Evidence of aortic dissection and Marfan syndrome in a mummy from the Capuchin Catacombs of Palermo, Sicily.

The authors report on the assessment of an anthropogenic mummy of a young man from the Capuchin Catacombs of Palermo, Sicily, tentatively dated from the mid- to late 19th century AD. The mummy was investigated by full-body CT examination. CT images clearly showed aortic dissection classified as Stanford-A. Due to the relation of aortic dissection to inherited connective tissue diseases in young people, such as Marfan syndrome, conspicuous and pathological findings possibly indicating the presence of underlying Marfan syndrome were assessed. Several systemic features were scored that supported the presence of underlying Marfan syndrome in this mummy. These findings were: pectus carinatum and chest asymmetry, dural ectasia, protrusio acetabuli, dolichocephaly, down-slanting palpebral fissures, malar hypoplasia and (probable) reduced elbow extension. Aortic dissection, a cardinal feature of Marfan syndrome, turned out to be the diagnostic key for the paleoradiological diagnosis of this disease. The demonstrated CT findings contribute to the spectrum of cardiovascular diseases and inherited connective tissue disease in the fields of paleopathology and paleoradiology.

Thomas Mann: Vascular Fatal Illness of the Writer Who Mastered Disease Through Literary Fiction.

Ruptured iliac artery may initially clinically mimic an isolated inferior limb venous involvement. It was indeed an acute iliac artery dissection complicated by contained rupture and misdiagnosed as inferior limb venous thrombosis that led to the death of Thomas Mann in 1955. The details of the complex case are analyzed. Considerations of medical interest and on actuality of his work are also added.

A Case of Sudden Death in Decameron IV.6: Aortic Dissection or Atrial Myxoma?

Giovanni Boccaccio's Decameron contains a novella that details the sudden death of a young man called Gabriotto, including a portrayal of the discomfort that the protagonist experienced and a rudimentary autopsy performed by local physicians. The intriguing description of symptoms and pathologies has made it possible to read a 7-century-old case through the modern clinical lens. Thanks to the medical and philological analysis of the text-despite the vast difference between modern and medieval medicine-2 hypothetical diagnoses have emerged: either an aortic dissection or an atrial myxoma.

Diagnosis and treatment of uncomplicated type B aortic dissection.

A type B dissection involves the aorta distal to the subclavian artery, and accounts for 25-40% of aortic dissections. Approximately 75% of these are uncomplicated with no malperfusion or ischemia. Multiple consensus statements recommend thoracic endovascular aortic repair (TEVAR) as the treatment of choice for acute complicated type B aortic dissections, while uncomplicated type B dissections are traditionally treated with medical management alone, including strict blood pressure control, as open repairs have a prohibitively high morbidity of up to 31%. However, with medical treatment alone, the morbidity, including aneurysm degeneration of the affected segment, is 30%, and mortality is 10% over 5 years. For both chronic and acute uncomplicated type B aortic dissections, emerging evidence supports the use of both best medical therapy and TEVAR. This paper reviews the current diagnosis and treatment of uncomplicated type B aortic dissections.

Aortic dissection: a 250-year perspective.

Two hundred fifty years have passed since Frank Nicholls' history-making, accurate observations on the anatomic findings and cause of death of King George II were published. Several decades later, the disease was named, using--for the first time--the terms dissection and dissecting attached to an aortic disease process. Another century went by before effective surgical treatment was developed. In sharp contrast, the evolution of the last 20 years has been nothing short of amazing. Our understanding of AD, while not yet complete, has improved dramatically. In addition, the introduction of nonsurgical endovascular therapy has had a profoundly transformative impact--and we are just at the beginning! It would not be unreasonable to predict that stent-graft repair will likely replace (or nearly replace) open surgery in the treatment of complicated type B dissection in the near future, especially as technologies continue to improve and indication-specific designs are developed and tested in the clinical setting. Moreover, it is predictable that endovascular solutions for some patients with type A aortic dissection will become available in the years to come as surgical results continue to be suboptimal. Finally, and amidst this plethora of "good news," it is appropriate to reflect on the formidable challenge that endovascular therapies face as they gear to "compete" with optimal medical therapy in the management of patients with acute uncomplicated type B dissection, because it will obviously be difficult (if not impossible) to improve on the already-achieved 30-day mortality rate of less than 10%. Long-term gains may well become the winning card when and if the late results of TEVAR can be shown to improve on the rather compromised outlook of medically treated dissection patients. Stay tuned.

