us to propose that modulation of calpain-1 activity is a potential therapeutic option for delaying age-associated organ pathology, particularly caused by the dysregulation of mineral ion homeostasis. PMID:25080854

  14. Segmental arterial mediolysis accompanied by renal infarction and pancreatic enlargement: a case report

    PubMed Central

    2012-01-01

    Introduction Due to recent advances in imaging diagnostic techniques, there are an increasing number of case reports of segmental arterial mediolysis. However, there are only a limited number of reports on segmental arterial mediolysis-related abnormalities of abdominal organs other than the intestine. This report describes a case of segmental arterial mediolysis accompanied by abnormalities of abdominal organs without clinical symptoms. Case presentation A 52-year-old Japanese man with hematuria and no prior medical history was referred to a urologist and was diagnosed as having urinary bladder cancer. He underwent trans-urethral resection of the bladder tumor and intra-vesical instillation therapy, which was followed by observation. During follow-up, although no abdominal symptoms were observed, an abdominal computed tomography scan revealed a dissection of the superior mesenteric artery. A false lumen partially occluded by a thrombus was located distal to this occlusion. The lumen was irregularly shaped with narrow and wide sections. Similar irregularities were also observed in the wall of the inferior mesenteric artery. Arterial dissection with thromboembolism in the left renal artery and renal infarction was also observed. Follow-up computed tomography after two months revealed an enlargement of the pancreatic tail adjacent to the splenic artery. Follow-up three-dimensional computed tomography showed gradual re-expansion of the true lumen of the superior mesenteric artery, improvement in arterial wall irregularities, and a reduction in the pancreas enlargement and renal infarction. Over the following 15 months, these changes gradually normalized. On the basis of the vascular changes in multiple arterial systems that resolved spontaneously, we considered that the lesions were associated with segmental arterial mediolysis. Conclusions We present a rare case of segmental arterial mediolysis accompanied by abnormalities of abdominal organs without clinical

  15. Carotid artery anatomy (image)

    MedlinePlus

    There are four carotid arteries, two on each side of the neck: right and left internal carotid arteries, and right and left external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to the head and brain.

  16. Intravascular Ultrasound and Histology in In Vitro Assessment of Iliac Artery Angioplasty

    SciTech Connect

    Lankeren, Winnifred van; Gussenhoven, Elma J.; Qureshi, Akeel; Lugt, Aad van der

    1999-01-15

    Purpose: Intravascular ultrasound (IVUS) was used to assess in vitro the morphologic and quantitative effects of balloon angioplasty (PTA) of the iliac artery. Methods: Forty human iliac arteries ({>=} 30% area stenosis) were studied with IVUS in vitro before and after PTA and the findings were validated with histology. Results: The sensitivity of IVUS for dissection was 74% and for media rupture 59%. The incidence of vascular damage was higher when the whole segment was analyzed rather than the target site alone. Dissections occurred at the thinnest region of the plaque, unrelated to plaque calcification. Following PTA, quantitative changes at the target site were greater compared with the overall data derived from all cross-sections. The increase in lumen area was caused solely by an increase in vessel area. Conclusions: IVUS is sensitive in detecting dissections, which occurred irrespective of calcification at the thinnest region of the plaque. The increase in lumen area after PTA was caused by stretching of the vessel.

  17. Effect of Partnership Status on Preferences for Facial Self-Resemblance

    PubMed Central

    Lindová, Jitka; Little, Anthony C.; Havlíček, Jan; Roberts, S. Craig; Rubešová, Anna; Flegr, Jaroslav

    2016-01-01

    Self-resemblance has been found to have a context-dependent effect when expressing preferences for faces. Whereas dissimilarity preference during mate choice in animals is often explained as an evolutionary adaptation to increase heterozygosity of offspring, self-resemblance can be also favored in humans, reflecting, e.g., preference for kinship cues. We performed two studies, using transformations of facial photographs to manipulate levels of resemblance with the rater, to examine the influence of self-resemblance in single vs. coupled individuals. Raters assessed facial attractiveness of other-sex and same-sex photographs according to both short-term and long-term relationship contexts. We found a preference for dissimilarity of other-sex and same-sex faces in single individuals, but no effect of self-resemblance in coupled raters. No effect of sex of participant or short-term vs. long-term attractiveness rating was observed. The results support the evolutionary interpretation that dissimilarity of other-sex faces is preferred by uncoupled individuals as an adaptive mechanism to avoid inbreeding. In contrast, lower dissimilarity preference of other-sex faces in coupled individuals may reflect suppressed attention to attractiveness cues in potential alternative partners as a relationship maintenance mechanism, and its substitution by attention to cues of kinship and psychological similarity connected with greater likelihood of prosocial behavior acquisition from such persons. PMID:27378970

  18. Vapor resistant arteries

    NASA Technical Reports Server (NTRS)

    Shaubach, Robert M. (Inventor); Dussinger, Peter M. (Inventor); Buchko, Matthew T. (Inventor)

    1989-01-01

    A vapor block resistant liquid artery structure for heat pipes. A solid tube artery with openings is encased in the sintered material of a heat pipe wick. The openings are limited to that side of the artery which is most remote from the heat source. The liquid in the artery can thus exit the artery through the openings and wet the sintered sheath, but vapor generated at the heat source is unlikely to move around the solid wall of the artery and reverse its direction in order to penetrate the artery through the openings. An alternate embodiment uses finer pore size wick material to resist vapor entry.

  19. Endoscopic submucosal dissection for early esophageal cancer associated with achalasia.

    PubMed

    Ohkura, Yu; Iizuka, Toshiro; Kikuchi, Daisuke; Yamashita, Satoshi; Nakamura, Masanori; Matsui, Akira; Mitani, Toshifumi; Hoteya, Shu; Kaise, Mitsuru; Yahagi, Naohisa

    2013-01-01

    Esophageal achalasia is often associated with esophageal cancer. However, in many cases, esophageal cancer tends to be found in an advanced stage, with a poor prognosis. However, early-stage cancer was detected recently due to the advances in endoscopic instruments. In those cases, it is important to facilitate successful treatment by endoscopic submucosal dissection. We analyzed a total of six cases of esophageal cancer with achalasia in four patients treated with endoscopic submucosal dissection. Three features common to all six cases had a bearing on how endoscopic submucosal dissection was performed. First, esophageal dilatation and diminished peristalsis facilitated the performance of successful endoscopic submucosal dissection. Second, the esophageal wall was thickened, primarily with muscular tissue. Third, the submucosal layer contained abundant blood vessels that made it difficult to minimize bleeding during dissection. Those findings suggest that endoscopic submucosal dissection for early esophageal cancer associated with achalasia is a safe and potentially curative procedure. It is important, therefore, to detect esophageal cancer early.

  20. Diagnosis and treatment of spontaneous coronary artery pseudoaneurysm: Rare anomaly with potentially significant clinical implications.

    PubMed

    Kar, Subrata; Webel, Richard R

    2017-03-04

    Spontaneous coronary artery pseudoaneurysm (PSA, false aneurysm) is an extremely rare occurrence with the precise incidence unknown. It is defined as an outwardly bulging monolayer or double layer within the coronary artery that lacks all 3 layers (intima, media, and adventitia) of the arterial wall. Coronary PSA commonly occurs from arterial dissection or perforation induced by catheter intervention, infection, pregnancy, or trauma. Traumatic dissection or perforation of the coronary artery after a percutaneous coronary intervention (PCI) remains the most common cause. Such cases may progress to myocardial ischemia, acute myocardial infarction, or acute coronary artery rupture causing death from cardiac tamponade. Intravascular ultrasound or cardiac computed tomography may aid in the diagnosis. Treatment options include PCI with a covered stent, bare or drug-eluting stent, coil embolization, coronary artery bypass graft with isolation of the PSA, or conservative management with vigilant clinical follow-up. In this review, we sought to describe the diagnosis, etiology, treatment, and the limited literature on spontaneous coronary artery PSA. © 2017 Wiley Periodicals, Inc.

  1. Resection-Reconstruction of Aberrant Right Hepatic Artery During Whipple Procedure (Pancreaticoduodenectomy).

    PubMed

    Sayyed, Raza; Rehman, Iffat; Niazi, Imran Khalid; Yusuf, Muhammed Aasim; Syed, Aamir Ali; V, Faisal

    2016-06-01

    Aberrant hepatic arterial anatomy poses a challenge for the surgeon during Whipple procedure. Intraoperative injury to the aberrant vasculature results in hemorrhagic or ischemic complications involving the liver and biliary tree. We report a case of replaced right hepatic artery arising from the superior mesenteric artery in a patient with periampullary carcinoma of the pancreas, undergoing pancreaticoduodenectomy. The aberrant artery was found to be coursing through the pancreatic parenchyma. This is a rare vascular anomaly. Resection of the arterial segment and end-to-end anastomosis was fashioned. Intrapancreatic course of the replaced right hepatic artery is a rare anomaly and is best managed by preoperative identification on radiology and meticulous intra-operative dissection and preservation. However, for an intrapancreatic course, resection and reconstruction may occasionally be required.

