Management of floating thrombus in the aortic arch

OBJECTIVE Floating aortic thrombus is an underrecognized source of systemic emboli and carries a life-threatening risk of stroke when located in the aortic arch. Optimal treatment is not established in available guidelines. We report our experience in managing floating thrombi in the aortic arch. METHODS Consecutive patients diagnosed with a floating aortic arch thrombus at a tertiary referral center between January 2008 and December 2014 were reviewed. Perioperative and midterm outcomes were assessed. RESULTS Ten patients (8 female) with a median age of 56 years (range, 47-82 years) were identified. Eight patients presented with a symptomatic embolic event, and 2 patients were asymptomatic. One patient presenting with stroke due to embolic occlusion of all supra-aortic vessels died 2 days after admission. Three patients (2 asymptomatic and 1 unfit for surgery) were treated conservatively by anticoagulation, leading to thrombus resolution in 2 patients. In the third patient, the thrombus persisted despite anticoagulation, resulting in recurrent embolic events. The remaining 6 patients underwent open thrombectomy of the aortic arch during deep hypothermic circulatory arrest. All patients treated by surgery had an uneventful postoperative course with no recurrent thrombus or embolic event during follow-up. Median follow-up of all patients was 17 months (range, 11-89 months). CONCLUSIONS Floating aortic arch thrombus is a dangerous source of systemic emboli. Surgical removal of the thrombus is easy to perform and followed by good clinical results. Conservative treatment with anticoagulation may be considered in asymptomatic, inoperable or high-risk patients.

Carta de su Magestad, el Rey nuestro señor Filipo IIII, a don Fray Iuan Merinero, Obispo de Valladolid y de su Consejo.

Respuesta a la carta de su magestad, supra scripta, por D. Fray Iuan Merinero ..., p. [5]-[7]. -- Prior propositio Diffinibilitas Articuli Immaculatae Conceptionis his temporibus pro comperto habenda est, p. 1-100.

Primaleon : los tres libros del muy esforçado cauallero Primaleon et Polendos su hermano, hijos del Emperador palmerin de Oliua.

En h. CCLXII(recto): "Fue trasladado y traduzido este Libro de Primaleon de Griego en nuestro Romace Castellano En la muy noble & Imperial ciudad de Toledo. Año del nascimiento del nuestro Rede[m]ptor Iesu Christo del mil & quinientos & veynte y ocho Años"

Pieśni nabożne /

Originally published: Supraśl, Drukarnia J.K. Mći: XX. Bazylianów, 1792.

Notizie degli scavi nell' anfiteatro Flavio e nel Foro Traiano, con iscrizioni ivi trovate supplite e illustrate

Bound with Testa, D., Dissertazione dell' Abate Domenigo Testa sopra due zodiaci. Roma, 1802.

Giegling's Market on south end of the Northern Hotel

verso: Louie Larsen said this was Nick Waal's Market for as long as he can remember. After the market quit Aug Redman had a cigar factory in the building. Later he added a pool room to the cigar factory. Harold (Capt.) Edwardsen tore it down about in the 1930's and built a summer cottage up north from the material. The market was adjacent [to] the Northern Hotel on the south.

Periodontal treatment needs in a native island community in Colombia determined with CPITN

Aims: To identify the prevalence and different degrees of periodontal disease in an isolated community (Isla Grande, Colombia) with no dental services and low educational level with the use of CPITN, and to establish periodontal treatment needs in different age groups. Results: Of 116 people examined, 0.9% were in periodontal health (CPITN value 0), 18.1% had gingival bleeding (CPITN value 1), 51.7% had supra or subgingival calculus (CPITN value 2),18.1% presented pockets 3.5-5.0mm deep (CPITN value 3), and 11.2% had pathological pockets of 5.5mm or deeper (CPITN value 4). No clear differences were observed between sexes. Conclusions: This study shows that 81% of the sample has some type of periodontal treatment need, with 69.8% of them requiring periodontal treatment that may be supplied by a hygienist and 11.2% requiring specialised treatment. Implementation of oral health education and oral prevention programmes was recommended to the authorities for this community.

Synaptology of the proximal segment of pyramidal cell basal dendrites

Pyramidal neurons are covered with dendritic spines, the main postsynaptic targets of excitatory (asymmetrical) synapses. However, the proximal portion of both the apical and basal dendrites is devoid of spines, suggesting a lack of excitatory inputs to this region. In the present study we used electron microscopy to analyse the proximal region of the basal dendrites of supra- and infragranular pyramidal cells to determine if this is the case. The proximal region of 80 basal dendrites sampled from the rat hindlimb representation in the primary somatosensory cortex was studied by electron microscopy A total of 317 synapses were found within this region of the dendrites, all of which were of the symmetrical type. These results suggest that glutamate receptors, although present in the cytoplasm, are not involved in synaptic junctions in the proximal portion of the dendrites. These data further support the idea that inhibitory terminals exclusively innervate the proximal region of basal dendrites.

Physicians' attitudes towards end-of-life decisions: a comparison between seven countries

In the context of an European collaborative research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among physicians in Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Australia also joined the consortium. A written questionnaire with structured questions was sent to practising physicians from specialties frequently involved in the care of dying patients. 10,139 questionnaires were studied. Response rate was equal to or larger than 50% in all countries except Italy (39%). Apart from general agreement with respect to the alleviation of pain and symptoms with possible life-shortening effect, there was large variation in support-between and within countries-for medical decision that may result in the hastening of death. A principal component factor analysis found that 58% of the variance of the responses is explained by four factors. 'Country' explained the largest part of the variation of the standardized factor scores. (c) 2004 Elsevier Ltd. All rights reserved.