scholarly journals Surgical treatment for secondary aortoesophageal fistula

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Kayo Sugiyama ◽  
Toru Iwahashi ◽  
Nobusato Koizumi ◽  
Toshiya Nishibe ◽  
Toshiki Fujiyoshi ◽  
...  
Keyword(s):  
Open Repair ◽  
Rare Condition ◽  
Aortic Aneurysms ◽  
Total Arch Replacement ◽  
University Hospital ◽  
Aortoesophageal Fistula ◽  
Thoracic Aortic Aneurysms ◽  
Life Threatening ◽  
Tokyo Medical ◽  
Medical University

Abstract Background Aortoesophageal fistula (AEF) is a relatively rare condition that is often life-threatening. Secondary AEF is a complication of previous surgery, which can be more critical and challenging than primary AEF. The number of secondary AEF is increasing due to increase in the number of thoracic endovascular aortic repair (TEVAR). Although TEVAR has become a successful alternative surgical strategy for thoracic aortic aneurysms, secondary AEF after TEVAR might be critical than other secondary AEF because of severe adhesion between the esophagus and residual thoracic aortic wall. Methods This study analyzed six patients with secondary AEF who were treated at Tokyo Medical University Hospital between 2011 and 2016. These participants included four patients who had undergone TEVAR and two who had undergone total arch replacement. Results Although they were subsequently hospitalized for a long period, open surgical repair was completed in two patients who had undergone total arch replacement. TEVAR alone was performed in two patients who had undergone TEVAR and they were discharged without major complications shortly. Combined repair of TEVAR as a bridge to open surgery was planned for two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization. Conclusions Definitive open repair was successfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondary AEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair. The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF. In secondary AEF after TEVAR, definitive open repair is difficult to complete because of catastrophic complication, and palliative treatment using TEVAR without reconstruction of aorta and esophagus can be an alternative.

scholarly journals Surgical treatment for secondary aortoesophageal fistula

2020 ◽  
Author(s):  
Kayo Sugiyama ◽  
Toru Iwahashi ◽  
Nobusato Koizumi ◽  
Toshiya Nishibe ◽  
Toshiki Fujiyoshi ◽  
...  
Keyword(s):  
Open Repair ◽  
Rare Condition ◽  
Aortic Aneurysms ◽  
Total Arch Replacement ◽  
University Hospital ◽  
Aortoesophageal Fistula ◽  
Thoracic Aortic Aneurysms ◽  
Life Threatening ◽  
Tokyo Medical ◽  
Medical University

Abstract BackgroundAortoesophageal fistula (AEF) is a relatively rare condition that is often life-threatening. Secondary AEF is a complication of previous surgery, which can be more critical and challenging than primary AEF. The number of secondary AEF is increasing due to increase in the number of thoracic endovascular aortic repair (TEVAR). Although TEVAR has become a successful alternative surgical strategy for thoracic aortic aneurysms, secondary AEF after TEVAR might be critical than other secondary AEF because of severe adhesion between the esophagus and residual thoracic aortic wall.MethodsThis study analyzed six patients with secondary AEF who were treated at Tokyo Medical University Hospital between 2011 and 2016. These participants included four patients who had undergone TEVAR and two who had undergone total arch replacement.ResultsAlthough they were subsequently hospitalized for a long period, open surgical repair was completed in two patients who had undergone total arch replacement. TEVAR alone was performed in two patients who had undergone TEVAR and they were discharged without major complications shortly. Combined repair of TEVAR as a bridge to open surgery was planned for two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization.ConclusionsDefinitive open repair was successfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondary AEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair. The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF. In secondary AEF after TEVAR, definitive open repair is difficult to complete because of catastrophic complication, and palliative treatment using TEVAR without reconstruction of aorta and esophagus can be an alternative.

scholarly journals Surgical Treatment for Secondary Aortoesophageal Fistula

2020 ◽  
Author(s):  
Kayo Sugiyama ◽  
Toru Iwahashi ◽  
Nobusato Koizumi ◽  
Toshiya Nishibe ◽  
Toshiki Fujiyoshi ◽  
...  
Keyword(s):  
Aortic Wall ◽  
Surgical Repair ◽  
Open Repair ◽  
Rare Condition ◽  
Thoracic Endovascular Aortic Repair ◽  
Aortic Aneurysms ◽  
Total Arch Replacement ◽  
Aortoesophageal Fistula ◽  
Open Surgical Repair ◽  
Long Period

