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Sample records for superior epigastric artery

  1. Immediate Bilateral Breast Reconstruction with Unilateral Deep Superior Epigastric Artery and Superficial Circumflex Iliac Artery Flaps

    Directory of Open Access Journals (Sweden)

    Keith S. Hansen

    2016-09-01

    Full Text Available Autologous breast reconstruction utilizing a perforator flap is an increasingly popular method for reducing donor site morbidity and implant-related complications. However, aberrant anatomy not readily visible on computed tomography angiography is a rare albeit real risk when undergoing perforator flap reconstruction. We present an operative case of a patient who successfully underwent a bilateral breast reconstruction sourced from a unilateral abdominal flap divided into deep superior epigastric artery and superficial circumflex iliac artery flap segments.

  2. Hypothenar hammer syndrome: Distal ulnar artery reconstruction with autologous inferior epigastric artery.

    Science.gov (United States)

    Smith, Hadley E; Dirks, Marco; Patterson, Robert B

    2004-12-01

    Digital artery embolization and ulnar artery thrombosis are consequences of repetitive trauma and can lead to digit loss and debility from ischemia and cold intolerance. We postulate that an arterial autograft is a theoretically superior conduit to traditional saphenous vein, and report reconstruction with inferior epigastric artery. Three adult male smokers, ages 39 to 49 years, had severe digital ischemia and cold-induced vasospasm. Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch, distal digital artery embolization, and normal proximal vasculature. All reconstructions were performed from the distal most patent ulnar artery at the wrist to the superficial palmar arch (1 patient) or sequentially to the involved common digital arteries (2 patients), with inferior epigastric artery. Handling characteristics and size match between the arterial autografts and bypassed arteries was excellent. Patency has been confirmed with duplex scanning at follow-up of 8 to 24 months, with resolution of cold intolerance and successful digital preservation.

  3. The new technique of using the epigastric arteries in renal transplantation with multiple renal arteries

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    Mohammad Ali Amirzargar

    2013-01-01

    Full Text Available The most common anatomic variant seen in the donor kidneys for renal transplantation is multiple renal arteries (MRA, which can cause an increased risk of complications. We describe the long-term outcomes of 16 years of experience in 76 kidney transplantations with MRAs. In a new reconstruction technique, we remove arterial clamps after anastomosing the donor to the recipient′s main renal vessels, which cause backflow from accessory arteries to prevent thrombosis. By this technique, we reduce the ischemic times as well as the operating times. Both in live or cadaver donor kidneys, lower polar arteries were anastomosed to the inferior epigastric artery and upper polar arteries were anastomosed to the superior epigastric arteries. Injection of Papaverine and ablation of sympathic nerves of these arteries dilate and prevent them from post-operative spasm. Follow-up DTPA renal scan in all patients showed good perfusion and function of the transplanted kidney, except two cases of polar arterial thrombosis. Mean creatinine levels during at least two years of follow-up remained acceptable. Patient and graft survival were excellent. No cases of ATN, hypertension, rejection and urologic complications were found. In conclusion, this technique can be safely and successfully utilized for renal transplantation with kidneys having MRAs, and may be associated with a lower complication rate and better graft function compared with the existing techniques.

  4. Partial breast reconstruction with mini superficial inferior epigastric artery and mini deep inferior epigastric perforator flaps.

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    Spiegel, Aldona J; Eldor, Liron

    2010-08-01

    In this study, partial breast reconstruction was undertaken after breast conservation therapy using mini abdominal free flaps on both an immediate and delayed basis.Patient demographics, oncologic status, reconstructive data, and complications were collected from medical records.Twelve patients (age range 39-60) were included in this study with a mean follow-up time of 5 years. Ten mini superficial inferior epigastric artery flaps and 2 mini deep inferior epigastric perforator flaps were used (7 immediate and 5 delayed reconstructions). No flap lost, 1 minor abdominal wound dehiscence, and no local or distant recurrences were noted. Good to excellent results were reported by 91% of the women.In properly selected patients with high motivation toward breast conservation, tailored abdominal mini-free flaps can safely and satisfactorily be implemented for the reconstruction of partial mastectomy defects. Patients should be comprehensively educated on the potential future implications of using the abdominal donor site for partial breast reconstruction.

  5. Inferior epigastric artery: Surface anatomy, prevention and management of injury.

    Science.gov (United States)

    Wong, Clare; Merkur, Harry

    2016-04-01

    The anatomical position of the inferior epigastric artery (IEA) subjects it to risk of injury during abdominal procedures that are close to the artery, such as laparoscopic trocar insertion, insertion of intra-abdominal drains, Tenckhoff(®) catheter (peritoneal dialysis catheter) and paracentesis. This article aims to raise the awareness of the anatomical variations of the course of the IEA in relation to abdominal landmarks in order to define a safer zone for laparoscopic ancillary trocar placement. Methods of managing the IEA injury as well as techniques to minimise the risk of injury to the IEA are reviewed and discussed.

  6. Spiral CT localization of the point where superior epigastric artery perforates rectus abdominis muscle%对腹壁上动脉穿腹直肌点的螺旋电子计算机断层扫描定位及其意义

    Institute of Scientific and Technical Information of China (English)

    张佳琦; 张金明; 陈宇宏; 冀晨阳

    2013-01-01

    目的 通过应用螺旋电子计算机断层扫描(CT)血管造影对腹壁上动脉进行定位,以评估乳房再造术后其预防供区并发症的意义.方法 对50例无上腹部手术史患者进行螺旋CT血管造影.建立坐标系,以脐为原点,平脐水平线为X轴,脐垂直线为Y轴.在上述坐标系中定位腹壁上动脉穿腹直肌点(下简称穿肌点)的位置.结果 50例患者在CT检测下共发现392个穿肌点,平均每例7.84个穿肌点.第1象限的穿肌点横轴主要分布在1.45~5.47 cm,纵轴主要分布在2.52~16.38 cm.第2象限的穿肌点横轴主要分布在2.02~6.80 cm,纵轴主要分布在2.30~14.46 cm.结论 螺旋CT血管造影具有高度的敏感性和特异性,进行腹壁上动脉穿肌点的定位可以避免术中切取多余的腹直肌,对减少腹壁供区的并发症有很大意义.%Objective To locate the points where the superior epigastric artery perforates the rectus abdominis muscle by using the spiral CT,in order to evaluate its control on abdominal complications after breast reconstruction.Methods Fifty cases had received abdominal spiral CT angiography,respectively.Then the coordinate system was established,with the umbilicus as the origin,the umbilicus horizontal line as X axis,vertical umbilical level line as Y axis.The point where superior epigastric artery perforates the rectus abdominis muscle in the coordinate system was located as described above.Results There were 392 perforating points in the rectus abdominis muscle in all 50 cases,with a mean of 7.84 perforators per patient.In the first quadrant,the points where superior epigastric artery perforate the rectus abdominis muscle were located in the range from 1.45 cm to 5.47 cm on the X axis,and in the range from 2.52 cm to 16.38 cm on the Y axis,respectively.In the second quadrant,the points where superior epigastric artery perforates the rectus abdominis muscle were located in the range from 2.02 cm to 6.80 cm on the X axis,and in

  7. Superior mesenteric artery syndrome causing growth retardation

    Directory of Open Access Journals (Sweden)

    Halil İbrahim Taşcı

    2013-03-01

    Full Text Available Superior mesenteric artery syndrome is a rare and lifethreateningclinical condition caused by the compressionof the third portion of the duodenum between the aortaand the superior mesenteric artery’s proximal part. Thiscompression may lead to chronic intermittent, acute totalor partial obstruction. Sudden weight-loss and the relateddecrease in the fat tissue are considered to be the etiologicalreason of acute stenosis. Weight-loss accompaniedby nausea, vomiting, anorexia, epigastric pain, andbloating are the leading complaints. Barium radiographs,computerized tomography, conventional angiography,tomographic and magnetic resonance angiography areused in the diagnosis. There are medical and surgical approachesto treatment. We hereby present the case ofa patient with superior mesenteric artery syndrome withdelayed diagnosis.Key words: superior mesenteric artery syndrome, nausea-vomiting, anorexia

  8. The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation.

    Science.gov (United States)

    El-Sherbiny, M; Abou-Elela, A; Morsy, A; Salah, M; Foda, A

    2008-01-01

    This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after declamping. Between 1988 and 2004, 477 consecutive live donor renal transplants were performed, including 429 with single and 48 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 15 grafts with multiple arteries. Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning +/- MRA in some patients. In live donor renal transplantation with multiple arteries, the anastomosis of the lower polar artery to the inferior epigastric artery after declamping avoids prolongation of the ischemia time that occurs with other surgical and microsurgical techniques of intracorporeal and ex vivo surgeries.

  9. [MASSIVE HEMORRHAGE FROM THE FISTULA FORMATION BETWEEN CUTANEOUS URETEROSTOMY AND INFERIOR EPIGASTRIC ARTERY: A CASE REPORT].

    Science.gov (United States)

    Fujinami, Hiroyuki; Shibuya, Tadamasa; Mori, Kenichi; Shin, Toshitaka; Sumino, Yasuhiro; Sato, Fuminori; Mimata, Hiromitsu; Sato, Yoshiyasu; Matsubara, Takanori; Sakamoto, Sadaaki; Kamei, Noritaka; Hongo, Tetsuo

    2015-04-01

    A 87-year-old man received radical nephroureterectomy for right renal pelvic cancer in 2009 and left cutaneous ureterostomy after radical cystectomy for bladder cancer in 2013. He visited the hospital for exchanging a 7 or 8 Fr single-J catheter every 2 to 4 weeks. Eleven months after the 2nd operation, massive bleeding from the stoma occurred when ureteral catheter was exchanged. Contrast-enhanced computed tomography showed that left inferior epigastric artery was located close to left ureter. Angiography of the left inferior epigastric artery didn't show an obvious fistula, but revealed the stoma was surrounded by ramified new blood vessels from left inferior epigastric artery. We suspected a rupture of the vessels and performed embolization for the branch of inferior epigastric artery to left ureter. This embolization made it possible for the bleeding to be controlled. Massive bleeding from the branch of inferior epigastric artery is very rare, and we report the case and review the literature.

  10. Measuring the Pressure in the Superficial Inferior Epigastric Vein to Monitor for Venous Congestion in Deep Inferior Epigastric Artery Perforator Breast Reconstructions : A Pilot Study

    NARCIS (Netherlands)

    Smit, Jeroen M.; Audolfsson, Thorir; Whitaker, Iain S.; Werker, Paul M. N.; Acosta, Rafael; Liss, Anders G.

    2010-01-01

    During deep inferior epigastric artery perforator (DIEP) flap dissection, we noted that in many cases the superficial vein on the ipsilateral side of the flap was engorged and tense, and in others, it was empty. This led us to believe that the pressure is increased as the result of preferential outf

  11. Isolated superior mesenteric artery dissection

    Directory of Open Access Journals (Sweden)

    Lalitha Palle

    2010-01-01

    Full Text Available Isolated superior mesenteric artery (SMA dissection without involvement of the aorta and the SMA origin is unusual. We present a case of an elderly gentleman who had chronic abdominal pain, worse after meals. CT angiography, performed on a 64-slice CT scanner, revealed SMA dissection with a thrombus. A large artery of Drummond was also seen. The patient was managed conservatively.

  12. Pseudoaneurysm of the inferior epigastric artery: a rare complication of laparoscopic ventral hernia repair.

    Science.gov (United States)

    Nichols-Totten, Kysha; Pollema, Travis; Moncure, Michael

    2012-02-01

    Pseudoaneurysm of the inferior epigastric artery (IEA) is a recognized complication of surgery; however, it is a very rare clinical occurrence. The anatomic position of the IEA subjects patients to possible IEA injury during abdominal wall procedures that are close to the artery, such as insertions of drains, Tenckhoff catheters, laparoscopic trocars, or paracentesis. Treatment options include open surgery, percutaneous coil embolization, embolization with N-butyl cyanoacrylate, sonographic-guided thrombin injection, or sonographic-guided compression. We report the first case of a pseudoaneurysm arising from the IEA after a laparoscopic ventral hernia repair. To our knowledge, 17 IEA pseudoaneurysms have been reported, only 3 of which were spontaneous. The pseudoaneurysm in our patient was successfully treated by percutaneous injection of thrombin by interventional radiology.

  13. [EFFECTIVENESS OF DEEP INFERIOR EPIGASTRIC ARTERY PERFORATOR FLAP FOR REPAIR OF PERINEAL AND PERIANAL CICATRICIAL CONTRACTURE].

    Science.gov (United States)

    Du, Liping; You, Xiaobo; Tang, Kuangyun; Fu, Rong

    2015-08-01

    To discuss the effectiveness of deep inferior epigastric artery perforator flap to repair perineal and perianal cicatricial contracture. Between March 2007 and December 2013, 23 patients with perineal and perianal cicatricial contracture were treated with deep inferior epigastric artery perforator flap. There were 15 males and 8 females, aged from 21 to 62 years (mean, 42 years). Burn depth was III degree. The burning scars involved in the fascia, even deeper, which was rated as peripheral type (mild stenosis of the anal region and perianal cicatricial contracture) in 13 cases and as central type (severe stenosis of the anal region and anal canal with shift or defect of external genitalia) in 10 cases. All patients had limited hip abduction and squatting. Repair operation was performed at 3 months to 2 years (mean, 6 months) after wound healing. The size of soft tissue defects ranged from 10 cmx6 cm to 28 cm x 13 cm after scar excision and release. The size of flaps ranged from 12 cmx7 cm to 30 cmx15 cm. The donor site was sutured directly in 16 cases and repaired by autograft of skin in 7 cases. The flap had distal necrosis, distal cyanosis, and spotted necrosis in 1 case, 2 cases, and 1 case respectively, which were cured after symptomatic treatment; the other flaps survived and wound healed primarily. Twenty-one patients were followed up 6 months to 2 years (mean, 1 year). Nineteen patients had good appearance of the perinea and position of external genitalia, normal function of defecation function; stenosis of the anal region was relived, and the flaps had good texture and elasticity. Linear scar contracture was observed at the edge of flap in 2 cases, and the appearance of the perineum was restored after Z plasty. The hip abduction reached 30-40°. No abdominal hernia was found at donor site. Deep inferior epigastric artery perforator flap has stable blood supply and flexible design, which is similar to the perianal and perineal tissues. The good effectiveness

  14. Diagnosis of ruptured superior mesenteric artery aneurysm mimicking a pancreatic mass

    Institute of Scientific and Technical Information of China (English)

    Stefano; Palmucci; Letizia; Antonella; Mauro; Pietro; Milone; Francesco; Di; Stefano; Antonino; Scolaro; Antonio; Di; Cataldo; Giovanni; Carlo; Ettorre

    2010-01-01

    Aneurysms and pseudoaneurysms of the superior mesenteric artery are potentially lethal and should be treated as urgently as possible.In a 52-year-old man with occasional epigastric pain,we accidentally discovered a superior mesenteric artery aneurysm that was ruptured with spontaneous tamponade in the uncinate process and in the head of the pancreas.The ruptured aneurysm had a heterogeneous appearance due to its thrombotic and hemorrhagic content,and it simulated a voluminous mass in the head and uncinate p...

  15. Epigastric Hernia

    OpenAIRE

    2015-01-01

    Epigastric hernia is a common condition, mostly asymptomatic although sometimes their unusual clinical presentation still represents a diagnostic dilemma for clinician. The theory of extra tension in the epigastric region by the diaphragm is the most likely theory of epigastric hernia formation. A detailed history and clinical examination in our thin, elderly male patient who presented with abdominal pain and constipation of 5 days of evolution was crucial in establishing a diagnosis. Noninva...

  16. Epigastric Hernia.

    Science.gov (United States)

    Suarez Acosta, Carlos Enrique; Romero Fernandez, Esperanza; Calvo Manuel, Elpidio

    2015-08-01

    Epigastric hernia is a common condition, mostly asymptomatic although sometimes their unusual clinical presentation still represents a diagnostic dilemma for clinician. The theory of extra tension in the epigastric region by the diaphragm is the most likely theory of epigastric hernia formation. A detailed history and clinical examination in our thin, elderly male patient who presented with abdominal pain and constipation of 5 days of evolution was crucial in establishing a diagnosis. Noninvasive radiologic modalities such as ultrasonographic studies in the case of our patient can reliably confirm the diagnosis of epigastric hernia.

  17. Phlegmonous gastritis secondary to superior mesenteric artery syndrome

    Directory of Open Access Journals (Sweden)

    Kosuke Nomura

    2015-12-01

    Full Text Available We herein report a case of phlegmonous gastritis secondary to superior mesenteric artery syndrome. An 80-year-old woman visited the hospital emergency department with the chief complaints of epigastric pain and vomiting. She was hospitalized urgently following the diagnosis of superior mesenteric artery syndrome based on abdominal computed tomography findings. Conservative therapy was not effective, and phlegmonous gastritis was diagnosed based on the findings of upper gastrointestinal endoscopy and biopsy performed on the 12th day of the disease. Undernutrition and reduced physical activity were observed on hospital admission, and proactive nutritional therapy with enteral nutrition was started. An upper gastrointestinal series, performed approximately 1 month later, confirmed the persistence of strictures and impaired gastric emptying. Because conservative therapy was unlikely to improve oral food intake, open total gastrectomy was performed on the 94th day of the disease. Examination of surgically resected specimens revealed marked inflammation and fibrosis, especially in the body of the stomach. Following a good postoperative recovery, the patient was able to commence oral intake and left our hospital on foot approximately 1 month after surgery.

  18. Superior mesenteric artery compression syndrome - case report

    OpenAIRE

    Paulo Rocha França Neto; Rodrigo de Almeida Paiva; Antônio Lacerda Filho; Fábio Lopes de Queiroz; Teon Noronha

    2011-01-01

    Superior mesenteric artery syndrome is an entity generally caused by the loss of the intervening mesenteric fat pad, resulting in compression of the third portion of the duodenum by the superior mesenteric artery. This article reports the case of a patient with irremovable metastatic adenocarcinoma in the sigmoid colon, that evolved with intense vomiting. Intestinal transit was carried out, which showed important gastric dilation extended until the third portion of the duodenum, compatible wi...

  19. [The superior laryngeal nerve and the superior laryngeal artery].

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    Lang, J; Nachbaur, S; Fischer, K; Vogel, E

    1987-01-01

    Length, diameter and anastomoses of the nervus vagus and its ganglion inferius were measured 44 halved heads. On the average, 8.65 fiber bundles of the vagus nerve leave the retro-olivary area. In the area of the jugular foramen is the near superior ganglion of the 10th cranial nerve. In this area were found 1.48 (mean value) anastomoses with the 9th cranial nerve. 11.34 mm below the margo terminalis sigmoidea branches off the ramus internus of the accessory nerve which has a length of 9.75 mm. Further anastomoses with the 10th cranial nerve were found. The inferior ganglion of the 10th nerve had a length of 25.47 mm and a diameter of 3.46 mm. Five mm below the ganglion the 10th nerve had a width of 2.9 and a thickness of 1.5 mm. The mean length of the superior sympathetic ganglion was 26.6 mm, its width 7.2 and its thickness 3.4 mm. In nearly all specimens anastomoses of the superior sympathetic ganglion with the ansa cervicalis profunda and the inferior ganglion of the 10th cranial nerve were found. The superior laryngeal nerve branches off about 36 mm below the margo terminalis sigmoidea. The width of this nerve was 1.9 mm, its thickness 0.8 mm on the right and 1.0 mm on the left side. The division in the internal and external rami was found about 21 mm below its origin. Between the n. vagus and thyreohyoid membrane the ramus internus had a length of 64 mm, the length of external ramus between the vagal nerve and the inferior pharyngeal constrictor muscle was 89 mm. Its mean length below the thyreopharyngeal part was 10.7 mm, 8.6 branchlets to the cricothyroid muscle were counted. The superior laryngeal artery had its origin in 80% of cases in the superior thyroideal artery, in 6.8% this vessel was a branch of the external carotid artery. Its average outer diameter was 1.23 mm on the right side and 1.39 mm on the left. The length of this vessel between its origin and the thyreohyoid membrane was 34 mm. In 7% on the right side and in 13% on the left, the superior

  20. Reperfusion hemorrhage following superior mesenteric artery stenting.

    LENUS (Irish Health Repository)

    Moore, Michael

    2012-02-03

    Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

  1. Pancreaticoduodenectomy with early superior mesenteric artery dissection

    Institute of Scientific and Technical Information of China (English)

    Yu-Fei Xu; Zuo-Jin Liu; Jian-Ping Gong

    2010-01-01

    BACKGROUND: Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive human tumors. At present, surgical resection is the only potentially curative treatment. Early neck division is inadequate when invasion of the superior mesenteric artery (SMA) is suspected or in cases of replaced or accessory right hepatic artery. Malignant periampullary tumors often invade retroperitoneal peripancreatic tissues and a positive resection margin is associated with a poor long-term survival. DATA SOURCES: English-language medical databases, PubMed, ELSEVIER and SPRINGERLINK, were searched for articles on"posterior approach pancreaticoduodenectomy","superior mesenteric artery ifrst approach", "retroperitoneal tissue","hanging maneuver", and related topics. RESULTS:The modiifcation allowed the surgeon to early identify the nonresectability of a replaced right hepatic artery if present, enabling complete dissection of the right side of the SMA and portal vein as well as complete excision of the retroportal pancreatic lamina. CONCLUSION: Pancreaticoduodenectomy with early retro-pancreatic dissection is a useful and safe technical variant, which is indicated for the improvement of the safety and curative effect of the procedure.

  2. Thermal injuries in the insensate deep inferior epigastric artery perforator flap: case series and literature review on mechanisms of injury.

    Science.gov (United States)

    Enajat, Morteza; Rozen, Warren M; Audolfsson, Thorir; Acosta, Rafael

    2009-01-01

    With the increasing use of the deep inferior epigastric artery perforator (DIEP) flap, complications that are particularly rare (less than 1%) may start to become clinically relevant. During DIEP flap harvest, cutaneous nerves innervating the flap are necessarily sacrificed, resulting in reduced sensibility. This impaired sensibility prevents adequate thermoregulatory reflexes, like vasodilatation, sweating, and protective behaviors, leaving the reconstructed breast considerably more susceptible to thermal insult. We present four DIEP flap cases who sustained postoperative thermal injury to the reconstructed breast. All four cases were operated on between 2001 and 2008, over the course of 600 DIEP flaps in our unit (an incidence of 0.7%). The injuries occurred between 2 and 18 months after reconstruction. Two patients sustained thermal injury while sunbathing, one while staying in a warm environment, and one sustained the injury while taking a shower. No flap losses ensued, but these were not without morbidity. A literature review discusses other similar cases in the literature and describes the mechanisms for these findings. As a majority of patients will regain both fine-touch and heat sensation by 3 years postoperatively, it is pertinent that prophylactic measures be instituted during this period, such as the avoidance of sunbathing and the use of cooler shower temperatures for the first 3 years postoperatively. While performing sensory nerve coaptation is the gold standard for maximizing the success of sensory regeneration, this is not always sought and the 0.7% incidence of thermal injury we have encountered suggest the role for greater consideration of such injury. (c) 2009 Wiley-Liss, Inc.

  3. Superior mesenteric artery compression syndrome - case report

    Directory of Open Access Journals (Sweden)

    Paulo Rocha França Neto

    2011-12-01

    Full Text Available Superior mesenteric artery syndrome is an entity generally caused by the loss of the intervening mesenteric fat pad, resulting in compression of the third portion of the duodenum by the superior mesenteric artery. This article reports the case of a patient with irremovable metastatic adenocarcinoma in the sigmoid colon, that evolved with intense vomiting. Intestinal transit was carried out, which showed important gastric dilation extended until the third portion of the duodenum, compatible with superior mesenteric artery syndrome. Considering the patient's nutritional condition, the medical team opted for the conservative treatment. Four months after the surgery and conservative measures, the patient did not present vomiting after eating, maintaining previous weight. Superior mesenteric artery syndrome is uncommon and can have unspecific symptoms. Thus, high suspicion is required for the appropriate clinical adjustment. A barium examination is required to make the diagnosis. The treatment can initially require gastric decompression and hydration, besides reversal of weight loss through adequate nutrition. Surgery should be adopted only in case of clinical treatment failure.A síndrome da artéria mesentérica superior é uma entidade clínica causada geralmente pela perda do tecido adiposo mesentérico, resultando na compressão da terceira porção do duodeno pela artéria mesentérica superior. Esse artigo relata o caso clínico de uma paciente portadora de adenocarcinoma de cólon sigmoide metastático irressecável, que evoluiu com vômitos incoercíveis. Realizou-se, então, trânsito intestinal que evidenciou dilatação gástrica importante, que se prolongava até a terceira porção duodenal, quadro radiológico compatível com pinçamento da artéria mesentérica superior. Diante da condição nutricional da paciente, foi optado por iniciar medidas conservadoras (porções alimentares pequenas e mais frequentes, além de dec

  4. Superior Mesenteric Artery Syndrome: An Infrequent Complication of Scoliosis Surgery

    Directory of Open Access Journals (Sweden)

    Metin Keskin

    2014-01-01

    Full Text Available Superior mesenteric artery syndrome is a rare condition that causes a proximal small intestinal obstruction due to contraction of the angle between the superior mesenteric artery and the aorta. Scoliosis surgery is one of the 15 reasons for superior mesenteric artery syndrome, which can present with acute or chronic manifestations. Although conservative treatment is usually possible, surgical treatment is required in certain cases that cannot be treated using conservative methods. In this paper, we describe a patient who developed superior mesenteric artery syndrome after scoliosis surgery and was treated with duodenojejunostomy due to failure and complications of conservative treatment.

  5. Coronary artery bypass and superior vena cava syndrome.

    Science.gov (United States)

    Thomas, T V; Masrani, K; Thomas, J L

    1999-01-01

    Superior vena cava syndrome is the obstruction of the superior vena cava or its main tributaries by benign or malignant lesions. The syndrome causes edema and engorgement of the vessels on the face, neck, and arms, nonproductive cough, and dyspnea. We discuss the case of a 48-year-old obese diabetic woman who was admitted with unstable angina. She had previously been diagnosed with superior vena cava syndrome. Urgent coronary artery bypass grafting was necessary Although thousands of coronary artery bypasses are performed every year, there are not many reports on patients with superior vena cava syndrome who successfully undergo cardiopulmonary bypass and coronary artery grafting with an internal mammary artery as the conduit. The results of the case and alternative recommended methods are discussed.

  6. Coronary artery bypass and superior vena cava syndrome.

    OpenAIRE

    Thomas, T V; Masrani, K; Thomas, J.L.

    1999-01-01

    Superior vena cava syndrome is the obstruction of the superior vena cava or its main tributaries by benign or malignant lesions. The syndrome causes edema and engorgement of the vessels on the face, neck, and arms, nonproductive cough, and dyspnea. We discuss the case of a 48-year-old obese diabetic woman who was admitted with unstable angina. She had previously been diagnosed with superior vena cava syndrome. Urgent coronary artery bypass grafting was necessary Although thousands of coronary...

  7. [Voluminous complicated epigastric hernia].

    Science.gov (United States)

    Palade, R; Voiculescu, D; Suliman, E; Lutic, C

    2009-01-01

    Epigastric hernia, apparently minor injury, neglected can reach impressive sizes, with major un-esthetic effect. In an unfavorable clinically context (morbid obesity, chronic respiratory failure, ground cancer, diabetes, heart failure) complications occur (incarceration, strangulation) with a complex picture. We present three clinical observations, including a low occlusion by fixed transverse colon necrosis in a strangulated epigastric hernia with pyo-stercoral phlegmon.

  8. Colgajos de perforantes de las arterias epigástricas inferiores profunda y superficial Deep and superficial inferior epigastric artery perforator flaps

    Directory of Open Access Journals (Sweden)

    A. R. Gagnon

    2006-12-01

    Full Text Available Con el desarrollo de los colgajos miocutáneos de recto abdominal (TRAM, el abdomen inferior ha sido reconocido como la principal área dadora de tejidos autólogos de alta calidad, especialmente útiles en reconstrucción mamaria. Más recientemente la habilidad para obtener componentes adiposocutáneos similares sin sacrificar el músculo recto ha revolucionado el campo de la Cirugía Reconstructiva. El advenimiento de los colgajos de perforantes ha permitido a los cirujanos plásticos lograr los mismos buenos resultados estéticos que con los colgajos miocutáneos tradicionales, pero con un considerable descenso en la morbilidad del área donante. Con los colgajos de perforantes de la arteria epigástrica inferior profunda (DIEP y de la arteria epigástrica inferior superficial (SIEA, los pacientes han incrementado sus opciones de reconstrucción. Este artículo revisa la anatomía quirúrgica de la pared abdominal relativa a los colgajos SIEA y DIEP. Se explican detalladamente los pasos principales para la preparación preoperatoria, la técnica quirúrgica y los cuidados postoperatorios. Se discuten las ventajas y desventajas y se presen- tan los trucos técnicos que pueden ayudar a mejorar el resultado final. Además se ilustran con ayuda de casos clínicos las indicaciones típicas y atípicas.Following the development of the transverse rectus abdominis myocutaneous (TRAM flap, the lower abdomen has been recognized as a prime source of high quality autogenous tissue, especially useful in breast reconstruction. More recently, the ability to harvest a similar adipocutaneous component without sacrifice of the rectus muscle has revolutionized the field of reconstructive surgery. The advent of perforator flaps has allowed plastic surgeons to achieve the same highly esthetic results as with the former myocutaneous flaps while significantly decreasing the donor site morbidity. With the deep inferior epigastric artery perforator (DIEP flap and

  9. Differences in superior thyroid artery and inferior thyroid artery blood flow spectrum parameters in subacute thyroiditis

    Institute of Scientific and Technical Information of China (English)

    Jin-Bo Li

    2016-01-01

    Objective:To study the differences in superior thyroid artery and inferior thyroid artery blood flow spectrum parameters in subacute thyroiditis. Methods:A Total of 40 cases of patients with subacute thyroiditis and 40 cases of healthy volunteers were selected for study and enrolled in pathology group and control group respectively, color Doppler ultrasonography was conducted to detect peak blood flow velocities (Vmax) of superior thyroid artery and inferior thyroid artery as well as resistance index (RI), and serum was collected to detect thyroid hormone contents, infection indexes and oxidative stress indexes. Results:Peak blood flow velocities Vmax of superior thyroid artery and inferior thyroid artery of pathology group were significantly higher than those of control group, and resistance index RI was not different from that of control group;FT3, FT4, TT3, TT4, ESR, CRP, PCT and MDA of pathology group were significantly higher than those of control group, and SOD and TAOC were significantly lower than those of control group;Vmax of superior thyroid artery and inferior thyroid artery were positively correlated with FT3, FT4, TT3, TT4, ESR, CRP, PCT and MDA, and negatively correlated with SOD and TAOC. Conclusion:Peak blood flow velocities (Vmax) of superior thyroid artery and inferior thyroid artery in subacute thyroiditis are significantly accelerated, Vmax has good consistency with thyroid hormone contents, infection indexes and oxidative stress indexes, and it can accurately assess the severity of the disease.

  10. SUPERIOR MESENTERIC ARTERY SYNDROME - AN UNUSUAL CAUSE OF DUODENAL OBSTRUCTION

    OpenAIRE

    Sahu SK, , , , , , ,; Singh PK; Ray J; Uniyal M; Sharma C; Sekhar C; Kapruwan H; Sachan PK

    2012-01-01

    Superior mesenteric artery (SMA) arising from aorta at the level of first lumbar vertebra usually takes an angular downward course from ventral surface of aorta. It is through this vascular angle that the 3rd part of duodenum passes at the level of 4th lumbar vertebra. Fat and lymphatics around SMA maintains the angle at 25° to 60° with a mean of 450 and provide protection against duodenal compression. In Superior Mesenteric Artery Syndrome, the SMA-aorta angle in narrowed down to 7° to 22° w...

  11. Pseudoaneurysm of the superior gluteal artery following polytrauma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dennis [Vancouver General Hospital, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Legiehn, Gerald M. [Vancouver General Hospital, Interventional Radiology, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Munk, Peter L. [Vancouver General Hospital, MSK Section, University of British Columbia and Department of Radiology, Vancouver, BC (Canada)

    2007-09-15

    Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis. (orig.)

  12. Pseudoaneurysm of the superior gluteal artery following polytrauma.

    Science.gov (United States)

    Lee, Dennis; Legiehn, Gerald M; Munk, Peter L

    2007-09-01

    Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis.

  13. Clinical significance of hepatic artery variations originating from the superior mesenteric artery in abdominal tumor surgery

    Institute of Scientific and Technical Information of China (English)

    HUANG Yuan; LIU Chao; LIN Jin-ling

    2013-01-01

    Background Hepatic artery variations are frequent clinical occurrences.The aim of this study was to investigate the characteristic course of variant hepatic arteries originating from the superior mesenteric artery for the purpose of providing instructions for abdominal tumor surgery.Methods The course of variant hepatic arteries originating from the superior mesenteric artery was studied in 400 patients with liver cancer confirmed by digital subtraction angiography (DSA) and multi-slice spiral computed tomography angiography (MSCTA),and 86 patients with gastric cancer confirmed by preoperative MSCTA between June 2008 and June 2010 in the First Affiliated Hospital of Guangxi Medical University.Results Hepatic artery variations originating from the superior mesenteric artery were noticed in 49 liver cancer patients and 14 gastric cancer patients (total 63 cases),with a variation rate of 12.96%,including two cases (3.17%) where the hepatic arteries ran along the anterior pancreas,and 61 cases (96.83%) where the hepatic arteries ran along the posterior pancreas.Conclusions Hepatic artery variations originating from the superior mesenteric artery present as two types:the pre-pancreas type and the post-pancreas type with the latter predominating.This finding is of clinical significance in abdominal tumor surgeries where clearance of portal lymph nodes is needed.

  14. Superior Mesenteric Artery Syndrome in a Young Military Basic Trainee

    Science.gov (United States)

    2013-03-01

    patients with severe anorexia nervosa .10 Severe cases may require surgery or parenteral feeding because of food avoidance leading to further loss of...2012. 10. Gwee K, Teh A, Huang C: Acute superior mesenteric artery syndrome and pancreatitis in anorexia nervosa . Australas Psychiatry 2010; 18(6): 523

  15. Analysis of deep inferior epigastric perforator (DIEP) arteries by using MDCTA: Comparison between 2 post-processing techniques

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca, E-mail: lucasaba@tiscali.it [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Atzeni, Matteo; Ribuffo, Diego [Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Mallarini, Giorgio [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Suri, Jasjit S. [Biomedical Technologies Inc., Denver, CO (United States); Idaho State University (Aff.), ID (United States)

    2012-08-15

    Purpose: Our purpose was to compare two post-processing techniques, Maximum-Intensity-Projection (MIP) and Volume Rendering (VR) for the study of perforator arteries. Methods: Thirty patients who underwent Multi-Detector-Row CT Angiography (MDCTA) between February 2010 and May 2010 were retrospectively analyzed. For each patient and for each reconstruction method, the image quality was evaluated and the inter- and intra-observer agreement was calculated according to the Cohen statistics. The Hounsfield Unit (HU) value in the common femoral artery was quantified and the correlation (Pearson Statistic) between image quality and HU value was explored. Results: The Pearson r between the right and left common femoral artery was excellent (r = 0.955). The highest image quality score was obtained using MIP for both observers (total value 75, with a mean value 2.67 for observer 1 and total value of 79 and a mean value of 2.82 for observer 2). The highest agreement between the two observers was detected using the MIP protocol with a Cohen kappa value of 0.856. The ROC area under the curve (Az) for the VR is 0.786 (0.086 SD; p value = 0.0009) whereas the ROC area under the curve (Az) for the MIP is 0.0928 (0.051 SD; p value = 0.0001). Conclusion: MIP showed the optimal inter- and intra-observer agreement and the highest quality scores and therefore should be used as post-processing techniques in the analysis of perforating arteries.

  16. Breast reconstruction with superficial inferior epigastric artery flap%腹壁浅动脉蒂游离腹壁皮瓣乳房再造术的初步临床应用

    Institute of Scientific and Technical Information of China (English)

    穆大力; 栾杰; 穆兰花; 严义坪

    2010-01-01

    Objective To present a method for breast reconstruction with the superficial inferior epigastric artery (S1EA) flap and to summarize the operative experiences. Methods The diameter and distribution were evaluated with multipledetector-row computed tomography (MDCT) angiography and doppler perfusion flowmeter. Bipedicle superficial inferior epigastric artery flap was designed below umbilicus. Superficial inferior epigastric artery and vein were anastomosed to the internal mammary artery and vein. Results Since 2007, we have used the superficial inferior epigastric artery flap in 4 cases of breast reconstruction. Four flaps survived completely. With the follow-up of 6-12 months, the reconstructed breasts were well-shaped and there were no complications such as abdominal hernia, bulge and weakness in donor sites. Conclusions Breast reconstruction using the superficial inferior epigastric artery flaps can not only preserve the advantages of the traditional method using the deep inferior epigastric perforator flaps, but also retain the maximal function of the fascia and the rectus abdominal muscle and prevent the occurrence of abdominal weakness and hernia. It is an ideal alternative method of breast reconstruction on condition that definitive preoperative assessment of vessels and skilled surgical technique are provided.%目的 探讨采用腹壁浅动脉(superficial inferior epigastric artery,SIEA)蒂游离腹壁皮瓣乳房再造术方法 、特点及适应证.方法 术前采用多层螺旋CT(multipledetector-row computed tomography,MDCT)三维血管造影及多普勒血流探测仪检查SIEA的直径、走行及分布,于脐与阴阜上缘之间设计皮瓣,采用单蒂或双蒂SIEA,与胸廓内动,静脉吻合,腹部供区直接拉拢缝合.结果 4例乳房再造病例皮瓣全部存活,皮瓣和腹部供区无脂肪液化、坏死、切口裂开、腹壁薄弱及腹壁疝等并发症的出现,再造乳房外形效果满意.结论 SIEA蒂游离腹壁皮瓣与腹

  17. Laparoscopic Pancreaticoduodenectomy: Right Posterior Superior Mesenteric Artery "First" Approach.

    Science.gov (United States)

    Pittau, Gabriella; Sànchez-Cabùs, Santiago; Laurenzi, Andrea; Gelli, Maximiliano; Cunha, Antonio Sa

    2015-12-01

    Pancreaticoduodenectomy (PD) is considered one of the most challenging abdominal operations for several reasons, including the anatomy, which is surrounded by vital vascular structures and also because of the serious complications that are possible in the postoperative period. Nowadays, thanks to the development of minimally invasive surgery and improvement of patients' selection, laparoscopic pancreatic resections have been proven to be technically feasible and safe especially in the case of left pancreatectomies. More recently, many series of laparoscopic PD for adenocarcinoma have been published demonstrating the feasibility of this technique. In pancreatic cancer, the advantage of superior mesenteric artery "first approach" is already known to achieve an oncological resection. The purpose of this video is to describe the different technical aspects of the laparoscopic superior mesenteric artery first approach in the right posterior fashion.

  18. Superior Mesenteric Artery Syndrome: An Infrequent Complication of Scoliosis Surgery

    OpenAIRE

    Metin Keskin; Turgut Akgül; Adem Bayraktar; Fatih Dikici; Emre Balık

    2014-01-01

    Case Report Superior Mesenteric Artery Syndrome: An Infrequent Complication of Scoliosis Surgery Metin Keskin,1 Turgut Akgül,2 Adem Bayraktar,1 Fatih Dikici,2 and Emre BalJk3 1 General Surgery Department, Istanbul Faculty of Medicine, Istanbul University, Capa, Millet Caddesi, 34093 Istanbul, Turkey 2Orthopedic Department, Istanbul Faculty of Medicine, Istanbul University, Capa, Millet Caddesi, 34093 Istanbul, Turkey 3 General Surgery Department, School of Medicine, Koc¸ Uni...

  19. Superior thyroid artery origin in Caucasian Greeks: A new classification proposal and review of the literature.

    Science.gov (United States)

    Natsis, Konstantinos; Raikos, Athanasios; Foundos, Ioannis; Noussios, George; Lazaridis, Nikolaos; Njau, Samouel N

    2011-09-01

    Studies on the origin of the superior thyroid artery, define that it could originate either from the external carotid artery, (at the level of common carotid bifurcation), or from the common carotid artery. However, there is a classical anatomic knowledge that the superior thyroid artery is a branch of the external carotid artery. Variability in the anatomy of the superior thyroid artery was studied on 100 carotids. Moreover, a review about the origin of superior thyroid artery between recent and previous cadaveric, autopsy, and angiographic studies, on adults and fetuses, was carried out. The superior thyroid artery originated from the external carotid artery in 39% and at the level of carotid bifurcation and common carotid artery in 61% of cases. The anterior branches of the external carotid artery were separate in 76% of cases, while common trunks between the arteries were found in 24% of the specimens. A new classification proposal on the origin of the superior thyroid artery is also suggested. In this study, the origin of superior thyroid artery is considered at the level of the carotid bifurcation and not from the external carotid artery as stated in many classical anatomy textbooks. This has a great impact on the terminology when referring to the anterior branches of the external carotid artery, which could be termed as anterior branches of the cervical carotid artery. Head and neck surgeons must be familiar with anatomical variations of the superior thyroid artery in order to achieve a better surgical outcome.

  20. Lipid peroxidation following superior mesenteric artery occlusion in rat intestine

    Directory of Open Access Journals (Sweden)

    P. Pasbakhsh

    2006-07-01

    Full Text Available Background: The aim of this study was to determine the level of lipid peroxidation and tissue protein after superior mesenteric artery occlusion tissue damage. The effect of melatonin as anti oxidant and free radical scavenger in prevention of tissue damage, were also evaluated. Methods: Thity six young male Wisatr-Albino rats (weight: 80-120 gr, were divided equally in 6 group with different concentrations of melatonin (10,20,30 mg/kg treatment. Group 1was control, group 2 the sham that surgical process was applied until superior mesenteric artery dissection and received vehicle solution only in equally volume by intra muscular route. Group 3 was ischemia- reperfusion (I/R, group 4 was I/R plus melatonin 10 mg/kg, group 5 I/R plus melatonin 20 mg/kg and finally group 6 I/R plus melatonin 30 mg/kg. After laparatomy, a microvascular atraumatic clip was placed across the superior mesenteric artery under general anaesthesia and itbremoved after ischemia for 30 minutes. The first dose of melatonin was applied just beforereperfusion, second dose, after reperfusion and third dose on the second day .On third day rats were killed and their bowels were removed. The level of tissue melandialdehyde (MDA as index of lipid peroxidation and tissue protein was determined. Results: The level of tissue MDA were significantly lower in group 4, 5, 6 than group 3 (p0, 05. Conclusion: These results suggest that melatonin 10 mg/kg has antioxidant effect in prevention of inducing tissue damage during SMA occlusion in rat intestine.

  1. Infantile intracranial aneurysm of the superior cerebellar artery.

    Science.gov (United States)

    Del Santo, Molly Ann; Cordina, Steve Mario

    2016-02-29

    Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes. 2016 BMJ Publishing Group Ltd.

  2. Polyarteritis nodosa in superior mesenteric artery : a case report

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Young Lan; Choi, Chul Soon; Kim, Ho Chul; Bae, Sang Hoon; Lee, Eil Seong; Nam, Eun Sook [Hallym Univ., Choonchun (Korea, Republic of). Coll. of Medicine

    1998-03-01

    Polyarteritis nodosa (PAN) is a multisystem disease characterized by necrotizing vasculitis of small and medium-sized arteries, and in 50 % of all cases there is gastrointestinal involvement. We describe a patient with PAN involving the gastrointestinal tract. A small bowel series showed nodular fold thickening, submucosal filling defects, shallow ulcerations, segmental luminal narrowing, and decreased peristalsis at the duodenum, jejunum, and ileum; superior mesenteric arteriography showed hypervascularity and microaneurysm. Segmental resection of the small bowel indicated the presence of PAN. (author). 10 refs.,3 figs.

  3. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Christos Bakoyiannis

    2012-01-01

    Full Text Available The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL.

  4. Mesenteric Ischemia:An unusual presentation of fistula between superior mesenteric artery and common hepatic artery

    Institute of Scientific and Technical Information of China (English)

    Ertugrul Kayacetin; Serdar Karak(o)se; Aydin Karabacakoglu; Dilek Emlik

    2004-01-01

    Chronic mesenteric ischemia is an uncommon condition associated with a high morbidity and mortality. We reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistula between superior mesenteric and common hepatic artery.

  5. Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects

    Institute of Scientific and Technical Information of China (English)

    HAI Heng-lin; SHEN Chuan-an; CHAI Jia-ke; LI Hua-tao; YU Yong-ming; LI Da-wei

    2013-01-01

    Background Perforator flaps are used extensively in repairing soft tissue defects.Superior gluteal artery perforatorflaps are used for repairing sacral defects,but the tension required for direct closure of the donor area after harvesting ofrelatively large flaps carries a risk of postoperative dehiscence.This research was to investigate a modified superiorgluteal artery perforator flap for repairing sacrococcygeal soft tissue defects.Methods From June 2003 to April 2010,we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients (study group).The wound and donor areas were measured,and the flaps were designed accordingly.Wound healing was assessed over a follow-up period of 6-38 months.From January 1998 to February 2003,twelve patients with sacrococcygeal pressure sores were treated with traditional methods,VY advancement flaps or oblong flaps,as control group.Results After debridement,the soft tissue defects ranged from 12 cm × 10 cm to 26 cm × 22 cm (mean 16.3 cm x 13.5cm).Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm (mean 18.2 cm × 14cm).Four patients were treated using left-sided flaps,and two were treated using both right-and left-sided flaps.Suction drains were removed on postoperative Days 3-21 (mean 5.9) and sutures were removed on postoperative Days 12-14.Each flap included 1-2 perforators for each of the donor and recipient sites.Donor sites were closed directly.All flaps survived.In eight patients,the wounds healed after single-stage surgery.After further debridement,the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33,respectively.The rate of first intention in the study group (80%,8/10) significantly increased than that of control group ((25%,3/12),X2=4.583,P=-0.032).Follow-up examinations found that the flaps had a soft texture without ulceration.In the two patients without

  6. Chronic dissection of the superior mesenteric artery: case report

    Energy Technology Data Exchange (ETDEWEB)

    Common, A.A.; Pressacco, J. [Univ. of Toronto, St. Michael' s Hospital, Dept. of Medical Imaging, Toronto, Ontario (Canada)

    1999-02-01

    Acute dissection of the thoracic aorta is a well-recognized, often fatal condition that frequently extends to involve the abdominal aorta and iliac vessels. The ostia of the renal and mesenteric vessels may be compromised, and the resulting visceral ischemia may necessitate surgical intervention. However, visceral perfusion may be restored if blood flow from true to false lumen is re-established or if the false lumen is obliterated, either spontaneously or by surgical or interventional techniques. Isolated dissections of mesenteric, renal, and carotid vessels are rarely reported. These may be spontaneous, related to high blood pressure and underlying disease of the vessel wall, or caused by abdominal trauma or medical intervention, including angiographic procedures. They are usually associated with pain and other signs and symptoms of ischemia in the appropriate territory. We present a case of chronic superior mesenteric artery (SMA) dissection, an incidental angiographic finding, in an asymptomatic patient being evaluated for resection of an abdominal aortic aneurysm (AAA). (author)

  7. Hypothalamic germinoma masquerading as superior mesenteric artery (SMA) syndrome.

    Science.gov (United States)

    Vethakkan, Shireene R; Venugopal, Yogeswari; Tan, Alexander T B; Paramasivam, Sharmila S; Ratnasingam, Jeyakantha; Razak, Rohaya A; Alias, Azmi; Kassim, Fauziah; Choong, Karen

    2013-01-01

    To report a case of superior mesenteric artery (SMA) syndrome secondary to hypothalamic germinoma. We describe the clinical presentation, diagnostic work-up, management, and clinical course of a patient admitted with SMA syndrome who was subsequently found to have a hypothalamic germinoma. An adolescent boy was admitted to the surgical ward with progressive weight loss over a 2 year period and postprandial vomiting. He was diagnosed with SMA syndrome based on evidence of proximal duodenal dilatation, extrinsic compression of the distal duodenum, and a narrowed aortomesenteric angle (16°). Investigations performed to exclude thyrotoxicosis unexpectedly revealed secondary hypothyroidism and further evaluation demonstrated evidence of pan-hypopituitarism. Psychiatric evaluation excluded anorexia nervosa and bulimia. Magnetic resonance imaging (MRI) of the brain revealed a heterogeneously enhancing hypothalamic lesion, but a normal pituitary gland. Hormone replacement with hydrocortisone, desmopressin, testosterone, and thyroxine resulted in weight gain and resolution of gastrointestinal symptoms. A transventricular endoscopic biopsy subsequently confirmed a hypothalamic germinoma and he was referred to an oncologist. SMA syndrome secondary to severe weight loss is an uncommon cause of upper gastrointestinal obstruction. While there have been reports of poorly controlled diabetes mellitus and thyrotoxicosis manifesting as SMA syndrome, there are no published reports to date of SMA syndrome secondary to hypothalamic/pituitary disease. Management of SMA syndrome is conservative, as symptoms of intestinal obstruction resolve with weight gain following treatment of the underlying cause. Awareness of this uncommon presentation of endocrine cachexia/hypothalamic disease will prevent unnecessary laparotomies and a misdiagnosis of an eating disorder.

  8. The superior mesenteric artery syndrome in patients with spinal deformity.

    Science.gov (United States)

    Altiok, Haluk; Lubicky, John P; DeWald, Christopher J; Herman, Jean E

    2005-10-01

    A retrospective review. To determine the incidence of the superior mesenteric artery syndrome (SMAS) after surgical correction for scoliosis and if it is influenced by newer derotation/translation surgical systems. The SMAS is a known complication after surgery. Of 2939 charts reviewed, 17 patients between 1960 and 2002 matched inclusion criteria. Our incidence of the SMAS was 0.5%. Onset of symptoms was 7.2 days. Several scoliosis diagnoses were included in the study group. Instrumentation that was used included: nondistraction systems (n = 14), Harrington rod with body cast (n = 1), Luque rod with sublaminar wires (n = 1), and casted in situ posterior spinal fusion (n = 1). Before surgery, 10 of 17 patients weighed less than the 50th percentile. Mean preoperative BMI was 18.6 kg/cm/cm. Postoperative height gain averaged 3.175 cm, and weight loss at onset of symptoms averaged 4.5 kg. There were 14 patients who required nasogastric suction for an average duration of 10.2 days, 11 required hyperalimentation, and 5 concurrently received hyperalimentation with enteric feeding. The SMAS recurred in 2 patients. Postoperative weight loss appears to be more important for the development of the SMAS than asthenic body type. Newer derotation/translation corrective techniques have not eliminated the SMAS. Gastrointestinal imaging is indicated when nausea and vomiting occur 6-12 days after surgery, associated with early satiety and normal bowel sounds. Decompression and nutritional support remain the mainstays of treatment.

  9. Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair.

    Science.gov (United States)

    Lala, Salim; Knowles, Martyn; Timaran, David; Baig, Mirza Shadman; Valentine, James; Timaran, Carlos

    2016-09-01

    The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR). During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study. Technical success for FEVAR was 100%. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P < .08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P < .05). Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  10. Upper limb amputation due to a brachial arterial embolism associated with a superior mesenteric arterial embolism: a case report

    Directory of Open Access Journals (Sweden)

    Yamada Tsuyoshi

    2012-07-01

    Full Text Available Abstract Background Acute mesenteric ischemia due to an embolism of the superior mesenteric artery is associated with a high mortality rate. Over 20 percent of acute mesenteric embolism cases consist of multiple emboli, and the long-term prognosis depends on the incidence of subsequent embolic events at other sites. The incidence of emboli in the upper extremity associated with a superior mesenteric arterial embolism has rarely been described. The signs and symptoms of ischemic change in the upper limb can be masked by other circumstances, such as postoperative conditions or complications. In these cases, a late presentation or delayed diagnosis and treatment can result in limb loss. Case presentation We present a rare case of a 67-year-old Japanese woman with atrial fibrillation who developed an embolic occlusion of the brachial artery associated with a superior mesenteric arterial embolism. She developed gangrene in her right hand, which had progressed to the point that amputation was necessary by the time the gastrointestinal surgeon had consulted the Department of Orthopedic Surgery. The brachial arterial embolism diagnosis was delayed by the severe abdominal symptoms and shock conditions that followed the emergency enterectomy, resulting in amputation of the upper limb despite anticoagulation therapy. In this case, multiple infarctions of the spleen were also observed, indicating a shower embolism. Conclusions When treating a superior mesenteric arterial embolism in a patient with atrial fibrillation, the possibility of recurrent or multiple arterial thromboembolic events should be considered, even after the procedure is completed.

