BACKGROUND

This case report describes a rare presentation of double-vessel Spontaneous Coronary Artery Dissection (SCAD) in a 54-year-old male. One dissection occurred in a coronary artery with atherosclerotic plaque deposition, while the second vessel exhibited dissection without evidence of plaque deposition, trauma or iatrogenic manipulation such as percutaneous coronary intervention. The patient, a known hypertensive and dyslipidemic, had a prior diagnosis of heart failure with reduced ejection fraction (HFrEF). He presented with progressively worsening shortness of breath and orthopnea (two-pillow orthopnea for three years. An initial coronary angiogram was recommended due to a high suspicion of underlying coronary artery disease (CAD).Subsequent diagnostic workup revealed multisegmental wall motion abnormalities on 2D echocardiography with Doppler imaging. Laboratory tests, including electrolytes, were unremarkable. A follow-up coronary angiogram revealed mild to moderate CAD in the left anterior descending (LAD) artery and spontaneous coronary artery dissection involving both the LAD and the right coronary artery (RCA). The patient was managed conservatively with aspirin and discharged on a regimen of sacubitril/valsartan, ivabradine, trimetazidine, and rosuvastatin. As typically seen in SCAD cases, conservative medical management was preferred over invasive procedures such as PCI or coronary artery bypass grafting (CABG), which are reserved for select clinical situations.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Arteries ; Dissection ; Hospitals ; Male ; Patients ; Research Report ; Tertiary Care Centers

BACKGROUND

This case report describes a rare presentation of double-vessel Spontaneous Coronary Artery Dissection (SCAD) in a 54-year-old male. One dissection occurred in a coronary artery with atherosclerotic plaque deposition, while the second vessel exhibited dissection without evidence of plaque deposition, trauma or iatrogenic manipulation such as percutaneous coronary intervention. The patient, a known hypertensive and dyslipidemic, had a prior diagnosis of heart failure with reduced ejection fraction (HFrEF). He presented with progressively worsening shortness of breath and orthopnea (two-pillow orthopnea for three years. An initial coronary angiogram was recommended due to a high suspicion of underlying coronary artery disease (CAD).Subsequent diagnostic workup revealed multisegmental wall motion abnormalities on 2D echocardiography with Doppler imaging. Laboratory tests, including electrolytes, were unremarkable. A follow-up coronary angiogram revealed mild to moderate CAD in the left anterior descending (LAD) artery and spontaneous coronary artery dissection involving both the LAD and the right coronary artery (RCA). The patient was managed conservatively with aspirin and discharged on a regimen of sacubitril/valsartan, ivabradine, trimetazidine, and rosuvastatin. As typically seen in SCAD cases, conservative medical management was preferred over invasive procedures such as PCI or coronary artery bypass grafting (CABG), which are reserved for select clinical situations.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Arteries ; Dissection ; Hospitals ; Male ; Patients ; Research Report ; Tertiary Care Centers

INTRODUCTION: This study was conducted to evaluate the efficacy of postoperative computed tomography (CT) measurements of aortic lumen volumes in predicting aortic-related complications following acute type A aortic dissection (ATAAD) repair. METHODS: We conducted a single-institution retrospective aortic volumetric analysis of patients after ascending aorta replacement performed during 2001-2015. The volumetric measurements of total lumen (total-L), true lumen (TL), false lumen (FL), as well as the TL:FL ratio from the first and second postoperative computer angiograms were obtained. A generalised structural equation model was created to analyse the predictive utility of TL:FL ratio. RESULTS: One hundred and twenty-five patients underwent surgical intervention, of whom 97 patients were eventually discharged and analysed for postoperative complications. A total of 19 patients were included in the final analysis. Patients with late postoperative aortic complications had a significantly higher FL volume and total-L volume on the first (FL volume P = 0.041, total-L volume P = 0.05) and second (FL volume P = 0.01, total-L volume P = 0.007) postoperative scans. The odds of having aortic complications were raised by 1% with a 1 cm 3 increase in total-L volume and by 2% with a 1 cm 3 increase in FL volume. The TL:FL ratio was significantly lower in patients who developed complications. CONCLUSION Postoperative CT volumetric measurements in patients who developed complications are characterised by a significant increase in the FL volume and total-L volume from the first postoperative scans. Patients with disproportionately expanded FL presenting with TL:FL ratios less than 1 were associated with aortic complications. Hence, the TL:FL ratio may be a reliable and useful parameter to monitor postoperative disease progression and to evaluate the risk of late complications in ATAAD patients.
Humans ; Male ; Female ; Retrospective Studies ; Singapore ; Aortic Dissection/diagnostic imaging* ; Middle Aged ; Postoperative Complications/diagnostic imaging* ; Aged ; Tomography, X-Ray Computed ; Aortic Aneurysm/diagnostic imaging* ; Aorta/surgery* ; Adult ; Treatment Outcome ; Computed Tomography Angiography