  2. Preceding bronchial cutting for exposure of the pulmonary artery buried in scar tissue after chemoradiotherapy.

    PubMed

    Nomori, Hiroaki; Cong, Yue; Sugimura, Hiroshi

    2017-01-01

    It is often difficult to expose the pulmonary artery buried in a scar tissue, especially in lung cancer patients that responded well to neoadjuvant chemoradiotherapy. Difficulty to access pulmonary artery branches may lead to potentially unnecessary pneumonectomy. To complete lobectomy in such cases, a technique with preceding bronchial cutting for exposure of the pulmonary artery is presented. After dissecting the pulmonary vein, the lobar bronchus is cut from the opposite side of the pulmonary artery with scissors. The back wall of the lobar bronchus is cut using a surgical knife from the luminal face, which can expose the pulmonary artery behind the bronchial stump and then complete lobectomy. Fourteen patients have been treated using the present technique, enabling complete resection by lobectomy (including sleeve lobectomy in 3 patients) without major bleeding. The present procedure can expose pulmonary artery buried in scar tissue, resulting in making the lobectomy safer.

  3. Aberrant Right Subclavian Artery: A Life-threatening Anomaly that should be considered during Esophagectomy

    PubMed Central

    Mahmodlou, Rahim; Sepehrvand, Nariman; Hatami, Sanaz

    2014-01-01

    Aberrant right subclavian artery (ARSA) is a rare anomaly, in which the right subclavian artery arises directly from the aortic arch instead of originating from the brachiocephalic artery. This anomaly should be taken into consideration during surgical procedures around esophagus, such as esophagectomy. Any unintentional injury of this artery during surgical procedures could be extremely life threatening. A 56-year-old woman presented with dysphagia, with concurrent aberrant subclavian artery and esophageal cancer. The transhiatal esophagectomy was performed successfully since the anomaly was preoperatively diagnosed using computed tomography scan. The presence of ARSA during esophagectomy may be challenging, but if diagnosed preoperatively, the precise and diligent dissection of the retroesophageal space during esophagectomy, may prevent any injury to the aberrant artery and consequent complications. PMID:25598945

  4. From similitude to success: The effects of facial resemblance on perceptions of team effectiveness.

    PubMed

    Wang, Ze; He, Xin; Liu, Fan

    2016-03-01

    Scant empirical research has focused on how impressions of teams are formed based on members' collective appearance, even though team photos are omnipresent in visual communications and teamwork is a common theme to elicit positive responses. Across 4 studies, we show that a subtle increase in the facial resemblance among team members enhances observers' evaluations of team effectiveness. This resemblance effect is mediated by perceived cooperative intent among team players. Furthermore, we demonstrate a reversal of the resemblance effect through the moderating role of information valence and extend the finding from team perception to behavioral intention. These results hold across different manipulations, contexts, stimuli, and sample characteristics. Collectively, this research presents the first empirical evidence that inferences based on facial morphology persist well beyond evaluations of individuals to influence the way a team, as a whole, is perceived.

  5. Transcatheter Thrombolysis with High-Dose Bolus Tissue Plasminogen Activator in Iatrogenic Arterial Occlusion after Femoral Arterial Catheterization

    SciTech Connect

    Tsetis, Dimitrios K.; Kochiadakis, George E.; Hatzidakis, Adam A.; Skalidis, Emannuel I.; Chryssou, Evangelia G.; Tritou, Ioanna N.; Vardas, Panos E.; Gourtsoyiannis, Nicholas C.

    2002-01-15

    Purpose: To assess the efficacy of percutaneous local thrombolysis with high-dose bolus recombinant tissue plasminogen activator (rt-PA) in patients with acute limb ischemia due to arterial thrombosis after cardiac catheterization.Methods: We treated eight patients (7 men; mean age 56 years) with thrombotic occlusion of both the common femoral artery (CFA) and external iliac artery (EIA) in six patients and of the CFA only in two patients. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 Fr end-hole catheter and subsequently two additional boluses of 5 mg rt-PA were given through a catheter with multiple side-holes. In case of a significant amount of residual thrombus, a continuous infusion of 2.5 mg/hr of rt-PA was started.Results: Successful lysis was achieved in all patients. The mean duration of lysis was 2 hr 41 min. The mean total amount of rt-PA delivered was 23.16 mg. In four patients unmasked flow-limited dissections confined to the CFA were managed by prolonged balloon dilatation, while in the remaining four patients with extension of the dissection to the external iliac artery one or two Easy Wallstents were implanted. There was prompt relief of lower limb ischemic symptoms and signs in all patients. Two groin hematomas were conservatively treated.Clinical and color Doppler flow imaging follow-up with a mean duration of 15 months, showed no reappearance of ischemic symptoms or development of restenosis in any of the patients. One patient died 6 months after thrombolysis.Conclusions: Transcatheter thrombolysis with high-dose bolus rt-PA is a safe and effective treatment inpatients with iatrogenic arterial occlusion after femoral catheterization. Underlying dissections should be treated by prolonged balloon dilatation but stent implantation is often required.

  6. Age-related changes of elements in thoracic and abdominal aortas and coronary, common carotid, pulmonary, splenic, common iliac, and uterine arteries and relationships in elements among their arteries.

    PubMed

    Ongkana, Nutcharin; Tohno, Setsuko; Payo, Iria Maria Prieto; Azuma, Cho; Moriwake, Yumi; Minami, Takeshi; Tohno, Yoshiyuki

    2007-01-01

    To elucidate whether the accumulation of elements occurred simultaneously in the various arteries with aging, the authors investigated age-related changes of elements in the eight arteries, such as the thoracic and abdominal aortas and the coronary, common carotid, pulmonary, splenic, common iliac, and uterine arteries, and the relationships in the element contents among their arteries. After ordinary dissection by medical students was finished, the thoracic and abdominal aortas and the coronary, common carotid, pulmonary, splenic, common iliac, and uterine arteries were resected from the subjects, who ranged in age from 58 to 94 yr. The element contents were analyzed by inductively coupled plasma-atomic emission spectrometry. It was found that the accumulation of Ca was the highest in the common iliac artery and decreased in the order of the uterine artery, abdominal aorta, coronary artery, thoracic aorta, splenic artery, common carotid artery, and pulmonary artery. Regarding the relationships in the element contents among the eight arteries, it was found that there were significant direct correlations in the contents of Ca, P, Mg, Zn, Fe, and Na between the coronary and splenic arteries, and there were significant correlations in the contents of Ca, P, and Mg between the abdominal aorta and pulmonary artery.

  7. Doing Dissections Differently: A Structured, Peer-Assisted Learning Approach to Maximizing Learning in Dissections

    ERIC Educational Resources Information Center

    Hall, Emma R.; Davis, Rachel C.; Weller, Renate; Powney, Sonya; Williams, Sarah B.

    2013-01-01

    Areas of difficulty faced by our veterinary medicine students, with respect to their learning in dissection classes, were identified. These challenges were both general adult-learning related and specific to the discipline of anatomy. Our aim was to design, implement, and evaluate a modified reciprocal peer-assisted/team-based learning…

  8. Background Music in the Dissection Laboratory: Impact on Stress Associated with the Dissection Experience

    ERIC Educational Resources Information Center

    Anyanwu, Emeka G.

    2015-01-01

    Notable challenges, such as mental distress, boredom, negative moods, and attitudes, have been associated with learning in the cadaver dissection laboratory (CDL). The ability of background music (BM) to enhance the cognitive abilities of students is well documented. The present study was designed to investigate the impact of BM in the CDL and on…

  9. Dissection and Dissection-Associated Required Experiences Improve Student Performance in Gross Anatomy: Differences among Quartiles

    ERIC Educational Resources Information Center

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

    2016-01-01

    To promote student learning, educational strategies should provide multiple levels of engagement with the subject matter. This study investigated examination data from five first year medical gross anatomy class cohorts (692 students) to determine if enhanced student performance was correlated with learning through dissection in a course that used…

  10. Dissection videos do not improve anatomy examination scores.

    PubMed

    Mahmud, Waqas; Hyder, Omar; Butt, Jamaal; Aftab, Arsalan

    2011-01-01

    In this quasi-experimental study, we describe the effect of showing dissection videos on first-year medical students' performance in terms of test scores during a gross anatomy course. We also surveyed students' perception regarding the showing of dissection videos. Two hundred eighty-seven first-year medical students at Rawalpindi Medical College in Pakistan, divided into two groups, dissected one limb in first term and switched over to the other limb in the second term. During the second term, instruction was supplemented by dissection videos. Second-term anatomy examination marks were compared with first-term scores and with results from first-year medical students in previous years. Multiple linear regression analysis was performed, with term scores (continuous, 0-200) as the dependent variable. Students shown dissection videos scored 1.26 marks higher than those not shown. The relationship was not statistically significant (95% CI: -1.11, 3.70; P = 0.314). Ninety-three percent of students favored regular inclusion of dissection videos in curriculum, and 50% termed it the best source for learning gross anatomy. Seventy-six percent of students did not perform regular cadaver dissection. The most frequent reason cited for not performing regular dissection was high student-cadaver ratio. Dissection videos did not improve performance on final examination scores; however, students favored their use.

  11. Acute aortic dissection provoked by sneeze: a case report.

    PubMed

    Baydin, A; Nural, M S; Güven, H; Deniz, T; Bildik, F; Karaduman, A

    2005-10-01

    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 risk factor, and we discuss the relationship between sneezing and aortic dissection. To our knowledge, this is the first report of aortic dissection provoked by sneezing in the literature.