  11. Superior mesenteric artery syndrome following initiation of cisplatin-containing chemotherapy: a case report

    Directory of Open Access Journals (Sweden)

    Ushiki Atsuhito

    2012-01-01

    Full Text Available Abstract Introduction Superior mesenteric artery syndrome is a rare cause of upper intestinal obstruction resulting from compression of the duodenum by the superior mesenteric artery and abdominal aorta. Case presentation We describe a case of superior mesenteric artery syndrome in a 61-year-old Japanese man with non-small cell lung cancer who had been treated with cisplatin-containing chemotherapy and had lost 7 kg in weight. The diagnosis was confirmed by the typical findings of abdominal computed tomography showing distended stomach resulting from compression of the third portion of the duodenum and reduction of an aortomesenteric distance and aortomesenteric angle. Conclusions This case highlights the importance of considering the possibility of superior mesenteric artery syndrome in patients treated with chemotherapy, especially those presenting with a low body mass index and showing weight loss during chemotherapy.

  12. Endovascular treatment of a Superior Mesenteric Artery Syndrome variant secondary to traumatic pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Abercrombie John F

    2010-03-01

    Full Text Available Abstract Pseudoaneurysms related to the superior mesenteric artery (SMA are a recognised complication of trauma to the vessel, and successful treatment with stenting has been previously described. We report the case of a patient who presented with obstruction of the fourth part of the duodenum secondary to a traumatic pseudoaneurysm, a hitherto unreported variant of superior mesenteric artery syndrome. Exclusion of the pseudoaneurysm and relief of the duodenal obstruction were simultaneously achieved by placement of a covered stent.

  13. Paraplegia after aortic and superior mesenteric artery stenting for occlusive disease.

    Science.gov (United States)

    Hans, Sachinder S; Ngo, William; McAllister, Michael

    2014-02-01

    Paraplegia after endovascular therapy for aortic and visceral artery occlusive disease is an extremely uncommon occurrence. Two cases of paraplegia after placement of an aortic covered stent for infrarenal aortic stenosis and a superior mesenteric artery stent for chronic visceral ischemia are presented. In both patients, embolization of the arterial supply to the spinal cord was the presumed cause. One patient had a slight recovery after intense physical therapy and rehabilitation. The second patient did not have any recovery from her paraplegia.

  14. Síndrome da artéria mesentérica superior Superior mesenteric artery syndrome

    OpenAIRE

    Haberlandh Sodré Lima; Accyoli Moreira Maia; Antonio Kneipp Pitta de Castro Neto

    2000-01-01

    The Superior Mesenteric Syndrome is a rare and controversial disease. The compression of the duodenum by the mesenteric artery and aorta causes an intermitent obstruction. Preoperative diagnosis is very difficult.We present one case of this syndrome in a pacient with severe weight loss and signs of high intestinal obstruction. The diagnosis was based on clinical and radiologic findings. A duodenojejunostomy was performed after medical treatment failure.This patient died on the 20th posoperati...

  15. Percutaneous Retrograde Recanalization of the Celiac Artery by Way of the Superior Mesenteric Artery for Chronic Mesenteric Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, George, E-mail: joseph59@gmail.com; Chacko, Sujith Thomas [Christian Medical College, Department of Cardiology (India)

    2013-02-15

    A 52-year-old man presented with recurrent postprandial abdominal pain, sitophobia, and progressive weight loss. Chronic mesenteric ischemia (CMI) due to subtotal occlusion of the superior mesenteric artery (SMA) and flush occlusion of the celiac artery (CA) was diagnosed. Retrograde recanalization of the CA by way of a collateral channel from the SMA was performed using contemporary recanalization equipment. The CA and SMA were then stented, resulting in sustained resolution of CMI-related symptoms.

  16. Endovascular Treatment of Totally Occluded Superior Mesenteric Artery by Retrograde Crossing via the Villemin Arcade

    Energy Technology Data Exchange (ETDEWEB)

    Ferro, Carlo; Rossi, Umberto G., E-mail: urossi76@hotmail.com; Seitun, Sara; Bovio, Giulio [IRCCS San Martino University Hospital-IST-National Institute for Cancer Research, Department of Radiology and Interventional Radiology (Italy); Fornaro, Rosario [IRCCS San Martino University Hospital-IST-National Institute for Cancer Research, Department of Surgery (Italy)

    2013-06-15

    Chronic mesenteric ischemia (CMI) is a rare disorder that is commonly caused by progressive atherosclerotic stenosis or occlusion of one or more mesenteric arteries. Endovascular treatment for symptomatic CMI represents a viable option, especially in high-operative risk patients. We report a case of acute symptomatic CMI with chronic totally occlusion of the superior mesenteric artery (SMA) associated with significant stenosis of celiac trunk (CT) and inferior mesenteric artery (IMA) that underwent endovascular treatment of all the three mesenteric arteries: stenting of CT and IMA stenosis, and recanalization of the SMA occlusion by retrograde crossing via the Villemin arcade.

  17. Dopamine-induced cyclic AMP increase in canine myocardium, kidney and superior mesenteric artery.

    Directory of Open Access Journals (Sweden)

    Kazuno,Hiroshi

    1982-04-01

    Full Text Available The effect of dopamine on cyclic AMP levels in tissue slices of canine myocardium and kidney, and in chopped superior mesenteric arterial wall was investigated to identify dopamine receptors. Tissues were incubated in modified Krebs-Henseleit Ringer bicarbonate solution at 37 degrees C for 20 min with test drugs, after 20-min preincubation. In the presence of 3-isobutyl-1-methylxanthine (IBMX, dopamine and apomorphine caused dose-dependent increases in cyclic AMP levels in the myocardium, kidney and superior mesenteric artery. Phentolamine significantly intensified the cyclic AMP-increasing effect of dopamine in the superior mesenteric artery, but it did not influence the cyclic AMP increase caused by dopamine or apomorphine in the myocardium and kidney. Propranolol markedly blocked the effect of dopamine on cyclic AMP levels in all tissues studied. Haloperidol slightly inhibited the effect of dopamine and completely blocked the effect of apomorphine in the myocardium and kidney. These data suggest that dopamine increases cyclic AMP levels by activating predominantly beta-adrenergic receptors and partly dopamine receptors in the canine myocardium, kidney and superior mesenteric artery. The present results also suggest that dopamine acts not only on beta-adrenergic and dopamine receptors but also on alpha-adrenergic receptors in the superior mesenteric artery. Contrary to the activation of beta-adrenergic and dopamine receptors, the activation of alpha-adrenergic receptors resulted in a decrease in cyclic AMP levels in this tissue.

  18. Intestinal brucellosis associated with celiac artery and superior mesenteric artery stenosis and with ileum mucosa and submucosa thickening

    Science.gov (United States)

    Wang, Miaoqian; Zhu, Qingli; Yang, Qian; Li, Wenbo; Wang, Xinning; Liu, Wei; Zhou, Baotong; Li, Zhenghong; Yang, Hong

    2017-01-01

    Abstract Rationale: Brucellosis is a multisystem infection found worldwide that has a broad range of characteristics, which range from acute fever and hepatomegaly to chronic infections that most commonly affect the central nervous system, cardiovascular system, or skeletal system. Gastrointestinal and splanchnic artery involvements in brucellosis are relatively uncommon. Patient concerns: We report a case of brucellosis in an adolescent presenting as intermittent abdominal pain, diarrhea, and fever, with intestinal tract involvement. And stenosis of the celiac artery and the superior mesenteric artery was found after exposed to risk factors of Brucella infection. Splanchnic vessels stenosis and an endothelial lesion may exacerbate the prevalent symptom of abdominal pain, as a form of colic pain, occurring after eating. Diagnoses: The patient was diagnosed as brucellosis. The narrowing of the SMA and CA was suspected to be vasculitis secondary to the brucellosis. Interventions: The patient was treated with minocycline and rifampicin for 12 weeks totally. Outcomes: The gastrointestinal manifestations of brucellosis recovered rapidly under intensive treatment. However, follow-up imaging revealed that the superior mesenteric artery and celiac artery stenosis was unimproved. Lessons: In brucellosis, gastrointestinal manifestations may be the only observable features of the disease. Splanchnic arterial stenosis is a rare complication of brucellosis. Sonography and computed tomography may be useful for both diagnosis and follow-up. PMID:28079834

  19. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation

    Directory of Open Access Journals (Sweden)

    Taylor J. Bergman

    2016-12-01

    Full Text Available Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male.

  20. Percutaneous treatment of a ruptured superior mesenteric artery aneurysm in a child

    Energy Technology Data Exchange (ETDEWEB)

    Oechsle, Susanne; Vollert, Kurt; Buecklein, Wolfgang; Michl, Wolfgang; Roemer, Frank W. [Klinikum Augsburg, Department of Radiology, Augsburg (Germany)

    2006-03-15

    Splanchnic artery aneurysms are very rare in children. We report a 10-year-old girl with a large atraumatic ruptured superior mesenteric artery aneurysm that was considered inoperable. She was ultimately treated with two percutaneous US-guided thrombin injections, which led to complete occlusion of the aneurysm. The aetiology of the aneurysm remained unclear, but a family history was suggestive of a congenital connective tissue disease such as Ehlers-Danlos syndrome subtype IV. (orig.)

  1. 放疗对上蒂横行腹直肌肌皮瓣乳房再造的影响%Impacts of radiation on reconstructed breasts by superior epigastric vessel pedicled transverse rectus abdominal myocutaneous in breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    路忠志; 肖春花; 李东生; 祝清华; 孙思敬; 李敏; 曹旭晨

    2015-01-01

    目的 评估放疗对上蒂横行腹直肌肌皮瓣(TRAM)乳房再造的影响.方法 回顾性分析2009年6月-2012年6月于天津医科大学肿瘤医院行上蒂TRAM术式乳腺癌490例,去除双乳再造18例,分为4组,A组即刻乳房再造+术后放疗组(123例),B组即刻乳房再造无放疗组(262例),C组放疗后择期乳房再造组(34例),D组延期乳房再造无放疗组(53例).主要评估指标为:术后3个月及术后或放疗后1年术后并发症及腹部功能、外观及心理学(BREAST-Q量表)评分,放疗对上蒂TRAM乳房再造的影响.结果 1.1%患者术后发生皮瓣坏死,2.5%切口延期愈合,1.1%血管栓塞,6.1%脂肪液化;7.0%患者术后发生脂肪坏死,5.3%再造乳房缩小,3.6%皮瓣挛缩,0.8%腹壁膨出及疝.与无放疗组患者相比,放疗组患者在肿瘤临床分期方面差异有统计学意义(P<0.05).本组平均随访时间(24.98 ±6.99)个月.在术后早期并发症方面差异均无统计学意义(均P>0.05),术后或放疗后晚期并发症方面差异有统计学意义(均P<0.05).各组患者在同一随访点对乳房美学、腹部功能与外观及心理学评价差异均无统计学意义(均P>0.05). 结论 TRAM乳房重建患者中,术前明确无需术后放疗者,可行即刻乳房重建;术后需放疗者,应在完成放疗后再行乳房重建.%Objective To assess the impact of radiation on superior epigastric vessel pedicled transverse rectus abdominal myocutaneous (TRAM) for breast reconstruction.Methods Female breast cancer patients were divided into 4 groups:group A (immediate breast reconstruction + radiation therapy,123 cases),group B (immediate breast reconstruction,262 cases),group C (radiation therapy + delayed breast reconstruction,34 cases),group D (delayed breast reconstruction,53 cases) from June 2009 to June 2012 at Department of Breast Oncology,Tianjin Medical University.Patient demographics,operative details,radiation therapy details

  2. Endovascular management of bilateral superior intercostal artery aneurysms following late repair of coarctation of the aorta.

    Science.gov (United States)

    Tapping, C R; Ettles, D F

    2011-08-01

    Endovascular management of massive bilateral superior intercostal artery aneurysms following late surgical repair of juxtaductal coarctation of the aorta is described in a 40-year-old male patient. Both aneurysms were successfully treated by coil embolisation without the need for further surgical intervention.

  3. Rare Anomalous Origin of Superior Left Pulmonary Artery from Left Subclavian Vein

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Tian-shi, E-mail: TerrenceLv@126.com; Wang, Chao, E-mail: wangchaoxs@163.com; Song, Li, E-mail: song9981@163.com; Lv, Yong-xing, E-mail: lyongxing@msn.com; Zou, Ying-hua, E-mail: yinghzou@139.com [Peking University First Hospital, Department of Interventional Radiology and Vascular Surgery (China)

    2013-10-15

    We report for the first time an extremely rare anomalous origin of the superior left pulmonary artery in a 60 year-old man. Although it was occult in clinical indications, such a malformation still ought to be considered, especially during endovascular procedures.

  4. Percutaneous stenting of the superior mesenteric artery for the treatment of chronic mesenteric ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Gweon, Hye Mi; Suh, Sang Hyun; Won, Jong Yun [Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Do Yun [Yonsei National College of Medicine, Seoul (Korea, Republic of); Kim, Sam Soo [Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2008-06-15

    We wanted to evaluate the effectiveness of stent placement on the superior mesenteric artery as a treatment for chronic mesenteric ischemia. Seven patients (mean age: 55 years, age range: 43-66 years) with chronic mesenteric ischemia were enrolled between March 2000 and September 2003. All the patients underwent pre-procedure contrast enhanced computerized tomography to evaluate for occlusion or stenosis of the mesenteric arteries and they then underwent an angiographic procedure. A balloon-expandable metal stent was placed in the superior mesenteric artery, and this was combined with balloon angioplasty and thrombolysis. We evaluated the angiographic and procedural success after the procedures. Angiographic and procedural success was obtained in 100% of the patients and the clinical symptoms improved in 100% of the patients. The patency at 6-months and 1-year was 85% and 71%, respectively. The mean follow-up period was 12 months (range: 1-25 months). During the follow-up period, ischemic symptoms recurred in 2 patients, and restenosis in a stent was confirmed with angiography; one patient was successfully treated by stent placement in the celiac artery and the other patient died due to extensive mesenteric thrombosis. For the treatment of chronic mesenteric ischemia, percutaneous stent placement on the superior mesenteric artery showed a favorable result and it was an effective alternative to surgery for the high-risk patients.

  5. Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization

    Directory of Open Access Journals (Sweden)

    Hyun Jeong Lee

    Full Text Available We present a case of pulmonary artery catheter (PAC placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.

  6. Morphine potentiates dextromethorphan-induced vasodilation in rat superior mesenteric artery.

    Science.gov (United States)

    Inan, Saadet; Tallarida, Ronald J

    2004-02-13

    The combined action of morphine and dextromethorphan on the superior mesenteric artery was investigated in this study. The artery was cut into rings, placed in a muscle bath and mounted to a force transducer for recording tension. Rings preconstricted with 1 microM phenylephrine produced a dose-dependent relaxation to graded doses of dextromethorphan but showed no response to morphine. An equimolar combination of morphine and dextromethorphan exhibited a marked synergism quantitated by a factor of 3.7 (1.8-7.7, 95% CI). Naloxone, which had no effect on the dextromethorphan dose-response relation, abolished the synergism. Removal of the endothelium produced a slight attenuation of the morphine-dextromethorphan synergism, but the magnitude of this attenuation was the same when dextromethorphan alone was examined in the denuded preparation. In contrast to the marked synergism seen in the mesenteric artery preparation, similar experiments on the carotid artery and the aorta produced only additive interactions.

  7. Reconstruction of intraoral defects with superior labial artery musculo-mucosal flap: a preliminary clinical study.

    Science.gov (United States)

    Güven, Erdem; Uğurlu, Alper Mete; Başaran, Karaca; Basat, Salih Onur; Yiğit, Bariş; Hafiz, Günter; Kuvat, Samet Vasfi

    2010-01-01

    In this article, we present the use of the superior labial artery musculo-mucosal (SLAMM) flap for intraoral reconstruction. The study included five patients (2 females, 3 males; mean age 36 years; range 11 to 56 years) who consulted at our clinic between October 2008 and January 2010. Five oral defects were reconstructed with the SLAMM flap. Three patients underwent reconstruction with SLAMM flap following oncologic resection. The other two patients had traumatic defects in the oral cavity which necessitated flap application. First, the distal end of the flap was incised and the superior labial artery was identified after dissection. After ligation of the artery, the mucosa, submucosa and the cuff of orbicularis oris muscle were elevated. The dissection was extended laterally and anteriorly, depending on the necessary flap size. None of the patients had partial or total flap necrosis. During the follow-up period, contracture developed in only one patient. Successful reconstruction was observed in all patients. The superior labial artery musculo-mucosal flap is a simple and feasible technique which can be used for reconstruction of intraoral defects.

  8. [Duplex scanning of hemodynamic parameters of the celiac trunk and superior mesenteric artery in healthy volunteers].

    Science.gov (United States)

    Kuntsevich, G I; Shilenok, D V

    1993-07-01

    The possibility of studying the hemodynamics in the visceral arteries of the abdominal aorta by duplex scanning was demonstrated. The results of examination of 30 healthy persons are discussed. Characteristic features of the blood flow spectrogram of the celiac trunk and superior mesenteric artery were revealed. According to the spectrogram, the flow of blood in the celiac trunk is characterized by rapidly increasing peak systolic rate and slowly diminishing diastolic rate to approximately 1/3 of the maximal value of systole. The character of the blood flow in the superior mesenteric artery is distinguished by a lesser peak systolic rate and the presence of a short-lived reverse rate before the sloping diastolic curve. Normal values of the blood flow volume rate were determined, it was 649 +/- 25.4 ml/min in the celiac trunk and 395 +/- 20.5 ml/min in the superior mesenteric artery. Among the advantages of the duplex scanning method are noninvasiveness and safety and the possibility of dynamic study of the hemodynamic parameters.

  9. Trauma to the Superior Mesenteric Artery and Superior Mesenteric Vein: A Narrative Review of Rare but Lethal Injuries.

    Science.gov (United States)

    Phillips, B; Reiter, S; Murray, E P; McDonald, D; Turco, L; Cornell, D L; Asensio, J A

    2017-09-05

    Mesenteric vessels, including the superior mesenteric artery (SMA) and vein (SMV), provide and drain the rich blood supply of the midgut and hindgut. SMA and SMV injuries are rare and often lethal. Clinical management of these injuries is not well established, but treatment options include operative, non-operative, and endovascular strategies. A narrative review of the literature was conducted using MEDLINE Complete-EBSCO. Relevant studies, specifically those focusing on diagnosis and management of SMA and SMV injuries, were selected. Only original reports and collected series were selected to prevent duplication of cases. A search of the literature for mesenteric arterial injuries yielded 87 studies. Vessel-specific breakdown of the studies yielded 40 with SMA injuries and 41 with SMV injuries. These searches were winnowed to 26 individual studies, which were included in this collective review. Limitations of this study are similar to all narrative literature reviews: the dependence on previously published research and availability of references as outlined in our methodology. Although historically rare, mesenteric vessel injuries are seen with increasing incidence and continue to present a challenge to trauma surgeons due to their daunting mortality rates. Currently, universal treatment guidelines do not exist, but the various options for their management have been extensively reviewed in the literature.

  10. Umbilical and epigastric hernia repair.

    Science.gov (United States)

    Muschaweck, Ulrike

    2003-10-01

    The repair of umbilical and epigastric hernias still represents a challenge to surgeons. Although a common and relatively simple procedure, there is no exact protocol today on how the repair should be done. The Mayo technique and its alterations could not stand the test of time: a recurrence rate of 20% and higher is not acceptable for any surgical procedure. Although there is no consensus opinion, one thing is clear: the importance of an anatomic repair without tension and without an artificial enlargement of the defect. In 1987 Lichtenstein reported on 6321 cases of herniorraphy with a tension free repair, and in 1994 Stuart reemphasized that special importance in his editorial in the Lancet. A newer study from Brancato and coworkers in Italy also states the advantage of a tension-free prosthetic repair in 16 patients with epigastric hernia. We have gone even further and recommend a tailored-to-the-patient repair using a customized polypropylene mesh and a one-layer running suture. The advantages should be obvious: no artificial creation of an even bigger than original defect, a completely tension-free repair, and little to no recurrence of the hernia. Our results clearly prove that assumption. Moreover, the procedure is extremely safe and complications are very rare and minor. We conclude that using a mesh plug in a customized tension-free repair of umbilical and epigastric hernia shows many advantages over the commonly used methods. And we finally conclude with the words of Albert Einstein: "The only source of knowledge is experience."

  11. The Anatomic Course of the First Jejunal Branch of the Superior Mesenteric Vein in Relation to the Superior Mesenteric Artery

    Directory of Open Access Journals (Sweden)

    Pavlos Papavasiliou

    2012-01-01

    Full Text Available Introduction. The purpose of this study is to determine the anatomic course of the first jejunal branch of the superior mesenteric vein (SMV in relation to the superior mesenteric artery (SMA. Methods. Three hundred consecutive contrast-enhanced computed tomography (CT scans were reviewed by a surgical oncologist with confirmation of findings by a radiologist. Results. The overall incidence of a first jejunal branch coursing anterior to the SMA was 41%. There was no correlation between patient gender and position of the jejunal branch. In addition, there was no correlation between size of the first jejunal branch and its location in relation to the SMA. The IMV drained into the SMV in 27% of the patients. The IMV drained into the SMV-portal vein confluence in 17% of patients and inserted into the splenic vein in 54%. An anterior coursing first jejunal branch statistically correlated with an IMV that drained into the SMV-portal vein confluence (=0.009. Conclusion. The first jejunal branch of the SMV has a highly variable course in relation to the SMA and has a higher incidence of an anterior location in this population than previously reported.

  12. Aneurysm of the Superior Posterior Pancreatic-Duodenal Artery Presenting with Recurrent Syncopes

    Directory of Open Access Journals (Sweden)

    I.A.J. van Doesburg

    2009-08-01

    Full Text Available We present a 61-year-old woman with hypovolemic shock due to a ruptured aneurysm of the superior posterior pancreatic-duodenal artery in whom recurrent syncopes were the first presenting sign of pancreatic-duodenal artery aneurysm (PDAA. PDAA is a rare but life-threatening condition. The widely varying symptomatology may lead to a delay in diagnosis and treatment. Patients with atypical symptoms, such as vague abdominal pain, recurrent dizziness or syncope, may actually suffer from a sentinel bleeding of the vascular malformation. Radiological imaging, especially selective angiography, may provide a diagnostic as well as a therapeutic tool in these patients.

  13. Successful recanalization of acute superior mesenteric artery thrombotic occlusion with primary aspiration thrombectomy

    Institute of Scientific and Technical Information of China (English)

    Hye; Jin; Yang; Young; Kwon; Cho; Yun; Ju; Jo; Yoon; Young; Jung; Seung; A; Choi; Suk; Hoon; Lee

    2010-01-01

    Prompt revascularization of the superior mesenteric artery(SMA) thrombotic occlusion can prevent intestinal infarction and decrease necrosis of the bowel segment.Herein,we describe two cases who underwent successful endovascular recanalization for acute SMA thrombosis using a primary aspiration thrombectomy because of possible consequent laparotomy for survey of bowel viability.The two patients had dramatic pain reliefimmediately after the procedure and remained symptomfree during the follow-up period.

  14. Traumatic pseudoaneurysm of the superior rectal artery with recurrent lower gastrointestinal and pelvic extraperitoneal bleeding: Importance of pretreatment recognition

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Joon; Seo, Jung Wook; Kim, You Sung [Dept. of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of)

    2015-01-15

    Traumatic pseudoaneurysm of the superior rectal artery is a rare cause of massive lower gastrointestinal bleeding. We reported a case of a 43-year-old male patient with pseudoaneurysm following a penetrating perineal wound. The patient had repeat massive lower gastrointestinal and pelvic extraperitoneal bleeding and was diagnosed as traumatic pseudoaneurysm of the superior rectal artery. To our knowledge, there are three case reports of traumatic pseudoaneurysm of the superior rectal artery treated by embolization. However, spontaneous regression occurred in the study subject after surgical hematoma removal, without any further pseudoaneurysm resection.

  15. Evaluation of the posterior superior alveolar artery and the maxillary sinus with CBCT

    Directory of Open Access Journals (Sweden)

    Dilhan Ilguy

    2013-09-01

    Full Text Available Assessment of the maxillary sinus anatomy before sinus augmentation is important for avoiding surgical complications, because of the close anatomical relationship between the posterior maxillary teeth and the maxillary sinus. The posterior superior alveolar artery (PSAA is the branch of the maxillary artery that supplies the lateral sinus wall and overlying membrane. We evaluated the location of the PSAA and its relationship to the alveolar ridge and maxillary sinus using cone beam computed tomography (CBCT. The study group consisted of 135 CBCT scans (270 sinuses obtained from the archive of the dentomaxillofacial radiology department at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. The distance between the lower border of the artery and the alveolar crest, bone height from the sinus floor to the ridge crest, distance from the artery to the medial sinus wall, and the diameter and location of the artery were determined. The occurrence of septa and pathology were recorded from CBCT scans. The PSAA was observed in 89.3% of sinuses, and 71.1% of arteries were intraosseous with diameters mostly < 1 mm (68.9%. The prevalence of sinus septa was 55.2%, and that of sinus pathology was 57.4%. The mean age was 43.07 ± 17.55 years. There was a statistically significant difference between the location of the artery and gender (p < 0.05. The prevalence of sinus membrane thickening was 57.4%. Detailed knowledge about the location of the PSAA and sinus morphology may be obtained with CBCT before maxillary sinus surgery.

  16. Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery

    Energy Technology Data Exchange (ETDEWEB)

    Hur, Saebeom; Chung, Jin Wook; Lee, Jae Hwan; Cho, SooBeum; Kim, Minuk; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Zhou, Chun Gao [First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology, Nanjing, Jangsu (China)

    2017-04-15

    To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey's superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA). From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries. The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery. Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time. (orig.)

  17. Role of Doppler ultrasonography evaluation of superior mesenteric artery flow volume in the assessment of Crohn's disease activity

    Directory of Open Access Journals (Sweden)

    Fabiana Paiva Martins

    2013-09-01

    Full Text Available Objective To investigate superior mesenteric artery flow measurement by Doppler ultrasonography as a means of characterizing inflammatory activity in Crohn's disease. Materials and Methods Forty patients were examined and divided into two groups – disease activity and remission – according to their Crohn's disease activity index score. Mean superior mesenteric artery flow volume was calculated for each group and correlated with Crohn's disease activity index score. Results The mean superior mesenteric artery flow volume was significantly greater in the patients with active disease (626 ml/min ± 236 × 376 ml/min ± 190; p = 0.001. As a cut off corresponding to 500 ml/min was utilized, the superior mesenteric artery flow volume demonstrated sensitivity of 83% and specificity of 82% for the diagnosis of Crohn's disease activity. Conclusion The present results suggest that patients with active Crohn's disease have increased superior mesenteric artery flow volume as compared with patients in remission. Superior mesenteric artery flow measurement had a good performance in the assessment of disease activity in this study sample.

  18. Thoraco-epigastric flap for breast reconstruction in cancer

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhayev,

    2015-01-01

    Full Text Available Reconstructive surgery for breast cancer are an integral method of rehabilitation of cancer patients. Breast reconstruction may be delayed and instantaneous. The article presents a description of the thoraco-epigastric flap for breast reconstruction in cancer. The operation involves the replacement of the remote volume (after radical resection of the breast and the breast skin adjacent tissues adjacent to the inframammary crease from the side of the anterior abdominal wall. Surgery is indicated when the tumor in the lower parts of the breast, closest to the skin, in combination with small size breast cancer. The article presents a clinical example of this operation. Described in detail the operation, received a good cosmetic result. The advantage of the application of thoraco-epigastric flap is in the simplicity of the technique of its execution, good blood supply, donor wound is easily sutured due to the possible wide separating cellular adjacent skin and subcutaneous tissue. The disadvantage of this method is limited and the need for careful monitoring of perforating branches of the upper epigastric artery. Thus, thoraco-epigastric flap, can be applicable when performing reconstructive operations for breast cancer in compliance with the necessary requirements for the formation of the flap and the correct attitude to feeding the flap vessels, and virtually eliminates possible complications with the healing of the flap. Undoubtedly, reconstructive plastic surgery for breast cancer, during the testimony and technical capabilities, are an essential component of surgical treatment.

  19. [Rupture of a superior mesenteric artery aneurysm in pediatric age: case report and literature review].

    Science.gov (United States)

    Gander, R; Pérez, M; Bueno, J; Lara, A; Segarra, A; Martínez, M A; Lloret, J

    2015-01-13

    Splanchnic artery aneurysms are rare in children. High mortality from rupture justifies its treatment, with various therapeutic options among which stand out surgery and recently, endovascular treatment. A 11 year old girl presented with abdominal pain and sudden drop in hematocrit. The urgent abdominal CT angiography showed a saccular aneurysm of the superior mesenteric artery (SMA) at 4 cm from the ostium with dissection and active bleeding. A selective angiography was performed which confirmed the dissection. A self-expanding stent was placed in the main trunk of the SMA and a transcatheter coil and onyx embolization of the aneurysm was performed. The control angiogram showed no evidence of residual perfusion of the false lumen and demonstrated proper vascularization of the distal jejunum-ileal branches. Dual antiplatelet therapy with aspirin and dipyridamole was begun. After 24 months of follow-up the patient is asymptomatic. Endovascular treatment of a SMA aneurysm is effective in the pediatric patient, even in emergency situations.

  20. Flow-dependent regulation of vascular function and gene expression in rat superior mesenteric artery

    Institute of Scientific and Technical Information of China (English)

    XIA Shang; DENG Chang-sheng

    2009-01-01

    Background Mesenteric artery thrombosis is prone to occur at specific arterial regions with different fluid flow patterns,yet mechanistic links between blood flow and vascular function remain unclear. This study aired to investigate the role of blood flow in regulation of vascular function and gene expression in rats.Methods Isometric tension was recorded in wire myograph to examine vascular function of specific regions (trunk parts and proximal parts from the origin) with different blood flow in superior mesenteric artery (SMA). Endothelial nitric oxide syntheses (eNOS), phosphorylated-eNOS (p-eNOS), serine-threonine kinase Akt and phosphorylated-Akt (p-Akt) protein expressions in SMA were examined by Western blotting. Significance was analyzed using a Student's ttest or analysis of variance (ANOVA) followed by a Dunnett's multiple-comparison post hoc test.Results Compared with trunks, proximal parts exhibited severely impaired relaxant responses to acetylcholine (Ach) (1 nmol/L to 10 pmol/L) (P 0.05).Conclusion Critical components that drive the vascular function and influence the localization of mesenteric artery thrombosis are flow-responsive elements within the vascular endothelium.

  1. Fusiform superior cerebellar artery aneurysm treated with STA-SCA bypass and trapping

    Directory of Open Access Journals (Sweden)

    Fabricio C Lamis

    2014-01-01

    Full Text Available Background: Fusiform aneurysms of cerebellar arteries are rare. Different surgical techniques to address these challenging lesions have been described, and their application depends on whether the goal is to maintain the flow in the parent vessel or to occlude it. Case Description: The authors reported a case of a fusiform aneurysm located in the lateral pontomesencephalic segment of the superior cerebellar artery (SCA in a 32-year-old man who presented with subarachnoid hemorrhage. The patient was subjected to aneurysm trapping followed by a bypass between the superficial temporal artery (STA and SCA and had an uneventful recovery. Conclusions: Although only a few cases of fusiform aneurysms in the supracerebellar artery have been reported in the literature, the treatment strategies adopted were diverse. In selected cases of patients in good neurological condition with ruptured fusiform aneurysms at the proximal segments of SCA and who have poor evidence of collateral supply, the possibility of a STA-SCA bypass with aneurysm trapping must be considered. A review of the current treatment modalities of this pathology is also presented.

  2. Anatomical study on the "perforator-free zone": reconsidering the proximal superior cerebellar artery and basilar artery perforators.

    Science.gov (United States)

    Garcia-Gonzalez, Ulises; Cavalcanti, Daniel D; Agrawal, Abhishek; Spetzler, Robert F; Preul, Mark C

    2012-03-01

    The proximal superior cerebellar artery (pSCA) is often considered a perforator-free area. Precise anatomical knowledge of this region clarifies the pathophysiology underlying posterior fossa ischemic syndromes and helps avoid treatment-related complications. To anatomically evaluate perforating branches arising from the pSCA and the upper basilar artery (BA). Forty-four SCAs from 20 cadaveric heads were examined to determine patterns of the pSCA; its morphometry for medial and lateral branches; and frequency, number, diameter, distribution, and vascular territory of perforators arising from the pSCA and rostral BA. SCA arose as a single trunk in 36 sides (90%): mean diameter at origin was 1.38 mm; mean length was 14.4 ± 7.9 mm. Ninety-nine pSCA perforator branches were present in 82% of specimens (mean, 2.3 ± 1.6; range, 0-7 perforators/side). Of these, 59% were direct, belonging to the interpeduncular group in 85% of cases; 28% were short circumflex, belonging to lateral and medial pontine group; and 13% were long circumflex, reaching the medullary perforation zone (basal cerebellar group). Median distance to the first perforator was 2.0 mm (range, 0.1-15 mm). There were 132 perforator branches in the last centimeter of the BA. The pSCA should not be regarded as a perforator-free area. Although the pSCA territories likely overlap with the posterior cerebral artery, BA, and anterior inferior cerebellar artery, the pSCA segment cannot be surgically manipulated with impunity.

  3. Sanjad-Sakati Syndrome and Its Association with Superior Mesenteric Artery Syndrome

    Directory of Open Access Journals (Sweden)

    Osamah Abdullah AlAyed

    2014-01-01

    Full Text Available Sanjad-Sakati syndrome (SSS is an autosomal recessive disorder found exclusively in people of Arabian origin. It was first reported in the Kingdom of Saudi Arabia in 1988 and confirmed by a definitive report in 1991. The syndrome comprises of congenital hypoparathyroidism, seizures, severe growth and developmental retardation, low IQ, and atypical facial features. Supportive treatment in the form of vitamin D and growth hormone supplementation is often offered to patients suffering from SSS. This case study focuses on the steps taken to help a patient who was found to have very unusual symptoms and was later found to have superior mesenteric artery syndrome.

  4. Unusual Complication of Superior Mesenteric Artery Syndrome: Spontaneous Upper Gastrointestinal Bleeding with Hypovolemic Shock

    Directory of Open Access Journals (Sweden)

    Kai-Hsiung Ko

    2009-01-01

    Full Text Available Superior mesenteric artery (SMA syndrome is an unusual form of duodenal obstruction. Complications of SMA syndrome may sometimes develop and are usually associated with marked gastric dilatation, although most complications can be corrected by supportive treatment. In this article, we report a case of severe SMA syndrome with hypovolemic shock in a 24-year-old man. Multidetector-row computed tomography with reconstructed images was performed to establish the diagnosis. Spontaneous gastrointestinal bleeding is an extremely uncommon complication of SMA syndrome, and emergent surgical intervention was unavoidable in our patient. To our knowledge, no other such case has been reported in the English-language literature.

  5. Seatbelt syndrome with superior mesenteric artery syndrome: leave nothing to chance!

    Science.gov (United States)

    Singla, Animesh A; Singla, Apresh A

    2015-11-12

    The introduction of seatbelts to legislation has dramatically reduced mortality and morbidity from motor vehicle accidents. However, overtime evidence has emerged of 'seatbelt syndrome' (SBS), particularly in the paediatric population. The report describes the diagnosis and management of this rare injury in a 12-year-old boy who sustained a chance lumbar fracture and mesenteric tear resulting in small bowel obstruction. His stay was subsequently complicated by superior mesenteric artery (SMA) syndrome. This is the first documented case of SBS with SMA syndrome. High index of suspicion and continuity of care, particularly in the setting of a 'seatbelt sign', is paramount to timely diagnosis and management.

  6. Superior mesenteric artery (SMA) syndrome: an unusual cause of intestinal obstruction in palliative care.

    Science.gov (United States)

    So, Chun-Yan; Chan, Kwok-Ying; Au, Ho-Yan; Chan, Man-Lui; Lai, Theresa

    2017-01-01

    Superior mesenteric artery (SMA) syndrome is an uncommon cause of intestinal obstruction and seldom been mentioned in palliative care. Hereby, we reported a case of SMA syndrome who presented with symptoms of upper intestinal obstruction in a 68-year-old patient; subsequent CT findings were classical of SMA syndrome. The patient's history of poliomyelitis and recent significant weight loss were the predisposing factors for SMA syndrome. It also highlights the importance of monitoring signs and symptoms of intestinal obstruction in such patients before considering switching to oral feeding.

  7. Superior Mesenteric Artery Syndrome—Believe in it! Report of a Case

    Directory of Open Access Journals (Sweden)

    Sante Capitano

    2012-01-01

    Full Text Available We present a case of a man with amyotrophic lateral sclerosis who developed superior mesenteric artery syndrome (SMAS following the confection of feeding jejunostomy. He was successfully managed by conservative treatment. Left lateral positioning during enteral feeding allowed quick resolution of the occlusive state. Various surgical interventions have been associated with SMAS, directly or indirectly, by reducing the width of the aortomesenteric angle. The operative stress was probably what triggered symptomatology in our patient thus to conclude that the surgical stress should be considered as a causal factor triggering the SMAS in a context of other predisposing factors.

  8. Delayed-Onset Superior Mesenteric Artery Syndrome Presenting as Oesophageal Peptic Stricture

    Directory of Open Access Journals (Sweden)

    Emanuele Sinagra

    2012-02-01

    Full Text Available Superior mesenteric artery (SMA syndrome is an infrequent cause of vomiting and weight loss due to compression of the third part of the duodenum by the SMA. We describe the case of a 17-year-old woman, admitted to our department for progressive dysphagia and severe weight loss due to an oesophageal peptic stricture, caused by chronic acid reflux secondary to duodenal compression by the SMA. Symptoms improved after (parenteral nutrition and repeated oesophageal dilatation, thus supporting the role of intensive medical and endoscopic intervention as an alternative to surgery, at least in some cases.

  9. Endoscopy-based early enterostomy closure for superior mesenteric arterial occlusion

    Institute of Scientific and Technical Information of China (English)

    Takatsugu; Oida; Hisao; Kano; Kenji; Mimatsu; Atsushi; Kawasaki; Youichi; Kuboi; Nobutada; Fukino; Sadao; Amano

    2010-01-01

    AIM:To evaluate the efficacy of endoscopic examination of blood flow and edema in the remnant bowel.METHODS:We retrospectively studied 15 patients who underwent massive bowel resection with enterostomy for superior mesenteric arterial occlusion (SMAO); the patients were divided into a delayed closure group (D group) and an early closure group (E group).RESULTS:The mean duration from initial operation to enterostomy closure was significantly shorter in the E group (18.3 ± 2.1 d) than in the D group (34.3 ± 5...

  10. Small bowel volvulus in pregnancy with associated superior mesenteric artery occlusion.

    Science.gov (United States)

    Esterson, Yonah B; Villani, Robert; Dela Cruz, Ronald A; Friedman, Barak; Grimaldi, Gregory M

    Here we report the case of a pregnant 28-year-old who presented with acute upper abdominal pain. CT demonstrated midgut volvulus with short segment occlusion of the superior mesenteric artery (SMA). Emergent detorsion of the small bowel was performed, at which time underlying intestinal malrotation was discovered. Following detorsion, the SMA had a bounding pulse and did not require thrombectomy or revascularization. Fewer than 25 cases of midgut volvulus during pregnancy have been reported over the past 20years. To our knowledge, this is the first report of maternal midgut volvulus in which imaging captures the resultant occlusion of the SMA.

  11. Sacral pressure sore reconstruction -- the pedicled superior gluteal artery perforator flap.

    Science.gov (United States)

    Hurbungs, A; Ramkalawan, H

    2012-02-14

    To report the use of the pedicled superior gluteal artery perforator (SGAP) fasciocutaneous flap as a reliable surgical option for sacral pressure sore reconstruction. A prospective study was conducted between September 2008 and September 2010 of 10 patients with stage 3 or 4 sacral pressure sores treated with a unilateral pedicled SGAP flap. All flaps survived completely with no complications in 9 patients. One patient had a haematoma below the flap that was easily drained. No recurrence of the bedsore occurred during follow-up. We suggest that the pedicled SGAP fasciocutaneous flap is a reliable surgical option for sacral pressure sore reconstruction.

  12. A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

    Science.gov (United States)

    Casal, Diogo; Pais, Diogo; Iria, Inês; Mota-Silva, Eduarda; Almeida, Maria-Angélica; Alves, Sara; Pen, Cláudia; Farinho, Ana; Mascarenhas-Lemos, Luís; Ferreira-Silva, José; Ferraz-Oliveira, Mário; Vassilenko, Valentina; Videira, Paula A.; Gory O'Neill, João

    2017-01-01

    Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat. This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue. Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training. PMID:28117814

  13. Superior Mesenteric Artery Syndrome due to a Vertebral Hemangioma and Postpartum Osteoporosis following Treatment

    Directory of Open Access Journals (Sweden)

    Mehmet Elmadag

    2015-01-01

    Full Text Available In pregnancy, advanced vertebral hemangiomas may be seen, and these require treatment. The case reported here is of a 35-year-old female in the 32nd week of pregnancy who was admitted to the orthopaedics clinic with a history of backache and difficulty walking. A burst fracture of L1 associated with a vertebral hemangioma was identified with an L3 compression fracture secondary to osteoporosis. The local kyphosis angle between T12 and L2 was 27°. Kyphotic deformity was corrected and postoperatively, the measured T12–L2 local kyphotic angle was 9°. Twelve hours postoperatively, oral nutrition was allowed, but she developed nausea and vomiting and twenty-four hours postoperatively, an electrolyte imbalance developed. Postoperatively, the patient was diagnosed with superior mesenteric artery syndrome. To the best of our knowledge, this is the first reported case of superior mesenteric artery syndrome, which occurred following the correction of a kyphotic deformity that had developed secondary to an advanced hemangioma in pregnancy.

  14. Changes in superior mesenteric artery Doppler waveform during reduction of cardiac stroke volume and hypotension

    DEFF Research Database (Denmark)

    Perko, M J; Perko, Grazyna; Just, S

    1996-01-01

    Influence of stroke volume reduction and hypotension on the superior mesenteric artery (SMA) Doppler waveform was evaluated during head-up tilt-induced central hypovolemia in 11 healthy volunteers. During normotensive reduction in stroke volume, peak systolic velocity (pV), mean velocity, pulsati......Influence of stroke volume reduction and hypotension on the superior mesenteric artery (SMA) Doppler waveform was evaluated during head-up tilt-induced central hypovolemia in 11 healthy volunteers. During normotensive reduction in stroke volume, peak systolic velocity (pV), mean velocity...... of the study indicate that alterations in stroke volume induce consequential changes in the SMA Doppler waveform. These changes originate from both direct influence of stroke volume and/or pressure on blood flow velocity, and alterations in SMA peripheral resistance that follow variations in stroke volume....... Presented interdependencies should be taken into consideration while studying mesenteric physiology with the use of Doppler technique and while interpreting the duplex results in patients suffering from diseases that may influence flow velocity and mimic or obscure Doppler effects of the SMA stenosis....

  15. Superior mesenteric arterial branch occlusion causing partial jejunal ischemia: a case report

    Directory of Open Access Journals (Sweden)

    Van De Winkel Nele

    2012-02-01

    Full Text Available Abstract Introduction Ischemic bowel disease comprises both mesenteric ischemia and colonic ischemia. Mesenteric ischemia can be divided into acute and chronic ischemia. These are two separate entities, each with their specific clinical presentation and diagnostic and therapeutic modalities. However, diagnosis may be difficult due to the vague symptomatology and subtle signs. Case presentation We report the case of a 68-year-old Caucasian woman who presented with abdominal discomfort, anorexia, melena and fever. A physical examination revealed left lower quadrant tenderness and an irregular pulse. Computed tomography of her abdomen as well as computed tomography enterography, enteroscopy, angiography and small bowel enteroclysis demonstrated an ischemic jejunal segment caused by occlusion of a branch of the superior mesenteric artery. The ischemic segment was resected and an end-to-end anastomosis was performed. The diagnosis of segmental small bowel ischemia was confirmed by histopathological study. Conclusion Mesenteric ischemia is a pathology well-known by surgeons, gastroenterologists and radiologists. Acute and chronic mesenteric ischemia are two separate entities with their own specific clinical presentation, radiological signs and therapeutic modalities. We present the case of a patient with symptoms and signs of chronic mesenteric ischemia despite an acute etiology. To the best of our knowledge, this is the first report presenting a case of acute mesenteric ischemia with segmental superior mesenteric artery occlusion.

  16. Mesenteric lymph reperfusion exacerbates spleen injury caused by superior mesenteric artery occlusion shock

    Energy Technology Data Exchange (ETDEWEB)

    Li, L.L.; Zhang, C.H.; Liu, J.C.; Yang, L.N.; Niu, C.Y.; Zhao, Z.G. [Institute of Microcirculation, Hebei North University, Zhangjiakou, Hebei, China, Institute of Microcirculation, Hebei North University, Zhangjiakou, Hebei (China)

    2014-04-15

    The intestinal lymph pathway plays an important role in the pathogenesis of organ injury following superior mesenteric artery occlusion (SMAO) shock. We hypothesized that mesenteric lymph reperfusion (MLR) is a major cause of spleen injury after SMAO shock. To test this hypothesis, SMAO shock was induced in Wistar rats by clamping the superior mesenteric artery (SMA) for 1 h, followed by reperfusion for 2 h. Similarly, MLR was performed by clamping the mesenteric lymph duct (MLD) for 1 h, followed by reperfusion for 2 h. In the MLR+SMAO group rats, both the SMA and MLD were clamped and then released for reperfusion for 2 h. SMAO shock alone elicited: 1) splenic structure injury, 2) increased levels of malondialdehyde, nitric oxide (NO), intercellular adhesion molecule-1, endotoxin, lipopolysaccharide receptor (CD14), lipopolysaccharide-binding protein, and tumor necrosis factor-α, 3) enhanced activities of NO synthase and myeloperoxidase, and 4) decreased activities of superoxide dismutase and ATPase. MLR following SMAO shock further aggravated these deleterious effects. We conclude that MLR exacerbates spleen injury caused by SMAO shock, which itself is associated with oxidative stress, excessive release of NO, recruitment of polymorphonuclear neutrophils, endotoxin translocation, and enhanced inflammatory responses.

  17. Changes of Blood Flow Volume in the Superior Mesenteric Artery and Brachial Artery with Abdominal Thermal Stimulation

    Directory of Open Access Journals (Sweden)

    Shin Takayama

    2011-01-01

    Full Text Available In traditional Chinese medicine, moxibustion is a local thermal therapy that is used for several conditions. Quantifying the effects of moxibustion therapy has been difficult because the treatment temperature depends on the physician's experience, and the temperature distribution in the target area is not uniform. This prospective observational study aims to quantify the effect of local thermal stimulation to the abdomen. We developed a heat transfer control device (HTCD for local thermal stimulation. Twenty-four healthy subjects were enrolled and they underwent abdominal thermal stimulation to the para-umbilical region with the device for 20 min. Blood flow volume in the superior mesenteric artery (SMA and brachial artery (BA, the heart rate and the blood pressure were measured at rest, 15 min after starting thermal stimulation and 10, 20, 30 and 40 min after completing thermal stimulation. Blood flow parameters were measured by high-resolution ultrasound. In the SMA, blood flow volume was significantly increased during thermal stimulation (, as well as at 10 min ( and 20 min ( after stimulation. In the BA, blood flow volume decreased at 40 min after stimulation (. In conclusion we could quantify the effect of local thermal stimulation with an HTCD and high-resolution ultrasound. Thermal stimulation of the para-umbilical region increased blood flow in the SMA 20 min after stimulation in healthy subjects.

  18. Pseudo-occlusion of the anastomotic pathway between the celiac and superior mesenteric arteries in 15 cases

    Institute of Scientific and Technical Information of China (English)

    QI Yue-yong; ZOU Li-guang; WANG Wen-xian; XU Jian; CHEN Wei-jun; LIANG Ping

    2004-01-01

    To study the causes and value of the pseudo-occlusion of the anastomotic pathway between celiacand superior mesenteric arteries. Methods: 15 patients including 12 patients with hepatocellular carcinoma and 3 patients withhepatic hemangioma underwent superior mesenteric arteriography (SMA) and celiac arteriography (CA) in interventional thera-py. The angiographic features of the 15 cases were dynamically observed by 2 experienced radiologists in double-blind manner.Results: Similar interpretations were given by the 2 radiologists. In CA,pseudo-ooclusion occurred at the bifurcation of thecommon hepatic artery and the celiac artery in 8 cases, at the bifurcation of the common hepatic artery and the gastroduodenalartery in 6 cases and at the bifurcation of the right hepatic artery and the celiac artery in 1 case. No occlusion was found inSMA and the angiographic wire and catheter could pass easily through the occluded regions seen in CA. Conclusion: Pseudo-occlusion of the anastomotic pathway between the superior mesenteric and celiac arteries is rare phenomenon. Its cause was notidentified in our cases. It may result from the hemodynamic change or abnormality of the hepatic artery. It is very important tounderstand the existence of pseudo-occlusion in order to guide the catheterization in interventional therapy.

  19. Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome

    Institute of Scientific and Technical Information of China (English)

    Andres; Vargas-Estrada; Dianna; Edwards; Mohammad; Bashir; James; Rossen; Firas; Zahr

    2015-01-01

    Saphenous vein grafts(SVG) pseudoaneurysms,especially giant ones,are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina,dyspnea,myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain,dyspnea and was noted to have significantly engorged neck veins. In the emergency department,a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery(RPDA). This imaging modality also demonstrated compression of the superior vena cava(SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films,a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVCcompression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary,saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications,the patency of the affected vein graft and the involved myocardial territory viability.

  20. Tapered self expandable bare stent to treat acute superior mesenteric artery ischemia.

    Science.gov (United States)

    Martinez Miguez, Marta; Carballo-Fernandez, Coral; Mosquera-Arochena, Nilo

    2012-01-01

    This case demonstrates the use of carotid stents in off-label emergency condition where standard self-expandable stents doesn't fit to native artery and balloon-expandable stents could not be also recommended. 56 years old patient, EVAR therapy performed 2 months before, suffering acute severe abdominal pain; emergency angioCT showed oclusion of superior mesenteric artery (SMA) and no complications related to previous EVAR. A percutaneuos supraselective trombolysis was performed. After 24 hours control DSA showed partial recanalization and tight stenoses in distal SMA with poor run-off to terminal branches. A 6-8 x 40 mm Carotid Stent (Acculink®, Abbot Vascular) was implanted with good inmediate technical result. After 6 months follow up both SMA and branches remain patent and no further treatment was required. tapered self expandable uncovered stents are a good treatment option to achieve better conformability to SMA,and bare metal stents do not compromise side-branches of this artery.

  1. Isolated superior mesenteric artery thrombosis: a rare cause for recurrent abdominal pain in a child.

    Science.gov (United States)

    Dahshan, Ahmed; Donovan, Kevin

    2002-01-01

    A 4-year-old boy was evaluated for recurrent abdominal pain and failure to thrive over a 1-year period in a pediatric subspecialty clinic. Results of the extensive workup mostly were unremarkable. Eventually, imaging studies of the abdominal aorta revealed an isolated thrombosis of the superior mesenteric artery trunk and compensatory hypertrophy of the inferior mesenteric artery. He had been having abdominal angina symptoms and fear of eating. A detailed family history suggested a possible hypercoagulable state. However, an extensive hematologic evaluation did not reveal a recognizable defect that could produce thrombotic events. He was treated by arterial graft bypass surgery and started on conventional anticoagulants. Several months later, he developed repeat, near-total thrombosis of the graft with recurrence of his symptoms. After balloon dilation of the graft and starting him on appropriate anticoagulant maintenance regimen, he had good symptom relief, and the graft remained patent. This presentation was unusually prolonged for the type of vascular problem identified. The possibility of vascular problems in children, therefore, should be considered. Unidentified cause of hereditary clotting tendency is another challenging aspect of this case.

