The ARCH Projects: design and rationale (IAASSG 001)

OBJECTIVE A number of factors limit the effectiveness of current aortic arch studies in assessing optimal neuroprotection strategies, including insufficient patient numbers, heterogenous definitions of clinical variables, multiple technical strategies, inadequate reporting of surgical outcomes and a lack of collaborative effort. We have formed an international coalition of centres to provide more robust investigations into this topic. METHODS High-volume aortic arch centres were identified from the literature and contacted for recruitment. A Research Steering Committee of expert arch surgeons was convened to oversee the direction of the research. RESULTS The International Aortic Arch Surgery Study Group has been formed by 41 arch surgeons from 10 countries to better evaluate patient outcomes after aortic arch surgery. Several projects, including the establishment of a multi-institutional retrospective database, randomized controlled trials and a prospectively collected database, are currently underway. CONCLUSIONS Such a collaborative effort will herald a turning point in the surgical management of aortic arch pathologies and will provide better powered analyses to assess the impact of varying surgical techniques on mortality and morbidity, identify predictors for neurological and operative risk, formulate and validate risk predictor models and review long-term survival outcomes and quality-of-life after arch surger

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

Mb. Wegener als Differenzialdiagnose zur Orbitaphlegmone nach FESS

Vorgestellt wird der Krankheits- und Therapieverlauf einer 43-jährigen Patientin die seit 6 Monaten an einer chronisch eitrigen Sinusitis litt. Nach mehrfachen antibiotischen Therapieversuchen sowie rezidivierender Schwellung und Rötungen infraorbital wurde auswärtig eine endonasale Pansinusoperation durchgeführt, wobei intraoperativ die Orbita akzidentiell eröffnet wurde. Postoperativ kam es zu einer Ausweitung der infraorbitalen Entzündung mit Exophthalmus, Doppelbildern und Visusverschlechterung. Bildmorphologisch zeigte sich eine Entzündung des orbitalen Gewebes ohne Anhalt für einen Abzess. Bei V.a. Orbitaphlegmone wurde die Orbita in unserer Klinik transnasal dekomprimiert und Gewebe zur mikrobiologischen Untersuchung eingeschickt. Trotz i.v. Antibiose kam es zu einer weiteren Befundverschlechterung. Die histologische Aufarbeitung ergab eine nekrotisierende Vasculitis, so dass der V.a. einen Mb. Wegener gestellt wurde. Nach Beginn der hochdosierten Prednisolontherapie kam es zu einem Rückgang der lokalen Entzündungsreaktion und zu einer Visusverbesserung. Die weitere Diagnostik und Therapie erfolgte in der Klinik für Rheumatologie wo sich die Verdachtsdiagnose eines Mb. Wegener bestätigte und eine Basistherapie mit Metothrexat eingeleitet wurde.Der Erstautor gibt keinen Interessenkonflikt an

Thoracic stent graft sizing for frozen elephant trunk repair in acute type A dissection

ObjectiveAlthough stenting of the descending aorta simultaneously with proximal aortic repair has become an accepted part of the therapy for acute type A dissection, no general recommendations have been accepted regarding the choice of diameter and length of the stent grafts. The present study explored the safety and effectiveness of sizing the stent graft of the hybrid prosthesis in relation to the total aortic diameter and extending the landing zone to the level of the T10–T12 vertebrae.MethodsThe frozen elephant trunk procedure was performed on 32 patients with acute type A aortic dissection. The stent graft size was chosen according to the total aortic diameter measured on contrast-enhanced computed tomography scans. The stent graft was inserted with the distal landing zone at the level of vertebrae T10–T12. All patients underwent computed tomography or magnetic resonance angiography before discharge; 8 patients underwent subsequent endovascular stent extension.ResultsThe 30-day survival was 100%, with 3.1% (1/32) overall mortality at 17 ± 4 months (range, 1–33) of follow-up. The postoperative complications included pneumonia in 5, pulmonary embolism in 3, sepsis in 1, and permanent recurrent laryngeal nerve damage in 1 patient. No ischemic brain or spinal cord injury occurred. During follow-up, no endoleaks or false lumen patency developed.ConclusionsSizing the stent graft of the hybrid prosthesis according to the total aortic diameter and choosing a distal landing zone between vertebrae T10 and T12 is safe, with low midterm mortality and morbidity. It allows an extensive repair of the dissected aorta with early definite occlusion of the false lumen and prepares for potential endovascular extension of the graft