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Type A dissection

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https://www.readbyqxmd.com/read/28529261/clinical-implications-of-electrocardiograms-for-patients-with-type-a-acute-aortic-dissection
#1
Masami Kosuge, Kazuo Kimura, Keiji Uchida, Munetaka Masuda, Kouichi Tamura
Type A acute aortic dissection (AAD) is a serious cardiovascular emergency requiring urgent surgery. Timely accurate diagnosis is essential, but often challenging, because of the wide spectrum of clinical presentations. In patients with type A AAD, chest pain is the most common symptom; furthermore, ischemic ST-T changes such as ST-segment elevation or depression or negative T waves are frequently observed on presentation ECG. These clinical presentations of type A AAD are difficult to differentiate from those of acute coronary syndrome (ACS), which could lead to delayed diagnosis and treatment of type A AAD or misdiagnosis of ACS followed by inappropriate treatment...
May 19, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28528051/undersized-stent-grafts-for-acute-mesenteric-ischemia-in-chronic-type-b-dissection
#2
Eden C Payabyab, Andrew H Maloney, Derek R Brinster
Acute ischemia in chronic type B dissections carries high rates of morbidity and mortality. A 29-year-old woman with a chronic type B dissection presented with acute abdominal pain. Imaging revealed a worsening dissection with pseudocoarctation causing near complete occlusion of the true lumen by the false lumen. We placed purposefully undersized stent grafts to treat acute mesenteric ischemia by improving true lumen flow. The patient was discharged on postoperative day 4 without adverse events. We suggest that endovascular rescue by placing undersized stent grafts can provide improved flow to the mesenteric vessels with continued false lumen flow to vital organs...
June 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28528045/endovascular-fenestration-for-distal-aortic-sealing-after-frozen-elephant-trunk-with-thoraflex
#3
Randolph H L Wong, Peter S Y Yu, Micky W T Kwok, Simon C Y Chow, Jacky Y K Ho, Malcolm J Underwood, Simon C H Yu
We describe a case of total arch replacement with frozen elephant trunk for chronic type B aortic dissecting aneurysm, which resulted in inadvertent landing of the frozen elephant trunk into the false lumen. A radiofrequency puncture system-assisted controlled endovascular fenestration of the dissection flap was performed at the upper abdominal aorta and subsequent thoracic endovascular stenting, successfully redirecting the blood flow from the false to the true lumen. Our case illustrated a possible way to seal distal reentry in chronic type B aortic dissection...
June 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28527583/molecular-characterization-of-aspergillus-fumigatus-tcsc-a-characteristic-type-iii-hybrid-histidine-kinase-of-filamentous-fungi-harboring-six-hamp-domains
#4
Anja Spadinger, Frank Ebel
The type III hybrid histidine kinase (HHK) TcsC enables the pathogenic mold Aspergillus fumigatus to thrive under hyperosmotic conditions. It is, moreover, of particular interest, since it is the target of certain antifungal agents, such as fludioxonil. This study was aimed at a functional characterization of the domains that constitute the sensing and the kinase module of TcsC. The sensing module consists of six HAMP domains, an architecture that is commonly found in type III HHKs of filamentous fungi. To dissect the functional role of the individual domains, we have analyzed a set of truncated derivatives of TcsC with respect to their impact on fungal growth and their ability to respond to hyperosmotic stress and fludioxonil...
May 11, 2017: International Journal of Medical Microbiology: IJMM
https://www.readbyqxmd.com/read/28526092/transapical-aortic-perfusion-using-a-deep-hypothermic-procedure-to-prevent-dissecting-lung-injury-during-re-do-thoracoabdominal-aortic-aneurysm-surgery
#5
Yuya Kise, Yukio Kuniyoshi, Mizuki Ando, Hitoshi Inafuku, Takaaki Nagano, Satoshi Yamashiro
BACKGROUND: Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery. CASE PRESENTATION: A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis...