  2. Mycotic aneurysm of the superior mesenteric artery after septic embolism; Entwicklung eines mykotischen Aneurysmas der A. mesenterica superior nach septischer Embolie

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, F.; Dinkel, H.P. [Institut fuer Diagnostische Radiologie, Inselspital, Universitaetsklinik Bern (Switzerland)

    2002-07-01

    Mycotic aneurysms of the aorta and the visceral arteries are life-threatening diseases, due to potential rupture and organ or limb ischemia. They occur in endocarditis, immunodeficiency, bacteremia and fungemia, and have a poor prognosis.We report on a case of a 54-year-old male patient suffering from abdominal angina after mitral valve replacement for septic mycotic endocarditis. In presence of a mycotic-embolic occlusion of the left popliteal artery and multiple septic organ infarctions a mycotic aneurysm of the superior mesenteric artery was found in abdominal spiral-CT.Based on sequential spiral-CT examinations, this case demonstrates the development of a septic aneurysm of the superior mesenteric artery. (orig.) [German] Mykotische Aneurysmen der Aorta und ihrer Aeste stellen wegen Rupturgefahr und moeglicher Minderperfusion von Organen und Extremitaeten eine lebensgefaehrliche Erkrankung mit unguenstiger Prognose dar. Beguenstigende Faktoren sind geschwaechte Immunabwehr, Endokarditis, Bakteriaemie und Fungaemie.Wir berichten ueber einen 54-jaehrigen Patienten, der nach einem Mitralklappenersatz bei mykotischer Endokarditis zunehmende abdominelle Beschwerden im Sinne einer Angina abdominalis entwickelte. Die abdominelle Spiralcomputertomographie zeigte ein mykotisches Aneurysma der A. mesenterica superior. Daneben bestanden ein mykotischer Verschluss der linken A. poplitea und multiple septische Organinfarkte.Der Fall demonstriert anhand sequentieller Computertomographien eindrucksvoll die Entwicklung eines septischen Viszeralarterienaneurysmas. (orig.)

  3. Hepatocellular Carcinoma Fed by the Hepatic Artery Arising from the Superior Mesenteric Artery: Angiographic Analysis and Interventional Treatment

    Institute of Scientific and Technical Information of China (English)

    MUWei; LIQiang; YOUJian; CHENJie

    2003-01-01

    Objective: To investigate the angiographic characteristics and the interventional catheterization techniques of hepatocellular carcinoma (HCC) fed by aberrant hepatic arteries arising from the superior mesenteric artery (SMA), namely SMA type. Methods: Digital subtraction angiography (DSA) manifes-tations and the data from interventional treatment in 41 cases of SMA type HCCs were retrospectively reviewed. The frequency of the aberrant arteries was summed up statistically and their anatomic charac-teristics (such as origin, course, branches and distribution) and the relationship with catheterization were described and analyzed. Results: Of 350 HCC cases, SMA type HCCs were found in 41 cases (11.9%),including accessory right hepatic artery (15 cases, 36.5%), replaced right hepatic artery (16 cases, 39.0%),common hepatic artery (8 cases, 19.5%) and celiac artery arising from SMA (2 cases, 5.0%). Of the 31 cases with accessory or replaced right hepatic arteries, right hepatic arteries were small or absent on celiac angiograph in 29 cases (94.0%), and there was an avascular zone on the right liver. Superselective catheter-ization was successfully performed in 25 cases (61%) by using RH catheter, but the rest acquired successful superselective catheterization by using Cobra, Simmon catheters and microcatheters. Conclusion: SMA type is a commonly seen variation of hepatic arterial blood supply. A knowledge of this is very important in transcatheter arterial chemoembolization for HCC.

  4. Top-down approach to the superior mesenteric artery and the mesopancreas during pancreatoduodenectomy for pancreatic cancer.

    Science.gov (United States)

    Welsch, Thilo; Bork, Ulrich; Distler, Marius; Weitz, Jürgen

    2016-05-01

    Complete surgical resection with microscopically tumor-free resection margins (R0) is the most important survival determinant for patients with localized pancreatic cancer. The medial and posterior resection margins are the dominant sites of microscopic tumor involvement, and outline the so-called mesopancreas. In this study, we present a modified surgical approach to the superior mesenteric artery, celiac trunc, and mesopancreas during pancreatoduodenectomy, which enables a comfortable exposure and radical en bloc clearance of the mesopancreas and the tissue adjacent to the superior mesenteric artery. The dissection of the mesopancreas is directed from the ventral aspect of the portal vein downward along the superior mesenteric artery and the celiac trunc, before the transection of the duodenal mesentery is accomplished. The described technique complements the established surgical approaches to pancreatic head tumors, and is indicated in the absence of portal vein infiltration. J. Surg. Oncol. 2016;113:668-671. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  5. Isolated superior mesenteric artery dissection: case for conservative treatment and endovascular repair

    Institute of Scientific and Technical Information of China (English)

    WU Bin; ZHANG Jian; YIN Ming-di; WANG Lei; SONG Jin-qiu; LI Xuan; YANG Dong; DUAN Zhi-quan; XIN Shi-jie

    2009-01-01

    @@ Dissection of the superior mesenteric artery (SMA) not associated aortic dissection is an uncommon event. The pathogenesis remains unclear. Diagnosis has become more efficient due to recent advances in imaging techniques and increased awareness of mesenteric vessel diseases. Early recognition has led to early interventions. Although there is still no consensus on the best option of management for this disease, an increasing number of patients in recent years have been reported to be treated successfully by non-operative approaches (medical therapy and/or percutaneous endovascular repair) rather than operations. We report the diagnosis and non-operative managements of isolated dissection of SMA in the acute stage in two cases at the First Hospital of China Medical University from October to December in 2006.

  6. Mesenteric autotransplantation: an alternative technique for reoperation and bypass of the superior mesenteric artery.

    Science.gov (United States)

    Carson, John G; Loor, Gabriel; Millis, Micheal J; Testa, Giuliano; Piano, Giancarlo

    2009-01-01

    Superior mesenteric artery (SMA) aneurysms represent a minority of visceral aneurysms but may result in lethal complications if left untreated. Options for treatment include aneurysmorraphy, bypass, ligation, or embolization. Here we present a case of a man with a history of celiac graft thrombosis who presents with a recurrent symptomatic SMA aneurysm. Given his compromised celiac axis, ligation was not an option. His SMA aneurysm was repaired with a PTFE patch. However, to secure longstanding blood flow to the small bowel in the event of graft thrombosis, the distal SMA pedicle was dissected free of the ileocolic vessels and anastomosed to the aorta. Follow-up studies demonstrated an occluded PTFE patch with a patent SMA autotransplant. This case depicts a novel approach to the surgical management of complex recurrent SMA aneurysms.

  7. Superior mesenteric artery syndrome following scoliosis surgery: Its risk indicators and treatment strategy

    Institute of Scientific and Technical Information of China (English)

    Ze-Zhang Zhu; Yong Qiu

    2005-01-01

    AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patients with adolescent scoliosis who had undergone surgical treatment were evaluated prospectively, and among them seven patients suffered from SMAS after operation. Each patient was assigned a percentile for weight and a percentile for height. Values of the 5th、 10th、 25th、 50th、 75th、 and 95thpercentiles were selected to divide the observations. The sagittal Cobb angle was used to quantify thoracic or thoracolumbar kyphosis. All the seven patients presented with nausea and intermittent vomiting about 5 d after operation.An upper gastrointestinal barium contrast study showed a straight-line cutoff at the third portion of the duodenum representing extrinsic compression by the superior mesenteric artery (SMA).RESULTS: The value of height in the seven patients with SMAS was above the mean of sex- and age-matchednormal population, and the height percentile ranged from 5% to 50%. On the contrary, the value of weight was below the mean of normal population with the weight percentile ranging from 5% to 25%. Among the seven patients, four had a thoracic hyperkyphosis ranging from 55° to 88°(average 72°), two had a thoracolumbar kyphosis of 25° and 32° respectively. The seven patients were treated with fasting, antiemetic medication, and intravenous fluids infusion. Reduction or suspense of traction was adopted in three patients with SMAS during halo-femoral traction after anterior release of scoliosis. All the patients recovered completely with no sequelae. No one required operative intervention with a laparotomy.CONCLUSION: Height percentile<50% , weight percentile <25%, sagittal kyphosis, heavy and quick halo-femoral traction after spinal anterior release are the potential risk indicators for SMAS in patients undergoing correction surgery

  8. Superior cerebellar artery infarction in endovascular treatment for tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Jingbo; Lv Xianli; Jiang Chuhan; Li Youxiang [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China)

    2010-06-15

    Background: Superior cerebellar artery (SCA) syndrome shows ipsilateral cerebellar ataxia and Horner's syndrome, contralateral superficial sensory disturbance, as well as nystagmus toward the impaired side, vertigo, and nausea. Occasionally, unilateral lesions may produce bilateral hypogeusia and contralateral hypoacusia. Objective: To report 2 patients with unilateral lower midbrain ischemic lesions of the inferior colliculus level caused by transarterial embolization for tentorial dural arteriovenous fistulas (TDAVFs). Methods: Hospital records for 21 patients with TDAVFs mainly treated by endovascular techniques between 2005 and 2008 were reviewed. Two patients with MRI evidence of unilateral SCA territory infarction were investigated. Results: Of 21 patients, 2 treated transarterially with Onyx-18 (a nonahesive liquid embolic agent) developed infarctions in the territory of SCA. One patient had lateral SCA infarction characterized by ipsilateral gait ataxia, contralateral hemihypoesthesia, with additional ipsilateral ocular motor palsy and bilateral gustatory loss. And the other patient had medial SCA infarction characterized by ipsilateral ataxia contralateral hemihypoesthesia with additional contralateral hypoacusia. Conclusion: SCA infarction can be caused by transarterial injection of Onyx-18 via SCA or the posterior cerebral artery (PCA) for TDAVFs and additionally presented with gustatory loss and deafness, which is generally not a feature of the SCA syndrome.

  9. Transient ischemic jejunitis due to symptomatic isolated superior mesenteric artery dissection: case report and review of literature

    Science.gov (United States)

    MOCAN, MIHAELA; JEICAN, IONUŢ ISAIA; MOALE, MIHAI; CHIRA, ROMEO

    2017-01-01

    Acute abdominal pain is one of the most common conditions encountered in the emergency department. The differential diagnosis of acute abdominal pain is extensive and identifying the underlying etiology can be challenging. We report a case of acute transient ischemic jejunitis due to symptomatic isolated superior mesenteric artery dissection in a patient with no cardiovascular risk factors or autoimmune diseases. Symptomatic isolated superior mesenteric artery dissection is a rare cause of acute abdominal pain usually treated in the surgical department. The patient had criteria for conservative treatment and rapidly recovered. We highlight a rare condition which should be taken into account for the differential diagnosis of acute abdominal pain.

  10. Embolisation of Posttraumatic Superior Mesenteric Artery Pseudoaneurysm in a Patient with Short Bowel Syndrome Preceding Bowel Transplantation

    Directory of Open Access Journals (Sweden)

    Vinko Vidjak

    2011-01-01

    Full Text Available Penetrating abdominal trauma often causes bowel injuries which may lead to “short bowel syndrome” which is a potential indication for bowel transplantation. Posttraumatic pseudoaneurysms of abdominal arteries are often a result of penetrating abdominal trauma. We report a successful embolisation of posttraumatic superior mesenteric artery (SMA branch pseudoaneurysm using microcoil, in a patient with short bowel syndrome who was successfully transplanted three months after embolisation.

  11. Prevalence and location of the posterior superior alveolar artery using cone-beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Tehranchi, Maryam; Taleghani, Ferial; Shahab, Shahriar [Faculty of Dentistry, Shahed University, Tehran (Iran, Islamic Republic of); Nouri, Arash [Nouri' s Dental Clinic, Tehran (Iran, Islamic Republic of)

    2017-03-15

    Insufficient knowledge of the anatomy of the maxillary sinuses prior to sinus graft surgery may lead to perioperative or postoperative complications. This study sought to characterize the position of the posterior superior alveolar artery (PSAA) within the maxillary sinuses using cone-beam computed tomography (CBCT). A total of 300 patients with edentulous posterior maxillae, including 138 females and 162 males with an age range of 33-86 years, who presented to a radiology clinic between 2013 and 2015 were enrolled in this retrospective cross-sectional study. The distance from the inferior border of the PSAA to the alveolar crest according to the residual ridge classification by Lekholm and Zarb, the distance from the PSAA to the nasal septum and zygomatic arch, and the diameter and position of the PSAA were all assessed on patients' CBCT scans. The data were analyzed using the Mann-Whitney test and the t-test. The PSAA was detected on the CBCT scans of 87% of the patients; it was located beneath the sinus membrane in 47% of cases and was intraosseous in 47% of cases. The diameter of the artery was between 1 and 2 mm in most patients (72%). The mean diameter of the artery was 1.29±0.39 mm, and the mean distances from the PSAA to the zygomatic arch, nasal septum, and alveolar crest were 22.59±4.89 mm, 26.51±3.52 mm, and 16.7±3.96 mm, respectively. The likelihood of detecting the PSAA on CBCT scans is high; its location is intraosseous or beneath the sinus membrane in most patients. Determining the exact location of the PSAA on CBCT scans preoperatively can help prevent it from being damaged during surgery.

  12. Prevalence and location of the posterior superior alveolar artery using cone-beam computed tomography

    Science.gov (United States)

    Tehranchi, Maryam; Shahab, Shahriar; Nouri, Arash

    2017-01-01

    Purpose Insufficient knowledge of the anatomy of the maxillary sinuses prior to sinus graft surgery may lead to perioperative or postoperative complications. This study sought to characterize the position of the posterior superior alveolar artery (PSAA) within the maxillary sinuses using cone-beam computed tomography (CBCT). Materials and Methods A total of 300 patients with edentulous posterior maxillae, including 138 females and 162 males with an age range of 33-86 years, who presented to a radiology clinic between 2013 and 2015 were enrolled in this retrospective cross-sectional study. The distance from the inferior border of the PSAA to the alveolar crest according to the residual ridge classification by Lekholm and Zarb, the distance from the PSAA to the nasal septum and zygomatic arch, and the diameter and position of the PSAA were all assessed on patients' CBCT scans. The data were analyzed using the Mann-Whitney test and the t-test. Results The PSAA was detected on the CBCT scans of 87% of the patients; it was located beneath the sinus membrane in 47% of cases and was intraosseous in 47% of cases. The diameter of the artery was between 1 and 2 mm in most patients (72%). The mean diameter of the artery was 1.29±0.39 mm, and the mean distances from the PSAA to the zygomatic arch, nasal septum, and alveolar crest were 22.59±4.89 mm, 26.51±3.52 mm, and 16.7±3.96 mm, respectively. Conclusion The likelihood of detecting the PSAA on CBCT scans is high; its location is intraosseous or beneath the sinus membrane in most patients. Determining the exact location of the PSAA on CBCT scans preoperatively can help prevent it from being damaged during surgery. PMID:28361028

  13. Recurrence of parasite in epigastric heteropagus

    Directory of Open Access Journals (Sweden)

    Takeshi Shirai

    2017-10-01

    Full Text Available Epigastric heteropagus (EH refers to asymmetrically conjoined twins in whom an incomplete parasite is attached to the autosite's epigastric region from the xiphisternum to the umbilicus. We herein report an extremely rare case of EH in which unexpected rapid recurrence occurred 22 months after excision of the parasite. The recurrent mass comprised the intestinal wall with peristalsis-like movement, urogenital tissues, and hepatic tissue of the parasite. The recurrence was caused by a remnant of the parasite that extended from the autosite's xiphisternum to intra-abdominal cavity.

  14. Repair of umbilical and epigastric hernias.

    Science.gov (United States)

    Earle, David B; McLellan, Jennifer A

    2013-10-01

    Umbilical and epigastric hernias are primary midline defects that are present in up to 50% of the population. In the United States, only about 1% of the population carries this specific diagnosis, and only about 11% of these are repaired. Repair is aimed at symptoms relief or prevention, and the patient's goals and expectations should be explicitly identified and aligned with the health care team. This article details some relevant and interesting anatomic issues, reviews existing data, and highlights some common and important surgical techniques. Emphasis is placed on a patient-centered approach to the repair of umbilical and epigastric hernias.

  15. Superior mesenteric artery aneurysm in a 9-year-old boy with classical Ehlers-Danlos syndrome

    NARCIS (Netherlands)

    de Leeuw, K.; Goorhuis, J. F.; Tielliu, I. F. J.; Symoens, S.; Malfait, F.; de Paepe, A.; van Tintelen, J. P.; Hulscher, J. B. F.

    2012-01-01

    A 9-year-old boy with the classical type of EhlersDanlos syndrome (EDS) developed a symptomatic aneurysm of the superior mesenteric artery. His EDS diagnosis had been confirmed biochemically and genetically. Vascular complications are known to be associated with the vascular type of EDS, but this is

  16. Blunt traumatic superior gluteal artery pseudoaneurysm presenting as gluteal hematoma without bony injury: A rare case report

    Institute of Scientific and Technical Information of China (English)

    Annu Babu; Amit Gupta; Pawan Sharma; Piyush Ranjan; Atin Kumar

    2016-01-01

    Blunt traumatic injuries to the superior gluteal artery are rare in clinic.A majority of injuries present as aneurysms following penetrating trauma,fracture pelvis or posterior dislocation of the hip joint.We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury.The gluteal hematoma was suspected clinically,confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma.Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery,which was successfully angioembolized.The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma.This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling.Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.

  17. Pseudoaneurysm of the superior lateral geniculate artery after an arthroscopic procedure in a 14-year-old patient

    Directory of Open Access Journals (Sweden)

    Esther Carbó

    2017-03-01

    Full Text Available Vascular injuries are a rare complication after arthroscopic knee surgery. Pseudoaneurysm of the superior lateral genicular artery occurred in a 14-year-old patient after a routine lateral release arthroscopy. The diagnosis was confirmed on a computed tomography scan with intravenous contrast. An arteriogram also demonstrated the pseudoaneurysm that was successfully obliterated with microcoils. To our knowledge, this is the first documented case of pseudoaneurysm of a superior lateral geniculate artery after an entirely arthroscopic knee surgery. Moreover, this is the first case of pseudoaneurysm around the knee in a pediatric patient after this procedure. Diagnosis and treatment options of arterial pseudoaneurysms following knee arthroscopy are discussed. [Arch Clin Exp Surg 2017; 6(1.000: 38-40

  18. Late-onset superior mesenteric artery syndrome four years following scoliosis surgery – a case report

    Directory of Open Access Journals (Sweden)

    Abol Oyoun Nariman

    2015-01-01

    Full Text Available Background: Superior mesenteric artery (SMA syndrome has been reported as an uncommon condition of external vascular compression of the SMA particularly after rapid weight loss, body casts, or after corrective surgery for spinal deformities, usually within the first few weeks after surgery. Methods: This is a retrospective report of a case of a non-verbal autistic female patient who started to develop SMA syndrome at the age of 16, 4 years after posterior spinal fusion surgery for scoliosis. She was treated conservatively by increasing oral caloric intake, which resulted in increased body weight and relief of symptoms. Results: Seen at 10 years’ follow up, the patient is doing well, and is functional within the limits of her suboptimal cognitive and verbal conditions. She maintains good trunk balance with solid spinal fusion and intact instrumentation at latest follow up. Conclusion: Spinal surgeons should maintain a high index of suspicion for diagnosis of SMA syndrome even years after scoliosis surgery, especially for patients with communication problems, like the case we present here. Appropriate conservative measures can succeed in relieving the symptoms, increasing body weight, and preventing complications including the risk of death.

  19. Late presentation of superior mesenteric artery syndrome following scoliosis surgery: a case report

    Directory of Open Access Journals (Sweden)

    Tsirikos Athanasios I

    2008-01-01

    Full Text Available Abstract Introduction Obstruction of the third part of the duodenum by the superior mesenteric artery (SMA can occur following surgical correction of scoliosis. The condition most commonly occurs in significantly underweight patients with severe deformities during the first few days to a week following spinal surgery. Case presentation We present the atypical case of a patient with normal body habitus and a 50° adolescent idiopathic thoracolumbar scoliosis who underwent anterior spinal arthrodesis with instrumentation and developed SMA syndrome due to progressive weight loss several weeks postoperatively. The condition manifested with recurrent vomiting, abdominal distension, marked dehydration, and severe electrolyte disorder. Prolonged nasogastric decompression and nasojejunal feeding resulted in resolution of the symptoms with no recurrence at follow-up. The spinal instrumentation was retained and a solid spinal fusion was achieved with good spinal balance in both the coronal and sagittal planes. Conclusion SMA syndrome can occur much later than previously reported and with potentially life-threatening symptoms following scoliosis correction. Early recognition of the condition and institution of appropriate conservative measures is critical to prevent the development of severe complications including the risk of death.

  20. The mechanism of functional vasodilatation in rabbit epigastric adipose tissue.

    Science.gov (United States)

    Lewis, G P; Mattews, J

    1970-03-01

    1. The effect of close-arterial infusions of fat-mobilizing substances has been examined on the release of free fatty acids and blood flow in the epigastric adipose tissue of rabbits.2. All the fat mobilizers in addition to causing the release of free fatty acids also caused an increased blood flow in the fat tissue.3. Both the fat mobilization and the vasodilatation continued for an hour or so after the end of infusion.4. Although no vasodilator substance could be detected in the venous effluent from the activated adipose tissue, a vasodilator could be detected in acid-ether extracts of adipose tissue excised during a period of fat mobilization.5. It is suggested that a vasodilator substance is released or formed in adipose tissue during fat mobilization and that this substance accounts for the vasodilatation accompanying activity in the tissue.

  1. Recurrent umbilical or epigastric hernia during and after pregnancy

    DEFF Research Database (Denmark)

    Oma, Erling; Jensen, Kristian K; Jorgensen, Lars N

    2016-01-01

    BACKGROUND: Umbilical and epigastric (umb/epi) hernia repairs are performed commonly in fertile female patients. Recent studies suggest mesh repair to be superior to suture repair; however, evidence is lacking concerning the optimal treatment of umb/epi hernias in female patients who might wish...... future pregnancies. The aim of this study was to compare the cumulative recurrence rate after mesh versus suture repair of umb/epi hernia in female patients subsequently becoming pregnant. METHODS: This retrospective nationwide cohort study included female patients who underwent primary umb/epi hernia...... repair and subsequently became pregnant between 2007 and 2013. The follow-up began at first day of pregnancy and ended May 2015. Data were obtained from the Danish Ventral Hernia Database, Medical Birth Registry, and National Patient Registry. Patients with recurrence before pregnancy were excluded...

  2. A consecutive series of 235 epigastric hernias.

    Science.gov (United States)

    Ponten, J E H; Leenders, B J M; Charbon, J A; Nienhuijs, S W

    2015-10-01

    Epigastric herniation is a common, though not always symptomatic condition. It is likely, that in accordance to the tension-free principles for other hernias, epigastric hernia repair should be mesh based. Patients from two large hospitals were investigated retrospectively if they were operated on an epigastric hernia for the past 6 years. Follow-up was completed with a postal questionnaire. A total of 235 patients (50 % male) were operated. Sixty-eight patients were operated with mesh and 167 patients with suture repair. Forty-six patients were loss-to follow-up (19.6 %). In the mesh operated patients the recurrence rate was 10.9 % (n = 6) compared to 14.9 % (n = 20) in the suture repair group. Cox-regression analysis showed an increased risk for recurrence in the suture repair group (odds ratio 1.43; 95 % CI 0.56-3.57; p = 0.44). Operation time for mesh repair (47 min) was significantly longer compared to suture repair (29 min) (p hernias. A total of 51 patients smoked and 14 patients had diabetes mellitus. Fourteen patients used steroids and 22 patients suffered from a chronic lung disease. Subgroup analysis showed a significant difference for pain in patients in which re-operation for a recurrence occurred (p = 0.004). This is one of the largest reported series on solely epigastric hernias. A recurrence occurred more often after sutured repair compared to mesh repair. No differences in chronic pain was seen between mesh and suture repaired patients. Male:female ratio of 1:1, which is different from the 3:1 ratio found in previous older smaller studies, could be more reliable.

  3. Superior cerebellar artery aneurysms: incidence, clinical presentation and midterm outcome of endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Peluso, Jo P.P.; Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2007-09-15

    The aim of this retrospective study was to determine the incidence, clinical presentation and midterm clinical and imaging outcome of endovascular treatment of 34 superior cerebellar artery (SCA) aneurysms in 33 patients. Between January 1995 and January 2007, 2,112 aneurysms were treated in our institution, and 36 aneurysms in 35 patients were located on the SCA (incidence 1.7%). Two of three distal SCA aneurysms were excluded. All the remaining 34 SCA aneurysms, of which 22 (65%) were ruptured and 12 (35%) were unruptured, in 33 patients were treated by endovascular techniques. There were 6 men and 27 women ranging from 29-72 years. In 14 patients (42%) multiple aneurysms were present. Initial angiographic occlusion was (near) complete in 32 aneurysms (94%) and incomplete in 2 aneurysms (6%). Complications leading to permanent morbidity or death occurred in two patients (6.1%, 95% CI 0.6 to 20.60%). Outcome at 6 months follow-up in 31 surviving patients was GOS5 in 26 (84%), GOS4 in 4 (13%) and GOS3 in 1 patient (3%). There were no episodes of (re)bleeding during 118 patient-years of follow-up. The 6-month angiographic follow up in 28 SCA aneurysms and extended angiographic follow-up in 19 showed stable occlusion in 27 aneurysms. No additional treatments were performed. SCA aneurysms are rare with an incidence of 1.7% of treated aneurysms at our institution. They are frequently associated with other aneurysms. Endovascular treatment is effective and safe in excluding the aneurysms from the circulation. (orig.)

  4. Endovascular Management of Superior Mesenteric Artery (SMA) Aneurysm - Adequate Access is Essential for Success - Case Report.

    Science.gov (United States)

    Tkalčić, Lovro; Budiselić, Berislav; Kovačević, Miljenko; Knežević, Siniša; Kovačić, Slavica; Miletić, Damir; Tomulić, Vjekoslav; Kuhelj, Dimitrij

    2017-01-01

    An aneurysm of the superior mesenteric artery (SMA) with a diameter of 2.2 cm was found incidentally on an ultrasound (US) examination in a 26-year-old woman. The only known risk factor was an intracranial aneurysm that was found on her grandmother's autopsy. Based on pregnancy planning and the current literature, endovascular management with a covered stent was proposed. Self-expandable, covered stent (Bard, Fluency(®)) was implanted using a single transfemoral approach. A stiff guidewire and a large sheath distorted the anatomy, which resulted in an incomplete aneurysmal neck covering. In the absence of additional covered stents, the procedure was terminated. Two weeks later, computed tomographic angiography (CTA) confirmed persistent aneurysmal perfusion due to the incomplete neck coverage. A multidisciplinary board opted for a second endovascular attempt, this time with a longer covered stent via the transaxillary approach in order to reduce anatomical distortion. Balloon, expandable, cobalt-chrome covered stent (Jotec, E-ventus BX(®)) was implanted in the SMA, covering the aneurysmal neck and overlapping the previously implanted covered stent. Angiography confirmed a complete exclusion of the aneurysm. A control US performed three weeks later confirmed a patent covered stent and complete aneurysmal exclusion. There was a mild median nerve damage periprocedurally that resolved in three months. The most recent US control examination, performed eleven months after the procedure, showed an excluded aneurysm and a patent covered stent. There were no clinical signs of bowel ischaemia during the follow-up period. Endovascular management of SMAA proved to be safe and efficient. The "access from above" is probably safer and should be considered in the majority of cases with acceptable sizes of access vessels. Mid-term results in our patient are good and life-long follow-up is planned to prevent late complications.

  5. The superiority of 256-slice spiral computed tomography angiography for preoperative evaluation of surrounding arteries in patients with gastric cancer

    Science.gov (United States)

    Wu, Deqing; Zhao, Linyong; Liu, Ying; Wang, Junjiang; Hu, Weixian; Feng, Xingyu; Lv, Zejian; Li, Yong; Yao, Xueqing

    2017-01-01

    Objective To evaluate the utilization of 256-slice spiral computed tomography (CT) angiography in preoperative assessment of perigastric vascular anatomy in patients with gastric cancer. Methods In this study, 80 gastric cancer patients were included. The medical procedure of 256-slice spiral CT angiography was performed on each of these patients consecutively. Thereafter, these patients were subjected to surgical treatment in our hospital. The techniques of volume rendering (VR) and maximum intensity projection (MIP) were used to image reconstruction of arteries around the stomach. Results Both VR and MIP were applied to reconstruct the images of perigastric arteries. The results indicated that VR imaging was inferior to MIP in determining the variant small artery anatomy around the greater curvature and fundus. The respective rates of imaging produced by VR and MIP for left gastroepiploic artery, short gastric artery, and posterior gastric artery, were 32.50% versus 100%, 16.25% versus 87.50%, and 3.75% versus 25.00%, respectively. According to Hiatt’s classification, 75 out of 240 cases were abnormal types, among which we found Type II in 30 cases, Type III in 33 cases, Type IV in three cases, Type V in six cases, and Type VI in only three cases. There was no significant difference for total and every single variation type, between our group and Hiatt’s group (P>0.05). Conclusion The 256-slice spiral CT angiography can be regarded as an effective and accurate diagnostic modality for preoperative assessing anatomical arterial variations in gastric cancer; MIP was superior to VR at identifying variations of some small artery, whereas VR was better than MIP at showing anatomical arterial variations due to its three-dimensional effect.

  6. The clinical analysis for 43 cases of acute superior mesenteric artery thrombosis confirmed by angiography and surgery

    Institute of Scientific and Technical Information of China (English)

    刘文徽

    2014-01-01

    Objective To investigate the clinical manifestations and mortality related risk factors in patients with acute superior mesenteric artery embolism(ASMAE).Methods Clinical data of forty-three confirmed ASMAE patients in the PLA General Hospital from June 2002 to June 2012were retrospectively analyzed.All patients were classified into a survival group(28 cases)and a death group(15 cases)according to the prognosis.The prognosis associated factors were further analyzed.Results The study

  7. Complicated type B aortic dissection causing ischemia in the celiac and inferior mesenteric artery distribution despite patent superior mesenteric artery bypass.

    Science.gov (United States)

    Afifi, Rana O; Zhu, Youwei; Leake, Samuel S; Kott, Amy; Azizzadeh, Ali; Estrera, Anthony L; Safi, Hazim J; Charlton-Ouw, Kristofer M

    2015-08-01

    Mortality rates associated with acute type B aortic dissection (ABAD) complicated by malperfusion remains significant. Optimal management of patients with ABAD is still debatable. We present a case report of a 50-year-old man who was admitted due to ABAD. He was treated medically with his pain resolved and he was discharged on oral antihypertensive medications. One month after initial diagnosis, he was readmitted with abdominal pain, nausea, vomiting, and diarrhea. On imaging, an extension of the aortic dissection into the visceral arteries with occlusion of the celiac and superior mesenteric arteries (SMA) was noted. He underwent thoracic endovascular aortic repair (TEVAR) and bypass grafting to the SMA. Despite the intervention, the patient developed large bowel, liver, and gastric ischemia and underwent bowel resection. He died from multi-organ failure. In selected cases of uncomplicated ABAD, TEVAR should be considered and when TEVAR fails and visceral malperfusion develops, an aggressive revascularization of multiple visceral arteries should be attempted.

  8. Functioning pancreas graft with thromboses of splenic and superior mesenteric arteries after simultaneous pancreas-kidney transplantation: a case report.

    Science.gov (United States)

    Matsumoto, I; Shinzeki, M; Asari, S; Goto, T; Shirakawa, S; Ajiki, T; Fukumoto, T; Ku, Y

    2014-04-01

    Graft thrombosis is the most common cause of early graft loss after pancreas transplantation. The grafted pancreas is difficult to salvage after complete thrombosis, especially arterial thrombosis, and graft pancreatectomy is required. We describe a patient presenting with a functioning pancreas graft with thromboses of the splenic artery (SA) and superior mesenteric artery (SMA) after simultaneous pancreas-kidney transplantation (SPK). A 37-year-old woman with a 20-year history of type 1 diabetes mellitus underwent SPK. The pancreaticoduodenal graft was implanted in the right iliac fossa with enteric drainage. A Carrel patch was anastomosed to the recipient's right common iliac artery, and the graft gastroduodenal artery was anastomosed to the common hepatic artery using an arterial I-graft. The donor portal vein was anastomosed to the recipient's inferior vena cava. Four days after surgery, graft thromboses were detected by Doppler ultrasound without increases in the serum amylase and blood glucose levels. Contrast enhanced computed tomography revealed thromboses in the SA, splenic vein and SMA. Selective angiography showed that blood flow was interrupted in the SA and SMA. However, pancreatic graft perfusion was maintained by the I-graft in the head of the pancreas and the transverse pancreatic artery in the body and tail of the pancreas. We performed percutaneous direct thrombolysis and adjuvant thrombolytic therapy. However, we had to stop the thrombolytic therapy because of gastrointestinal hemorrhage. Thereafter, the postoperative course was uneventful and the pancreas graft was functioning with a fasting blood glucose level of 75 mg/dL, HbA1c of 5.1%, and serum C-peptide level of 1.9 ng/mL at 30 months post-transplantation.

  9. Scarless laparoscopic repair of epigastric hernia in children

    OpenAIRE

    2015-01-01

    Background Despite the small size of the incision, the scar left by open repair of epigastric hernia in children is unaesthetic. Few laparoscopic approaches to epigastric hernia repair have been previously proposed, but none has gain wide acceptance from pediatric surgeons. In this study, we present our experience with a scarless laparo- scopic approach using a percutaneous suturing technique for epigastric hernia repair in children. Methods Ten consecutive patients presenting with ep...

  10. The superiority of 256-slice spiral computed tomography angiography for preoperative evaluation of surrounding arteries in patients with gastric cancer

    Directory of Open Access Journals (Sweden)

    Wu D

    2017-02-01

    Full Text Available Deqing Wu, Linyong Zhao, Ying Liu, Junjiang Wang, Weixian Hu, Xingyu Feng, Zejian Lv, Yong Li, Xueqing Yao Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China Objective: To evaluate the utilization of 256-slice spiral computed tomography (CT angiography in preoperative assessment of perigastric vascular anatomy in patients with gastric cancer. Methods: In this study, 80 gastric cancer patients were included. The medical procedure of 256-slice spiral CT angiography was performed on each of these patients consecutively. Thereafter, these patients were subjected to surgical treatment in our hospital. The techniques of volume rendering (VR and maximum intensity projection (MIP were used to image reconstruction of arteries around the stomach. Results: Both VR and MIP were applied to reconstruct the images of perigastric arteries. The results indicated that VR imaging was inferior to MIP in determining the variant small artery anatomy around the greater curvature and fundus. The respective rates of imaging produced by VR and MIP for left gastroepiploic artery, short gastric artery, and posterior gastric artery, were 32.50% versus 100%, 16.25% versus 87.50%, and 3.75% versus 25.00%, respectively. According to Hiatt’s classification, 75 out of 240 cases were abnormal types, among which we found Type II in 30 cases, Type III in 33 cases, Type IV in three cases, Type V in six cases, and Type VI in only three cases. There was no significant difference for total and every single variation type, between our group and Hiatt’s group (P>0.05. Conclusion: The 256-slice spiral CT angiography can be regarded as an effective and accurate diagnostic modality for preoperative assessing anatomical arterial variations in gastric cancer; MIP was superior to VR at identifying variations of some small artery, whereas VR was better than MIP at showing anatomical arterial variations

  11. The MDCT and MRI Findings of a Pancreatic Arteriovenous Malformation Combined with Isolated Dissection of the Superior Mesenteric Artery: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Soo; Jeong, Woo Kyoung [Hanyang University Guri Hospital, Seoul (Korea, Republic of); Kim, Jin Oo [Naval Pohang Hospital, Pohang (Korea, Republic of); Oh, Ji Young; Song, Soon Young [Hanyang University Medical College, Seoul (Korea, Republic of)

    2010-03-15

    Pancreatic arteriovenous malformation and isolated spontaneous dissection of the superior mesenteric artery are both rare maladies, and now they can be easily diagnosed due to the development of such noninvasive modalities as multi-detector computed tomography and magnetic resonance imaging. We report here on the multi-detector computed tomography and magnetic resonance imaging findings of a rare case of pancreatic arteriovenous malformation combined with isolated dissection of the superior mesenteric artery.

  12. Loss of visual evoked potential following temporary occlusion of the superior hypophyseal artery during aneurysm clip placement surgery. Case report.

    Science.gov (United States)

    Goto, Tetsuya; Tanaka, Yuichiro; Kodama, Kunihiko; Kusano, Yoshikazu; Sakai, Keiichi; Hongo, Kazuhiro

    2007-10-01

    The authors report a case in which a 62-year-old woman with a history of subarachnoid hemorrhage due to a ruptured aneurysm was found to have a de novo paraclinoid aneurysm in the right internal carotid artery during a routine medical examination. Surgical clip placement was performed via a contralateral pterional approach under visual evoked potential (VEP) monitoring. The superior hypophyseal artery (SHA) was found to originate from the aneurysm body. The artery was temporarily occluded prior to application of the clip to the aneurysm neck. The VEP signal was lost 3 minutes after the SHA was occluded, and the potentials gradually recovered 10 minutes after the artery was released. The disappearance of VEP signal was reproducible with SHA occlusion. The clip was applied to the aneurysm body to preserve the origin of the SHA. The patient did not have any deterioration of vision after surgery. Intraoperative VEP monitoring can be used to help determine whether the SHA can be sacrificed safely.

  13. Treatment of 68 Cases of Epigastric Pain with Acupucnture

    Institute of Scientific and Technical Information of China (English)

    李友军; 崔学军

    2008-01-01

    @@ Acute and chronic gastritis, gastric and duodenal globular ulcer, and antral gastritis are commonly encountered diseases of digestive system, and epigastric pain is their main symptom. The author treated 68 cases of epigastric pain with acupuncture, now it is reported as follows.

  14. Acute Superior Mesenteric Venous Thrombosis: Transcatheter Thrombolysis and Aspiration Thrombectomy Therapy by Combined Route of Superior Mesenteric Vein and Artery in Eight Patients

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Shuofei, E-mail: yangshuofei@gmail.com; Liu, Baochen, E-mail: 306446264@qq.com; Ding, Weiwei, E-mail: dingwei-nju@hotmail.com; He, Changsheng, E-mail: hechsh@163.com; Wu, Xingjiang, E-mail: wuxingjiang@sohu.com; Li, Jieshou, E-mail: lijieshou2013@sohu.com [Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University (China)

    2015-02-15

    PurposeTo assess the feasibility, effectiveness, and safety of catheter-directed thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery (SMV+SMA) for acute superior mesenteric venous thrombosis (ASMVT).MethodsThis retrospective study reviewed eight ASMVT patients with transcatheter direct thrombolysis and aspiration thrombectomy therapy via SMV and indirect thrombolysis via SMA during a period of 14 months. The demographics, etiology, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. Anatomic and imaging classification of location and extent of thrombus at diagnosis and degree of thrombus lysis were described.ResultsTechnical success was achieved with substantial improvement in symptoms and thrombus resolution after thrombolytic therapy in all patients. The local urokinase infusion by SMA and SMV was performed for 5–7 (6.13 ± 0.83) and 7–15 (12 ± 2.51) days. Anticoagulation was performed catheter-directed and then orally throughout hospitalization and after discharge. Four patients required delayed localized bowel resection after thrombolytic therapy with no death. Thrombolytic therapy was not interrupted despite minor bleeding at the puncture site in two patients and sepsis in another two postoperatively. Nearly complete removal of thrombus was demonstrated by contrast-enhanced CT scan and portography before discharge. Patients were discharged in 10–27 (19.25 ± 4.89) days after admission. No recurrence developed during the follow-up of 10–13 (12.13 ± 0.99) months.ConclusionsCatheter-directed thrombolytic and aspiration therapy via SMV+SMA is beneficial for ASMVT in avoiding patient death, efficient resolving thrombus, rapid improving symptoms, reversing extensive intestinal ischemia, averting bowel resection, or localizing infarcted bowel segment and preventing short bowel syndrome.

  15. Evaluation of the location of the posterior superior alveolar artery in the maxillary sinus by Cone beam computed tomography

    Directory of Open Access Journals (Sweden)

    Sina Haghanifar

    2016-06-01

    Full Text Available Background: Considering the growing interest in dental implants to replace missing teeth and the subsequent increase in sinus augmentation surgery, one of the anatomical landmarks that may be injured during this procedure is the posterior superior alveolar artery (PSAA.The purpose of this study was to evaluate thelocation of PSAAusing cone beam computed tomography (CBCT scans. Methods:160 CBCT scans of 80 females and 80 males with age range of 20 to 86 years were selected. The location of PSAA were examined on cross-sectional images from the first premolar to the third molar areas of left and right maxillary sinuses. The distances ofarteryto sinus floor, alveolar crest and medial wall of the maxillary sinus and the artery diameter were measured. Data were analyzedusing SPSS softwareV.22and T-Test and ANOVA. Results: The mean PSAA diameter from the first premolar to the third molar was 0.75, 0.82, 0.92, 0.95 and 1.03mm, respectively. The closest distances of the artery to alveolar crest were seen in the first and second molars areas with mean 16.11 and 16.65 mm in which, PSAA is close to the maxillary sinus membrane. The distances of artery tosinus floor and alveolar crest and artery diameter were higher in males than females (p<0.001. The distance of the PSAA to the medial wall of the sinus is decreased with increasing age (p=0.015. Left and right sidesshowed no significant differences. Conclusion: Due to anatomical variation, evaluation of maxillary sinus using CBCT before sinus augmentation surgery by a surgeon or radiologist can be useful in planning a more precise treatment and avoiding unwanted side effects.

  16. Acute-onset of superior mesenteric artery syndrome following surgical correction of scoliosis: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Christian Ovalle-Chao

    2017-04-01

    Full Text Available Superior mesenteric artery (SMA syndrome is a rare condition caused by compression of the third portion of duodenum by the angle between the superior mesenteric artery against the aorta. A rare presentation of SMA syndrome is following scoliosis repair and spinal fusion with a low incidence and most of these patients present with symptoms within one to two weeks or even more after the surgical repair. A high suspicion index after surgical correction of scoliosis with well-known risk factors (low BMI, low percentile of weight for height, and a high degree of change in the Cobb's angles can anticipate the postoperative diagnosis. Management has been described for postsurgical scoliosis repair with a late onset presentation of SMA syndrome with nutritional support with good success rates, but there is no data for best treatment management for acute onset especially when the surgical correction of the spine causes complete duodenal obstruction and a surgical intervention might be warranted. Here in, we present a 14 year-old boy with an acute 24-h postoperative SMA syndrome following surgical correction of scoliosis.

  17. TREATMENT OF EPIGASTRIC PAIN WITH SUBCUTANEOUS NEEDLING

    Institute of Scientific and Technical Information of China (English)

    GUO Jia-tu

    2006-01-01

    @@ Subcutaneous needling is a new therapeutic method which is based on the features of the meridian-collateral theory of cutaneous regions in traditional Chinese medicine and the neurohumeral theory and skin anatomy of modern medicine and is of the features of "fixed meridian but not fixed acupoints", "micro stimulation", and "subcutaneous needling with filiform needles" to achieve the goal of treating diseases. This method is indicated clinically to the analgesia and relaxation of spasm especially the pain caused by the disorders of the internal organs and marked therapeutic effect has been obtained. With method, 150 cases of epigastric pain were treated by our department and the total effective rate was over 90%. It is presented herein below.

  18. ACE inhibition is superior to angiotensin receptor blockade for renography in renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Karanikas, Georgios; Becherer, Alexander; Wiesner, Karoline; Dudczak, Robert; Kletter, Kurt [Department of Nuclear Medicine, University of Vienna (Austria)

    2002-03-01

    Angiotensin converting enzyme (ACE) inhibitors as well as angiotensin II receptor antagonists are able to prevent the vasoconstrictive effect of angiotensin II on the efferent renal vessels, which is believed to play an important role in renovascular hypertension. This effect is assumed to be essential for the demonstration of renovascular hypertension by captopril renography. In this study, renographic changes induced by captopril and the AT1 receptor antagonist valsartan were compared in patients with a high probability for renovascular hypertension. Twenty-five patients with 33 stenosed renal arteries (grade of stenosis >50%) and hypertension were studied. Captopril, valsartan and baseline renography were performed within 48 h using technetium-99m mercaptoacetyltriglycine. Blood pressure was monitored, plasma renin concentration before and after intervention was determined and urinary flow was estimated from the urinary output of the hydrated patients. Alterations in renographic curves after intervention were evaluated according to the Santa Fe consensus on ACE inhibitor renography. Captopril renography was positive, indicating renovascular hypertension, in 25 of the 33 stenosed vessels, whereas valsartan renography was positive in only ten. Blood pressure during captopril and valsartan renography was not different; reduction in blood pressure was the same after valsartan and captopril. Plasma renin concentration was comparable for valsartan and captopril studies, showing suppressed values after intervention in as many as 12 of the 25 patients. Urinary flow after valsartan was higher than after captopril (P<0.05). However, this difference could not explain the markedly higher sensitivity of captopril compared with valsartan in demonstrating renal artery stenosis. In 14 of the 25 patients, blood pressure response to revascularisation was monitored, showing a much better predictive value for captopril renography. It is concluded that captopril renography is much

  19. "Bronchial Artery Delivery of Viral Vectors for Gene delivery in Cystic Fibrosis; Superior to Airway Delivery?"

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    Coutelle Charles C

    2002-04-01

    Full Text Available Abstract Background Attempts at gene therapy for the pulmonary manifestations of Cystic Fibrosis have relied mainly on airway delivery. However the efficiency of gene transfer and expression in the airway epithelia has not reached therapeutic levels. Access to epithelial cells is not homogenous for a number of reasons and the submucosal glands cannot be reached via the airways. Presentation We propose to inject gene delivery vectors directly into bronchial arteries combined with pre-delivery of vascular endothelial growth factor to increase vascular endothelial permeability and post-delivery flow reduction by balloon occlusion. Thus it may be possible to reach mucous secreting cells of the bronchial luminal epithelium and the submucosal glands in an increased and homogenous fashion. Testing This combination of techniques to the best of our knowledge has not previously been investigated, and may enable us to overcome some of the current limitations to gene therapy for Cystic Fibrosis.

  20. Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review.

    Science.gov (United States)

    Jegatheeswaran, Santhalingam; Baltatzis, Minas; Jamdar, Saurabh; Siriwardena, Ajith K

    2017-06-01

    Resection of the superior mesenteric artery (SMA) during pancreatectomy is performed infrequently and is undertaken with the aim of removing non-metastatic locally advanced pancreatic tumours. SMA resection reports also encompass resection of other visceral vessels. The consequences of resection of these different arteries are not necessarily equivalent. This is a focused systematic review of the outcome of SMA resection during pancreatectomy for cancer. A computerized search of the English language literature was undertaken for the period 1st January 2000 through 30th April 2016. The keywords "Pancreatic surgery" and "Vascular resections" were used. Thirteen studies reported 70 patients undergoing pancreatectomy with SMA resection from 10,726 undergoing pancreatectomy. Individual patient-level outcome data were available for 25. Median (range) accrual period was 132 (48-372) months. Reported peri-operative morbidity ranged from 39% to 91%. There were 5 peri-operative deaths in the 25 patients with individual-outcome data. Median survival was 11 months (95% Confidence interval 9.5-12.5 months; standard error 0.8 months). SMA resection during pancreatectomy is undertaken infrequently incurring high peri-operative morbidity and mortality. Median survival is 11 (95% CI 9.5-12.5) months. In contemporary practice there is no evidence to support SMA resection during pancreatectomy. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. All rights reserved.

  1. [A case of multiple aneurysms originated from the superior mesenteric artery branch, and a review of literature].

    Science.gov (United States)

    Fukumoto, T; Shirakura, T; Usui, M; Kashii, A; Kanazawa, K; Shimizu, H

    1988-11-01

    A case of multiple aneurysm of superior mesenteric artery (SMA) branch is presented. A 54-year-old man with sudden onset of back pain was admitted to our hospital. Severe abdominal pain was developed and he fell into shock. Selective angiography of the SMA demonstrated aneurysm of the accessory middle colic artery to splenic flexure. Laparotomy disclosed much intraperitoneal blood and a large clot under the pancreatic body with a gushing hemorrhage. The bleeding vessel was ligated and sutured. The postoperative course was uneventful, but the subsequent angiography revealed another aneurysm of SMA branch, which was not able to be seen in the previous angiography because of overlapping with main SMA trunk. Resection of the aneurysm was done. The etiology of the latter aneurysm was suggested to be medial degeneration histologically. Fourty-nine cases of SMA aneurysm from the Japanese literature were reviewed and discussed. Emphasis is placed on early diagnostic laparotomy for appropriate management and the role of angiography in confirmation of bleeding site in case of spontaneous intraabdominal hemorrhage.

  2. Further experience with epigastric pain reproduction test in duodenal ulceration.

    Science.gov (United States)

    Earlam, R J

    1972-06-17

    Further evidence is presented that the epigastric pain of duodenal ulceration, situated between the rib margins and just below the xiphisternum, arises from the lower oesophagus.One-hundred patients with duodenal ulceration were divided into those with epigastric pain (61) and those with pain in the upper abdomen but not in the epigastrium (39). Perfusion of 0.1 N HCl into the lower oesophagus reproduced epigastric pain in 53 of the 61 with epigastric pain (mean 37 ml) but in none of the 39 without (mean 125 ml). All those who had been woken by epigastric pain at night in the previous four weeks had a positive test.In five the test remained positive even though the acid was neutralized by a continuous perfusion of alkali just below the gastro-oesophageal junction. In another five 200 ml 0.1 N HCl instilled into the stomach for 21 minutes did not reproduce epigastric pain, even though 30 ml perfused for three minutes into the lower oesophagus did.

  3. Total aortic arch replacement: superior ventriculo-arterial coupling with decellularized allografts compared with conventional prostheses.

    Directory of Open Access Journals (Sweden)

    Alexander Weymann

    Full Text Available To date, no experimental or clinical study provides detailed analysis of vascular impedance changes after total aortic arch replacement. This study investigated ventriculoarterial coupling and vascular impedance after replacement of the aortic arch with conventional prostheses vs. decellularized allografts.After preparing decellularized aortic arch allografts, their mechanical, histological and biochemical properties were evaluated and compared to native aortic arches and conventional prostheses in vitro. In open-chest dogs, total aortic arch replacement was performed with conventional prostheses and compared to decellularized allografts (n = 5/group. Aortic flow and pressure were recorded continuously, left ventricular pressure-volume relations were measured by using a pressure-conductance catheter. From the hemodynamic variables end-systolic elastance (Ees, arterial elastance (Ea and ventriculoarterial coupling were calculated. Characteristic impedance (Z was assessed by Fourier analysis.While Ees did not differ between the groups and over time (4.1±1.19 vs. 4.58±1.39 mmHg/mL and 3.21±0.97 vs. 3.96±1.16 mmHg/mL, Ea showed a higher increase in the prosthesis group (4.01±0.67 vs. 6.18±0.20 mmHg/mL, P<0.05 in comparison to decellularized allografts (5.03±0.35 vs. 5.99±1.09 mmHg/mL. This led to impaired ventriculoarterial coupling in the prosthesis group, while it remained unchanged in the allograft group (62.5±50.9 vs. 3.9±23.4%. Z showed a strong increasing tendency in the prosthesis group and it was markedly higher after replacement when compared to decellularized allografts (44.6±8.3 dyn·sec·cm(-5 vs. 32.4±2.0 dyn·sec·cm(-5, P<0.05.Total aortic arch replacement leads to contractility-afterload mismatch by means of increased impedance and invert ventriculoarterial coupling ratio after implantation of conventional prostheses. Implantation of decellularized allografts preserves vascular impedance thereby improving

  4. Treatment of a coronary artery to superior vena cava fistula resulting from early closure of a Possis Perma-Flow graft.

    Science.gov (United States)

    Graham, M M; Kells, C M; Sullivan, J; O'Neill, B J

    1999-06-01

    The Perma-Flow graft used in bypass surgery achieves more complete revascularization when paucity of native conduits exists. We report a coronary artery to superior vena cava fistula as a complication of this graft, leading to severe right heart failure. The fistula was successfully occluded percutaneously, improving the patient's clinical situation.

  5. Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study

    Directory of Open Access Journals (Sweden)

    Naveen G Singh

    2016-01-01

    Full Text Available Background: Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF. Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE during cardiac surgery under hypothermic cardiopulmonary bypass (CPB. Methodology: Thirty-five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP, cardiac output (CO, SMABF, superior mesenteric artery (SMA diameter, superior mesentric artery blood flow over cardiac output (SMA/CO ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure. Results: SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO-decreased significantly (P 0.05 between T0 and T2. Lactates increased progressively from T0 to T2. Conclusion: Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period.

  6. Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Binkert, Christoph A., E-mail: christoph.binkert@ksw.ch [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hirzel, Florian C. [Kantonsspital Winterthur, Department of Gynecology (Switzerland); Gutzeit, Andreas; Zollikofer, Christoph L. [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hess, Thomas [Kantonsspital Winterthur, Department of Gynecology (Switzerland)

    2015-10-15

    PurposeTo evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.Materials and methodsIn this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500–700 or 700–900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°–15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right–left distribution the needle was repositioned.ResultsAll SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s–9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.ConclusionThe SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.

