Descending aortic intramural hematoma with pulmonary embolism: A case report / 中国胸心血管外科临床杂志

@#Aortic intramural hematoma and pulmonary embolism are two rapidly progressive and life-threatening diseases. A 65-year-old male patient with descending aortic intramural hematoma and pulmonary embolism underwent pulmonary embolectomy and descending aortic stent-graft placement, with good postoperative results.

Surgical versus conservative treatment for acute type A aortic intramural hematoma: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH). Methods    Clinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group). Results    Finally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P>0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P<0.001). Conclusion    The mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.

A rare case of traumatic intramural hematoma in pediatricage group successfully managed with expectant approach

Acute colonic intramural hematoma is a rare clinical entity. In most cases reported in literature a surgical management is used. Here we present a case of an 8-year-old boy who was found to have a colonic intramural hematoma following a fall from bicycle. Considering the age of the child and hemodynamic stability a conservative management wasadopted and the child was successfully managed

Esophageal Intramural Pseudodiverticulosis / Pseudodiverticulosis intramural del esófago

Abstract A report of two cases of esophageal intramural pseudodiverticulosis, a very unusual disease, with other 240 cases reported in the entire world literature since 1960. Its etiology and pathogenesis are still not fully understood. However, it is believed that hypertrophy of the submucosal glands, with chronic inflammation, fibrosis, and consequent esophageal stenosis, causes dysphagia, which is the primary manifestation of esophageal intramural pseudodiverticulosis. The main diagnostic methods include the radiological examination of the esophagus with barium contrast (esophagogram) and esophagogastroduodenoscopy (EGD). Both reported cases were treated with endoscopic dilation, exemplifying the safety and efficacy of this therapeutic option for treating dysphagia in these individuals.

Resumen Reporte de dos casos de pseudodiverticulosis esofágica intramural, una enfermedad muy inusual, con otros 240 casos reportados en toda la literatura mundial desde 1960. Su etiología y patogenia aún no se conocen completamente; sin embargo, se cree que existe una hipertrofia de las glándulas submucosas, con inflamación crónica, fibrosis y consecuente estenosis esofágica, lo que provoca disfagia, que es la principal manifestación de la pseudodiverticulosis esofágica intramural. El examen radiológico del esófago con contraste de bario (esofagograma) y la endoscopia digestiva alta (EDA) son los principales métodos de diagnóstico. Ambos casos reportados se trataron con dilatación endoscópica, lo que ejemplifica la seguridad y eficacia de dicha opción terapéutica para el tratamiento de la disfagia en estos individuos.

Surgical treatment of infants with transposition of the great arteries and intramural coronary artery / 中国胸心血管外科临床杂志

@#Objective    To summarize the surgical experience of infants with transposition of the great arteries (TGA) and intramural coronary artery (IMCA) in our center, and analyze the early and mid-term outcomes. Methods    We retrospectively analyzed the clinical data of 384 infants with TGA undergoing arterial switch operation (ASO) from June 2010 to December 2018 at Fuwai Hospital. According to operative records, 21 (5.5%) infants had IMCA, among whom 20 were males, with a median age of 33 (9-319) d. Coronary transfer using double coronary buttons with unroofed intramural course was performed in all 21 infants. Results    There was no statistical difference in the early mortality after ASO between infants with IMCA and infants with normal coronary anatomy (9.5% vs. 3.0%, P=0.15). In the IMCA group, 2 dead patients presented inadequate coronary artery perfusion after first aortic unclamping. In addition, 1 patient underwent extracorporeal membrane pulmonary support for myocardial dysfunction. The follow-up was available for all 19 survivors, with an average follow-up time of 29.0-120.0 (74.8±27.3) months. During the follow-up, all patients had no obvious symptoms, death, reoperation, or coronary complications. One patient developed moderate pulmonary valve regurgitation and another patient developed distal stenosis of the right pulmonary artery. Conclusion    For infants with TGA and IMCA, coronary transfer using double coronary buttons with unroofed intramural course is a safe and reliable technique, with satisfactory early and mid-term outcomes.

