The Rarity of Penetrating Ulcer with Intramural Hematoma of the Ascending Aorta

ABSTRACT We report a case of a 58-year-old man with multiple symptomatic penetrating atherosclerotic ulcers and concomitant intramural hematoma of the ascending aorta. The patient was successfully treated using a 24-mm Gelweave graft in the ascending aorta. He was discharged four days post operation and remains asymptomatic 14 months postoperatively. This case uniquely illustrates the rare entity of penetrating atherosclerotic ulcer with intramural hematoma, which presents in only 0.28% of all acute aortic syndrome cases.

The Rarity of Penetrating Ulcer with Intramural Hematoma of the Ascending Aorta.

We report a case of a 58-year-old man with multiple symptomatic penetrating atherosclerotic ulcers and concomitant intramural hematoma of the ascending aorta. The patient was successfully treated using a 24-mm Gelweave graft in the ascending aorta. He was discharged four days post operation and remains asymptomatic 14 months postoperatively. This case uniquely illustrates the rare entity of penetrating atherosclerotic ulcer with intramural hematoma, which presents in only 0.28% of all acute aortic syndrome cases.

Extracorporeal Membrane Oxygenation for Pediatric Burn Patients: Is Management Improving Over Time?

Over the last few decades, extracorporeal membrane oxygenation (ECMO) has become a lifesaving modality for patients with severe respiratory failure following burn injury. With the advancement in critical care and ECMO management, this study aims to analyze the outcomes of ECMO in pediatric burn patients. The Extracorporeal Life Support Organization database was queried from 1999 to 2018 for patients 18 years old and under with a burn injury. The data were divided into two decades, the first (1999-2008) and the second (2009-2018), for analysis of background characteristics and clinical outcomes. Ninety-five patients met inclusion criteria. The overall use of ECMO increased in the second decade (60 cases) when compared to the first decade (35 cases), and use of venovenous ECMO increased in the second decade from 16 cases to 38 cases. Although more patients survived because of the increased application of venovenous ECMO, the survival rate was unchanged between decades (53.4% vs. 54.3%; P = 0.937). Patients with pre-ECMO cardiac arrest had a significant improvement in mortality during the second decade (54.5% vs. 0%; P = 0.043). Metabolic (P = 0.022) and renal (P = 0.043) complications were most common in nonsurvivors during the first decade whereas cardiovascular (P = 0.031) and neurologic (P = 0.003) complication were higher in the second decade (P = 0.031, 0.003). Use of ECMO after burn injury has become more common; however, overall mortality remains unchanged. The data suggests pre-ECMO cardiac arrest is no longer a contraindication to start ECMO.

Depressive symptoms predict low physical performance among older Mexican Americans.

BACKGROUND: Depressive symptoms are common in older adults and predict functional dependency. AIMS: To examine the ability of depressive symptoms to predict low physical performance over 20 years of follow-up among older Mexican Americans who scored moderate to high in the Short Physical Performance Battery (SPPB) test and were non-disabled at baseline. METHODS: Data were from the Hispanic Established Population for the Epidemiologic Study of the Elderly. Our sample included 1545 community-dwelling Mexican American men and women aged 65 and older. Measures included socio-demographics, depressive symptoms, SPPB, handgrip strength, activities of daily living, body mass index (BMI), mini-mental state examination, and self-reports of various medical conditions. General Equation Estimation was used to estimate the odds ratio of developing low physical performance over time as a function of depressive symptoms. RESULTS: The mean SPPB score at baseline was 8.6 ± 1.4 for those with depressive symptoms and 9.1 ± 1.4 for those without depressive symptoms. The odds ratio of developing low physical performance over time was 1.53 (95% Confidence Interval = 1.27-1.84) for those with depressive symptoms compared with those without depressive symptoms, after controlling for all covariates. CONCLUSION: Depressive symptoms were a predictor of low physical performance in older Mexican Americans over a 20-year follow-up period. Interventions aimed at preventing decline in physical performance in older adults should address management of their depressive symptoms.