Analysis of death-related factors of type B aortic dissection treated medically during the acute phase / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the death-related risk factors of type B aortic dissection treated medically during the acute phase (symptoms presenting within 14 d), and to determine the predictors of surgical indications for acute type B aortic dissection.</p><p><b>METHODS</b>Clinical data of 42 patients with acute type B aortic dissection admitted from January 2007 to May 2009 was retrospectively reviewed. There were 33 male and 9 female with a mean age of (50 +/- 12) years old. Therapy included analgesia, controlled hypotension and beta-receptor blocker, the mortality in acute phase was 33.3% (14/42). Univariate and multivariate logistic regression analyses were performed to identify the predictors of the death in acute phase.</p><p><b>RESULTS</b>In univariate logistic regression analysis, the malperfusion of aortic branches (P = 0.018) and maximum aortic diameter (P = 0.002) were significant predictors of death. In the multivariate logistic regression model, the malperfusion of aortic branches (P = 0.041) and maximum aortic diameter (P = 0.005) were also considered as the significant death-related factors.Risk of death augmented significantly (P = 0.000) when the maximum aortic diameter over 40 mm.</p><p><b>CONCLUSION</b>Malperfusion of aortic branches and the large maximum aortic diameter (> 40 mm) are the indications of surgery or endovascular therapy for acute type B aortic dissection.</p>

Experience in the management of acute superior mesenteric artery ischemia / 中华外科杂志

<p><b>OBJECTIVE</b>To study the management of acute superior mesenteric artery (SMA) ischemia and to improve its prognosis.</p><p><b>METHOD</b>The clinical data of 37 patients treated from January 1996 to August 2007 was retrospectively reviewed.</p><p><b>RESULTS</b>Of the cases, 19 (51.4%) patients were diagnosed with acute SMA embolism, 15 (40.5%) with acute SMA thrombosis, 2 (5.4%) with spontaneous isolated dissection of SMA and 1 (2.7%) with SMA aneurysm. Nineteen (51.4%) patients were misdiagnosed in emergency. Eighteen (48.6%) patients died in the hospital, and most of them died of severe infection and multiple organ failure. Three cases of the survived 19 patients experienced severe complications (2 with short gut syndrome, 1 with cerebral hemorrhage). Nine cases were followed-up for a mean period of 15 months, and 5 died during that term.</p><p><b>CONCLUSIONS</b>Acute SMA ischemia has multiple etiological factors. Early intervention can improve the prognosis.</p>