Hematoma disecante de esófago como diagnóstico diferencial del dolor torácico agudo / Dissecting hematoma of the esophagus as a differential diagnosis of acute chest pain

Resumen El dolor torácico es un motivo de consulta muy frecuente en el servicio de urgencias. El abordaje adecuado del paciente en el que se incluye el diligenciamiento de la historia clínica, el examen físico y la toma de paraclínicos iniciales son cruciales para determinar cuáles son los posibles diagnósticos diferenciales. A continuación, presentamos el caso de un paciente de 71 años que ingresa al servicio de urgencias por un dolor retroesternal intenso posterior al consumo de alimentos, en quien, ante la persistencia del dolor, biomarcadores cardíacos negativos y patología aórtica descartada, se realiza una endoscopia que evidencia un hematoma disecante del esófago. En general, el pronóstico es bueno, pero es de gran importancia una buena historia clínica para su sospecha.

Abstract Chest pain is a very common reason for consultation in the emergency department. An adequate approach to the patient, including medical history, physical examination and initial laboratory tests, is crucial for determining possible differential diagnoses. The following is the case of a 71-year-old patient that visited the emergency room due to severe retrosternal pain after food consumption. In view of the persistence of pain and negative cardiac biomarkers, and after ruling out aortic disease, the patient underwent an endoscopy that showed dissecting hematoma of the esophagus. The prognosis is generally favorable, but a thorough medical history is required to suspect it.

Progress of Intramural Metastasis of Esophageal Squamous Cell Carcinoma / 肿瘤防治研究

Intramural metastasis (IM) is defined as metastatic tumor from the primary tumor to the digestive tracts through the intramural lymphatic system. It can occur in esophageal, gastric and colorectal carcinomas, especially in esophageal squamous cell carcinoma. The combination of histological morphological evaluation and molecular pathology can assist in the identification of IM and multiple primary carcinomas (MPCs). IM is usually associated with a poor prognosis and also affects the treatment. This article reviews the anatomical and histological basis, clinicopathological characteristics, treatment and prognosis of IM in ESCC, the identification of IM and MPCs and how to improve the detection rate of IM, to guide accurate diagnosis and treatment.

Advanced esophagogastric junction cancer with brain, bone and gastric intramural metastases responding to combined modality therapy / Journal of Rural Medicine

A 63-year-old man was admitted to our hospital in March 2017 with dysphagia and right homonymous hemianopsia. We diagnosed him with esophagogastric junction cancer (adenocarcinoma) with metastases to the cerebral occipital lobe, bone, and lymph nodes. After one cycle of 5FU + cisplatin (FP), the brain metastasis was resected because of the hemiplegic symptoms he developed. Histology of the resected tissue showed no viable tumor cells. After three cycles of FP, the primary lesion and metastases were resolved. Upper gastrointestinal endoscopy revealed a scar at the primary site. This was considered a complete response (CR). In April 2018, CT revealed a mass at the cardia, which was considered as lymph node metastases with gastric wall invasion. Although two additional cycles of FP were administered for recurrent tumors, the efficacy was progressive. In August 2018, proximal gastrectomy and D1 + lymph node dissection were performed. The pathological diagnosis was gastric intramural metastases and lymph node metastases (ypN1 [2/22]). Weekly paclitaxel therapy was administered for three months after surgery. Two years have passed since the last surgery without recurrence. We report a rare case of esophagogastric junction cancer with brain, bone, and gastric intramural metastases that responded to combined modality therapy.

Early survival analysis of acute type A aortic dissection and intramural hematoma / 中国胸心血管外科临床杂志

