Advances in the Treatment of Aortic Dissection 12:43-14:05 If you look at what predicts a problem and if you have an aneurysm your aorta is getting bigger and bigger and bigger. At what point does it become a problem, because it's like a, …

Advances in the Treatment of Aortic Dissection 12:00-12:42 We don't do natural history studies like this anymore because we can treat these patients but this was a study from the late 50s looking at what happened to patients who had dissec…

Advances in the Treatment of Aortic Dissection 11:27-11:59 Risk factors include the classic patients, a male age 50 to 70, who has hypertension but that's also the typical patient that has a myocardial infarction or a heart attack. 大動脈…

Advances in the Treatment of Aortic Dissection 9:40-11:26 The clinical presentation is abrupt onset. I always ask the patient, "When did your pain start?" and they will say, "4:30 when I got, done watching television, went up to go get a b…

Advances in the Treatment of Aortic Dissection 8:51-9:39 The classification of dissections. There's two classifications. 大動脈解離の分類法は2種類あります。 DeBakey, who is a surgeon down in Houston for many, many years, who actually had a…

Advances in the Treatment of Aortic Dissection 7:18-8:49 So acute aortic syndromes involve various portions of the aortic wall. There's essentially three major sections of the wall. The adventitia, which is on the outside, the media, which…

Advances in the Treatment of Aortic Dissection 6:23-7:17 Let's look at some anatomy of the aorta. It starts, essentially, this is a drawing I draw in the clinic almost two or three or five times a week in clinic. I only have clinic one day…

Advances in the Treatment of Aortic Dissection 3:46-6:23 Well, I was asked to talk about surgical management of acute type A aortic dissection, which is, you know, a critical component of treating patients with connective tissue disorder, …

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 34:49-36:50 To summarize, in the emergency room consider aortic dissection in individuals presenting with chest, back or abdominal pain, syncope or features of malperfu…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 33:49-34:47 Type A dissections again emergency surgery is associated with a much improved survival than this medical management. 繰り返しになりますが、A型解離において、…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 32:39-32:48 Once the dissection is identified in emergency room, prompt blood pressure control is critical. The goal is to lower blood pressure to the lowest level that…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 30:15-32:39 CT scan again most commonly used in aortic dissection in the emergency room, highly sensitive and specific but you must use contrast. 繰り返しになりますが、…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 27:36-30:15 Biomarkers can be very helpful in suspected aortic dissection and D-dimer is the one that's most readily available and, and has the most data supporting its…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 26:24-27:33 When facing a patient with suspected dissection, urgent evaluation is required. First to exclude other possibilities that are more common and to do diagnost…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 24:47-26:24 Malperfusion occurs in about a quarter of patients with dissection. The most common is known as dynamic malperfusion, so in this cartoon here's the dissecti…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 23:59-24:46 The complications of dissection, which may arise in the emergency room or thereafter, include frank rupture of the aorta as demonstrated here with hemorrhag…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 22:18-23:57 Again, classifying dissection because type A dissection, in which the ascending aorta is involved, requires emergency surgery. Type B dissection or type III…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 21:18-22:16 People with aortic dissection often look acutely ill, hypertension is present in about half the individuals in emergency room with dissection but not at all…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 20:30-21:17 This is a study looking at 83 people from emergency room with acute aortic dissection and the initial physician correctly suspected dissection in 65 percent…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 19:03-20:28 So take a very careful history. Aortic dissection typically begins with the abrupt onset of severe pain and that's different than the crescendo or increasin…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 16:41-19:02 So one of the most important factors leading to a correct diagnosis of this condition is a high clinical suspicion that aortic dissection may be the cause o…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 15:05-16:40 In summary aortic dissection is related, is the most common cause in the aortic syndrome family, leading to disruption of the aorta, which can have life-thr…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 14:16-16:40 So in summary aortic dissection is most commonly associated with hypertension. Think about the 20 percent of individuals with thoracic disease, who have a f…

手術に向けてすべきこと 手術に向けた準備の大切さ 手術に向けた体力面でのアドバイス 手術に向けた精神面でのアドバイス 術後の回復に向けたアドバイス 手術のストレスを減らすには マルファン症候群、ロイス・ディーツ症候群、血管型エーラス・ダンロス症…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 13:48-14:15 Finally, other causes for thoracic aneurysms that can lead to dissection or degenerative aneurysms. These are atherosclerotic associated with hypertension a…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 12:46-13:47 Tuner syndrome occurs in 1 in 2,500 live-born girls associated with short stature averaging under five feet tall when not treated with growth hormone, can h…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 11:53-12:45 Bicuspid valve disease is common, mostly sporadic and isolated but can associate with other conditions like coarctation of the aorta and Turner syndrome and…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 10:56-11:53 Familial aneurysm syndromes or non-syndromic heritable thoracic disease is a common cause for aortic aneurysms. In fact we recognize that 20 percent of indi…

Diagnosis and Treatment of Aortic Dissection in the ER (Parts 1 and 2) 9:49-10:55 Vascular Ehlers-Danlos syndrome is one of the rarer causes of familial aneurysm disorder, affecting about one in fifty to a hundred thousand individuals due …

仕事を選ぶ 自分に合うように仕事を調整する 患者とのかけがえのない絆 進学する大学や最初のキャリアに頭を悩ませることは、大半の若者にとって雲をつかむような話であり、恐怖を感じる道のりとなることもあります。マルファン症候群やマルファン類縁疾患の…