  12. Orientation to dissection: Assisting students through the transition.

    PubMed

    Lamdin, R; Weller, J; Kerse, N

    2012-03-01

    Human dissection continues to be strongly argued for teaching human anatomy to medical students and is technically and emotionally demanding. An orientation to dissection and the laboratory are provided for students before beginning their work because students' and families' reactions to dissection are often complex. This study explored medical students' experiences of attending an orientation to human dissection and the anatomy laboratory. Students' reactions, feelings, and thoughts were enquired about 1 year after beginning dissection at the University of Auckland, New Zealand. Qualitative research methods, specifically one-on-one semistructured interview were utilized. Third-year medical students self-selected into the study and were interviewed 1 year after entering the laboratory. Transcribed audiotapes of the interviews were analyzed for themes across the interviews. One year after dissection students have vivid memories with differing ways of viewing the body that may help or hinder with dissection. The themes presented include orientation, student anticipation, psychological approach to the body, normalizing-continuing disquiet, and social reference. The orientation eases student entry into the laboratory. There can be ongoing feelings of ambivalence regards the body for some students. Novel findings include that students not only have their own feelings to deal with but also those of friends and family who question them and may feel uncomfortable with the idea of them dissecting. Even one year after beginning dissection, students may emotionally struggle with their work and may require further support, including how they talk about sensitive topics with other people.

  13. Repair of Chronic Aneurysmal Aortic Dissection Using a Stent Graft and an Amplatzer(®) Vascular Plug: A Case Study.

    PubMed

    Kanaoka, Yuji; Ohki, Takao; Ozawa, Hirotsugu

    2017-02-01

    We report a case in which a stent graft and an Amplatzer(®) vascular plug (AVP) were effective for the treatment of chronic aneurysmal aortic dissection. The patient was a 52-year-old man. At 45 years of age, he developed acute aortic dissection, for which he underwent surgery 4 times with prosthetic graft replacement in the abdominal aorta, descending thoracic, ascending aorta (without neck branch reconstruction), and thoracoabdominal aorta with the reconstruction of the celiac, superior mesenteric, and bilateral renal arteries. At the time of thoracoabdominal aortic surgery, strong adhesion was evident, particularly in the thoracoabdominal area. The adhesion was dissected in a part of the chest, and prosthetic graft replacement was performed the following day. Subsequently, the dissection of the residual distal aortic arch enlarged, and the patient was examined at our hospital. Computed tomography (CT) revealed a small intimal tear at the site of anastomosis distal to the graft in the ascending aorta and a large intimal tear in the descending thoracic aorta with a maximum diameter of 67 mm. Furthermore, open repair by prosthetic graft replacement seemed difficult; therefore, treatment with stent grafting was considered. Because the prosthetic graft in the abdomen was extremely tortuous, stent-graft insertion via the femoral artery seemed to be impossible. The planned treatment involved the placement of a thoracic stent graft using the chimney technique which included reconstruction of the brachiocephalic artery and left common carotid arteries using chimney stent graft and coverage of the left subclavian artery. The thoracic stent graft was planned to be inserted via the abdominal prosthetic graft site because the abdominal prosthetic graft was crooked and was located close to the body surface. However, a small intimal tear distal to the graft in the ascending aorta which had not been revealed by intraoperative aortography was detected by the selective

  14. The Effect of a Prior Dissection Simulation on Middle School Students' Dissection Performance and Understanding of the Anatomy and Morphology of the Frog

    NASA Astrophysics Data System (ADS)

    Akpan, Joseph Paul; Andre, Thomas

    1999-06-01

    Science teachers, school administrators, educators, and the scientific community are faced with ethical controversies over animal dissection in classrooms. Simulation has been proposed as a way of dealing with this issue. One intriguing previous finding was that use of an interactive videodisc dissection facilitated performance on a subsequent actual dissection. This study examined the prior use of simulation of frog dissection in improving students' actual dissection performance and learning of frog anatomy and morphology. There were three experimental conditions: simulation before dissection (SBD); dissection before simulation (DBS); or dissection-only (DO). Results of the study indicated that students receiving SBD performed significantly better than students receiving DBS or DO on both actual dissection and knowledge of the anatomy and morphology. Students' attitudes toward the use of animals for dissection did not change significantly from pretest to posttest and did not interact with treatment. The genders did not differ in achievement, but males were more favorable towards dissection and computers than were females.

  15. Prostacyclin production by arterialized autogenous venous grafts in dogs.

    PubMed

    Eldor, A; Hoover, E L; Pett, S B; Gay, W A; Alonso, D R; Weksler, B B

    1981-09-01

    Arteries are capable of producing significantly larger quantities of prostacyclin than are veins. To test the hypothesis, whether prostacyclin production by the vessel wall is related to blood pressure and flow, we measured the amounts of PGI2 released and synthesized by venous segments transplanted for 6 weeks into the arterial circulation. These results were compared with the production of prostacyclin by normal veins and arteries. In 20 dogs a segment of jugular vein was interposed into the carotid system; a sham dissection was done on the opposite side. "Arterialized" vein grafts showed prominent intima lined by endothelium, medial smooth muscle cell proliferation and fibrotic proliferation in adventitia. Spontaneous and arachidonic acid-stimulated prostacyclin production (measured by radioimmunoassay for 6-keto-PGF1 alpha) was not significantly different between arterialized venous autografts and jugular veins. Significantly larger amounts of prostacyclin were synthesized by the carotid artery. Thus, histologic changes and rheologic effects occurring in vein grafts transposed to the arterial site do not affect prostacyclin production.

  16. A gallbladder with the “hidden cystic duct”: A brief overview of various surgical techniques of the Calot’s triangle dissection

    PubMed Central

    Hilton, Joanna

    2015-01-01

    We present a case of a middle-aged female who attended for a routine laparoscopic cholecystectomy as a day case surgery. At operation, she was found to have a distended gallbladder with an unusually prominent distal portion. This has made the dissection of the Calot’s triangle challenging. As a result, the “critical view of safety” technique was applied. This allowed for the clear Calot’s triangle visualization and identification of the cystic duct and artery. This case highlights that the knowledge of various ways of the cystic duct dissection is essential to every surgeon. Furthermore, this helps to adjust the dissection approach on an individual case bases ensuring avoidance of the common bile duct injuries. PMID:25838927

  17. Biology teachers' dissection practices and the influences that lead to their adoption: An exploratory research

    NASA Astrophysics Data System (ADS)

    Milano, Regina Nicole

    The lack of resolution in the on-going animal dissection debate inspired this mixed methods study to identify Connecticut secondary biology teachers' dissection practices and the influences that lead to their adoption. Qualitative findings indicate past experiences, managing objections to dissection, school culture, goals of biology teaching and ethics as major influences on dissection practices with 58.4% (n=7) of the sample dissecting and 41.6% not dissecting (n=5). Quantitative findings reveal gender, standards and curriculum, advantages of dissection and experiences as a student as major influences on dissection practices with 71.9% (n=92) of the sample dissecting and 28.1% (n=36) not dissecting. The study concludes that dissection policies are necessary and imminent in Connecticut school districts. Furthermore, it advises teacher-initiated, qualitative and quantitative assessments to expose disparities between student dissection perspectives and their own, prior to conducting dissection. Finally, it provides suggestions for addressing potential differences including administrative involvement.

  18. Laser versus dissection technique of tonsillectomy.

    PubMed

    Ishlah, L Wan; Fahmi, A M; Srinovianti, N

    2005-03-01

    Tonsillectomy is the single most common operation performed in Ear Nose and Throat Department. Various methods of tonsillectomy have been practiced over the century aimed at reducing or eliminating intraoperative and postoperative morbidity. Due to various blood supplies received, intraoperative bleeding is the most difficult problem and securing it is time-consuming. The time taken to control the bleeding would invariably determine the length of operation. Common postoperative complications are bleeding and pain. This study evaluated the operative time, intraoperative blood loss, postoperative pain and other postoperative complications of tonsillectomy performed by laser as compared to conventional dissection technique. This is a prospective randomized study whereby sixty patients were divided into two groups of equal number. In one group, the tonsillectomy performed by laser and in the other group the tonsillectomy performed by conventional dissection technique. Operative time and amount of blood loss is significantly reduced in the laser group. Total postoperative pain and post operative complications were not significantly different between the two groups. Tonsillectomy by using laser have shown less intraoperative bleeding and shortened the operative time. In the hospital where laser machine and expertise are available, it is justifiable to use this technique as effective method of performing tonsillectomy.

  19. Homarus Americanus Stomatogastric Nervous System Dissection

    PubMed Central

    Tobin, Anne-Elise; Bierman, Hilary S.

