Aortic arch dissection: a controversy of classification.

Aortic dissections originating in the ascending aorta and descending aorta have been classified as type A and type B dissections, respectively. However, dissections with intimal flap extension into the aortic arch between the innominate and left subclavian arteries are not accounted for adequately in the widely used Stanford classification. This gap has been the subject of controversy in the medical and surgical literature, and there is a tendency among many radiologists to categorize such arch dissections as type A lesions, thus making them an indication for surgery. However, the radiologic perspective is not supported by either standard dissection classification or current clinical management. In this special report, the origin of dissection classification and its evolution into current radiologic interpretation and surgical practice are reviewed. The cause for the widespread misconception about classification and treatment algorithms is identified. Institutional review board approval and waiver of informed consent were obtained as part of this HIPAA-compliant retrospective study to assess all aortic dissection studies performed at the University of Maryland Medical Center, Baltimore between 2010 and 2012 to determine the prevalence of arch dissections. Finally, a unified classification system that reconciles imaging interpretation and management implementation is proposed.

Effects of management legacies on stream fish and aquatic benthic macroinvertebrate assemblages.

Fish and benthic macroinvertebrate assemblages often provide insight on ecological conditions for guiding management actions. Unfortunately, land use and management legacies can constrain the structure of biotic communities such that they fail to reflect habitat quality. The purpose of this study was to describe patterns in fish and benthic macroinvertebrate assemblage structure, and evaluate relationships between biota and habitat characteristics in the Chariton River system of south-central Iowa, a system likely influenced by various potential management legacies (e.g., dams, chemical removal of fishes). We sampled fishes, benthic macroinvertebrates, and physical habitat from a total of 38 stream reaches in the Chariton River watershed during 2002-2005. Fish and benthic macroinvertebrate assemblages were dominated by generalist species tolerant of poor habitat quality; assemblages failed to show any apparent patterns with regard to stream size or longitudinal location within the watershed. Metrics used to summarize fish assemblages and populations [e.g., presence-absence, relative abundance, Index of Biotic Integrity for fish (IBIF)] were not related to habitat characteristics, except that catch rates of piscivores were positively related to the depth and the amount of large wood. In contrast, family richness of benthic macroinvertebrates, richness of Ephemeroptera, Trichoptera, and Plecoptera taxa, and IBI values for benthic macroinvertebrates (IBIBM) were positively correlated with the amount of overhanging vegetation and inversely related to the percentage of fine substrate. A long history of habitat alteration by row-crop agriculture and management legacies associated with reservoir construction has likely resulted in a fish assemblage dominated by tolerant species. Intolerant and sensitive fish species have not recolonized streams due to downstream movement barriers (i.e., dams). In contrast, aquatic insect assemblages reflected aquatic habitat, particularly the amount of overhanging vegetation and fine sediment. This research illustrates the importance of using multiple taxa for biological assessments and the need to consider management legacies when investigating responses to management and conservation actions.

Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography.

OBJECTIVE Dorsal arachnoid webs (DAWs) and spinal cord herniation (SCH) are uncommon abnormalities affecting the thoracic spinal cord that can result in syringomyelia and significant neurological morbidity if left untreated. Differentiating these 2 entities on the basis of clinical presentation and radiological findings remains challenging but is of vital importance in planning a surgical approach. The authors examined the differences between DAWs and idiopathic SCH on MRI and CT myelography to improve diagnostic confidence prior to surgery. METHODS Review of the picture archiving and communication system (PACS) database between 2005 and 2015 identified 6 patients with DAW and 5 with SCH. Clinical data including demographic information, presenting symptoms and neurological signs, and surgical reports were collected from the electronic medical records. Ten of the 11 patients underwent MRI. CT myelography was performed in 3 patients with DAW and in 1 patient with SCH. Imaging studies were analyzed by 2 board-certified neuroradiologists for the following features: 1) location of the deformity; 2) presence or absence of cord signal abnormality or syringomyelia; 3) visible arachnoid web; 4) presence of a dural defect; 5) nature of dorsal cord indentation (abrupt "scalpel sign" vs "C"-shaped); 6) focal ventral cord kink; 7) presence of the nuclear trail sign (endplate irregularity, sclerosis, and/or disc-space calcification that could suggest a migratory path of a herniated disc); and 8) visualization of a complete plane of CSF ventral to the deformity. RESULTS The scalpel sign was positive in all patients with DAW. The dorsal indentation was C-shaped in 5 of 6 patients with SCH. The ventral subarachnoid space was preserved in all patients with DAW and interrupted in cases of SCH. In no patient was a web or a dural defect identified. CONCLUSIONS DAW and SCH can be reliably distinguished on imaging by scrutinizing the nature of the dorsal indentation and the integrity of the ventral subarachnoid space at the level of the cord deformity.