A Case of Primary Intraosseous Adenoid Cystic Carcinoma of the Mandible.

Primary intraosseous adenoid cystic carcinoma (PIACC) of the jaw is rare. To our knowledge, only 51 cases have been reported in the English literature. We present a rare case of PIACC arising in the mandible with multiple bone metastases and review the previous articles. A 70-year-old woman presented with paresthesia of the right chin and lower gingiva for 4 months. Radiography revealed an irregular radiolucent region on the right side of the ramus, infiltrating to the mandibular canal. Biopsy revealed a pathological diagnosis of adenoid cystic carcinoma. Multiple bone metastases were present in the sternum, scapula, and thighs. The treatment effect was progressive disease for chemotherapy; therefore, best supportive care was provided for 3 years.

Theoretical Study of the Mechanism for the Reaction of Trimethylaluminum with Ozone.

The mechanism for the reaction of trimethylaluminum (TMA, Al(CH3)3) with ozone (O3) was investigated in detail using density functional theory calculations to understand the atomic layer deposition processes that form aluminum oxide surfaces. We examined the reactions of TMA and some possible intermediates with O3 and revealed plausible paths to form methoxy (-OCH3), formate (-OCHO), bicarbonate (-CO3H), and hydroxyl (-OH) species. These species have been observed in previous experimental studies. It was shown that TMA easily reacts with O3 to generate the Al(CH3)2(OCH3)(O2) intermediate. The subsequent reaction between the OCH3 and O2 groups finally generated an intermediate having a formate group. When all of the CH3 groups are converted into OCH3 or OCHO, O3 will react with these groups. In the latter reaction, bicarbonate was shown to be formed.

[Mitral Valvuloplasty of Infective Endocarditis During Pregnancy].

This report describes a case in which we treated a patient who developed infective endocarditis in the mitral valve at 28 weeks' gestation. The condition was resolved by performing mitral valvuloplasty 2 days after an emergency cesarean section. Although the patient was in a relatively stable period at 32 weeks' gestation, the mother had an extremely high risk of embolism;thus, emergency surgery was required. We believe that an accurate diagnosis in a timely manner and a valvuloplasty shortly after cesarean section saved the life of the mother and child.

Right axillary arterial perfusion for descending thoracic or thoracoabdominal aortic aneurysm repair with open proximal anastomosis through left thoracotomy.

BACKGROUND: We examined the effectiveness of right axillary arterial perfusion through an interposed Dacron graft in the prevention of cerebral embolism or complications related to ascending aortic cannulation in open proximal anastomosis technique of descending thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA) repair under deep hypothermic circulatory arrest through left thoracotomy. METHODS: Between May 2000 and August 2012, 44 patients underwent TAA or TAAA repair using open proximal technique under DHCA. These patients were divided into two groups for evaluation of the effectiveness of right axillary arterial perfusion. Group A included patients who underwent TAA or TAAA repair with ascending aortic cannulation (n=15). Group B was composed of patients who had TAA or TAAA repair with right axillary arterial perfusion through the interposed Dacron graft (n=29). RESULTS: Mortality in this series was 4.5% (2 of 44 patients; 1 in each group); wherein, the causes were sepsis due to graft infection and aortic dissection (Stanford type A). The incidence rates of cerebral embolism were 27 % (4 of 15 patients in group A) and 3.4% (1 of 29 patients in group B) (p=0.0392, Fisher's exact test). The rates of complications in relation to the aortic cannulation site (dissection or bleeding) were 13% (2 of 15 patients in group A) and 0% (0 of 25 patients in group B). CONCLUSIONS: Right axillary perfusion facilitates easy evacuation of air and allows prompt recommencement of upper body circulation. Consequently, it minimizes the risk of cerebral embolism or complications in relation to aortic cannulation through left thoracotomy.

Infradiaphragmatic malperfusion of acute aortic dissection associated with previous abdominal aortic aneurysm repair.