    2009-01-01

    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. PMID:19483669

  20. Thread-Traction with a Sheath of Polypectomy Snare Facilitates Endoscopic Submucosal Dissection of Early Gastric Cancers

    PubMed Central

    Noda, Hisatsugu; Ogasawara, Naotaka; Koshino, Akira; Fukuta, Shouko; Nagoya, Takuroh; Hoshino, Hironori; Nagao, Kazuhiro; Sugiyama, Tomoya; Kondo, Yoshihiro; Ito, Yoshitsugi; Izawa, Shinya; Ebi, Masahide; Funaki, Yasushi; Sasaki, Makoto; Kasugai, Kunio

    2016-01-01

    Although the thread-traction (TT) method has been found useful during endoscopic submucosal dissection (ESD) for early gastric cancers, the movement of the thread interferes with the movement of the endoscope, and the lesion can only be pulled to the mouth side. We have developed the novel TT method using a sheath of polypectomy snare (TTSPS). The TTSPS method enables free and independent movement of the thread and the endoscope and allows pulling the lesion towards the anal as well as oral side. The median dissection times, numbers of instances of arterial bleeding, and numbers of local injections into the submucosal layer were significantly lower for ESD with TTSPS than for conventional ESD. Countertraction ESD using the TTSPS method is straightforward, safe, easy, noninvasive, and cost effective, and it uses instruments readily available in most hospitals to enhance visualization of cutting lines. Therefore, the TTSPS method can be universally applied in conventional ESD. PMID:26843860

  1. Preoperative Embolization of a Tumor-Bearing Horseshoe Kidney Via Both Channels of a Concomitant Aortic Dissection

    SciTech Connect

    Palmowski, Moritz Kiessling, Fabian; Lopez-Benitez, Ruben; Kauffmann, Guenter Werner; Hallscheidt, Peter

    2007-06-15

    Renal cell carcinoma arising in a horseshoe kidney is a rare entity. Preoperative tumor embolization can be performed to prevent massive bleeding complications during organ-preserving surgery. We report the first case of a patient with a tumor-bearing horseshoe-kidney in whom the preoperative embolization, already complex because of the abnormal vascular supply, was additionally complicated by an aortic dissection. An aberrant, horseshoe-kidney-supplying artery originated from the false dissection channel of the aorta, and thus had to be catheterized separately while the other tumor-supplying vessels could be reached via the true aortic lumen. After devascularization of the tumor, organ-preserving surgery was performed without bleeding complications.

  2. Bilateral internal carotid artery occlusion associated with the antiphospholipid antibody syndrome.

    PubMed

    Anand, Pria; Mann, Sharan K; Fischbein, Nancy J; Lansberg, Maarten G

    2014-01-01

    A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies.

  3. Bilateral Internal Carotid Artery Occlusion Associated with the Antiphospholipid Antibody Syndrome

    PubMed Central

    Anand, Pria; Mann, Sharan K.; Fischbein, Nancy J.; Lansberg, Maarten G.

    2014-01-01

    A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies. PMID:24707268

  4. Number of coronary ostia in Syrian hamsters (Mesocricetus auratus) with normal and anomalous coronary arteries.

    PubMed

    Durán, A C; Fernández, M C; Fernández, B; Fernández-Gallego, T; Arqué, J M; Sans-Coma, V

    2007-12-01

    Little attention is being paid to the presence of accessory coronary artery ostia in man and non-human mammals due to their limited clinical relevance. However, information about their frequency and the cardiac territories irrigated by the vessels arising from them is of interest to obtain an accurate survey of the establishment of the coronary artery system in each species. The aim here was to compare the incidence and significance of the accessory coronary ostia in Syrian hamsters with normal coronary arteries and several coronary anomalies characterized by the absence of a left coronary artery originating from the left aortic sinus. The hearts from 2829 hamsters were examined using a corrosion-cast technique, micro-dissection, histochemical techniques, and scanning electron microscopy. Overall, 148 specimens displayed accessory ostia. A limited number of them belonged to the conal artery which supplies the wall of the right ventricular outflow tract. The other accessory ostia led to the septal artery, a vessel which irrigates the most part of the interventricular septum. The incidence of accessory ostia in normal and anomalous coronary artery patterns was quite similar. This suggests that the morphogenetic deviations producing the coronary artery anomalies reported in this study do not alter the connections of the septal and conal arteries to the aorta. The present observations lead to the notion that in the Syrian hamster, the septal artery should be regarded as a third coronary artery.

  5. Cooled artery extension

    NASA Technical Reports Server (NTRS)

    Gernert, Nelson J. (Inventor)

    1990-01-01

    An artery vapor trap. A heat pipe artery is constructed with an extension protruding from the evaporator end of the heat pipe beyond the active area of the evaporator. The vapor migrates into the artery extension because of gravity or liquid displacement, and cooling the extension condenses the vapor to liquid, thus preventing vapor lock in the working portion of the artery by removing vapor from within the active artery. The condensed liquid is then transported back to the evaporator by the capillary action of the artery extension itself or by wick located within the extension.

  6. Children and Adolescents' Understandings of Family Resemblance: A Study of Naive Inheritance Concepts

    ERIC Educational Resources Information Center

    Williams, Joanne M.

    2012-01-01

    This paper aims to provide developmental data on two connected naive inheritance concepts and to explore the coherence of children's naive biology knowledge. Two tasks examined children and adolescents' (4, 7, 10, and 14 years) conceptions of phenotypic resemblance across kin (in physical characteristics, disabilities, and personality traits). The…

  7. Schwannoma of the biliary tract resembling cholangiocarcinoma: A case report and review

    PubMed Central

    Garcia Sanz, I; Muñoz de Nova, JL; Valdés de Anca, A; Martín Pérez, ME

    2016-01-01

    Schwannomas are benign tumours derived from Schwann cells and are extremely rare in the biliary tract. We present the case of a 62-year-old patient with a common bile duct schwannoma that resembled a cholangiocarcinoma. We also review all 17 previously published cases of schwannoma of the biliary tract and discuss the challenges of preoperative diagnosis. PMID:27269434

  8. LINGAM AS A SACRED OBJECT AND THE HEAD-DRESS OF SUFI RESEMBLING IT

    PubMed Central

    Mahdihassan, S.

    1990-01-01

    This study scans into past of ancient man and discusses meticulously how the reproductive organ Lingam became sacred object to Hindus and why a sufi wore a phallus shaped head-dress resembling to it. In this manner the author demystifies here the procreation, the law of nature. PMID:22557692

  9. Bilateral Leg Ischemia due to Descending Aortic Dissection: Combined Treatment with Femoro-femoral Cross-over Bypass and Unilateral Aorto-iliac stenting

    SciTech Connect

    Frahm, Christian; Widmer, Matthias K.; Do, Dai-Do

    2002-10-15

    We report a case of aorto-iliac occlusion due to descending aortic dissection treated initially with femoro-femoral cross-over bypass and secondarily with unilateral aorto-iliac stenting because of progression of the dissection. A 75-year-old man presented with acute ischemia of the right leg. CT revealed occlusion of the right iliac artery due to descending aortic dissection with a clotted false lumen. Three days after femoro-femoral cross-over bypass,ischemia of both legs developed and angiography demonstrated occlusion of the infrarenal aorta and left common iliac artery. Two overlapping stents were deployed in these vessel segments. Completion angiography confirmed successful recanalization with adequate distal flow and good patency of the cross-over bypass. Peripheral pulses were restored and the patient's symptoms were alleviated. Combined treatment with cross-over bypass and endovascular recanalization may be considered as a viable alternative to open aortic surgery in selected cases of complicated aorto-iliac dissection with bilateral leg ischemia.

  10. First dorsal metacarpal artery flap in hand reconstruction. I. Anatomical study.

    PubMed

    Sherif, M M

    1994-01-01

    Twenty-one human hands were dissected to study the anatomy of the first dorsal metacarpal artery (FDMA). The artery was found in all the dissected hands. It constantly gave three fascial branches: a radial branch, an ulnar branch, and an intermediate branch. A cutaneous branch was also observed, which may arise either from the radial artery or from the FDMA. It runs with the radial nerve supplying dorsal hand skin. This branch may supplement the vascularization of FDMA flap. The FDMA supplies the dorsal hand skin from the thumb metacarpal to the long metacarpal, as well as the skin on the dorsal surfaces of the thumb and index to the proximal interphalangeal joint.

  11. The Effect of a Prior Dissection Simulation on Middle School Students' Dissection Performance and Understanding of the Anatomy and Morphology of the Frog.

    ERIC Educational Resources Information Center

    Akpan, Joseph Paul; Andre, Thomas

    1999-01-01

    Reports on a study that examined the prior use of simulation on frog dissection in improving students' actual dissection performance and learning of frog anatomy and morphology. Finds that students who performed the simulation before dissection performed significantly better than students who performed dissection before using the simulation or…

  12. A Modified Dissection Method to Preserve Neck Structures

    ERIC Educational Resources Information Center

    Hankin, Mark H.; Stoller, Jeremy L.

    2009-01-01

    The neck is not only one of the more challenging anatomical regions to dissect but also has important application to clinical conditions, diseases, and procedures. In this study, we describe two simple modifications for dissection of the neck that (1) aid in the identification and preservation of the cutaneous branches of the cervical plexus and…

  13. Alternatives To Animal Dissection in School Science Classes. ERIC Digest.

    ERIC Educational Resources Information Center

    Haury, David L.

