Objectives:The objectives of this study were the evaluation of low dose multidetector com-puted tomography (MDCT) in localizing the site of the transition zone (TZ) ofHirschsprung’s Disease (HD) for preoperative planning.Patients and methods:Twenty-two infants were recruited from pediatric and surgical clin-ics in Assiut University Hospital and Sohag University Hospital. The recruited patients weresedated before examination. Examinations were done using 64-rows MDCT. Each MDCTexamination was reviewed to determine the location and length of the TZ and comparedwith operative and pathological results. Results were analyzed by chi square test and inter-observer agreement using Kappa test.P 0.05 was considered statistically significant.Results:According to operative and pathological data, the site of the TZ: 17 (77.27%) wereof short-segment disease (rectosigmoid HD), 2 (9%) were of long segment (above sigmoidcolon), and 3 (13.63%) were of ultrashort segment. A correct diagnosis of TZ by MDCT wasmade in 19 out of 22 with 82.4% sensitivity and 80% specificity. The site of TZ wasconcordant in 17. Results yielded a moderate strength of inter-observer agreement in local-izing the site of TZ (k= 0.546) and (P= 0.009).Conclusion:Low-dose MDCT has a good role in localizing the site of TZ of HD in infants.

Objectives:The objectives of this study were the evaluation of low dose multidetector com-puted tomography (MDCT) in localizing the site of the transition zone (TZ) ofHirschsprung’s Disease (HD) for preoperative planning.Patients and methods:Twenty-two infants were recruited from pediatric and surgical clin-ics in Assiut University Hospital and Sohag University Hospital. The recruited patients weresedated before examination. Examinations were done using 64-rows MDCT. Each MDCTexamination was reviewed to determine the location and length of the TZ and comparedwith operative and pathological results. Results were analyzed by chi square test and inter-observer agreement using Kappa test.P 0.05 was considered statistically significant.Results:According to operative and pathological data, the site of the TZ: 17 (77.27%) wereof short-segment disease (rectosigmoid HD), 2 (9%) were of long segment (above sigmoidcolon), and 3 (13.63%) were of ultrashort segment. A correct diagnosis of TZ by MDCT wasmade in 19 out of 22 with 82.4% sensitivity and 80% specificity. The site of TZ wasconcordant in 17. Results yielded a moderate strength of inter-observer agreement in local-izing the site of TZ (k= 0.546) and (P= 0.009).Conclusion:Low-dose MDCT has a good role in localizing the site of TZ of HD in infants.

Abstract Background: The indications for and technology surrounding thoracic endovascular aortic repair (TEVAR) have undergone significant evolution with increasing adoption. The purpose of this report is to evaluate pathology-specific incidence, timing, and types of secondary aortic intervention (SAI) after TEVAR and their impact on survival. Methods: A single-center retrospective review was made of all TEVAR and SAI performed from 2004 to 2018. Kaplan-Meier and multivariable logistic regression were used to estimate freedom from SAI and survival, and to identify SAI predictors. Results: Of 1037 patients (mean age 65.4 ± 15.1 years), 155 (14.9%) underwent 212 SAIs (median 5 months; interquartile range, 1.5 to 18) with 37 (3.6%) requiring more than one SAI. The primary aortic pathology at index TEVAR significantly (P = .0001) affected the incidence of SAI: chronic dissection, 26.5%; postsurgical anastomotic pseudoaneurysm, 19.4%; degenerative aneurysm, 15.3%; and acute dissection, 11.2%. The most common indications for SAI were endoleaks (44.8%), disease progression or remote aortic procedure (23.1%), and persistent false lumen flow (9.9%). After exclusion of 30-day mortality events, patients who did not undergo a SAI had better survival compared with patients having SAI: no SAI 1 year 88.8% ± 1.1%, 5 years 75.2% ± 1.7%, and 10 years, 66.5% ± 2.3%; SAI 1 year 91.7% ± 2.4%, 5 years 61.9% ± 4.9%, and 10 years 33.5% ± 8.4% (log rank P = .004). Conclusions: Secondary aortic intervention after TEVAR is not uncommon, particularly among patients with chronic dissection pathology. Patients surviving their index hospitalization who undergo SAI have worse long-term survival. The varying incidence of SAI by indication identifies the need for pathology-specified patient selection, surveillance strategies after TEVAR, and better device design that addresses the limitations of TEVAR, particularly in dealing with dissection-related indications.

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