@#Objective    To explore the early clinical outcomes of patients with acute type A aortic dissection and intramural hematoma. Methods    The clinical data of 61 patients with acute type A aortic dissection or intramural hematoma in our hospital from January 23, 2020 to March 10, 2020 were retrospectively analyzed, including 43 males and 18 females, aged 22-81 (52.1±13.0) years. The patient's time of visit, clinical characteristics and early survival were analyzed. Kaplan-Mier survival curve and log-rank test were used for the survival analysis. Results    There were 48 (78.7%) patients diagnosed with acute type A aortic dissection and 13 (21.3%) patients with intramural hematoma; 34 patients received operation and 11 were emergent. The 30-day mortality was 2.9% among the patients receiving operation. There were 48 patients alive and 13 patients dead during the study period. The cumulative survival rates for all the patients on postoperative 1 day, 3 days and 7 days were 93.4%, 86.4% and 77.5%, respectively. The cumulative survival rates for the patients with dissection on postoperative 1 day, 3 days and 7 days were 95.7%, 88.7% and 79.4%, respectively. The cumulative survival rates for the patients with hematoma on postoperative 1 day, 3 days and 7 days were 92.3%, 84.6% and 84.6%, respectively. The difference of survival rates between the two groups was not statistically significant (P>0.05). The cumulative survival rate of all the patients on postoperative 14 days was 74.5%. No statistically significant difference in survival rate on postoperative 14 days was found between patients with intramural hematoma and patients with aortic dissection (P>0.05). The proportions of the patients with unstable hemodynamics were found statistically significant between the survival patients and the dead patients (P<0.05). Conclusion    Patients with acute aortic dissection and intramural hematoma who survive to the hospital still have the risk of death under active drug therapy, and rupture of the dissection is the leading cause of death in these patients, especially for those with hemodynamic unstability.

Profile of neonatal mortality in special newborn care unit of tertiary care hospital

Background: In India presently around 8 million LBW infant are born each year. India accounts for 24% of global neonatal mortality. Improving NMR is an essential component of reducing U-5MR. The aim of this study was to determine the causes of morbidity and mortality in neonates admitted in our hospital.Methods:' This study was conducted at SNCU of Kamala Raja Hospital, Gwalior providing level III neonatal care. This is a retrospective hospital based observational study. Data from SNCU online database were taken for a period of 3 year from March 2016 to March 2019. Data obtained included sex, birth weight, Gestation age, morbidity profile, Diagnosis, and Mortality profile, Duration of stay and outcome. Categorical variables were tabulated and Statistical analysis was done.Results:' A total of 12,027 neonates were recruited, 63.07% were males and 36.92% were females. 54.87% were extramural, while 45.13% were intramural neonates. Prematurity was the most common morbidity 56.98% in the admitted neonates. Major contributors to the neonatal morbidity were Birth asphyxia (24.61%), others (21.60%), Respiratory Distress(14.06%), Sepsis(13.77%). The mortality rate in the present study is 25.45%. Major contributors for neonatal mortality includes Respiratory distress (37.76%), Birth Asphyxia (26.75%), Sepsis(13.91%). Mortality was more in out born babies 33.03% compared to inborn babies 22.03%.'Conclusions:' Improving antenatal care, more deliveries at institutions with SNCU facility, improved access to health facility, early identification of danger signs,'' timely referral of high risk cases, capacity building, can reduce neonatal mortality and its complications.

Expression and cellular distribution of insulin-like growth factor 1 receptor during window of implantation in infertile women with intramural fibroids

Background: The “window of implantation” (WOI) is a transient but well defined period during which the hostile endometrial lining is transformed to a surface receptive to accept the embryo. Recently, data are beginning to accumulate suggesting negative influence of non-cavity distorting intramural uterine fibroids (NCD-IMF) on endometrial receptivity that may have implications for implantation failure. However, molecular mechanisms underlying infertility associated with NCD-IMF remain unclear. The aim of present study was to examine the expression and cellular distribution of insulin-like growth factor 1 receptor (IGF1R) during WOI in infertile women with NCD-IMF and fertile controls. While, reports are available that support role of IGF1R in mediating adhesive interaction with the implanting blastocyst, the effect of NCD-IMF on IGF1R expression during the WOI is not defined.Methods: Quantitative real-time polymerase chain reaction and immunohistochemistry were used to evaluate messenger RNA (mRNA) and protein expression of IGF1R in midsecretory endometrial biopsies obtained from infertile women with NCD-IMF (n=20) and healthy fertile controls (n=10).Results: As compared to fertile controls, significantly higher IGF1R: i) mRNA levels (1.59 fold up regulation; p=0.044) and ii) immunoscore in the luminal epithelium (8.94±3.13 versus 6.31±1.49; p=0.009) were observed in infertile women with NCD-IMF.Conclusions: Over expression of IGF1R in infertile women with NCD-IMF, during the window of receptivity, may result in altered ability of uterine epithelial cells for blastocyst adhesion and subsequent implantation, which might lead to poor reproductive outcome in these women.