  7. Initial and middle-term results of treatment for symptomatic spontaneous isolated dissection of superior mesenteric artery.

    Science.gov (United States)

    Jia, Z Z; Zhao, J W; Tian, F; Li, S Q; Wang, K; Wang, Y; Jiang, L Q; Jiang, G M

    2013-05-01

    Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is extremely rare. Various treatment options are currently available, including conservative treatment, endovascular stenting (ES) and surgical repair. Herein, we present our experience in the treatment of symptomatic SIDSMA. A retrospective study was conducted on 17 consecutive patients with symptomatic SIDSMA from May 2002 to May 2012. Conservative treatment consisted of strict blood-pressure control, bowel rest, nasogastric suction, intravenous fluid therapy and nutritional support as required; fasting was released on resolution of abdominal pain, and fluid food was given first; then, diet was resumed after complete resolution of abdominal pain. The decision to intervene was based on patient symptoms and signs, as well as the morphological characteristics of SMA dissection on computed tomography (CT) angiography. Self-expandable stents were placed via the common femoral artery approach. ES was indicated in patients with severe compression of the true lumen or dissecting aneurysm likely to rupture. All patients had acute-onset abdominal pain. Treatment included conservative treatment with the use of anticoagulation in five and without in nine patients, respectively. Three patients with severe compression of the true lumen or large dissecting aneurysm underwent ES as a primary treatment. ES was performed in two patients in whom initial conservative treatment failed. Patients who underwent ES were maintained on anti-platelet therapy for 3 months postoperatively. The median follow-up time was 24 months (range, 2-72 months). No complications were associated with the SIDSMA or ES. The patency of stents was demonstrated on follow-up CT scans up to 8.5 months (range, 4-38 months). Conservative treatment without anticoagulation can be applied successfully to the patients with symptomatic SIDSMA. Our strategy of restricting ES for these patients who have compression of the true lumen or dissecting

  8. Iatrogenic pseudoaneurysm of the superior gluteal artery presenting as pelvic mass with foot drop and sciatica: case report and review of literature.

    Science.gov (United States)

    Ge, Phillip S; Ng, Gladys; Ishaque, Brandon M; Gelabert, Hugh; de Virgilio, Christian

    2010-01-01

    We report an unusual case of a pseudoaneurysm of the superior gluteal artery as a complication of bone marrow biopsy. A 51-year-old man presented with sciatic pain and foot drop after undergoing bone marrow biopsy and was initially diagnosed as having degenerative disc disease based on his past medical history. Pelvic magnetic resonance imaging (MRI) revealed a large heterogeneous mass suggestive of a neurogenic tumor, but pulsatile blood was instead encountered during computed tomography (CT)-guided needle biopsy. Subsequent workup established the diagnosis of a superior gluteal artery pseudoaneurysm, which was treated with coil embolization, followed by surgical evacuation of the hematoma, which relieved his sciatic pain. However, the patient continues to have a persistent foot drop. Gluteal artery pseudoaneurysms are exceedingly uncommon but should be considered in the workup of a patient with gluteal pain or sciatic nerve palsy following trauma or medical procedures in the gluteal region.

  9. Unique challenges for appropriate management of a 16-year-old girl with superior mesenteric artery syndrome as a result of anorexia nervosa: a case report

    Directory of Open Access Journals (Sweden)

    Verhoef Philip A

    2009-11-01

    Full Text Available Abstract Introduction Nausea and vomiting in an adolescent, though common presenting symptoms, often pose a diagnostic and therapeutic challenge to the physician. When the diagnosis involves both medical and psychiatric components, management can be complex, especially in the current healthcare system in the United States. To the best of our knowledge, there have been no previous publications detailing successful management of a patient with anorexia nervosa and superior mesenteric artery syndrome. Case presentation We report the case of a 16-year-old Caucasian girl who presented to our emergency department with nausea, abdominal pain, diminished appetite and vomiting. Her history and examination were notable for a 15 kg weight loss and diffuse abdominal tenderness. A barium swallow X-ray with small bowel follow-through and computed tomography scan demonstrated remarkable duodenal narrowing between the superior mesenteric artery and the aorta, consistent with superior mesenteric artery syndrome. Initial management focused on relieving the obstruction and supporting the nutritional needs of the patient. Further history confirmed a diagnosis of anorexia nervosa, requiring intensive psychiatric and medical management, and necessitating a multifaceted approach to patient care involving social work, multiple primary care physicians and subspecialists, insurance company representatives, and the patient's immediate family. Conclusion This case illustrates important points regarding the pathogenesis of superior mesenteric artery syndrome in the setting of anorexia, and it highlights the complexities that arise when managing an adolescent with both medical and psychiatric needs, as well as outlining a viable solution. While superior mesenteric artery syndrome is an uncommon cause of small bowel obstruction, the general pediatrician and child psychiatrist should be aware of this complication of anorexia nervosa.

  10. Morfologia da artéria cerebelar superior do macaco prego (Cebus apella L., 1766: divisões e anastomoses Morphology of the superior cerebellar artery of the “macaco prego” (Cebus paella L., 1766: divisions and anastomoses

    Directory of Open Access Journals (Sweden)

    Rosimeire Alves da Silva

    2002-04-01

    Full Text Available Dando continuidade a estudos já existentes na área de mapeamento da vascularização cerebral do Cebus apella e considerando a semelhança desse animal com outros primatas descritos, inclusive os humanos, estudou-se a morfologia das artérias cerebelares superiores, que destinam a irrigar a superfície superior do cerebelo. 57 hemisférios cerebelares foram injetados com látex corado e fixados em solução de formol a 10%, dissecados sob mesoscopia de luz com microdissecações. As artérias cerebelares superiores são simétricas em 84,21% e assimétricas em 7,01%, ramificam-se em 4 ramos: sendo 1 para o mesencéfalo e 3 troncos principais para a superfície superior do cerebelo e regiões anterior dessa superfície. Estas artérias terminam na fissura póstero-superior ou pós-semilunar após emitir vários ramos colaterais de hierarquia decrescente de calibreIn order to continue studies already done in the area of mapping the cerebral vascularization of Cebus paella and taking into consideration the resemblance of this animal with other primates described, humans included, we studied the morphology of the superior cerebellar arteries determined to perfuse the superior surface of the cerebellum. Fifty-seven cerebellar hemispheres were injected with stained latex, fixed in 10% formol solution and dissected under light mesoscopy. The superior cerebellar arteries are symmetrical in 84,21% and asymmetrical in 7,01%, and give off four branches, one to the mesencephalon and three mains branches to the upper surface of the cerebellum and its anterior portion. These arteries end in the posterior superior or post-semilunar fissure, after giving off many collaterals of decreasing diameter

  11. A study on variation types in celiac axis and superior mesenteric artery using 3D volume rendering of MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Keun; Jang, Seong Joo [Dept. of Radiological physics Graduate School of Dongshin University, Naju (Korea, Republic of); Jang, Young Ill [Dept. of Radiological Technology of Kwangyang Health College, Kwangyang (Korea, Republic of)

    2013-06-15

    The aim of this study was to evaluate the variation which based on Celiac axis and SMA using by CT volume rendering images. 613 patients underwent abdominal CTA, there were 552 patients (99.05%, TypeⅠ, Ⅱ ) with normal anatomical form and 61 (9.95%, Type Ⅲ-Ⅻ) with variation. TypeⅠ was 339(55.31%), Type Ⅱ was 213 (34.74%), Type Ⅲ was 18 (2.93%), Type Ⅳ was 12 patients (1.95%), Type Ⅴ was 11 patient (1.79%), Type Ⅵ was 9 patients (1.46%), Type Ⅶ was 6 patients (0.97%), Type Ⅷ was 1 patient (0.16%), Type Ⅸ was 1 patient (0.16%), Type Ⅹ was 1 patient (0.16%), Type Ⅺ was 1 patient (0.16%), and Type Ⅻ was 1 patient (0.16%) into totally new types of variation. In conclusion, we could found 9 new types of variation by classifying based on celiac axis and superior mesenteric artery. These results were considered to be an important opportunity for a new vessel map.

  12. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

    Energy Technology Data Exchange (ETDEWEB)

    Raupach, J., E-mail: janraupach@seznam.cz; Lojik, M., E-mail: miroslav.lojik@fnhk.cz; Chovanec, V., E-mail: chovanec.v@seznam.cz; Renc, O., E-mail: ondrejrenc@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Strýček, M., E-mail: m.strycek@gmail.com [Faculty of Medicine at Charles University (Czech Republic); Dvořák, P., E-mail: petr.dvorak@fnhk.cz; Hoffmann, P., E-mail: hoffmpet@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Guňka, I., E-mail: gunka@email.cz; Ferko, A., E-mail: a.ferko@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Surgery (Czech Republic); Ryška, P., E-mail: ryska@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Omran, N., E-mail: nidal81@gmail.com [Faculty of Medicine at Charles University and University Hospital, Department of Cardiac Surgery (Czech Republic); Krajina, A., E-mail: krajina@fnhk.cz; Čabelková, P., E-mail: pavla.cabelkova@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Čermáková, E., E-mail: cermakovae@lfhk.cuni.cz [Faculty of Medicine at Charles University, Computer Technology Center (Czech Republic); Malý, R., E-mail: malyr@volny.cz [Faculty of Medicine at Charles University and University Hospital, Department of Medicine (Czech Republic)

    2016-02-15

    PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

  13. The prevalence of umbilical and epigastric hernia repair

    DEFF Research Database (Denmark)

    Burcharth, J; Pedersen, M.S.; Pommergaard, H C;

    2015-01-01

    PURPOSE: Umbilical and epigastric hernia repair are common surgical procedures; however, the nationwide gender and age-specific prevalence of these repairs is unknown, and this knowledge could form the basis for new studies. METHODS: A nationwide register-based study covering all people living...... in Denmark on December 31st, 2010 was performed. Within this population all umbilical and epigastric hernia repairs from January 1st, 2006 to December 31st, 2010 were identified using data from the Danish National Hospital Register, and 5-year prevalence estimates were calculated. RESULTS: The study...... population covered 5,639,885 persons (49 % males). A total of 10,107 patients (68 % males) were operated for an umbilical hernia and 2412 patients (55 % males) were operated for an epigastric hernia. The age-specific 5-year prevalence differed for both hernia types. The highest 5-year prevalence of umbilical...

  14. Infrarenal aorta as the donor site for bypasses to the superior mesenteric artery for chronic mesenteric ischemia: A prospective clinical series of 24 patients.

    Science.gov (United States)

    Illuminati, Giulio; Pizzardi, Giulia; Calio', Francesco G; Pasqua, Rocco; Masci, Federica; Vietri, Francesco

    2017-08-11

    Treatment of symptomatic, chronic mesenteric ischemia is indicated to relieve symptoms and prevent acute ischemia and death. Current therapeutic options include endovascular and open surgery. The purpose of this prospective study was to evaluate the results of bypasses to the superior mesenteric artery arising from the infrarenal aorta or infrarenal aortic grafts. From January 1999 to December 2016, 24 consecutive patients with a mean age of 61 years underwent a prosthetic bypass to the superior mesenteric artery. Nine patients (37%) presented with an associated clinically important stenosis of the celiac artery and 10 (42%) of the inferior mesenteric artery. Five patients (21%) received preoperative parenteral nutrition. Four patients (17%) underwent dual antiplatelet treatment. The donor site was the infrarenal aorta in 19 patients (79%) and an infrarenal, Dacron graft was used in 5 (21%). The origin of the bypass was from the distal infrarenal aorta or Dacron graft in 19 patients (79%) and from the proximal infrarenal aorta in 5 patients (21%). The graft material consisted of 7 mm polytetrafluoroethylene in 19 cases (79%) and 7 mm Dacron in 5 cases (21%). A concomitant bypass to the inferior mesenteric artery was performed in 4 patients (17%). The primary end points were postoperative mortality, morbidity, graft infection, late survival, primary patency, and symptom-free rate. The secondary end point was postoperative hemorrhagic complications. No postoperative mortality occurred. Postoperative morbidity included a prolonged postoperative ileus in 4 patients (17%), transitory postoperative increases in serum creatinine concentrations in 3 patients (12%), and myocardial ischemia in 2 patients (8%). No postoperative hemorrhagic complications or graft infection were observed. Overall, the cumulative survival rate was 77% at 60 months. The overall late-patency rate and freedom from recurrence of symptoms were both 87% at 60 months. Infrarenal aorta and

  15. Combined epigastric hernia repair and mini-abdominoplasty. Case report.

    Science.gov (United States)

    Grella, Roberto; Razzano, Sergio; Lamberti, Rossella; Trojaniello, Biagio; D'Andrea, Francesco; Nicoletti, Giovanni Francesco

    2015-01-01

    The objectives of abdominal hernia repair are to restore the structural integrity of the abdominal wall. Current techniques include primary closure, staged repair and the use of prosthetic materials. Techniques for mini-abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. We report a case of epigastric hernia repair through a transverse lower abdominal incision with the resection of excess of skin. Our purpose is to evaluate the results of the procedure by incorporating these aspects into an epigastric hernia repair, we found out that the procedures are made safer and the results are improved. Proper indication and details of the technique are described.

  16. Spontaneous epigastric hernia causing gastric outlet obstruction: a case report.

    Science.gov (United States)

    Arowolo, O A; Ogundiran, T O; Adebamowo, C A

    2006-09-01

    Epigastric hernia, a rare form of ventral abdominal hernia, accounts for 0.4 - 1.5% of all abdominal wall hernias. It usually occurs in middle - aged individuals and is rarely large enough to admit more than a small amount of extra-peritoneal fat. In this case report, we present a 64 years old woman with 6 days history of sudden onset of painful epigastric swelling associated with acute gastric outlet obstruction. We did not find a previous report of a similar case in the medical literature.

  17. Acute thrombosis of the superior mesenteric artery in a 39-year-old woman with protein-S deficiency: a case report

    Directory of Open Access Journals (Sweden)

    Luceretti Remo

    2011-01-01

    Full Text Available Abstract Introduction Acute thromboembolic occlusion of the superior mesenteric artery is a condition with an unfavorable prognosis. Treatment of this condition is focused on early diagnosis, surgical or intravascular restoration of blood flow to the ischemic intestine, surgical resection of the necrotic bowel and supportive intensive care. In this report, we describe a case of a 39-year-old woman who developed a small bowel infarct because of an acute thrombotic occlusion of the superior mesenteric artery, also involving the splenic artery. Case presentation A 39-year-old Caucasian woman presented with acute abdominal pain and signs of intestinal occlusion. The patient was given an abdominal computed tomography scan and ultrasonography in association with Doppler ultrasonography, highlighting a thrombosis of the celiac trunk, of the superior mesenteric artery, and of the splenic artery. She immediately underwent an explorative laparotomy, and revascularization was performed by thromboendarterectomy with a Fogarty catheter. In the following postoperative days, she was given a scheduled second and third look, evidencing necrotic jejunal and ileal handles. During all the surgical procedures, we performed intraoperative Doppler ultrasound of the superior mesenteric artery and celiac trunk to control the arterial flow without evidence of a new thrombosis. Conclusion Acute mesenteric ischemia is a rare abdominal emergency that is characterized by a high mortality rate. Generally, acute mesenteric ischemia is due to an impaired blood supply to the intestine caused by thromboembolic phenomena. These phenomena may be associated with a variety of congenital prothrombotic disorders. A prompt diagnosis is a prerequisite for successful treatment. The treatment of choice remains laparotomy and thromboendarterectomy, although some prefer an endovascular approach. A second-look laparotomy could be required to evaluate viable intestinal handles. Some authors

  18. Interrupted inferior vena cava with hemiazygos continuation in an adult with a persistent left superior vena cava and left single coronary artery: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeo Jin; Kwon, Se Hwan; Ahn, Sung Eun; Kim, Soo Joong; Oh, Joo Hyeong [College of Medicine, Kyung Hee University, Seoul (Korea, Republic of); Shin, Jong Soo [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

    2016-06-15

    A 50-year-old woman was referred to our institution for medical screening due to an incidental finding on abdominal ultrasonography. She underwent chest, abdomen and cardiac multi-detector computed tomography (MDCT). Her MDCT revealed absence of the hepatic segment of the inferior vena cava (IVC), with hemiazygos continuation and a left single coronary artery. The dilated hemiazygos vein drained directly into the persistent left superior vena cava (SVC). Herein, we reported a very rare case combining an incidentally found interrupted IVC with hemiazygos vein continuation, persistent left SVC and a left single coronary artery diagnosed by MDCT.

  19. Effect of Meconium on the Contractility of the Superior Mesenteric Artery: A Clue to Intestinal Damage in Gastroschisis.

    Science.gov (United States)

    Karakuş, Osman Z; Solmaz, Bora; Ateş, Oğuz; Ateş, Mehmet; Hakgüder, Gülce; Olguner, Mustafa; Akgür, Feza M

    2015-08-01

    Intestinal damage has been shown to occur when intra-amniotic meconium concentration exceeds threshold level. However, the mechanism of the meconium-induced intestinal damage is still unclear. Intestinal ischemia can cause intestinal damage in gastroschisis. This study was aimed to determine the effects of intra-amniotic meconium on the contractility of superior mesenteric artery (SMA). Eighteen-day-old fertilized chick embryos (Gallus Domesticus) were extirpated and intestines were harvested. The SMA specimens were prepared as 4 mm segments in the organ bath with Krebs-Henseleit buffer. The isometric contraction responses of the SMA specimens were evaluated with norepinephrine, different meconium concentrations, and clear amniotic fluid. Maximum isometric contractions responses (MICR) of the SMA specimens were recorded with an amplifier system on a computer. In the norepinephrine group, MICR was found as 2.92 ± 0.57 mN. While MICR of the 1/100 meconium group (highest meconium concentration) was found as 1.56 ± 0.40 mN, MICR of the clear amniotic fluid group was 0.41 ± 0.07 mN. The MICR of the norepinephrine group was significantly increased compared with the 1/100 meconium and clear amniotic fluid groups. MICR of the 1/100 meconium group was also found to be significantly increased compared with clear amniotic fluid group. No statistically significant difference was found among the meconium subgroups. Intra-amniotic meconium in fetuses with gastroschisis might cause ischemic intestinal damage by reducing the intestinal blood flow. Further studies are needed to show the outcomes of the vasoactive effect of meconium on the SMA blood flow. Georg Thieme Verlag KG Stuttgart · New York.

  20. Blood flow parameters of the superior mesenteric artery as an early predictor of intestinal dysmotility in preterm infants

    Energy Technology Data Exchange (ETDEWEB)

    Robel-Tillig, Eva; Knuepfer, Matthias; Pulzer, Ferdinand; Vogtmann, Christoph [University of Leipzig, Department of Neonatology, Children' s Hospital, Leipzig (Germany)

    2004-12-01

    Blood flow parameters in the superior mesenteric artery (SMA) change with vasoconstriction or vasodilatation of the intestinal vascular bed. In cases of severe growth retardation as a result of haemodynamic disturbances, the blood flow changes persist into postnatal life. To assess early changes of Doppler sonographic blood flow parameters in the SMA for prediction of later intestinal motility disturbances in preterm infants and tolerance of enteral feeding during the first week of life. Doppler sonographic blood flow parameters in the SMA were measured on the first day of life and the following 5 days in 478 neonates with a birth weight below 1,500 g. According to the Doppler results, the neonates were divided into two groups - those with pathological parameters and those with normal blood flow parameters. Correlations between blood flow parameters, the development of intestinal dysmotility and the tolerated amount of enteral feeding were calculated. Pathological blood flow parameters were observed in 148 neonates (group 1) and normal blood flow parameters in 330 neonates (group 2). Intestinal motility disturbance occurred in 125 neonates (83%) of group 1 and 47 neonates (15%) of group 2. Neonates in group 2 tolerated significantly more feed by the fifth day of life than neonates in group 1. Postnatal adaptation did not differ between the two groups, although the majority of neonates with intestinal dysmotility were small for gestational age. The predictive value of blood flow parameters for prediction of intestinal motility revealed high sensitivity and specificity by the first postnatal day, 2 or 3 days before development of clinical signs of intestinal dysmotility. There was a strong negative correlation between pathological pulsatility index on day 1 and the quantity of tolerated enteral feeding on day 5. Pathological blood flow parameters in the SMA can predict problems of intestinal motility and tolerance of enteral feeding. With the early detection of these

  1. Endovascular Management of Superior Mesenteric Artery (SMA) Aneurysm – Adequate Access is Essential for Success – Case Report

    Science.gov (United States)

    Tkalčić, Lovro; Budiselić, Berislav; Kovačević, Miljenko; Knežević, Siniša; Kovačić, Slavica; Miletić, Damir; Tomulić, Vjekoslav; Kuhelj, Dimitrij

    2017-01-01

    Summary Background An aneurysm of the superior mesenteric artery (SMA) with a diameter of 2.2 cm was found incidentally on an ultrasound (US) examination in a 26-year-old woman. The only known risk factor was an intracranial aneurysm that was found on her grandmother’s autopsy. Based on pregnancy planning and the current literature, endovascular management with a covered stent was proposed. Case Report Self-expandable, covered stent (Bard, Fluency®) was implanted using a single transfemoral approach. A stiff guidewire and a large sheath distorted the anatomy, which resulted in an incomplete aneurysmal neck covering. In the absence of additional covered stents, the procedure was terminated. Two weeks later, computed tomographic angiography (CTA) confirmed persistent aneurysmal perfusion due to the incomplete neck coverage. A multidisciplinary board opted for a second endovascular attempt, this time with a longer covered stent via the transaxillary approach in order to reduce anatomical distortion. Balloon, expandable, cobalt-chrome covered stent (Jotec, E-ventus BX®) was implanted in the SMA, covering the aneurysmal neck and overlapping the previously implanted covered stent. Angiography confirmed a complete exclusion of the aneurysm. A control US performed three weeks later confirmed a patent covered stent and complete aneurysmal exclusion. There was a mild median nerve damage periprocedurally that resolved in three months. The most recent US control examination, performed eleven months after the procedure, showed an excluded aneurysm and a patent covered stent. There were no clinical signs of bowel ischaemia during the follow-up period. Conclusions Endovascular management of SMAA proved to be safe and efficient. The “access from above” is probably safer and should be considered in the majority of cases with acceptable sizes of access vessels. Mid-term results in our patient are good and life-long follow-up is planned to prevent late complications. PMID

  2. An unusual presentation of perforated appendicitis in epigastric region☆

    Science.gov (United States)

    Odabasi, Mehmet; Arslan, Cem; Abuoglu, Hasan; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, M.A. Tolga

    2013-01-01

    INTRODUCTION Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation. PRESENTATION OF CASE A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver. DISCUSSION While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. CONCLUSION Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia. PMID:24441442

  3. Acute acalculous cholecystitis due to an incarcerated epigastric hernia.

    OpenAIRE

    1985-01-01

    A case of a 96 year old woman with an incarcerated gallbladder in an epigastric hernia causing acute acalculous cholecystitis is described. At operation the gallbladder was replaced in its anatomical site and the hernia was repaired. This unique case of acute acalculous cholecystitis demonstrates cystic duct obstruction and cystic vessel compression as possible aetiologies for this pathology.

  4. Percutaneous retrograde crossing of a near-occluded celiac trunk via the superior mesenteric artery as an adjuvant maneuver for antegrade stenting

    Directory of Open Access Journals (Sweden)

    Martin Andreas Geiger

    2016-03-01

    Full Text Available Abstract We describe the case of a 63-year-old woman with chronic mesenteric ischemia, persistent postprandial upper abdominal pain and progressive weight loss. Retrograde recanalization was performed via the superior mesenteric artery in order to achieve the goal of crossing the near-occlusion, showing that retrograde catheterization of the celiac trunk can be a feasible approach in challenging cases in which an antegrade approach fails as a single maneuver.

  5. Unrecorded origin of external pudendal artery with variant obturator vessels

    Directory of Open Access Journals (Sweden)

    El-Sawaf ME

    2010-08-01

    Full Text Available During routine dissection of a female cadaver for teaching purposes, the vessels in the ilioinguinal region in both sides showed some anatomical variations. In the right side, the external iliac artery gave off the obturator artery and a common trunk for both external pudendal artery and inferior epigastric artery. The obturator vein followed the variant obturator artery while the external pudendal vein showed a normal course. Meanwhile, the obturator artery in the left side originated from the inferior epigastric artery and the obturator vein drained into the external iliac vein. These anatomical findings may have important clinical implications.

  6. [Our experience on the treatment of epigastric hernia].

    Science.gov (United States)

    Tenaglia, L; Iuppa, A; Trovato, S; Di Stefano, C; Iuppa, G; Minona, E; Vacirca, S; Scilletta, S; Catania, G

    2008-10-01

    The epigastric hernia represents a rare surgical affection, sometimes insidious, whose pathogenesis has been discussed for a long time, revealing, in the course of the years, multiple predisposing and responsible factors of its appearance. From our experience and the data reported in the literature, it is clear that a standard surgery does not exist for this pathology, and it is often necessary to perform preliminary uncommon diagnostic exams. Our retrospective study consists in the analysis of the surgical treatments executed, from 2003 to 2006, on 37 patients suffered from epigastric hernia, for everyone of which, on the basis of the clinical features, of the preoperative diagnostic results and of the characteristics of the hernia defect, it has been encouraged a personalized surgical procedure,obtaining therefore, for the same pathology, different treatment protocols (open or laparoscopic procedures, ordinary hospital stay or day-surgery, prosthetic or not surgical repair).

  7. Combined epigastric hernia repair and mini-abdominoplasty. Case report

    Directory of Open Access Journals (Sweden)

    Grella Roberto

    2015-01-01

    Full Text Available The objectives of abdominal hernia repair are to restore the structural integrity of the abdominal wall. Current techniques include primary closure, staged repair and the use of prosthetic materials. Techniques for mini-abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. We report a case of epigastric hernia repair through a transverse lower abdominal incision with the resection of excess of skin. Our purpose is to evaluate the results of the procedure by incorporating these aspects into an epigastric hernia repair, we found out that the procedures are made safer and the results are improved. Proper indication and details of the technique are described.

  8. Strangulated double omental hernia presenting as an epigastric lump.

    Science.gov (United States)

    Mukherjee, Ramanuj; Paira, Susil Kumar; Ghosh, Parthasarathi; Halder, Sandip K; Roy, Bipradas; Ray, Debasis; Mukherjee, Saibal Kumar

    2012-09-01

    Internal herniations constitute one of the relatively uncommon surgical emergencies. Among them double omental hernia with bowel strangulation is very rare and is a major diagnostic challenge. A case of a strangulated double omental hernia in a 42-year-old female patient is reported. The patient presented with a painful tender epigastric lump.There was a diagnostic dilemma. CT scan was followed by laparotomy which revealed a strangulated double omental hernia.

  9. Eosinophilic Gastroenteritis as a Rare Cause of Recurrent Epigastric Pain

    Directory of Open Access Journals (Sweden)

    Mohammad Taghi Safari

    2016-04-01

    Full Text Available Eosinophilic gastroenteritis (EGE is a rare inflammatory disorder of gastrointestinal tract characterized by eosinophilic infiltration of the bowel wall. It can mimic many gastrointestinal disorders due to its wide spectrum of presentations. Diagnose is mostly based on excluding other disorders and a high suspicion. Here we report a case of 26 year old man with a history of sever epigastric pain followed by nausea, vomiting since a few days before admission with final diagnosis of EGE.

  10. Tomographic Evaluation of Prevalence, Position, and Diameter of the Intraosseous Branch of the Posterior Superior Alveolar Artery in Fully Edentulous Individuals.

    Science.gov (United States)

    de Oliveira, Guilherme José Pimentel Lopes; Abdala, Marciel Antônio; Nary-Filho, Hugo; Sakakura, Celso Eduardo; Garcia, Valdir Gouveia; Leite, Felipe Coletti

    2017-03-21

    The objective of this study was to evaluate the presence, position, and diameter of the intraosseous branch (IObr) of the posterior superior alveolar artery in fully edentulous patients. Two-hundred five computed tomography scans of fully edentulous patients were analyzed. The presence of the IObr was investigated in the coronal plane at the lateral wall of the maxillary sinus. In patients in whom the IObr was detected, the artery diameter was measured, and the distance from the artery to the bone crest of the alveolar ridge, the maxillary sinus floor, and the distance of the maxillary sinus floor to the bone crest of the alveolar ridge were measured as well. A descriptive statistical analysis of these parameters was conducted. The IObr was identified in the maxillary sinus in 105 tomography images (51.2%), and its diameter varied between 0.8 and 3.3 mm (1.29 ± 0.49 mm). The IObr presented with an artery diameter less than 1 mm in 29% of the patients, between 1 and 2 mm diameter in 61% of the patients and with a diameter larger than 2 mm in 10% of patients. Regarding the IObr topography, the distance from the artery to the floor of the maxillary sinus was 9.62 ± 4.59 mm, and the distance from the artery to the top of crestal bone was 15.15 ± 4.47 mm. At least 10% of edentulous patients are at risk of bleeding complications during interventions in the maxillary sinus.

  11. Evaluation of the position of the posterior superior alveolar artery in relation to the maxillary sinus using the Cone-Beam computed tomography scans

    Science.gov (United States)

    Chitsazi, Mohammad-Taghi; Faramarzi, Masoumeh; Esmaieli, Farzad; Chitsazi, Shadi

    2017-01-01

    Background The aim of the present study was to evaluate the diameter, relationship and position of the posterior superior alveolar artery and its relationship with the alveolar ridge, the medial wall of the maxillary sinus, the prevalence of pathologic conditions and the maxillary sinus septa on CBCT images. Material and Methods A total of 200 CBCT images (400 maxillary sinuses) of patients over 20 years of age were evaluated. The distances between the lower border of the artery and the alveolar crest and between the artery and the medial wall of the sinus and the diameter of the artery were measured. The position of the artery, the presence of pathologic conditions and septa were recorded in the posterior region in: a) males edentulous in the posterior region; b) males having teeth in the posterior region; c) females edentulous in the posterior region; and d) females having teeth in the posterior region. Results The mean distance between the artery and the alveolar crest, irrespective of groupings, was 16.17±1.63 mm, with significant differences between the groups (P<0.05). The mean distance between the artery and the medial wall of the sinus was 11.65±1.21 mm, with no significant differences between the groups (P=0.796). The mean diameter of the canal was 1.37±0.44 mm, with no significant differences between the 4 groups (P=0.570). The position of the artery was intraosseous in 73.2%, beneath the sinus membrane in 21.7% and external to the lateral wall of the sinus in 4.9% of the cases. The overall prevalence rates of pathologic conditions and septa in the maxillary sinus were 45.7% and 26%, respectively. Conclusions CBCT technique is useful for such evaluations and for possible variations in maxillary sinuses and presence of septa and pathologic entities in maxillary sinuses. Key words:Maxillary sinus, maxillary artery, Cone-Beam computed tomography. PMID:28298981

  12. Analysis of Acupuncture Treatment Characteristics of Epigastric Pain in Ancient Times

    Institute of Scientific and Technical Information of China (English)

    LIU Li-gong; GU Jie; XIAO Yuan-chun

    2005-01-01

    @@ Epigastric pain involves the inflammation, ulcer,spasm and tumor in the stomach, esophagus,diaphragm and the like. The heart, liver, gallbladder and spleen are near to the epigastrium, so the pain associated with these organs is mistakenly taken as epigastric pain. Consequently, some of these organs' disorders are inevitably included in this study. With the help of computer, we have statistically analyzed the information concerning the treatment of epigastric pain by acupuncture in 93 ancient medical books. Results show that 66 pieces of information and 60 acupoints (139 times in frequency) are involved in the treatment of epigastric pain.

  13. Pre-expanded Deep Inferior Epigastric Perforator Flap.

    Science.gov (United States)

    Monsivais, Sharon E; Webster, Nicholas D; Wong, Stacy; Saint-Cyr, Michel H

    2017-01-01

    The deep inferior epigastric perforator (DIEP) flap can be used to cover large defects of the proximal lower extremity, abdominal wall, perineum, vulva, and buttock. Pre-expanding DIEP flaps cause a possible delay phenomenon improving vascularity, decrease donor site morbidity, and increase the area that can be covered. Pre-expansion requires staged procedures, has risk of extrusion and infection, causes temporary contour deformity during the expansion process, and requires a longer course. Pre-expanded DIEP flaps can be a useful flap with proper patient selection and planning. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Transcutaneous PTCCO2 measurement in combination with arterial blood gas analysis provides superior accuracy and reliability in ICU patients.

    Science.gov (United States)

    Spelten, Oliver; Fiedler, Fritz; Schier, Robert; Wetsch, Wolfgang A; Hinkelbein, Jochen

    2017-02-01

    Hyper or hypoventilation may have serious clinical consequences in critically ill patients and should be generally avoided, especially in neurosurgical patients. Therefore, monitoring of carbon dioxide partial pressure by intermittent arterial blood gas analysis (PaCO2) has become standard in intensive care units (ICUs). However, several additional methods are available to determine PCO2 including end-tidal (PETCO2) and transcutaneous (PTCCO2) measurements. The aim of this study was to compare the accuracy and reliability of different methods to determine PCO2 in mechanically ventilated patients on ICU. After approval of the local ethics committee PCO2 was determined in n = 32 ICU consecutive patients requiring mechanical ventilation: (1) arterial PaCO2 blood gas analysis with Radiometer ABL 625 (ABL; gold standard), (2) arterial PaCO2 analysis with Immediate Response Mobile Analyzer (IRMA), (3) end-tidal PETCO2 by a Propaq 106 EL monitor and (4) transcutaneous PTCCO2 determination by a Tina TCM4. Bland-Altman method was used for statistical analysis; p analysis revealed good correlation between PaCO2 by IRMA and ABL (R(2) = 0.766; p analysis revealed a bias and precision of 2.0 ± 3.7 mmHg for the IRMA, 2.2 ± 5.7 mmHg for transcutaneous, and -5.5 ± 5.6 mmHg for end-tidal measurement. Arterial CO2 partial pressure by IRMA (PaCO2) and PTCCO2 provided greater accuracy compared to the reference measurement (ABL) than the end-tidal CO2 measurements in critically ill in mechanically ventilated patients patients.

  15. Use of arterial blood gas analysis as a superior method for evaluating respiratory function in pet rabbits (Oryctolagus cuniculus).

    Science.gov (United States)

    Eatwell, K; Mancinelli, E; Hedley, J; Benato, L; Shaw, D J; Self, I; Meredith, A

    A retrospective study compared invasive (arterial blood gas analysis) and non-invasive (capnography and pulse oximetry) methods of monitoring respiratory function in conscious rabbits. Arterial samples from 50 healthy dwarf lop rabbits, presenting for routine surgical neutering, were analysed on a point-of-care blood gas analysis machine. Reference intervals were obtained for pH (7.35-7.54), PaCO2 (mm Hg) (25.29-40.37), PaO2 (mm Hg) (50.3-98.2), base excess (mmol/l) (6.7-6.5), HCO3 (mmol/l) (17.96-29.41), TCO2 (mmol/l) (18.9-30.5). SaO2 (per cent) (88.8-98.0), Na (mmol/l) (137.6-145.2), K (mmol/l) (3.28-4.87), iCal (mmol/l) (1.64-1.94), glucose (mmol/l) (6.23-10.53), haematocrit (per cent) (23.3-40.2) and haemoglobin (mg/dl) (7.91-13.63). Pulse oximetry (SPO2) and capnography (ETCO2) readings were taken concurrently. There was no statistically significant relationship between SPO2 and SaO2 with a mean difference between SPO2 and SaO2 of 8.22 per cent. There was a statistically significant relationship between ETCO2 vs PaCO2, but a wide range of ETCO2 values were observed for a given PaCO2. The mean difference between these was 16.16 mm Hg. The study has provided reference intervals for arterial blood gas analysis in rabbits and demonstrated that capnography and pulse oximetry readings should not be relied upon in conscious rabbits as a guide to ventilation and oxygenation.

  16. Nationwide prospective study on readmission after umbilical or epigastric hernia repair

    DEFF Research Database (Denmark)

    Helgstrand, F; Jørgensen, L N; Rosenberg, J;

    2013-01-01

    The primary aim of the present study was to investigate risk factors for readmission after elective umbilical and epigastric hernia repair and secondarily to evaluate causes for readmission.......The primary aim of the present study was to investigate risk factors for readmission after elective umbilical and epigastric hernia repair and secondarily to evaluate causes for readmission....

  17. Weight loss is superior to exercise in improving the atherogenic lipid profile in a sedentary, overweight population with stable coronary artery disease

    DEFF Research Database (Denmark)

    Pedersen, Lene Rørholm; Olsen, Rasmus Huan; Anholm, Christian

    2016-01-01

    maintenance diet. Lipid profile atherogenicity was described using lipoprotein particle size and density profiling. Low-grade inflammation was evaluated by tumor necrosis factor alpha (TNFα), C-reactive protein, interleukin 6 and soluble urokinase plasminogen activator receptor. RESULTS: Twenty-six (74%) AIT......BACKGROUND: Dyslipidemia and low-grade inflammation are integral in the pathogenesis of atherosclerosis. We aim to compare the effects of a considerable weight loss and intensive exercise training on lipid atherogenicity and low-grade inflammation in a high-risk population with coronary artery...... profile curve. LED was superior to AIT in decreasing atherogenicity reflected by increased LDL (between-group: 1.0 Å {0.4; 1.7},P = 0.003) and high-density lipoprotein (between-group: 1.2 Å {0.2; 2.4},P = 0.026) particle size and a decreased proportion of total lipoprotein constituted by the small, dense...

  18. Anatomical variations in the origins of the celiac axis and the superior mesenteric artery: MDCT angiographic findings and their probable embryological mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yi; Cheng, Cheng; Wang, Lu; Li, Ran; Chen, Jin-hua; Gong, Shui-gen [Institute of Surgery Research, Daping Hospital, Third Military Medical University, Department of Radiology, Chongqing (China)

    2014-08-15

    To identify the spectrum and prevalence of anatomical variations in the origin of the celiac axis (CA), the superior mesenteric artery (SMA) and their major branches by using multidetector computed tomographic (MDCT) angiography. A retrospective evaluation was carried out on 1,500 abdominal MDCT angiography images. The aortic origins of the CA, the SMA and their major branch patterns were investigated. Normal aortic origins of CA and SMA were noted in 1,347 (89.8 %) patients. Seven types of CA and SMA origin variants were identified in 153 (10.2 %) patients. The three most common variations were hepatomesenteric trunk (67 patients, 4.47 %), celiomesenteric trunk (CMT) (51 patients, 3.4 %) and splenomesenteric trunk (18 patients, 1.2 %). An evaluation of CMT was classified as long (34 patients, 66.7 %) or short (17 patients, 33.3 %) subtypes, compared with the length of the common trunk. Further CMT classification was based on the origin of the left gastric artery: subtype I, 26 patients (53.1 %); subtype II, 5 patients (10.2 %); subtype III, 15 patients (30.6 %); subtype IV, 3 patients (6.1 %). Dislocation interruption, incomplete interruption and persistence of the longitudinal anastomosis could be the embryological mechanisms of the variant origins of the CA, the SMA and their major branches. (orig.)

  19. Epigastric and Umbilical Hernia; Work Relatedness and Return to Work

    Directory of Open Access Journals (Sweden)

    Ramin Mehrdad

    2013-03-01

    Full Text Available Abdominal wall hernia is common but reliable scientific data about its work relatedness is very limited and inconsistent. In this paper, a less common type of abdominal wall hernia in a 30 year old male worker is presented with recurrence after first surgery when he returned to work. In contrast with almost all kinds of hernia, a lifelong limitation for heavy lifting was recommended. It seems that contrary to popular belief, work relatedness of abdominal wall hernia is seriously doubtful, although conclusive evidences are not enough. It is preferable to make decisions cautiously for return to heavy duties of work after surgery of large umbilical, umbilical & epigastric or incisional hernia, while avoiding recommendations for long days off work after surgery of any hernia.

  20. Epigastric and umbilical hernia; work relatedness and return to work.

    Science.gov (United States)

    Mehrdad, Ramin; Sadeghniiat Haghighi, Khosro; Naseri Esfahani, Amir Hossein

    2013-01-01

    Abdominal wall hernia is common but reliable scientific data about its work relatedness is very limited and inconsistent. In this paper, a less common type of abdominal wall hernia in a 30 year old male worker is presented with recurrence after first surgery when he returned to work. In contrast with almost all kinds of hernia, a lifelong limitation for heavy lifting was recommended. It seems that contrary to popular belief, work relatedness of abdominal wall hernia is seriously doubtful, although conclusive evidences are not enough. It is preferable to make decisions cautiously for return to heavy duties of work after surgery of large umbilical, umbilical & epigastric or incisional hernia, while avoiding recommendations for long days off work after surgery of any hernia.

  1. Extra-anatomic iliac to superior mesenteric artery bypass after bridge endovascular treatment for chronic mesenteric ischemia. A case report.

    Science.gov (United States)

    Bajardi, Guido; Pakeliani, David; Dinoto, Ettore; Bracale, Umberto M; Pecoraro, Felice

    2015-07-03

    Un uomo di 60 anni con ischemia mesenterica cronica (CMI) è stato trattato con una terapia ‘bridge’ verso una terapia di chirurgia open tradizionale, mediante stenting dell’arteria mesenterica superiore (SMA). Al follow-up a 5 mesi lo stent della SMA è andato incontro ad occlusione. Durante questo periodo ‘bridge’ il paziente ha migliorato le sue condizioni generali e il suo indice di massa corporea (BMI) è incrementato da 18 a 22. Il paziente è stato sottoposto successivamente ad intervento chirurgico di bypass iliaco-SMA in configurazione ‘Cloop’. Al follow-up a 6 mesi il bypass è pervio, il paziente non riferisce sintomatologia di CMI ed il suo BMI è di 25. Il trattamento endovascolare non ha precluso una successiva riparazione chirurgica e può essere impiegato in maniera sicura come terapia ‘bridge’. Un miglioramento delle condizioni cliniche, anche durante un limitato periodo ‘bridge’, può migliorare i risultati della terapia chirurgica tradizionale.

  2. [Identification of perforating vessels by augmented reality: Application for the deep inferior epigastric perforator flap].

    Science.gov (United States)

    Bosc, R; Fitoussi, A; Pigneur, F; Tacher, V; Hersant, B; Meningaud, J-P

    2017-08-01

    The augmented reality on smart glasses allows the surgeon to visualize three-dimensional virtual objects during surgery, superimposed in real time to the anatomy of the patient. This makes it possible to preserve the vision of the surgical field and to dispose of added computerized information without the need to use a physical surgical guide or a deported screen. The three-dimensional objects that we used and visualized in augmented reality came from the reconstructions made from the CT-scans of the patients. These objects have been transferred through a dedicated application on stereoscopic smart glasses. The positioning and the stabilization of the virtual layers on the anatomy of the patients were obtained thanks to the recognition, by the glasses, of a tracker placed on the skin. We used this technology, in addition to the usual locating methods for preoperative planning and the selection of perforating vessels for 12 patients operated on a breast reconstruction, by perforating flap of deep lower epigastric artery. The "hands-free" smart glasses with two stereoscopic screens make it possible to provide the reconstructive surgeon with binocular visualization in the operative field of the vessels identified with the CT-scan. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  3. “Caught by the Eye of Sound” – Epigastric Swelling due to Xiphisternal Tuberculosis

    Science.gov (United States)

    Grover, Shabnam Bhandari; Arora, Sumit; Kumar, Amit; Grover, Hemal; Katyan, Amit; Nair, Deepthi Mohan

    2017-01-01

    Summary Background Common causes of an epigastric mass include hepatomegaly, pancreatic pseudocyst and epigastric hernia, less common causes being carcinoma of the stomach or pancreas, whereas diseases of the sternum presenting as an epigastric swelling is extremely uncommon. We report a case of tubercular infection of the sternum located in the xiphoid process resulting in its presentation as an epigastric swelling. Case Report A 30-year-old immunocompetent woman with complaints of an epigastric swelling and undocumented pyrexia for four months was referred for sonographic evaluation with a clinical suspicion of an incompletely treated liver abscess. The patient was examined with ultrasound, sternal radiographs, CT and MRI. Ultrasound revealed a heterogeneous epigastric collection with linear echogenic components suggestive of bone fragments. These appearances suggested chronic infective osteomyelitis of the xiphoid process of the sternum. Lateral chest radiograph demonstrated lytic destruction of the xiphisternum. Tubercular etiology was considered and further evaluation with Multidetector Computed tomography (MDCT) and Magnetic Resonance Imaging (MRI) demonstrated erosive osteomyelitis of the xiphoid process with enhancing inflammation and collection in the adjoining soft tissue. Ultrasound-guided aspiration, PCR and Amplified Mycobacterium tuberculosis DNA test confirmed tubercular infection. Conclusions We report a new case of osteo-articular tuberculosis localized to the xiphisternum, a rare clinical entity with an extremely unusual clinical presentation as an epigastric mass. The role of ultrasound in primary diagnosis and as an interventional diagnostic modality for guided aspiration is highlighted. PMID:28217237

  4. Chronic complaints after simple sutured repair for umbilical or epigastric hernias may be related to recurrence

    DEFF Research Database (Denmark)

    Westen, Mikkel; Christoffersen, Mette W; Jorgensen, Lars N

    2014-01-01

    PURPOSE: Umbilical and epigastric hernia repairs are minor, but are commonly conducted surgical procedures. Long-term results have only been sparsely investigated. Our objective was to investigate the risk of chronic complaints after a simple sutured repair for small umbilical and epigastric...... hernias. METHODS: A retrospective cohort study with a 5-year questionnaire and clinical follow-up was conducted. Patients undergoing primary elective, open non-mesh umbilical or epigastric sutured hernia repair were included. Patients completed a structured questionnaire regarding chronic complaints...

  5. CT and clinical presentation of superior mesenteric artery syndrome%肠系膜上动脉综合征的 CT及临床表现

    Institute of Scientific and Technical Information of China (English)

    祖大报; 李建瑞; 唐春香; 杨来华

    2015-01-01

    目的:探讨肠系膜上动脉综合征的临床及CT影像学表现,以提高对该病的认识。方法对11例已确诊的肠系膜上动脉综合征患者的临床和影像学资料进行回顾性分析。结果患者多为年轻女性,主要表现为早期饭后饱腹感、上腹痛、呕心、呕吐及体重下降,部分患者可出现厌食症。 CT影像学特征主要表现为:主动脉和肠系膜上动脉夹角和距离的变小;胃和十二指肠的扩张;左肾静脉的扩张及左侧侧支循环的建立。结论结合临床病史,CT表现可对肠系膜上动脉综合征作出明确诊断。%Objective To evaluate CT and clinical presentation of the superior mesenteric artery syndrome ( SMAS) in or-der to improve the recognition of the disease.Methods Clinical data and CT findings of 11 patients were retrospectively ana-lyzed who had been diagnosed with superior mesenteric artery syndrome.Results The patients were mostly young women who experienced early post-prandial satiety,abdominal pain,nausea,vomiting and often resulted in weight loss.CT main findings in-cluded the narrowed aortomesenteric angle and distance,distension of the stomach and duodenum,and dilatation of the left re-nal vein with left-sided venous collaterals.Conclusion Combined with the clinical history,CT can make a definite diagnosis of SMAS.

  6. Diagnosis and management of acute superior mesenteric artery embolus%急性肠系膜上动脉栓塞的诊治

    Institute of Scientific and Technical Information of China (English)

    方国恩; 章琎

    2006-01-01

    肠系膜上动脉栓塞(superior mesenteric artery embolism,SMAE)是指栓子进入肠系膜上动脉,发生急性完全性血管闭塞。SMAE可使肠系膜上动脉血供突然减少或消失,导致肠壁肌肉功能障碍,肠急性缺血、坏死;是小肠血运障碍性肠梗阻中最常见的一种,约占急性肠系膜血管缺血性疾病的50% 。临床上SMAE是一种少见的疾病,年发病率约为8.6/10万 ,但其一旦发生,病情极其凶险,病死率极高,达70%~100% 。过去由于诊疗技术的落后,往往延误诊断。近年来,诊疗技术的进步,该病的术前确诊率有了很大提高。但该病的发生率有升高趋势 ,因此对本病应高度重视。

  7. Diagnosis and treatment of acute superior mesenteric artery embolism%急性肠系膜上动脉栓塞46例诊治体会

    Institute of Scientific and Technical Information of China (English)

    仝麟龙; 仝现州

    2016-01-01

    目的 探讨急性肠系膜上动脉栓塞(acute superior mesenteric artery embolism,ASMAE)早期诊断及早期治疗要点,避免误诊,降低致残及致死率.方法 对2004-01~2011-01该院收治的46例ASMAE患者的临床资料进行回顾性分析.结果 病程1 h~10d,46例均经上腹CT及腹部计算机断层X线血管造影(CTA)检查确诊为ASMAE.手术切除肠管28例,经皮介入肠系膜上动脉置管溶栓10例,肠系膜上动脉切开取栓血管再成型8例.围手术期死亡5例,短肠综合征8例,随访3年死亡,其余33例随访3年,恢复良好.结论 如出现突发剧烈腹痛和不典型的腹部体征,应警惕是ASMAE,尽早行腹部CTA检查,早期确诊、早期治疗是降低致残及致死率的关键.

  8. A Fatal Aortoesophageal Fistula Caused by Critical Combination of Double Aortic Arch and Nasogastric Tube Insertion for Superior Mesenteric Artery Syndrome

    Directory of Open Access Journals (Sweden)

    Tomofumi Miura

    2010-06-01

    Full Text Available Double aortic arch (DAA is a rare vascular congenital abnormality. Since a vascular ring surrounds bronchus and esophagus, any oral or nasal intubation can physically cause fatal aortoesophageal fistula (AEF. We report herein the first case of association of DAA and superior mesenteric artery (SMA syndrome and the second case of AEF caused by nasogastric intubation in an adult with DAA. A 19-year-old woman visited our hospital for nausea and vomiting. She was diagnosed with SMA syndrome by computed tomography (CT. Nasogastric intubation relieved her symptoms in 4 days. Extramural compression with top ulceration was found in esophagogastroduodenoscopy on the 5th hospital day. She suddenly showed massive hematemesis on the 12th hospital day. AEF was found by CT. Soon, she died despite of intensive care. Retrospective interview disclosed the fact that DAA was pointed out in her childhood. We conclude that intubation must be avoided in DAA and a detailed clinical interview about DAA is mandatory to avoid AEF.

  9. Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in Tri-Service General Hospital

    Directory of Open Access Journals (Sweden)

    Chin-Ta Lin

    2014-01-01

    Full Text Available Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old. Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients′ age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24. No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The

  10. Heart Rate Variability and Hemodynamic Change in the Superior Mesenteric Artery by Acupuncture Stimulation of Lower Limb Points: A Randomized Crossover Trial

    Directory of Open Access Journals (Sweden)

    Soichiro Kaneko

    2013-01-01

    Full Text Available Objective. We investigated the relationship between superior mesenteric artery blood flow volume (SMA BFV and autonomic nerve activity in acupuncture stimulation of lower limb points through heart rate variability (HRV evaluations. Methods. Twenty-six healthy volunteers underwent crossover applications of bilateral manual acupuncture stimulation at ST36 or LR3 or no stimulation. Heart rate, blood pressure, cardiac index, systemic vascular resistance index, SMA BFV, and HRV at rest and 30 min after the intervention were analyzed. Results. SMA BFV showed a significant increase after ST36 stimulation (0% to 14.1% ± 23.4%, P=0.007; very low frequency (VLF, high frequency (HF, low frequency (LF, and LF/HF were significantly greater than those at rest (0% to 479.4% ± 1185.6%, P=0.045; 0% to 78.9% ± 197.6%, P=0.048; 0% to 123.9% ± 217.1%, P=0.006; 0% to 71.5% ± 171.1%, P=0.039. Changes in HF and LF also differed significantly from those resulting from LR3 stimulation (HF: 78.9% ± 197.6% versus −18.2% ± 35.8%, P=0.015; LF: 123.9% ± 217.1% versus 10.6% ± 70.6%, P=0.013. Conclusion. Increased vagus nerve activity after ST36 stimulation resulted in increased SMA BFV. This partly explains the mechanism of acupuncture-induced BFV changes.