    Until recently, one of the most expected and accepted experiences among students in biology classrooms of the United States has been the dissection of vertebrate animals, from frogs and mice to cats and fetal pigs. However, resistance to animal dissection has grown during the past decade with concerns ranging from inhumane treatment of animals by…

  14. Local repair of distal thoracal aortic dissections (Locus minoris resistencia).

    PubMed

    Belov, Iu V; Komarov, R N; Stepanenko, A B; Gens, A P; Charchian, E R

    2007-01-01

    The paper presents the method of local repair of distal aortic dissections. Local aortic grafting for surgical correction of type B dissecting aortic aneurysms helped to decrease hospital mortality up to 15.4%, the rate of paraparesis and multiorgan failure - up to 11.5%.

  15. Outcomes of a Rotational Dissection System in Gross Anatomy

    ERIC Educational Resources Information Center

    Marshak, David W.; Oakes, Joanne; Hsieh, Pei-Hsuan; Chuang, Alice Z.; Cleary, Leonard J.

    2015-01-01

    At the University of Texas Houston Medical School, a rotational dissection system was introduced to improve coordination between the Gross Anatomy and the Introduction to Clinical Medicine (ICM) courses. Six students were assigned to each cadaver and divided into two teams. For each laboratory, one team was assigned to dissect and the other to…

  16. Dissection Videos Do Not Improve Anatomy Examination Scores

    ERIC Educational Resources Information Center

    Mahmud, Waqas; Hyder, Omar; Butt, Jamaal; Aftab, Arsalan

    2011-01-01

    In this quasi-experimental study, we describe the effect of showing dissection videos on first-year medical students' performance in terms of test scores during a gross anatomy course. We also surveyed students' perception regarding the showing of dissection videos. Two hundred eighty-seven first-year medical students at Rawalpindi Medical College…

  17. Student Attitudes toward Cadaveric Dissection at a UK Medical School

    ERIC Educational Resources Information Center

    Quince, Thelma A.; Barclay, Stephen I. G.; Spear, Michelle; Parker, Richard A.; Wood, Diana F.

    2011-01-01

    A more humanistic approach toward dissection has emerged. However, student attitudes toward this approach are unknown and the influences on such attitudes are little understood. One hundred and fifty-six first-year medical students participated in a study examining firstly, attitudes toward the process of dissection and the personhood of the…

  18. Traditional versus Computer-Based Dissections in Enhancing Learning in a Tertiary Setting: A Student Perspective.

    ERIC Educational Resources Information Center

    Franklin, Sue; Peat, Mary; Lewis, Alison

    2002-01-01

    Describes a study that investigates both the use and usefulness of laboratory dissections and computer-based dissections in a tertiary, first-year human biology course. Explores attitudes toward dissection. (DDR)

  19. Impact of bilateral neck dissection on recovery following supraglottic laryngectomy.

    PubMed

    Weber, P C; Johnson, J T; Myers, E N

    1993-01-01

    Previously reported data from our institution has led us to perform bilateral neck dissections for therapeutic as well as staging advantages for horizontal supraglottic laryngectomies. Concern over the possibility of increased morbidity associated with simultaneous bilateral neck dissection prompted this retrospective review of patients with supraglottic laryngectomy who were treated with either unilateral (46 patients) or bilateral (23 patients) neck dissection. No significant differences were found in morbidity when patients were evaluated for transfusion rate, cervical wound drainage, need for tracheotomy, oral diet, or duration of hospitalization. Significant differences were noted in surgical operating time, eg, it took 100 minutes longer to perform bilateral dissections, and slight increases were noted in estimated blood loss and fluids given intravenously. No significant differences were noted in the percentage or type of postoperative complications. It seems that bilateral neck dissection in conjunction with supraglottic laryngectomy does not increase postoperative surgical morbidity and may actually avoid complications associated with postoperative radiation therapy in patients with supraglottic laryngectomy.

  20. Lymph node dissection for gastric cancer: a critical review

    PubMed Central

    Batista, Thales Paulo; Martins, Mário Rino

    2012-01-01

    Gastric cancer is one of the most common neoplasms and an important cause of cancer-related death worldwide. Efforts to reduce its high mortality rates are currently focused on multidisciplinary management. However, surgery remains a cornerstone in the management of patients with resectable disease. There is still some controversy as to the extent of lymph node dissection for potentially curable stomach cancer. Surgeons in eastern countries favor more extensive lymph node dissection, whereas those in the West favor less extensive dissection. Thus, extent of lymph node dissection remains one of the most hotly discussed aspects of gastric surgery, particularly because most stomach cancers are now often comprehensively treated by adding some perioperative chemotherapy or chemo-radiation. We provide a critical review of lymph nodes dissection for gastric cancer with a particular focus on its benefits in a multimodal approach. PMID:25992202

  1. Controlled ultrasonic micro-dissection of thin tissue sections.

    PubMed

    Ru, Changhai; Liu, Jun; Pang, Ming; Sun, Yu

    2014-08-01

    In order to obtain sufficient quantities of pure populations of cells or a single cell from surrounding tissue for analytical investigation, we have developed an ultrasonic microdissection system. The system utilizes a vision-based method for detecting the contact between the microdissection needle tip and a target surface. A multilayer stack piezoelectric actuator is employed to generate ultrasonic vibrations for histological isolation. Automated micro-dissection is also realized using visual feedback and vision-based control. Experimental results on tumor tissue sections show that the system has a high dissection accuracy and efficiency and is able to realize dissecting arbitrary shapes in specified locations on a tissue sample. Furthermore, effects in variations of vibration amplitude and frequency of ultrasonic micro-dissection as well as needle insertion depths on micro-dissection accuracy and speed were evaluated.

  2. Coronary artery disease

    MedlinePlus Videos and Cool Tools

    ... heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, a process called atherosclerosis ...

  3. Carotid artery surgery - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100124.htm Carotid artery surgery - series—Normal anatomy To use the sharing ... out of 4 Overview There are four carotid arteries, with a pair located on each side of ...

  4. Peripheral artery bypass - leg

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/007394.htm Peripheral artery bypass - leg To use the sharing features on this page, please enable JavaScript. Peripheral artery bypass is surgery to reroute the blood supply ...

  5. Coronary Artery Bypass

    MedlinePlus

    ... Overview Aneurysm Repair Balloon Angioplasty and Stents Carotid Artery Angioplasty and Stents Carotid Endarterectomy Catheter Ablation Heart ... Limited-Access Heart Surgery Maze Surgery Pacemakers Radial Artery Access Transmyocardial Laser Revascularization Valve Repair or Replacement ...

  6. Uterine artery embolization - discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000161.htm Uterine artery embolization - discharge To use the sharing features on this page, please enable JavaScript. You had uterine artery embolization (UAE). UAE is a procedure to treat ...

  7. Coronary Artery Disease

    MedlinePlus

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened ...

  8. Retinal artery occlusion

    MedlinePlus

    ... These blockages are more likely if there is hardening of the arteries ( atherosclerosis ) in the eye. Clots ... Blindness and vision loss Blood clots Diabetes Glaucoma Hardening of the arteries High blood cholesterol levels High ...

  9. Radial Artery Catheterization

    MedlinePlus

    ... of the radial artery for cardiac catheterization procedures. Advantages of Radial Artery Catheterization Any catheter placement into ... walk, and eat immediately. This is a particular advantage for patients with back problems because there is ...

  10. Carotid Artery Disease

    MedlinePlus

    ... sites within the artery. This process is called atherosclerosis. Carotid arteries that are clogged with plaques are ... at greater risk of high blood pressure and atherosclerosis. High blood-fat levels. High levels of low- ...

  11. What Is Peripheral Artery Disease?

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Peripheral Artery Disease? Peripheral artery disease (P.A.D.) is ... that affects blood flow to the legs. Normal Artery and Artery With Plaque Buildup The illustration shows ...

  12. Dissecting Japan's Dengue Outbreak in 2014

    PubMed Central

    Quam, Mikkel B.; Sessions, October; Kamaraj, Uma Sangumathi; Rocklöv, Joacim; Wilder-Smith, Annelies

    2016-01-01

    Despite Japan's temperate climate, a dengue outbreak occurred in Tokyo for the first time in over 70 years in 2014. We dissected this dengue outbreak based on phylogenetic analysis, travel interconnectivity, and environmental drivers for dengue epidemics. Comparing the available dengue virus 1 (DENV1) E gene sequence from this outbreak with 3,282 unique DENV1 sequences in National Center for Biotechnology Information suggested that the DENV might have been imported from China, Indonesia, Singapore, or Vietnam. With travelers arriving into Japan, Guangzhou (China) may have been the source of DENV introduction, given that Guangzhou also reported a large-scale dengue outbreak in 2014. Coinciding with the 2014 outbreak, Tokyo's climate conditions permitted the amplification of Aedes vectors and the annual peak of vectorial capacity. Given suitable vectors and climate conditions in addition to increasing interconnectivity with endemic areas of Asia, Tokyo's 2014 outbreak did not come as a surprise and may foretell more to come. PMID:26711518

  13. Recent traction methods for endoscopic submucosal dissection

    PubMed Central

    Tsuji, Kunihiro; Yoshida, Naohiro; Nakanishi, Hiroyoshi; Takemura, Kenichi; Yamada, Shinya; Doyama, Hisashi