A prospective study to evaluate influence of maternal, obstetric and fetal risk factors on the outcome of asphyxiated neonates born intramurally and extramurally

Background: The present study was planned to determine the influence of maternal, obstetric and fetal risk factors on the outcome of intramurally (born at a tertiary care centre) and extramurally (born at a peripheral centre, home or a private facility) born asphyxiated neonates.Methods: It was an observational clinical research with a prospective design and was conducted in Neonatal Intensive Care Unit (NICU), Paediatric Neurology Clinic attached to Department of Paediatrics and Department of Obstetrics and Gynecology, Dr S N Medical College Jodhpur, Rajasthan. A total of 160 asphyxiated neonates (80 intramural and 80 extramural) were included in the study. A detailed antenatal and perinatal history with obstetrical interventions were recorded. The progress or deterioration in the clinical status of child was noted in hours. Outcome was evaluated in terms of survival, severest Hypoxic Ischaemic Encephalopathy (HIE) stage, time taken to reach non encephalopathic state, requirement of vasopressors and anticonvulsants, ventilator support, hemodynamic stability, time period to attain full enteral feeding, neurological examination at time of discharge and time taken for discharge.Results: Significant difference was observed in the antenatal and perinatal profile, perinatal management and resuscitation, postnatal management, morbidity, mortality and neurodevelopment outcome of extramurally delivered neonates in a peripheral health centre or at home as compared to intramurally delivered neonates in a tertiary institute.Conclusions: It is of paramount importance to have an early referral of asphyxiated neonates to a well equipped NICU using an appropriate well equipped transport unit/ chain so as to improve their outcome.

A new experimental model of intrinsic denervation in ileum from wistar rats through intramural microinjections of benzalkonium chloride / Um novo modelo experimental de desnervação intrínseca em íleo de ratos wistar através de micro injeções intramurais de cloreto de benzalcônio

Extensive literature is available about the intrinsic denervation of segments of the digestive tube through the application of CB in the serosa of the viscera. However, this technique has some disadvantages like causing peritonitis, flanges and high mortality, limiting its use in humans. The aim of the present study was to evaluate the feasibility of benzalkonium chloride (CB) to induce intrinsic chemical denervation, through applications of CB in the intramural ileum of wistar rats, as well as deepen the knowledge about the evolution of neuronal injury caused in the process. We used 40 rats, divided into two groups (control-GC and benzalkonium-GB) of 20 animals each, divided into four sub-groups according to the time of postoperative assessment of 24, 48 hours, 30 and 90 days. The animals were submitted to intramural microinjections of sterile saline solution 0.9% (GC) or benzalkonium chloride (GB) in ileal portion, and subsequent histopathological analysis and immunohistochemistry for evaluation of neuronal injury. A significant decrease (p<0.05) was found of the neuronal myenteric count over time in groups, GB3, GB4 and GB2. The specific positive immunolabeling for H2AX and Caspase-3 confirmed the results obtained in the histopathological evaluation, denoting the ignition of irreversible cell injury in 24 hours, evolving into neuronal apoptosis in 48 hours after application of the CB 0.3%. Under the conditions in which this work was conducted, it can be concluded that the application of CB 0.3% by means of microinjections intramural in the ileal wall is able to induce intrinsic chemical denervation of the diverticulum of wistar rats and that the main mechanism of neuronal death is induction of apoptosis.(AU)

