Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From April 1981 to December 1988, a total of 23 patients were operated upon for the repair of an aneurysm of the descending thoracic aorta with a tridodecylmethylammonium chloride (TDMAC)-heparin-impregnated shunt. There were 20 men and 3 women. The ages ranged from 29 to 72 years with a mean of 52.3 years. The major pathological change of the aortic wall was medial cystic necrosis in 19 patients and atherosclerosis in 4. Among them, only 6 patients underwent elective surgery, while 17 patients underwent emergency operations with the surgical indication being shock in 4, oliguria in 3, persistence of chest pain in 2, massive hemoptysis in 1, rapid size progression of the aneurysm in 3, and impending rupture of the aneurysm in 4. During surgery, the aortic cross-clamping time ranged from 40 to 76 minutes with a mean of 54 minutes. Hospital death was limited to 2 patients with a mortality rate of 8.7%. Postoperative complications were noted in 5 patients, cerebrovascular accidents in 4 and transient paraparesis in 1. However, the clinical conditions recovered before those patients were discharged. The follow-up period ranged from 4 to 84 months with a mean of 32.3 months. Except for 1 patient who died of anaphylactic shock due to drug allergy, the other 20 survivors had an apparent improvement of their clinical status and life quality.
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PMID:The use of TDMAC-heparin-impregnated shunt for managing aneurysm of the descending thoracic aorta. 197 26

Between 1953 and 1993, 659 patients underwent descending thoracic aneurysm resection. The most common etiology was atherosclerosis. Pain was the main presenting symptom. Perioperative mortality fell from 24.2% between 1953 and 1964 to 14.3% between 1970 and 1993. Paraplegia occurred in 4.1% (27/659) patients overall and was little affected by time of operation or use of atriofemoral bypass. Paraparesis occurred in 5.9% (39/659) patients and was reduced by use of atriofemoral bypass. The low rate of paraparesis in the earlier experience was offset by the higher perioperative mortality from hemorrhage, attributable to the use of systemic heparin. The use of heparin-free circuits with centrifugal pumps should be considered in patients likely to have a clamp time greater than 30 minutes. The major source of perioperative morbidity and mortality was cardiac causes (48%) followed by perioperative hemorrhage (14.4%), pulmonary complications (14.4%), and rupture of another aneurysmal segment (12.0%). Late mortality occurred most commonly from cardiac causes (30.6% of deaths) and rupture of another aneurysm (16.3% of deaths). Improvement in results was due to general refinements of management in all areas rather than any single factor. These results indicate that complete preoperative assessment of the patient and the entire aorta is essential and that regular life-long follow-up is critical in order to avoid unnecessary morbidity and mortality from cardiac, cerebrovascular, or subsequent aneurysmal complications.
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PMID:Evolution of surgical techniques for aneurysms of the descending thoracic aorta: twenty-nine years experience with 659 patients. 784 45

A consecutive series of 28 patients operated on at the Oulu University Hospital during the years 1974-1994 for aneurysms of the descending thoracic aorta is presented. Twenty-five cases were elective and three were operated on as emergencies. Their mean age was 58 years. During the aortic cross-clamp, circulatory support of the lower body, was used in 27 cases as follows: a direct aorto-femoral shunt without a pump (12/28), left-heart bypass (11/28) or femoro-femoral perfusion (4/28). Hospital mortality was 14% (4/28). One patient with a ruptured aneurysm died of renal failure, but there were no other renal complications. None had paraplegia postoperatively. Three had symptoms of paraparesis, but only one of them had a slight permanent discomfort while walking. The mean follow-up time was 100 months, range 2-242 months. Late actuarial survival including hospital mortality, was 65% at 5 years and 41% at 10 years, reflecting the generalized aortic disease with a high risk of very late rupture (4) and other manifestations of atherosclerosis with myocardial infarction (6) or cerebral atherosclerosis (1), the remaining late deaths being unrelated. The efficacy of lower body circulatory support in avoiding peroperative renal and spinal cord ischaemic complications is demonstrated.
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PMID:Surgical and long-term outcome of graft replacement of aneurysms of the descending thoracic aorta. Analysis of 28 consecutive cases. 926 61