Jason Varzaly

E-VITA Jotec Open Hybrid Stent Graft System for the Treatment of Complex Thoracic Aortic Aneurysm and Dissection—A Four Year Experience

INTRODUCTION The management of complex aortic aneurysms and dissections involving both the aortic arch and descending aorta include operations associated with significant risks of mortality and morbidity. The advent of hybrid systems such as the E-VITA Jotec open hybrid stent graft system (E-VITA) provides the advantage of single stage repair with follow up repair of any remaining downstream aneurysm and dissection being easier to manage. METHODS Herein we report a series of seven cases utilising E-VITA over a four year period. RESULTS The average patient age was 66.9 years of age (range: 55-78 years). The average cardiopulmonary bypass and circulatory arrest times were 237.14 min and 47.83 min. There was one operative mortality. Follow up as far as three years revealed good results with few complications. CONCLUSION The E-VITA is a feasible management option in the treatment of complex aortic aneurismal disease and dissections. It allows treatment of patients that may have previously not been considered suitable for two-stage surgical procedure.

Upper endoscopy and random biopsies: endoscopic findings with disconcordant pathology

direct and indirect evidence that it has a Schwann cell origin. 1–8% of GCTs occur in visceral organs, including the GI tract; the majority are in the oesophagus and large bowel, rarely in the stomach. In about 10% of the cases, GCT is multifocal, simultaneously involving the skin, submucosa and viscera. The tumours arising in the GI tract are usually benign, although a previous report has described their malignant potential. Endoscopically, GCT arising in the stomach can be difficult to distinguish from other submucosal tumours, including carcinoid tumour, GI stromal tumour (GIST) and lipoma. Carcinoid tumours are usually fixed, hard, yellowish lesions corresponding to GCTs, whereas GIST and lipoma usually have mobile, hard and flexible yellowish structures. Endoscopic biopsy may be a useful confirmative diagnosis. However, the biopsy-proven GCT is less than 50% because only small tumour lesions near the surface mucosa are obtained from endoscopic biopsy, despite the fact that main tumour components are present in deeper mucosa or submucosa. Consequently, ESD as ‘diagnostic therapy’ may be helpful for differential diagnosis of GCT and other submucosal tumours in the stomach. References