Existe vasta literatura sobre a desnervação intrínseca de segmentos do tubo digestório através da aplicação de CB na serosa da víscera. Entretanto, essa técnica tem a desvantagem de causar peritonite, formação de bridas e alta mortalidade, não sendo factível para eventuais utilizações em humanos. O objetivo do presente estudo foi avaliar a viabilidade do Cloreto de benzalcônio (CB) induzir desnervação química intrínseca, por meio de aplicações intramurais em íleo de ratos wistar, além de aprofundar o conhecimento sobre a evolução da lesão neuronal causada neste processo. Foram utilizados 40 ratos, distribuídos em dois grupos (controle- GC e benzalcônio- GB) de 20 animais cada, subdivididos em quatro subgrupos de acordo com o tempo de avaliação pós-operatória de 24, 48 horas, 30 e 90 dias. Os animais foram submetidos à microinjeções intramurais de solução salina estéril 0,9% (GC) ou de cloreto de benzalcônio (GB) em porção ileal, e posterior análise histopatológica e imuno-histoquímica, para avaliação da lesão neuronal. Houve diminuição significativa (p<0,05) na contagem neuronal mientérica ao longo do tempo nos grupos GB2, GB3 e GB4. A imunomarcação específica positiva para H2AX e Caspase-3 confirmou os resultados obtidos na avaliação histopatológica, denotando início da lesão celular irreversível em 24 horas, evoluindo para apoptose neuronal em 48 horas após a aplicação do CB 0,3%. Nas condições em que este trabalho foi conduzido, é possível concluir que a aplicação de CB 0,3% por meio de microinjeções intramurais na parede ileal é capaz de induzir desnervação química intrínseca da porção ileal de ratos wistar e que o principal mecanismo de morte neuronal é a indução de apoptose.(AU)

Hematoma intramural e úlcera penetrante da aorta: incertezas e controvérsias / Intramural hematoma and penetrating atherosclerotic ulcers of the aorta: uncertainties and controversies

A história natural do hematoma intramural (HI) e da úlcera penetrante (UP) é muito variável, já que podem progredir para a formação de aneurisma, ruptura, dissecção, e podem até mesmo regredir, no caso específico do HI. Exames de imagem têm crescente papel no manejo clínico e operatório da UP e do HI. Ao contrário das projeções semelhantes a úlcera, achados de lagos sanguíneos não são relatados nos estudos tomográficos de pacientes com HI. O entendimento das características da imagem e do curso natural de cada uma dessas entidades ajudará clínicos e cirurgiões a identificar os pacientes com maior risco para um mau prognóstico e pode melhorar os desfechos. A fisiopatologia dessas entidades, as controvérsias no que se refere a suas histórias naturais e os fatores prognósticos das imagens tomográficas são discutidos neste artigo

The natural histories of intramural hematoma (IMH) and penetrating atherosclerotic ulcer (PAU) are highly variable as they may progress to aneurysm formation, rupture, or dissection, or even resolve, in the specific case of IMH. Imaging plays an increasingly important role in clinical and surgical management of IMH and PAU. In contrast to ulcer-like projections, images of intramural blood pools have not been widely reported in CT studies of patients with IMH. Understanding the imaging characteristics and the natural course of each of these entities would help clinicians and surgeons to identify patients at greatest risk for bad prognosis and may improve outcomes. This paper discusses the pathophysiology of these entities, the controversies regarding their natural history, and the prognostic factors that should be identified in CT scans

Correlation between C-reactive Protein and Morphology of Aortic Intramural Hematoma on CT Angiography / 中国医学科学杂志(英文版)

Objectives To investigate the morphologic characteristics of intramural hematoma (IMH) on CT angiography (CTA), and evaluate the possible correlation of serum C-reactive protein (CRP) with morphologic characteristics of IMH. Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study, including 30 males and 12 females, with the mean age of 61 ± 14 years old. The volumetric CT data were retrospectively processed and analyzed on post-processing workstation. Based on the thickness of IMH and the length-area curve, the cross-sectional area of true lumen and total vessel were measured, the hematoma-vessel ratio (HVR) was calculated. Imaging characteristics were compared between patients who had pathological elevated CRP (> 0.8 mg/dl) and those did not. Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic validity of CRP. Results Of all 42 IMH patients, the mean serum CRP was 3.94 ± 4.71 mg/dl, and the mean HVR was 46.7%± 14.2%. HVR in patients with elevated CRP was significantly higher than those with normal CRP (49.7% ± 15.0% vs. 40.7% ± 10.5 %, P = 0.030). HVR was mildly correlated with CRP in all patients (r =0.48, P < 0.001). CRP levels differed neither between patients with Stanford type A and B (P = 0.207), nor between patients with and without intimal disruption (P = 0.230). To discriminate HVR > 47% (the mean value), the area under curve (AUC) were 0.700 (95% CI: 0.535-0.865) for CRP at a cutoff point of 3.55 mg/dl, with a sensitivity of 54.5% and a specificity of 90.0%. Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH, but not with Stanford types and the presence of intimal disruption.

