The progression of traumatic Stanford type A acute aortic dissection.

Key Clinical Message: Cardiopulmonary bypass for trauma patients carries the risk of bleeding from injured organs, while traumatic aortic dissection can progress rapidly. It is sometimes difficult to determine the optimal time for aortic repair in trauma patients. Abstract: An 85-year-old woman was diagnosed with traumatic ascending aortic dissection, right clavicle and left first rib fracture, and abdominal contusions after a vehicle accident. After admission, the aortic dissection progressed, and emergent surgery was performed. Although the risk of hemorrhagic complications needs to be evaluated, prompt aortic repair is required.

A laryngeal foreign body resembling cervical emphysema.

An 81-year-old woman was referred to our hospital with a chief complaint of chest discomfort; CT imaging suggested for cervical emphysema. However, direct observation revealed a grilled liver stuck to the larynx. Carefully taking the patient's history, especially diet, is important to diagnose a laryngeal foreign body correctly.

Optical properties and Faraday effect of ceramic terbium gallium garnet for a room temperature Faraday rotator.

The optical properties, Faraday effect and Verdet constant of ceramic terbium gallium garnet (TGG) have been measured at 1064 nm, and were found to be similar to those of single crystal TGG at room temperature. Observed optical characteristics, laser induced bulk-damage threshold and optical scattering properties of ceramic TGG were compared with those of single crystal TGG. Ceramic TGG is a promising Faraday material for high-average-power YAG lasers, Yb fiber lasers and high-peak power glass lasers for inertial fusion energy drivers.

A high-energy 160-ps pulse generation by stimulated Brillouin scattering from heavy fluorocarbon liquid at 1064 nm wavelength.

We have achieved a high compression ratio by stimulated Brillouin scattering (SBS) consisting of two long cells. A 13-ns Nd:YAG laser pulse was temporally compressed to about 160-ps phase-conjugated pulse in heavy fluorocarbon FC-40 liquid at a 1064 nm wavelength. The maximum reflectivity of SBS process was over 80 % without an optical damage. The compressed pulse brightness was about 65-fold higher than that of the incident pulse.

Low systemic vascular resistance state following off-pump coronary artery bypass grafting.

OBJECTIVE: To determine the prevalence, hemodynamic characteristics, and risk factors for low systemic vascular resistance (SVR) state following after off-pump coronary artery bypass (OPCAB). PATIENTS AND METHODS: SVR data could be obtained for 116 OPCAB patients. Low SVR was defined as an indexed systemic vascular resistance (SVRi) of <1,800 dyne x s/cm(5) x m(2) at the end of operation. Hemodynamic data were recorded preoperatively, at the end of operation, just after entering ICU, and the following morning. RESULTS: Low SVR state was noted in 54 of 116 patients (53%). The SVRi values in low-SVR and non-low-SVR patients were 1,406+/-253 and 2,326+/-509 dyne x s/cm(5) x m(2) at the end of operation (p<0.0001). Increased CI level, decreased MAP level, but unchanged CVP level was observed postoperatively in the low-SVR patients. The increase in CI and decrease in MAP were maximal at the end of operation. Patients with low SVR were more likely to have a higher body mass index (24.5+/-3.6 vs. 22.9+/-2.9; p=0.013) and to be male (82% vs. 62%; p=0.036) than no-low-SVR patients. In low-SVR patients, fluid balance was more positive intraoperatively (3,537+/-1,411 vs. 3,068+/-1,597; p=0.09), but more negative at 6 hours postoperatively (-136+/-978 vs. 234+/-844; p=0.034) and 12 h postoperatively (-282+/-1,321 vs. 268+/-1,238; p=0.024). CONCLUSIONS: Low SVR state, a probable manifestation of systemic inflammatory response (SIRS), is common in patients who have undergone OPCAB. For these patients it is more reasonable to maintain MAP with vasopressors by restoring vascular tone, than by volume loading.

Successful Endovascular Repair of Mycotic Aortic Pseudoaneurysm Followed by Aortoesophageal Fistula.

Mycotic aneurysm of the aorta is a rare, but life-threatening pathology. In recent years, endovascular stent graft placement has been introduced as an effective alternative for treating infected aortic aneurysms. A 64-year-old woman with a history of paraplegia due to spinal cord injury was referred to our institute with fever and blood-tinged sputum. Computed tomography (CT) scan showed an 11-cm pseudoaneurysm arising from the proximal descending aorta, which was normal 1 month ago at the previous CT scan. The patient underwent thoracic endovascular aortic repair for the pseudoaneurysm, deployed with a transiliac access approach, and received antibacterial medical therapy. On postoperative day 11, she developed signs of infection, caused by an aortoesophageal fistula. The infection was treated conservatively with parenteral nutrition and antibiotic administration. The patient had an uneventful recovery and was discharged on postoperative day 113. At 2-year follow-up, she had a normal physical examination and CT angiography showed a marked reduction of the pseudoaneurysm sac. We report a successful endovascular stent grafting and subsequent medical treatment in a patient with a mycotic thoracic aortic pseudoaneurysm followed by a postoperative aortoesophageal fistula.

