Electrocardiographic changes in patients with type A acute aortic dissection. Incidence, patterns and underlying mechanisms in 159 cases.

BACKGROUND: Not only symptoms but electrocardiographic (ECG) changes mimicking acute coronary syndrome as well have been known to develop in acute aortic dissection (AAD). However, detailed information is lacking. OBJECTIVE: We sought to evaluate incidence, patterns, and underlying mechanisms for acute ECG changes in type A AAD. METHODS: Retrospective study in a single tertiary care hospital. A total of 159 cases (mean age 65.1±14.8 years, male/female=67/92) that presented within 12 h from the onset were included. Shift of the ST segment ≥0.1 mV or changes of the T wave were considered acute ECG changes. RESULTS: Acute and chronic ECG changes were observed in 49.7% and 36.5% cases, respectively. ECG was normal only in 27.0% cases. ST elevation was observed in 8.2% cases and was closely related to direct coronary involvement. ST depression and T wave changes were observed in 34.0% and 21.4% cases, respectively. Cases with ST depression or T wave changes had higher incidence of shock (65.2% vs. 28.8%, p<0.001) and cardiac tamponade (51.2% vs. 15.0%, p<0.001) compared with those without changes. CONCLUSION: Acute ECG changes were common in type A AAD. Physicians taking care of patients with chest pain and acute ECG changes should consider the possibility of AAD before performing thrombolysis or percutaneous catheter intervention.

Effectiveness of diagnostic paracentesis and ascites analysis for suspected strangulation obstruction.

Strangulation obstruction is a surgical emergency, but its accurate diagnosis and timely surgical treatment are still matters of debate. We conducted a prospective observational study. We performed diagnostic paracentesis preoperatively for patients with suspected strangulation obstruction or, if that was impossible, we obtained ascites at the time of laparotomy. We examined each specimen to see whether ascites color and laboratory parameters could be reliable indicators of strangulation obstruction. During 18 months, 32 patients had suspected strangulation obstruction. At laparotomy, we confirmed strangulation obstruction in 21 patients, simple obstruction in two patients, and pseudo-obstruction in one patient. We treated eight patients conservatively, including one patient with a complication. We identified ascites red blood cell count, hematocrit, and lactic acid as indicators for strangulation obstruction by univariate analysis. An ascites red blood cell count was statistically high in cases with strangulation obstruction by multivariate analysis. Ascites red blood cell count above 20,000/mm(3) had a positive predictive value for strangulation obstruction of 100%, and above 40,000/mm(3), bowel resection was highly necessary. Diagnostic paracentesis and ascites analysis are useful methods for diagnosis of strangulation obstruction. Diagnostic paracentesis and ascites analysis should be combined with careful clinical exams for diagnosis of strangulation obstruction.

[Damage control in vascular trauma].

During the era of frequent occurrence of motor vehicle accidents and criminal injuries with lethal weapons, trauma surgeons have accumulated much experience in managing severely injured victims. Very often, efforts to proceed with definitive repair at initial surgery led to patient death despite the control of anatomic bleeding. Damage control methods were thus developed to save patients who otherwise would hove died. Damage control treatment for vascular trauma patients is still in its infancy in Japan. This paper presents an overview of the relevant reports form international journals dealing with the present status of damage control methods in vascular trauma patients.