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Evolution toward dissection of an intramural hematoma of the ascending aorta
No full textIntramural hematoma of the aorta is a condition increasingly observed in clinical practice. Uncertainty exists whether such lesions represent a different pathology or simply the precursors of classic dissecting aneurysm. The patient was a 76-year-old woman with intramural hematoma of the ascending aorta. Clinical course, progression of the lesion to type A aortic dissection, and surgical treatment are described. Although natural history of intramural hematoma of the ascending aorta is not clearly elucidated, the case presented confirms that the evolution toward intimal flap formation is possible and that we cannot foresee the stabilization of these lesions. We stress that intramural hematoma of the ascending aorta has to be managed as an aortic type A dissection and that aggressive treatment is advisable
Neoral versus Sandimmun: clinical impact and modification of immunosoppressive therapy in cardiac transplantation
No full textAxillary artery cannulation in type A aortic dissection operations
No full textBackground: Femoral arteries are the preferred site of peripheral cannulation for arterial inflow in type A aortic dissection operations. The presence of aortoiliac aneurysms, severe peripheral occlusive disease, atherosclerosis of the femoral vessels, and distal extension of the aortic dissection may preclude their utilization. Axillary artery cannulation may represent a valid alternative in these circumstances. Methods: Between January 15, 1989, and August 20, 1998, in our institution, 22 of 152 operations (14.4%) for acute type A aortic dissection were performed with the use of the axillary artery for the arterial inflow. Axillary artery cannulation was undertaken in the presence of femoral arteries bilaterally compromised by dissection in 12 patients (54.5%), abdominal aorta and peripheral aneurysm in 5 patients (22.7%), severe atherosclerosis of both femoral arteries in 3 patients (13.6%), and aortoiliac occlusive disease in 2 patients (9.1%). In all patients, distal anastomosis was performed with an open technique after deep hypothermic circulatory arrest. Retrograde cerebral perfusion was used in 9 patients (40.9%). Results: Axillary artery cannulation was successful in all patients. The left axillary artery was cannulated in 20 patients (90.9 %), and the right axillary artery was cannulated in 2 patients (9.1%). Axillary artery cannulation followed an attempt of femoral artery cannulation in 15 patients (68.2%). All patients survived the operation, and no patient had a cerebrovascular accident. No axillary artery thrombosis, no brachial plexus injury, and no intraoperative malperfusion were recorded in this series. Two patients (9.1%) died in the hospital of complications not related to axillary artery cannulation. Conclusions: In patients with type A aortic dissection in whom femoral arteries are acutely or chronically diseased, axillary artery cannulation represents a safe and effective means of providing arterial inflow during cardiopulmonary bypass
Serial assessment of peak VO2 and VO2 kinetics early after heart transplantation
No full textPURPOSE: Serial evaluation of aerobic metabolism and exercise tolerance early after heart transplantation (HT). METHODS: Fifteen heart transplant recipients (HTR), aged 52.0 +/- 9.9 yr (mean +/- SD), not undergoing structured rehabilitation programs, were tested two to four times during the first 2 yr post-HT. As a reference, a group of 11 healthy untrained controls (C) was utilized. Peak heart rate (peak HR), peak O2 uptake (peak VO2), and ventilatory threshold (VT) were determined during incremental bicycle exercise to voluntary exhaustion. VO2 kinetics were evaluated during constant-load exercise below VT, with determination of the duration of the "cardiodynamic" component (TDp) and of the time constant of the "primary" component (taup). RESULTS: Peak VO2 (L.min-1) was positively related to months post-HT (y=1.17 + 0.02x, P=0.003), and it increased by approximately 30% during the investigated period, although values in HTR were lower than in C (2.19 +/- 0.24). Peak HR was lower in HTR (136 +/- 15 beats.min-1) than in C (168 +/- 5), and it was not related to time post-HT. TDp was longer in HTR (31.4 +/- 6.3 s) than in C (23.2 +/- 6.1), and it was not related to time post-HT. A subgroup of HTR with markedly longer taup during the first months post-HT showed a significant decrease of this parameter as a function of time post-HT. CONCLUSIONS: Aerobic metabolism is impaired in HTR. Both central (cardiovascular) and peripheral (skeletal muscle) factors contribute to the reduced exercise tolerance. HTR showed, during the first 2 yr post-HT, a significant increase in peak VO2 and (in the patients with the slowest VO2 kinetics during the first months after HT) a significant improvement of the VO2 kinetics. The main gains seem to occur at the peripheral level
Localized dissection and delayed rupture of the abdominal aorta after extracorporeal shock wave lithotripsy
No full textExtracorporeal shock wave lithotripsy (ESWL) represents the preferred treatment for most upper ureteric and renal calculi. Complication rates associated with ESWL are low, justifying the enthusiasm and acceptance of this treatment modality. As the technique has become more widely available, some deleterious effects on the kidneys and the surrounding tissues are increasingly recognized. We report on the rupture of a severely calcified abdominal aorta in a 65-year-old man who underwent 3 months of ESWL treatment earlier for renal calculi. The patient was seen with an acute recrudescence of a long-standing abdominal and left flank pain, which began immediately after the last of the three sessions of ESWL and was associated with an episode of hypotension that occurred an hour before admission. Patient history and chronologic course of events strongly suggest the role of ESWL in the genesis of abdominal aorta rupture
Symptomatic coronary-subclavian steal syndrome: Report of a case with complete occlusion of proximal left subclavian artery and anomalous origin of left vertebral artery from the aortic arch
No full textA case of severe resting angina in a patient with a patent left internal thoracic artery (LITA) graft on the left anterior descending coronary artery (LAD), complete occlusion of the proximal left subclavian artery, and anomalous origin of the left vertebral artery from the aortic arch is presented. The clinical picture, hemodynamic pattern, and treatment are described
C2 and C0 values for monitoring cyclosporine therapy in stable heart transplant recipients.
No full textIntroduction. We sought to evaluate the behavior of C2 values and their correlation with
acute rejection episodes and cyclosporine (CyA) side effects in heart transplant patients
whose immunosuppressive therapy, was monitored with C0 trough levels.
Methods. Sixty stable patients who had received heart transplants from 3 months to 60
months prior were randomly observed from September 2001 to June 2004. Four area
under the concentration-time curves (AUC) were performed on each patient, a total of 240
AUC curves.
Results. Regarding the variability of CyA absorption, two groups of patients were
distinguished: group A, “constant absorbers,” namely, low variability (15%) of CyA
absorption; group B, “inconstant absorbers” patients with higher (15%) variability of
absorption. Group B patients showed more acute rejection episodes (41%) than group A
(19%). CyA side effects were more serious in patients with higher variability of absorption:
systemic hypertension, neurological disorders, hyperlipidemia, and gum hyperplasia;
Group B patients who developed CyA side effects showed higher maximum and mean C2
levels (P .05) than group A patients. No differences were found with regard to renal
dysfunction between the two groups: all patients showed a mean increase of serum
creatinine by at least 50% compared to the baseline value.
Conclusion. Higher C2 levels were not sufficient to predict acute rejection compared to
lower but constants, C2 levels. Patients with inconstant absorption were more often
overexposed to CyA than underexposed, developing more side effects than patients with
lower variability of absorption. Monitoring CyA theraphy with C0 and C2 may prevent
over- or underexposure to the drug
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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