Abstract BackgroundAortoesophageal fistula(AEF) is a relatively rare condition that is often life-threatening.Secondary AEF is a complication ofprevious surgery,whichcan be more critical and challenging than primary AEF.The number of secondary AEF is increasing due to increase in the number of thoracic endovascular aortic repair (TEVAR). Although TEVAR has become a successful alternative surgical strategy forthoracic aortic aneurysms, secondary AEF after TEVAR might be critical than other secondary AEF because of severe adhesion between the esophagus and residual thoracic aortic wall.Methods This study analyzedsixpatients with secondaryAEFwho were treated at TokyoMedical University Hospitalbetween 2011 and 2016. These participants includedfour patients who had undergone TEVAR and two who had undergone total arch replacement.ResultsAlthough they were subsequently hospitalized for a long period, open surgical repair was completed intwo patients who had undergonetotal archreplacement.TEVAR alone was performedin two patients who had undergone TEVAR and they were discharged without major complications shortly. Combined repair of TEVARas a bridge to open surgery was plannedfor two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization. ConclusionsDefinitive open repair wassuccessfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondaryAEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair.The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF. In secondary AEF after TEVAR, palliative treatment using TEVAR without reconstruction of aorta and esophagus should be considered.

Ultrasound diagnosis of dissecting thoracic aortic aneurysms: procedure with a handheld device and a video-illustrated case

2021 ◽  
Vol 51 (1) ◽  
pp. 10-15
Author(s):  
Kenneth V Iserson ◽  
Sri Devi Jagjit ◽  
Balram Doodnauth
Keyword(s):  
Aortic Dissection ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms ◽  
Handheld Device ◽  
Thoracic Aortic Dissection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Handheld Ultrasound

Acute thoracic aortic dissection is an uncommon, although not rare, life-threatening condition. With protean signs and symptoms that often suggest more common cardiac or pulmonary conditions, it can be difficult to diagnose. Ultrasound has proven useful in making the correct diagnosis. This case demonstrates that training gained using standard ultrasound machines can be easily and successfully adapted to newer handheld ultrasound devices. The examination technique using the handheld device is illustrated with photos and a video.

scholarly journals Mapping Semaphorins and Netrins in the Pathogenesis of Human Thoracic Aortic Aneurysms

2019 ◽  
Vol 20 (9) ◽  
pp. 2100
Author(s):  
Alebrahim ◽  
Nayak ◽  
Ward ◽  
Ursomanno ◽  
Shams ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Aortic Aneurysms ◽  
Axonal Guidance ◽  
Full Spectrum ◽  
Thoracic Aortic Aneurysms ◽  
Persistent Inflammation ◽  
Novel Association ◽  
Life Threatening ◽  
Ecm Degradation ◽  
Matrix Degrading Enzymes

Thoracic aortic aneurysm (TAA) is a complex life-threatening disease characterized by extensive extracellular matrix (ECM) fragmentation and persistent inflammation, culminating in a weakened aorta. Although evidence suggests defective canonical signaling pathways in TAA, the full spectrum of mechanisms contributing to TAA is poorly understood, therefore limiting the scope of drug-based treatment. Here, we used a sensitive RNA sequencing approach to profile the transcriptomic atlas of human TAA. Pathway analysis revealed upregulation of key matrix-degrading enzymes and inflammation coincident with the axonal guidance pathway. We uncovered their novel association with TAA and focused on the expression of Semaphorins and Netrins. Comprehensive analysis of this pathway showed that several members were differentially expressed in TAA compared to controls. Immunohistochemistry revealed that Semaphorin4D and its receptor PlexinB1, similar to Netrin-1 proteins were highly expressed in damaged areas of TAA tissues but faintly detected in the vessel wall of non-diseased sections. It should be considered that the current study is limited by its sample size and the use of internal thoracic artery as control for TAA for the sequencing dataset. Our data determines important neuronal regulators of vascular inflammatory events and suggest Netrins and Semaphorins as potential key contributors of ECM degradation in TAA.

scholarly journals Endovascular versus open repair of ruptured descending thoracic aortic aneurysms: A nationwide risk-adjusted study of 923 patients