May 19, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28523430/long-term-durability-of-preserved-aortic-root-after-repair-of-acute-type-a-aortic-dissection
#6
Keiji Kamohara, Shugo Koga, Jun Takaki, Nozomi Yoshida, Kojiro Furukawa, Shigeki Morita
BACKGROUND: Optimal management of aortic root in type A aortic dissection (AAD) is controversial. To determine the most appropriate strategy, we studied the late outcomes after conservative repair of aortic root. METHODS: 234 AAD patients (mean age 68 ± 12 years) underwent surgical repair using supracommissural replacement (SCR) for aortic root reconstruction from 1989 to 2014. Ascending aortic replacement or hemi-arch replacement was performed in 180 patients (non-arch group), whereas total arch replacement (TAR) was performed in 54 patients...
May 18, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28523169/risk-factors-for-continuous-renal-replacement-therapy-after-surgical-repair-of-type-a-aortic-dissection
#7
Hai-Bo Wu, Wei-Guo Ma, Hong-Lei Zhao, Jun Zheng, Jian-Rong Li, Ou Liu, Li-Zhong Sun
BACKGROUND: To identify the risk factors for continuous renal replacement therapy (CRRT) following surgical repair of type A aortic dissection (TAAD) using the total arch replacement and frozen elephant trunk (TAR + FET) technique. METHODS: The study included 330 patients with TAAD repaired using TAR + FET between January 2014 and April 2015. Mean age was 47.1±10.2 years (range, 18-73 years) and 242 were male (73.3%). Univariate and multivariate analyses were used to identify the risk factors for CRRT...
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28523157/impact-of-maximum-standardized-uptake-value-of-non-small-cell-lung-cancer-on-detecting-lymph-node-involvement-in-potential-stereotactic-body-radiotherapy-candidates
#8
Shanyuan Zhang, Shaolei Li, Yuquan Pei, Miao Huang, Fangliang Lu, Qingfeng Zheng, Nan Li, Yue Yang
BACKGROUND: The retrospective study investigated the association between the maximum standardized uptake value (SUVmax) of primary tumor and lymph node involvement in potential stereotactic body radiotherapy (SBRT) candidates. METHODS: A total of 185 patients with clinical stage I NSCLC were enrolled in the current study. All patients underwent lobectomy with systematic lymph node dissection following preoperative FDG-PET/CT scanning. The association between clinicopathological variables and lymph node involvement was analyzed by univariate and multivariate analysis...
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28523015/transcription-factors-in-fungi-tfome-dynamics-three-major-families-and-dual-specificity-tfs
#9
Ekaterina Shelest
Transcription factors (TFs) are essential regulators of gene expression in a cell; the entire repertoire of TFs (TFome) of a species reflects its regulatory potential and the evolutionary history of the regulatory mechanisms. In this work, I give an overview of fungal TFs, analyze TFome dynamics, and discuss TF families and types of particular interest. Whole-genome annotation of TFs in more than 200 fungal species revealed ~80 families of TFs that are typically found in fungi. Almost half of the considered genomes belonged to basidiomycetes and zygomycetes, which have been underrepresented in earlier annotations due to dearth of sequenced genomes...
2017: Frontiers in Genetics
https://www.readbyqxmd.com/read/28522954/current-practices-in-endoscopic-submucosal-dissection-for-colorectal-neoplasms-a-survey-of-indications-among-korean-endoscopists
#10
Tae Jun Kim, Eun Ran Kim, Sung Noh Hong, Young-Ho Kim, Dong Kyung Chang
BACKGROUND/AIMS: The indications for colorectal endoscopic submucosal dissection (ESD) vary in clinical practice. To establish colorectal ESD as a standard treatment, standard indications are essential. For establishing standard indications for colorectal ESD, we surveyed the preferences and criteria of endoscopists for colorectal ESD in their practices. METHODS: A multiple-choice questionnaire was sent to 27 members of the Korean Society of Gastrointestinal Endoscopy/ESD group...