PURPOSE: To evaluate the association of previous abdominal aortic aneurysm (AAA) graft replacement with infradiaphragmatic malperfusion in patients with acute aortic dissection. METHODS: Between November 2006 and June 2011, 133 patients were referred to our hospital for management of acute aortic dissection. Eight (6.0 %) of these patients had undergone AAA graft replacement prior to the acute aortic dissection. We compared the computed tomography (CT) images of these 8 patients with those of the remaining 125 patients without previous AAA graft replacement, in terms of organ ischemia as a complication induced by acute aortic dissection. RESULTS: Infradiaphragmatic malperfusion from acute aortic dissection was confirmed in four of the eight patients who had undergone AAA graft replacement. Contrasted CT scan images indicated that the main cause of infradiaphragmatic malperfusion was collapse of the true lumen from compression by the false lumen into the suprarenal aorta. Although there was no significant difference between the groups in terms of cerebral ischemia and myocardial ischemia, bilateral leg ischemia and visceral ischemia occurred more frequently in the patients who had undergone AAA graft replacement. CONCLUSION: Previous AAA graft replacement is a risk factor for infradiaphragmatic malperfusion in patients with acute aortic dissection.

A treatment strategy for early thrombosed Stanford type A acute aortic dissection.

OBJECTIVE: Early thrombosed aortic dissection is a form of aortic dissection and includes the condition called aortic intramural hematoma. It was generally considered as surgical emergency. However, the optimal treatment strategy for acute type A intramural hematoma is becoming controversial after recent studies indicated more benign clinical course for this disease. We evaluated our strategy that integrated medical therapy, serial imaging, and timed surgery. METHODS: We reviewed 34 consecutive patients who were admitted to our hospital for early thrombosed Stanford type A acute aortic dissection from 2006 to 2011. Medical therapy or timed surgery was offered on the basis of radiological findings. Emergency or urgent surgery was not considered for a hemodynamically stable patient unless the ascending aortic diameter was ≧50 mm or the thickness of the thrombosed false lumen was ≧10 mm. Follow-up computed tomography was performed to detect a potential progression to aortic dissection. RESULTS: During the average follow-up period of 24.3 months, there was no aortic dissection-related mortality. And aortic dissection-related event was not recorded in patients who had surgical repair; however, in patients who did not have surgery, 3 (8.8 %) surgical conversions were recorded due to aortic dissection progression during the follow-up period. Twenty-one patients (61.8 %) ultimately had surgical repair, and 13 patients (38.2 %) had complete medical therapy. The overall survival rate at 3 years was 86.5 %. CONCLUSIONS: Our strategy for the treatment of early thrombosed Stanford type A acute aortic dissection is reasonable, and the mid-term results were acceptable.

Conversion to Open Repair from Emergency EVAR in a Patient with Ruptured AAA: Report of a Case.

A 77-year-old woman with a ruptured abdominal aortic aneurysm (AAA) was transferred to our hospital. Due to a severe comorbidity, endovascular aortic repair of the ruptured AAA was proposed. During the operation, although a Zenith(®) AAA endovascular graft was deployed, digital subtracted angiography revealed an enhancement of the endoleak, and the patient became hemodynamically unstable. Therefore, we decided to convert to graft replacement of the abdominal aorta through a median laparotomy. During the postoperative period, the patient suffered from ischemic colitis, which resolved with conservative therapy. She was discharged after 33 postoperative days.

Surgical treatment for aortic coarctation with chronic type B dissection: report of a case.

The aim of this paper is to report a rare case of aortic coarctation with type B aortic dissection. A 37 year-old man had sudden, intense back pain. Enhanced computed tomography revealed aortic coarctation (CoA) at the proximal descending aorta and acute type B aortic dissection just distal to the CoA. The dissecting, descending aortic aneurysm had expanded to a maximal diameter of 52 mm. The aortic coarctation was resected and then the descending aorta was replaced with prosthetic grafts in an uneventful procedure. Surgical repair resulted in a good outcome.