Aortic dissection (AD) is a life-threatening cardiovascular disease characterized a tear in the aortic intima, which leads to the formation of two separate channels within the aortic wall due to blood flow. The mortality rate of AD is high, especially when dissection ruptures, as it can rapidly trigger acute cardiac and vascular complications, ultimately leading to death. Therefore, understanding the pathogenesis of AD and identifying potential therapeutic strategies is of critical clinical importance. Vascular smooth muscle cell (VSMC) play a central role in the structural and functional integrity of the aortic wall, and dysfunction of VSMC is closely associated with the development of AD. Recent studies suggest that the functional alterations of VSMC involve multiple mechanisms, including apoptosis, oxidative stress, and aberrant intracellular signaling, all of which play key roles in the disruption of the aortic wall structure. This review focuses on the role of VSMC in AD, particularly the specific involvement of VSMC apoptosis in the progression of AD, and further explores therapeutic strategies targeting the pathological processes of VSMC in AD, such as the inhibition of inflammatory mediators and oxidative stress. Despite some progress in current treatments, effectively intervening in the pathological progression of VSMC remains a significant challenge. Future research will further investigate these mechanisms, providing new insights and strategies for the treatment of AD. Studying the role of VSMC in AD is crucial for the development of novel therapeutic approaches.
Apoptosis ; Humans ; Muscle, Smooth, Vascular/pathology* ; Aortic Dissection/therapy* ; Oxidative Stress ; Myocytes, Smooth Muscle/pathology* ; Aortic Aneurysm/pathology*

OBJECTIVE: To explore the feasibility of reconstruction of phonatory function by using a tubular free flap from upper-lateral upper arm to repair the laryngotracheal circumferential defect after near-total laryngectomy for laryngeal cancer. METHODS: A retrospective study was conducted on 7 patients who underwent near-total laryngectomy between June 2021 and October 2023, aged from 48 to 70 years (median, 59 years), 6 males and 1 female. The disease duration ranged from 1 to 11 months, with a median of 6 months. Pathological diagnosis of preoperative biopsy was squamous cell carcinoma. Tumor classification: glottic type in 5 cases, supraglottic type in 1 case, transglottic type in 1 case; TNM staging: T ₄N ₀M ₀ in 6 cases, T ₄N ₂M ₀ in 1 case; American Joint Committee on Cancer (AJCC) staging in 2017 was stage Ⅳ. Preoperative MRI angiography of upper arm was performed to investigate the blood supply in the upper and lateral regions of the upper arm. After near-total laryngectomy and bilateral neck lymph node dissection, the area of the laryngotracheal defect was measured. A free flap measuring 7.0 cm×5.0 cm to 8.0 cm×7.0 cm was harvested from the upper-lateral upper arm, rolled into a tube shape, and connected between the stump of the cervical trachea in the neck root and that of the epiglottis at the tongue base. Four patients received adjuvant radiochemotherapy, 1 patient received radiochemotherapy and targeted therapy, 2 patients adopted no further adjuvant treatment. RESULTS: All 7 patients were followed-up 1-2 years (mean, 1 year and 3 months). Four patients had primary wound healing, 2 patients had minor pharyngeal fistulas that healed after dressing change, 1 patient experienced pharyngeal fistula because of flap necrosis and the wound still healed without secondary surgery. All patients took food orally within 1 month after operation, and the tracheal cannula was retained. Six patients with survived flap gradually adapted to their new pronunciation mode and obtained satisfactory phonatory function from 15 days to 2 months after operation. Four patients had slight aspiration after operation. Till the end of the follow-up, all patients survived and no local recurrence or distant metastasis had been observed. The motor function of the upper arm was not affected, only partial sensory loss occurred in the area near the incision. The scar of the incision could be covered by the short sleeve so as to obtain a better aesthetic effect. CONCLUSION Using a tubular free flap from upper-lateral upper arm to repair the laryngotracheal circumferential defect after near-total laryngectomy for laryngeal cancer can achieve satisfactory phonatory restoration while preserve the motor function and aesthetics of the donor site.
Humans ; Laryngectomy/methods* ; Male ; Middle Aged ; Female ; Laryngeal Neoplasms/surgery* ; Aged ; Free Tissue Flaps ; Retrospective Studies ; Plastic Surgery Procedures/methods* ; Carcinoma, Squamous Cell/surgery* ; Phonation ; Arm/surgery* ; Neck Dissection