  11. Diagnostic Accuracy of 256-Slice CT for Detecting Isolated Superior Mesenteric Artery Lesions%256层CT对孤立性肠系膜上动脉病变的诊断价值

    Institute of Scientific and Technical Information of China (English)

    叶自青; 王珏; 范占明; 刘英峰

    2016-01-01

    目的:探讨孤立性肠系膜上动脉病变(isolated superior mesenteric artery lesions,ISMAL)的256层CT的影像特征。方法回顾性分析12例ISMAL患者的影像及临床资料,以平扫横轴位、增强扫描横轴位、容积再现(VR)、曲面重建(CPR)、最大密度投影(MIP)等重建方法对肠系膜上动脉病变进行分析观察,总结其影像学特征。结果 ISMAL患者平均年龄为(50.1±2.7)岁,男性9例占75%,女性3例占25%,男性发生率高于女性。肠系膜上动脉栓塞(superior mesenteric artery embolism, SMAE)共8例,其中男性5例,女性3例;肠系膜上动脉夹层(superior mesenteric artery dissection, SMAD)共4例,均为男性;管腔局部增宽、腔内充盈缺损是SMAE典型征象;腔内条形低密度影并双腔的显示是SMAD的典型表现。结论256层CT平扫及CTA图像后处理技术可清晰显示肠系膜上动脉病变,确定其病变性质,了解其累及范围,为临床诊治提供有力的影像学依据。%Objective To evaluate the image features of isolated superior mesenteric artery lesion (ISMAL) by using 256 slice CT.Methods The images and clinical data of 12 patients were analyzed retrospectively. Every case was analyzed by the methods of vascular reconstruction, such as plain scan transverse axial, enhanced scan transverse axis, the volume rendering (VR), curved planar reformation (CPR), maximum intensity projection (MIP), and summarize the imaging characterization.Results The average age of ISMAL patients was (50.1±2.7)years old, 9 male (75%), 3 female (25%), the prevalence's of SMAD are higher among men than women. 8 patients were superior mesenteric artery embolism (SAME) including5 male and 3 female. 4 patients were superior mesenteric artery dissection (SMAD), all of them were male. The appearance of SMAE were filling defect in arteries and luminal local broadening. The typical manifestation of SMAD was the double chamber display of the strip and

  12. Prevalência da estenose aterosclerótica do tronco celíaco e da artéria mesentérica superior na arteriopatia oclusiva dos membros inferiores Prevalence of atherosclerotic stenosis of celiac trunk and superior mesenteric artery in occlusive arteriopathy of lower limbs

    Directory of Open Access Journals (Sweden)

    Wenes Pereira Reis

    2010-01-01

    Full Text Available Contexto: A eventual relação entre a aterosclerose das artérias dos membros inferiores com a aterosclerose das artérias intestinais foi pouco estudada. Objetivo: Avaliar pela ecografia vascular (Doppler presença de lesões com estenose 70% na artéria mesentérica superior e/ou tronco celíaco em doentes com arteriopatia obstrutiva crônica dos membros inferiores. Método: Foram estudados dois grupos, cada um com 60 doentes (40 homens e 20 mulheres. O grupo-caso foi composto por doentes com arteriopatia obstrutiva crônica dos membros inferiores, claudicação intermitente limitante ou dor de repouso e/ou lesões tróficas de extremidade, sem queixas gastrintestinais. O grupo-controle foi constituído por enfermos sem doença arterial obstrutiva dos membros inferiores e sem queixas gastrintestinais. Consideraram-se fatores de risco presença de diabetes melito, hipertensão arterial, obesidade, angina/infarto, tabagismo e dislipidemia. Todos os doentes foram submetidos a ecografia vascular do tronco celíaco e da artéria mesentérica superior. Os doentes do grupo-caso foram separados pela presença de claudicação intermitente limitante (N = 12 ou lesão trófica e/ou dor de repouso (N = 48. Resultados: Houve associação significante entre idade (p = 0,04 e cardiopatia isquêmica (p = 0,04 com aterosclerose da artéria mesentérica superior. Os fatores de risco não mostraram associação significante com presença de estenose do tronco celíaco. Observou-se associação significante entre arteriopatia dos membros inferiores e lesão estenótica da artéria mesentérica superior (p = 0,006 e do tronco celíaco (p Background: The occasional relationship between arterial atherosclerosis of lower limbs and atherosclerosis of intestinal arteries has not been fully studied yet. Objective: To assess the presence of lesions with ≥ 70% stenosis in the superior mesenteric artery and/or in the celiac trunk in patients with chronic obstructive

  13. Posterior Superior Mesenteric Artery (SMA) First Approach vs. Standard Pancreaticoduodenectomy in Patients with Resectable Periampullary Cancers: a Prospective Comparison Focusing on Circumferential Resection Margins.

    Science.gov (United States)

    Pal, Sujoy; George, Joseph; Singh, Anand Narayan; Mathur, Sandeep; Dash, Nihar Ranjan; Garg, Pramod; Sahni, Peush; Chattopadhyay, T K

    2017-03-18

    The 'SMA-first' (P-SMA) pancreatoduodenectomy (PD) allows dissection directly on the right lateral aspect of superior mesenteric artery (SMA) which may decrease circumferential resection margin (CRM) positivity. This comparative study between standard PD (sPD) and P-SMA approach was planned focusing on CRM involvement. This was a prospective study comparing consecutive patients with resectable periampullary cancers (PACA) undergoing PD using the standard or P-SMA approach. The perioperative outcomes and the CRM positivity rates (specimens analysed according to the standardized Leeds pathology protocol (LEEPP)) were compared. Overall, 39 patients (28 men; mean age 54 years; sPD 21, P-SMA 18) were included. Both groups were comparable with regard to demographic/tumour characteristics and perioperative outcomes. The P-SMA technique was significantly faster (321.1 ± 54.0 vs. 357.6 ± 55.8 min; p = 0.05). Though the mean tumour size (2.2 vs. 2.1 cm; p = 0.84) and T stage (T2 and T3) distribution were similar in both groups, lymph node yield was significantly higher in the P-SMA group (10.7 vs. 5.95; p = 0.001; mean 8 (2-21)). Though CRM positivity (margin SMA PD to yield significantly lower CRM positivity rates compared to the sPD (3/17 (17.6%) vs. 5/21(23.8%); p = 0.71). At a median follow-up of 28 months, fewer patients in the P-SMA PD group developed recurrence (2/15 vs. 5/19; p = 0.3) or died (3/15 vs. 7/19; p = 0.19), though this difference was not significant. In patients with resectable PACA, P-SMA PD was significantly faster and yielded higher lymph node counts in the specimen but did not lower the rate of CRM positivity as determined by the LEEPP.

  14. Asymptomatic congenital intrapericardial diaphragmatic hernia and epigastric hernia in the adult.

    Science.gov (United States)

    La Greca, Gaetano; Sofia, Maria; Randazzo, Valentina; Barbagallo, Francesco; Lombardo, Rosario; Soma, Pierfranco; Russello, Domenico

    2007-08-01

    The congenital intrapericardial hernia is a rare kind of diaphragmatic hernia. It is due to an embryologic defect of the central tendon of the diaphragm, often accompanied by other congenital malformations. This work presents a unique case report in the literature of the congenital association between intrapericardial diaphragmatic hernia and epigastric hernia in an adult woman. In spite of herniation of the colon and omentum the patient was completely asymptomatic, requesting surgery for an epigastric hernia for aesthetic reasons. The defect of the diaphragm was sutured and the abdominal wall was repaired with a prosthetic mesh.

  15. [Arterial reconstructive surgery of a coarctation of the abdominal aorta with involvement of renal and visceral arteries. Clinical and imagiologic evaluation 26 years after the operation].

    Science.gov (United States)

    Dinis da Gama, A

    2009-01-01

    The clinical case of a 13 years old female is reported, with the diagnosis of congenital coarctation of the abdominal aorta, with involvement of renal and visceral arteries, causing arterial hypertension and a systolic bruit in the auscultation of the epigastric and umbilical areas. Conventional angiography disclosed a stenotic process of the upper abdominal aorta, with concomitant ostial stenosis of the renal and digestive arteries, and post-stenotic dilatation of the celiac axis and superior mesenteric artery. The physical development of the patient, close to the adult pattern, allowed the performance of a complex revascularization procedure,accomplished in May 1984, consisting in the implantation of an aorto-aortic bypass graft, through the diaphragm, followed by visceral and renal revascularization, by means of independent prosthesis taken from the aortic bypass. The post-operative course was uneventful and blood pressure returned immediately to normal levels. Reviewed recently, the patient was found in good clinical condition,asymptomatic and with normal blood pressure, developing a normal family, social and Professional life. An Angio-CT evaluation, performed in February 2010, almost 26 years after the operation, revealed the complex revascularization procedure patent and working in excellent condition. To our knowledge, this seems to be the longest follow up of such a procedure employed successfully in a very rare clinical entity, thus justifying its presentation and divulgation.

  16. Spontaneous arterial hemorrhage as a complication of dengue

    Directory of Open Access Journals (Sweden)

    Shoma Vinay Rao

    2016-01-01

    Full Text Available Bleeding complications of dengue hemorrhagic fever such as epistaxis, gum bleeding, gastrointestinal bleeding, hypermenorrhea, hematuria, and thrombocytopenia have been documented. A 49-year-old female presented with complaints of intermittent high-grade fever for the past 4 days, lower abdominal pain and altered sensorium for 1 day. Laboratory investigations revealed severe anemia, mild thrombocytopenia, hypofibrinogenemia, and positive dengue serology. Emergency ultrasound examination of the abdomen revealed a possible rapidly expanding hematoma from the inferior epigastric artery and suggested urgent computed tomography (CT angiogram for confirmation of the same. CT angiogram was confirmatory, and patient underwent emergency embolization of the right inferior epigastric artery. We report the first case of inferior epigastric hemorrhage and rectus sheath hematoma as a consequence of dengue.

  17. Randomized-controlled trial of esomeprazole in functional dyspepsia patients with epigastric pain or burning

    DEFF Research Database (Denmark)

    Talley, N J; Vakil, N; Lauritsen, K;

    2007-01-01

    BACKGROUND: Early identification of true responders to acid suppression in functional dyspepsia patients with symptoms of epigastric pain or burning may enable clinicians to optimally tailor treatment. AIM: To evaluate whether a 1-w acid suppression trial is useful for identifying true responders...

  18. A Collective Review on Mesh-Based Repair of Umbilical and Epigastric Hernias.

    Science.gov (United States)

    Ponten, Jeroen E H; Thomassen, Irene; Nienhuijs, Simon W

    2014-10-01

    In accordance with the tension-free principles for other hernias, umbilical and epigastric hernia repair should probably be mesh-based. The number of randomized studies is increasing, most of them showing significantly less recurrences with the use of a mesh. Different devices are available and are applicable by several approaches. The objective of this review was to evaluate recent literature for the different types of mesh for umbilical and epigastric hernia repair and recurrences after mesh repair. A multi-database search was conducted to reveal relevant studies since 2001 reporting mesh-based repair of primary umbilical/epigastric hernia and their outcomes in adult patients. A total of 20 studies were included, 15 of them solely involved umbilical hernias, whereas the remaining studies included epigastric hernias as well. A median of 124 patients (range, 17-384) was investigated per study. Three quarters of the included studies had a follow-up of at least 2 years. Six studies described the results of laparoscopic approach, of which one reported a recurrence rate of 2.7 %; in the remaining studies, no recurrences occurred. Two comparative studies reported a lower incidence of complications and postoperative pain after laparoscopic repair compared to open repair. Seventeen studies reported results of open techniques, of which seven studies showed no recurrence. Other studies reported recurrence rates up to 3.1 %. A wide range of complication rates were reported (0-33 %). This collective review showed acceptable recurrence rates for mesh-based umbilical and epigastric hernia repair. A wide range of devices was investigated. A tendency toward more complications after laparoscopic repair was found compared to open repair.

  19. Spontaneous isolated celiac artery dissection

    Directory of Open Access Journals (Sweden)

    Tuba Cimilli Ozturk

    2011-01-01

    Full Text Available Dyspepsia with mild, stabbing epigastric discomfort without history of trauma is a very common symptom that emergency physicians see in their daily practice. Vascular emergencies, mostly the aortic dissection and aneurysm, are always described in the differential diagnosis with persistent symptoms. Isolated celiac artery dissection occurring spontaneously is a very rare diagnosis. The involvement of branch vessels is generally observed and patients show various clinical signs and symptoms according to the involved branch vessel. Here we are presenting a case with spontaneous isolated celiac artery dissection, without any branch vessel involvement or visceral damage, detected by computed tomography scans taken on admission.

  20. Weight loss is superior to exercise in improving the atherogenic lipid profile in a sedentary, overweight population with stable coronary artery disease

    DEFF Research Database (Denmark)

    Pedersen, Lene Rørholm; Olsen, Rasmus Huan; Anholm, Christian;

    2016-01-01

    BACKGROUND: Dyslipidemia and low-grade inflammation are integral in the pathogenesis of atherosclerosis. We aim to compare the effects of a considerable weight loss and intensive exercise training on lipid atherogenicity and low-grade inflammation in a high-risk population with coronary artery...

  1. Superior diagnostic strength of combined contrast enhanced MR-angiography and MR-imaging compared to intra-arterial DSA in liver transplantation candidates

    NARCIS (Netherlands)

    Boeve, WJ; Kok, T; Haagsma, EB; Slooff, MJH; Sluiter, WJ; Kamman, RL

    2001-01-01

    To evaluate the diagnostic value of combined contrast enhanced MRA (ce-MRA) and MRI compared to that of intra-arterial DSA (i.a.DSA) in liver transplantation, transjugular porto-systemic (TIPSS) and spleno-renal shunt candidates. 50 patients in the workup for liver transplantation underwent ce-MRA/M

  2. Poly (I:C) impairs NO donor-induced relaxation by overexposure to NO via the NF-kappa B/iNOS pathway in rat superior mesenteric arteries.

    Science.gov (United States)

    Ando, Makoto; Matsumoto, Takayuki; Taguchi, Kumiko; Kobayashi, Tsuneo

    2017-11-01

    Recent studies have suggested a link between vascular dysfunction and innate immune activation including toll-like receptors (TLRs), but the detailed mechanism remains unclear. Here we investigated whether poly (I:C) [a synthetic double-strand RNA recognized by TLR3, melanoma differentiation-associated gene 5 (MDA5), and retinoic acid-inducible gene I (RIG-I)] affected nitric oxide (NO)/cGMP-related vascular relaxation, one of the major cascades of relaxation, in rat superior mesenteric arteries. Using organ-cultured arteries, we found that poly (I:C) (30μg/mL for approximately 1 day) markedly reduced sodium nitroprusside (SNP)-induced relaxation (vs. vehicle); this was prevented by co-treatment with a TLR3 inhibitor. Relaxation induced by 8-Br cGMP (a phosphodiesterase (PDE)-resistant cGMP analogue) and the expression of proteins related to NO/cGMP signaling did not differ between vehicle- and poly (I:C)-treated groups. When PDEs were inhibited by IBMX (a nonselective PDE inhibitor), the SNP-induced relaxation was still greatly reduced in poly (I:C)-treated arteries (vs. vehicle). Poly (I:C) reduced SNP-stimulated cGMP production, but increased NO production and iNOS expression (vs. vehicle). The impairment of SNP-induced relaxation by poly (I:C) was prevented by co-treatment with either iNOS or a nuclear factor-kappa B (NF-κB) inhibitor. This effect induced by poly (I:C) appeared to be independent of oxidative stress. The SNP-induced relaxation was reduced in freshly isolated arteries by pre-incubation with SNP in a concentration-dependent manner. Poly (I:C) did not alter protein levels of TLR3, TRIF/TICAM-1, or phospho-IRF3/IRF3, whereas RIG-I and MDA5 were significantly upregulated (vs. vehicle). These results suggest that poly (I:C) impairs NO donor-induced relaxation in rat superior mesenteric arteries via overexposure to NO produced by the NF-κB/iNOS pathway. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Experience on Treatment of Epigastric Pain by Acupoint-pressing and Back-pushing Methods

    Institute of Scientific and Technical Information of China (English)

    WU Ming-zhong; HUANG Guo-qi

    2005-01-01

    @@ Epigastric pain is mostly and frequently encountered clinically and can be seen in acute and chronic gastritis, gastric and duodenal ulcer,prolapse of gastric mucosa, and gastrointestinal disorders and other digestive diseases and is often treated by medications. The author has treated this disease by acupoint-pressing and back-pushing methods and obtained instant therapeutic effects.This method is simple and easy and practical.

  4. Rare complex aneurysm of special type in the superior segment of clinoid process of internal carotid artery%瘤颈处理困难的床突上段动脉瘤三例报告

    Institute of Scientific and Technical Information of China (English)

    刘峥; 尚明超; 李琦; 王如密; 王守森; 林航; 张小军; 郑兆聪; 魏梁锋; 杨少春; 荆俊杰

    2009-01-01

    目的 探讨罕见颈内动脉床突上段特殊类刑复杂动脉瘤某些特征,临床特点及治疗方法.方法 通过3例十分罕见颈内动脉床突上段动脉瘤的治疗经过,总结手术中所遇见的瘤颈撕裂,载瘤动脉壁薄、撕裂,血栓形成,无法夹闭等特殊情况,并且与术前的影像学资料进行对比研究,寻找这些动脉瘤的特征.结果 发现这种特殊动脉瘤,载瘤动脉局部不规则钙化、增粗畸形,甚至载瘤动脉壁菲薄;动脉瘤发生部位不规则,瘤颈及瘤体壁非薄,显微镜下见瘤体壁薄旱紫红色,手术时轻微分离瘤颈或夹闭时容易撕裂,或载瘤动脉壁撕裂,无法修补止血;2例术中由丁载瘤动脉钙化而坚硬,其近端不能予以临时阻断控制;瘤颈内有部分血栓侵犯,导致瘤夹闭合不全,调整瘤夹易撕裂瘤颈.结论 手术需谨慎,术中有可能无法夹闭或载瘤动脉壁破裂,术前造影具有明显特征,手术方法 以颅内外血管吻合+孤立为妥.%Objective To discuss the features, clinical characteristics and therapies of rare aneurysm of special type in the superior segment of clinoid process of internal carotid artery. Method From clinical courses of treatment of 3 patients with extremely rare aneurysms in the superior segment of clinoid process of internal eardotid artery, we summarized special clinical characteristics including torn aneurysm neck, thin or tom tumor-loading artery wail, thrombosis, and clipping failure, etc. , encountered during the surgery, and compared them with pro-surgical imaging data, to investigate features of this type of aneurysms. Results Of such special neurysms, it was found that the tumor-loading artery was irregularly calcified, thickened and deformed, or even the tumor-loading artery wall was extremely thin. Such neurysms occurred in irregular sites, with quite thin tumor neck and tumor body wall. Under a microscope,the tumor body wall was carmine. It was readily torn in slight

  5. 孤立性肠系膜上动脉夹层的病例荟萃分析%Cfinical features and therapeutic strategies of isolated superior mesenteric artery dissection:a metaanalysis of 101 cases

    Institute of Scientific and Technical Information of China (English)

    陈跃鑫; 刘昌伟; 刘暴

    2008-01-01

    目的 探讨孤立性肠系膜上动脉夹层的病例特点,治疗方法和措施选择.方法 回顾性分析北京协和医院血管外科中心诊治和文献报道的共101例孤立性肠系膜上动脉夹层病例,分析其临床特点、治疗方案及预后.结果 孤立性肠系膜上动脉夹层病例中男性占84.16%.平均发病年龄53.95岁.保守治疗成功率约70%,36例手术和16例腔内治疗症状缓解率100%,腔内支架治疗再狭窄率12.50%.结论 与保守治疗相比,手术和腔内治疗疗效确切,临床有效率高.治疗策略的制定有赖于临床表现和影像学检查.%Objective To summarize the clinical characters and therapeutic strategies of isolated superior mesenteric artery dissection, a rare disease.Methods The clinical data of 101 patients of isolated superior mesenterie artery dissection, including 2 cases treated in the Peking Union Medical College Hospital and 99 cases collected from the literatures were analyzed.Results 84.16% of the patients were males.The average age of the patients was 53.95.70% conservative treatment was successful in 70% of the patients.The symptoms were alleviated in 52 patients, of which 36 had undergone surgeries and 16 had endovascular therapy.The restenosis rate of endovascular therapy was 12.50%.Conclusion Surgery and endovaseular therapy are more effective than conservative treatments for isolated superior mesenteric artery dissection.The therapeutic strategies depend on the clinical symptoms and imaging examinations.

  6. The anatomical characteristics and clinical application of the lateral superior genicular artery perforator iliotibial band flap%膝上外侧动脉穿支髂胫束皮瓣的解剖特点与临床应用

    Institute of Scientific and Technical Information of China (English)

    高建明; 徐达传; 储旭东; 郭峰; 卢绪; 骆宇春; 刘云鹏

    2010-01-01

    Objective To discuss anatomical characteristics and clinical results of the lateral superior genicular artery perforator iliotibial band flap. Methods From September 1999 to July 2009, the origin,course, branches and distribution of the lateral superior genicular artery and blood supply of iliotibial band were observed on 40 sides adult lower limbs perfused with red latax. Five perforator iliotibial band and 4 perforator iliotibial band flaps of 9 cases were treated with anastomosis of lateral superior genicular artery perforating rami. Results The lateral superior genicular artery of 35 cases (80%) originates from the popliteal artery. Its originated external diameter was (1.8 ± 0.4) mm. It divides into ascending branch and descending branch, and they gives off septofascio-cutaneous perforator, or anatomoses the lateral uppermost genicular artery in the vastus lateralis muscle, and then formes the musculocutaneous perforator of iliotibial band. The originated external diameter of the larger perforator of iliotibial bands was ( 1.0 ± 0.2) mm and they provides for the skin and iliotibial band of lateral superior genicular area. Nine cases, including 5 cases of simple Achilles tendon defects, two cases of achilles tendon defects with skin defects, and 2 cases of lower extremity and foot soft tissue defects were treated with transplantation of the vascularized iliotibial band (flap) with perforator vascular anastomoses. All cases were followed up 6 - 92 months. The results showed significant improvement in "heel test" and Thompson sign in the rerupture of the Achilles tendon occurred. Four perforator iliotibial band flaps survived well. Conclusion The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and new donor in the reconstruction of soft tissue and composite defects.%目的 探讨膝上外侧动脉穿支髂胫束皮瓣的解剖学基础与临床应用效果.方法 自1999年9月至2009年7月,在40侧经动脉灌注红

  7. The ent-15α-Acetoxykaur-16-en-19-oic Acid Relaxes Rat Artery Mesenteric Superior via Endothelium-Dependent and Endothelium-Independent Mechanisms

    Directory of Open Access Journals (Sweden)

    Êurica Adélia Nogueira Ribeiro

    2012-01-01

    Full Text Available The objective of the study was to investigate the mechanism of the relaxant activity of the ent-15α-acetoxykaur-16-en-19-oic acid (KA-acetoxy. In rat mesenteric artery rings, KA-acetoxy induced a concentration-dependent relaxation in vessels precontracted with phenylephrine. In the absence of endothelium, the vasorelaxation was significantly shifted to the right without reduction of the maximum effect. Endothelium-dependent relaxation was significantly attenuated by pretreatment with L-NAME, an inhibitor of the NO-synthase (NOS, indomethacin, an inhibitor of the cyclooxygenase, L-NAME + indomethacin, atropine, a nonselective antagonist of the muscarinic receptors, ODQ, selective inhibitor of the guanylyl cyclase enzyme, or hydroxocobalamin, a nitric oxide scavenger. The relaxation was completely reversed in the presence of L-NAME + 1 mM L-arginine or L-arginine, an NO precursor. Diterpene-induced relaxation was not affected by TEA, a nonselective inhibitor of K+ channels. The KA-acetoxy antagonized CaCl2-induced contractions in a concentration-dependent manner and also inhibited an 80 mM KCl-induced contraction. The KA-acetoxy did not interfere with Ca2+ release from intracellular stores. The vasorelaxant induced by KA-acetoxy seems to involve the inhibition of the Ca2+ influx and also, at least in part, by endothelial muscarinic receptors activation, NO and PGI2 release.

  8. Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias

    DEFF Research Database (Denmark)

    Christoffersen, Mette W; Helgstrand, Frederik; Rosenberg, Jacob;

    2015-01-01

    and risk of chronic pain in small primary ventral hernias. METHODS: A cohort study with questionnaire and clinical follow-up was conducted. Patients with primary, elective, open mesh or sutured repair for a small umbilical or epigastric hernia (≤ 2 cm) were included. RESULTS: One thousand three hundred......BACKGROUND: Mesh repair reduces the risk of reoperation for recurrence in patients with primary ventral hernias. However, reoperation for recurrence underestimates total recurrence (reoperation + clinical) and mesh reinforcement may induce chronic pain. This study investigated the total recurrence......-term risk of recurrence after repair for small ventral hernias without increased risk of chronic pain....

  9. Internal hernia through the foramen of Winslow: a diagnosis to consider in moderate epigastric pain.

    Science.gov (United States)

    Sikiminywa-Kambale, Pélagie; Anaye, Anass; Roulet, Daniel; Pezzetta, Edgardo

    2014-06-25

    Herniation through the foramen of Winslow is a rare condition that can lead to a delayed diagnosis and treatment with a high mortality rate. In most reported cases, patients present to the emergency department with symptoms suggesting intestinal obstruction or with sudden and severe pain in the upper abdomen. Symptoms are non-specific. Clinical diagnosis may be difficult or even missed. The widespread availability of cross-sectional imaging can improve the percentage of correct preoperative diagnosis. We report a case of a caecal and right colic herniation through the foramen of Winslow found incidentally on abdominal computed tomography in a patient presenting with mild epigastric pain.

  10. A nationwide study on readmission, morbidity, and mortality after umbilical and epigastric hernia repair

    DEFF Research Database (Denmark)

    Bisgaard, T; Kehlet, H; Bay-Nielsen, M

    2011-01-01

    stay, risk of readmission, complications, and mortality  1 day. Readmissions occurred in 5.3% of cases (open 4.9%; laparoscopic 10.5%). In the majority of patients readmissions were due to wound-related problems (haematoma, bleeding and/or infection) (46%), seroma (19%), or pain (7%). At 30 days...... of wound problems, seroma formation, or pain. Future research should focus on early outcomes in terms of wound problems, seroma formation, and pain after umbilical and epigastric hernia repair....

  11. Free deep inferior epigastric perforator flap used for management of post-pneumonectomy space empyema.

    Science.gov (United States)

    Manley, Kate; Gelvez, Sandra; Meldon, Charlotte J; Levai, Irisz; Malata, Charles M; Coonar, Aman S

    2013-04-01

    Various solutions exist for management of post-pneumonectomy space empyema. We describe the use of a free deep inferior epigastric perforator (DIEP) flap to fill the space and close a pleural window. Previously, flaps involving abdominal muscle or omentum have been used for this purpose. Abdominal surgery to harvest such flaps can impair ventilatory mechanics. The DIEP flap--harvested from the abdomen, and composed primarily of skin and muscle avoids this problem, thus is a desirable technique in patients with impaired lung function. We believe this is the first report of the DIEP flap to close a postpneumonectomy empyema space.

  12. Superiority of proximal embolization of the gastroduodenal artery with the Amplatzer vascular plug 4 before yttrium-90 radioembolization: a retrospective comparison with coils in 134 patients.

    Science.gov (United States)

    Bulla, Karsten; Hubich, Sebastian; Pech, Maciej; Löwenthal, David; Ricke, Jens; Dudeck, Oliver

    2014-04-01

    To evaluate the effectiveness of proximal embolization of the gastroduodenal artery (GDA) using the Amplatzer Vascular Plug 4 (AVP 4) compared with pushable coils to avoid hepaticoenteric collaterals of the GDA stump, which may serve as pathways for nontarget embolization. One hundred thirty-four patients scheduled for 90-yttrium radioembolization (Y-90 RE) using either plugs (n = 67) or standard coils (n = 67) for GDA occlusion were retrospectively analyzed. Parameters recorded were length of the perfused GDA stump, distance device to the GDA origin, perfused proximal side branches after embolization, and durability of vessel occlusion at Y-90 RE. Length of the residually perfused GDA stump was 3.89 ± 2.86 mm for the AVP 4, which was significantly shorter compared with 5.78 ± 3.85 mm for coils (p = 0.005). Distance of the plug to the GDA origin was 1.41 ± 2.60 mm, which was also significantly shorter than 4.73 ± 3.44 mm for coils (p < 0.001). This resulted in significantly fewer patients with residually perfused side branches in the AVP 4 group (n = 2; 3.0%) compared with the coil group (n = 18; 26.9%; p < 0.001). At Y-90 RE, no GDA reperfusion was found after plug embolization compared with 2 cases after coil embolization (3.0%; p = 0.156). Only one patient had a radiation-induced duodenal ulcer after coil embolization, whereas no Y-90-related toxicity was identified after plug embolization. Use of the AVP 4 for embolization of the GDA allowed an optimal proximal and more effective target vessel occlusion compared with coil embolization, which can avoid complications caused by extrahepatic gastrointestinal deposition of Y-90 microspheres by way of residually perfused proximal side branches.

  13. Clinical outcomes after elective repair for small umbilical and epigastric hernias.

    Science.gov (United States)

    Christoffersen, Mette Maria Willaume

    2015-11-01

    Repair for an umbilical or epigastric hernia is one of the most frequently conducted gastrointestinal surgical procedures. Al-though it is a minor procedure, there is no consensus on the optimal repair technique. The readmission rate is surprisingly high due to postoperative pain, wound-related complications, and long-term results in terms of recurrence and chronic pain is not well investigated. The overall objective of this thesis was to improve early and long-term postoperative outcomes after repair for umbilical or epigastric hernias. The present thesis consisted of one RCT, one protocol article for a running RCT, and two register-based cohort studies. An abdominal binder had no analgesic effects or impact on seroma formation. We await early and late post-operative outcomes from a running RCT studying clinical effect of closing the hernia defect (inclusion is expected to end in October 2015). The two cohort studies included in the present theses found that mesh repair halved the long-term risk of recurrence compared with sutured repair. Mesh repair did not increase the risk of chronic pain or rate of reoperation for complications.

  14. The preperitoneal approach to the groin and the inferior epigastric vessels.

    Science.gov (United States)

    Read, R C

    2005-03-01

    Preperitoneal, a word coined by Nyhus in the 1960s, has been applied not only to posterior approaches that he, Stoppa, and Wantz popularized but to anterior exposures of the groin, which divide the transversalis fascia. This assumes that all give similar views of the easily cleaved space of Bogros. However, accumulated anatomical observations reveal the transversalis fascia as having not one but two layers. The inferior epigastric vessels run between rather than in the preperitoneal space, which is avascular and has its own fascia lining the peritoneum. Historical evidence shows that both the midline Cheatle-Henry and lateral Ugahary-Kugel approaches, which transect the abdominal wall, provide excellent exposure of the avascular preperitoneal space. However, neither the unilateral posterior McEvedy approach nor the anterior approach does, as only part of the musculature and fasciae are retracted. The inferior epigastric vasculature and posterior lamina transversalis fascia, which remain in situ, block the view. Unless they are disrupted or circumvented, neither of the latter approaches or subsequent repairs should be labeled preperitoneal.

  15. ASYMPTOMATIC EXTENSIVE PELVIC LIPOMATOSIS ASSOCIATED WITH SYMPTOMATIC EPIGASTRIC HERNIA: A RARE CASE REPORT

    Directory of Open Access Journals (Sweden)

    Mohamed Shies

    2014-11-01

    Full Text Available INTRODUCTION: Pelvic lipomatosis is a rare benign disorder characterized by deposition of mature fat tissue in the pelvic cavity and absence of delimitation by a capsule. Peak incidence of this disease is between 25 to 60 years of age with a staggering male predominance of 10:1. CASE REPORT: A 45 yr. old male presented with epigastric swelling and abdominal pain. Clinically, he was diagnosed with epigastric hernia. Ultrasound showed bladder wall thickening with bilateral hydroureteronephrosis. CT showed bilateral hydrouretronephrosis with pear shaped bladder, non-encapsulated fatty mass surrounding urinary bladder symmetrically, with attenuation similar to that of subcutaneous fat suggesting extensive pelvic lipomatosis. On laparotomy there is a large pelvic lipoma filling the whole of pelvis and bladder was surrounded by fatty tissue all around along with lipoma of the cord. Patient underwent pre peritoneal hernioplasty for ventral hernia and excision of pelvic lipoma and the lipoma of the cord. DISCUSSION: Pelvic lipomatosis is a benign overgrowth of adipose tissue with small amount of inflammatory and fibrotic components found especially in the perivesical and perirectal spaces. The best definitive diagnostic procedure is CT. Various treatments have been attempted, but no single treatment has proved effective to date.

  16. Epigastric pain as presentation of an addisonian crisis in a patient with Schmidt syndrome.

    Science.gov (United States)

    Lelubre, Christophe; Lheureux, Philippe E R

    2008-02-01

    A 39-year-old woman presented with a 10-day history of epigastric pain accompanied by persistent fatigue and loss of appetite for 3 months. She had presented several weeks earlier with adhesive capsulitis, treated by local infiltration of corticosteroids. She was not taking any other medications. Results of heart, lung, and abdominal examinations were unremarkable, except for mild epigastric tenderness. Purple stretch marks were observed on examination of the skin. The only blood chemistry abnormalities were hyponatremia (125 mEq/L) and hyperkalemia (6.8 mEq/L). Based on the clinical and biologic picture, adrenal insufficiency was suspected. The patient was transferred to the intensive care unit and received hydrocortisone intravenously for 3 days. She was then given oral hydrocortisone and fludrocortisone. Biologic abnormalities reversed entirely; the final diagnosis was primary autoimmune adrenal insufficiency (Addison's disease) associated with autoimmune hypothyroidism (Schmidt syndrome). Adrenal insufficiency should be considered in patients with abdominal pain, especially when associated with electrolyte abnormalities.

  17. Randomized Clinical Trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair

    DEFF Research Database (Denmark)

    Christoffersen, Mette; Olsen, B H; Rosenberg, J;

    2015-01-01

    -reducing effect of an abdominal binder in patients undergoing laparoscopic umbilical or epigastric hernia repair. METHODS: Based on power analysis, a minimum of 54 patients undergoing laparoscopic umbilical and epigastric hernia repair were to be included. Patients were randomized to abdominal binders vs......PURPOSE: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma...

  18. A content analysis of cognitive and affective uses of patient support groups for rare and uncommon vascular diseases: comparisons of may thurner, thoracic outlet, and superior mesenteric artery syndrome.

    Science.gov (United States)

    Walker, Kimberly K

    2015-01-01

    Rare disease patients are the predominant group of patients who are now connecting online to patient support groups, yet research on their uses of support groups has received little attention. This is a content analysis of three vascular diseases of differing degrees of rarity. Wall posts from Facebook patient support groups for May Thurner syndrome, thoracic outlet syndrome, and superior mesenteric artery syndrome were analyzed over a period of two years. Using Uses and Gratifications as the theoretical framework, the study purpose was to assess how variations in health condition and rarity of condition affect online support group user needs. Results indicated common main cognitive and affective uses across conditions, indicating a consistent pattern of needs communicated by all patients. However, there were nuanced differences in subcategories of cognitive and affective uses between the most and least rare disorders, which inform areas for tailored support mechanisms. Additionally, these vascular patients used their respective support groups primarily for cognitive reasons, especially for the rarest conditions, which informs of basic medical informational needs these patients face related to tests, treatment, surgery, and diagnoses.

  19. Displaying inguinal lymph nodes before transplantation in a deep inferior epigastric perforator flap breast reconstruction using an innovative projection method

    NARCIS (Netherlands)

    Hummelink, S.L.; Schultze Kool, L.J.; Ulrich, D.J.

    2016-01-01

    INTRODUCTION: Lymphedema of the arm is a common postoperative complication as a result of breast cancer surgery. One of the surgical treatments comprises modification of a deep inferior epigastric perforator (DIEP) flap breast reconstruction to facilitate additional lymph node transplantation from t

  20. Congenital Left Ventricular Diverticulum Associated with ASD, VSD, and Epigastric Hernia

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Dalili

    2008-12-01

    Full Text Available Congenital left ventricular diverticulum is a rare cardiac malformation. Two categories of congenital ventricular diverticulum have been identified with regard to their localization: apical and non-apical. Apical diverticula are always associated with midline thoraco-abdominal defects and other heart malformations. Non-apical diverticula are always isolated defects. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging, or left ventricular angiography. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities, and possible complications. We report a 10-month-old girl with left ventricular apical diverticulum, large atrial septal defect, two small muscular ventricular septal defects, and pulmonary hypertension, associated with epigastric hernia. This patient underwent total surgical repair for intra-cardiac defects as well as diverticular resection.

  1. Incisional, epigastric and umbilical hernia repair using the Prolene Hernia System: describing a novel technique.

    Science.gov (United States)

    Khera, Goldie; Berstock, David A

    2006-08-01

    The Prolene Hernia System (PHS) is already widely in use in the United Kingdom for inguinal hernias. We describe the novel technique of using the three-in-one design of the PHS (Ethicon Endo-Surgery, Bracknell, UK) for repairing incisional, epigastric and umbilical herniae. This is a three-dimensional device and consists of an onlay patch, a tubular connector and an underlay patch. We recommend a four 'corner' suturing of the underlay patch under vision (and then) through the full thickness of abdominal wall layers to ensure a flat underlay mesh. These four sutures flatten out the underlay patch and can be tied or removed with equal effect. The sutures are placed at 3, 6, 9 and 12 o'clock, which simplifies the procedure and ensures that the underlay lays correctly and is corrugation-free and tension-free, thereby providing a two-layer repair for those herniae with a high rate of recurrence.

  2. A Large Left Ventricle Myxoma: Presenting with Epigastric Pain and Weight Loss

    Directory of Open Access Journals (Sweden)

    Solmaz Fakhari

    2016-01-01

    Full Text Available Cardiac myxomas are the most common benign tumors found in the heart. They usually appear in the left atrium. Those originating from the left ventricle (LV are rare. Although clinical presentation may vary, dyspnea and embolism are the most commonly reported symptoms. In the present case study, a 27-year-old woman with a large myxoma originating from the left ventricular free wall is studied. She had atypical complaints, mainly epigastric discomfort, nausea, vomiting, and anorexia. She was hospitalized for acute abdomen, but subsequent investigations revealed a large myxoma that fully filled the LV and severely compromised the flow of the aortic and mitral valves. After successful emergency tumor resection, all symptoms disappeared. The uncommon presentation caused by these tumors is discussed in this study.

  3. Temperature can influence gastric accommodation and sensitivity in functional dyspepsia with epigastric pain syndrome.

    Science.gov (United States)

    Wang, Rui-Feng; Wang, Zhi-Feng; Ke, Mei-Yun; Fang, Xiu-Cai; Sun, Xiao-Hong; Zhu, Li-Ming; Zhang, Jing

    2013-09-01

    Functional dyspepsia-epigastric pain syndrome (FD-EPS) is characterized pathophysiologically by visceral hypersensitivity, but the effect of the temperature stimulation on gastric function has been seldom studied. The purpose of this study was to investigate the effects of liquid nutrients at different temperatures on the gastric accommodation, sensitivity, and gastric-wall compliance of healthy subjects (HS) and FD-EPS patients. Ten FD-EPS patients (Roma III criteria) and ten HS were recruited into the study. Intragastric pressure (IGP) and gastric perfusion were measured and compared following the administration of liquid nutrients at 37 °C on day 1 and at 8 °C on day 2. Seven patients developed abdominal discomfort or abdominal pain after being given cold liquid nutrient. The administration of liquid nutrient at 8 °C resulted in an increase of IGP in HS (P=0.044), a significant decrease in gastric perfusion (PIGP (P=0.015), and a dramatic reduction in gastric wall compliance (P=0.012) in patients compared to the effects of liquid nutrient at 37 °C. In addition, IGP in patients was lower than that in HS at 37 °C liquid nutrient (P=0.036), and the gastric perfusion volume in patients at maximal satiety was also significantly reduced at 8 °C liquid nutrient compared with HS (P=0.017). Cold stimulation can increase the IGP in HS and FD-EPS patients, elevate the visceral sensitivity and reduce the gastric volume of FD-EPS patients. FD-EPS patients who are sensitive to cold may develop epigastric discomfort or pain.

  4. Chest pain in children and adolescents: epigastric tenderness as a guide to reduce unnecessary work-up.

    Science.gov (United States)

    Sabri, M R; Ghavanini, A A; Haghighat, M; Imanieh, M H

    2003-01-01

    Our objective was to evaluate and highlight the significance of epigastric tenderness in children and adolescents with chest pain. In a 26-months period, patients who were referred for pediatri cardiology evaluation at Shiraz University of Medical Sciences with chief complaint of chest pain were studied. Patients with epigastric tenderness were evaluated endoscopically by gastroenterologist. Patients who had positive findings on endoscopy were appropriately treated. Since there were no serious findings on cardiac evaluation, no other treatment was necessary. The patients were re-evaluated 4 weeks later. Response to therapy was defined as relief of the initial symptoms as well as epigastric tenderness. One hundred thirty-two patients were referred for evaluation of chest pain during this period. Epigastric tenderness was found in 44 (33.3%) of these patients and endoscopy was performed. Endoscopy showed positive findings in 41 (93.2%). Thirty (75%) of these patients had varying degrees of gastritis. Duodenitis was found in six (13.6%) and gasteroduodenitis in five (11.4%). Esophagitis, which was always associated with gastritis, was seen in five (11.4%). Only three (6.8%) had normal endoscopy. Urease test was positive in three (7.3%) of the specimens. Two of the patients did not return for follow up. From the remaining 39 patients who received gastroenterology treatment, resolution of symptoms was seen in 38 (97.4%). Careful history and physical examination must guide the assessment of children and adolescents referred for evaluation of chest pain. Epigastric tenderness must be used as a reliable sign to initiate a gastrointestinal evaluation.

  5. SUPERIOR MESENTERIC ARTERY SYNDROME: CASE REPORT

    African Journals Online (AJOL)

    2003-06-06

    Jun 6, 2003 ... uneventful post operative recovery and was discharged on the third day ... complaints in whom endoscopic and conventional X ray findings are ... The Online version is distributed by the non-profit service; Bioline International,.

  6. Diagnosis and treatment of acute superior mesenteric artery embolism:a report of 15 cases%急性肠系膜上动脉栓塞的诊断与治疗(附15例报告)

    Institute of Scientific and Technical Information of China (English)

    翁延宏; 顾国胜; 朱永龙; 叶小利

    2016-01-01

    目的:探讨急性肠系膜上动脉栓塞(SMAE)的临床特点及诊疗策略。方法回顾性收集并分析15例急性SMAE患者的临床资料,其中男12例,女3例;年龄44~77岁,平均(62.5±11.3)岁,从症状发作至入院的间隔时间为3小时至5天。结果9例患者术前得到确诊。7例初始接受介入溶栓治疗的患者中有2例中转接受部分肠管切除手术。8例患者立即接受开腹手术,其中2例为单纯剖腹探查,2例为肠系膜动脉取栓术,1例为部分肠管切除术,其余3例同时接受肠系膜动脉取栓和部分肠管切除术。8例患者死亡,死亡率为53.3%。结论临床医生应提高对急性SMAE的认识,早期诊断疾病并及时进行介入溶栓或手术治疗,提高患者的生存率。%Objective To investigate the clinical features and to discuss the strategies of diagnosis and treatment of acute superior mesenteric artery embolism (SMAE) in combination with literature review. Methods The clinical data of 15 patients with SMAE were retrospectively retrived and analyzed. Results Nine patients were diagnosed as SMAE before the therapeutic interventions. Of 7 cases that received interventional embolectomies, 5 patients were finally discharged from hospital, among whom 1 underwent additional bowel resection. Laparotomies were initially performed in the remaining 8 patients. Two cases underwent only laparotomies, 2 cases received superior mesenteric artery thromboembolectomies, 1 received partial bowel resection, and 3 received both. Four patients suffered multiple operations. The overall mortality was 53.3%. Conclusion Clinicians should boost the knowledge of SMAE, in order to make the early diagnosis and promptly take appropriate therapeutic measures including interventional or surgical procedures, with the ultimate goal of improving the survival of patients with SMAE.

  7. Treatment of extra large area severe burne patient complicated with superior mesenteric artery syndrome%特大面积重度烧伤合并肠系膜上动脉综合征患者救治体会

    Institute of Scientific and Technical Information of China (English)

    曹贵军; 李冬严; 孙丽莉; 李继华; 刘志军

    2012-01-01

    [Objective] To summarize the treatment of extra large area severe patient complicated by superior mesenteric artery syndrome. [Methods] After aggressive anti-infection, improvement of renal dysfunction, microskin and allograft skin grafting were performed to one patient with extensive burns of 95TBSA% (Ⅲ° 85%TBSA). SMAS was diagnosed by color Doppler flow imaging, including vomiting, abdominal distension occurred on 20 days postburns. After fasting and gastrointestinal decompression, the intravenous and enteral nutrient support was applied via duodenal tube by endoscopy. [Results] Symptoms of vomiting and abdominal distension of SMAS were disappeared on 21 days postburns. The wounds healed on 38 days post burns. [Conclusions] The color Doppler flow imaging is the optimal method to diagnosis on SMAS. A systemic treatment of strategy is needed to the successful treatment of major burns complicated by SMAS, such as aggressive wound management, sound allogenic or heterogenic skin grafting, the intravenous and enteral nutrient support by duodenal tube put by endoscopy.%[目的]总结成功救治特大面积烧伤患者合并肠系膜上动脉综合征(superior mesenteric artery syndrome,SMAS)的临床经验.[方法]治疗1例95%总体表面积(Ⅲ°85%总体表面积)烧伤患者,在积极补液复苏、抗感染、纠正肾功能不全及维护机体水电解质酸碱平衡的基础上,于伤后5d行四肢Ⅲ°创面切痂自体微粒皮大张异体皮移植术,伤后3周再行背、臀、四肢部残余创面清创,分期自体邮票皮+异种(猪)皮相间移植术.患者因反复呕吐、腹胀3d,于伤后20d经彩色多普勒超声检查确诊为肠系膜上动脉综合征,立即给予禁食、胃肠减压等措施,纤维胃镜下放置鼻肠管置入空肠,行肠内营养支持及静脉高营养维持.[结果]患者于伤后21d呕吐、腹胀消失,肠系膜上动脉综合征明显好转.伤后38d创面已基本愈合.[结论]彩色多普勒超声检查是

  8. Experiences and Thinking in Diagnosis and Treatment of Seven Patients with Acute Superior Mesenteric Arterial Embolism%急性肠系膜上动脉栓塞七例诊治经验与反思

    Institute of Scientific and Technical Information of China (English)

    许春梅; 刘波

    2014-01-01

    目的 探讨急性肠系膜上动脉栓塞(superior mesenteric arterial embolism,SMAE)的临床特点、早期诊断与治疗,以避免误诊及降低病死率.方法 对2010年1-12月收治的7例SMAE的临床资料进行回顾性分析.结果 5例术前均经常规检查、上腹部CT及腹部计算机断层X线血管造影(CTA)检查确诊为SMAE,3例转上级医院行手术治疗,2例转血管外科予抗凝溶栓治疗;1例因腹腔穿刺抽出血性积液后转普外科行手术治疗证实为SMAE;1例按急性重症胰腺炎治疗后症状继续加重,剖腹探查确诊SMAE后行手术治疗.术后随访7例均恢复良好,无严重并发症、后遗症及死亡病例.结论 对于中老年合并心脑血管疾病患者,突然发生剧烈腹痛且症状与体征不相符时,应考虑SMAE的可能,尽早行腹部CTA检查,及时诊断和治疗是提高治愈率的关键.

  9. Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): Assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images

    Energy Technology Data Exchange (ETDEWEB)

    Woodhams, Reiko, E-mail: reikow@hotmail.co.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan); Nishimaki, Hiroshi, E-mail: emgrad@yhb.att.ne.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan); Emergency Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa, 228-8555 (Japan); Fujii, Kaoru, E-mail: kaorufujii@yahoo.co.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan); Kakita, Satoko, E-mail: skakita@kitasato-u.ac.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan); Hayakawa, Kazushige, E-mail: hayakazu@med.kitasato-u.ac.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan)

    2010-10-15

    Objective: The purpose of this study was to assess the efficacy of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI) by analyzing morphology and diameter of superior mesenteric artery (SMA). We assessed whether MDCT was as useful as angiography for the diagnosis of NOMI. Materials and methods: Four patients who were diagnosed with NOMI were retrospectively analyzed. All patients had 8-row MDCT followed by laparotomy. Two of them underwent angiography after MDCT. The morphology and diameter of SMA of these cases was analyzed on multi-planar reconstructed (MPR) images. The mean diameter of SMA of NOMI cases was compared to that of 13 control cases. Results: MPR images of all NOMI cases showed irregular narrowing of the SMA, spasm of the arcades of SMA, and poor demonstration of intramural vessels. MPR images of two patients who had angiography were concordant with their angiograms. The mean diameter of SMA of NOMI patients was 3.4 {+-} 1.1 mm, which was statistically smaller than that of 13 control patients, 6.0 {+-} 1.5 mm (P < 0.05, Wilcoxon rank sum tests). Conclusion: Angiography has been recognized essential for the diagnosis of NOMI. This study shows the possibility of MDCT to be an equivalently useful modality compared to angiography for the diagnosis of NOMI by interpreting morphologic appearance and diameter of SMA. Introduction of MDCT in the decision tree of NOMI treatment may bring the benefit of prompt diagnosis and subsequent early and efficient initiation of therapy, which may improve the mortality.

  10. 腔内导管抽栓或联合溶栓在肠系膜上动脉栓塞中的应用%Catheter aspiration alone or combined with thrombolysis in the treatment of superior mesenteric artery embolism

    Institute of Scientific and Technical Information of China (English)

    黄渊全; 贾中芝; 王祁; 陈文华; 何忠明; 张俊; 王凯; 田丰

    2014-01-01

    目的:探讨腔内导管抽栓或联合溶栓在肠系膜上动脉栓塞(SMAE)治疗中的应用价值。方法回顾性分析江苏省常州市第一和第二人民医院于2005年1月至2013年7月期间接受导管抽栓或联合尿激酶溶栓治疗的25例SMAE患者的临床及影像资料。患者均经数字减影血管造影(DSA)确诊后即采用右侧股动脉穿刺,在导丝的配合下,将肾动脉导管送至栓塞部位反复抽吸进行抽栓治疗;若残留栓子堵塞远端或分支血管,则经导管缓慢推注尿激酶进行溶栓治疗。结果对25例患者中初诊为主干栓塞的20例SMAE行导管抽栓治疗后,主干均完全开通,但有6例其残留或破碎的小栓子脱落栓塞至远端分支血管。对初诊为分支动脉栓塞的5例SMAE以及抽栓治疗导致分支动脉栓塞的6例共计11例患者,采用抽栓联合尿激酶溶栓治疗,其中5例分支动脉完全开通,3例部分开通,另3例虽未开通但侧枝循环明显增多。1例患者治疗24 h后发现小肠坏死,行肠切除术后出现短肠综合征。其余24例患者治疗后随访(4.1±2.2)月,临床症状均缓解,消化功能均恢复正常。结论导管抽栓或联合尿激酶溶栓治疗SMAE疗效满意。%Objective To investigate the efficacy of catheter aspiration or combined with thrombolysis in the treatment of superior mesenteric artery embolism (SMAE). Methods Clinical and imaging data of 25 SMAE patients who underwent catheter aspiration or combined with urokinase thrombolysis in the First People′s Hospital and the Second People′s Hospital of Changzhou from January 2005 to July 2013 were retrospectively analyzed. Results Twenty patients were confirmed as SMA trunk embolism and 5 as SMA branch artery embolism. The embolic SMA trunks were completely recannulated by catheter aspiration in the above 20 cases, but small emboli embolized distal branch artery in 6 cases. These 6 patients plus above 5

  11. Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

    Directory of Open Access Journals (Sweden)

    Joseph W. Duncumb

    2016-01-01

    Full Text Available Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™ used for administering primary chemotherapy in breast cancer.

  12. Strauch's technique for epigastric free flaps in rats revisited: a simple and effective method to increase patency rates.

    Science.gov (United States)

    Horibe, Elaine Kawano; Sacks, Justin Michael; Aksu, Ali Emre; Unadkat, Jignesh; Song, Dennis Yong; Ferreira, Lydia Masako; Feili-Hariri, Maryam; Lee, W P Andrew

    2007-08-01

    Described by Strauch and Murray in 1967, the rodent epigastric free flap remains a versatile tool for microsurgery research and training. We report herein three sequential phases of our quest to improve efficiency and effectiveness of the original technique, making it more accessible to more microsurgeons. Ninety-six allotransplants were performed. Surgical technique, complication rates, clinical findings, and histopathologic correlation of each phase are reported. In phase I, two experienced microsurgeons employed the original technique and succeeded in 77% of the procedures. In phase II, two junior microsurgeons achieved a patency rate of 16.6% using the same technique, as opposed to 100% in phase III, utilizing the not-yet-described simplified flow-thru technique. Although patency rate using the original method varies from 9 to 78% (according to other reports), this technical modification can increase even the less experienced microsurgeons' success rates, perpetuating the use of Strauch's epigastric flap in experimental microsurgery.

