Tętniak rozwarstwiający aorty z zajęciem pnia ramienno-głowowego, pnia trzewnego i lewej tętnicy biodrowej wspólnej powodujący niedokrwienie nerki : opis przypadku

Background: Acute aortic dissection is one of the most dramatic cardiovascular emergencies. To limit the possibility of death, a detailed morphologic and functional diagnosis must be obtained quickly. Aortography has been the traditional method of assessing suspected aortic dissection; however, concern over the low sensitivity of aortography has prompted the investigation of other imaging techniques for this purpose. Transesophageal echocardiography and magnetic resonance imaging are increasingly used in the evaluation of aortic dissection. A recent study found that the sensitivity and specificity of helical computed tomography compare well with those of MR imaging and transesophageal echocardiography. Case report: The 55-year-old patient with acute chest and abdominal pain were examined due to suspected aortic dissection. CT examination of thoracic and abdomial aorta was performed. The examination begins with conventional, unenhanced CT. Both unenhanced CT scans and scans after administering of contrast agent were performed. Enhanced images reveal contrast flow in both the false and true aortic lumen. the intima flap in the ascending aorta, aortic arch, and descending aorta, extending to the brachiocephalic trunk, was seen on axial images. In the abdominal aorta, the intimal flap extended to the celiac trunk, without evidence of its occlusion. In one patient, the occlusion of the left renal artery with renal infract was seen on axial images. The intimal flap calcification enables diagnosis even on unenhanced images. The morphology and extent of the dissection was also seen on MPR and VRT images. Conclusions: Helical CT can be used to study the entire aorta in aortic dissection and for follow-up. This technique allows accurate diagnosis of the type of dissection, atypical forms of aortic dissection, and early and late complications after surgery or medical treatment. In addition, helical CT is useful in the surveillance of abdominal branch-vessel compromise, which can be life-threatening in the acute or chronic phase of aortic dissection. In most cases of aortic dissection, axial images are sufficient to demonstrate the presence, location, and extent of an intimal flap. MPR images provide an overall view of the aortic dissection and demonstrate the anatomic relationships between the flap and the adjacent great vessels. VRT images can be produced in several colors and provide a more realistic three-dimensional view; thus, they are more easily understood by the vascular surgeon

Results of the treatment of patients with solid tumours and liver metastases: 8 years experience of one institution

Wstęp. Leczenie chirurgiczne przerzutów nowotworów litych do wątroby powinno odbywać się w ramach zespołu wielodyscyplinarnego.Cel pracy. Celem pracy jest ocena wyników leczenia skojarzonego chorych na różne nowotwory lite z przerzutami do wątroby przez zespół wielodyscyplinarny jednego ośrodka onkologicznego w ciągu ostatnich 8 lat.Materiał i metody. Retrospektywną analizą objęto 166 chorych (84 kobiety i 82 mężczyzn) w wieku od 19 do 78 lat (średnia 58 ± 11,2), leczonych z powodu przerzutów do wątroby pierwotnych nowotworów litych o różnej lokalizacji, z wyjątkiem guzów neuroendokrynnych. Każdorazowo rozważano okołooperacyjne leczenie systemowe zgodnie z aktualnymi zaleceniami Polskiej Unii Onkologii.Wyniki. W czasie obserwacji (mediana 35 miesięcy) zmarło 46% chorych. Resekcje wątroby wykonano u 107 (65%)chorych, w tym u 19 chorych połączono je z (RF-)termoablacją zmian przerzutowych, którą wykonano jako samodzielny zabieg u dalszych 59 (36%) chorych. Śmiertelność pooperacyjna wyniosła 1,2%. Powikłania II° wg klasyfikacji Clavien-Dindo wystąpiły u 33 (19,8%) chorych, natomiast III° i IV° — u 8 (4,8%) chorych. Przeżycia 1-roczne, 3-letniei 5-letnie wyniosły odpowiednio 78%, 41% i 37%. Pięcioletnie przeżycia całkowite u chorych na raka jelita grubego po resekcjach przerzutów metachronicznych wyniosły 48%.Wnioski. Skojarzone leczenie chorych na nieendokrynne nowotwory lite z przerzutami do wątroby przez zespół wielodyscyplinarny jest bezpieczne i skuteczne. W starannie dobranej grupie chorych można osiągnąć blisko 50% całkowitych przeżyć 5-letnich. Resekcja wątroby jest optymalną metodą leczenia chirurgicznego przerzutów do wątroby.Introduction. Surgical treatment of liver metastases from solid tumours should be provided by multidisciplinary teams.Aim. The aim of the present study is to analyse results of the combined treatment of patients with different solid tumours and liver metastases by single institution multidisciplinary team for last 8 years.Material and methods. This is a retrospective analysis of 166 patients (84 females and 82 males), aged from 19 to 78 years (mean 58 ± 11.2), treated due to liver metastases from solid tumours in various primary localizations: except neuroendocrine tumours. In every patient, perioperative systemic therapy was evaluated in agreement with current recommendations of the Polish Union of Oncology.Results. In the follow-up time available (median 35 months) 46% of patients died. Liver resections were performed in 107 (65%) patients, including 19 patients in whom resections were supplemented with (RF-)thermoablations of their liver metastases. This was the sole surgical treatment in the 59 (36%) patients. Perioperative mortality was 1.2%. Grade II complications according to the Clavien-Dindo classification were found in 33 (19.8%) patients, whereas grade III and IV complications were treated in 8 (4.8%) patients. One-, 3-, and 5-year survival rates were respectively 78%, 41%, and 37%. Five-year overall survival in patients with colorectal carcinoma after liver resection of metachronous metastases was 48%. We conclude that combined treatment of patients with liver metastases from non-endocrine solid tumours by the multidisciplinary team is safe and effective. A nearly 50% 5-year survival is achievable in a carefully selected group of patients. We also conclude that hepatic resection is an optimal method of surgical treatment of liver metastases

"Der Balkan" in der Krone: Austria between "frontier Orientalism" and amnesiac nationalism

This article traces the “silent inscription” of (former) colonial relations in the European integration project to their re-inflection in an EU-sceptical medium. To do so, this contribution draws on a corpus of data comprising news-coverage, commentaries and readers’ letters published in Austria’s largest newspaper, the Kronen Zeitung, whose reach, influence and leanings are well-known. The analysis considers the Krone’s representations of, and discursive references to, “the Balkans” during the crises-littered period between 2009 and 2017. For analytical purposes this discussion focuses on a sub-sample of invocations of “the Balkans” in the Krone, which have appeared with growing frequency since 2015. Conceptually, the discourse-analytical notion of the topos, or argumentative structure, and anthropological literature on “identity grammars” inform the analysis. The discussion reveals continuities with Austria’s historically long-established representational regimes of South-Eastern Europe, and novel discursive features. A contemporary paternalism is shown to re-appropriate the nineteenth-century topos of Austria’s alleged “civilizing mission” and what André Gingrich (2005) has described as Central Europe’s “frontier Orientalism”. Further, preoccupations with “the Balkan-route” and its closure articulate a topos of external threats tied to recent migration flows. The article reflects on an “amnesiac nationalism”, and its post-imperial entanglements, that are currently re-shaping the European Union