    2016-01-01

    Endoscopic mucosal resection (EMR) is problematic with regard to en bloc and curable resection rates. Advancements in endoscopic techniques have enabled novel endoscopic approaches such as endoscopic submucosal dissection (ESD), which has overcome some EMR problems, and has become the standard treatment for gastrointestinal tumors. However, ESD is technically difficult. Procedure time is longer and complications such as intraoperative perforation and bleeding occur more frequently than in EMR. Recently various traction methods have been introduced to facilitate ESD procedures, such as clip with line, external forceps, clip and snare, internal traction, double scope, and magnetic anchor. Each method must be used appropriately according to the anatomical characteristics. In this review we discuss recently proposed traction methods for ESD based on the characteristics of various anatomical sites. PMID:27468186

  14. Chemical Genetics in Dissecting Membrane Glycerolipid Functions.

    PubMed

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

    2016-01-01

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

  15. Nanoscale scraping and dissection of collagen fibrils.

    PubMed

    Wenger, M P E; Horton, M A; Mesquida, P

    2008-09-24

    The main function of collagen is mechanical, hence there is a fundamental scientific interest in experimentally investigating the mechanical and structural properties of collagen fibrils on the nanometre scale. Here, we present a novel atomic force microscopy (AFM) based scraping technique that can dissect the outer layer of a biological specimen. Applied to individual collagen fibrils, the technique was successfully used to expose the fibril core and reveal the presence of a D-banding-like structure. AFM nanoindentation measurements of fibril shell and core indicated no significant differences in mechanical properties such as stiffness (reduced modulus), hardness, adhesion and adhesion work. This suggests that collagen fibrils are mechanically homogeneous structures. The scraping technique can be applied to other biological specimens, as demonstrated on the example of bacteria.

  16. Berry splenic artery aneurysm rupture in association with segmental arterial mediolysis and portal hypertension.

    PubMed

    Imai, Miwa Akasofu; Kawahara, Ei; Katsuda, Shogo; Yamashita, Tatsuya

    2005-05-01

    A rare case of berry splenic artery aneurysm (SAA) rupture associated with segmental arterial mediolysis (SAM) and portal hypertension is reported. A 66-year-old woman, diagnosed as having liver cirrhosis and portal hypertension 6 years earlier, suddenly developed a lancinating pain in the upper abdomen and lost consciousness. She recovered consciousness while being transferred to hospital by ambulance. During the investigations, her level of consciousness suddenly deteriorated. Ultrasonography showed a massive intraperitoneal hemorrhage, and she died 5(1/2) h after admission. On gross examination at autopsy it was not possible to find the rupture point of the vessel because the pancreas was embedded in a massive hematoma. However, careful dissection of the pancreatic tail after fixation revealed a berry aneurysm measuring 0.8 cm in diameter in a branch adjacent to the bifurcation in the distal third of the main splenic artery. Microscopic examination detected a rupture of the aneurysm. The histology of the arterial wall proximal to the aneurysm showed typical SAM. In general, berry SAA caused by SAM is rare and unlikely to rupture. The SAA in the present case likely occurred and ruptured due to the combination of SAM and portal hypertension.

  17. Aneurysms of the renal arteries associated with segmental arterial mediolysis in a case of polyarteritis nodosa.

    PubMed

    Soga, Yoshiko; Nose, Masato; Arita, Norimasa; Komori, Hiroaki; Miyazaki, Tatsuhiko; Maeda, Toshiharu; Furuya, Keizo

    2009-03-01

    This is the first report of segmental arterial mediolysis (SAM) accompanied with polyarteritis nodosa (PN), and manifesting aneurysms of the renal arteries. A 73-year-old woman was admitted to hospital because of a high fever. Laboratory tests showed leukocytosis with increased CRP level in the serum. Myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA) and proteinase 3 (PR3)-ANCA were negative. There were no signs indicating infection or malignancy. After admission renal function rapidly deteriorated. Treatment was then started with daily oral prednisolone and hemodialysis. On the 40th day of hospitalization the patient suddenly became comatose. Cranial CT showed a subarachnoid hemorrhage. The patient died and an autopsy was performed. The pathological findings showed necrotizing vasculitis of the small arteries in various organs, but not associated with that of arterioles or renal glomerular lesions, indicating PN. Unexpectedly, the segmental arteries of the bilateral kidneys showed vascular lesions of dissecting aneurysms, indicating SAM. This case indicates that SAM is one of the causes of aneurysms in PN and is clinically important when the clinical course of PN patients rapidly advances.

  18. Influence of a Dissection Video Clip on Anxiety, Affect, and Self-Efficacy in Educational Dissection: A Treatment Study

    PubMed Central

    Randler, Christoph; Demirhan, Eda; Wüst-Ackermann, Peter; Desch, Inga H.

    2016-01-01

    In science education, dissections of animals are an integral part of teaching, but they often evoke negative emotions. We aimed at reducing negative emotions (anxiety, negative affect [NA]) and increasing positive affect (PA) and self-efficacy by an experimental intervention using a predissection video to instruct students about fish dissection. We compared this treatment with another group that watched a life history video about the fish. The participants were 135 students studying to become biology teachers. Seventy received the treatment with the dissection video, and 65 viewed the life history video. We applied a pre/posttest treatment-comparison design and used the Positive and Negative Affect Schedule (PANAS), the State–Trait–Anxiety Inventory for State (STAI-S), and a self-efficacy measure three times: before the lesson (pretest), after the film treatment (posttest 1), and after the dissection (posttest 2). The dissection film group scored higher in PA, NA, and state anxiety (STAI-S) after the dissection video treatment and higher in self-efficacy after the dissection. The life history group showed no differences between the pretest and posttest 1. The dissection film has clear benefits—increasing PA and self-efficacy—that come at the cost of higher NA and higher STAI-S. PMID:27290738

  19. Influence of a Dissection Video Clip on Anxiety, Affect, and Self-Efficacy in Educational Dissection: A Treatment Study

    ERIC Educational Resources Information Center

    Randler, Christoph; Demirhan, Eda; Wüst-Ackermann, Peter; Desch, Inga H.

    2016-01-01

    In science education, dissections of animals are an integral part of teaching, but they often evoke negative emotions. We aimed at reducing negative emotions (anxiety, negative affect [NA]) and increasing positive affect (PA) and self-efficacy by an experimental intervention using a predissection video to instruct students about fish dissection.…

  20. The Effects of Computer Animated Dissection versus Preserved Animal Dissection on the Student Achievement in a High School Biology Class.

    ERIC Educational Resources Information Center

    Kariuki, Patrick; Paulson, Ronda

    The purpose of this study was to examine the effectiveness of computer-animated dissection techniques versus the effectiveness of traditional dissection techniques as related to student achievement. The sample used was 104 general biology students from a small, rural high school in Northeast Tennessee. Random selection was used to separate the…

  1. Influence of a Dissection Video Clip on Anxiety, Affect, and Self-Efficacy in Educational Dissection: A Treatment Study.

    PubMed

    Randler, Christoph; Demirhan, Eda; Wüst-Ackermann, Peter; Desch, Inga H

    2016-01-01

    In science education, dissections of animals are an integral part of teaching, but they often evoke negative emotions. We aimed at reducing negative emotions (anxiety, negative affect [NA]) and increasing positive affect (PA) and self-efficacy by an experimental intervention using a predissection video to instruct students about fish dissection. We compared this treatment with another group that watched a life history video about the fish. The participants were 135 students studying to become biology teachers. Seventy received the treatment with the dissection video, and 65 viewed the life history video. We applied a pre/posttest treatment-comparison design and used the Positive and Negative Affect Schedule (PANAS), the State-Trait-Anxiety Inventory for State (STAI-S), and a self-efficacy measure three times: before the lesson (pretest), after the film treatment (posttest 1), and after the dissection (posttest 2). The dissection film group scored higher in PA, NA, and state anxiety (STAI-S) after the dissection video treatment and higher in self-efficacy after the dissection. The life history group showed no differences between the pretest and posttest 1. The dissection film has clear benefits - increasing PA and self-efficacy - that come at the cost of higher NA and higher STAI-S.

  2. Zygomatico-orbital artery as a recipient vessel for microsurgical head and neck reconstruction.

    PubMed

    Higashino, Takuya; Sawamoto, Naoya; Hirai, Rintaro; Arikawa, Masaki

    2013-07-01

    The selection of recipient vessels in head and neck reconstruction is one of the key factors influencing its difficulty and outcome. We report a case of a microsurgical scalp reconstruction using the zygomatico-orbital artery as a recipient vessel.A 71-year-old woman had intractable skin ulcers on her head after neurosurgeries. Computed tomography angiography findings showed that the superficial temporal artery was obstructed and that the zygomatico-orbital artery ran forward and upward. She underwent scalp reconstruction using a free anterior lateral thigh flap. The zygomatico-orbital artery was dissected distally, cut, and turned over cranially. The diameter of the zygomatico-orbital artery was 1.2 mm. The blood flow through the zygomatico-orbital artery was sufficient. The thinned scalp area was excised, and some of the titanium devices and infectious tissues were removed. An anterior lateral thigh flap measuring 20 × 9 cm was harvested and transferred to the defect in the head. The discrepancy in calibers was within double, and the zygomatico-orbital artery fit the descending branch of the lateral circumflex femoral artery. The flap was transferred successfully.The zygomatico-orbital artery is one of the branches from the external carotid artery and supports the suprazygomatic territory. The zygomatico-orbital artery is present in 78% to 92% of people and originates from the superficial temporal artery and sometimes from the frontal branch of superficial temporal artery. The mean diameter of the zygomatico-orbital artery at origin is reported to be 1.20 mm. The zygomatico-orbital artery is another option as a recipient vessel in head and neck reconstruction.