  13. Combined free toe and free deep inferior epigastric perforator flap for reconstruction of the thumb and thumb web space.

    Science.gov (United States)

    Li, X J; Tong, J; Wang, Y

    2000-08-01

    To repair a complexly injured hand with composite loss of the thumb and the thumb web space in one stage, the combined transfer of a free second toe and a free deep inferior epigastric perforator flap was designed. It was used to simultaneously reconstruct the thumb and thumb web space of the injured hand in five cases. All flaps survived and there were no complications at any donor site after the reconstructions. In follow-up averaging 35.6 months, the final functional and cosmetic outcomes of the reconstructed thumbs and thumb web spaces were satisfactory. Results demonstrated that the combined transfer of a free second toe and a free deep inferior epigastric perforator flap is a valid method for simultaneous reconstruction of the thumb and the thumb web space of the injured hand.

  14. Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

    Science.gov (United States)

    Miyagi, Kana; Forouhi, Parto

    2016-01-01

    Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer. PMID:27651974

  15. Risk of peptic ulcer, oesophagitis, pancreatitis or gallstone in patients with unexplained chest/epigastric pain and normal upper endoscopy

    DEFF Research Database (Denmark)

    Munk, E.M.; Drewes, A.M.; Gorst-Rasmussen, Anders

    2007-01-01

    Background: No studies have examined the risk of upper gastrointestinal diseases among patients with unexplained chest/epigastric pain (UCEP) and a normal upper endoscopy. Aim: To examine the relative risk of peptic ulcer, oesophagitis, pancreatitis or gallstone in UCEP patients. Methods: This Da......Background: No studies have examined the risk of upper gastrointestinal diseases among patients with unexplained chest/epigastric pain (UCEP) and a normal upper endoscopy. Aim: To examine the relative risk of peptic ulcer, oesophagitis, pancreatitis or gallstone in UCEP patients. Methods...... for peptic ulcer, oesophagitis, pancreatitis or gallstone. Results: Compared with controls, the adjusted relative risks among UCEP patients Conclusions: UCEP is positively associated with all study outcomes especially in the first year after upper endoscopy, indicating that peptic ulcer, oesophagitis......, pancreatitis or gallstone could be underlying early UCEP symptoms. However, the long-term association remained strong for pancreatitis and gallstone, suggesting a genuine excess risk....

  16. Epigastric hernia in pregnancy: a management plan based on a systematic review of literature and a case history.

    Science.gov (United States)

    Debrah, Samuel A; Okpala, Amalachukwu M

    2013-06-01

    Symptomatic epigastric hernia is rare in pregnant women. A case history, management of which prompted a systematic review of the literature and proposed plan for treatment of such cases, is hereby presented. There is paucity of information on management of this condition in the standard literature as searches in Pubmed, Science Direct, Hinari, Medline, African Journal Online, Bioone as well as Cochrane library revealed. There are two schools of thought for the management of hernias in pregnancy-watchful waiting and herniorrhaphy in pregnancy. There is no consensus or definite guideline on the management of epigastric hernias in pregnancy. Based on the literature review, a management algorithm is proposed, which combines the two schools of thought.

  17. Prevascular femoral hernia and its relation with inferior epigastric vessels: a rare presentation of the femoral hernia sac.

    Science.gov (United States)

    Boshnaq, Mohamed; Phan, Yih Chyn; Akhtar, Mansoor; Hamade, Ayman

    2016-04-18

    A 61-year-old man presented to the emergency department, with a 2-week history of a painful lump on his right groin. A diagnosis of an irreducible right femoral hernia was made. As such, an urgent operation was carried out on the same day, and the patient was found to have a rare prevascular femoral hernia in which the sac was lying over the femoral vessels and split by the inferior epigastric vessels into 2 components resembling 2 trouser limbs. The hernia sac presented in a different and challenging way that necessitated meticulous dissection and full orientation of the anatomy of the femoral triangle. Complete dissection and control of the inferior epigastric vessels, and complete reduction of the sac followed by repair with a prosthetic mesh plug were performed successfully. The patient was discharged home the next day.

  18. Outcomes of 157 V-Patch(TM) Implants in the Repair of Umbilical, Epigastric, and Incisional Hernias.

    Science.gov (United States)

    Keating, Jane J; Kennedy, Gregory T; Datta, Jashodeep; Schuricht, Alan

    2016-01-01

    Umbilical, epigastric, and incisional hernias have traditionally been repaired using a Mayo or tensioned suture technique, with recurrence rates of approximately 50 per cent. Recent studies have shown that a tension-free repair using mesh can drastically decrease recurrence rates. Reinforced deployment prostheses are preferred because they enable retrofascial placement through a small incision, thus avoiding the potential morbidity of a larger incision and the costs associated with a laparoscopic approach. A retrospective chart review was performed of all umbilical, epigastric and incisional hernias repaired with V-Patch, a reinforced deployment prosthesis, by a single surgeon. Data analysis included patient characteristics, operative and postoperative metrics, hernia recurrence, and complication rates. Between 2009 and 2012, 157 implantations were performed in 152 patients during 156 procedures. Patient age ranged from 20 to 85 (mean 48). There were 88 females (57.9%) and 64 males (42.1%) with average body mass index of 30.6. Patch size distribution was 78 small (49.7%), 55 medium (35.0%), and 24 large (15.3%). There were 81 umbilical hernias (51.6%), 36 epigastric hernias (22.9%), 39 incisional hernias (24.8%), and 1 multiple recurrent inguinal hernia (0.6%) repaired. Follow-up time ranged from 18 months to 4.3 years. There were six hernia recurrences (3.2%). Complications included three patients (1.9%) with mesh infection, one with an enterocutaneous fistula (0.6%), and one patient with a postoperative small bowel obstruction (0.6%). Four patients required patch explantation (2.5%). The V-Patch reinforced deployment prosthesis is effective in the treatment of umbilical, epigastric, and incisional hernias, and has a low rate of complications.

  19. Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

    OpenAIRE

    Joseph W. Duncumb; Kana Miyagi; Parto Forouhi; Malata, Charles M.

    2016-01-01

    Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdomi...

  20. A novel duplex finding of superficial epigastric vein flow reversal to diagnose iliocaval occlusion.

    Science.gov (United States)

    Kolluri, Raghu; Fowler, Brian; Ansel, Gary; Silver, Mitchell

    2017-05-01

    Although duplex ultrasound (DUS) imaging is the current gold standard in the diagnosis of femoropopliteal deep venous thrombosis, it is not an optimal diagnostic modality to diagnose iliocaval occlusion. Screening for iliocaval occlusion thus remains a challenge for clinicians because of the lack of a reliable noninvasive technique. This challenge results in most patients undergoing computed tomography venography or magnetic resonance venography or invasive venography and intravascular ultrasound imaging. This study reports a novel, yet simple, reproducible and intuitive, surface DUS finding of physiologic flow reversal within the superficial epigastric vein (SEV) as a sign of proximal iliocaval occlusion (ICO). This was a retrospective study of 15 patients who were diagnosed with ICO based on the finding of SEV flow reversal on DUS imaging. Patient demographics, presenting CEAP C scores, ICO characteristics, correlation with advanced imaging, and short-term follow-up findings are reported. Physiologic reversal of the SEV resulted in confirmation of ICO in all patients who underwent advanced imaging, including computed tomography venography or traditional venogram along with intravascular ultrasound imaging. All patients who underwent follow-up DUS scans demonstrated normalization of the SEV flow after ICO recanalization. ICO can result in deep venous thrombosis, post-thrombotic syndrome, and chronic venous insufficiency. Physiologic flow reversal in SEV is diagnostic of ICO. To the best of our knowledge, this is the first report of this novel DUS finding. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  1. Gastric intramural hematoma accompanied by severe epigastric pain and hematemesis after endoscopic mucosal resection

    Institute of Scientific and Technical Information of China (English)

    Peng Sun; Shi-Yun Tan; Guo-Hai Liao

    2012-01-01

    Gastric intramural hematoma is a rare injury of the stomach,and is most often seen in patients with underlying disease.Such injury following endoscopic therapy is even rarer,and there are no universally accepted guidelines for its treatment.In this case report,we describe a gastric intramural hematoma which occurred within 6 h of endoscopic mucosal resection (EMR).Past medical history of this patient was negative,and laboratory examinations revealed normal coagulation profiles and platelet count.Following EMR,the patient experienced severe epigastric pain and vomited 150 mLof gastric contents which were bright red in color.Subsequent emergency endoscopy showed a 4 cm × 5 cm diverticulum-like defect in the anterior gastric antrum wall and a 4 cm × 8 cm intramural hematoma adjacent to the endoscopic submucosal dissection lesion.Following unsatisfactory temporary conservative management,the patient was treated surgically and made a complete recovery.Retrospectively,one possible reason for the patient's condition is that the arterioles in the submucosa or muscularis may have been damaged during deep and massive submucosal injection.Thus,endoscopists should be aware of this potential complication and improve the level of surgery,especially the skills required for submucosal injection.

  2. Fat necrosis in deep inferior epigastric perforator flaps: an ultrasound-based review of 202 cases.

    Science.gov (United States)

    Peeters, Wouter J; Nanhekhan, Lloyd; Van Ongeval, Chantal; Fabré, Gerd; Vandevoort, Marc

    2009-12-01

    In autologous breast reconstruction after mastectomy, fat necrosis is a rather common complication that may lead to secondary corrective surgery. The understanding of fat necrosis until now has been limited because previous studies were based exclusively on physical examination and used diverse definitions. The authors retrospectively reviewed the incidence of fat necrosis and the correlation of several risk factors in 202 deep inferior epigastric perforator (DIEP) flaps for breast reconstruction. The incidence of fat necrosis was based on both physical examination and ultrasound imaging. The following risk factors were studied: age, smoking, body mass index, timing of reconstruction, and timing and extent of radiation therapy fields. Physical examination revealed a palpable mass or nodule in 14 percent of the DIEP flaps (28 of 202). Ultrasound examination added another 21 percent of DIEP flaps (42 of 202) with a firm area of scar tissue (diameter >or=5 mm). The overall ultrasound incidence of fat necrosis in this study was 35 percent (71 of 202). Although the overall ultrasound incidence of fat necrosis was very high, only 7 percent of the DIEP flaps (15 of 202) needed to undergo an extra surgical procedure for removal of this area. In contrast to previous studies, none of the risk factors studied was statistically significant for the occurrence of fat necrosis. These results suggest that there is no significant association between previously suspected risk factors and fat necrosis. The overall incidence of fat necrosis, however, is much higher than previously accepted, even though the need for corrective surgery is limited.

  3. Gastric emptying patterns of a liquid meal in newborn infants, measured by epigastric impedance

    DEFF Research Database (Denmark)

    Lange, Aksel; Funch-Jensen, Peter; Thommesen, Peter

    1997-01-01

      Epigastric impedance was used to measure patterns of the gastric emptying of a liquid non-caloric meal (5 ml water/kg) in newborn infants. The emptying patterns consisted of two components, theemptying signal - the DC component - and a phasic 3 cycle per minutes (CPM) signal - the AC component....... Phasic 3 CPM signal was also seen during the fasting state. Measurements were erformed in thirty healthy infants. Twenty-six mature infants were examined in the first eight days of life, and four preterm infants were examined within 6 weeks after birth. For the emptying signal the median half emptying.......A periodic change of the impedance signal, the phasic 3 CPM signal, was observed after a meal in 24 of the infants. The median frequency was 3.03 CPM in 20 mature and 2.93 CPM in 4 preterminfants. In 9 infants a phasic 3 CPM signal was observed during fasting state. The median frequency was 2.9 CPM...

  4. Gastric emptying patterns of a liquid meal in newborn infants, measured by epigastric impedance

    DEFF Research Database (Denmark)

    Lange, Aksel; Funch-Jensen, Peter; Thommesen, Peter;

    1997-01-01

      Epigastric impedance was used to measure patterns of the gastric emptying of a liquid non-caloric meal (5 ml water/kg) in newborn infants. The emptying patterns consisted of two components, theemptying signal - the DC component - and a phasic 3 cycle per minutes (CPM) signal - the AC component....... Phasic 3 CPM signal was also seen during the fasting state. Measurements were erformed in thirty healthy infants. Twenty-six mature infants were examined in the first eight days of life, and four preterm infants were examined within 6 weeks after birth. For the emptying signal the median half emptying.......A periodic change of the impedance signal, the phasic 3 CPM signal, was observed after a meal in 24 of the infants. The median frequency was 3.03 CPM in 20 mature and 2.93 CPM in 4 preterminfants. In 9 infants a phasic 3 CPM signal was observed during fasting state. The median frequency was 2.9 CPM...

  5. Pathological internal mammary lymph nodes in secondary and tertiary deep inferior epigastric perforator flap breast reconstructions.

    Science.gov (United States)

    Hofer, Stefan O P; Rakhorst, Hinne A; Mureau, Marc A M; Moolenburgh, Sanne E; van Huizum, Martine A; van Geel, Albert N

    2005-12-01

    Use of internal mammary vessels during breast reconstruction provides information on part of the internal mammary chain lymph nodes (LNs). It was evaluated whether our current practice of screening should be changed to identify those delayed breast reconstruction patients with tumor-positive internal mammary nodes (IMNs) and whether breast reconstruction should be continued, in case suspicious IMNs were found intraoperatively. From February 2002 to December 2004, 81 patients had received 98 deep inferior epigastric perforator flaps for delayed breast reconstruction. Prospectively collected data for suspicious internal mammary LNs were evaluated. In 13 patients (16%) who had received a delayed breast reconstruction, macroscopically suspicious LNs were detected in the course of the internal mammary chain. Three patients (4%) had a pathologic diagnosis of malignancy, which was found to match their primary tumor. No relationship between positive internal mammary chain LNs and location of the primary tumor, TNM-stage, or previously administered adjuvant therapy was found. Suspicious internal mammary chain LNs found during recipient vessel dissection for breast reconstruction can have important consequences for treatment of malignant disease in individual patients. Presented data do not support changing the current perioperative approach of delayed breast reconstruction.

  6. Methodology study on the examination of superior mesenteric artery by color Doppler ultrasound%肠系膜上动脉彩色多普勒超声检查方法学研究

    Institute of Scientific and Technical Information of China (English)

    杨兵; 胡亚飞; 谭必勇; 叶茂; 王开权; 杨淑蓉

    2012-01-01

    Objective To establish methodology of the superior mesenteric artery( SMA )by color Doppler ultrasound. Methods Color Doppler ultrasound examination of SMA and its branches was performed before and after giving a new type of oral administration contrast agent in 40 normal adults. Results The upper SMA can be displayed in all the study subjects through conventional color Doppler ultrasound examination, nine cases displayed all segments SMA trunk, the branches were not shown. After oral administration of self-made mixed small intestine contrast agent,the SMA trunk with all the branches could be observed in all subjects by color Doppler ultrasound examination. The SMA trunk showed as straight in color Doppler imaging with an heliconia-like end, the branches showed various shapes, mostly are dendroid branched,some are tortuous. The blood flow of SMA are intertwined with a network-like or daisy-like shape. The SMA branch blood flow into the intestinal wall in a ring pattern. After oral administration of mixed small intestine contrast agent,the whole SMA trunk and branches can be observed by color Doppler ultrasound,the artery peak systolic velocity( PS ),resistance index( RI ),pulsatility index( PI )and the diameter,of SMA were measured:male group( 0. 692 ± 0. 059 )cm, female group( 0. 704 ± 0. 094 )cm; artery: male group PS ( 1.089 ±0.328 )m/s,RI( 0. 835 ± 0.045 ),PI( 2.495 ± 0.436 ), female group PS( 1.078 ± 0. 273 )m/s, RI ( 0. 860 ±0.421 ),PI( 2. 889 ±0.702 );artery a branch:male group PS( 0. 520 ±0. 226 )m/s,RI( 0.772 ±0.066 ), PI( 1.956 ± 0. 506 ), female group PS( 0. 645 ± 0. 156 )m/s, RI( 0. 833 ± 0. 070 ), PI( 2. 847 ± 0. 909 ); Artery two branches:the male group PS( 0. 344 ± 0. 143 )m/s, RI( 0. 661 ±0.045 ),PI( 1. 306 ± 0. 268 ). Female group PS( 0. 392 ± 0. 134 )m/s,RI( 0. 781 ±0. 072 ),PI( 2. 185 ±0. 754 );between arterial wall: male group PS( 0. 196 ±0.061 )m/s,RI( 0. 619 ±0.080 ),PI( 1. 101 ±0. 315 ),female group:PS( 0. 224 ± 0

  7. Lower Reoperation Rate for Recurrence after Mesh versus Sutured Elective Repair in Small Umbilical and Epigastric Hernias. A Nationwide Register Study

    DEFF Research Database (Denmark)

    Christoffersen, Mette Willaume; Helgstrand, F; Rosenberg, J;

    2013-01-01

    Repair for a small (≤2 cm) umbilical and epigastric hernia is a minor surgical procedure. The most common surgical repair techniques are a sutured repair or a repair with mesh reinforcement. However, the optimal repair technique with regard to risk of reoperation for recurrence is not well...... documented. The aim of the present study was in a nationwide setup to investigate the reoperation rate for recurrence after small open umbilical and epigastric hernia repairs using either sutured or mesh repair....

  8. Leiomyosarcoma of the superior vena cava.

    Science.gov (United States)

    de Chaumont, Arthus; Pierret, Charles; de Kerangal, Xavier; Le Moulec, Sylvestre; Laborde, François

    2014-08-01

    Leiomyosarcoma of the superior vena cava is a very rare tumor and only a few cases have been reported, with various techniques of vascular reconstruction. We describe a new case of leiomyosarcoma of the superior vena cava in a 61-year-old woman with extension to the brachiocephalic arterial trunk. Resection and vascular reconstruction were performed using, respectively, polytetrafluoroethylene and polyethylene terephtalate vascular grafts.

  9. Pulmonary artery sling: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Gil Hyun; Lee, Sun Wha; Cha, Sung Ho [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

    1993-09-15

    Aberrant left-sided pulmonary artery(pulmonary artery sling) is an uncommon anomaly,which may cause significant respiratory abnormality. We report a case of pulmonary artery sling which is combined with persistent left superior vena cava and dextrocardia. This case were identified by esophagogram and CT and confirmed by MRI and angiography. We consider that MRI is a valuable new method for the diagnosis of aberrant left-sided pulmonary artery.

  10. Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report.

    Science.gov (United States)

    Zelones, Justin T; Nigriny, John F

    2017-04-01

    Pyoderma gangrenosum (PG) is a rare skin disorder of the neutrophilic dermatoses spectrum that can mimic wound infections in surgical patients. PG after breast surgery has been reported but in limited amounts in autologous breast reconstruction patients. We present the first case of PG after a delayed bilateral deep inferior epigastric perforator flap breast reconstruction in the setting of systemic disease along with a systematic review. PubMed, Ovid, and Web of Science were systematically searched to obtain cases of PG after autologous breast reconstruction. Sixty articles were identified but only 16 were relevant to this study. Systemic disease was present in 2 patients (13%). Wound onset occurred typically 5 days after surgery. Fever and/or leukocytosis was observed in 10 patients (63%). Wound cultures were positive in 2 patients (13%). Donor-site wounds were present in 9 patients (56%). Bilateral breast wounds were present in 67% of bilateral cases. Debridement was performed in 10 cases (63%). Skin graft or substitute was performed in 6 cases (38%). Resection of autologous flap was performed in 3 cases (19%). All patients were treated with systemic steroids (81%) and/or immunosuppressive medications (50%). Complete wound healing occurred by 4 months on average. If early ulcerative wounds develop at multiple sites after autologous breast reconstruction with worsening after debridement and antibiotic therapy, then PG should be considered. It is imperative that an early diagnosis and subsequent treatment with steroids and/or immunosuppressive medications be initiated so further surgical procedures, flap loss, and scarring can be minimized.

  11. The Impact of Perforator Number on Deep Inferior Epigastric Perforator Flap Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Ritwik Grover

    2014-01-01

    Full Text Available Background Perforator flaps minimize abdominal site morbidity during autologous breast reconstruction. The purpose of this study was to assess whether the number of perforators harvested influences the overall deep inferior epigastric perforator (DIEP flap survival and flap-related complications. Methods A retrospective review was performed of all DIEP flaps performed at the Hospital of the University of Pennsylvania from 2006 to 2011. The outcomes assessed included flap loss and major complications. We compared flaps by the number of total perforators (1-4 and then carried out a subgroup analysis comparing flaps with one perforator to flaps with multiple perforators. Lastly, we conducted a post-hoc analysis based on body mass index (BMI categorization. Results Three hundred thirty-three patients underwent 395 DIEP flaps. No significant differences were noted in the flap loss rate or the overall complications across perforator groups. However, the subgroup analysis revealed significantly higher rates of fat necrosis in the case of one-perforator flaps than in the case of multiple-perforator flaps (10.2% vs. 3.1%, P=0.009. The post-hoc analysis revealed a significant increase in the flap loss rate with increasing BMI (40=42.9%, P<0.001 in the DIEP flaps, but no increase in fat necrosis. Conclusions This study demonstrates that the number of perforators does not impact the rate of flap survival. However, the rate of fat necrosis may be significantly higher in DIEP flaps based on a single perforator. Multiple perforators should be utilized if possible to decrease the risk of fat necrosis.

  12. 腹壁下动脉穿支皮瓣在小儿足踝部软组织缺损中的应用%Repair of foot and malleolus defects with deep inferior epigastric perforator flap in children

    Institute of Scientific and Technical Information of China (English)

    高曙光; 唐举玉; 罗令; 雷光华; 李雄; 李康华

    2009-01-01

    目的 探讨腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣移植修复小儿足踝部软组织缺损的可行性及临床疗效.方法 2005年8月-2007年10月,采用DIEP皮瓣移植修复小儿足踝部软组织缺损18例.左13例,右5例.致伤原因均为交通伤.软组织缺损面积最小11 cm ×6 cm,最大17 cm ×6 cm,均合并肌腱和骨关节外露.DIEP皮瓣面积最小12 cm×7 cm,最大18 cm ×7 cm,9例腹壁下动静脉与胫前动静脉吻合,4例腹壁下动静脉与足背动静脉吻合,5例腹壁下动静脉与胫后动静脉吻合,腹部皮瓣供区直接缝合.结果 18例DIEP皮瓣移植术后顺利成活,皮瓣受区与供区创口Ⅰ期愈合.术后随访3~20个月,平均10.3个月,皮瓣颜色、血运好,外形不臃肿,足踝功能恢复良好,13例恢复保护性感觉,腹部供瓣区外形恢复好,腹壁功能无明显影响,无腹壁薄弱、腹壁疝等并发症发生.结论 DIEP皮瓣保留了传统下腹部横形腹直肌皮瓣乳房再造所具有的优点,可最大限度保留腹直肌的功能,避免术后出现腹壁薄弱、腹壁疝等并发症,其皮瓣薄,修复足踝部创面不需Ⅱ期修薄整形,是修复小儿足踝部软组织缺损的较好方法.%Objective To discuss the feasibility and the preliminary clinical effect of deep inferior epigastric perforator (DIEP) flap in repair of foot and malleolus defects in child.Methods From August 2003 to October 2006,18 child patients with foot and malleolus defects were treated with DIEP flap.There were 10 males and 8 females,at age range of 3-7 years (average 4.6 years).The defects were on the left joints in 13 patients and on the right in five.All soft tissue defects were caused by traffic accidents that resulted in exposure of the tendons and skeleton.The size of the defect ranged from 11 cm ×6 cmto 17 cm ×6 cm.The minimum DIEP flap in size was 12 cm ×7 cm.The maximum DIEP flap in size was 18 cm × 7 cm.The inferior epigastric artery ( vein

  13. Spontaneous isolated dissection of the superior mesenteric artery:multi-slice computed tomographic angiography findings in seven cases%MSCT血管成像对孤立性肠系膜上动脉夹层的诊断价值

    Institute of Scientific and Technical Information of China (English)

    陈则君; 谢旭纲; 孟宪平; 朱建新; 王伯元

    2011-01-01

    目的:探讨MSCT血管成像诊断孤立性肠系膜上动脉夹层(SISAMD)的临床应用价值.方法:对7例急性肠缺血患者行MSCT血管成像,采用容积再现(VR)、多平面重组(MPR)、曲面重组(CPR)及最大密度投影(MIP)重组图像,由两位经验丰富的心血管影像医师评估夹层的部位和范围.结果:SISAMD与主动脉夹层CT血管成像(CTA)表现相同,CTA清晰显示撕裂内膜5例,破裂口均位于肠系膜上动脉(SMA)近心端.根据Yun分型:Ⅰ型1例,Ⅱa型3例,Ⅱb型2例,Ⅲ型1例.SMA直径增粗2例,SMA周围脂肪间隙模糊2例,局部回肠壁增厚、水肿2例,升结肠扩张、积液1例,腹腔及盆腔内少量积液2例.结论:MSCTA能清晰显示病变特征和累及范围,是孤立性肠系膜上动脉夹层首选的检查方法.%Objective : To asscss the value of multi-slice computed tomographic angiography (MSCTA) in the diagno sis of spontancous isolated dissection of superior mesenteric artery (SMA). Methods:7 patients with clinically suspected a cute mesenteric ischemia underwent MSCTA. Multiplanar and three-dimensional images were obtained by imaging postpro cessing techniques including volume rendering technique (VRT) , multiplanar reconstruction (MPR) , curved planar reforma tion (CPR) and maximum intensity projection (MIP) on a workstation. Image reading was performed in consensus by two experienced cardiovascular radiologists. Results: According to Yun's classification,there were one case of type Ⅰ , three type Ⅱ a,two type Ⅱ b and one type Ⅲ . Spontaneous isolated dissection of SMA displays the same MSCTA features as aortic dis section. Intimal flaps were seen in five patients,with intimal tears at the proximal SMA. Other MSCTA findings associated with spontaneous isolated dissection of SMA were enlarged diameter of the SMA (n=2) ,increased attenuation of the fat a round the SMA (n=2) ,local ileum wall thickening due to edema (n=2) , dilated ascending colon (n=1) and hemorrhagic

  14. The Evaluation of Superior Mesenteric artery CT Angiography in Diagnosis of Small Intestinal Disease%肠系膜上动脉MSCTA对小肠疾病的诊断价值

    Institute of Scientific and Technical Information of China (English)

    郑楠楠; 胡道予; 邵剑波; 闫学强; 方磊; 陈亮

    2012-01-01

    Objective To evaluate the value of superior mesenteric artery CTA in diagnosis of small intestinal disease irom the change of SMA and superior mesenteric vein (SMV). Methods 362 patients clinically suspected intestinal dis ease were collected from January 2008 to December 2010. Dual phase MSCT scan was performed and source images of a 0. 625 mm thickness were used for image reconstruction. The reconstruction technique of MPR (Multiplanar Reconstruction) , M1P ( Maximal intensity projection) and VR ( volume rendering) were used. The diagnostic accuracy of reconstruction ima ging was compared with the source images. Results A total of 101 cases with intestinal disease were proved by operation or pathology, which included intestinal tumor(29 cases) , inflammatory process(25 cases) , intestinal diverticulum (12 ca ses) , arteriovenous malformation(AVM, 5 cases) , intestinal volvulus(7 cases) , intestinal entocele(3 cases) , enterolith intestinal obstruction (6 cases) , adhesion intestinal obstruction (6 cases) , stomal stenosis after surgery(3 cases) , intus susception (4 cases) , oblique inguinal hernia(1 cases). In the 101 cases of intestinal disease proved by operation or pa thology , 64 cases were diagnosed correctly with source image, and 94 cases were diagnosed correctly with reconstruction MSCTA image. There was significant difference between source image and reconstruction MSCTA image in diagnostic accu racy. Conclusion MSCT source image with reconstruction techniques are helpful for evaluation of small intestinal dis ease, and also helpful to differential diagnosis and decide treatment planning.%目的 探讨肠系膜上动脉MSCTA对小肠疾病的定位诊断价值;并观察肠系膜血管的改变对部分小肠疾病的定性诊断价值.方法 搜集2008年1月至2010年12月,因腹痛、腹泻、呕吐、黑便等临床症状行MSCT双期增强扫描的患者362例.采用动脉期、静脉期双期增强扫描,原始图像0.625mm重组传入ADW4.3工作

  15. Avaliação e tratamento fisioterápico na doença arterial obstrutiva periférica de membro superior: um estudo de caso Assessment and physical therapy treatment for peripheral artery occlusive disease of the upper limb: a case study

    Directory of Open Access Journals (Sweden)

    Danielle Aparecida Gomes Pereira

    2008-03-01

    Full Text Available O objetivo deste artigo é apresentar um estudo de caso em que se propõe um protocolo de avaliação e intervenção para uma paciente com claudicação de membro superior. Descrição do caso: mulher de 50 anos com 4 meses de evolução de quadro de obstrução de artéria braquial esquerda pós-cateterismo. Na avaliação com Doppler contínuo, observou-se presença de som monofásico em artérias radial e ulnar. No teste do cicloergômetro, a dor isquêmica iniciou aos 2 minutos e 30 segundos e atingiu o ponto máximo aos 9 minutos e 26 segundos. Foi realizado tratamento em cicloergômetro três vezes por semana durante 8 semanas. Após o tratamento, o tempo de teste em cicloergômetro aumentou: dor inicial aos 5 minutos e 7 segundos e máxima aos 18 minutos. A paciente relatou desaparecimento da cianose e melhora na realização de atividades de vida diária. O protocolo de avaliação proposto envolvendo medidas objetivas (cicloergômetro e subjetivas (questionário SF-36 traduzido e validado em português foi bem tolerado, tendo sido capaz de detectar alterações no estado funcional da paciente. As alterações detectadas no tempo de surgimento de dor inicial e de dor máxima podem ter acontecido de modo espontâneo, mas não se pode descartar que a intervenção possa, potencialmente, ser benéfica para indivíduos com claudicação de membros superiores. Os resultados observados neste estudo de caso avalizam futuros estudos envolvendo maior número de participantes.The aim of this paper was to present a case study proposing a protocol for assessment and rehabilitation of a patient with upper limb intermittent claudication. Case description: 50-year-old woman with obstruction of the left brachial artery secondary to catheterization performed 4 months ago. Monophasic sound was observed during continuous Doppler ultrasound assessment of both the radial and ulnar arteries. During the arm crank test, ischemic pain started at 2 minutes and

  16. Deep inferior epigastric perforator flap for breast reconstruction: experience with 43 flaps

    Institute of Scientific and Technical Information of China (English)

    YAN Xiao-qing; YANG Hong-yan; ZHAO Yu-ming; YOU Lei; XU Jun

    2007-01-01

    Background In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap.Methods Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap (3 patients had bilateral procedures), 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up.Results The mean age of the patients was 38.6 years (range, 28-50). The size of the flaps was 11 cm×26 cm in average (height 10-12 cm, width 15-33 cm). The mean length of the vascular pedicles was 9.3 cm (range, 7-12). The patients were followed up for a mean of 16 months (range, 6-30 months). During the follow-up, 2 (5%) patients had total flap loss, 2 (5%) had partial necrosis, 4 (9%) had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal.Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce

  17. Risk of gastrointestinal cancer in patients with unexplained chest/epigastric pain and normal upper endoscopy: a Danish 10-year follow-up study

    DEFF Research Database (Denmark)

    Munk, Estrid Muff; Drewes, Asbjørn Mohr; Gorst-Rasmussen, Anders;

    2007-01-01

    Unexplained chest/epigastric pain is a common symptom in the general population. However, it has not previously been studied whether such pain could be a marker of subsequent gastrointestinal cancer. We aimed to estimate the risk of gastrointestinal cancers in a Danish 10-year follow-up study among...... patients with chest/epigastric pain, normal upper endoscopy, and no prior discharge diagnosis of ischemic heart disease (N = 386), compared with population controls (N = 3860). The overall 10-year risk of gastrointestinal cancer (stomach, colorectal, liver, and pancreas) was 2.9% for patients...... of gastrointestinal cancer within the first year after upper endoscopy. Consequently, unexplained chest/epigastric pain might be an early gastrointestinal cancer symptom....

  18. Epigastric Distress Caused by Esophageal Candidiasis in 2 Patients Who Received Sorafenib Plus Radiotherapy for Hepatocellular Carcinoma: Case Report.

    Science.gov (United States)

    Chen, Kuo-Hsin; Weng, Meng-Tzu; Chou, Yueh-Hung; Lu, Yueh-Feng; Hsieh, Chen-Hsi

    2016-03-01

    Sorafenib followed by fractionated radiotherapy (RT) has been shown to decrease the phagocytic and candidacidal activities of antifungal agents due to radiosensitization. Moreover, sorafenib has been shown to suppress the immune system, thereby increasing the risk for candida colonization and infection. In this study, we present the 2 hepatocellular carcinoma (HCC) patients suffered from epigastric distress caused by esophageal candidiasis who received sorafenib plus RT. Two patients who had received sorafenib and RT for HCC with bone metastasis presented with hiccups, gastric ulcer, epigastric distress, anorexia, heart burn, and fatigue. Empiric antiemetic agents, antacids, and pain killers were ineffective at relieving symptoms. Panendoscopy revealed diffuse white lesions in the esophagus. Candida esophagitis was suspected. Results of periodic acid-Schiff staining were diagnostic of candidiasis. Oral fluconazole (150 mg) twice daily and proton-pump inhibitors were prescribed. At 2-weak follow-up, esophagitis had resolved and both patients were free of gastrointestinal symptoms. Physicians should be aware that sorafenib combined with RT may induce an immunosuppressive state in patients with HCC, thereby increasing their risk of developing esophagitis due to candida species.

  19. 多层螺旋CT在肠系膜上动脉栓塞诊断中的应用价值%Application of Multi-slice CT in the Diagnosis of Superior Mesenteric Artery Embolization

    Institute of Scientific and Technical Information of China (English)

    张银; 吴智玲; 周立强; 杨建平; 徐开鹏; 陈士花; 宋淮

    2013-01-01

    Objective To investigate the value of multi - slice CT ( MSCT ) in diagnosis of superior mesenteric artery embolization ( SMAE ) . Methods Clinical and imaging data of 18 SMAE patients admitted to our hospital from April 2006 to November 2011 were retrospectively analyzed to summarize the MSCT imaging characteristics of SMAE. Results All the 18 patients were given MSCT three - phase scan, and 11 patients were also given DSA test. The accuracy of MSCT in predicting trunk embolism of SMA was 100. 0% ( 13/13 ), while the accuracy of MSCT in predicting branch embolism was 60% ( 3/5 ), and 2 cases were suspected of SMAE and then confirmed by DSA. MSCT plain scan showed that the embolus was low density and could not be easily differentiated from normal SMA. 4 cases were combined with gut cavity expansion, but without seroperitoneum or intestinal obstruction. Enhancement scan showed that 13 cases had filling defects of SMA trunk, and dotted or oval enhanced shadow were seen in 6 incomplete SMA trunk embolism cases and filling defect shadow were seen in 5 complete branch embolism cases. Data post -processing and image reconstruction showed that volume rendering ( VR ) of the 13 SMA trunk embolism cases could well demonstrate space relationship and could well demonstrate the shape of blood vessels and their relationship with surroundings. MIP of the 3 cases showed the formation of plaque on blood vessel wall. Multi - planar reconstruction ( MPR ) and curve planar reformation ( CPR ) could demonstrate vessel lumen more directly. Conclusion MSCT and post - processing technology is non - invasive, and can diagnose SMAE rapidly and accurately, providing reliable information for assessing the condition of SMAE.%目的 探讨多层螺旋CT(MSCT)在肠系膜上动脉栓塞(SMAE)诊断中的应用价值.方法 回顾性分析我院2006年4月-2011年11月收治的18例SMAE患者的临床及影像学资料,总结SMAE的MSCT影像学特征.结果 18例

  20. [Acupoint catgut-embedding therapy: superiorities and principles of application].

    Science.gov (United States)

    Zhang, Xuan-Ping; Jia, Chun-Sheng; Wang, Jian-Ling; Shi, Jing; Zhang, Xin; Li, Xiao-Feng; Xu, Xiao-Kang; Qin, Liang; Zhang, Mei-Ling; Kang, Su-Gang; Duan, Xiao-Dong

    2012-10-01

    To analyze the superiorities of acupoint catgut-embedding therapy, discuss its law of clinical application and provide scientific decision-making for clinical treatment. Literatures on acupoint catgut-embedding therapy in the recent 40 years were selected, input, examined and verified, picked up and analyzed by establishing database with the modern computer technology. (1) One thousand and seventy-five literatures were input. It shows that the acupoint catgut-embedding therapy has an extensive application in all departments, especially in the internal department, accounting for 48.54% (50/103) of the total disease category. It has the most extensive application on treatment of epigastric pain, with the frequency of 102 times, and obesity of 74 times. The next is surgery, accounting for 14.56% (15/103). The major application is on low back pain and leg pain with the frequency of 79 times. Psoriasis, with the frequency of 30 times, holds the major application in dermatological department. And blepharoplasty, with the frequency of 30 times, gains the most application in department of ophthalmology and otorhinolaryngology. (2) In the included literatures, selection of adjacent acupoints and distal acupoints are held as the major method of acupoint selection. The adjusted lumbar puncture needle is taken as the major tool for the acupoint catgut-embedding therapy. And catguts of different sizes are adopted for the operation. (3) Analysis of the therapeutic effect shows that acupoint catgut-embedding therapy has obvious effect in all departments, especially in surgery and dermatology, with the total effective rate over 90%. Epigastric pain, obesity, epilepsy, asthma, abdominal pain, facial paralysis and constipation of the internal medicine, low back pain and leg pain of the surgical department, psoriasis of the dermatological department and blepharoplasty of the department of ophthalmology and otorhinolaryngology are considered as the dominant diseases for acupoint

  1. One-week acid suppression trial in uninvestigated dyspepsia patients with epigastric pain or burning to predict response to 8 weeks' treatment with esomeprazole

    DEFF Research Database (Denmark)

    van Zanten, S V; Flook, N; Talley, N J;

    2007-01-01

    BACKGROUND: While empiric acid-suppressive therapy for uninvestigated dyspepsia patients with symptoms of epigastric pain or burning is standard practice, it is unknown whether an early response to therapy predicts outcome. AIM: To evaluate whether a 1-w acid suppression trial is effective for pr...

  2. Importance of diastolic velocities in the detection of celiac and mesenteric artery disease by duplex ultrasound

    DEFF Research Database (Denmark)

    Perko, M J; Just, S; Schroeder, T V

    1997-01-01

    To assess the predictive value of ultrasound duplex scanning in the detection of superior mesenteric artery (SMA) and celiac artery (CA) occlusive disease.......To assess the predictive value of ultrasound duplex scanning in the detection of superior mesenteric artery (SMA) and celiac artery (CA) occlusive disease....

  3. [Rib-sparing technique for internal mammary vessels exposure and anastomosis in breast reconstruction with deep inferior epigastric perforator flap].

    Science.gov (United States)

    Zeng, Ang; Zhu, Lin; Liu, Zhifei; Wang, Xiaojun; Zhang, Hailin; Bai, Ming; Wang, Zhi

    2014-11-01

    To explore the feasibility and reliability of rib-sparing technique for internal mammary vessels exposure and anastomosis in breast reconstruction and thoracic wall repair with deep inferior epigastric perforator (DIEP) flaps. Between November 2009 and September 2011, 11 female patients with post-mastectomy deformities were treated. The mean age was 42 years (range, 33-65 years). Of them, 10 patients underwent breast reconstruction with the DIEP flaps, and 1 patient received defect repair for chronic thoracic wall irradiated ulcer with the DIEP flap. The size of the flap ranged from 18 cm x 9 cm to 28 cm x 12 cm. Rib-sparing technique was applied in all these cases. The internal mammary vessels were exposed by dissection intercostal space and anastomosed with the deep inferior epigastric vessels. The donor sites were closed directly in all cases. In all cases, the rib-sparing technique for internal mammary vessels exposure and anastomosis was successfully performed. The mean time for internal mammary vessels exposure was 52 minutes (range, 38-65 minutes). The mean exposure length of the internal mammary vessels was 1.7 cm (range, 1.3-2.2 cm). All flaps survived completely postoperatively, and wounds and incisions at donor sites healed primarily. All patients were followed up 8-26 months (mean, 12 months). All patients were satisfied with the reconstructive outcomes. No collapse deformity or discomfort of the thoracic wall occurred. The rib-sparing technique for internal mammary vessels exposure and anastomosis is a reliable and reproducible approach to reconstruct the breast and repair the thoracic wall with DIEP flap, and it can reduce collapse deformity of the thoracic wall.

  4. Rare anatomic variation of left gastric artery and right hepatic artery in a female cadaver.

    Science.gov (United States)

    Troupis, Theodore; Chatzikokolis, Stamatis; Zachariadis, Michael; Troupis, George; Anagnostopoulou, Sofia; Skandalakis, Panayiotis

    2008-05-01

    The present report describes a rare case in which the left gastric artery arises directly from the abdominal aorta and the right hepatic artery from the superior mesenteric artery, as observed during the dissection of a female cadaver. The left gastric artery usually rises as one of the three branches of the celiac trunk, which was originally described by Haller in 1756, whereas the right hepatic artery usually originates from the proper hepatic artery. The knowledge of the typical anatomy of the abdominal arteries, and their variations, is especially important due to the numerous interventions performed in the abdominal area.

  5. 以上唇动脉为蒂的逆行鼻唇沟瓣修复鼻眶下区缺损的临床研究%The clinical effect of reversed nasolabial flap pedicled with superior labial artery for the reconstruction of nasal and infraorbital defects

    Institute of Scientific and Technical Information of China (English)

    刘平; 李勇; 郑田; 季平; 邱丽华; 李颖; 张碧; 鲁琦; 赵洪伟

    2014-01-01

    Objective To evaluate the clinical effect of reversed nasolabial flap pedicled with superior labial artery for the recon-struction of nasal and infraorbital defects .Methods From September 2006 to May 2013 ,13 cases with large nasal and infraorbital defects were reconstructed by the reversed nasolabial flap pedicled with superior labial artery .In all patients these defects were re-sulted by the excision of carcinomas .The disease course ranged from 2 months to 28 years .The size of nasal and infraorbital defects was from 2 .0 cm × 1 .2 cm to 4 .0 cm × 3 .6 cm .All defects were restored by the reversed nasolabial flap pedicled with superior labial artery in 10 cases and by the island flap in 3 cases .The size of flap was similar to that of defects .The donor areas were sutured di-rectly .Results All flaps were completely survived .The incision at the donor and accepted sites healed in the first stage .In 4 pa-tients flap revision was performed after 6-12 months because of mild swelling at the pedicles of skin flaps .Patients were followed up for 4-60 months (the mean was 28 .4 months) .All patients were satisfied with the nasal ventilatory function and appearance , flap texture and color .No obvious scars were found at donor sites .Conclusion Reversed nasolabial flap pedicled with superior labial artery is a better choice to repair the nasal and infraorbital defect after excision of carcinomas .%目的:探讨以上唇动脉为蒂的逆行鼻唇沟瓣修复鼻眶下区缺损的手术方法和疗效。方法2006年9月至2013年5月,收治鼻眶下缺损患者13例。所有患者为肿瘤切除术鼻眶下区缺损,病程为2个月至28年。缺损范围为2.0cm×1.2cm~4.0 cm ×3.6 cm。术中采用同侧上唇动脉为蒂的逆行鼻唇沟瓣修复缺损,其中10例为带蒂皮瓣,3例为轴型岛状皮瓣;皮瓣切取范围与缺损大小相近。供区直接对位缝合。结果所有皮瓣全部成活,供、受区切口全

  6. Superior Hiking Trail

    Data.gov (United States)

    Minnesota Department of Natural Resources — Superior Hiking Trail main trail, spurs, and camp spurs for completed trail throughout Cook, Lake, St. Louis and Carlton counties. These data were collected with...

  7. Bathymetry of Lake Superior

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Bathymetry of Lake Superior has been compiled as a component of a NOAA project to rescue Great Lakes lake floor geological and geophysical data and make it more...

  8. Superior Hiking Trail Facilities

    Data.gov (United States)

    Minnesota Department of Natural Resources — Superior Hiking Trail main trail, spurs, and camp spurs for completed trail throughout Cook, Lake, St. Louis and Carlton counties. These data were collected with...

  9. CT血管成像双期和三期扫描对急性肠系膜上动脉栓塞筛查性诊断的影响%Phase CT Angiography Double and Three Scan Screening Diagnosis of Acute Superior Mesenteric Artery Embolism

    Institute of Scientific and Technical Information of China (English)

    秦定文

    2014-01-01

    Objective:To investigate 64 row spiral CT imaging of mesenteric vessels two scanning meth-ods:arteriovenous dual phase scanning and arteriovenous balanced three phase scanning display ability of mesenteric vessels , compare two scanning methods for clinical screening diagnosis of suspected acute superior mesenteric artery embolism presence of influence , and to facilitate choice less exposure time can get a clear diagnosis of image space .Method:A retrospective analysis of 22 cases of acute abdominal pain in patients with clinically suspected cases superior mesenteric artery embolism , line 64 row CT abdominal vascular ima-ging , 7 patients with arteriovenous dual phase scanning , 15 patients with arteriovenous balanced three phase scanning .Stage of double scanning , three scan of the superior mesenteric artery , the lesions showed ability and each phase scan signs .With exposure time matching chi-square test and shows that the difference in sta-tus.The results of two kinds of scanning methods of mesenteric vascular branch showed rate was 100%, more than 3 dual phase scanning in the diagnosis of acute superior mesenteric artery embolism in 2 cases, the third phase of scanning in the diagnosis of acute superior mesenteric artery embolism (3 cases), arteriovenous du-al phase scanning and arteriovenous balanced three phase scanning for patients to accept exposure time had statistical significance (P 0.05) .Conclusion:64 row spiral CT dual phase and three phase scan screening diag-nosis of acute superior mesenteric artery embolism has no obvious difference , choose arteriovenous dual phase scanning does not affect the screening diagnosis accuracy , patients with double scanning is helpful to reduce unnecessary radiation dose .%目的:探讨64排螺旋CT肠系膜血管成像2种扫描。方法:动静脉双期扫描和动静脉平衡三期扫描对肠系膜血管的显示能力,比较2种扫描方法对临床疑似急性肠系膜上动脉栓塞

  10. Imaging Evaluation of Blood Supply in Deep Inferior Epigastric Perforator Skin Flap%影像学评估腹壁下动脉穿支皮瓣血运的研究进展

    Institute of Scientific and Technical Information of China (English)

    孙敬岩

    2012-01-01

    应用不同影像学方法评估游离皮瓣的穿支血管走行及血供特性在乳房再造术中的重要作用.腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣属穿支皮瓣,穿支血管细小,解剖变异大,术前影像评估穿支血管的位置,管径大小及其走行,对提高手术成功率和安全性具有重要意义.评估血管的方法包括手持多普勒、色彩双超声、数字减影血管造影、CT血管造影、核磁血管造影、多层螺旋CT以及吲哚菁绿激光辅助的血管造影等,本文初步介绍不同检查方法评估DIEP皮瓣血管走行及血供特性的优缺点,辅助乳腺癌乳房再造术中血管分布的评估.%The use of various imaging methods to evaluate the characteristics of vascular direction and blood supply in the perforator artery of the free flap plays an important role in breast reconstruction. The deep inferior epigastric perforator ( DIEP ) flap has tiny blood vessels but its anatomy varies in individuals. The use of preoperative imaging on vascular position, pipe diameter size, and vascular direction can improve the success rate and safety of surgery. The evaluation methods used in blood circulation include hand-held doppler, color duplex ultrasound examination, digital subtraction angiography, angiography, imaging angiography, modified discrete cosine transform, and indocyanine green laser-assisted angiography. This article introduces the merits and demerits of different preliminary inspection methods used in evaluating the features of vascular direction and blood supply of the DIEP flap, as well as the distribution of blood vessels during adjuvant breast reconstruction.

  11. Livergraftvascularvariantwith 3 extra-hepatic arteries

    Institute of Scientific and Technical Information of China (English)

    Paulo N Martins

    2010-01-01

     Vascular anatomy of the liver is varied, and the"standard"anatomy is seen in 55%-80%of cases. It is very important that extrahepatic arteries are identiifed precisely at the time of graft procurement to avoid injuries that might compromise the liver function. In the present case the liver donor had the vascular anatomy of Michels type Ⅶ, e.g. a hepatic artery originating from the celiac trunk and going to the left lobe, an accessory left hepatic artery coming from the left gastric artery, and a replaced right hepatic artery coming from the superior mesenteric artery. This pattern of vascular supply is uncommon, representing less than 5%of cases. The replaced hepatic artery was reconstructed in the back-table with polypropylene suture 7.0 by connecting it to the stump of the splenic artery, and the celiac trunk of the graft was anastomosed to the recipient common hepatic artery.

  12. A case report: accessory right renal artery

    Directory of Open Access Journals (Sweden)

    Patasi B

    2009-10-01

    Full Text Available Anatomical variations in the origin of the arteries in the abdominal area are very common. The arteries that show frequent variations include the celiac trunk, renal and gonadal arteries. During a routine dissection of a male cadaver, one main and one inferior accessory renal artery were found in the abdominal region. We discovered that the inferior accessory renal artery that originated from the right anterolateral aspect of abdominal aorta was running into the lower pole of the right kidney. The origin of the main right renal artery and the inferior accessory right renal artery were 19.8 mm and 53 mm below the superior mesenteric artery, respectively. The inferior accessory right renal artery ran directly into the inferior pole of the right kidney, in the area where the accessory right renal vein was leaving the right kidney. These anatomical variations and anomalies are important to know before any therapeutic or diagnostic procedures are performed in the abdominal area.

  13. Riscos e consequências do uso da técnica transportal na reconstrução do ligamento cruzado anterior: relação entre o túnel femoral, a artéria genicular lateral superior e o epicôndilo lateral do côndilo femoral Risks and consequences of using the transportal technique in reconstructing the anterior cruciate ligament: relationships between the femoral tunnel, lateral superior genicular artery and lateral epicondyle of the femoral condyle

    Directory of Open Access Journals (Sweden)

    Diego Costa Astur

    2012-10-01

    Full Text Available OBJETIVO: Definir zona de segurança para evitar possíveis complicações vasculares e ligamentares durante a reconstrução do ligamento cruzado anterior. MÉTODOS: Reconstrução artroscópica com uso de técnica transportal e transtibial em joelhos de cadáver foi realizada seguida de dissecção e mensuração da distância entre o túnel femoral e a inserção proximal do ligamento colateral lateral e o túnel femoral e a artéria genicular lateral superior. RESULTADOS: A mensuração das distâncias analisadas mostra uma aproximação maior do principal ramo da artéria genicular lateral superior e da inserção proximal do ligamento colateral lateral com o túnel femoral, realizado com a técnica transportal. CONCLUSÃO: Percebemos que o uso da técnica transportal para reconstrução artroscópica do LCA apresenta maior probabilidade de lesão da artéria genicular lateral e da inserção do ligamento colateral lateral, favorecendo complicações pós-cirúrgicas como instabilidade do joelho, osteonecrose do côndilo femoral lateral e ligamentização do enxerto.OBJECTIVE: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. METHODS: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. RESULTS: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. CONCLUSION: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and

  14. PERSISTENT LEFT SUPERIOR VENACAVA

    Directory of Open Access Journals (Sweden)

    Devinder Singh

    2014-05-01

    Full Text Available A Persistent Left Superior Venacava (PLSVC is the most common variation of the thoracic venous system and rare congenital vascular anomaly and is prevalent in 0.3% of the population. It may be associated with other cardiovascular abnormalities including atrial septal defect, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, and cor triatriatum. Incidental rotation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. The diagnosis should be confirmed by saline contrast echocardiography. Condition is usually asymptomatic. Here we present a rare case of persistent left superior vena cava presented in OPD with dyspnoea & palpitations.

  15. Operative procedures of single-incision laparoscopic repair of pediatric epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle

    Directory of Open Access Journals (Sweden)

    Kyoichi Deie

    2016-01-01

    Full Text Available We describe a simple and feasible procedure for single-incision laparoscopic repair of a pediatric epigastric hernia using a novel suture-assisting needle. A multichannel port was inserted through the umbilical vertical incision. After the orifice of the hernia was identified, a suture-assisting needle, which can hold a suture at its tip, with a 2-0 thread was pierced through the skin into one side of the rectus muscle sheath into the abdominal cavity. Next, after releasing the thread, the needle was pulled out to the subcutis and pierced through another side of the rectus muscle sheath. The needle, grasping the thread again, was subsequently pulled out through the abdominal wall outside, and the thread was tied extracorporeally. This knot was buried subcutaneously. Operative procedures of single-incision laparoscopic repair of an epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle with an excellent cosmetic result.

