OBJECTIVES In this study, we investigated the early and midterm outcomes of initial watch-and-wait strategy for Stanford type A intramural haematoma and acute aortic dissection with thrombosed false lumen of the ascending aorta in patients with a maximum aortic diameter of ≤50 mm, pain score of ≤3/10 and no ulcer-like projection in the ascending aorta. METHODS Inpatient and outpatient records were retrospectively reviewed. RESULTS Of the 81 patients with type A intramural haematoma and acute aortic dissection with the thrombosed false lumen of the ascending aorta between April 2011 and April 2019, a watch-and-wait strategy was selected in 46 patients. The mean age of the patients was 68 years, and 22 (48%) patients were female. Ten patients underwent emergency pericardial drainage for cardiac tamponade at the time of presentation and 8 patients underwent aortic repair during hospitalization for new ulcer-like projection, re-dissection or rupture. In-hospital mortality occurred in 2 (4%) patients. During follow-up, survival at 1 and 2 years was 95% and 92%, respectively. There was no significant difference in survival or aortic events between patients in whom the watch-and-wait strategy and emergency surgical treatment were indicated. CONCLUSIONS The early and midterm outcomes of the initial watch-and-wait strategy were favourable for type A intramural haematoma and acute aortic dissection with the thrombosed false lumen of the ascending aorta in Japanese patients with a maximum aortic diameter of ≤50 mm, pain score of ≤3/10 and no ulcer-like projection. Further study is required to show the safety of this strategy.

However, in some cases of distal DVT there is extension to the proximal vein, and so anticoagulation therapy is still performed for all DVT patients in many institutes, a practice that is believed to be related to an insufficiency of evidence regarding the optimal treatment method for distal DVT, including indications for anticoagulation therapy. A flowchart of the medical treatment method for venous thrombosis is described in the medical safety handbook of Kitasato University Hospital, and most patients who develop DVT in hospital have a consultation in the Department of Cardiovascular Surgery. In accordance with the guidelines, anticoagulation therapy is not the firstline treatment for patients with distal DVT; the patients are re-evaluated using ultrasonography 2 weeks and 3 months after their first visit. Anticoagulation therapy is only initiated for patients who showed DVT exacerbation. Therefore, the present study aimed to retrospectively investigate the treatment results of patients with distal DVT to clarify the risk factors for extension to the proximal vein and indications for anticoagulation therapy.

The rat is one of the most popular experimental animals in medical fields. However, the rat is not so often used in complicated neurological studies because of its size of the brain. To investigate the localization of waveform of auditory brainstem responses (ABRs), two rats were examined. Twelve or 13 platinum-rhodium coated electrodes were implanted on the dura mater through the cranial bone. The waveform of ABRs with 6 peaks was clearly recorded. These peaks were comparable with those of the human. However, the latency of these peaks was slightly shorter compared with that of the human. These 6 peaks were clearly identified in the waveform measured on the occipital area. On the other hand, these peaks recorded in frontal region were fused together. From these results, electrodes should be placed on the occipital area of the cranial bone to identify these peaks originated from brainstem by the auditory stimulation. Therefore, it is expected that latency changes can be evaluated clearly. This measurement system has a new possibility to analyze the details of various kinds of evoked potentials waveforms.

Background Degos disease, also known as malignant atrophic papulosis, is characterised by cutaneous manifestations due to chronic thrombo-obliterative vasculopathy. There have been reports of the rare late-onset Degos disease complicated by constrictive pericarditis (CP). This study reports a case of CP caused by Degos disease that developed 20 years after diagnosis. Case presentation A 62-year-old woman who had been taking aspirin for 20 years for Degos disease was hospitalised for worsening of heart failure. The patient was diagnosed with CP and underwent pericardiectomy. Pathological findings suggested the involvement of Degos disease. The postoperative course was uneventful, and her heart failure and Degos disease did not worsen. Conclusions The study findings suggests that Degos disease can cause long-term CP. Aspirin effectively inhibited the progression of Degos disease, and surgical treatment was necessary when heart failure due to CP was refractory to treatment.

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Background: Aortic wrapping aims to prevent aortic enlargement or dissection; it is less invasive than ascending aorta replacement. Several studies have reported low mortality and morbidity rates in patients treated using aortic wrapping. Wrapping is often accompanied by aortic valve replacement, which may require a redo surgery after some years. However, only few reports have focused on the redo surgery after aortic wrapping. We report three such cases of redo surgery in patients who previously underwent aortic wrapping using polytetrafluoroethylene felt.Case presentation: Among the three cases, two were referred with complaints associated with the deterioration of the prosthetic valve, 10 years or longer after the initial surgery. In all the cases, the aortic wall exhibited severe erosion, necessitating replacement of the ascending aorta.Conclusion: The portion of the ascending aortic wall wrapped with polytetrafluoroethylene felt exhibited severe erosion late after surgery. Therefore, ascending aorta graft replacement is highly likely to be necessary in redo surgery performed long after initial ascending aorta wrapping.

Ascites is a rare sign of aortic valve disease. Here, we report two cases of refractory ascites that had resulted from aortic stenosis and insufficiency and consequently improved after aortic valve replacement. The first case was a 44-year-old female who had undergone aortic valve repair for aortic stenosis 15 years earlier. She complained of dyspnea and severe abdominal distension due to unimproved massive ascites despite medical therapy. She was diagnosed with aortic stenosis and insufficiency and functional tricuspid insufficiency as well as complete atrioventricular block. She underwent mechanical aortic valve replacement, tricuspid annuloplasty and DDD pacemaker implantation. The second case was a 61-year-old man with a history of alcoholic liver disease who had been hospitalized for massive ascites, progressing rapidly in spite of aggressive medical therapy. Echocardiography revealed severe aortic stenosis and insufficiency ; thus, he underwent bioprosthetic aortic valve replacement. Both patients were completely free from ascites about 6 months after surgery.

Background: Degos disease, also known as malignant atrophic papulosis, is characterized by cutaneous manifestations due to chronic thrombo-obliterative vasculopathy. There have been reports of rare late-onset Degos disease complicated by constrictive pericarditis (CP). We report a case of CP caused by Degos disease that developed 20 years after diagnosis.Case presentation: A 62-year-old woman who has been taking aspirin for 20 years for Degos disease was hospitalized for worsening heart failure. The patient was diagnosed with CP and underwent pericardiectomy. Pathological findings suggested the involvement of Degos disease. The postoperative course was uneventful, and her heart failure and Degos disease did not worsen.Conclusions: This report suggests that Degos disease can cause long-term CP. Aspirin effectively inhibited the progression of Degos disease, and surgical treatment is necessary when heart failure due to CP is refractory to treatment.