Early diagnosis of multilevel aortic dissection in accident and emergency department can save life case report

Acute aortic dissection is the most common catastrophe of the aorta and is associated with high morbidity and mortality. The 2-week mortality rate approaches 75% in patients with undiagnosed ascending aortic dissection. Despite advances in diagnostics and medical and surgical techniques, as well as the emergence of an endovascular management approach, the overall mortality associated with aortic dissection is 27%. An aortic dissection lesion begins with a tear that is typically transverse and does not involve the entire circumference of the vessel. The tear in the aortic intima and media allows for the blood to surge into the aortic wall. A 56-year-old Egyptian male patient known ischemic heart disease, heavy smoker presents to the Emergency Department with a history of sudden onset of constricting epigastric pain and right loin pain with radiation to the back and parasternal area, with normal blood pressure ,equal pulse. ECG showed incomplete RBBB, T wave inversion from V2 to V6. Bedside echocardiography showed good LVEF, good kinesis of LV wall, widened Aortic root [43mm]. TEE has proven extensive partially thrombosed aortic dissection starting 1 cm above the root of the aortic valve and Involving all the visible thoracic aorta communication between real lumen and false lumen was seen at the level of 25 cm of descending aorta. Spiral CT for chest and abdomen showed extensive Aortic dissection involving anterolateral aspect of ascending, descending thoracic aorta and posterolateral aspect of abdominal aorta. Right renal artery was involved as well, with multiple right renal infarctions, angiography was done and revealed occluded right renal artery and dilated ascending aorta, LAD had a 70% lesion near the apex, LCX had a 30% osteal lesion. Aortic angiogram showed grossly dilated ascending and arch of aorta. Aortic branches are not compromised. Patient was treated with nitroglycerin infusion, sodium nitroprusside infusion, labetalol and sedation. Was stabilized, then surgical repair of ascending Aorta with reposition of the Aortic valve was done. Eariy diagnosis of aortic dissection can speed up the process of management medically or surgically, and can increase the survival rate for such patients. Once you suspect aortic dissection you should proceed to more investigations with out excluding the clinical presentation from the picture

[Comparison of the diagnostic validity and accuracy of the spiral tomography and spiral C.T. scan in maxillary implant assessment]

The accuracy and validity of CT scan images have been established by various investigators. However, there are controversies about the accuracy and validity of tomography techniques. The purpose of this study was to compare the accuracy and validity of diagnostic measurements made out of spiral tomography and spiral CT of human maxilla. Eight partially or fully edentulous dry human maxillae were used in this invitro investigation. A total of 50 edentulous areas were identified as potential implant sites. These locations were composed of 8 sites in midline, 14 in canine, 15 in premolar and 13 sites in molar areas. The spiral tomographies as well as spiral CTs were taken for the selected sites. The following bone parameters were measured in each maxilla: I] Vertical distance between the surface of alveolar bone and floor of nasal cavity or maxillary sinuses [Height]. II] Buccopalatal alveolar ridge distance at the mid-height section[Width]. Tomography measurements were compared with that of CT images in order to determine the measurements precision. To investigate the validity, the method of Inter-device Inter-observer and test of Intra-class Correlation Coefficient of One-Way Random Effects model was applied. Only 6 out of 100 measurements of tomography showed more than 1mm difference with CT images. The accuracy of tomograms in measuring height and width of alveolar bone was 96% and 92% respectively. This accuracy was 100% in midline, 93.3% in canine, 86.7% in premolar and 100% in molar area. The mean difference was 0.66mm between measurements of these two techniques. The reliability of tomograms was 96%. This investigation demonstrated that spiral tomography is highly accurate in cross sectional imaging of the jaw bones. The validity and reliability of spiral tomography technique is good and acceptable .Therefore, we can use tomography for jaw bones imaging in potential implant cases with high level of confidence

review of urinary stone analysis techniques

Knowledge of the chemical composition and structure of urinary stones is of great value in the choice of treatment and prevention of recurrence. This is a brief review and a comparative study of the principles and practical application of various chemical and physical techniques used for urinary stone analysis. The different methods of classifying and grouping urinary stones by results of chemical analytic techniques are, also, compared and evaluated. In addition to reviewing various techniques used for the in-vitro analysis of removed stone samples, the newly emerging physical and radiological techniques for the in-vivo intact-stone analysis are, also, evaluated. These in-vivo techniques, particularly the rapidly advancing unenhanced spiral CT scanning, represent an important step forward towards the notion of non- destructive analysis of urinary stones while still in situ before the choice of treatment modality