Aortic Dissection Involving the Ostium of Left Main Coronary Artery

Α 58-year-old hypertensive man was referred from another hospital with diagnosis of myocardial infraction. He presented with a two hour sudden onset of severe chest pain radiating to his interscapular region. Pain did not respond to IV administration of nitrates and morphine. His blood pressure was 110/70 mmHg and physical examination revealed no murmurs The ECG showed extensive ST-segment elevation in the anterior and lateral leads suggesting acute anterior myocardial infarction. A transthoracic echocardiogram (TTE) demonstrated a dilated ascending aorta with an intimal flap that extended from the aortic valve to the mid-ascending aorta, (Figure 1) consistent with a Stanford type A acute aortic dissection (AAD). A multiplane transoesophageal echocardiogram (TOE) was then performed showed AAD extending into the aortic arch, the take-off of the left subclavian artery (Figure 2) and the descending aorta (Figure 3). The intimal flap was thin, smooth showed a pulsatile mobility with systolic convexity towards the false lumen (Figure 4). Flow was present in the false lumen which was larger than the true lumen (Figure 5). The left coronary ostium seemed to be obstructed by prolapse of the intimal flap during diastole (Figure 6). The aortic valve was normal and mild aortic regurgitation was noted caused by the aortic dilatation. Regional and global left ventricular function was normal.There were no periaortic or pericardial fluids. The patient was transferred for emergency surgery and the ascending aorta was successfully replaced by a supracoronary interposition prosthetic graft

''Day-to-day" entrepreneurship within organisations: The role of trait Emotional Intelligence and Perceived Organisational Support

Summary The aim of this article is to deepen the understanding of the factors, which influence individual entrepreneurial behaviour in organisations. Using a sample of 224 employees from four organisations, we tested by means of structural equation modeling the influence of personal traits (represented by trait EI or emotional self-efficacy) and contextual factors (represented by Perceived Organisational Support - POS) on entrepreneurial behaviour. Results indicate that both personal and contextual variables correlate with individual entrepreneurial behaviour. Moreover, findings demonstrate a significant negative relationship of the joint impact of POS and organisation tenure on entrepreneurial behaviour. The present effort extends theoretical and empirical research on the effects of personal and contextual factors on corporate entrepreneurship while applications of the results are discussed.Entrepreneurial behaviour Perceived Organisational Support Trait EI Corporate entrepreneurship Organisational tenure

Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty

BACKGROUND: This phase 3 trial compared the efficacy and safety of rivaroxaban, an oral direct inhibitor of factor Xa, with those of enoxaparin for extended thromboprophylaxis in patients undergoing total hip arthroplasty. METHODS: In this randomized, double-blind study, we assigned 4541 patients to receive either 10 mg of oral rivaroxaban once daily, beginning after surgery, or 40 mg of enoxaparin subcutaneously once daily, beginning the evening before surgery, plus a placebo tablet or injection. The primary efficacy outcome was the composite of deep-vein thrombosis (either symptomatic or detected by bilateral venography if the patient was asymptomatic), nonfatal pulmonary embolism, or death from any cause at 36 days (range, 30 to 42). The main secondary efficacy outcome was major venous thromboembolism (proximal deep-vein thrombosis, nonfatal pulmonary embolism, or death from venous thromboembolism). The primary safety outcome was major bleeding. RESULTS: A total of 3153 patients were included in the superiority analysis (after 1388 exclusions), and 4433 were included in the safety analysis (after 108 exclusions). The primary efficacy outcome occurred in 18 of 1595 patients (1.1%) in the rivaroxaban group and in 58 of 1558 patients (3.7%) in the enoxaparin group (absolute risk reduction, 2.6%; 95% confidence interval [CI], 1.5 to 3.7; P<0.001). Major venous thromboembolism occurred in 4 of 1686 patients (0.2%) in the rivaroxaban group and in 33 of 1678 patients (2.0%) in the enoxaparin group (absolute risk reduction, 1.7%; 95% CI, 1.0 to 2.5; P<0.001). Major bleeding occurred in 6 of 2209 patients (0.3%) in the rivaroxaban group and in 2 of 2224 patients (0.1%) in the enoxaparin group (P=0.18). CONCLUSIONS: A once-daily, 10-mg oral dose of rivaroxaban was significantly more effective for extended thromboprophylaxis than a once-daily, 40-mg subcutaneous dose of enoxaparin in patients undergoing elective total hip arthroplasty. The two drugs had similar safety profiles. (ClinicalTrials.gov number, NCT00329628