Chest
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Case Reports
Acute dissection of the ascending aorta. Initial presentation as acute lower GI bleeding.
We present the unusual case of a 56-year-old man with acute dissection of the ascending aorta (DeBakey type I) whose presenting symptoms were those of lower gastrointestinal (GI) bleeding. Surgical repair was successfully accomplished with resection of the aorta with a Dacron tubular graft combined with aortic valvular replacement after obtaining bowel viability.
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The importance of intrathoracic pressure in generating blood flow during cardiopulmonary resuscitation has recently been emphasized. The purpose of this study was to investigate the factors involved in generating intrathoracic pressure. Studies were performed in anesthetized paralyzed dogs with the circulation intact. ⋯ The combination of inflating the lung and compressing the chest produced the highest intrathoracic pressure (48 +/- 18 cm H2O; p less than 0.001). The pressure developed was highly variable and the distribution of pressures within the thorax was not uniform. As the intrathoracic pressure became large, a pressure gradient developed from thorax to abdomen, and the diaphragm everted; this pressure gradient could divert blood from the brain.