ABSTRACT
Objective To investigate the clinical features of aortic dissection (AD) and emergency treatments. Methods Data from 784 patients with aortic dissection were collected in the Department of Emergency from January 2000 through December 2009. A retrospective analysis was carried out to determine the survival rate, mortality rate and treatment efficiency. Results Pain was the most common onset symptom (77.7% , 609/784). The majority of patients (86.5%) had essential hypertension (678/784). All the patients with preoperative diagnosis of aortic dissection underwent emergency medical intervention by internists resulting in 81.5% survival rate (639/784) and 18.5% mortality rate (145/784). There were 157 patients without improvement (20.0% ) and the total efficiency rate was (83. 1% ). The efficiency rate of conventional treatment was 76.4% , while the efficiency rate of triple four-procedure treatment was 89. 8% (P<0.05). Of them, 139 patients (17. 7% ) died in the hospital. Among them,. 26 patients died within 24 hours (18.4% ) and 47 cases died within 48 hours (33. 8% ) and 66 patients died within 72 hours (47.2% ). There were 92 patients who refused treatments after diagnosis, and among them, 81 patients died within 72 hours (88.04% ). The difference in mortality rate between two groups was significant (P<0.05). Conclusions The diagnosis of aortic dissection depends on detailed history, physical examination and CT or MRI imaging. Analgesia, sedation and control of blood pressure are essential for emergency treatments. Early diagnosis and effective emergency treatments are the critical strategy for the early surgical intervention and time window for further treatment to improve the survival rate of AD.
ABSTRACT
Objective To explore the microneurosurgical technique and prevention of postoper-ative complications for the fourth ventricle tumors in adults. Methods We retrospectively analyzed the clinical data of 68 patients with the fourth ventricle tumors between August 2005 and August 2007 in Xiangya Hospital after microsurgical operation. Tumors were excised by inferior vermis cere-bellar approach or cerebellomedullary fissure approach. The extent of tumor removal should take into consideration the possible injury of brain stem respiratory center, especially tumors adherent to the brain stem. Cerebral aqueduct obstructions were removed in all patients, suspending dura on the neck muscles during closing skull to eliminate scalp hydrops. Results There were 58 total tumor excisions and 10 subtotal tumor excisions. No patient died and no suboccipital hydrops took place before dis-charge in this study. Postoperative symptomatic hydrocephalus was found in 10 patients, but it was cured by ventricle-abdomen shunt. Hemorrhage in tumor lumen happened in 4 patients, who received second microsurgery. Drugs were given to 8 patients with intracranial pneumatocele, 10 with intracra-nial infection, and 18 with upper gastrointestinal hemorrhage. Five patients out of the 16 tracheoto-mies recovered well by mechanical ventilation. Conclusion Protecting the life center of brain stem and dredging the aqueduct outlet completely were the key to surgical success. Therapeutic effect could be improved by adept microneurosurgical techniques after operation. The prognosis of patients may be improved by preventing complications actively and combined therapy after the operation.