Esophageal necrosis after endovascular repair for ruptured aortic dissection.

A 78-year-old man presented with back pain and shock and was transferred to our hospital. Computed tomography showed a ruptured aortic dissection in which the false lumen was thrombosed with an ulcer-like projection, and the mid-esophagus was shifted to the right due to a mediastinal hematoma. He underwent emergency thoracic endovascular aortic repair of the descending thoracic aorta. One week later, esophageal necrosis occurred, and he died of mediastinitis and sepsis on postoperative day 16. Although esophageal necrosis is a rare and fatal complication after thoracic endovascular aortic repair, a management strategy has not yet been established.

Limitations of right internal thoracic artery to left anterior descending artery bypass: a comparative quantitative study of postoperative angiography of the bilateral internal thoracic artery bypass grafts.

BACKGROUND: It remains controversial whether right internal thoracic artery (RITA) to left anterior descending artery (LAD) bypass has qualitative limitations which cannot be evaluated based on the patency rate alone. METHODS: The 111 subjects underwent graft angiography after bypass grafting of the left or right internal thoracic artery (ITA) to the LAD. The vascular caliber was measured at the origin of the ITA, at an ITA site adjacent to the anastomotic site, and at an LAD site immediately below the anastomotic site, regarding the outer diameter of the catheter as a reference. RESULTS: The caliber of the ITA immediately above the anastomotic site of the LAD was significantly lower in the RITA group. In the left internal thoracic artery (LITA) group, no patient showed a caliber of less than 1.25 mm, but five patients (7.8%) did in the RITA group. The preoperative cardio-thoracic ratio was significantly higher than that in patients in whom the caliber of the ITA immediately above the anastomotic site was 1.25 mm or more, and the height was significantly lower. CONCLUSIONS: In many patients, the RITA is appropriate as a graft material to the LAD. However, in patients with a high cardio-thoracic ratio and those with a low height, the RITA may not reach the LAD in a favorable state, and the LITA should be anastomosed to the LAD in some patients.

Pitfalls of skeletonized internal thoracic artery: comparison of graft kinking between skeletonized and pedicled grafts based on postoperative angiography findings.

BACKGROUND AND AIM OF THE STUDY: Skeletonization of the internal thoracic artery (ITA) has several advantages: sequential bypass grafting can be easily performed, and a graft of increased length can make the distal coronary artery accessible. However, kinking of the grafts has been observed on postoperative angiograms in a few cases. We investigated whether there were significant differences in the frequency of graft kinking and stenosis degree at the kink site between pedicled and skeletonized grafts. METHODS: Postoperative angiography was performed for all cases. In pedicled (n = 65) and skeletonized (n = 129) groups, the results of postoperative graft angiography were analyzed to investigate the presence of graft kinking and stenosis degree at the kink site. RESULTS: Kinking was observed in 4 (5.9%) and 9 (3.9%) arteries in the pedicled and skeletonized groups, respectively (p = 0.341). The stenosis degree at the kink site (mean +/- SD) was significantly higher in the skeletonized group (47.2 +/- 16.8%) than in the pedicled group (23.5 +/- 13.7%), (p = 0.032). In four patients in whom early postoperative angiography showed a kink with more than 50% stenosis, late-term angiography was performed. All four cases showed regression of the stenosis degree at the kink site. CONCLUSIONS: When the ITA had a kink, the stenosis degree at the kink site was significantly higher in the skeletonized group than in the pedicled group. Late angiography often reveals regression of stenosis at the kink site. Immediate intervention need not always be performed if the patient has no angina caused by a stenotic lesion at the kink site.

Electron acceleration in an ultraintense-laser-illuminated capillary.

An ultraintense laser injected a 10 J of power at 1.053 microm in 0.5 ps into a glass capillary of 1 cm long and 60 microm in diameter and accelerated plasma electrons to 100 MeV. One- and two-dimensional particle codes describe wakefields with 10 GV/m gradient excited behind the laser pulse, which are guided by a plasma density channel far beyond the Rayleigh range. The blueshift of the laser spectrum supports that a plasma of 10(16) cm(-3) is inside the capillary. A bump at the high energy tail suggests the electron trapping in the wakefield.