Anticoagulants ; therapeutic use ; Cardiomyopathy, Hypertrophic ; complications ; diagnostic imaging ; therapy ; Coronary Angiography ; Death, Sudden, Cardiac ; prevention & control ; Defibrillators, Implantable ; Echocardiography ; Electric Countershock ; Electrocardiography ; Heart Aneurysm ; complications ; diagnostic imaging ; therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tachycardia, Ventricular ; diagnosis ; etiology ; therapy

Adult ; Cerebral Angiography ; Female ; Humans ; Intracranial Aneurysm ; complications ; diagnostic imaging ; Lupus Erythematosus, Systemic ; complications ; diagnostic imaging ; Subarachnoid Hemorrhage ; diagnosis ; diagnostic imaging ; etiology ; Young Adult

Adult ; Aneurysm, Dissecting ; diagnosis ; etiology ; Computed Tomography Angiography ; methods ; Conservative Treatment ; methods ; Coronary Angiography ; methods ; Coronary Vessels ; diagnostic imaging ; pathology ; Electrocardiography ; methods ; Heart Injuries ; complications ; Humans ; Magnetic Resonance Imaging, Cine ; methods ; Male ; Multimodal Imaging ; methods ; Myocardial Infarction ; diagnosis ; etiology ; therapy ; Treatment Outcome ; Wounds, Nonpenetrating ; complications

PURPOSE: Acute aortic diseases, such as aortic dissection and aortic aneurysm, can be life-threatening vascular conditions. In this study, we compared outcomes before and after the implementation of a critical pathway (CP) for patients with acute aortic disease at the emergency department (ED). MATERIALS AND METHODS: This was a retrospective observational cohort study. The CP was composed of two phases: PRE-AORTA for early diagnosis and AORTA for prompt treatment. We compared patients who were diagnosed with acute aortic disease between pre-period (January 2010 to December 2011) and post-period (July 2012 to June 2014). RESULTS: Ninety-four and 104 patients were diagnosed with acute aortic disease in the pre- and post-periods, respectively. After the implementation of the CP, 38.7% of acute aortic disease cases were diagnosed via PRE-AORTA. The door-to-CT time was reduced more in PRE-AORTA-activated patients [71.0 (61.0, 115.0) min vs. 113.0 (56.0, 170.5) min; p=0.026]. During the post-period, more patients received emergency intervention than during the pre-period (22.3% vs. 36.5%; p=0.029). Time until emergency intervention was reduced in patients, who visited the ED directly, from 378.0 (302.0, 489.0) min in the pre-period to 200.0 (170.0, 299.0) min in the post-period (p=0.001). The number of patients who died in the ED declined from 11 to 4 from the pre-period to the post-period. Hospital mortality decreased from 26.6% to 14.4% in the post-period (p=0.033). CONCLUSION: After the implementation of a CP for patients with acute aortic disease, more patients received emergency intervention within a shorter time, resulting in improved hospital mortality.
Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting/diagnosis/mortality/*surgery ; Aorta ; Aortic Aneurysm/diagnosis/mortality/*surgery ; Aortic Diseases/diagnosis/mortality/*surgery ; *Critical Pathways ; Emergency Service, Hospital/*organization & administration ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications/mortality ; Republic of Korea/epidemiology ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Vascular Surgical Procedures/*methods

No abstract available.
Aged ; Aneurysm/surgery ; Anti-Bacterial Agents/pharmacology ; Brain Diseases/surgery ; Craniotomy/adverse effects ; DNA, Bacterial/chemistry/genetics/metabolism ; Female ; Flavobacteriaceae Infections/etiology/microbiology ; Flavobacterium/classification/drug effects/*isolation & purification ; Humans ; Meningitis/*diagnosis/microbiology ; Microbial Sensitivity Tests ; Phylogeny ; Postoperative Complications ; Sequence Analysis, DNA

No abstract available.
Aged ; Anti-Inflammatory Agents/therapeutic use ; Carotid Artery Diseases/*complications/diagnosis/therapy ; Cerebral Angiography/methods ; Diagnosis, Differential ; Female ; Glucocorticoids/therapeutic use ; Humans ; Hydrocortisone/therapeutic use ; Hypopituitarism/diagnosis/*etiology/therapy ; Intracranial Aneurysm/*complications/diagnosis/therapy ; Magnetic Resonance Imaging ; Plasma Substitutes/administration & dosage ; Predictive Value of Tests ; Prednisolone/therapeutic use ; Sella Turcica ; Thyroid Hormones/therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome

No abstract available.
Aneurysm, Dissecting/diagnosis/*etiology/physiopathology/therapy ; Anticoagulants/therapeutic use ; Aortic Aneurysm/diagnosis/*etiology/physiopathology/therapy ; Behcet Syndrome/*complications/diagnosis/drug therapy ; Cerebral Infarction/diagnosis/etiology ; Diffusion Magnetic Resonance Imaging ; Echocardiography, Doppler, Color ; Electrocardiography ; Hemodynamics ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Middle Aged ; *Sinus of Valsalva/physiopathology/ultrasonography ; Thrombosis/diagnosis/drug therapy/*etiology/physiopathology ; Ventricular Septal Rupture/diagnosis/*etiology/physiopathology/therapy

No abstract available.
Aged, 80 and over ; Aortic Aneurysm, Abdominal/*complications/diagnosis ; Aortography/methods ; Duodenal Obstruction/diagnosis/drug therapy/*etiology ; Gastrointestinal Agents/therapeutic use ; Humans ; Male ; Risk Factors ; Syndrome ; Tomography, X-Ray Computed

Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding.
Adult ; Aneurysm/*diagnosis/etiology ; Arteries ; Embolization, Therapeutic ; Gastroscopy ; Head and Neck Neoplasms/complications/*diagnosis ; Hepatic Artery/diagnostic imaging ; Humans ; Male ; Neurofibromatosis 1/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*etiology ; Radiography

A 44-year old male patient was admitted to the First Affiliated Hospital, Zhejiang University School of Medicine with left ptosis and pain on the left head and neck for 20 days.Brain MRI showed subacute cerebral infarction on left parietal lobe and intramural hematoma on left internal carotid artery. CT angiography showed stenosis line on the C1 segment of left internal carotid artery. Digital subtraction angiography showed dissection on the C1 segment of left internal carotid artery.The condition of patients was improved after anticoagulant therapy.
Adult ; Aneurysm, Dissecting ; complications ; diagnosis ; Carotid Artery, Internal ; pathology ; Cerebral Infarction ; pathology ; Horner Syndrome ; complications ; diagnosis ; Humans ; Magnetic Resonance Imaging ; Male