ABSTRACT
BACKGROUND: An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair. CASE PRESENTATION: A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient's postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation. CONCLUSION: Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Rupture , Endovascular Procedures , Esophageal Fistula , Esophageal Perforation , Humans , Female , Esophageal Fistula/surgery , Esophageal Fistula/etiology , Aged , Endovascular Procedures/methods , Aortic Aneurysm, Thoracic/surgery , Aortic Rupture/surgery , Esophageal Perforation/surgery , Esophageal Perforation/etiology , Vascular Fistula/surgery , Vascular Fistula/etiology , Blood Vessel Prosthesis Implantation , Salvage Therapy/methods , Animals , Hematemesis/etiology , Aortic Diseases/surgery , Aortic Diseases/etiology , Aorta, Thoracic/surgery , Treatment Outcome , Fishes , Endovascular Aneurysm RepairABSTRACT
The purpose of this study is to weigh psychological state, patients' demographics, seizure-related factors, and medical comorbidity in older adults with epilepsy against the same parameters in younger adults in an attempt to identify best quality of life (QoL) predictors. The Quality of Life in Epilepsy Inventory for Adults (QOLIE-31) and the Beck Depression Inventory-II (BDI-II) were completed by 146 patients with localization-related epilepsy. There was no statistical difference in the QOLIE-31 total score between younger and older adults. Best QoL predictors were BDI-II and seizure frequency, with BDI-II providing more than 3 times the impact of seizure frequency. BDI-II also substantively predicted most QOLIE-31 domains. Additionally, epilepsy duration positively correlated with overall QoL only among older adults. In summary, in younger as well as older adult epilepsy patients, depressive symptoms emerge as the strongest predictor of QoL. However, older adults appear to adapt better to their chronic health problem.
Subject(s)
Epilepsy/epidemiology , Epilepsy/psychology , Quality of Life , Adult , Age Factors , Aged , Aged, 80 and over , Cross-Sectional Studies , Data Interpretation, Statistical , Depression/psychology , Female , Humans , Linear Models , Male , Middle Aged , Multivariate Analysis , Neuropsychological Tests , Psychiatric Status Rating Scales , Seizures/psychologyABSTRACT
Although menopausal insomnia is of clinical significance, the essential features of this form of disrupted sleep are poorly understood. The aim of the present study was to identify the sleep characteristics of menopausal insomnia by using overnight polysomnography (PSG). Twenty-one subjects with menopausal insomnia (MI) and 13 sex- and age-matched normal control (NC) subjects without sleep complaints took part in the present study. All MI and NC subjects underwent PSG on two consecutive nights. In comparison with NC, MI subjects had non-specific findings such as significantly shorter total sleep time, longer sleep latency, higher wake time after sleep onset, and lower sleep efficiency. As for rapid eye movement (REM) sleep variables, MI subjects had significantly shorter total REM sleep time, fewer numbers of REM sleep periods, longer REM latency, and higher REM density than did the NC subjects. As for the time course of REM density, REM density during the first 3 h period of nocturnal sleep was significantly higher for MI than for NC subjects. Unlike NC subjects, REM density for MI subjects did not tend to rise progressively during nocturnal sleep. The MI subjects had objective evidence of disrupted sleep and the most striking characteristics of this dysfunction were observed in REM sleep variables. The sleep characteristics of MI subjects were found to differ in REM sleep variables from those of patients with major depression (except for REM density). Menopausal insomnia patients appear to be similar to patients with generalized anxiety disorder accompanied by severe sleep disruption. These data lend support to the clinical distinction between menopausal insomnia and insomnia associated with major psychiatric disorders.