Uncomplicated type B dissection: are there any indications for early intervention?

Currently thoracic endovascular repair (TEVAR) has a limited role in uncomplicated type B aortic dissection. Aggressive medical therapy is deemed appropriate for most of these patients allowing one-year survival rate of 80-90%. Outcomes are less than optimal in the long term, however, since aorta related complications (disease progression, rapid deterioration, acute rupture and elevated mortality) may occur in up to 50% of patients at five years. Subgroups of patients with uncomplicated type B dissection may benefit from early stent-graft placement, but identification of these remains difficult. Only future studies, especially randomized trials, will clarify the utility of early TEVAR in the setting of uncomplicated acute type B dissection.

Acute aortic dissection: natural history and classification.

Acute aortic dissection is an uncommon but potentially catastrophic pathology with high mortality and morbidity. Significant advances in the understanding, diagnosis and management of aortic dissection have been made since the first case was reported 3 centuries ago. This article aims to review our current understanding of the natural history and classification of acute aortic dissection.

Endoleaks after endovascular aortic stent-grafting: impact, diagnosis, and management.

Endoleaks and endotension remain the primary limitation of endovascular aortic repair with stent-grafts. Consequently, all endovascular surgeons performing thoracic or abdominal endovascular aortic repairs require a comprehensive knowledge and understanding of how to survey and manage endoleaks. The derivation of the current endoleak classification scheme, the clinical impact of endoleaks, the diagnostic tools relevant to endoleak detection, an endoleak surveillance protocol, and the strategies in use for their management are outlined in this review.

The history of surgery of the thoracic aorta.

Until the late 19th century, treatment of thoracic aortic aneurysms relied on ligation of the parent vessel or introduction of foreign materials to promote coagulation or fibrosis. A major breakthrough occurred in 1888, when Rudolph Matas reported an internal repair technique known as endoaneurysmorrhaphy. In this approach, the clot was excised from the aneurysmal sac, and the orifices of the arteries that entered the sac were sutured from within, reestablishing continuous blood flow. At the beginning of the 20th century, Alexis Carrel and Charles Guthrie began to lay the foundation for modern vascular anastomotic techniques. Although isolated successes were reported, optimal treatment of thoracic aortic disease awaited the development of reliable synthetic grafts in the 1950s and 1960s. During the past 15 years, the treatment goal has reverted to endoaneurysmorrhaphy, involving the use of a suitable graft to restore aortic continuity.

[Raeder's syndrome]. / Raeders syndrom.

Raeder's syndrome was first described by the Norwegian ophthalmologist J.G. Raeder in 1918 and again in 1924 by the same author. The seminal report was a description of a young male patient with unilateral periocular pain combined with ipsilateral miosis and ptosis, and with slight objective signs of trigeminal nerve involvement. Autopsy demonstrated a tumour at the base of the skull in the middle cranial fossa. Raeder coined the term "paratrigeminal" for the reported clinical picture. Later case reports by Raeder and other authors have included patients experiencing a more benign clinical course, some with spontaneous remissions, with unilateral periocular pain and ipsilateral signs of oculosympathetic paresis as the common denominator. This article is a chronological survey of the main contributions to the medical literature. Various definitions of the syndrome are outlined, including the more recent classification, as well as some pathophysiological and prognostic considerations.

Three famous autopsies.

George II, the King of England, died from dissecting aneurism of the aorta. Napoleon died from a carcinoma of the stomach. Frederick III, Emperor of Germany, died of a laryngeal cancer; his untimely death, and the succession of his son, Wilhelm II, was largely responsible for the great catastrophe of 1914. An autopsy was performed on each of these three famous and historical figures.