April 2017: Intestinal Research
https://www.readbyqxmd.com/read/28522906/magnetic-anchor-guidance-for-endoscopic-submucosal-dissection-and-other-endoscopic-procedures
#11
REVIEW
Mohamed Mortagy, Neal Mehta, Mansour A Parsi, Seiichiro Abe, Tyler Stevens, John J Vargo, Yutaka Saito, Amit Bhatt
Endoscopic submucosal dissection (ESD) is a well-established, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection...
April 28, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28521033/lymph-node-metastases-in-thymic-malignancies-a-chinese-alliance-for-research-in-thymomas-retrospective-database-analysis%C3%A2
#12
Zhitao Gu, Yucheng Wei, Jianhua Fu, Lijie Tan, Peng Zhang, Yongtao Han, Chun Chen, Renquan Zhang, Yin Li, Keneng Chen, Hezhong Chen, Yongyu Liu, Youbing Cui, Yun Wang, Liewen Pang, Zhentao Yu, Xinming Zhou, Yangchun Liu, Yi Shen, Wentao Fang
OBJECTIVES: Lymphatic involvement is believed to be relatively rare in thymic epithelial tumours. The incidence and prognostic significance of nodal metastases are still unclear. The goal of this study was to define the incidence and prognostic relevance of nodal metastasis in patients with thymic epithelial tumours, using a nationwide retrospective database of the Chinese Alliance for Research in Thymomas. METHODS: Patients who underwent upfront surgical resection without preoperative therapy were enrolled for the study...
May 18, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28520479/dissecting-the-complexities-of-the-relationship-between-police-officer-civilian-race-ethnicity-dyads-and-less-than-lethal-use-of-force
#13
Katelyn K Jetelina, Wesley G Jennings, Stephen A Bishopp, Alex R Piquero, Jennifer M Reingle Gonzalez
OBJECTIVES: To examine how sublethal use-of-force patterns vary across officer-civilian race/ethnicity while accounting for officer-, civilian-, and situational-level factors. METHODS: We extracted cross-sectional data from 5630 use-of-force reports from the Dallas Police Department in 2014 and 2015. We categorized each officer-civilian interaction into race/ethnicity dyads. We used multilevel, mixed logistic regression models to evaluate the relationship between race/ethnicity dyads and the types of use of force...
May 18, 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28516966/expanded-transcanal-transpromontorial-approach-to-the-internal-auditory-canal-and-cerebellopontine-angle-a-cadaveric-study
#14
L Presutti, M Bonali, D Marchioni, G Pavesi, A Feletti, L Anschuetz, M Alicandri-Ciufelli
The aim of this paper is to describe and evaluate the feasibility of an expanded endoscopic transcanal transpromotorial approach (ExpTTA) to the internal auditory canal and the cerebellopontine angle. To this end, we performed a cadaveric dissection study in September 2015. In total, 2 heads (4 sides) were dissected focusing on anatomical landmarks and surgical feasibility. Data from dissections were reviewed and analysed for further consideration. In all 4 sides of the cadavers the procedure was feasible. In all cadavers, it was necessary to extensively drill the temporo-mandibular joint and to calibrate the external ear canal to allow adequate room to manoeuver the instruments and optics and to comfortably access the cerebellopontine angle...
June 2017: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/28516179/%C3%AE-diazo-oxime-ethers-for-n-heterocycle-synthesis
#15
Subin Choi, Sujin Ha, Cheol-Min Park
This Feature Article introduces the preparation and synthetic utility of α-diazo oxime ethers. α-Oximino carbenes are useful synthons for N-heterocycles, and can be easily prepared from α-diazo oxime ethers as precursors. We begin with the preparation of α-diazo oxime ethers and their application in [3+2] cycloaddition. It turns out that the nature of metals bound to carbenes plays a crucial role in modulating the reactivity of α-oximino carbenes, in which copper carbenes smoothly react with enamines, whereas the less reactive enol ethers and nitriles require gold carbenes...
