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Diseases of the Aorta
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Acute aortic dissection is a life-threatening condition associated with high morbidity and mortality rates. The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 as a global database. Although presenting symptoms and physical findings have not changed significantly over the past two decades, the widespread use of CT has improved the diagnostic pathway. Moreover, more patients are managed with appropriate procedures, such as surgery in Type A, and endovascular therapy in subsets of Type B aortic dissection. With these ongoing improvements in swift diagnostic workup and therapeutic care, more patients are diagnosed rapidly and survive once they reach hospital.9 Historically, acute dissection has been defined as occurring within 2 weeks of symptom onset, with chronic dissection occurring beyond the second week, based upon survival data. European Society of Cardiology (ESC) guidelines have recently suggested to further divide the time course of aortic dissection into acute (<14 days), subacute (15–90 days), and chronic (>90 days) phases.
Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
There are alternatives to the aforementioned method, the most effective being dissection by the anatomical layers. Using toothed forceps, first place traction on the anterior portion of the digastric muscle, then use the scalpel to cut tangentially and behind the internal border of the mandible, then sever the insertion of this muscle. Detach the muscle from the front to the back until the dissection reaches the tendinous portion of the muscle that attaches to the hyoid bone by a fibrous loop (Figure 2.63).
Surgery of the Thoracolumbar Spine
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Daniel P Ahern, Joseph S Butler, Matthew Shaw, Sean Molloy
Dissection: Subcutaneous fat and fasciaSpinous process identified and subperiosteal dissection: Ensure haemostasis – diathermy, gauze packingDissection to identify transverse processes, medial and lateral borders of the facet joints, and the pars
Progress in surgical interventions for aortic root aneurysms and dissections
Published in Expert Review of Cardiovascular Therapy, 2022
Shamini Parameswaran, Bulat A. Ziganshin, Mohammad Zafar, John A. Elefteriades
When it comes to operative strategies for a Type A dissection (ascending aortic dissection), replacing the ascending aorta and hemi-arch represents the ‘standard’ operation [11]. In the acute Type A dissection setting, bringing to the ICU (intensive care unit) a patient who is alive, not bleeding, and awake represents a great success. The ‘standard’ ascending replacement operation is usually life-saving acutely and satisfactory in terms of later prognosis. Doing more, proximally for the root or distally for the arch, is a matter of judgment and experience, dependent also on the overall presenting condition of the patient. Specifically, whether or not to replace the aortic root with a composite graft replacement is a question that often arises. Most authorities would agree that this should be done for patients with Marfan disease or in case of enlargement of the aortic root beyond 4.5 to 5 cm (with associated “effacement’ of the root – that is, loss of the normal ‘waist’ at the sino-tubular junction). However, to replace the aortic root adds the technical complexity of mobilizing and reattaching coronary artery buttons in the setting of an acutely dissected aortic wall [11]. By taking a less complex approach, saving the aortic root, the surgeon can reduce the magnitude of the urgent procedure and possibly the postoperative morbidity and mortality. This is a highly debated topic, balancing increased technical complexity at the time of acute dissection against more complete extirpation of dissection tissues.
Vertebral artery dissection and high-intensity workouts
Published in Baylor University Medical Center Proceedings, 2021
Kenneth J. Guinn, Raycho G. Kurkchijski, Christie A. Shen
Strokes caused by cerebrovascular dissections often present with a range of nonspecific symptoms that often are missed.4,5 This case illustrates the impact of age bias and comprehensive history taking. In addition, dissections can also be missed on routine imaging. There remains no gold standard between CT angiogram and MR/MR angiogram for cerebrovascular dissections,6 and obtaining both during a workup may offset their respective likelihood ratios. Also, current guidelines for treatment and return to sport are limited and often set by the clinical experience of the provider,7 as there is no evidence to date of superiority with anticoagulation vs antiplatelet therapy.8 A bias toward age may lead to more aggressive therapy compared with younger patients with the same mechanically triggered event.
Electron microscopy in renal pathology: overall applications and guidelines for tissue, collection, preparation, and stains
Published in Ultrastructural Pathology, 2021
David N. Howell, Guillermo A. Herrera
The more common procedure is to pool all of the biopsy tissue, keep it moist with saline, and delegate specimen apportionment and fixation to a pathologist or other trained individual (resident/fellow, PhD with renal laboratory experience, pathology technologist with renal pathology specialization and pathologist oversight). There are two basic approaches to this process. Ideally, the biopsy core(s) are examined and subdivided under a dissecting microscope with transillumination; the vascularity of glomeruli causes them to show up as small red spheres in a tan background if the specimen is fresh and as pale excrescences if the tissue has been placed in saline (Figure 2). (Parenchymal fibrosis makes this process more challenging, as sclerotic glomeruli lose their red appearance.) Renal medulla (devoid of glomeruli, often with long, relatively straight vessels) and other non-renal tissue contaminants (skeletal muscle, adipose tissue) are also easy to detect. If adequate staffing is available, specimen examination and dissection can be performed at the bedside, with the advantage that the clinician can be instructed to perform more biopsy passes if the initial yield is inadequate.