Role of somatosensory evoked potentials in predicting outcome during thoracoabdominal aortic repair.

Background: Clinical utility of somatosensory evoked potentials (SSEP) in descending thoracic and thoracoabdominal aortic repair is debated. We reviewed our practical experience with SSEP in descending thoracic and thoracoabdominal aortic repairs.

Methods: Between January 2000 and April 2005, we used SSEP monitoring in 444 patients (270 thoracoabdominal aorta and 174 descending thoracic aorta).

MYH11 mutations result in a distinct vascular pathology driven by insulin-like growth factor 1 and angiotensin II.

Non-syndromic thoracic aortic aneurysms and dissections (TAADs) are inherited in an autosomal dominant manner in approximately 20% of cases. Familial TAAD is genetically heterogeneous and four loci have been mapped for this disease to date, including a locus at 16p for TAAD associated with patent ductus arteriosus (PDA). The defective gene at the 16p locus has recently been identified as the smooth muscle cell (SMC)-specific myosin heavy chain gene (MYH11).

Total sternal reconstruction using a titanium plate-supported methyl methacrylate sandwich.

We report a case of total sternal reconstruction using a methyl methacrylate polypropylene sandwich secured by using titanium plates. After previously failed attempts to wean the patient from the ventilator, this reconstruction allowed successful separation from ventilatory support in 6 days.

Transcriptional regulation of multi-drug tolerance and antibiotic-induced responses by the histone-like protein Lsr2 in M. tuberculosis.

Multi-drug tolerance is a key phenotypic property that complicates the sterilization of mammals infected with Mycobacterium tuberculosis. Previous studies have established that iniBAC, an operon that confers multi-drug tolerance to M. bovis BCG through an associated pump-like activity, is induced by the antibiotics isoniazid (INH) and ethambutol (EMB).

Proximal reoperations after repaired acute type A aortic dissection.

Background: Concerned with the associated risks of proximal reoperation, some have proposed an aggressive approach of aortic root replacement during emergent repair of acute type A aortic dissection. Because few data exist regarding late reoperations, we report outcomes of proximal reoperation after repaired type A aortic dissection.

Methods: Between January 1991 and March 2006, 63 patients underwent reoperation after previous repair for acute type A aortic dissection.

Successful descending thoracic aortic aneurysm repair during a twin pregnancy: case report and literature review.

A 28-year-old woman in the first trimester of a twin pregnancy presented with a symptomatic descending thoracic aortic aneurysm. We report our experience in managing a descending thoracic aortic aneurysm in this patient.

Multilevel somatosensory evoked potentials and cerebrospinal proteins: indicators of spinal cord injury in thoracoabdominal aortic aneurysm surgery.

Objective: Multilevel somatosensory evoked potentials (SSEP) and the release of biochemical markers in cerebrospinal fluid (CSF) were investigated to identify patients with spinal cord ischemia during thoracoabdominal aortic repair and/or a vulnerable spinal cord during the postoperative period.

Methods: Thirty-nine consecutive patients undergoing elective aneurysm repair using distal aortic perfusion and cerebrospinal fluid drainage were studied. Continuous SSEP were monitored using nerve stimulation of the right and left posterior tibial nerves with signal recording at the level of both common peroneal nerves, the cervical cord and at the cortical level.

Update on outcomes of acute type B aortic dissection.

Background: The optimal treatment of acute type B aortic dissection remains controversial. This study reports early clinical outcomes of medical management for acute type B aortic dissection.

Methods: Between January 2001 and April 2006, data on 159 consecutive patients (55 women [35%]) with the confirmed diagnosis of acute type B aortic dissection were prospectively collected and analyzed.

Optimization of aortic arch replacement: two-stage approach.

Background: Aneurysms of the aortic arch seldom occur alone. They usually involve the ascending aorta. Occasionally, the aneurysm also involves the descending thoracic or thoracoabdominal aorta.

Asymmetrical skull, ptosis, hypertelorism, high nasal bridge, clefting, umbilical anomalies, and skeletal anomalies in sibs: is Carnevale syndrome a separate entity?

A group of syndromes, consisting of Malpuech syndrome, Michels syndrome, Carnevale syndrome, OSA syndrome, and Mingarelli syndrome share the combination of symptoms of highly arched eyebrows, ptosis, and hypertelorism, and vary in other symptoms such as asymmetry of the skull, eyelid, and anterior chamber anomalies, clefting of lip and palate, umbilical anomalies, and growth and cognitive development. It has been suggested that they are in fact part of the same entity. Here, we describe a brother and sister with the same constellation of symptoms, and compare these with the various entities.

