ABSTRACT
Blunt injury of the abdominal aorta is highly fatal. We present an unusual case of an osteophyte impaling the abdominal aorta treated by endovascular repair. A 77-year-old man sustained a thoracolumbar fracture-dislocation with posterior aortic rupture between his celiac and superior mesenteric artery origins. His aortic injury was treated with a stent graft, excluding the celiac origin. He was dismissed on postoperative day 6. At 6 months, he had returned to most preinjury activities, and at 2-year follow-up, he continues to have good functional outcome. Endovascular repair may be successfully employed in select aortic injuries in hemodynamically stable patients.
Subject(s)
Aneurysm, False/etiology , Aorta, Abdominal/injuries , Aortic Aneurysm, Abdominal/etiology , Aortic Rupture/etiology , Osteophyte/complications , Vascular System Injuries/etiology , Wounds, Nonpenetrating/etiology , Accidents, Traffic , Aged , Aneurysm, False/diagnosis , Aneurysm, False/surgery , Aorta, Abdominal/diagnostic imaging , Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/diagnosis , Aortic Rupture/surgery , Aortography/methods , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Humans , Male , Osteophyte/diagnosis , Tomography, X-Ray Computed , Treatment Outcome , Vascular System Injuries/diagnosis , Vascular System Injuries/surgery , Wounds, Nonpenetrating/diagnosisSubject(s)
Lower Extremity/blood supply , Peripheral Vascular Diseases/diagnosis , Peripheral Vascular Diseases/therapy , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/therapy , Humans , Iliac Artery , Ischemia/diagnosis , Ischemia/therapy , Mesenteric Arteries , Peripheral Vascular Diseases/pathology , Renal Artery Obstruction/diagnosis , Renal Artery Obstruction/therapySubject(s)
Peripheral Vascular Diseases/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Algorithms , Aneurysm/diagnosis , Aneurysm/surgery , Aorta, Abdominal/pathology , Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/epidemiology , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/epidemiology , Aortic Rupture/etiology , Aortic Rupture/surgery , Atherosclerosis/diagnosis , Atherosclerosis/epidemiology , Atherosclerosis/therapy , Cardiovascular Agents/therapeutic use , Combined Modality Therapy , Comorbidity , Diagnostic Imaging/methods , Evidence-Based Medicine , Female , Femoral Artery/pathology , Femoral Artery/surgery , Humans , Iliac Artery/pathology , Iliac Artery/surgery , Intestines/blood supply , Ischemia/epidemiology , Ischemia/surgery , Ischemia/therapy , Leg/blood supply , Male , Mesenteric Arteries/pathology , Middle Aged , Peripheral Vascular Diseases/diagnosis , Peripheral Vascular Diseases/epidemiology , Peripheral Vascular Diseases/surgery , Popliteal Artery/pathology , Popliteal Artery/surgery , Prevalence , Randomized Controlled Trials as Topic , Renal Artery/pathology , Risk Factors , Risk Reduction Behavior , Treatment Outcome , Vascular Surgical ProceduresABSTRACT
The International Conference on Harmonization (ICH) E5 guidelines were developed to provide a general framework for evaluating the potential impact of ethnic factors on the acceptability of foreign clinical data, with the underlying objective to facilitate global drug development and registration. It is well recognized that all drugs exhibit significant inter-subject variability in pharmacokinetics and pharmacologic response and that such differences vary considerably among individual drugs and depend on a variety of factors. One such potential factor involves ethnicity. The objective of the present work was to perform an extensive review of the world literature on ethnic differences in drug disposition and responsiveness to determine their general significance in relation to drug development and registration. A few examples of suspected ethnic differences in pharmacokinetics or pharmacodynamics were identified. The available literature, however, was found to be heterologous, including a variety of study designs and research methodologies, and most of the publications were on drugs that were approved a long time ago.
Subject(s)
Drug Therapy/standards , Pharmacokinetics , Racial Groups/statistics & numerical data , Clinical Trials as Topic , Data Interpretation, Statistical , Dose-Response Relationship, Drug , Drug Approval , Drug Design , Drug Therapy/statistics & numerical data , Female , Guidelines as Topic , Humans , International Cooperation , MaleABSTRACT
Myocardial performance in the intact human heart can be assessed from the analysis of ejection phase indices. Accordingly, among 20 consecutive patients who were studied by means of biplane left ventricular cineangio-cardiography, 18 were selected solely on the basis of high quality angiograms. The characteristics of left ventricular contraction were expressed quantitatively by the systolic ejection fraction, the mean velocity of circumferential fiber shortening at the left ventriculalr equator, and at several chords, the mean velocity of shortening of the hemichords and the mean normalized systolic ejection rate. All 18 patients had abnormalities of contraction based on the velocity of the hemichords. Both ejection fraction and mean normalized systolic ejection rate showed a low sensitivity in detecting depressed myocardial function in patients with segmental asynergy. Equatorial V(CF) provided additional information only when the affected areas were adjacent to the left ventricular minor axis. The sensitivity of this index was markedly increased by construction of several chords perpendicular to the left ventricular long axis (segmental V(CF)). However, when only one wall was affected, measurement of the velocity of shortening of the hemichords provided a better definition of the regional performance.