  16. Revision breast and chest wall reconstruction in Poland and pectus excavatum following implant complication using free deep inferior epigastric perforator flap.

    Science.gov (United States)

    Dionyssiou, Dimitrios; Demiri, Efterpi; Batsis, Georgios; Pavlidis, Leonidas

    2015-01-01

    This study aims to present the case of a female patient with Poland's syndrome and pectus excavatum deformity who underwent breast and chest wall reconstruction with a pre-shaped free deep inferior epigastric perforator flap. A 57-year-old female patient with Poland's syndrome and pectus excavatum presented with a Baker III capsular contracture following a previously performed implant-based right breast reconstruction. After a chest and abdominal CT angiography, she was staged as 2A1 chest wall deformity according to Park's classification and underwent implant removal and capsulectomy, followed by a pre-shaped free abdominal flap transfer, providing both breast reconstruction and chest wall deformity correction in a single stage operation. Post-operative course was uneventful, and the aesthetic result remains highly satisfactory 24 months after surgery. Deep inferior epigastric free flap represents an interesting reconstructive solution when treating Poland's syndrome female patients with chest wall and breast deformities.

  17. Free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps for breast reconstruction: a systematic review of flap complication rates and donor-site morbidity.

    Science.gov (United States)

    Sailon, Alexander M; Schachar, Jeffrey S; Levine, Jamie P

    2009-05-01

    Free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps represent increasingly popular options for breast reconstruction. Although several retrospective, small-scale studies comparing these flaps have been published, most have failed to find a significant difference in flap complication rates or donor-site morbidity. We systematically reviewed the current literature, and subsequently pooled and analyzed data from included studies. Included studies reported flap complications and/or donor site morbidities for both flap types. Eight studies met the inclusionary criteria. For flap complications, there was a statistically significant difference between deep inferior epigastric perforator and free transverse rectus abdominis myocutaneous flaps in fat necrosis rates (25.5 +/- 0.49 vs. 11.3% +/- 0.41%, P flap options.

  18. Intestinal Infarction Through Arterial Vascular Obstruction - Case Series from 1st and 3rd Surgery Clinics Cluj-Napoca.

    Science.gov (United States)

    Jeican, Ionuţ Isaia; Mocan, Mihaela; Gheban, Dan

    2016-01-01

    This article presents a case series of intestinal infarction through obstruction of superior mesenteric artery - two cases of acute mesenteric artery embolism, two cases of acute mesenteric artery thrombosis and a case of volvulus.

  19. Endoscopic-assisted linea alba reconstruction plus mesh augmentation (ELAR plus for treatment of umbilical and/or epigastric hernias and rectus abdominis diastasis – Early results

    Directory of Open Access Journals (Sweden)

    Ferdinand eKöckerling

    2016-05-01

    Full Text Available IntroductionSymptomatic umbilical and/or epigastric hernias are often seen concomitantly with rectus abdominis diastasis (RAD, and suture repair of such defects has a high recurrence rate. In the literature there are reports of both endoscopic and open techniques for repair of symptomatic umbilical and/or epigastric hernias in association with RAD. This paper now reports on the early results of a hybrid technique used for reconstruction of the linea alba and mesh augmentation (ELAR plus.Material and methodsBetween 15 June 2015 and 31 January 2016, 40 patients with symptomatic umbilical and /or epigastric hernia and concomitant RAD underwent reconstruction of the linea alba using a hybrid technique involving a small umbilical incision and the use of video endoscopic equipment. The patients comprised 29 men and 11 women with a mean age of 53.6 years and mean BMI of 32.6. The mean operating time was 120 minutes. The mesh had a mean longitudinal extension of 18.6 cm and transverse extension of 9.1 cm. ResultsThirty-day follow-up results are available for all patients. Thirty-seven out of 40 patients (92.5 % experienced no postoperative complication. Two cases of discrete impaired umbilical wound healing and one seroma were successfully managed with conservative treatment. On 30-day follow-up, three out of 40 patients (7.5 % complained of intermittent pain on exertion, and two out of 40 patients (5 % still took painkillers when required.ConclusionEndoscopic-assisted linea alba reconstruction plus mesh augmentation (ELAR plus is a novel minimally invasive procedure for repair of symptomatic umbilical and/or epigastric hernias with concomitant RAD. Reconstruction of the linea alba via a minimally invasive access route is able to restore the normal anatomy of the abdominal wall.

  20. Rat allotransplantation of epigastric microsurgical flaps: a study of rejection and the immunosuppressive effect of cyclosporin A

    Directory of Open Access Journals (Sweden)

    Carramaschi Fábio R.

    2000-01-01

    Full Text Available The rejection of allotransplantation of epigastric microsurgical flaps and the effect of immunosuppression have been studied in 58 rats. Three sets of experiments were planned: (1 Wistar Furth isogenic donors and receptors (control set; (2 Brown Norway donors and Wistar Furth receptors (rejection set; and (3 Brown Norway donors and Wistar Furth immunosuppressed receptors (cyclosporin A set. Cyclosporin A (10 mg/kg/d treated rats had a transplantation survival rate of up to 30 days: 83.3% among isogenic animals and 60% among allogeneic. There was 100% rejection by the 9th day after the transplantation in allogeneic non-immunosuppressed rats. Biopsies embedded with historesin were taken from the flap and normal contralateral skin (used as control on the 3rd, 7th, 15th, and 30th days after the surgery. A quantitative study of infiltrating lymphocytes in the flaps, with and without cyclosporin A, was done by evaluating the local inflammatory infiltrate. A significant increase in the number of lymphocytes among the rejection and immunosuppressed groups was seen, as compared to the isogenic set. Local lymphocytosis in allogeneic non-immunosuppressed transplantations reached its highest level on the 3rd day after surgery, before gross findings of rejection, which could only be seen by naked eye on the 5th or 6th day. Therefore, we conclude that cyclosporin A is effective in preserving allogenic transplantation in rats. Biopsies of transplanted areas may contribute to earlier diagnosis of the need for immunosuppressive therapy.

  1. Combined Double Sleeve Lobectomy and Superior Vena Cava Resection for Non-small Cell Lung Cancer with Persistent Left Superior Vena Cava

    Institute of Scientific and Technical Information of China (English)

    Daxing ZHU; Xiaoming QIU; Qinghua ZHOU

    2015-01-01

    A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department. Bronchoscopy displayed complete obstruction of right upper lobe bronchus and inifltration of the bronchus intermedius with tumor. Chest contrast computed tomography revealed the tumor invaded right pulmonary artery, superior vena cava, and the persistant letf superior vena cava lfowed into the coronary sinus. hTe tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava (SVC) utilizing ringed polytetralfuoroethylene gratf. To the best of our knowledge, this was the ifrst report of complete resection of locally advanced lung cancer involving superior vena cava, right pulmonary artery trunk and main bronchus with persistant letf superior vena cava.

  2. The lateral superior genicular artery perforator iliotibial band flap for the treatment of scar contraction of popliteal fossa%膝上外侧动脉穿支髂胫束皮瓣修复腘窝部瘢痕挛缩

    Institute of Scientific and Technical Information of China (English)

    郑鑫; 安洪宾; 陈滔; 王海宝

    2013-01-01

    Objective:To discuss clinical results of the lateral superior genicular artery perforator iliotibial band flap for the treatment of scar contracture of popliteal fossa. Methods: Form January 1999 to December 2011,11 patients with scar contraction of popliteal fossa were treated with the lateral superior genicular artery perforator iliotibial band flap. Among the patients , 7 patients were male and 4 patients were female, ranging in age from 24 to 58 years old, with an average of 33 years old. The operation time ranged from 3 months to 1 year after trauma. Eight patients had injuries in the right side and 3 patients had the injuries in the left. Five patients had the injuries caused by traffic, 3 patients had the injuries caused by hot compression and other 3 patients suffered from burns. The flap area ranged from 7.0 cm×4.0 cm to 20.0 cm×8.0 cm. Results:AH the flaps survived. Three patients had epidermis necrosis. After 5 months to 2 years follow-up period,the knee function recovered,the flap shape was favorable and the skin firmness was moderated. Conclusion: The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and an ideal donor in the reconstruction of popliteal fossa scar contracture.%目的:探讨膝上外侧动脉穿支髂胫束皮瓣治疗腘窝部瘢痕挛缩的临床疗效,为腘窝区瘢痕挛缩寻找最佳的手术方式.方法:自2009年1月至2011年12月,应用膝上外侧动脉穿支髂胫束动脉皮瓣修复腘窝瘢痕挛缩11例,男7例,女4例;年龄24~58岁,平均33岁;病程3个月~1年,平均6.5个月;右膝关节8例,左膝关节3例;交通伤5例,热压伤3例,烧伤3例.采用膝上外侧动脉穿支髂胫束皮瓣局部转移修复创面,切取皮瓣面积最大20.0 cm×8.0 cm,最小7.0 cm×4.0 cm.结果:术后皮瓣全部成活,3例远端血运差,局部色素沉着,表皮坏死脱痂.术后随访5个月~2年,膝关节活动均恢复正常,皮瓣外形良好,皮肤松紧度适中.

  3. 裸支架腔内血管重建术治疗孤立性肠系膜上动脉夹层动脉瘤%Percutaneous endovascular reconstruction with endovascular stent placement for isolated spontaneous dissection of the superior mesenteric artery

    Institute of Scientific and Technical Information of China (English)

    苏浩波; 顾建平; 楼文胜; 何旭; 陈亮; 陈国平; 宋进华; 汪涛; 徐克

    2011-01-01

    目的 评价裸支架载瘤动脉腔内血管重建术治疗孤立性肠系膜上动脉夹层的安全性和疗效.方法 2007年至2010年对5例经腹部CT血管成像(CTA)及数字减影血管造影(DSA)明确诊断的肠系膜上动脉夹层动脉瘤患者行裸支架载瘤动脉腔内血管重建术治疗.按照Sakamoto血管影像学分型,Ⅰ、Ⅱ型各1例,Ⅲ型3例.患者术后继续给予抗凝、抗血小板治疗,术后1、3、6个月进行CTA或血管造影随访.结果 5例患者手术均获成功,其中支架联合弹簧圈栓塞2例,双支架重叠技术3例,无并发症发生.4例症状性患者术后3周内症状消失.5例患者术后3 ~ 6个月时肠系膜上动脉CTA及DSA显示动脉瘤腔不显影,支架腔内血流通畅.随访3 ~ 12个月(平均7.8个月)夹层动脉瘤无复发.结论 裸支架载瘤动脉腔内血管重建术是治疗孤立性肠系膜上动脉夹层安全、有效的方法.%Objective To evaluate the safely arid efficacy of percutaneous endovaseular reconstruction with endovaseular slent placement for Isolated spontaneous dissection of the superior mesenteric artery. Methods Five patients with Isolated spontaneous dissection of the superior mesenteric artery were enrolled in tliis study. The diagnosis was confirmed by abdominal computed tomography auglography (CTA ) and percutaneous transcatheter digital subtraction angiography (DSA ) in all the five patients. One asymptomatic case was discovered by medical examination, which was classified to type I (Sakamoto angiographic categorization). The other four cases were admitted to hospital with acute abdominal pain and diarrhea, which were classified to type JI( 1 case ) and type UK 3 cases). Fasting together with antiplatelet and antieoagulation therapy was initially employed. Then, percutaneous endovaseular reconstruction with stenting was carried out and the patients were kept on antiplatelet therapy. Follow-up checkups with CTA or DSA were conducted at 1. 3 and 6

  4. 直肠上动脉亚甲蓝灌注法增加直肠癌淋巴结获检数%Perfusion with methylene blue via superior rectal artery can increase detected number of lymph node in rectal cancer specimen

    Institute of Scientific and Technical Information of China (English)

    毛方术; 顾晓辉; 字灿忠; 曹加兴

    2013-01-01

    目的 探讨经直肠上动脉灌注亚甲蓝对直肠癌行全直肠系膜切除术(TME)后标本淋巴结获检数的临床意义.方法 将按照TME原则进行直肠癌根治术的40例直肠癌患者的切除标本,按随机数字表法分为对照组和亚甲蓝组,每组20例.术后立即于标本肠系膜上动脉灌注亚甲蓝,获取标本淋巴结数目,并进一步探讨所获检淋巴结的阳性率.结果 常规组经传统触摸法获检淋巴结为(13.9±3.4)枚/例,亚甲蓝组获检淋巴结为(22.5±4.0)枚/例,两组淋巴结获检数差异显著(P<0.05);亚甲蓝组检出阳性淋巴结获检(2.9±1.8)枚/例,常规组获检(1.3±1.2)枚/例,两组淋巴结获检数差异显著(P<0.05).结论 经直肠上动脉灌注亚甲蓝是一种简单、安全、经济的方法,能够提高直肠癌患者术后标本淋巴结的获检数目,提供更准确的临床分期.%Objective To evaluate the clinical significance of methylene blue perfusion through the superior rectal artery to the improvement of lymph node harvest in rectal cancer specimen after total mesorectal excision( TME ). Methods Forty patients with rectal carcinoma received the radical resection according to the TME principle. Their excision specimens were randomly divided into control group (n=20)and methylene blue group( n = 20 ). After the operation, methylene blue was injected into the superior mesenteric artery of the specimen immediately. The numbers of the lymph node in the specimens were obtained,and the positive lymph nodes were counted. Results The number of lymph node obtained by the conventional touching method was 13.9 ±3.4 per case in the control group and was 22.5 ±4.0 per case in the methylene blue group( P <0.05 ). The positive lymph node number was 2.9 ±1.8 per case in the methylene blue group and was 1.3 ±1.2 per case in the control group( P < 0. 05 ). Conclusion Methylene blue perfusion via superior rectal artery is a simple, safe, and economical method,which is

  5. 改良亚甲蓝注射法增加直肠癌淋巴结检获的研究%Modefied Method of Methylene Blue Injection into the Superior Rectal Artery Improves Lymph Node Harvest in Rectal Cancer Specimens

    Institute of Scientific and Technical Information of China (English)

    刘健培; 黄勇; 郑宗珩; 郭卫平; 卫洪波

    2011-01-01

    目的:探讨采用改良的体外经直肠上动脉注射亚甲蓝法增加直肠癌标本淋巴结检获数的可行性.方法:选取2009年8月至12月中山大学附属第三医院胃肠外科收治的20例直肠癌患者的手术标本作为自身对照,先后采用传统触摸法和改良亚甲蓝注射法在同一标本上检获淋巴结,结果用配对t检验和交叉分类资料的卡方检验进行统计学分析.结果:20例手术标本经传统触摸法检获淋巴结共194枚,平均(9.7±0.7)枚/例.标本进一步循亚甲蓝染色多检获201枚淋巴结,其中57.2%为直径≤5 mm的小淋巴结.经过两次处理后20例直肠癌标本共检获淋巴结395枚,(19.8±0.9)枚/例,P<0.000 1.用传统触摸法共发现有4例标本有淋巴结转移,经亚甲蓝注射法多发现4例阳性标本,经过两次处理后共有8例标本有淋巴结转移,转移率为40%,P=0.045 5.结论:改良的体外经直肠上动脉注射亚甲蓝法是一种简单、安全、经济的方法,不但能提高术后直肠癌标本淋巴结的检获数目,而且能发现更多的阳性淋巴结,提供更准确的分期,值得在临床推广.%Objective: To explore the feasibility of improving lymph node harvest in rectal cancer specimens by modified method of methylene blue injection into the superior rectal artery.Methods: Between August 2009 and December 2009, 20 rectal cancer patients treated in the Third Affiliated Hospital of Sun Yat-sen University were managed by traditional method of palpation and modified method of methylene blue injection into the superior rectal artery.The lymph nodes were picked up in three regions according to Dukes staging.Data of lymph node harvest were analyzed by paired t test and x2 test.Results: The total number of detected lymph nodes in traditional method group was 194.Another 201 lymph nodes were added to final harvest with modified method of methylene blue.The average lymph nodes detected by traditional method and modified method were

  6. 多层螺旋CT对孤立性肠系膜上动脉夹层的诊断价值及与数字减影血管造影的对比分析%Comparison of diagnostic value between multislice CT and digital subtraction angiography in isolated supe-rior mesenteric artery dissection

    Institute of Scientific and Technical Information of China (English)

    张杨贵; 何旭升; 温志玲; 陈珊红; 高振华; 许俊丽

    2016-01-01

    目的:探讨64层螺旋CT血管成像及后处理技术对孤立性肠系膜上动脉夹层(SISMAD)的诊断价值,及与数字减影血管造影对比分析。方法回顾分析17例使用64层螺旋CT及数字减影血管造影(DSA)所发现的孤立性肠系膜上动脉夹层,结合横断位原始图像及各后处理方法重建图像,分析其影像征像。结果64层螺旋CT血管成像动脉期能清晰显示肠系膜上动脉及其低密度的内膜片,真假腔及破裂口显示良好,夹层累及范围,是否存在血栓及累及分支血管,术后追踪观察方便、准确。结论多层螺旋CT能清晰显示孤立性肠系膜上动脉夹层的病变特征,其检出率、并发症显示优于DSA,并能较好地指导DSA介入治疗及预后观察,是孤立性肠系膜上动脉夹层首选的无创检查方法。%Objective To compare the diagnostic value between 64-slice CT and digital subtraction angiogra-phy (DSA) in isolated superior mesenteric artery (SISMAD) dissection. Methods Retrospective study was taken in 17 patients with SMA Dissection, evidenced by both 64-slice CT and DSA,analyze the eikonic signs according to trans-verse view and reconstruction images. Results In artetial phase, multislice CT could clearly showed superior mesen-teric artery, its hypodense intimal orifice, true and false double lumen and oral cleft, intercalated bed range involved, with or without thrombus and lateral branch blood vessels could be indicated well, which had great convenience to follow-up postoperative. Conclusion Multislice CT, an atraumatic mothod for SMA dissection, could clearly present its pathological changes. It also has better detection rate and less complication compared with DAS. Moreover, multi-slice CT could help to direct treatment by DSA.

  7. Air Superiority Fighter Characteristics.

    Science.gov (United States)

    1998-06-05

    many a dispute could have been deflated into a single paragraph if the disputants had just dared to define their terms.7 Aristotle ...meaningful. This section will expand on some key ideology concepts. The phrase "air superiority fighter" may bring to mind visions of fighter... biographies are useful in garnering airpower advocate theories as well as identifying key characteristics. Air campaign results, starting with World

  8. Alterações gastrointestinais no diabetes mellitus: estresse oxidativo e fluxo sangüíneo da artéria mesentérica - estudo experimental Gastrointestinal alterations in diabetes mellitus: oxidative stress and blood flow in the superior mesenteric artery - experimental study

    Directory of Open Access Journals (Sweden)

    Alexandre Simões Dias

    2004-06-01

    .BACKGROUND: Gastrointestinal symptoms are frequent in diabetes mellitus and may be related to the oxidative stress, which is defined by an imbalance between the pro-oxidant and antioxidant systems. AIMS: To assess some of the gastrointestinal changes in the diabetes mellitus model, such as the oxidative stress in the stomach and liver of diabetic animals and the blood flow in the superior mesenteric artery at different times of study. MATERIAL AND METHODS: Male Wistar rats weighing 250-350 g were used and ascribed to four different groups as follows: group I - 7 days of diabetes, group II - 30 days of diabetes, group III - 60 days of diabetes, and group IV - 90 days of diabetes. Diabetes was obtained by administering streptozotocin (70 mg/kg intraperitoneally. RESULTS: A significant increase in liver and stomach lipoperoxidation of diabetic animals was found only at 90 days. A significant decrease in the activity of antioxidant enzymes catalase e glutathione transferase was found in stomach, whereas in liver only glutathione transferase was significantly decreased. The blood flow in the superior mesenteric artery of animals with 90 days of diabetes was increased as compared to controls. CONCLUSIONS: It is possible to suppose that the increase in the oxidative stress in stomach and liver as well as the change in the blood flow in the superior mesenteric artery are affected by the length of diabetes and the hyperglycemia found in the animals studied, which would determine gastrointestinal changes.

  9. Mechanical evaluation of anastomotic tension and patency in arteries.

    Science.gov (United States)

    Zhang, F; Lineaweaver, W C; Buntic, R; Walker, R

    1996-02-01

    This study quantified arterial anastomotic tension, evaluated subsequent patency rates, and examined the degree of tension reduction with vessel mobilization. The study was divided into two components. In part I, a mechanical analysis was undertaken to evaluate tension, based on the determination of the force required to deflect a cable (vessel) laterally, and its resulting lateral displacement. Six Sprague-Dawley rats with 12 femoral arteries were divided into two subgroups: 1) no mobilization; and 2) axial mobilization by ligation and transection of superficial epigastric and gracilis muscular branches. The tension of femoral arterial anastomoses was calculated in vessels with no segmental defect and with 1.5-, 3-, 4.5-, 6-, and 7.5-mm defects. In part II, patency was evaluated. Fifty-five rats with 110 femoral arteries were divided into two sub-groups as defined in part I: 1) no mobilization; and 2) axial mobilization by ligation and transection of superficial epigastric and gracilis muscular branches. Microvascular anastomoses were performed with no segmental defect and with 1-, 2-, 3-, 4-, 5-, 6-, 7-, 8-, 9-, and 10-mm segmental vessel defects. Patency was evaluated 24 hr postoperatively. Part I of the study revealed that anastomotic tension gradually increased along with an increase in the length of the vessel defect, from 1.9 to 11.34 g in the no-mobilization group and from 1.97 to 8.44 g in the axial-mobilization group. Comparison of tension linear regression coefficient showed a significant difference between the two groups (p tension approximately 6 g) in the no-mobilization group and 6 mm in the axial-mobilization group (tension approximately 6.48 g). Microanastomotic tension was related to the size of the vessel defect, with increasing tension leading to thrombosis. Axial mobilization significantly reduced the tension in vessels with segmental defects and decreased thrombosis rates.

  10. The G-Protein β3 subunit 825 TT genotype is associated with epigastric pain syndrome-like dyspepsia

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    Hori Kazutoshi

    2010-01-01

    Full Text Available Abstract Background Although familial clustering of functional dyspepsia (FD has been reported, the role of genetics in the susceptibility to FD is still not well understood. Several reports indicate an association between FD and G-protein β3 (GNB3 subunit gene polymorphism (C825T; however, these studies had small sample sizes and the findings are inconclusive. In the present study we clarified the association between GNB3 gene polymorphism and dyspepsia in a large population of Japanese subjects who visited a hospital for annual health check-up. Methods Subjects with significant upper gastrointestinal findings were excluded. Subjects with dyspeptic symptoms were divided into either a postprandial distress syndrome (PDS group or an epigastric pain syndrome (EPS group according to the Rome III criteria. The presence of the GNB3 C825T polymorphism was then evaluated and logistic regression analysis was used to test all variables. Results The GNB3 genotype distribution in subjects without dyspepsia was 191 CC (25.1%, 368 TC (48.4%, and 202 TT (26.5% and 17 CC (25.0%, 29 TC (42.6%, and 22 TT (32.4% in subjects with dyspepsia. No significant correlation was found between the GNB3 825TT genotype and dyspepsia. However, the TT genotype was significantly associated with subjects with EPS-like symptoms (odds ratio (OR = 2.00, 95% confidence interval (CI; 1.07-3.76 compared to the CT/CC genotype adjusted for gender and age. No significant correlation was found between GNB3 polymorphism and PDS-like symptoms (OR = 0.68, 95% CI; 0.31-1.51. With the exclusion of subjects with both EPS- and PDS-like symptoms, only the TT genotype was significantly associated with EPS-like symptoms (OR = 2.73, 95% CI; 1.23-5.91. Conclusion The homozygous GNB3 825T allele influences the susceptibility to EPS-like dyspepsia.

  11. Failed pneumoperitoneum for laparoscopic surgery following autologous Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: a case report.

    Science.gov (United States)

    Balkin, Daniel M; Duh, Quan-Yang; Kind, Gabriel M; Chang, David S; McGrath, Mary H

    2016-04-27

    Laparoscopic abdominal surgery may prove difficult in patients who have undergone previous abdominal procedures. No reports in the medical literature have presented an aborted laparoscopic procedure for failed pneumoperitoneum following autologous flap-based breast reconstruction. A 55-year-old woman presented with recurrent invasive lobular carcinoma of the right breast as well as a history of ductal carcinoma in situ of the left breast. The patient desired to proceed with bilateral skin- and nipple-sparing mastectomies with right axillary lymph node biopsy, followed by immediate bilateral autologous deep inferior epigastric perforator (DIEP) flap-based breast reconstruction. Preoperatively, a computerized tomography angiogram was obtained for reconstructive preparation, which revealed a left adrenal mass. Ensuing work-up diagnosed a pheochromocytoma. Given the concern for breast cancer progression, the patient elected to proceed first with breast cancer surgery and reconstruction prior to addressing the adrenal tumor. Subsequently, 3 months later the patient was brought to the operating room for a laparoscopic left adrenalectomy for the pheochromocytoma. With complete pharmacologic abdominal relaxation, the abdomen proved too tight to accommodate sufficient pneumoperitoneum and the laparoscopy was aborted. The patient was evaluated in the outpatient setting for assessment of abdominal wall compliance at regular intervals. Five months later, the patient was taken back to the operating room where pneumoperitoneum was established without difficulty and the laparoscopic left adrenalectomy was performed without complications. Pneumoperitoneum for laparoscopic surgery subsequent to autologous DIEP flap-based breast reconstruction may prove difficult as a result of loss of abdominal wall compliance. Prior to performing laparoscopy in such patients, surgeons should consider the details of the patient's previous reconstructive procedure and assess potential risk factors

  12. STUDY OF POSTERIOR DIVISION OF INTERNAL ILIAC ARTERY

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    Pavan P Havaldar

    2014-06-01

    Full Text Available Background: The internal iliac artery originates from the common iliac artery at the level of sacroiliac joint. The internal iliac artery descends posterior to the greater sciatic foramen thereby dividing into anterior and posterior divisions. The posterior division of the internal iliac artery is known to give rise to three main branches i.e. iliolumbar artery, lateral sacral artery. Accidental haemorrhage is common during erroneous interpretation of anomalous blood vessels. The knowledge of the normal and the abnormal anatomy of the branches of the internal iliac artery is essential for obstetric surgeons. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: Out of 50 specimens, ilio-lumbar artery took origin from posterior division, directly in 22 specimens (44%, with obturator artery in 5 specimens (10% and with superior gluteal artery in 2 specimens (4%. From anterior division, with obturator artery in 6 specimens (12% and with inferior gluteal artery in 1 specimen (2%. From common trunk, as direct branch in 10 specimens (20%, with lateral sacral artery in 1 specimen (2%, with vertebral branch in 1 specimen (2%, with superior gluteal artery in 1 specimen (2% and was found to be absent in 1 specimen (2%. Posterior division of internal iliac artery given origin directly to superior gluteal artery in 44 specimens (88%, with ilio-lumbar artery in 1 specimen (2%, with obturator artery in 2 specimens (4%. Lateral sacral artery from posterior division was observed in 38 specimens (76% and unpaired origin was observed in 7 specimens (14%. Conclusion: Internal iliac artery supplies the pelvic viscera and musculature the knowledge of its branches helpful in pelvis surgeries.

  13. A major pain in the … Back and epigastrium: an unusual case of spontaneous celiac artery dissection

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    Kumkum Sarkar Patel

    2014-11-01

    Full Text Available A 60-year-old woman with mitral valve prolapse, chronic low back pain, and a 30-pack year smoking history presented for a second admission of poorly controlled mid-back pain 10 days after her first admission. She had concomitant epigastric pain, sharp/burning in quality, radiating to the right side and to the mid-back, not associated with food nor improving with pain medications. She denied nausea, vomiting, diarrhea, constipation, dark stools, or blood per rectum. Our purpose was to determine the cause of the patient's epigastric pain. Physical examination revealed epigastric and mid-back tenderness on palpation. Labs were normal except for a hemoglobin drop from 14 to 12.1 g/dL over 2 days. Abdominal ultrasound and subsequent esophagogastroduodenoscopy were normal. Contrast-enhanced abdominal computed tomographic (CT scan revealed the development of a spontaneous celiac artery dissection as the cause of the epigastric pain. The patient was observed without stenting and subsequent CT angiography 4 days later did not reveal worsening of the dissection. She was discharged on aspirin and clopidogrel with outpatient follow-up. Thus far, less than 100 cases of isolated spontaneous celiac artery dissections have been reported. The advent of CT scans and magnetic resonance imaging has increasingly enabled its detection. Risk factors may include hypertension, arteriosclerosis, smoking, and cystic medial necrosis. There is a 5:1 male to female ratio with an average presenting age of 55. Management of dissections may include surgical repair, endovascular stenting, and selective embolization. Limited dissections can be managed conservatively with anti-platelet and/or anticoagulation agents and strict blood pressure control, as done in our patient.

  14. Contabilidad Financiera Superior

    OpenAIRE

    Ipiñazar Petralanda, Izaskun

    2013-01-01

    Duración (en horas): De 31 a 40 horas. Destinatario: Estudiante y Docente A través de este material se presentan las pautas necesarias para implementar un aprendizaje basado en problemas en la asignatura de Contabilidad Financiera Superior dentro de los temas “Constitución de S.A. y S.R.L.” (Tema 2), “Ampliaciones de Capital” (Tema 3) y “Reducciones de Capital” (Tema 4). En primer lugar se presentan las guías generales de la asignatura, y a continuación, las diferentes activida...

  15. Contabilidad Financiera Superior

    OpenAIRE

    Ipiñazar Petralanda, Izaskun

    2013-01-01

    Duración (en horas): De 31 a 40 horas. Destinatario: Estudiante y Docente A través de este material se presentan las pautas necesarias para implementar un aprendizaje basado en problemas en la asignatura de Contabilidad Financiera Superior dentro de los temas “Constitución de S.A. y S.R.L.” (Tema 2), “Ampliaciones de Capital” (Tema 3) y “Reducciones de Capital” (Tema 4). En primer lugar se presentan las guías generales de la asignatura, y a continuación, las diferentes activida...

  16. Statistics of superior records

    Science.gov (United States)

    Ben-Naim, E.; Krapivsky, P. L.

    2013-08-01

    We study statistics of records in a sequence of random variables. These identical and independently distributed variables are drawn from the parent distribution ρ. The running record equals the maximum of all elements in the sequence up to a given point. We define a superior sequence as one where all running records are above the average record expected for the parent distribution ρ. We find that the fraction of superior sequences SN decays algebraically with sequence length N, SN˜N-β in the limit N→∞. Interestingly, the decay exponent β is nontrivial, being the root of an integral equation. For example, when ρ is a uniform distribution with compact support, we find β=0.450265. In general, the tail of the parent distribution governs the exponent β. We also consider the dual problem of inferior sequences, where all records are below average, and find that the fraction of inferior sequences IN decays algebraically, albeit with a different decay exponent, IN˜N-α. We use the above statistical measures to analyze earthquake data.

  17. Frenillo labial superior doble

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    Carlos Albornoz López del Castillo

    Full Text Available El frenillo labial superior doble no sindrómico es una anomalía del desarrollo que no hemos encontrado reportada en la revisión bibliográfica realizada. Se presenta una niña de 11 años de edad que fue remitida al servicio de Cirugía Maxilofacial del Hospital "Eduardo Agramonte Piña", de Camagüey, por presentar un frenillo labial superior doble de baja inserción. Se describen los síntomas clínicos asociados a esta anomalía y el tratamiento quirúrgico utilizado para su solución: una frenectomía y plastia sobre la banda muscular frénica anormal que provocaba exceso de tejido en la mucosa labial. Consideramos muy interesante la descripción de este caso, por no haber encontrado reporte similar en la literatura revisada.

  18. Acute arterial occlusion - kidney

    Science.gov (United States)

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidney can often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury or trauma to ...

  19. Survey on the prevalence of GERD and FD based on the Montreal definition and the Rome III criteria among patients presenting with epigastric symptoms in Japan.

    Science.gov (United States)

    Ohara, Shuichi; Kawano, Tatsuyuki; Kusano, Motoyasu; Kouzu, Teruo

    2011-05-01

    The present survey aimed to clarify the prevalence of gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) in patients presenting with epigastric symptoms in Japan based on the Montreal definition and the Rome III criteria, respectively, and to determine the degree of overlap between the two disease entities and the validity of using these Western-developed diagnostic criteria in Japan. Patients presenting with epigastric symptoms for whom the first upper gastrointestinal endoscopy was scheduled from April through August 2007 at 55 institutions were asked to complete a questionnaire to ascertain the type, frequency, and severity of epigastric symptoms. The prevalence of esophageal mucosal damage was also determined from endoscopic findings. A total of 1,076 patients were included in the analysis population. There was a high degree of coincidence for all symptoms, with the mean number of symptoms per patient of 2.8. With strict application of the Montreal and Rome III definitions, symptomatic GERD accounted for 15.6% (168 patients), whereas FD accounted for 10.3% (111 patients), and the overlap between GERD and FD symptoms was less than 10%. However, when frequency and severity alone were considered in more broadly defined criteria, the overlap between GERD and FD symptoms was 30-40%. A highly specific disease classification is possible when the Montreal definition and the Rome III criteria are strictly applied. On the other hand, the present survey highlighted a problem with the criteria whereby a definitive diagnosis could not be made in a substantial number of patients. This problem will require further research.

  20. Atypical twin renal arteries with altered hilar anatomy

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    Loh HK

    2009-10-01

    Full Text Available Twin renal arteries (superior and inferior were encountered on the left side in a 58-year-old male Indian cadaver. Both the renal arteries took a tortuous course to the hilum. The inferior renal artery, labeled as the accessory renal artery travelled sinuously and anteriorly over the left renal vein to enter the inferior most part of the hilum. The superior artery, labeled as main renal artery bifurcated before the hilum and its two branches were placed anterior to the vein. Thus the normal anteroposterior disposition of structures viz. renal vein, renal artery and the renal pelvis was not seen. Such renal arteries having sinuous course with atypical sequence of structures at the hilum are of worth concern to the urologists performing renal angiography and to surgeons performing laparoscopies or renal transplantation.

  1. Intraabdominal Hemorrhage Due to Spontaneous Rupture of Superior Mesenteric Artery

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    Onder Ozden

    2014-04-01

    Ehlers Danlos Syndrome Type IV should be kept in mind in cases of abdominal apoplexy. Repair of vascular complications could be impossible due to abnormal type III collagen leaded vascular fragility. [Cukurova Med J 2014; 39(2.000: 408-411

  2. Computed tomography hepatic arteriography has a hepatic falciform artery detection rate that is much higher than that of digital subtraction angiography and 99mTc-MAA SPECT/CT: Implications for planning 90Y radioembolization?

    Energy Technology Data Exchange (ETDEWEB)

    Burgmans, M.C., E-mail: mburgmans@hotmail.com [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Too, C.W., E-mail: too.chow.wei@singhealth.com.sg [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Kao, Y.H., E-mail: yung.h.kao@gmail.com [Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Goh, A.S.W., E-mail: anthony.goh.s.w@sgh.com.sg [Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Chow, P.K.H., E-mail: gsupc@singnet.com.sg [Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857 (Singapore); Department of Surgical Oncology, National Cancer Center Singapore, 11 Hospital Drive, Singapore 169610 (Singapore); Tan, B.S., E-mail: tan.bien.soo@sgh.com.sg [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Tay, K.H., E-mail: tay.kiang.hiong@sgh.com.sg [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Lo, R.H.G., E-mail: richard.lo.h.g@sgh.com.sg [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore)

    2012-12-15

    Purpose: To compare the hepatic falciform artery (HFA) detection rates of digital subtraction angiography (DSA), computed tomography hepatic arteriography (CTHA) and 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography with integrated CT (SPECT/CT) and to correlate HFA patency with complication rates of yttrium-90 (90Y) radioembolization. Material and methods: From August 2008 to November 2010, 79 patients (range 23–83 years, mean 62.3 years; 67 male) underwent pre-treatment DSA, CTHA and 99mTc-MAA scintigraphy (planar/SPECT/CT) to assess suitability for radioembolization with 90Y resin microspheres. Thirty-seven patients were excluded from the study, because CTHA was performed with a catheter position that did not result in opacification of the liver parenchyma adjacent to the falciform ligament. DSA, CTHA and 99mTc-MAA SPECT/CT images and medical records were retrospectively reviewed. Results: A patent HFA was detected in 22 of 42 patients (52.3%). The HFA detection rates of DSA, CTHA and 99mTc-MAA SPECT/CT were 11.9%, 52.3% and 13.3%, respectively (p < 0.0001). An origin from the segment 4 artery was seen in 51.7% of HFAs. Prophylactic HFA coil-embolization prior to 90Y microspheres infusion was performed in 2 patients. Of the patients who underwent radioembolization with a patent HFA, none developed supra-umbilical radiation dermatitis. One patient experienced epigastric pain attributed to post-embolization syndrome and was managed conservatively. Conclusion: The HFA detection rate of CTHA is superior to that of DSA and 99mTc-MAA SPECT/CT. Complications related to non-target radiation of the HFA vascular territory rarely occur, even in patients undergoing radioembolization with a patent HFA.

  3. Level of arterial ligation in rectal cancer surgery: Low tie preferred over high tie. A review

    NARCIS (Netherlands)

    M.M. Lange (Marilyne); M. Buunen (Mark); C.J.H. van de Velde (Cornelis)

    2008-01-01

    textabstractConsensus does not exist on the level of arterial ligation in rectal cancer surgery. From oncologic considerations, many surgeons apply high tie arterial ligation (level of inferior mesenteric artery). Other strategies include ligation at the level of the superior rectal artery, just cau

  4. Integrity evaluation of resected mesentery specimen after total mesorectal excision by methylene blue perfusion via superior rectal artery%直肠上动脉亚甲蓝灌注法判断全直肠系膜切除术后标本系膜的完整性

    Institute of Scientific and Technical Information of China (English)

    楼征; 张卫; 梅祖兵; 王莉莉; 季秋芳; 孟荣贵; 傅传刚

    2010-01-01

    Objective To evaluate the integrity of the resected mesentery specimen after total mesorectal excision (TME)for low rectal cancer using methylene blue peffusion via the superior rectal artery. Methods Twenty patients with low rectal cancer were randomly divided into the methylene blue group (n=10) and the control group (n=10). All the patients received TME and macroscopic examination of the mesorectal surface was performed to evaluate the quality of the surgical specimen. The methylene blue was injected into the specimen postoperatively via superior rectal artery. Results The mesorectal surface of all the specimens was intact on macroscopic examination.However, after methylene blue perfusion, 2 specimens were found to be incomplete. The number of lymph nodes in the methylene blue group were significantly larger (17.3±2.4 vs. 12.4±5.4,P=0.016).Conclusions Integrity evaluation of TME specimen is necessary. Methylene blue perfusion is a convenient and effective method to identify subtle incompleteness of specimen and can improve the detection of lymph node.%目的 探讨经直肠上动脉灌注亚甲蓝对低位直肠癌行全直肠系膜切除术(TME)后标本系膜完整性判断的临床意义.方法 将按照TME原则进行根治性手术的20例低位直肠癌患者的切除标本,按随机数字表法分为亚甲蓝组和常规检测组,每组10例.常规检测组术后肉眼观察直肠系膜完整性情况,亚甲蓝组经直肠上动脉灌注肝素和亚甲蓝,观察有无亚甲蓝从系膜表面溢出,并进一步对亚甲蓝溢出处系膜及系膜淋巴结情况进行镜检.结果 所有病例标本肉眼下观察直肠系膜均完整,亚甲蓝组经直肠上动脉灌注亚甲蓝后,直肠系膜染色明显,8例直肠系膜面无亚甲蓝溢出,提示直肠系膜完整,2例出现亚甲蓝溢出,提示系膜存在肉眼观察无法辨别的缺损,并在镜下得到证实.此外,亚甲蓝组淋巴结平均检出数目(17.3±2.4)枚,而常规检测组为(12

  5. Sobredentadura total superior implantosoportada

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    Luis Orlando Rodríguez García

    2010-06-01

    Full Text Available Se presenta un caso de un paciente desdentado total superior, rehabilitado en la consulta de implantología de la Clínica "Pedro Ortiz" del municipio Habana del Este en Ciudad de La Habana, Cuba, en el año 2009, mediante prótesis sobre implantes osteointegrados, técnica que se ha incorporado a la práctica estomatológica en Cuba como alternativa al tratamiento convencional en los pacientes desdentados totales. Se siguió un protocolo que comprendió una fase quirúrgica, procedimiento con o sin realización de colgajo y carga precoz o inmediata. Se presenta un paciente masculino de 56 años de edad, que acudió a la consulta multidisciplinaria, preocupado, porque se le habían elaborado tres prótesis en los últimos dos años y ninguna reunía los requisitos de retención que él necesitaba para sentirse seguro y cómodo con las mismas. El resultado final fue la satisfacción total del paciente, con el mejoramiento de la calidad estética y funcional.

  6. Revision breast and chest wall reconstruction in Poland and pectus excavatum following implant complication using free deep inferior epigastric perforator flap

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    Dimitrios Dionyssiou

    2015-01-01

    Full Text Available This study aims to present the case of a female patient with Poland′s syndrome and pectus excavatum deformity who underwent breast and chest wall reconstruction with a pre-shaped free deep inferior epigastric perforator flap. A 57-year-old female patient with Poland′s syndrome and pectus excavatum presented with a Baker III capsular contracture following a previously performed implant-based right breast reconstruction. After a chest and abdominal CT angiography, she was staged as 2A1 chest wall deformity according to Park′s classification and underwent implant removal and capsulectomy, followed by a pre-shaped free abdominal flap transfer, providing both breast reconstruction and chest wall deformity correction in a single stage operation. Post-operative course was uneventful, and the aesthetic result remains highly satisfactory 24 months after surgery. Deep inferior epigastric free flap represents an interesting reconstructive solution when treating Poland′s syndrome female patients with chest wall and breast deformities.

  7. Anatomical and radiographical studies on the venous drainage of the udder in goat with special reference to the cranial superficial epigastric vein

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    Z.A. Adam

    2016-09-01

    Full Text Available The present study was achieved to clarify the venous drainage of the udder in twelve healthy Egyptian Baladi goats. Gum-milk latex injection (nine specimens and radiographic imaging technique (three specimens were used to demonstrate the course and tributaries of the main veins draining the udder. The obtained results revealed that the udder of goat was drained through three venous circles, one at its base, while the other two were present in the form of one circle at the base of each teat. The basal venous circle was formed by the external pudendal and cranial superficial epigastric veins, as well as the dorsal labial and mammary branch of the ventral perineal vein. While the papillary venous circle was formed mainly by the cranial and caudal lateral sinus branches of the cranial mammary vein of the external pudendal vein. Also, the origin, course, distribution and termination of the cranial superficial epigastric vein were described. The venous architecture reported in this study could serve as a guide for the further surgical interference within the udder of goat.

  8. Novel biomarkers of arterial and venous ischemia in microvascular flaps.

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    Gerard K Nguyen

    Full Text Available The field of reconstructive microsurgery is experiencing tremendous growth, as evidenced by recent advances in face and hand transplantation, lower limb salvage after trauma, and breast reconstruction. Common to all of these procedures is the creation of a nutrient vascular supply by microsurgical anastomosis between a single artery and vein. Complications related to occluded arterial inflow and obstructed venous outflow are not uncommon, and can result in irreversible tissue injury, necrosis, and flap loss. At times, these complications are challenging to clinically determine. Since early intervention with return to the operating room to re-establish arterial inflow or venous outflow is key to flap salvage, the accurate diagnosis of early stage complications is essential. To date, there are no biochemical markers or serum assays that can predict these complications. In this study, we utilized a rat model of flap ischemia in order to identify the transcriptional signatures of venous congestion and arterial ischemia. We found that the critical ischemia time for the superficial inferior epigastric fasciocutaneus flap was four hours and therefore performed detailed analyses at this time point. Histolgical analysis confirmed significant differences between arterial and venous ischemia. The transcriptome of ischemic, congested, and control flap tissues was deciphered by performing Affymetrix microarray analysis and verified by qRT-PCR. Principal component analysis revealed that arterial ischemia and venous congestion were characterized by distinct transcriptomes. Arterial ischemia and venous congestion was characterized by 408 and 1536>2-fold differentially expressed genes, respectively. qRT-PCR was used to identify five candidate genes Prol1, Muc1, Fcnb, Il1b, and Vcsa1 to serve as biomarkers for flap failure in both arterial ischemia and venous congestion. Our data suggests that Prol1 and Vcsa1 may be specific indicators of venous congestion and

  9. Implication of the presence of a variant hepatic artery during the Whipple procedure

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    Mercedes Rubio-Manzanares-Dorado

    2015-07-01

    Full Text Available Introduction: The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD in patients with or without a variant hepatic artery arising from superior mesenteric artery. Material and methods: We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean ± standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05. Results: We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%. The most frequent variant was an aberrant right hepatic artery (n = 7, following by the accessory right hepatic artery (n = 2 and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2. In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications. Conclusion: Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.

  10. An unusual cause of intraoperative acute superior vena cava syndrome

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    Adam W Amundson

    2013-01-01

    Full Text Available Acute intraoperative superior vena cava (SVC syndrome is an exceedingly rare complication in the cardiac surgical population. We describe the case of a 71-year-old female undergoing multi-vessel coronary artery bypass grafting who developed acute intraoperative SVC syndrome following internal thoracic artery harvest retractor placement. Her symptoms included severe plethora, facial engorgement and scleral edema, which was associated with hypotension and severe elevation of central venous pressure. Transesophageal echocardiography was crucial in the diagnosis, management, and optimal retractor placement ensuring adequate SVC flow. Potential causes of intraoperative SVC syndrome are reviewed as well as management options.

  11. Rib-sparing and internal mammary artery-preserving microsurgical breast reconstruction with the free DIEP flap.

    Science.gov (United States)

    Kim, Hyungsuk; Lim, So-Young; Pyon, Jai-Kyong; Bang, Sa-Ik; Oh, Kap Sung; Lee, Jeong Eon; Nam, Seok Jin; Mun, Goo-Hyun

    2013-03-01

    Using an internal mammary artery as the recipient vessel in a free flap autologous breast reconstruction is common practice, but this vessel is often sacrificed for end-to-end anastomosis and is typically assessed by removing a costal cartilage segment. The authors studied the reliability of the end-to-side arterial anastomosis using a rib-sparing approach by comparing it with end-to-end anastomosis. The authors analyzed 100 consecutive medical records of patients who underwent autologous breast reconstruction with a free deep inferior epigastric artery perforator flap in which the internal mammary vessels were assessed using a rib-sparing technique. The study compared the complications between the two groups of end-to-side arterial anastomosis (50 cases) and end-to-end arterial anastomosis (50 cases). Exposure of the internal mammary artery using a rib-sparing technique was performed successfully in all 100 flaps. The second and third intercostal spaces were used in 46 and 54 cases, respectively. The mean width of the used intercostal space was 18.3 ± 2.4 mm in the end-to-side group and 18.3 ± 2.9 mm in the end-to-end group (p = 0.923). All flaps survived without partial or total necrosis. One case of venous insufficiency that required exploration occurred in the end-to-side group; the flap was totally saved with venous revision. There was no significant statistical difference between the end-to-side and end-to-end groups in all other variables, including mean flap ischemic time (p = 0.431) and fat necrosis (p = 0.339). The rib-sparing and internal mammary artery-preserving free deep inferior epigastric artery perforator flap transfer is an efficient and safe technique for microsurgical breast reconstruction.

  12. The clinical analysis for 43 cases of acute superior mesenteric artery thrombosis confirmed by angiography and surgery%手术及血管造影确诊的急性肠系膜上动脉栓塞43例临床分析

    Institute of Scientific and Technical Information of China (English)

    刘文徽; 石卉; 廖亮; 吴本俨

    2014-01-01

    Objective To investigate the clinical manifestations and mortality related risk factors in patients with acute superior mesenteric artery embolism (ASMAE).Methods Clinical data of forty-three confirmed ASMAE patients in the PLA General Hospital from June 2002 to June 2012 were retrospectively analyzed.All patients were classified into the survival group (28 cases) and the death group (15 cases)according to the prognosis.The prognosis associated factors were further analyzed.Results The study group consisted of 31 men (72.1%)and 12 women (27.9%),with average age of (63 ± 11) years.The majority patients with ASMAE in our study had history of atherosclerotic diseases.The main clinical manifestationsincluded abdominal pain [100% (43/43)],nausea and vomitting [55.8% (24/43)],hematochezia [32.6% (14/43)].Abdominal CT scan was performed in 74.4% (32/43) patients with a high positive result of 96.9% (31/32).Weight loss occurred more frequently in survival group than in death group [32.1% (9/28) vs 6.7% (1/15),P =0.001].Moreover,weight loss has been shown as a protective factor for ASMAE survival (OR =0.75,P =0.038) by logistic analysis.Compared with the death group,the incidence of either peritoneal irritation sign or ascites was significantly lower in survival group [respectively 7.1%(2/28) vs 66.7% (10/15),14.3% (4/28) vs 73.3% (11/15),P <0.05],which were two independent risk factors of mortality(OR =8.51,P =0.014 ; OR =3.07,P =0.028).The incidence of main artery embolism of superior mesentery artery (SMA) in death group was higher than that in survival group [93.3% (14/15) vs 60.7% (17/28),P =0.023].Main artery embolism of SMA was also an independent mortality risk factor of ASMAE patients (OR =5.05,P =0.039).A total of 18 patients were treated with enterectomy.Intestine excision length was shorter in survival group than in death group [(82.8 ± 25.2) cm vs (141.0 ± 18.1)cm,P =0.017].The time from onset to operation in survival group

  13. Hepatogastric Fistula following Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma

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    Inderpreet Grover

    2014-10-01

    Full Text Available Hepatogastric fistula (HGF formation following transcatheter arterial chemoembolization (TACE leads to increased morbidity and mortality. A 51-year-old Caucasian male with chronic hepatitis B virus-associated cirrhosis and unresectable hepatocellular carcinoma (HCC presented to the Interventional Radiology Unit for TACE to achieve tumor necrosis. Following the procedure, the patient was admitted with symptoms of fever, epigastric and right upper quadrant pain secondary to the development of an abscess. The abscess was drained; however, an exceedingly rare HGF resulted that was favored to represent a direct invasion of HCC. HGF, the rare complication following TACE, leads to grave consequences and vigilant monitoring, for the development of this entity is recommended to reduce patient mortality. We present a case and literature review of HGF development following TACE for HCC.

  14. Arterial Catheterization

    Science.gov (United States)

    ... way of keeping the blood pressure up. The arterial catheter allows accurate, second-to-second measurement of the blood pressure; repeated meas- urement is called monitoring. ■ High blood pressure (hypertension)— In some sit- uations, ...

  15. Arterial Stiffness.

    Science.gov (United States)

    Avolio, Alberto

    2013-04-01

    Stiffness of large arteries has been long recognized as a significant determinant of pulse pressure. However, it is only in recent decades, with the accumulation of longitudinal data from large and varied epidemiological studies of morbidity and mortality associated with cardiovascular disease, that it has emerged as an independent predictor of cardiovascular risk. This has generated substantial interest in investigations related to intrinsic causative and associated factors responsible for the alteration of mechanical properties of the arterial wall, with the aim to uncover specific pathways that could be interrogated to prevent or reverse arterial stiffening. Much has been written on the haemodynamic relevance of arterial stiffness in terms of the quantification of pulsatile relationships of blood pressure and flow in conduit arteries. Indeed, much of this early work regarded blood vessels as passive elastic conduits, with the endothelial layer considered as an inactive lining of the lumen and as an interface to flowing blood. However, recent advances in molecular biology and increased technological sophistication for the detection of low concentrations of biochemical compounds have elucidated the highly important regulatory role of the endothelial cell affecting vascular function. These techniques have enabled research into the interaction of the underlying passive mechanical properties of the arterial wall with the active cellular and molecular processes that regulate the local environment of the load-bearing components. This review addresses these emerging concepts.