Robinow syndrome: report of two cases and review of the literature.

We report two patients with Robinow syndrome, review the published literature and stress the importance and limitations of radiographic examination in the diagnosis of this disorder, which shows extreme clinical and radiographic variability. The radiographic differential diagnosis of Robinow syndrome is discussed.

Craniocervical junction malformation in a child with Oromandibular-limb hypogenesis-Möbius syndrome.

We report a male child with Oromandibular-limb hypogenesis (OMLH), the main features being bilateral sixth and seventh nerve palsies, limb anomalies and hypoplasia of the tongue. Additional features were shortness of the neck associated with torticollis. Radiographs of the cervical spine were non-contributory, but 3D computed tomography (CT) scanning of this area identified: a) congenital hypoplasia of the atlas; b) the simultaneous development of occiput-atlas malformation/developmental defect.

Management of distal femoral and popliteal arterial injuries: an update.

Background: The management of combined arterial and musculoskeletal injuries to the lower extremity remains controversial, particularly with regard to the initial order of intervention and the use of intravascular shunting. In this study, we review the contemporary management and outcome of patients treated for acute traumatic distal femoropopliteal arterial injuries.

Methods: From January 2001 to January 2006, we repaired 57 acute traumatic lower-extremity arterial injuries in a level 1 trauma center.

Acute type A aortic dissection complicated by stroke: can immediate repair be performed safely?

Objective: Emergency surgical intervention for acute type A aortic dissection complicated by stroke remains controversial. The urgency of immediate repair in this setting is tempered by the concern that cerebral reperfusion may worsen neurologic outcome. The purpose of this study was to report and analyze our results with acute type A aortic dissection complicated by stroke.

[Fracture of the ulna and bilateral congenital dislocation of the head of the radius: A case report].

We report a case of bilateral congenital dislocation of the radial head discovered at the time of a fracture of the ulna. The dislocation was missed initially and when considered as part of the Monteggia fracture, raised a problem concerning the therapeutic approach. The purpose of this report is the emphasize the importance of careful physical examination before undertaking treatment of any lesion.

Chylothorax complicating repairs of the descending and thoracoabdominal aorta.

Background: Chylothorax occurring during thoracic aortic surgery is an infrequent but serious complication. The purpose of this study was to analyze our experience with this complication and the resulting outcomes.

Methods: From January 1991 to July 2005, we performed 1,233 descending thoracic and thoracoabdominal aortic surgical procedures.

Inflammatory aneurysm of the ascending aorta.

Inflammatory aneurysms of the aorta are usually seen in the infrarenal abdominal aorta and very rarely in the ascending aorta. We present the case of a 76-year-old male with inflammatory aneurysm of the ascending aorta.

Gastrointestinal complications after descending thoracic and thoracoabdominal aortic repairs: a 14-year experience.

Objective: There is a paucity of data regarding gastrointestinal (GI) complications after descending thoracic and thoracoabdominal aortic (DTA/TAA) surgical repairs. We examined our 14-year experience with these repairs to determine the incidence, outcomes, and risk factors for postoperative GI complications.

Methods: Between February 1991 and February 2005, we repaired 1,159 DTA/TAA.

Thoracic aortic aneurysms.

Remarkable progress has been made in the surgical treatment of thoracoabdominal aortic aneurysms. The decline in mortality and complication rates can be attributed to improvements in perioperative care and in surgical technique, particularly the adoption of adjunct distal aortic perfusion and cerebrospinal fluid drainage. Neurologic deficit is no longer a major threat to patients, as the use of adjuncts has brought the incidence down to 2.

The hybrid elephant trunk procedure: a single-stage repair of an ascending, arch, and descending thoracic aortic aneurysm.

Surgical repair of extensive aortic aneurysms requires a two-stage approach. We present the case of a single-stage repair using a hybrid procedure. This case demonstrates the technical feasibility of repairing properly selected extensive aortic aneurysms in a single procedure.

Outcomes of medical management of acute type B aortic dissection.

Background: Currently, the optimal treatment of acute type B aortic dissection remains controversial. The purpose of this study was to report early clinical outcomes of medical management for acute type B aortic dissection.

Methods And Results: Between January 2001 and March 2005, 129 consecutive patients with the confirmed diagnosis of acute type B aortic dissection were studied.

Transverse aortic arch replacement associated with MAGIC syndrome: case report and literature review.

We report a case of ascending and transverse aortic arch aneurysm repair with aortic valve replacement in a patient with MAGIC syndrome (mouth and genital ulcers with inflamed cartilage), the unusual setting of both Behçet's disease and relapsing polychondritis.