Traumatic aortic injury (TAI) is an acute, critical, and severe disease, and then combined with multiple organ damage, it is even more dangerous. TAI progresses very rapidly, with a pre-hospital mortality rate of 57%-80%, and even when arriving at the hospital, more than one-third of the patients die within 4 h, and it is the 2nd leading cause of death in individuals aged 4-34 years. In addition, the incidence of TAI combined with injury was 81.4%. Therefore, early diagnosis, expeditious surgery, and timely and effective multidisciplinary cooperation are essential for successful rescue. The authors report 2 patients with acute traumatic aortic dissection combined with multiple organ injuries and treated with emergency endovascular surgery to discuss their clinical characteristics and treatment experience, and to provide experience in the diagnosis and treatment of such patients.
Humans ; Aortic Dissection/surgery* ; Endovascular Procedures ; Multiple Trauma/surgery*

Objective:To investigate the clinical efficacy of robotic surgery via the bilateral axillo-breast approach（BABA） in lateral lymph node dissection for papillary thyroid carcinoma（PTC）. Methods:Clinicopathological records of 324 PTC patients receiving unilateral neck dissection in Tianjin Medical University Cancer Institute and Hospital from December 2020 to November 2024 were retrospectively analyzed. Of these patients, 108 underwent robotic surgery via BABA（robotic group）, while the remaining patients underwent conventional open surgery（open group）. The extent of lateral neck lymph node dissection included level Ⅱ, Ⅲ and Ⅳ. The differences in surgical indexes, postoperative complication rates and cosmetic outcomes of incisions were compared between two groups. Results:All study subjects completed the operation successfully, and there was no conversion in the robotic group. The average age of patients in the robotic group was lower than that in the open group, and the proportion of female patients was higher in the robotic group compared to the open group（P<0.05）. Patients in the robotic group had a greater number of dissected lymph nodes in level ⅡB and higher cosmetic scores（P<0.05）. There were no statistically significant differences between the two groups in the average dissection time of lateral cervical lymph nodes, the number of dissected lymph nodes and metastatic lymph nodes in level ⅡA, Ⅲ, and Ⅳ, average postoperative drainage volume, average postoperative hospital stay, and postoperative complication rates（P>0.05）. Conclusion:The application of robotic surgical system via BABA in lateral neck lymph node dissection for PTC is safe and feasible, with superior advantages in level ⅡB dissection and better postoperative cosmetic outcomes.
Humans ; Thyroid Neoplasms/surgery* ; Robotic Surgical Procedures/methods* ; Female ; Retrospective Studies ; Neck Dissection/methods* ; Lymph Node Excision/methods* ; Male ; Thyroid Cancer, Papillary ; Axilla/surgery* ; Thyroidectomy/methods* ; Breast/surgery* ; Middle Aged ; Adult ; Lymph Nodes/surgery* ; Treatment Outcome

This is a case of a 56-year-old Filipina female who presented with a four-month history of a palpable right infraclavicular lymph node that was diagnosed as metastatic melanoma on histopathology and immunohistochemical staining with no apparent primary tumor on physical examination, nasopharyngoscopy, colonoscopy and imaging studies. Patient then underwent modified radical neck dissection, right, with an unremarkable intra-operative and post-operative course. This report aimed to document the clinical profile, laboratory and imaging parameters and treatment of melanoma of unknown primary on a 65-year-old female.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Melanoma ; Neoplasms ; Neck Dissection ; Philippines

Humans ; Lymph Nodes/pathology* ; Lymph Node Excision ; Neoplasms/pathology* ; Dissection

Recent studies have shown that iron metabolism dysregulation and lipid peroxidation-induced ferroptosis, triggered by oxidative stress, play a key role in the development of aortic dissection. Dysregulated iron metabolism leads to excessive production of hydroxyl radicals due to abnormal iron levels and heme metabolism, while lipid peroxidation is linked to system Xc^－ dysfunction and accumulation of phospholipid hydroperoxides. These factors synergistically disrupt aortic homeostasis and drive ferroptosis in vascular cells, including endothelial and smooth muscle cells. Furthermore, disruptions in ferroptosis-related genes, along with risk factors such as smoking, epigenetic modifications such as protein methylation, and abnormalities in immune cells, particularly T cells, are closely linked to aortic dissection. Several small molecules and nanomaterials have shown potential in inhibiting ferroptosis in this context. This review elucidates the roles of ferroptosis in aortic dissection and proposes strategies for its targeted prevention and treatment.
Ferroptosis ; Humans ; Aortic Dissection/etiology* ; Lipid Peroxidation ; Iron/metabolism* ; Oxidative Stress ; Risk Factors ; Animals