  3. Internal carotid artery rupture caused by carotid shunt insertion

    PubMed Central

    Illuminati, Giulio; Caliò, Francesco G.; Pizzardi, Giulia; Vietri, Francesco

    2015-01-01

    Introduction Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. Presentation of case A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful. Discussion Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect. Conclusion Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. PMID:26255001

  4. The role of carotid artery stenting for recent cerebral ischemia.

    PubMed

    Bosiers, M; Callaert, J; Deloose, K; Verbist, J; Keirse, K; Peeters, P

    2010-06-01

    Patients with cerebral ischemia as a result of acute cervical internal carotid artery occlusion are generally considered to have a poor prognosis. Despite maximal medical treatment, a better treatment for patients with acute ischemic stroke who present with serious neurologic symptoms on admission or continue to deteriorate neurologically due to a total occlusion, a dissection or a high-grade stenosis of the internal carotid artery is required. An effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established and represents a challenging and complex problem. Treatment of acute symptomatic occlusion of the cervical internal carotid artery includes intravenous administration of thrombolytic agent, carotid endarterectomy and an interventional approach (intra-arterial administration of thrombolytic agent, transluminal angioplasty with or without stenting). The endovascular interventional approach is becoming a part of the stroke therapy armamentarium for intracranial occlusion. It may also now be considered in select patients with acute internal carotid artery occlusion. Stenting and angioplasty for acute internal carotid artery occlusion appears to be feasible, safe and may be associated with early neurological improvement. The encouraging preliminary results await confirmation from prospective, randomized studies.

  5. Radiological findings and endovascular management of three cases with segmental arterial mediolysis.

    PubMed

    Davran, Ramazan; Cinar, Celal; Parildar, Mustafa; Oran, Ismail

    2010-06-01

    Segmental arterial mediolysis (SAM) is an uncommon self-limited disorder that can cause abdominal catastrophes through massive bleeding or bowel infarction. The former arise from arterial aneurysms, and the latter from arterial stenosis or occlusions. Although this is an acute self-limiting disease, the catastrophic consequence, originating from intra-abdominal hemorrhage (arterial dilatation, aneurysms, dissecting hematomas) or bowel infarction (arterial stenosis, arterial occlusions), is not rare. The identification of these lesions is very important in the differential diagnosis of suspected patients with complaints of abdominal pain with hemorrhage. We report computerized tomography angiography and digital subtraction angiography findings of three cases with abdominal SAM, who were treated with endovascular management due to abdominal bleeding. Angiography showed arterial dilatations, aneurysms, and occlusions of visceral arteries in all three cases, The string-of-beads appearance was present in only one case. Bleeding stopped immediately after embolization of three cases and follow-up revealed no evidence of recurrences at 23, 18, and 15 months, respectively, Arterial coil embolization is an effective treatment modality for bleeding complications of SAM. Close follow-up is recommended, primarily to ascertain the fate of the nontreated arterial lesions.

  6. Superficial brachial artery: A possible cause for idiopathic median nerve entrapment neuropathy.

    PubMed

    Nkomozepi, Pilani; Xhakaza, Nkosi; Swanepoel, Elaine

    2017-02-15

    Nerve entrapment syndromes occur because of anatomic constraints at specific locations in both upper and lower limbs. Anatomical locations prone to nerve entrapment syndromes include sites where a nerve courses through fibro-osseous or fibromuscular tunnels or penetrates a muscle. The median nerve (MN) can be entrapped by the ligament of Struthers; thickened biceps aponeurosis; between the superficial and deep heads of the pronator teres muscle and by a thickened proximal edge of flexor digitorum superficialis muscle. A few cases of MN neuropathies encountered are reported to be idiopathic. The superficial branchial artery (SBA) is defined as the artery running superficial to MN or its roots. This divergence from normal anatomy may be the possible explanation for idiopathic median nerve entrapment neuropathy. This study presents three cases with unilateral presence of the SBA encountered during routine undergraduate dissection at the University of Johannesburg. Case 1: SBA divided into radial and ulnar arteries. Brachial artery (BA) terminated as deep brachial artery. Case 2: SBA continued as radial artery (RA). BA terminated as ulnar artery (UA), anterior and posterior interosseous arteries. Case 3: SBA continued as UA. BA divided into radial and common interosseous arteries. Arteries that take an unusual course are more vulnerable to iatrogenic injury during surgical procedures and may disturb the evaluation of angiographic images during diagnosis. In particular, the presence of SBA may be a course of idiopathic neuropathies.

  7. Hepatic artery reconstruction in living donor liver transplantation from the microsurgeon's point of view.

    PubMed

    Furuta, S; Ikegami, T; Nakazawa, Y; Hashikura, Y; Matsunami, H; Kawasaki, S; Makuuchi, M

    1997-07-01

    Microvascular surgery for the reconstruction of the hepatic artery in living donor liver transplantation is discussed from the microsurgeon's point of view. A refined operative procedure to improve the safety of the anastomosis is described. In living donor liver transplantation, the hepatic artery of the graft is short and small, the operative site is deep and mobile, and the anatomic arrangement of the graft left hepatic artery may differ from that of the recipient's dilated hepatic artery. To create a safe anastomosis under these conditions, recipient arteries that were slightly smaller than the graft artery were dissected. Without the size discrepancy, and end-to-end anastomosis could be created. Some refinements to create a good operative field made the anastomosis easy. The apparatus and techniques used in free-flap transfer facilitated a clean anastomosis. We anastomosed 44 arteries in 40 patients undergoing living donor liver transplantation using microsurgical techniques. Neither a decrease in the arterial blood flow nor hepatic artery thrombosis was noted. The refined operative procedure we describe in this report can be used to overcome the problems associated with the hepatic artery anastomosis in living donor liver transplantation.

  8. Radiological Findings and Endovascular Management of Three Cases with Segmental Arterial Mediolysis

    SciTech Connect

    Davran, Ramazan; Cinar, Celal; Parildar, Mustafa; Oran, Ismail

    2010-06-15

    Segmental arterial mediolysis (SAM) is an uncommon self-limited disorder that can cause abdominal catastrophes through massive bleeding or bowel infarction. The former arise from arterial aneurysms, and the latter from arterial stenosis or occlusions. Although this is an acute self-limiting disease, the catastrophic consequence, originating from intra-abdominal hemorrhage (arterial dilatation, aneurysms, dissecting hematomas) or bowel infarction (arterial stenosis, arterial occlusions), is not rare. The identification of these lesions is very important in the differential diagnosis of suspected patients with complaints of abdominal pain with hemorrhage. We report computerized tomography angiography and digital subtraction angiography findings of three cases with abdominal SAM, who were treated with endovascular management due to abdominal bleeding. Angiography showed arterial dilatations, aneurysms, and occlusions of visceral arteries in all three cases, The string-of-beads appearance was present in only one case. Bleeding stopped immediately after embolization of three cases and follow-up revealed no evidence of recurrences at 23, 18, and 15 months, respectively, Arterial coil embolization is an effective treatment modality for bleeding complications of SAM. Close follow-up is recommended, primarily to ascertain the fate of the nontreated arterial lesions.

  9. The interactions between bloodstream and vascular structure on aortic dissecting aneurysmal model: A numerical study

    NASA Astrophysics Data System (ADS)

    Chen, Zeng-Sheng; Fan, Zhan-Ming; Zhang, Xi-Wen

    2013-06-01

    Stent-graft implantation is an important means of clinical treatment for aortic dissecting aneurysm (ADA). However, researches on fluid dynamics effects of stent were rare. Computer simulation was used to investigate the interactions between bloodstream and vascular structure in a stented ADA, which endures the periodic pulse velocity and pressure. We obtained and analyzed the flow velocity distribution, the wall displacement and wall stress in the ADA. By comparing the different results between a non-stented and a stented ADA, we found that the insertion of a vascular graft can make the location of maximum stress and displacement move from the aneurysm lumen wall to the artery wall, accompanied with a greatly decrease in value. These results imply that the placement of a stent-graft of any kind to occlude ADA will result in a decreased chance of rupture.

  10. Spontaneous Coronary Dissection: “Live Flash” Optical Coherence Tomography Guided Angioplasty

    PubMed Central

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

    2016-01-01

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

  11. Segmental arterial mediolysis: report of 2 cases and review of the literature.

    PubMed

    Filippone, Edward J; Foy, Andrew; Galanis, Taki; Pokuah, Marian; Newman, Eric; Lallas, Costas D; Gonsalves, Carin F; Farber, John L

    2011-12-01

    Segmental arterial mediolysis (SAM) is an idiopathic noninflammatory vasculopathy involving small to medium arteries, usually in the abdomen, although arteries in the cerebral and coronary circulations also may be affected. Some cases present as abdominal apoplexy due to aneurysmal rupture, but ischemia and infarction also occur. Not uncommonly, SAM may be misdiagnosed as a systemic necrotizing vasculitis. We present 2 patients with bilateral renal infarctions, cerebral arterial dissections, and visceral artery microaneurysms. Both were diagnosed initially as polyarteritis nodosa. The diagnosis was changed to SAM, in one case based on clinical and radiologic features, and in the other, on an open wedge kidney biopsy. We discuss the differential diagnosis and review the literature on SAM.

