Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection.

Purpose: To report a case who required a thoracic endovascular stenting (TEVAR) following the deployment of frozen elephant trunk due to false lumen expansion.

Case Report: A 47 years old male patient undergone emergency repair of acute type A aortic dissection in 2011 with bioprosthetic aortic root conduit. Seven years later he presented with moderate aortic valve disease and expanding chronic dissection of the aortic arch, therefore a redo operation with replacement of the prosthetic aortic valve, ascending aorta, total arch and deployment of frozen elephant trunk and he was discharged in good health.

Setting up and utilizing a service for measuring perioperative transcranial motor evoked potentials during thoracoabdominal aortic surgery and thoracic endovascular repair.

Objectives: Paraplegia is a complication that may occur following surgery or endovascular stenting of thoracic and thoracoabdominal aortic pathology. Measuring transcranial motor evoked potentials (tcMEPs) has been shown to provide a reliable measure of spinal cord function during such procedures allowing interventions to protect cord function. In the spirit of sharing experience and eliminating the learning curve for others, this manuscript describes our experience of setting up a service for tcMEP monitoring as well as the documents and algorithms for measuring, recording and acting on the patient data, the so-called 'MEP Pathway'.

Novel application of acetazolamide to reduce cerebrospinal fluid production in patients undergoing thoracoabdominal aortic surgery.

Objectives: Paraplegia is a rare but devastating complication, which may follow thoracoabdominal aortic surgery. Many adjuncts have been developed to reduce this risk including cerebrospinal fluid (CSF) drainage. Acetazolamide (carbonic anhydrase inhibitor) is a drug used to counteract mountain sickness and one of its effects is to reduce CSF production.

Combined cardiac surgery and endovascular repair of abdominal aortic aneurysms.

Purpose: To report an initial experience of concomitant endovascular repair of abdominal aortic aneurysms (AAA) and cardiac surgery.

Methods: Records for 10 consecutive patients (all men; median age 68 years, range 60-79) with AAA treated by a multidisciplinary team at a tertiary specialist center were retrospectively reviewed. Each patient had independent indications for surgical correction of their cardiac disease and AAAs.

Three strikes--don't die of a broken heart.

There are multiple layers of complexity in prevention of vehicle related blunt traumatic aortic rupture (BTAR), many of which are enshrined within government policy and car design. We present a 'layers of protection analysis' (LOPA) based loosely on original work by Professor John Doyle, which describes these attempts to 'design out' the risk of BTAR following a vehicle collision. We have modified this approach to include a physiological dimension suggesting that this may be a factor in susceptibility to aortic injury following trauma.

Blunt trauma and acute aortic syndrome: a three-layer finite-element model of the aortic wall.

Objective: The exact process by which blunt trauma to the aorta produces a typical characteristic lesion set of primary, transverse, intimal injury remains unknown. The likely cause is a combination of intraluminal hypertension and mechanical deformation. We set about creating a three-layer finite-element model of the aorta.

Small vessel avulsion and acute aortic syndrome: a putative aetiology for initiation and propagation of blunt traumatic aortic injury at the isthmus.

Based on literature, clinical observation and the analysis of material properties of the aorta, we hypothesize that the aortic isthmus is intrinsically susceptible to blunt trauma because it has a higher density of tributary vessels than other elements of the aortic tree, the avulsion of which during trauma, is a contributory factor in the development of an acute aortic syndrome resulting from intra-mural haematoma, localized dissection and ultimately rupture. This hypothesis provides putative explanations for several aspects of the injury profile including: localized peri-isthmus injuries, inside out injury profiles and the concept of initiation versus propagation of blunt traumatic aortic injury.

Survival after esophageal resection for carcinoma: the importance of the histologic cell type.

Background: The significance of tumor cell type on survival after esophageal resection for carcinoma is uncertain. We reviewed our experience in order to compare the outcome in the two main histologic groups.

Methods: Between January 1987 and April 2000, 621 patients underwent esophagectomy with curative intention for squamous cell carcinoma or adenocarcinoma.

Anticipatory Valsalva-type response as a contributory factor in low impact blunt traumatic aortic rupture.

Despite a range of trauma scenarios, fatal blunt injury to the chest commonly results from rupture of the aorta at the isthmus. The aetiology whereby blunt traumatic aortic rupture predictably occurs at the isthmus remains uncertain, and although a number of theoretical mechanisms have been proposed, no direct evidence exists supporting any one process. In addition, it is uncertain why some individuals who are exposed to relatively minor blunt trauma, sustain this injury.

Functional compartmentation of glycogen phosphorylase with creatine kinase and Ca2+ ATPase in skeletal muscle.

This manuscript discusses aspects of functional compartmentation in the regulation of metabolism. The functional consequences of enzymes coupling between creatine kinase, glycogen phosphorylase and sarcoplasmic reticular Ca2+ ATPase is examined. It is proposed that the coupling of creatine kinase and glycogen phosphorylase classifies as a novel class of diazyme complex with an important regulatory role in the inhibition of glycogenolysis at rest.

Redo antireflux surgery--the importance of a tailored approach.

Objective: Although several studies have examined early outcome following redo antireflux surgery, there is little data on the long-term efficacy of these procedures. We reviewed our experience of these operations in order to assess the long-term results which can be achieved by choosing redo antireflux procedures based on the results obtained from pre-operative oesophageal function testing.

Methods: The case notes of 26 patients who underwent a repeat antireflux procedure between 1981 and 2000 were reviewed.

Histological determinants of survival in completely resected T1-2N1M0 nonsmall cell cancer of the lung.

Background: The histologic determinants of survival after surgical resection of stage II nonsmall cell lung cancer are poorly understood. We analyzed the prognostic significance of a number of histologic features after complete resection of T1-2N1M0 nonsmall cell cancer of the lung.

Methods: The case notes and histology of all patients who underwent a potentially curative surgical resection for T1-2N1M0 nonsmall cell carcinoma of the lung between 1991 and 1997 were reviewed retrospectively.