2011 ◽  
Vol 142 (5) ◽  
pp. 1010-1018 ◽  
Author(s):  
Raja R. Gopaldas ◽  
Tam K. Dao ◽  
Scott A. LeMaire ◽  
Joseph Huh ◽  
Joseph S. Coselli
Keyword(s):  
Open Repair ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms

scholarly journals Its Congenital Hepatic Fibrosis; Not Cirrhosis At All

2018 ◽  
Vol 1 (2) ◽  
pp. 124-126
Author(s):  
Ananta Shrestha ◽  
Mamun Al-Mahtab ◽  
Salimur Rahman ◽  
Jahangir Sarkar ◽  
Thupten K Lama
Keyword(s):  
Portal Hypertension ◽  
Hepatic Fibrosis ◽  
Autosomal Recessive ◽  
Rare Condition ◽  
Recessive Trait ◽  
Congenital Hepatic Fibrosis ◽  
Life Threatening ◽  
Hepatic Histology ◽  
Upper Abdomen ◽  
Medical University

Congenital hepatic fibrosis is a rare condition characterized by extensive fibrosis of liver but with preserved normal lobular architecture inherited as autosomal recessive trait. We report a 19 year-old-female admitted to Bangabandhu Sheikh Mujib Medical University with the complaints of lump in upper abdomen since last 13 years and episodes of fever and abdominal pain for same duration. She was diagnosed with hepatic TB on hepatic histology. Congenital hepatic fibrosis is a rare cause of portal hypertension that presents during childhood. Prognosis of congenital hepatic fibrosis is good. Life threatening events in these patients are related with variceal bleeding and episodes of cholangitis. Owing to relatively good liver function these patients tolerate portosystemic shunt surgeries quite well.Though rare, congenital hepatic fibrosis should be included in the differential diagnosis of portal hypertension in early life.

Clinical Treatment to a Child with Profound Hearing Impairment-Attempt of Auditory and Cochlear Implant Center of Tokyo Medical University Hospital (ACICTMU)-

2009 ◽  
Vol 102 (6) ◽  
pp. 415-422
Author(s):  
Atsushi Kawano ◽  
Michio Hazama ◽  
Akira Hagiwara ◽  
Nobuhiro Nishiyama ◽  
Sachie Kawaguchi ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Hearing Impairment ◽  
Clinical Treatment ◽  
University Hospital ◽  
Tokyo Medical ◽  
Medical University

Photodynamic therapy using Laserphyrin for centrally located early stage lung cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7229-7229 ◽  
Author(s):  
J. Usuda ◽  
H. Kato ◽  
T. Okunaka ◽  
K. Furukawa ◽  
H. Honda ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Photodynamic Therapy ◽  
Early Stage ◽  
Stage I ◽  
University Hospital ◽  
Early Stage Lung Cancer ◽  
Endobronchial Ultrasonography ◽  
Tokyo Medical ◽  
Medical University ◽  
Stage Lung Cancer

7229 Background: In central type early stage lung cancer, the tumor must be located only as far as the segmental bronchi and be carcinoma in situ or with only limited invasion into the bronchial wall. Laserphyrin (mono-L-aspartyl chlorine e6, NPe6) is a second generation photosensitize and approved by the Japanese government and has been on sale from June 2004. Methods: Four h after the administration of Laserphyrin 40 mg/m2, we irradiated using diode laser (100 mJ/cm2). Before PDT, we evaluated the tumor lesions and tumor depth using autofluorescence bronchoscopy and endobronchial ultrasonography (EBUS), and we confirmed the area of laser irradiation. Results: From February 1980 to December 2005, a total number of 204 patients with 264 lesions of centrally located early stage lung cancer underwent photodynamic therapy (PDT) in the Department of Thoracic Surgery, Tokyo Medical University Hospital. There were 185 clinical stage 0 lesions and 79 stage I lesions. CRs and PRs were obtained in 224 lesions (84.8%) and 40 lesions (15.2%) out of 264 lesions. From July 2004 to December 2005, we performed Laserphyrin-PDT for 28 lesions of centrally located early stage lung cancer in Tokyo Medical University Hospital. The rate of CR was 92.9% (26 lesions) in 28 lesions. For Laserphyrin-PDT, Skin photosensitivity was very low and the clean-up bronchoscopies were not frequently needed, and the period of hospitalization was shorter compared to that for Photofrin-PDT. Conclusions: We conclude that PDT using Laserphyrin will be a standard option for stage 0 (TisN0M0) and stage I (T1N0M0) centrally located early stage lung cancer. No significant financial relationships to disclose.

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