Objectives: The aims of this study are to evaluate our current surgical strategy for AEF and to provide insight to further improve the prognosis of such a devastating condition. Methods and Results: Between 2007 and 2015, we retrospectively reviewed clinical charts of five patients requiring surgical treatment for aortoesophageal fistula (AEF) in Tenri Hospital. Two cases were primary and three were secondary. Initially, subtotal esophagectomy and complete debridement of infected mediastinal tissue were performed. Then, the patients underwent in situ aortic replacement with rifampicin-bonded Dacron grafts in a controlled infection. Esophageal reconstruction was planned following general physical status improvement after 2–5 months. The completion of the staged strategy achieving successful esophageal reconstruction was possible in three patients. Conclusions: The staged surgical treatment strategy for AEF consisted of subtotal esophagectomy and subsequent in situ reconstruction of the aorta with rifampicin-bonded gelatin-sealed Dacron graft. Avoiding delay in the diagnosis and initial treatment and resolving complications at each treatment step should further improve the treatment of AEF.
Primary aldosteronism is a representative disease of secondary hypertension accounting for 5–10% of patients with hypertension. While primary aldosteronism is curable, when the duration of the disease is long, it causes treatment-resistant hypertension and cerebrovascular diseases. We report a case of aortic dissection in a young patient with primary hyperaldosteronism. On admission for acute aortic dissection, it was difficult to control the blood pressure of the patient. After resection of the right adrenal gland, the blood pressure became controllable compared with pre-operation.
A 79-year-old woman presented to our hospital with ischemic gangrene in the right little finger and with pain and cyanosis in the right index, middle, ring fingers. Intravenous injection of heparin and PGE1 was instituted without any clinical improvement. She underwent selective digital subtraction arteriography. An arteriogram revealed the occlusion of the digital artery. We initially treated the patient by continuous arterial administration of urokinase and heparin. After 5 days of fibrinolytic infusion, angiography showed resolution of the digital thrombi. The patient showed clinical improvement with the hand. We cautiously recommend fibrinolytic treatment for acute digital artery occlusion.