  12. A Family Resemblance Approach to the Nature of Science for Science Education

    NASA Astrophysics Data System (ADS)

    Irzik, Gürol; Nola, Robert

    2011-07-01

    Although there is universal consensus both in the science education literature and in the science standards documents to the effect that students should learn not only the content of science but also its nature, there is little agreement about what that nature is. This led many science educators to adopt what is sometimes called "the consensus view" about the nature of science (NOS), whose goal is to teach students only those characteristics of science on which there is wide consensus. This is an attractive view, but it has some shortcomings and weaknesses. In this article we present and defend an alternative approach based on the notion of family resemblance. We argue that the family resemblance approach is superior to the consensus view in several ways, which we discuss in some detail.

  13. Accumulation of calcium and phosphorus in the coronary arteries of Thai subjects.

    PubMed

    Tohno, Yoshiyuki; Tohno, Setsuko; Mahakkanukrauh, Pasuk; Minami, Takeshi; Sinthubua, Apichat; Suwannahoy, Patipath; Khanpetch, Pongsak; Azuma, Cho

    2012-03-01

    To clarify the manner of accumulation of Ca and P in the coronary arteries, the authors divided the coronary arteries into many segments based on arterial ramification and investigated the element contents of the segments by direct chemical analysis. After ordinary dissection at Chiang Mai University was finished, the left coronary (LC) and the right coronary (RC) arteries were removed successively from the hearts of Thai subjects. The Thai subjects consisted of seven men and five women, ranging in age from 42 to 87 years (average age = 73.9 ± 13.5 years). The LC and the RC arteries were divided into 19 segments based on arterial ramification. After incineration with nitric acid and perchloric acid, element contents of the segments were analyzed by inductively coupled plasma-atomic emission spectrometry. In two cases, a significant content of Ca and P was contained only in the left anterior descending (LAD) artery (type I). In four cases, a significant content of Ca and P was contained in both the LAD and the RC arteries (type II). In five cases, a significant content of Ca and P was contained in all the LAD, the RC, and the circumflex (CF) arteries (type III). In the other one case, no significant content of Ca and P was contained in the coronary arteries. The manner of accumulation of Ca and P in the coronary arteries was classified into the three types, I, II, and III. Regarding the average content of elements in 12 cases, the average content of Ca was the highest in the segment of the LAD artery ramifying the first left diagonal artery and was higher in the proximal and distal adjacent segments of the LAD artery ramifying the first left diagonal artery, the proximal segment of the RC artery, and the proximal segment of the CF artery. To examine an effect of arterial ramification on accumulation of Ca and P, the differences in the Ca and P content between artery-ramifying and non-ramified proximal or distal segments of the coronary arteries were

  14. Aortic Dissection and Sudden Unexpected Deaths: A Retrospective Study of 31 Forensic Autopsy Cases.

    PubMed

    Li, Yang; Li, Ling; Mu, Hong-Shu; Fan, Shuan-Liang; He, Fang-Gang; Wang, Zhen-Yuan

    2015-09-01

    Acute aortic dissection (AAD) is the most common cause of sudden unexpected death related to aortic diseases. A retrospective study of 31 sudden unexpected deaths caused by AAD was conducted at Xi'an Jiaotong University Forensic Center from 2001 to 2012. We summarized the forensic characteristics of AAD and assessed the clinically diagnostic accuracy of AAD. The characteristics of sudden unexpected death due to AAD were male predominant (male: female=6.7:1), relatively young with the mean age of 44, and predominance of type A dissection (77.4%). Cardiac tamponade was the most frequent cause of sudden death (87.1%). Of the 31 cases, 26 (83.9%) patients were not recognized clinically and were misdiagnosed with acute myocardial infarction, coronary artery disease, cholecystitis, acute gastroenteritis, renal/urinary lithiasis, or acute pancreatitis. In summary, AAD can be difficult to recognize, diagnosis is therefore sometimes delayed or missed. The medicolegal death investigation can help physicians have a better understanding of AAD.

  15. Arterial supply to the thyroid gland and the relationship between the recurrent laryngeal nerve and the inferior thyroid artery in human fetal cadavers.

    PubMed

    Ozgüner, G; Sulak, O

    2014-11-01

    The aim of this study was to identify the arterial supply to the thyroid gland and the relationship between the inferior thyroid artery (ITA) and the recurrent laryngeal nerve (RLN) in fetal cadavers using anatomical dissection. The anterior necks of 200 fetuses were dissected. The origins of the superior thyroid artery (STA) and the ITA and location of the ITA in relation to the entrance of the thyroid lobe were examined. The relationship between the ITA and the RLN was determined. The origins of the STA were classified as: external carotid artery, common carotid artery (CCA), and the thyrolingual trunk. The origins of the ITA were the thyrocervical trunk and the CCA. The ITA was absent on the left side in two cases. The relationship of the RLN to the ITA fell into seven different types. Type 1: the RLN lay posterior to the artery; right (42.5%), left (65%). Type 2: the RLN lay anterior to the artery; right (40.5%), left (22.5%). Type 3: the RLN lay parallel to the artery; right (11.5%), left (7%). Type 4: the RLN lay between the two branches of the artery; right (1%), left (3.5%). Type 5: The extralaryngeal branch of the RLN was detected before it crossed the ITA; right (4.5%), left (0%). Type 6: the ITA lay between the two branches of the RLN; right (0%), left (0.5%). Type 7: the branches of the RLN lay among the branches of the ITA; right (0%), left (0.5%). The results from this study would be useful in future thyroid surgeries.

  16. External artery heat pipe

    NASA Technical Reports Server (NTRS)

    Gernert, Nelson J. (Inventor); Ernst, Donald M. (Inventor); Shaubach, Robert M. (Inventor)

    1989-01-01

    An improved heat pipe with an external artery. The longitudinal slot in the heat pipe wall which interconnects the heat pipe vapor space with the external artery is completely filled with sintered wick material and the wall of the external artery is also covered with sintered wick material. This added wick structure assures that the external artery will continue to feed liquid to the heat pipe evaporator even if a vapor bubble forms within and would otherwise block the liquid transport function of the external artery.

  17. Jet pump assisted artery

    NASA Technical Reports Server (NTRS)

    1975-01-01

    A procedure for priming an arterial heat pump is reported; the procedure also has a means for maintaining the pump in a primed state. This concept utilizes a capillary driven jet pump to create the necessary suction to fill the artery. Basically, the jet pump consists of a venturi or nozzle-diffuser type constriction in the vapor passage. The throat of this venturi is connected to the artery. Thus vapor, gas, liquid, or a combination of the above is pumped continuously out of the artery. As a result, the artery is always filled with liquid and an adequate supply of working fluid is provided to the evaporator of the heat pipe.

  18. Renal artery aneurysms.

    PubMed

    González, J; Esteban, M; Andrés, G; Linares, E; Martínez-Salamanca, J I

    2014-01-01

    A renal artery aneurysm is defined as a dilated segment of renal artery that exceeds twice the diameter of a normal renal artery. Although rare, the diagnosis and incidence of this entity have been steadily increasing due to the routine use of cross-sectional imaging. In certain cases, renal artery aneurysms may be clinically important and potentially lethal. However, knowledge of their occurrence, their natural history, and their prognosis with or without treatment is still limited. This article aims to review the recent literature concerning renal artery aneurysms, with special consideration given to physiopathology, indications for treatment, different technical options, post-procedure complications and treatment outcomes.

  19. Extracranial vertebral artery intervention.

    PubMed

    Mukherjee, Debabrata; Pineda, Guillermo

    2007-12-01

    Atherosclerosis is the commonest cause of vertebral artery stenosis and has a predilection for the origin and proximal section of the extracranial portion of the vessel and also the intracranial portion of the vessel. Although it has generally been thought that extracranial vertebral artery (ECVA) disease has a more benign outcome compared to intracranial vertebral artery disease, significant occlusive disease of the proximal vertebral artery is the primary cause of vertebral artery ischemia in a significant proportion of patients. We focus on the interventional management of patients with proximal ECVA disease in this article.

  20. Gastrointestinal symptoms resembling ulcerative proctitis caused by larvae of the drone fly Eristalis tenax

    PubMed Central

    Desoubeaux, Guillaume; Gaillard, Julien; Borée-Moreau, Diane; Bailly, Éric; Andres, Christian R; Chandenier, Jacques

    2014-01-01

    We report a case of facultative intestinal myiasis due to larvae of the drone fly Eristalis tenax, also named the rat-tailed maggots. The development of larvae in the lower bowel was responsible for non-specific gastrointestinal symptoms that resembled ulcerative proctitis. The diagnosis was established upon the observation of four spontaneously excreted mobile larvae. The definite identification of the E. tenax species was made possible by scanning electron microscopy. The clinical outcome was satisfactory. PMID:24766340