京都大学 / 新制・論文博士 / 博士(医学) / 乙第13421号 / 論医博第2229号 / 新制||医||1052(附属図書館) / (主査)教授 伊達 洋至, 教授 大鶴 繁, 教授 中山 健夫 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

The optimal timing of valve replacement surgery in chronic severe aortic regurgitation (AR) has remained a major clinical problem in the management of these patients. Although the onset of symptoms is the generally accepted indication for aortic valve replacement (AVR), the unpredictable development of pre-symptomatic left ventricular (LV) dysfunction as a result of prolonged volume overload has resulted in numerous reports attempting to formulate a risk profile for these patients. Although aortic root and LV cineangiography have been the "gold standard" for defining the severity of AR and its effect on LV performance, serial follow-up by these means is impractical. More recently numerous non-invasive measures of LV size (echocardiogram) and function both at rest and on exercise (echocardiogram and equilibrium radionuclide angiocardiography., ERNA) have been serially utilised~ In these endeavours, the thinking has been clouded by a tendency to equate these two measures and failing to appreciate that apparent preoperative LV dysfunction (particularly on exercise) may be rapidly reversible by AVR and the consequent changes in LV loading conditions. This study was a prospective, sequential evaluation of left ventricular function using both non-invasive and invasive techniques in symptomatic and asymptomatic patients with isolated chronic, severe (4+) AR at cardiac catheterisation. The aims of the study were to (I) Identify differences in the clinical, echocardiographic, resting and exercise haemodynamic and I radionuclide measures of left ventricular function in symptomatic and asymptomatic patients with chronic severe A.R. with particular reference to the incidence of presymptomatic development of left ventricular dysfunction. (II) Critically evaluate the role of exercise stress (both isotonic and isometric) in the assessment of patients with chronic severe A.R. (III) Evaluate the influence of time (sequential studies) on the haemodynamic burden in asymptomatic patients. (IV) Study the impact of successful aortic valve replacement on the reversibility of abnormal pre-operative LV function in an attempt to predict which patients would benefit from this therapeutic intervention and whether operation for symptoms alone is the correct clinical practice.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20231号 / 医博第4190号 / 新制||医||1019(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 湊谷 謙司, 教授 山下 潤, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21652号 / 医博第4458号 / 新制||医||1035(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川村 孝, 教授 福原 俊一, 教授 佐藤 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Aortic dissection is a life-threatening emergency associated with significant mortality rate. Early diagnosis is essential to improve the survival. Although the most common presentation is severe chest pain, it can be variable leading to delay in the diagnosis especially if it is painless. Painless aortic dissection is a rare entity with sparse data available based on case reports. We present a case of a young male with an atypical presentation where the presumptive diagnosis of infective endocarditis was made based on initial presentation but was eventually diagnosed as painless aortic dissection.

No description available.

Kollberg, S. Torbjörnsson, E. (2012). The lived experience in patients with screening-diagnosed abdominal aortic aneurysm (AAA).     ABSTRACT The aim of this study was to describe the patients’ experiences of living with the knowledge of having an abdominal aortic aneurysm (AAA) that was found during screening. Eleven patients from two different screening centers, with initially measured aneurysms of 40-46 mm, were invited to participate in the interview study. Three of the men declined to participate, so in total eight men were interviewed. The interviews were analyzed by qualitative content analysis.  Four categories were identified: the informant’s reasons for taking part in the screening program for abdominal aortic aneurysm, the experience of the screening, the experience of living with their abdominal aortic aneurysm and the thoughts on the present screening program. The result showed that the men joined the screening program (SCP) with very little knowledge of both aneurysms and the purpose of the screening. In connection with the ultrasound the men became upset over the information about them having an AAA. After they had received information about the diagnose from the vascular surgeon , all of the men felt soothed and understood that despite of their aneurysm, they could continue to live their life as they used to do. The men didn’t believe that the AAA affected their lives, though most of them had made changes in their way of living.   The result of this interview study shows that the men experience a lack of information between the ultrasound and the appointment with the physician. It could be of interest to investigate if an aortic nurse with the same function as the breast nurse in the mammography screening could be the solution of this problem.   Keywords: Abdominal Aortic Aneurysm, screening, information / Kollberg, S. Torbjörnsson, E. (2012). The lived experience in patients with screening-diagnosed abdominal aortic aneurysm (AAA).   SAMMANFATTNING Syftet med den här studien var att beskriva patienternas upplevelse av att leva med kunskapen av att ha en förstorad kroppspulsåder som är hittat via screening. Elva patienter från två olika screeningcenter, med en ursprunglig diameter på sin aorta uppmätt till 40 – 46 mm, bjöds in för deltagande i studien. Tre avböjde att delta, så totalt utfördes åtta intervjuer. Intervjuerna analyserades med kvalitativ innehållsanalys. Fyra kategorier identifierades: Informanternas anledning till att delta i screeningprogrammet, upplevelsen av screeningen, upplevelsen av att leva med AAA och patienternas tankar om det nuvarande screeningprogrammet. Resultatet visade att männen deltog i screeningsprogrammet (SCP) med en begränsad kunskap både om vad aneurysm är och vad syftet med screeningen är. I samband med ultraljudsundersökningen blev männen upprörda över beskedet att de har ett förstorat aneurysm, men efter besöket hos en kärlkirurg som gav information om diagnosen blev de lugnade och förstod att det går bra att fortsätta leva som vanligt trots deras diagnos. Männen i studien tyckte inte att diagnosen påverkade de i deras dagliga liv, trots att många av dem hade genomfört förändringar. Resultatet av den här studien visar att männen upplever en brist i informationen mellan ultraljudsundersökningen och besöket hos läkaren. Det skulle vara intressant att se om en aortasjuksköterska, med samma funktion som en bröstsjuksköterska inom mammografiscreeningen har, skulle kunna vara en lösning på problemet.   Nyckelord: Abdominellt aorta aneurysm, screening, information   Abstraktet är justerat efter instruktioner i Journal of Vascular Nursing

Thesis (doctoral)--Ludwig Maximilians-Universität zu München, 1979.

Thesis (MScEng)--University of Stellenbosch, 2008. / Bibliography. Also available via the Internet.

In calcific aortic valve disease, the early sclerotic valve lesion is similar to the atherosclerotic arterial plaque, but at the later stage calcification prevails. Our aim was to assess the association of several new potential risk factors, eg. systemic inflammation, neurohormonal activation and altered calcium metabolism with aortic stenosis (AS) in patients with significant coronary artery disease..