May 18, 2017: Chemical Communications: Chem Comm
https://www.readbyqxmd.com/read/28516103/simplified-approach-for-repair-of-early-pseudoaneurysm-of-the-left-coronary-button-following-composite-graft-due-to-acute-type-a-aortic-dissection
#16
Thierry Carrel, Samuel Hurni, Christoph Huber, Lars Englberger
We present a simplified surgical technique that was performed on a 37-year-old man who presented with a pseudoaneurysm of the left coronary ostium two months after repair of acute Type A aortic dissection with a composite graft. Intraoperatively, the surgical sites showed extreme adhesions. The leakage at the level of the coronary suture line was exposed from inside the aortic graft. Repair was performed using 7.0 polypropylene sutures, and the postoperative course was uneventful. The patient was discharged on postoperative day six without further complications...
December 2016: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28516101/early-spontaneous-resolution-of-an-iatrogenic-acute-type-a-aortic-dissection
#17
Mohammad A Zafar, Philip Y K Pang, Glen A Henry, Bulat A Ziganshin, Maryann Tranquilli, John A Elefteriades
Acute aortic dissection is a rare but devastating complication during cardiac catheterization. We present the case of an elderly female who incurred a Stanford Type A/DeBakey Type I acute aortic dissection extending into the arch vessels and descending aorta likely occurring during right coronary artery engagement for angioplasty. The patient was treated successfully by immediately sealing the entrance of the dissection via the placement of a stent and anti-impulse therapy. Follow-up computed tomography scan showed complete resolution of the dissection within one month...
December 2016: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28516099/conservative-management-of-extensive-iatrogenic-aortic-dissection
#18
Derrick Y Tam, Amine Mazine, Asim N Cheema, Bobby Yanagawa
Iatrogenic aortic dissection (IAD) is a rare complication of percutaneous coronary interventions (PCI). There are no clear guidelines for IAD management, and limited data are available. Registry data and case series combined with extrapolations from our experience with spontaneous Type-A dissections suggest that very limited dissections are often managed conservatively with coronary stenting of the entry tear when possible, while more extensive dissections are managed surgically. We present a case report of a 50-year-old woman who underwent PCI for an ST-elevation myocardial infarction that resulted in an extensive IAD from the ostium of the right coronary artery to the aortic root, ascending aorta, and aortic arch...
December 2016: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28516093/iatrogenic-supravalvular-aortic-stenosis
#19
Paolo Bosco, Antonella Ferrara, Samer A M Nashef
We describe a case of hemolytic anemia and proximal anastomotic site stenosis following emergency repair of a Type A aortic dissection. This rare complication led to a reoperation to correct the iatrogenic aortic stenosis and cure the consequent hemolysis. A "sandwich" technique (with two Teflon strips on the outside and inside of the aortic wall) was used in the initial repair to reinforce the suture line and prevent bleeding from the aortic anastomoses. At the time of reoperation, the inner Teflon strip at the proximal aortic anastomosis was found to have inverted into the aortic lumen, as suggested by the preoperative magnetic resonance imaging...
October 2016: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28516092/frozen-elephant-trunk-and-antegrade-visceral-debranching-in-the-surgical-treatment-of-type-b-aortic-dissection-an-alternative-method
#20
Altug Tuncer, Mustafa Akbulut, Taylan Adademir, Serpil Tas, Adnan Ak, Özgür Arslan, Benay Erden, Mesut Şişmanoğlu
Intervention is inevitable in complicated Type B aortic dissections. Classical surgical procedures and endovascular interventions are far from ideal treatments due to their high risk of periprocedural complications and mortality. There is often a need for alternative method in cases of difficult anatomy. We present the combined use of frozen elephant trunk and antegrade visceral debranching methods in the treatment of a 54-year-old male patient with complicated Type B aortic dissection.
October 2016: Aorta (Stamford, Conn.)
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