Since the operative mortality rate of the Acute aortic dissection has been reducing, a more extensive primary repair of the dissected aorta is preferred for acute aortic dissection to reduce the needs of secondary procedures. We performed a total aortic arch replacement with distal stent-grafting in acute type A aortic dissection. The patient was a 50-years old man. He recovered from the operation and was followed up for 7 months. The pseudolumen in the descending aorta was obliterated with the stent.
Mortality

BACKGROUND: Thoracoabdominal aortic replacement is an extensive operation that opens both the pleural cavity and abdominal cavity, which has high mortality and morbidity rate. The authors have reported 9 cases of the thoracoabdominal aortic replacement in 2001. Since 2003 we have applied the deep hypothermic circulatory arrest to the Crawford type I and II thoracoabdominal aortic replacement. Therefore, we analysed the effect of the changes in operative techniques. MATERIAL AND METHOD: Between 1996 and 2005, we have performed 20 cases of thoracoabdominal aortic replacement. The underlying diseases were 8 cases of atherosclerotic aneurysm with 4 cases of ruptured aneurysm and 12 cases of aortic dissection with 10 cases of a previous operations. According to Crawford classification, there were 2 cases of type I, 7 cases of type II, 1 case of type III, 7 cases of type IV, and 3 cases of type V. We compaired the results of the patients who underwent thoracoabdmoninal replacement before 2001 which already has been reported and after then. RESULT: Before 2001 we have performed 9 cases of thoracoabdominal replacement and 5 patients were died of the operation. All three patients with type I and II were died. There was no case of thoracoabdominal replacement between 2001 and 2002, but after 2003 we have performed 11 cases of thoracoabdominal replacement which involved 1 case of type I, 5 cases of type II, 1 case of type III, 2 cases of type IV and 2 cases of type V. There was no mortality and no fetal complications. CONCLUSION: The deep hypothermic circulatory arrest is a safe method of extended thoracoabdominal aortic replacement.
Abdominal Cavity ; Aneurysm ; Aneurysm, Ruptured ; Circulatory Arrest, Deep Hypothermia Induced* ; Classification ; Humans ; Mortality ; Pleural Cavity

No abstract available.
Meningioma* ; Neoplasm Metastasis*

BACKGROUND: The aortic arch replacement in an acute aortic dissection is technically demanding procedure that has a lot of postoperative morbidity and high mortality. The authors have applied several techniques of aortic arch replacement to overcome the risks of the procedure. Therefore we analysed the results of these techniques. MATERIAL AND METHOD: From March of 1996 to July of 2002, we performed 31 cases of the aortic arch replacement in the Stanford type A acute aortic dissection. There were 12 male and 19 female patients with 59.6+/-9.4 years of mean age. Among them 18 cases were treated with the hemiarch replacement and 13 cases with the total arch replacement. We approached the aortic arch through median sternotomy in all but 3 cases of Clamshell incision and applied the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The associated procedures were 2 Bentall's procedures, an axillobifemoral bypass, a femorofemoral bypass and a carotid artery bypass. RESULT: The postoperative morbidities were 8 acute renal failures, 3 CNS complications, 2 low cardiac output syndromes, 2 malperfusion syndromes, and 2 deep wound infections. There were 4 cases of early hospital mortality which were from an acute renal failure, a postoperative bleeding, a low cardiac output syndrome, and a reperfusion syndrome. There were 3 cases of late hospital mortality which were from an acute renal failure, and 2 multiorgan failures. So the total mortality rate was 22.5%. There were 4 cases of late mortality after the discharge, which were form 2 cases of distal anastomotic rupture and 2 cases of intracranial hemorrhage. CONCLUSION: The hemiarch replacement has relatively shorter operative time and lower hospital mortality but higher late mortality than the total arch replacement. The total arch replacement needs more technically demanding procedure.
Acute Kidney Injury ; Aorta, Thoracic* ; Cardiac Output, Low ; Carotid Arteries ; Circulatory Arrest, Deep Hypothermia Induced ; Female ; Hemorrhage ; Hospital Mortality ; Humans ; Intracranial Hemorrhages ; Male ; Mortality ; Operative Time ; Perfusion ; Reperfusion ; Rupture ; Sternotomy ; Wound Infection

