Fatal Aortic Dissection in a Patient with Giant Cell Arteritis: A Case Report and Review of the Literature

Giant cell arteritis may lead to catastrophic, large-vessel complications from chronic vascular wall inflammation without prompt diagnosis and treatment. We describe a rare case of acute aortic dissection without preceding aneurysm secondary to histologically confirmed giant cell arteritis (GCA) in an 85-year-old female with a four-year history of polymyalgia rheumatica and temporal arteritis diagnosed per biopsy six months prior to presentation. The literature is reviewed and the clinical implications of this case are discussed

Case Report Fatal Aortic Dissection in a Patient with Giant Cell Arteritis: A Case Report and Review of the Literature

Giant cell arteritis may lead to catastrophic, large-vessel complications from chronic vascular wall inflammation without prompt diagnosis and treatment. We describe a rare case of acute aortic dissection without preceding aneurysm secondary to histologically confirmed giant cell arteritis (GCA) in an 85-year-old female with a four-year history of polymyalgia rheumatica and temporal arteritis diagnosed per biopsy six months prior to presentation. The literature is reviewed and the clinical implications of this case are discussed. Case Report An 85-year-old woman with a four-year history of polymyalgia rheumatica and temporal arteritis diagnosed per biopsy six months prior to presentation with an acute sensation of neck tightness with radiation to her bilateral shoulders and the epigastrium. Past medical history was significant for atrial fibrillation status following ablation, coronary artery disease status following remote myocardial infarction medically managed, hyperlipidemia, and hypertension. Her home medications included atenolol, coumadin, and prednisone 20 mg PO twice daily. She had intermittently received several rapidly tapered oral steroid courses over the preceding two years for polymyalgia rheumatica and temporal arteritis flares with resolution of clinical symptoms and normalization of acute inflammatory markers. At admission, her vital signs and cardiopulmonary exam were within normal limits. An electrocardiogram showed sinus rhythm with first-degree atrioventricular block. Cardiac biomarkers and a chest radiograph were unremarkable. Labs were significant for a stable known normochromic normocytic anemia of chronic disease (hemoglobin 10.3 g/dL), indolent chronic lymphocytic leukemia (white blood cell count of 11,400), an international normalized ratio of 2.0, and an erythrocyte sedimentation rate (ESR) of 49 mm/hr. A transthoracic echocardiogram eight months prior to admission demonstrated hyperdynamic left ventricular function with ejection fraction of 65%-70%, mild aortic insufficiency, and mild concentric left ventricular hypertrophy. Within several hours of admission, the patient was found to be unresponsive and progressively bradycardic with a depressed left ventricular function with ejection fraction of 45%. She later developed a wide complex tachycardia before terminating in pulseless electrical activity. Subsequent autopsy showed extensive granulomatous inflammation with lymphocytes, giant cells, and elastic membrane destruction in the aorta and vertebrobasilar and coronary arteries. There was evidence of early aortic root and proximal segment dissection without aneurysmal dilatation, associated with a mild pericardial effusion and a left hemothorax. Despite mild, nonobstructive atherosclerosis, there was no evidence of coronary artery occlusion or myocardial focal ischemic changes. Additionally, no large artery stenosis was appreciated

Twenty months development for the Cassis telescope: re-use building blocks and concurrent engineering

On board of the ExoMars Trace Gas Orbiter (TGO), the Colour and Stereo Surface Imaging System (CaSSIS) developed under the lead of University of Bern, has the mission to provide stereo images of the planet's surface in colour at a resolution of better than 5 m (4.54m from a circular orbit of 400 km) for enhancing our knowledge of the surface of Mars [1]

Diagenetic Evolution of the Cangulo Formation Pre-Salt Carbonates (Onshore Namibe Basin, Angola)

AAPG 2016 Annual Convention & Exhibition Occured on 19-22 June 2016 Calgary, CanadaThe Cangulo Fm., exposed onshore within the Namibe Basin of Angola, belongs to the Pre-Salt succession, characterized by fluvial to marginal marine sediments deposited during Early Aptian times along the entire West African margin. This unit is composed of two types of carbonate separated by an erosional unconformity. Prevailing carbonate facies below the unconformity are peritidal-like dolostones deposited during a transgressive period. The petrological and geochemical data points to slightly evaporated marine waters responsible for the early dolomitization of these carbonates. In addition, oxidation of organic matter occurred during this time as suggested by the highly depleted values of ¿13C. The erosive surface recorded in the Cangulo Valley is related to a major regressive event. The development of karstic systems affecting the peritidal-like carbonates together with the calcitization of the dolomite cements and Fe-rich mineralization, indicate that meteoric fluids circulated during this period. The drop-off of the phreatic level caused the spring flow onset from basement highs and precipitation of tufa deposits. The ¿18O and ¿13C values together with the Mg/Ca molar ratios of these deposits are coherent with the precipitation from low temperature meteoric waters. The progressively depletion of ¿13C and the decreasing trend of Mg/Ca molar ratio indicate an input of soil-derived CO2 in the system and the transition from phreatic to a vadose diagenetic environment. Tidally-influenced sandstones onlap the tufa deposits. The geochemistry of the cements together with the values from the partially dolomitized tufa carbonates, suggest that mixed marine and meteoric waters were circulating at this time. The end of the transgression is marked by deposition of the Aptian evaporites (Bambata Fm.) representing the maximum transgressive stage in the Cangulo Valley. The tectono-sedimentary and diagenetic reconstruction of the Pre-Salt succession in the Namibe Basin demonstrates a periodic marine influence in the sedimentary record, linked to at least two transgressive events. These are separated by a major forced regression that generated an erosional gap, the consequent drop-off of the phreatic level and the tufa system development. These new data appear to indicate that the latest Pre-Salt succession is not a simple transgressive succession, but rather there is a more complex transgressive-regressive story that needs to be examined in more detail

On-Ground Performance and Calibration of the ExoMars Trace Gas Orbiter CaSSIS Imager

The European Space Agency’s ExoMars Trace Gas Orbiter (TGO) seeks to investigate the biological or geological origin of trace gases found on Mars. The TGO carries a payload of four instruments in order to reach its scientific goals, including the Colour and Stereo Surface Imaging System (CaSSIS). CaSSIS is a colour and stereo telescopic camera that will be capable of taking high-resolution images of the martian surface. Before shipment of the instrument for integration onto the TGO, a detailed calibration campaign was performed, and a number of calibration products were gathered and utilised as part of the in-flight calibration campaign. This paper presents the results of on-ground calibration measurements carried out in order to assess the pre-flight performance of CaSSIS. All indications are that CaSSIS will perform very well on arrival at Mars and will be successful in reaching its scientific objectives