Arterial switch operation: 10-year experience at a single center / 中华胸心血管外科杂志

Objective To summarize the outcomes and experience of arterial switch operation (ASO) in the past 10 years in our center.Methods From September 2008 to July 2017,238 patients underwent ASO at Guangzhou Women and Children Medical Center for repair of transposition of the great arteries and Taussig-Bing anomaly.There were 193 male and 45 female.Median age at operation was 2 months (2 days to 10 years) and mean body weight was(4.2 ± 1.7) kg (1.8-20.6 kg).There were TGA and VSD 91 cases,TGA/IVS 110 cases,and Taussig-Bing anomaly 37 cases.Among them 24 patients had an aortic arch anomaly.Intramural coronary artery was found in 8 patients.Results All patients successfully completed the operation,one-stage ASO was perfonned in 232 patients.Two-stage ASO was performed in 6 patients.The mortality was 14.2％.The follow-up duration was 1-10 years (median time,46 mouths).There were 3 died.Two suffered sudden death,and another one arrhythmia.10-year survival rate was 92.8％.Conclusion The outcomes of ASO were satisfactory.The long-term reoperation rate was rare.

The characteristic and treatment of intramural hematoma in elderly patients without trauma / 中华胸心血管外科杂志

Objective To analyze the characteristics and treatment of aortic intramural hematoma ( IMH) in non-traumat-ic elderly patients, and to provide clinical reference for the diagnosis and treatment of this disease .Methods A retrospective analysis of clinical data of 36 elderly patients without trauma during the period from March 2013 to May 2017 in our hospital , to clarify the characteristics of pathogenesis and imaging feature , and to evaluate treatment options.Results 36 patients were followed up and the outcomes of them were satisfactory .Of which 17 asymptomatic patients were given conservative treatment . 19 cases of emergency patients, 7 patients received the emergency operation, 9 patients were given interventional treatment after initial conservative medical treatment, 3 patients received drug treatment, of which 1 patient was conservatively successful, and 2 patients progressed.During follow-up, the imaging data of most of the patients were obtained.The aortic enhanced CT indi-cated that the hematoma disappeared or decreased markedly, and the asymptomatic patients were in stable condition, and the dilatation of aorta was not obvious in patients who have access to imaging examination .Conclusion Elderly patients with IMH are more common in men, especially Stanford B type.IMH in asymptomatic elderly patients with multiple penetrating aortic ul-cer(PAU), but the range of hematoma is limited, no significant progress.And this type of patients can be considered only for conservative treatment.On the contrary, IMH of symptomatic elderly patients usually involve a wide range of aorta , and most of them were caused by single small ulcer.Although the patients have been treated with conservative medicine , the disease is still progress and endovascular treatment repair of aorta can be considered .

Surgical treatment of Stanford A intramural hematoma / 中华胸心血管外科杂志

Objective@#To summarize experience and result in surgical treatment of Stanford type A intramural hematoma.@*Methods@#60 patients with Stanford type A intramural hematoma were operated from February 2015 to August 2017. Surgery was indicated in complicated cases with penetrating ulcer or ulcer-like projection in ascending aorta, maximum aorta diameter≥50 mm, progressive maximum aortic wall thickness≥10 mm, pericardial or pleural effusion, persistent or recurrent pain. Aortic valve regurgitation. In our group, 46 patients recieved ascending aorta replacement+ Sun' s procedure. 6 patients recieved Bentall+ Sun' s procedure. 4 patients recieved asceding aorta+ hemiarch replacement. 2 patients recieved Bentall+ hemiarch replacement. 2 patients recieved asceding aorta replacement.@*Results@#In the whole group, there was 1(1.7%)operative death because of multiple organ failure after operation. Hyoxemiaoccured in 5(8.3%) patients, 2(3.3%) patients occurred new renal failure and required CRRT treatment, cerebrovascular complication occurred in 1 (1.7%)patient, re-sternotomy due to bleeeding occured in 1 (1.7%)patient and paraplegia occured in 1(1.7%) patient after operation. but they recoved quickly after proper treatment. During follow up period, there were 4 cases need reintervention, including TEVAR for type B dissection at 3 months and distal stent-graft new entry at 1 year. Two other reinterventions were performed for endoleak by interventional occlusion. During the follow-up, hematoma absorption rates after treatment 1、3 and 6 months were 68.6%, 84.7% and 94.8%.@*Conclusion@#Given the dynamic evolution of acute type A IMH pre-operative accurate indications and the proper surgical strategy maybe the keys for success.

