Analysis of 287 patients with aortic dissection: general characteristics, outcomes and risk factors in a single center.

The general characteristics, outcomes and risk factors of the patients with aortic dissection (AD) were evaluated in a single medical center. From January 2002 to December 2008, 284 patients with AD were treated and followed-up at our institution, including 105 cases of type A AD and 179 cases of type B AD. The patients in each type were divided into three groups according to management: medical treatment group (A or B), open surgery group (A or B), and stent-graft group (A or B). The characteristics and follow-up outcomes were compared between the groups or subgroups. The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group, but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group. Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis (HR, 3.807; 95% confidence interval [CI], 1.489 to 7.611; P=0.003), in-hospital hypotension/shock (HR, 4.687; 95% CI, 1.846 to 11.900; P=0.001), in-hospital myocardial ischemia or infarction (HR, 3.734; 95% CI, 1.613 to 8.643; P=0.002), pleural effusion (HR, 2.210; 95% CI, 1.080 to 4.521; P=0.030), branch vessel involvement (HR, 2.747; 95% CI, 1.202 to 6.278; P=0.016) and surgical treatment (HR, 0.177; 95% CI, 0.063 to 0.502; P=0.001). And there were insignificant independent predictors for mortality of the patients with type B AD. It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD, but after one year, there was no significant difference in the mortality and complications of them. There were several discordant risk factors of AD, such as female gender, age, thrombus, abrupt onset of pain that were considered as the risk factors in some papers. And there was no definite risk factor of mortality in this study in the patients with type B AD.

Extrahepatic portal vein aneurysm: two case reports of surgical intervention.

We report two cases of extrahepatic portal vein aneurysm, and both of them underwent surgical intervention. The first case had a mild pain in right upper quadrant of the abdomen; the second had no obvious symptoms. Physical examination revealed nothing abnormal. Both of them were diagnosed by magnetic resonance imaging angiography (MRA). One of the aneurysms was located at the main portal vein, the other, at the confluence of the superior mesenteric vein and the splenic vein, and these two places are exactly the most common locations of the extrahepatic portal vein aneurysm reported in the literature (30.7% each site). The first case underwent aneurysmorrhaphy and the second case, aneurysm resection with splenectomy. Both of them recovered soon after the operation, and the symptom of the first case was greatly alleviated. During the follow-up of half a year, no complication and adverse effect of surgical intervention was found and the color Doppler ultrasonography revealed no recurrence of the aneurysmal dilation. We suggest that surgical intervention can alleviate the symptom of the extrahepatic portal vein aneurysm and prevent its complications effectively and safely for low risk patients.

[Analysis of management on 23 cases of carotid body tumors].

OBJECTIVE: By reviewing the clinical material in 23 cases (25 tumors) of carotid body tumors, we concluded our experience in selecting the appropriate diagnostic modality and surgical therapy to facilitate surgical maneuvers and decrease the incidence of postoperative complications. METHOD: From 2003 to 2008, 23 cases of carotid body tumors were admitted and treated in Wuhan Union Hospital. All the 23 cases were operated after determining diagnosis that was deterred by angiography and noninvasive examinations including color Doppler scan, computed tomography angiography and magnetic resonance angiography. RESULT: There was no patient died, no cerebral infarctions, no recurrence after operation. Nervous complications occurred in 5 cases post operatively. CONCLUSION: Preoperative angiography is a appropriate diagnostic modality for carotid body tumor, which can shows the supply arteries of the tumor and estimate the structure of the Willis Circle, so that we can judge the possibility to temporarily clamp the carotid artery during the operation to control the hemorrhage and eliminate the postoperative nervous complications.

Analysis of 287 Patients with Aortic Dissection: General Characteristics, Outcomes and Risk Factors in a Single Center / 华中科技大学学报（医学）（英德文版）

The general characteristics,outcomes and risk factors of the patients with aortic dissection (AD) were evaluated in a single medical center.From January 2002 to December 2008,284 patients with AD were treated and followed-up at our institution,including 105 cases of type A AD and 179 cases of type B AD.The patients in each type were divided into three groups according to management:medical treatment group (A or B),open surgery group (A or B),and stent-graft group (A or B).The characteristics and follow-up outcomes were compared between the groups or subgroups.The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group,but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group.Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis (HR,3.807; 95％ confidence interval [CI],1.489 to 7.611; P=0.003),in-hospital hypotension/shock (HR,4.687; 95％ CI,1.846 to 11.900;P=0.001),in-hospital myocardial ischemia or infarction (HR,3.734; 95％ CI,1.613 to 8.643; P=0.002),pleural effusion (HR,2.210; 95％ CI,1.080 to 4.521; P=0.030),branch vessel involvement (HR,2.747;95％ CI,1.202 to 6.278; P=0.016) and surgical treatment (HR,0.177; 95％ CI,0.063 to 0.502; P=0.001).And there were insignificant independent predictors for mortality of the patients with type BAD.It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD,but after one year,there was no significant difference in the mortality and complications of them.There were several discordant risk factors of AD,such as female gender,age,thrombus,abrupt onset of pain that were considered as the risk factors in some papers.And there was no definite risk factor of mortality in this study in the patients with type B AD.