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Acute aortic dissection - case description

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Aortic dissection is a tearing in the inner wall of the aorta which spreads along the wall of the vessel. Acute aortic dissection is one of acute aortic syndromes, that is, sudden clinical conditions which are associated with abnormalities of the aortic wall and threaten patient’s life. It is estimated that the number of aortic dissections in Poland amounts to around 1000 cases per year. The symptoms of aortic dissection are so equivocal that they may suggest other diseases of various organs in the thorax and abdominal cavity. The described case of a 57-year-old man is an example of a complication of hypertension which, as a result of an isometrical physical effort, caused tearing of an inner membrane and forming of an aortic dissection of type I in the DeBakey classification. After performing medical imagining the patient with the diagnosis of aortic dissection, hematoma in the pseudoaneurysm cavity and renal infarction was submitted to emergency cardiac surgery. The diagnostics and selection of a place at cardiac surgery were carried out within an hour. However, the surgery did not take place, because the patient died due to a circulatory collapse. Acute aortic dissection is subject to high mortality rate during the first hour since the onset of symptoms. Therefore, rapid recognition is crucial for the further prognosis of the patient.
The increase of the serum urea to creatinine ratio (UCR) was observed in dogs infected with Babesia canis. Previous studies have suggested that decrease of blood pressure can be one of the reasons for this phenomenon. In this work statistically significant increase of the UCR was observed in dogs with babesiosis. Comparison of the UCR between 23 azotaemic dogs and 25 non-azotaemic dogs infected with Babesia canis showed statistically significantly higher mean of the UCR in azotaemic dogs. Correlations between UCR and systolic, diastolic and mean arterial pressure (SAP, DAP and MAP) in 48 dogs infected with B. canis were negative (UCR and SAP: r = −0.3909; UCR and DAP: r = −0.3182; UCR and MAP: r = −0.3682) and statistically significant (p < 0.05). This result may indicate contribution of hypotension in the increase of the UCR in canine babesiosis. However, the correlations were not high, and there was no statistically significant correlation between UCR and arterial pressures in azotaemic dogs. Thus, it seems that decrease of blood pressure in dogs with babesiosis explains only partially the cause of increased UCR in infected dogs. The other authors suggested hyperureagenesis and myocardial injury as a potential reason for the increased UCR in canine babesiosis. Thus, further studies are needed to determine causes of increased UCR in dogs with babesiosis, especially on the connection between UCR changes and the concentrations of plasma cardiac troponins and ammonia, and the occurrence of occult blood on fecal examination.
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