Relationship between PET/CT metabolic parameters and pathological features and prognosis in ESCC patients with intramural gastric metastasis / 中国肿瘤生物治疗杂志

@#Objective: To investigate the relationship between PET/CT metabolic parameters and pathological features and prognosis in esophageal squamous cell carcinoma (ESCC) patients with intramural gastric metastasis (IGM). Methods: Totally 86 cases of ESCC IGM patients treated in Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2008 to December 2014 were selected for this study. The patients received the imaging examination by positron emission tomography and computed tomography (PET/CT). The metabolic parameters including maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), PET tumor length (PTL) and mean standard uptake value (SUVmean) were examined to calculate the total lesion glycolysis (TLG). The survival of the patients during 5-year follow-up was recorded, and the relationship between metabolic parameters and clinical pathological features and prognosis was analyzed. Results: SUVmax and SUVmean of IGM patients were related to the diameter of the primary tumor (all P<0.05); MTV was associated with the tumor diameter, lymph node metastasis, and TNM staging (all P<0.05); TLG was associated with the tumor diameter, lymph node metastasis, TNM stage, and tissue differentiation (all P<0.05). During the 5-year follow-up, 6 patients were lost to follow-up, 36 patients died and 44 patients survived; SUVmax, MTV, TLG, PTL, SUVmean, and TNM staging were predictors for patients’prognosis (all P<0.05); MTV, TLG, PTL, SUVmean, and TNM staging were risk factors for prognosis (all P< 0.05). Conclusion: The metabolic parameters including SUVmax, MTV, TLG, PTL and SUVmean in ESCC patients with IGM are related to the pathological characteristics of patients; moreover, MTV, TLG, PTL, SUVmean and TNM staging are risk factors for prognosis; so, PET/CT examination has certain clinical value for the prognosis assessment in ESCC patients with IGM.

Surgical treatment of Stanford A intramural hematoma / 中华胸心血管外科杂志

Objective To summarize experience and result in surgical treatment of Stanford type A intramural hematoma.Methods 60 patients with Stanford type A intramural hematoma were operated from February 2015 to August 2017.Surgery was indicated in complicated cases with penetrating ulcer or ulcer-like projection in ascending aorta,maximum aorta diameter≥50 mm,progressive maximum aortic wall thickness≥i0 mm,pericardial or pleural effusion,persistent or recurrent pain.Aortic valve regurgitation.In our group,46 patients recieved ascending aorta replacement + Sun's procedure.6 patients recieved Bentall + Sun's procedure.4 patients recieved asceding aorta + hemiarch replacement.2 patients recieved Bentall + hemiarch replacement.2 patients recieved asceding aorta replacement.Results In the whole group,there was 1 (1.7％) operative death because of multiple organ failure after operation.Hyoxemiaoccured in 5(8.3％) patients,2(3.3％) patients occurred new renal failure and required CRRT treatment,cerebrovascular complication occurred in 1 (1.7％)patient,re-sternotomy due to bleeeding occured in 1 (1.7％) patient and paraplegia occured in 1 (1.7％) patient after operation.but they recoved quickly after proper treatment.During follow up period,there were 4 cases need reintervention,including TEVAR for type B dissection at 3 months and distal stent-graft new entry at 1 year.Two other reinterventions were performed for endoleak by interventional occlusion.During the follow-up,hematoma absorption rates after treatment 1、3 and 6 months were 68.6％,84.7％ and 94.8％.Conclusion Given the dynamic evolution of acute type A IMH pre-operative accurate indications and the proper surgical strategy maybe the keys for success.