Humans ; Maxillary Sinus ; Prognosis ; Survival Rate ; Transplantation, Heterologous ; Transplantation, Homologous ; Transplants

Airway Obstruction ; Arteries ; Cellulose, Oxidized ; Hemorrhage ; Hemostasis ; Humans ; Male ; Mandible ; Postoperative Hemorrhage

BACKGROUND: The total aortic arch replacement is one of the most difficult operations with high mortality rate. But the arch first technique with subclavian arterial perfusion has been reported to be a safe methods for arch replacement. MATERIAL AND METHOD: Between Feb 2003 and July 2004, 18 patients, 10 men and 8 women, underwent total aortic arch replacement with arch first technique. Their mean age was 59.3+/-12.9 years. The patietns received 11 acute aortic dissections, 3 chronic aortic dissectiong aneurysms, and 4 ruptured aortic arch aneurysms. RESULT: The mean admission period was 20.2+/-7.4 days. There was one early mortality case which died of low cardiac output syndrome and another late mortality case which died of cerebral hemorrhage. The others were discharged without any sequelae and they were followed up for an average period of 180+/-156.3 days. CONCLUSION: The total aortic arch replacement with arch first technique and subclavian arterial perfusion is a good method that will reduce the surgical mortality and the possibility of secondary late reoperation from the remnant distal aortic problems.
Aneurysm ; Aorta, Thoracic* ; Cardiac Output, Low ; Cerebral Hemorrhage ; Female ; Humans ; Male ; Mortality ; Perfusion ; Reoperation

BACKGROUND: The total aortic arch replacement is one of the most difficult operations with high mortality rate. But the arch first technique with subclavian arterial perfusion has been reported to be a safe methods for arch replacement. MATERIAL AND METHOD: Between Feb 2003 and July 2004, 18 patients, 10 men and 8 women, underwent total aortic arch replacement with arch first technique. Their mean age was 59.3+/-12.9 years. The patietns received 11 acute aortic dissections, 3 chronic aortic dissectiong aneurysms, and 4 ruptured aortic arch aneurysms. RESULT: The mean admission period was 20.2+/-7.4 days. There was one early mortality case which died of low cardiac output syndrome and another late mortality case which died of cerebral hemorrhage. The others were discharged without any sequelae and they were followed up for an average period of 180+/-156.3 days. CONCLUSION: The total aortic arch replacement with arch first technique and subclavian arterial perfusion is a good method that will reduce the surgical mortality and the possibility of secondary late reoperation from the remnant distal aortic problems.
Aneurysm ; Aorta, Thoracic* ; Cardiac Output, Low ; Cerebral Hemorrhage ; Female ; Humans ; Male ; Mortality ; Perfusion ; Reoperation

Background: The quality of a vaccine depends strongly on the effects of the adjuvants applied simultaneously with the antigen in the vaccine. The adjuvants enhance the protective effect of the vaccine against a viral challenge. Conversely, oil-type adjuvants leave oil residue inside the bodies of the injected animals that can produce a local reaction in the muscle. The longterm immunogenicity of mice after vaccination was examined. ISA206 or ISA15 oil adjuvants maintained the best immunity, protective capability, and safety among the oil adjuvants in the experimental group. Objectives: This study screened the adjuvant composites aimed at enhancing foot-andmouth disease (FMD) immunity. The C-type lectin or toll-like receptor (TLR) agonist showed the most improved protection rate. Methods: Experimental vaccines were fabricated by mixing various known oil adjuvants and composites that can act as immunogenic adjuvants (gel, saponin, and other components) and examined the enhancement effect on the vaccine. Results: The water in oil (W/O) and water in oil in water (W/O/W) adjuvants showed better immune effects than the oil in water (O/W) adjuvants, which have a small volume of oil component. The W/O type left the largest amount of oil residue, followed by W/O/W and O/W types. In the mouse model, intramuscular inoculation showed a better protection rate than subcutaneous inoculation. Moreover, the protective effect was particularly weak in the case of inoculation in fatty tissue. The initial immune reaction and persistence of long-term immunity were also confirmed in an immune reaction on pigs. Conclusions The new experimental vaccine with immunostimulants produces improved immune responses and safety in pigs than general oil-adjuvanted vaccines.

No abstract available.
Angina Pectoris* ; Electrocardiography* ; Pheochromocytoma*