  16. Clinical application of modified deep inferior epigastric perforator flap%改良腹壁下动脉穿支皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    谢庆平; 郭恩琪; 王亮; 范奔; 倪建平; 许新伟; 晋培红

    2009-01-01

    Objective To improve the techniques of harvesting the deep inferior epigastric perforator (DIEP) flap and broaden the clinical application of the flap. Methods A modified DIEP flap (or DIEP osteofasciocutaneous flap with iliac or rib) involving perforating vessels of the bilateral deep inferior epigastric vasculature with a muscle cuff was used to cover large defects of the extremities. There were 5 cases of defects of the forearm and 6 cases with defects of the hand and wrist. The areas of the defects were 10.0 cm × 5.0 cm to 45.0 cm × 20.0 cm. All flap transfers were done in the emergent setting. Results 10 of the 11 flaps survived completely while one flap survived with partial necrosis. Follow up ranged from 3 to 61 months. The flaps healed well. Function of the hand was satisfactory. There was no abdominal wall hernia at the donor sites. Conclusion The modified DIEP flap involving bilateral pedicles is the procedure of option for reconstruction of large defects.%目的 探讨腹壁下动脉穿支皮瓣(deep inferior epigastric perforator flap,DIEP皮瓣)切取方式的改进,扩大DIEP皮瓣的临床应用范围.方法 采用双腹壁下血管蒂仅带肌袖的DIEP皮瓣(并可通过筋膜蒂携带髂骨或肋骨)修复四肢大面积软组织缺损,其中前臂缺损5例,手腕部缺损6例,创面面积为10.0 cm×5.0 cm~45.0cm×20.0 cm,均为急诊修复.结果 术后11例皮瓣中全部存活10例,大部分存活1例.随访时间3~61个月,皮瓣愈合良好,手功能恢复满意.所有供区均未发生腹壁疝.结论 改良DIEP皮瓣是修复大面积皮肤缺损的首选皮瓣之一.

  17. Accessory belly of piriformis, as a cause of superior gluteal neurovascular entrapment

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    Rimple Bansal

    2013-06-01

    Full Text Available During routine dissection on 50 years old male cadaver, an accessory belly of piriformis was observed. This accessory belly was superior and parallel to the main piriformis muscle. This was associated with emergence of superior gluteal nerve and superior gluteal artery between the two bellies. Piriformis muscle and its relation to sciatic nerve has been suggested as a cause of piriformis syndrome. But interestingly in the present case, superior gluteal nerve was interposed between two bellies that may help the clinicians to establish a rare yet important cause of piriformis syndrome and a rare cause of undiagnosed chronic pain in gluteal region. As superior gluteal artery was also interposed, so this rare variation holds interest to surgeons especially in isolated buttock claudication despite otherwise normal vascular investigations. [Int J Res Med Sci 2013; 1(3.000: 296-298

  18. Clinical aspects of chronic gastritis in patients with concomitant arterial hypertension

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    Мар'яна Миколаївна Курбан

    2015-10-01

    Full Text Available Aim: The work deals with special features of chronic gastritis clinical course with comorbid arterial hypertension.Methods: 96 patients underwent complex examination: 62 patients with combined clinical course of arterial hypertension and chronic gastritis and 34 ones with isolated chronic gastritis. All patients underwent clinical, laboratory and instrumental examination.Result: At analysis of results it was established that in the 1 group of patients took place the more heavy clinical course and the main complaints were presented as pain syndrome (of an acute, nagging character especially in epigastric zone or without strict localization that took place after ingestion, dyspeptic syndrome (with predominant meteorism, spreading feeling in epigastrium and eructation and asthenoneurotic syndrome (with sleep disorders, general weakness and work disability as opposed to patients of the 11 group whose pain syndrome was predominantly stable or periodic of an acute character in epigastric zone. Among complaints that are specific for dyspeptic syndrome prevailed eructation, spreading feeling in epigastrium and nausea. At the same time the chronic gastritis duration and pain syndrome intensity correlated with helicobacterial infection and comorbidity.Conclusions: Combined pathology is characterized with more intense clinical symptomatology as a direct consequence of mutual influence of diseases. The researches aimed at the study of clinical features of comorbid states allow the grounded approach to its therapy with special attention to all aspects of interaction

  19. Surgical repair of an aberrant splenic artery aneurysm: report of a case.

    Science.gov (United States)

    Illuminati, Giulio; LaMuraglia, Glenn; Nigri, Giuseppe; Vietri, Francesco

    2007-03-01

    Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.

  20. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  1. Pediatric nonaortic arterial aneurysms.

    Science.gov (United States)

    Davis, Frank M; Eliason, Jonathan L; Ganesh, Santhi K; Blatt, Neal B; Stanley, James C; Coleman, Dawn M

    2016-02-01

    Pediatric arterial aneurysms are extremely uncommon. Indications for intervention remain poorly defined and treatments vary. The impetus for this study was to better define the contemporary surgical management of pediatric nonaortic arterial aneurysms. A retrospective analysis was conducted of 41 children with 61 aneurysms who underwent surgical treatment from 1983 to 2015 at the University of Michigan. Arteries affected included: renal (n = 26), femoral (n = 7), iliac (n = 7), superior mesenteric (n = 4), brachial (n = 3), carotid (n = 3), popliteal (n = 3), axillary (n = 2), celiac (n = 2), ulnar (n = 2), common hepatic (n = 1), and temporal (n = 1). Intracranial aneurysms and aortic aneurysms treated during the same time period were not included in this study. Primary outcomes analyzed were postoperative complications, mortality, and freedom from reintervention. The study included 27 boys and 14 girls, with a median age of 9.8 years (range, 2 months-18 years) and a weight of 31.0 kg (range, 3.8-71 kg). Multiple aneurysms existed in 14 children. Obvious factors that contributed to aneurysmal formation included: proximal juxta-aneurysmal stenoses (n = 14), trauma (n = 12), Kawasaki disease (n = 4), Ehlers-Danlos type IV syndrome (n = 1), and infection (n = 1). Preoperative diagnoses were established using arteriography (n = 23), magnetic resonance angiography (n = 6), computed tomographic arteriography (n = 5), or ultrasonography (n = 7), and confirmed during surgery. Indications for surgery included risk of expansion and rupture, potential thrombosis or embolization of aneurysmal thrombus, local soft tissue and nerve compression, and secondary hypertension in the case of renal artery aneurysms. Primary surgical techniques included: aneurysm resection with reanastomsis, reimplantation, or angioplastic closure (n = 16), interposition (n = 10) or bypass grafts (n = 2), ligation (n = 9), plication (n = 8), endovascular occlusion (n = 3), and nephrectomy (n = 4) in

  2. Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease

    Science.gov (United States)

    Samak, Mostafa; Fatullayev, Javid; Sabashnikov, Anton; Zeriouh, Mohamed; Schmack, Bastian; Ruhparwar, Arjang; Karck, Matthias; Popov, Aron-Frederik; Dohmen, Pascal M.; Weymann, Alexander

    2016-01-01

    Total arterial revascularization is the leading trend in coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD). Adding to its superiority to vein conduits, arteries allow for a high degree of versatility and long-term patency, while minimizing the need for reintervention. This is especially important for patients with multi-vessel coronary artery disease, as well as young patients. However, arterial revascularization has come a long way before being widely appreciated, with some yet unresolved debates, and advances that never cease to impress. In this review, we discuss the evolution of this surgical technique and its clinical success, as well as its most conspicuous limitations in light of accumulated published date from decades of experience. PMID:27698339

  3. Variant origin of thyrolingual trunk from left common carotid artery

    Directory of Open Access Journals (Sweden)

    Budhiraja V

    2010-03-01

    Full Text Available A case is reported in which there was a variant origin of thyrolingual trunk from left common carotid artery 2 cm below its bifurcation in the neck. The trunk was running forward and medially and later it was dividing into upper lingual and lower superior thyroid branches. No such artery was seen on right side.

  4. Multiple vascular anomalies involving testicular, suprarenal arteries and lumbar veins

    Directory of Open Access Journals (Sweden)

    P Jyothsna

    2012-01-01

    Full Text Available Testicular arteries arise from the abdominal aorta and the inferior suprarenal artery from the renal artery. There are reports about variant origin and course of these arteries. Accessory testicular artery is also a common finding but its providing origin to inferior suprarenal artery is an important observation. During a routine dissection of abdomen of approximately 55-year-old male cadaver, unique vascular abnormality was observed. On the left side, a common arterial trunk originating from abdominal aorta immediately branched to give rise to superior testicular and inferior suprarenal arteries, the former after a short course hooked by the left suprarenal vein. In addition, the left suprarenal vein, second left lumbar vein, and left testicular vein joined to form a common trunk which drained into the left renal vein. A sound knowledge of vascular variations in relation to the kidney and suprarenal gland is important to surgeons dissecting the abdominal cavity.

  5. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  6. Hepatic artery pseudoaneurysms arising from within a hepatocellular carcinoma

    Science.gov (United States)

    Chingkoe, C M; Chang, S D; Legiehn, G M; Weiss, A

    2010-01-01

    We report a case of a 70-year-old man with a large hepatocellular carcinoma (HCC) containing two pseudoaneurysms measuring up to 2 cm in diameter. The pseudoaneurysms and part of the HCC were supplied by branches from the middle colic artery, which arises from the superior mesenteric artery. This complex arterial vasculature was visualised on CT and confirmed with conventional angiography. PMID:21088082

  7. 75 FR 28542 - Superior Resource Advisory Committee

    Science.gov (United States)

    2010-05-21

    ... orient the new Superior Resource Advisory Committee members on their roles and responsibilities. DATES... of the roles and responsibilities of the Superior Resource Advisory Committee members; Election of... Forest Service Superior Resource Advisory Committee AGENCY: Forest Service, USDA. ACTION: Notice...

  8. The management of superior sulcus tumors

    Energy Technology Data Exchange (ETDEWEB)

    Komaki, Ritsuko; Cox, J.D.; Putnam, J.B. Jr [Texas Univ., Houston, TX (United States). Anderson Cancer Center] (and others)

    2001-09-01

    Superior sulcus tumors are a rare type of lung cancer arising in the apex of the lung above the sulcus and cause specific symptoms and signs depending on the location and whether the tumor extends into the surrounding structures. Because of the closeness of critical structures to the tumor (e.g., the subclavian artery for anterior lesions, the brachial plexus for lesions in the middle location, and the sympathetic stellate ganglion causing Horner's syndrome [Pancoast's tumor], the vertebral bodies, nerve foramen, and spinal cord for posterior lesions), superior sulcus tumors were often considered marginally respectable or unresectable. Therefore, for many years, preoperative radiation therapy was considered routine treatment for those tumors. However, with the evolution in our understanding of these tumors and modern imaging techniques such as computerized tomography (CT) and magnetic resonant imaging (MRI) and surgical techniques, there is now considerable debate about the roles and timing of surgical resection, radiation therapy, and chemotherapy in the treatment of patients with these tumors. If mediastinoscopy reveals microscopic mediastinal lymph node involvement, the patient can be treated with preoperative concurrent chemoradiotherapy followed by surgery. If there was a gross mediastinal lymph node involvement (N2) on CT, N3 or T4 lesions, the patient can be treated with concurrent chemoradiotherapy with a curative intent; the outcome of such treatment appears to be better than that of sequential chemotherapy followed by radiation therapy. Whenever possible, without compromising the patient's quality of life, surgery should be considered to improve outcome. (author)

  9. Hepatic artery pseudoaneurysm treated using stent-graft implantation and retrograde gastroduodenal artery coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Basile, Antonio; Patti, Maria Teresa [Ospedale Ferrarotto, Department of Diagnostic and Interventional Radiology, Catania (Italy); Ragazzi, Salvatore; Piazza, Diego [Ospedale Vittorio Emanuele, Department of Surgery I, Catania (Italy); Tsetis, Dimitrios [University Hospital of Heraklion, Medical School of Crete, Department of Radiology, Heraklion (Greece); Lupattelli, Tommaso [Multimedica Holding, Department of Interventional Radiology, Sesto S. Giovanni (Italy)

    2008-11-15

    Endovascular treatment options for visceral artery pseudoaneurysms depend on lesion location and size. Exclusion methods fall into two categories, embolization and stent placement, and these procedures aim to exclude the pseudoaneurysm from the circulation and if possible to maintain distal blood flow. Embolization of the afferent artery can be used in pseudoaneurysms that arise from a donor artery without collateral supply such as a visceral branch, whereas in the case of visceral arteries with well-established collateral supply, the embolization of both proximal and distal branches to the pseudoaneurysm is mandatory in preventing backflow from the collateral circulation. A direct embolization delivering coils or glue into the sac can also be performed if the aneurismal neck is narrow. Stent-graft placement represents another option to exclude the pseudoaneurysm, in the case of wide neck, reduced arterial tortuosity and large-diameter arteries. We present a case of common hepatic artery pseudoaneurysm involving the gastroduodenal artery origin treated by a combination of techniques. An hepatic stent-graft implantation plus retrograde embolization of the gastroduodenal artery through the pancreaticoduodenal anastomosis from the superior mesenteric artery was performed. (orig.)

  10. AN UNUSUAL PANCREATIC ARTERIAL PATTERN: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Rohini Motwani

    2013-09-01

    Full Text Available Pancreas is an important digestive gland in our body with wide range of both exocrine and endocrine functions. Pancreas has a rich vascular supply from the celiac axis and superior mesenteric artery. The superior pancreatico-duodenal artery (from gastro-duodenal artery and the inferior pancreatico-duodenal artery (from superior mesenteric artery runs in the groove between the pancreas and the duodenum to supply the head of pancreas. Pancreas also derives its blood supply from splenic artery which supplies its head, body and tail region. Profuse vascular supply makes it prone for haemorrhage and that may be the reason that pancreatic blood supply has always been an area of constant interest. In depth knowledge of the variations of blood vessels in this region is utmost important for the successful accomplishment of complex surgical procedures like resection of head of pancreas. The present case report brings in light abnormal pattern of vascularisation in the head region of pancreas and an unusual pancreatic branch from the junction of superior and inferior pancreatic arteries.

  11. What are Millian Qualitative Superiorities?

    Directory of Open Access Journals (Sweden)

    Jonathan Riley

    2008-04-01

    Full Text Available In an article published in Prolegomena 2006, Christoph Schmidt-Petri has defended his interpretation and attacked mine of Mill’s idea that higher kinds of pleasure are superior in quality to lower kinds, regardless of quantity. Millian qualitative superiorities as I understand them are infinite superiorities. In this paper, I clarify my interpretation and show how Schmidt-Petri has misrepresented it and ignored the obvious textual support for it. As a result, he fails to understand how genuine Millian qualitative superiorities determine the novel structure of Mill’s pluralistic utilitarianism, in which a social code of justice that distributes equal rights and duties takes absolute priority over competing considerations. Schmidt-Petri’s own interpretation is a non-starter, because it does noteven recognize that Mill is talking about different kinds of pleasant feelings, such that the higher kinds are intrinsically more valuable than the lower. I conclude by outlining why my interpretation is free of any metaphysical commitment to the “essence” of pleasure.

  12. Pelvic magnetic resonance imaging angioanatomy of the arterial blood supply to the penis in suspected prostate cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Thai, Cao Tan, E-mail: bstanhatinh@gmail.com [Department of Urology, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre Lès Nancy Cedex (France); IADI Laboratory, INSERM-U947, Brabois Hospital, University Hospital of Nancy, Tour Drouet, rue du Morvan, 54511 Vandoeuvre Lès Nancy Cedex (France); Karam, Ibrahim Michel [Clinical Epidemiology and Evaluation Department, University Hospital of Nancy (France); Department of Anatomy, Faculty of Medicine Nancy, 9 Avenue de la Foret de haye BP, 54505 Vandoeuvre Lès Nancy Cedex (France); Nguyen-Thi, Phi Linh [Clinical Epidemiology and Evaluation Department, University Hospital of Nancy (France); INSERM, CIC-EC CIE6, 92 Avenue du Maréchal de Lattre de Tassigny, 54000 Nancy (France); Lefèvre, Frédéric [Department of Radiology, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre Lès Nancy Cedex (France); Hubert, Jacques [Department of Urology, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre Lès Nancy Cedex (France); IADI Laboratory, INSERM-U947, Brabois Hospital, University Hospital of Nancy, Tour Drouet, rue du Morvan, 54511 Vandoeuvre Lès Nancy Cedex (France); Felblinger, Jacques [IADI Laboratory, INSERM-U947, Brabois Hospital, University Hospital of Nancy, Tour Drouet, rue du Morvan, 54511 Vandoeuvre Lès Nancy Cedex (France); Eschwège, Pascal [Department of Urology, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre Lès Nancy Cedex (France)

    2015-05-15

    Highlights: • Three patterns of penile arterial supply (according to the classification of Stéphane Droupy). • Our classification about accessory pudendal artery. • Origin of accessory pudendal artery. - Abstract: Purpose: To describe the internal pudendal artery (IPA) and accessory pudendal artery (APA) detected by magnetic resonance (MR) angiography to help surgeons to find and preserve them during radical prostatectomy (RP). Materials and methods: Constrast-enhanced MR 3.0 T angiography of the pelvis were performed in 111 male patients suspected diagnosis of prostate cancer (PCa), and describe the penile arterial blood supply. Results: There are three patterns of the arterial blood supply to the penis (IPA and/or APA) accounting for 51.4%, 46.8% and 1.8% of cases, respectively. About the accessory pudendal artery (APA): 54/111 (48.6%) patients had APA with five different branching patterns, they were type I (APA bilateral symmetry): 17 (31.5%); type II (APA bilateral asymmetry): 1 (1.9%); type III (APA unilateral lateral): 13 (24%); type IV (APA unilateral apical): 21 (38.9%); type V (APA unilateral mix): 2 (3.7%). APA origin were from inferior epigastric artery (IEA): 7 (9.5%); from inferior vesical artery (IVA): 32 (43.2%); from obturator artery (OA): 35 (47.3%). Conclusion: A precise angioanatomic evalutation of arteries destined to the penis by MR angiography pre-operation for male pelvic organs will help surgeons to preserve them and contributes to reduce the erectile dysfunction after these procedures.

  13. A escrita no Ensino Superior

    Directory of Open Access Journals (Sweden)

    Maria Conceição Pillon Christofoli

    2013-01-01

    Full Text Available http://dx.doi.org/10.5902/198464445865 O presente artigo trata de apresentar resultados oriundos de pesquisa realizada no Ensino Superior, enfocando a escrita em contextos universitários. Depoimentos por parte dos acadêmicos evidenciam certa resistência ao ato de escrever, o que acaba muitas vezes distanciando o sujeito da produção de um texto. Assim sendo, mesmo que parciais, os resultados até então analisados dão conta de que: pressuposto 1 – há ruptura da ideia de coerência entre o que pensamos, o que conseguimos escrever, o que entende nosso interlocutor; pressuposto 2 – a autocorreção de textos como exercício de pesquisa é imprescindível para a qualificação da escrita; pressuposto 3 – os diários de aula representam rico instrumento para a qualificação da escrita no Ensino Superior; pressuposto 4 – há necessidade de que o aluno do Ensino Superior escreva variados tipos de escrita, ainda que a universidade cumpra com seu papel, enfatizando a escrita acadêmica; pressuposto 5 – o trabalho com a escrita no Ensino Superior deve enfatizar os componentes básicos da expressão escrita: o código escrito e a composição da escrita. Palavras-chave: Escrita; Ensino Superior; formação de professores.

  14. A STUDY OF ARTERIAL SUPPLY OF VERMIFORM APPENDIX IN HUMANS

    Directory of Open Access Journals (Sweden)

    Hosmani

    2012-11-01

    Full Text Available ABSTRACT: The surgical procedures like appendicectomy, demands a precise knowledge of vascular anatomy of ileocolic region. The aim of th is study is to study the arterial supply of the appendix, findings of which may reveal more anatomica l facts about the arteries of appendix and their variations. Total 52 specimens of caecum a nd appendix with their arteries intact were collected, cleaned and dissected. The ileocolic art ery and its branches to the appendix were traced carefully and observations were recorded. Th e ileocolic artery arises independently from superior mesenteric artery in 96.88% of cases and en ds by dividing into superior and inferior division in 93.76% of cases. The appendicular artery arises from inferior division in 46.88%, ileal branch 28.13%, ileocolic artery 18.75% and fr om arterial arcade in 6.25% of cases. 21.87% of cases showed additional appendicular artery. KEYWORDS: Caecum, appendix, ileocolic artery, appendicular arter y.

  15. Anomalous origin of right coronary artery from left coronary sinus.

    Science.gov (United States)

    Hamzeh, Gadah; Crespo, Alex; Estarán, Rafael; Rodríguez, Miguel A; Voces, Roberto; Aramendi, José I

    2008-08-01

    Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.

  16. Celiac artery stenosis/occlusion treated by interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)

    2009-08-15

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  17. TEVAR and covering the celiac artery. Is it safe or not?

    DEFF Research Database (Denmark)

    2010-01-01

    in these patients. If the distal sealing zone above the celiac axis is too short, several endovascular alternatives are possible; hybrid procedures with TEVAR and open by-pass to the celiac artery, custom made stent-grafts with scallop or fenestration for the celiac artery, or intentional coverage of the celiac...... artery. In the latter case, adequate collateral supply to the upper gastrointestinal tract is crucial. Collateral arteries joining the celiac and the superior mesenteric arteries are well characterized in patients with chronic celiac stenosis or occlusion. Are these collateral pathways sufficient also...... for sudden iatrogenic closure of the celiac artery? By performing a preoperative angiography of the superior mesenteric artery with temporary balloon occlusion of the celiac artery, collateral capacity between the two vessels can be tested in advance. Exact positioning of the distal end of a large thoracic...

  18. Preperitoneal sutureless mesh repair of inguinal hernia by open inguinal approach using inferior epigastric vessel complex as landmark: A tertiary care centre experience

    Directory of Open Access Journals (Sweden)

    Inderjit Chawla

    2014-01-01

    Full Text Available Introduction: The study is a clinical trial done on patients with inguinal hernia, who were treated by open preperitoneal sutureless mesh repair, using inferior epigastric vessel complex as landmark. Aim: To study the postoperative complications and recurrence rates associated with the open preperitoneal sutureless mesh repair. Materials and Methods: Total 100 patients of inguinal hernia were recruited in this clinical trial from January 2009 to December 2012. Those with bilateral inguinal hernia or recurrent hernias were excluded from the study. Results: The average time taken to complete the surgery was 42.2 minutes and the average hospital stay was 2.5 days. Post-surgery, at a median follow-up period of 2 years, only 2 patients had seroma formation. Visual analog scale pain scores of 4 and 6 were seen in 60% and 40% cases, respectively. No recurrences were encountered post-surgery in any of the case till the last follow-up. Conclusion: This procedure was found to have fewer complications and was less time-consuming as compared to the other conventional open hernia repairs.

  19. Course and variation of the intercostal artery by CT scan.

    Science.gov (United States)

    Helm, Emma J; Rahman, Najib M; Talakoub, Omid; Fox, Danial L; Gleeson, Fergus V

    2013-03-01

    It is conventionally taught that the intercostal artery is shielded in the intercostal groove of the superior rib. The continuous course and variability of the intercostal artery, and factors that may influence them, have not been described in a large number of arteries in vivo. Maximal intensity projection reformats in the coronal plane were produced from CT scan pulmonary angiograms to identify the posterolateral course of the intercostal artery (seventh to 11th rib spaces). A novel semiautomated computer segmentation algorithm was used to measure distances between the lower border of the superior rib, the upper border of the inferior rib, and the position of the intercostal artery when exposed in the intercostal space. The position and variability of the artery were analyzed for association with clinical factors. Two hundred ninety-eight arteries from 47 patients were analyzed. The mean lateral distance from the spine over which the artery was exposed within the intercostal space was 39 mm, with wide variability (SD, 10 mm; 10th-90th centile, 28-51 mm). At 3 cm lateral distance from the spine, 17% of arteries were shielded by the superior rib, compared with 97% at 6 cm. Exposed artery length was not associated with age, sex, rib space, or side. The variability of arterial position was significantly associated with age (coefficient, 0.91; P intercostal artery is exposed within the intercostal space in the first 6 cm lateral to the spine. The variability of its vertical position is greater in older patients and in more cephalad rib spaces.

  20. Right hepatic artery crossing the common hepatic artery: an unusual blood supply to the liver.

    Science.gov (United States)

    Felli, Emanuele; Vennarecci, Giovanni; Santoro, Roberto; Guglielmo, Nicola; Ettorre, Giuseppe Maria

    2016-04-01

    To perform hepatic surgery a precise preoperative and intraoperative study of liver vascular supply is mandatory. Detecting vascular variations may have great importance on surgical strategy and outcome, and details of anatomy do not concern only academical knowledge but become deeply involved in practice. We present a case of unusual blood supply to the liver, the common hepatic artery was directed to the right liver and a right hepatic artery originating from the superior mesenteric artery was directed to the left liver. The right hepatic artery crossed the common hepatic artery in the proximal part of the hepatic pedicle, anterior to the portal vein. To our knowledge this type of anatomical variation has not been described before and it represents a rare finding that has to be kept in mind, especially in case of major hepatectomies and more demanding splitting liver procedures such as A.L.P.P.S., in situ split, ex situ split and living donor liver transplantation.

  1. Revascularisation of atherosclerotic mesenteric arteries

    DEFF Research Database (Denmark)

    Christensen, Max Greve; Lorentzen, Jørgen Ewald; Schroeder, T V

    1994-01-01

    in 25 patients, chronic ischaemia in 53 and prophylactic reconstruction in connection with aortic surgery in 12 patients. The superior mesenteric artery (SMA) was revascularised in 87 patients and the coeliac axis or common hepatic artery in six. Thus, only three patients had both territories...... revascularised. Thromboendarterectomy was performed in 15 patients, transposition of the SMA directly into the infrarenal aorta in 30 and bypass in 48 patients. CHIEF OUTCOME MEASURES: Cumulative symptom-free and survival rates. MAIN RESULTS: The overall perioperative (30 days) mortality rate was 13%, mainly...... rates were 81, 60 and 35% after 5, 10 and 20 years, respectively which indicated a mortality rate three times that of an age- and sex-matched Danish population. During follow-up symptoms recurred in 30 patients, more often following emergency surgery and SMA transposition. CONCLUSIONS: Mesenteric...

  2. A report of unusual origin of right renal artery

    Directory of Open Access Journals (Sweden)

    Bamac B

    2011-05-01

    Full Text Available During evaluation of abdominal aorta in the serial forensic autopsy cases in the Istanbul Forensic Medicine Institute Morgue, we observed a variation in the origin of the right renal artery in a 49-year-old woman who died of external cause. In this case the right renal artery originated from the superior mesenteric artery. On the left side, the left renal artery arose from the aorta. Clinical significance and embryonic development of this variation have been discussed briefly and a short overview of the literature was given.

  3. Pensamiento Superior y Desarrollo Territorial

    Directory of Open Access Journals (Sweden)

    Víctor Manuel Racancoj Alonzo

    2015-04-01

    Full Text Available Esta reflexión pretende explicar el papel, fundamental, que juega el pensamiento superior, en la formulación y la práctica de modelos de desarrollo territorial local; para que contribuyan de forma sustantiva, en la transformación de las condiciones socioeconómicas adversas que hoy viven comunidades indígenas y rurales de muchos países, como Guatemala, situación que puede resumirse en altos índices de pobreza y desnutrición. Pero, el pensamiento superior, debe ser competencia de la población con pertenencia a lo local, pues si y solo si esta condición existe, se dará validez y viabilidad al desarrollo territorial. Para alcanzar competencias de pensamiento superior, en los espacios locales, se tiene que superar obstáculos en el modelo de universidad, que hoy estamos familiarizados a ver y pensar; modelos que tienen las características de: herencia colonial, disfunción con la problemática económica, cultural, social y política de la sociedad y la negación de los saberes ancestrales.

  4. Superior sulcus tumors (Pancoast tumors).

    Science.gov (United States)

    Marulli, Giuseppe; Battistella, Lucia; Mammana, Marco; Calabrese, Francesca; Rea, Federico

    2016-06-01

    Superior Sulcus Tumors, frequently termed as Pancoast tumors, are a wide range of tumors invading the apical chest wall. Due to its localization in the apex of the lung, with the potential invasion of the lower part of the brachial plexus, first ribs, vertebrae, subclavian vessels or stellate ganglion, the superior sulcus tumors cause characteristic symptoms, like arm or shoulder pain or Horner's syndrome. The management of superior sulcus tumors has dramatically evolved over the past 50 years. Originally deemed universally fatal, in 1956, Shaw and Paulson introduced a new treatment paradigm with combined radiotherapy and surgery ensuring 5-year survival of approximately 30%. During the 1990s, following the need to improve systemic as well as local control, a trimodality approach including induction concurrent chemoradiotherapy followed by surgical resection was introduced, reaching 5-year survival rates up to 44% and becoming the standard of care. Many efforts have been persecuted, also, to obtain higher complete resection rates using appropriate surgical approaches and involving multidisciplinary team including spine surgeon or vascular surgeon. Other potential treatment options are under consideration like prophylactic cranial irradiation or the addition of other chemotherapy agents or biologic agents to the trimodality approach.

  5. 肌酸激酶及CT血管造影检查评估肠系膜上动脉栓塞的短期预后%Creatine kinase and computed tomography angiography to evaluate short-term prognosis of patients with superior mesenteric artery embolism

    Institute of Scientific and Technical Information of China (English)

    吕和平; 倪海真; 黄景勇; 陈祥建; 虞冠锋

    2016-01-01

    .8例患者肠系膜上动脉主干栓塞呈低密度影,伴远端分支动脉显影,其中肠缺血3例,部分肠坏死4例,长段肠坏死1例.2例患者肠系膜上动脉非主干栓塞呈低密度影,伴远端分支动脉不显影,均为部分肠坏死.3例患者肠系膜上动脉非主干栓塞呈低密度影,伴远端分支动脉显影,其中肠缺血2例,部分肠坏死1例.②间接征象:5例患者肠壁增厚,其中部分肠坏死3例,长段肠坏死2例.17例患者肠道扩张伴积气、积液,局部肠管内可见气液平,其中肠缺血2例,部分肠坏死5例,长段肠坏死10例.2例患者肠壁积气,呈肠壁气泡影,均为长段肠坏死.(4)治疗及预后:6例肠缺血患者,其中1例行肠系膜上动脉取栓术,其余5例行低分子肝素抗凝、前列地尔扩血管等治疗.8例部分肠坏死患者,行坏死肠管切除术.12例长段肠坏死患者中,5例术后短肠综合征行坏死肠管切除术,术后联合静脉营养支持治疗.上述患者均经对症支持和手术治疗好转出院.12例长段肠坏死患者中,7例全小肠坏死及部分结肠坏死仅行剖腹探查,短期内死亡.结论 肌酸激酶明显升高及CT血管造影检查示肠系膜上动脉主干栓塞伴远端分支不显影,预示肠系膜上动脉栓塞患者短期不良预后.%Objective To investigate the value of creatine kinase and computed tomography(CT)angiography to evaluate short-term prognosis of patients with superior mesenteric artery embolism(SMAE).Methods The retrospective cross-sectional study was adopted.The clinical data of 26 patients with SMAE who were admitted to the first Affiliated Hospital of Wenzhou Medical University between January 2008 and October 2015 were collected.The patients received serologic examination and CT angiography firstly,and then medicinal conservative method and surgical method were respectively conducted according to the results of above examinations.Observation indices:(1)clinical features,(2)serum indicators

  6. Peripheral arterial line (image)

    Science.gov (United States)

    A peripheral arterial line is a small, short plastic catheter placed through the skin into an artery of the arm or leg. The purpose of a peripheral arterial line is to allow continuous monitoring of ...

  7. Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

    Institute of Scientific and Technical Information of China (English)

    Feng-Yong Liu; Mao-Qiang Wang; Qing-Sheng Fan; Feng Duan; Zhi-Jun Wang; Peng Song

    2009-01-01

    AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females,aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were accurately diagnosed with Doppler ultrasound scans, computed tomography and magnetic resonance imaging.They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutaneous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization).RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these 45 patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment.In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful.CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

  8. The pattern of the arterial supply of the pancreas in anthropoid apes, catarrhine monkeys and platyrrhine monkeys.

    Science.gov (United States)

    Shawuti, Alimujiang; Miyaki, Takayoshi; Saito, Toshiyuki; Itoh, Masahiro

    2009-11-01

    To get the full understanding of the arterial distribution to the pancreas, the analysis of the distribution of the variety of monkey species would be helpful. In this study, we studied the layout of the pancreatic artery in anthropoids (1 gorilla, 3 chimpanzees and 2 white-handed gibbons), in catarrhine monkeys (1 hamadryas baboon, 2 anubid baboons, 10 savannah monkeys) and in platyrrhine monkeys (6 squirrel monkeys). The pancreas of the monkeys was supplied by the arteries originating from the celiac trunk and/or superior mesenteric artery. There were three patterns in the arterial distribution; (1) the celiac artery supplied the major area of the pancreas. (2) the superior mesenteric artery supplied the major area of the pancreas. (3) the celiac artery supplied the whole pancreas. The pattern of the arterial distribution to the monkey pancreas had a wide variety. The result would be helpful for the elucidation of the development of the vascular distribution in the pancreas.

  9. Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery

    Science.gov (United States)

    Boodhwani, Munir; Hanet, Claude; de Kerchove, Laurent; Navarra, Emiliano; Astarci, Parla; Noirhomme, Philippe; El Khoury, Gebrine

    2016-01-01

    Background— Bilateral internal thoracic arteries (BITA) have demonstrated superior patency and improved survival in patients undergoing coronary artery bypass grafting. However, the optimal configuration for BITA utilization and its effect on long-term outcome remains uncertain. Methods and Results— We randomly assigned 304 patients undergoing coronary artery bypass grafting using BITA to either in situ or Y grafting configurations. The primary end point was 3-year angiographic patency. Secondary end points included major adverse cardiac and cerebrovascular events (ie, death from any cause, stroke, myocardial infarction, or repeat revascularization) at 7 years. More coronary targets were able to be revascularized using internal thoracic arteries in patients randomized to Y grafting versus in situ group (3.2±0.8 versus 2.4±0.5 arteries/patient; P<0.01). The primary end point did not show significant differences in graft patency between groups. Secondary end points occurred more frequently in the in situ group (P=0.03), with 7-year rates of 34±10% in the in situ and 25±12% in the Y grafting groups, driven largely by a higher incidence of repeat revascularization in the in situ group (14±4.5% versus 7.4±3.2% at 7 years; P=0.009). There were no significant differences in hospital mortality or morbidity or in late survival, myocardial infarction, or stroke between groups. Conclusions— Three-year systematic angiographic follow-up revealed no significant difference in graft patency between the 2 BITA configurations. However, compared with in situ configuration, the use of BITA in a Y grafting configuration results in lower rates of major adverse cardiovascular and cerebrovascular events at 7 years. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01666366. PMID:27406988

  10. Entidades fiscalizadoras superiores y accountability

    OpenAIRE

    Estela Moreno, María

    2016-01-01

    OBJETIVOS DE LA TESIS: El objetivo general del trabajo es establecer el nivel de eficacia de las Entidades Fiscalizadoras Superiores (EFS) como agencia asignada y herramienta de accountability horizontal, a través de la valoración de su diseño institucional y de la calidad de sus productos finales, los informes de auditoría, estableciéndose los siguientes objetivos específicos: 1. Relevar las nociones de accountability, actualizando el Estado del Arte de la cuestión. 2. Analizar la ...

  11. Atypical right diaphragmatic hernia (hernia of Morgagni, spigelian hernia and epigastric hernia in a patient with Williams syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Rashid Farhan

    2009-01-01

    Full Text Available Abstract Introduction Williams syndrome is rare genetic disorder resulting in neurodevelopmental problems. Hernias of the foramen of Morgagni are rare diaphragmatic hernias and they mostly present on the right side, in the anterior mediastinum. They are usually asymptomatic and are difficult to diagnose, especially in patients with learning disabilities. Case presentation This 49-year-old woman with Williams syndrome, cognitive impairment and aortic stenosis presented to physicians with right-sided chest pain. She had previously undergone repair of her right spigelian and epigastric hernia. Her abdominal examination was unremarkable. Chest X-ray suggested right-sided diaphragmatic hernia and pleural effusion for which she received treatment. The computed tomography scan showed a diaphragmatic hernia with some collapse/consolidation of the adjacent lung. Furthermore, the patient had aortic stenosis and was high risk for anaesthesia (ASA grade 3. She underwent successful laparoscopic repair of her congenital diaphragmatic hernia leading to a quick and uneventful postoperative recovery. Conclusion These multiple hernias suggest that patients with Williams syndrome may have some connective tissue disorder which makes them prone to develop hernias especially associated with those parts of the body which may have intracavity pressure variations like the abdomen. Diaphragmatic hernia may be the cause of chest pain in these patients. A computed tomography scan helps in early diagnosis, and laparoscopic repair helps in prevention of further complications, and leads to quick recovery especially in patients with learning disabilities. In the presence of significant comorbidities, a less invasive operative procedure with quick recovery becomes advisable.

  12. Importance of the third arterial graft in multiple arterial grafting strategies.

    Science.gov (United States)

    Glineur, David

    2013-07-01

    The long-term benefit of multiple arterial grafts for coronary artery bypass (CABG) is not clear. This protocol was elaborated to see if multiple arterial grafts would provide better long-term outcomes when compared with conventional strategies. Prospective data was collected for 588 patients undergoing isolated CABG between 1985 and 1995. We analyzed long term survival and freedom from cardiac death. The analysis compared patients with BITA grafting receiving a right gastro-epiploic artery (RGEA) versus those receiving a saphenous vein graft (SVG) as a third conduit. Cox proportional hazards modelling was used to adjust for relevant confounders. The mean age was 59±9 years and 49% received BITA. Mean follow-up was 16.1±5.4 years. Multivariable analysis revealed in that patients receiving the RGEA as a third conduit had superior overall survival (HR, 0.46; P=0.015) and cardiac survival (HR, 0.20; P=0.005) compared to those receiving an SVG. In our experience, the use of multiple arterial grafting is independently associated with superior outcomes. Furthermore, the use of a third arterial conduit targeted to the RCA should be considered to improve long-term survival.

  13. Treatment of Superior Lobe Central Lung Cancer with Lung Replantation

    Directory of Open Access Journals (Sweden)

    Yulun YANG

    2010-11-01

    Full Text Available Background and objective Patients suffering from lung cancer often have poor quality of life after pneumonectomy. It has clinical significances to preserve maximum lobes of the “healthy” lung. The aim of this study is to report the applications of lung replantation in treatment of superior lobe central lung cancer. Methods Three lung cancer cases were included and analysed. The bronchus and margin of lower lung lobe were encroached by cancer. Pulmonary artery was invaded and surrounded by metastatic lymph node. Complete pneumonectomy, antegrade perfusion and retroperfusion with low-potassium dextran (LPD solution in vitro were performed. The retainable lower pulmonary lobe was selected from the isolated lung and superior pulmonary vein was replaced with inferior pulmonary veins. The bronchus and pulmonary artery were inosculated by turns. Results The operative cumulative time ranged from 220 min to 250 min. The isolated time of lobus inferior pulmonary ranged from 120 min to 150 min. The chest tube was pulled out after chest X-ray confirmed the reimplant lung full re-expansion. The patients were followed up for 4 months to 8 months and accomplished adjuvant chemotherapy for 3 or 4 periodicities. The patients had a sound quality of life. Conclusion Lung replantation removing the extensive tumor tissue and retaining the maximum pulmonary normal tissue is an useful method for treatment of lung cancer.

  14. Lingual and facial arteries arising from the external carotid artery in a common trunk.

    Science.gov (United States)

    Troupis, Theodore G; Dimitroulis, Dimitrios; Paraschos, Alexandros; Michalinos, Adamantios; Protogerou, Vassilis; Vlasis, Konstantinos; Troupis, George; Skandalakis, Panayiotis

    2011-02-01

    The present study describes analytically a rare case in which lingual and facial arteries arise together from an external carotid artery in a common trunk. Thirty anatomic dissections were performed on 15 cadavers in the macroscopic laboratory in the Department of Anatomy of the Medical School of National and Kapodistrian University of Athens. One common trunk from which originated lingual and facial arteries was found. The frequency of this morphology is measured at 6 per cent. The length of the common trunk is measured at 7.3 mm between its origin and its diversion at the facial artery and lingual artery, its diameter at 2.8 mm, its distance from carotid bifurcation at 7.9 mm, and from the superior thyroid artery at 3.3 mm. At the left side of the neck region, facial and lingual arteries arose separately. The anatomic variations of the branching pattern of the external carotid artery and the micrometric values of the vessels are especially important as a result of the numerous operations performed in the neck region that implicate various specialties such as general surgery, head and neck surgery, plastic surgery, and maxillofacial surgery.

  15. The sentence superiority effect revisited.

    Science.gov (United States)

    Snell, Joshua; Grainger, Jonathan

    2017-11-01

    A sentence superiority effect was investigated using post-cued word-in-sequence identification with the rapid parallel visual presentation (RPVP) of four horizontally aligned words. The four words were presented for 200ms followed by a post-mask and cue for partial report. They could form a grammatically correct sentence or were formed of the same words in a scrambled agrammatical sequence. Word identification was higher in the syntactically correct sequences, and crucially, this sentence superiority effect did not vary as a function of the target's position in the sequence. Cloze probability measures for words at the final, arguably most predictable position, revealed overall low values that did not interact with the effects of sentence context, suggesting that these effects were not driven by word predictability. The results point to a level of parallel processing across multiple words that enables rapid extraction of their syntactic categories. These generate a sentence-level representation that constrains the recognition process for individual words, thus facilitating parallel word processing when the sequence is grammatically sound. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Left testicular artery arching over the ipsilateral renal vein

    Institute of Scientific and Technical Information of China (English)

    Munekazu Naito; Hayato Terayama; Yoichi Nakamura; Shogo Hayashi; Takayoshi Miyaki; Masahiro Itoh

    2006-01-01

    Aim: To report two cases of the left testicular artery arching over the left renal vein (LRV) before running downward to the testis. Methods: The subjects were obtained from two Japanese cadavers. During the student course of gross-anatomical dissection, the anatomical relationship between the testicular vessels and the renal vein was specifically observed. Results: The arching left testicular artery arose from the aorta below the LRV and made a loop around the LRV, which appeared to be mildly compressed between the arching artery and the psoas major muscle.Conclusion: Clinically, compression of the LRV between the abdominal aorta and the superior mesenteric artery occasionally induces LRV hypertension, resulting in varicocele, orthostatic protenuria and hematuria. Considering that the incidence of a left arching testicular artery is higher than that of a right one, an arching left artery could be an additional cause of LRV hypertension.

  17. Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

    Directory of Open Access Journals (Sweden)

    Ferrón JA

    2010-06-01

    Full Text Available Abstract Background Visceral artery aneurysms (VAA, although uncommon, are increasingly being detected. We describe a case of spontaneous retroperitoneal hemorrhage from a ruptured IMA aneurysm associated with stenosis of the superior mesenteric artery (SMA and celiac trunk, successfully treated with surgery. Methods A 65-year-old man presented with abdominal pain and hypovolemic shock. Abdominal CT scan showed an aneurysm of the inferior mesenteric artery with retroperitoneal hematoma. In addition, an obstructive disease of the superior mesenteric artery and celiac axis was observed. Results Upon emergency laparotomy a ruptured inferior mesenteric artery aneurysm was detected. The aneurysm was excised and the artery reconstructed by end-to-end anastomosis. Conclusions This report discusses the etiology, presentation, diagnosis and case management of inferior mesenteric artery aneurysms.

  18. Incidental visceral and renal artery stenosis in patients undergoing coronary angiography.

    Science.gov (United States)

    Bageacu, S; Cerisier, A; Isaaz, K; Nourissat, A; Barral, X; Favre, J-P

    2011-03-01

    The study aimed to examine the association between incidentally discovered mesenteric artery stenosis, renal artery stenosis (RAS) and coronary artery disease in patients undergoing coronary angiography. We performed a prospective analysis of consecutive patients undergoing routine cardiac catheterisation. Abdominal aortograms in lateral and antero-posterior view were obtained to assess arterial stenosis of the coeliac axis, superior mesenteric artery and renal arteries. Significant arterial stenosis was defined as a narrowing of at least 50% compared with the normal artery. Demographic data and cardiovascular risk factors were analysed. The prevalence of visceral artery stenosis (VAS) was 63/450 (14%) including 48/450 (10.6%) cases of coeliac axis stenosis and 15/450 (3.3%) cases of superior mesenteric artery stenosis. Female sex (p = 0.01), older age (p = 0.03) and the presence of coronary artery disease (p = 0.05) were significant predictors for the presence of VAS in univariate analysis. The determinants for VAS in multivariate analysis were female sex and three-vessel coronary artery disease, while two- and three-vessel coronary artery disease was significant for RAS. Screening for VAS and RAS in female patients older than 60 years with more than two diseased coronary segments could have a high diagnostic value. Copyright © 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  19. 78 FR 21116 - Superior Supplier Incentive Program

    Science.gov (United States)

    2013-04-09

    ... Department of the Navy Superior Supplier Incentive Program AGENCY: Department of the Navy, DoD. ACTION... policy that will establish a Superior Supplier Incentive Program (SSIP). Under the SSIP, contractors that..., performance, quality, and business relations would be granted Superior Supplier Status (SSS). Contractors...

  20. superior en México

    Directory of Open Access Journals (Sweden)

    César Mureddu Torres

    2008-01-01

    Full Text Available El presente artículo desarrolla algunos de los retos que ha traído consigo el acceso a la información existente en la red de Internet y lo que ello supone. Se abordan principalmente las consecuencias de la presencia actual de una sociedad llamada del conocimiento, si se mantiene la confusión entre conocimiento e información. Por ello, la sola gestión de la información no puede ser tomada como definitoria respecto a la función de educación superior confiada a las universidades. Hacerlo sería cometer un error aún más grave que la confusión teórica entre los términos mencionados.

  1. Anatomical variation of the origin of the left vertebral artery

    OpenAIRE

    Patasi B; Yeung A; Goodwin S; Jalali A

    2009-01-01

    This paper presents and describes the anatomical variation of the left vertebral artery originating from the arch of aorta as a case report. This variation was found in one of the cadavers at the Division of Clinical and Functional Anatomy, Faculty of Medicine, University of Ottawa. During routine dissection of a male cadaver, in the superior mediastinum and the neck we observed an atypical origin of the left vertebral artery. Atypical origin was compared to the typical origin of the left ver...

  2. A big floating thrombus in the common carotid artery.

    Science.gov (United States)

    La Spada, Michele; Stilo, Francesco; Barillà, David; Spinelli, Francesco

    2011-11-01

    The management of the free-floating thrombus (FFT) is difficult, and it is unclear whether surgical or medical treatment is superior. The common carotid artery is rarely involved. An 80-year-old woman presented with right hand weakness and syncope. Ultrasound showed the presence of FFT in the left common carotid artery. A carotid endarterectomy with Dacron patch angioplasty was immediately performed without complications. In the presence of symptoms, the interventional management of FFT is advised.

  3. Carotid artery stenting will replace carotid endarterectomy.

    Science.gov (United States)

    McCormick, Daniel J; Vlad, Tudor; Fasseas, Panayotis

    2007-09-01

    Stroke is the third leading cause of death in the United States. Carotid artery stenosis represents one of the most common etiologies of stroke. The current treatment modalities available for the treatment of carotid artery stenosis are carotid endarterectomy (CEA) and carotid artery stenting (CAS). Several clinical trials comparing CEA with medical management showed superiority of the surgical arm; however, the applicability of these results to the general population is limited by the fact that the patients and surgeons enrolled in these trials were carefully selected, and the optimal medical therapy used does not meet the current treatment standards. Carotid artery stenting has emerged as a treatment alternative to CEA, as shown in randomized trials comparing the 2 treatment modalities. Recent data from large-volume CAS registries indicate that percutaneous treatment of carotid artery stenosis compares favorably to CEA. Furthermore, the CAS trial designs make these results more applicable to the community standards. These data suggest that CAS will become the treatment of choice in patients with carotid artery stenosis.

  4. Escuela Superior de Palos Verdes

    Directory of Open Access Journals (Sweden)

    Neutra, Richard J.

    1965-02-01

    Full Text Available Before initiating the building operations for the «Palos Verdes» School, the site was divided into two large horizontal surfaces, at different levels. The lower one served to accommodate the playing fields, a car park, the physical training building, and shop and ancillary buildings. On the higher of these two surfaces, and to the West of the access road, there is a car park and also the building and plot of ground devoted to agricultural technology, as well as the literary studies and general purpose buildings. As a complement to these, there is a series of blocks, arranged in parallel rows, which house the administrative offices, the art school, the craft's school, the general classrooms, and those devoted to higher education. The fascinating aspect of this school is the outstanding penetration of the architect's mind into the essential function of the project. Its most evident merit is the sense of comradeship and harmony that permeates the whole architectural manifold.Antes de construir el complejo escolar «Palos Verdes» se comenzó por crear, en el terreno, dos grandes mesetas a niveles diferentes. Sobre el inferior se organizaron: los campos de juegos, de deportes, un aparcamiento, el edificio para educación física y los destinados a tiendas y servicios. Sobre la meseta superior, al oeste de la vía de acceso, se dispuso un aparcamiento y el edificio y campo para adiestramiento agrícola; al este, otro aparcamiento, el edificio dedicado a materias literarias, y el destinado a usos múltiples. Completan las instalaciones de la escuela una serie de bloques paralelos: la administración, la escuela de arte, las clases de trabajos manuales, las aulas de enseñanzas generales, y las de los cursos superiores. Lo fascinante de este complejo escolar es la perfecta y magistral compenetración del arquitecto con el tema proyectado, y su mayor mérito, la sensación de cordialidad y armonía con el ambiente.

  5. Derivação com veias de membro superior após trombólise de aneurisma de artéria poplítea: alternativa para salvamento de membro Arm vein bypass after popliteal artery aneurysm thrombolysis: an alternative for limb salvage

    Directory of Open Access Journals (Sweden)

    João Antonio Corrêa

    2007-06-01

    Full Text Available Os autores relatam um caso de aneurisma de artéria poplítea trombosado em que se realizou fibrinólise com sucesso na fase aguda. Foram utilizadas veias de braço para realização do enxerto e exclusão do aneurisma, pois o paciente havia sido previamente submetido à safenectomia bilateral e revascularização do miocárdio com as veias do outro braço. Apesar das dificuldades, o salvamento do membro foi alcançado.The authors report a case of a thrombosed popliteal artery aneurysm successfully treated by fibrinolysis in its acute stage. Arm veins were used to perform a bypass and aneurysm exclusion, since the patient had previously been submitted to bilateral saphenous vein stripping and myocardial revascularization using the veins of the other arm. Despite the difficulties, limb salvage was achieved.

  6. [Intra-arterial thrombolysis of acute mesenteric ischemia].

    Science.gov (United States)

    Nathan, N; Wintringer, P; Bregeon, Y; Cassat, C; Le Blanche, A; Boulanger, J P; Feiss, P

    1995-01-01

    A 73-year-old man with pre-existing cardiac failure, coronary artery and chronic obstructive pulmonary disease was presented for an acute mesenteric ischaemia, resulting from an embolic obstruction of the superior mesenteric artery. An intra-arterial fibrinolysis with a bolus of 250 000 units of streptokinase, followed by an infusion of 150 mg rtPA with adequate heparin dosage was performed 10 hours after the first symptoms. An abdominal guarding occurred 24 hours later, despite radiological improvement, justifying emergency surgery which confirmed the partial efficiency of the medical therapy. Unfortunately, a cardiogenic shock occurred preoperatively and the patient died five days later from intractable cardiovascular failure.

  7. Sobredentadura total superior implantosoportada Superior total overdenture on implants

    Directory of Open Access Journals (Sweden)

    Luis Orlando Rodríguez García

    2010-06-01

    Full Text Available Se presenta un caso de un paciente desdentado total superior, rehabilitado en la consulta de implantología de la Clínica "Pedro Ortiz" del municipio Habana del Este en Ciudad de La Habana, Cuba, en el año 2009, mediante prótesis sobre implantes osteointegrados, técnica que se ha incorporado a la práctica estomatológica en Cuba como alternativa al tratamiento convencional en los pacientes desdentados totales. Se siguió un protocolo que comprendió una fase quirúrgica, procedimiento con o sin realización de colgajo y carga precoz o inmediata. Se presenta un paciente masculino de 56 años de edad, que acudió a la consulta multidisciplinaria, preocupado, porque se le habían elaborado tres prótesis en los últimos dos años y ninguna reunía los requisitos de retención que él necesitaba para sentirse seguro y cómodo con las mismas. El resultado final fue la satisfacción total del paciente, con el mejoramiento de la calidad estética y funcional.This is the case of a total maxilla edentulous patient seen in consultation of the "Pedro Ortíz" Clinic Implant of Habana del Este municipality in 2009 and con rehabilitation by prosthesis over osteointegration implants added to stomatology practice in Cuba as an alternative to conventional treatment in patients totally edentulous. We follow a protocol including a surgery or surgical phase, technique without or with flap creation and early or immediate load. This is a male patient aged 56 came to our multidisciplinary consultation worried because he had three prostheses in last two years and any fulfilled the requirements of retention to feel safe and comfortable with prostheses. The final result was the total satisfaction of rehabilitated patient improving its aesthetic and functional quality.

  8. DETERMINATION OF AMMONIA IN EAR-LOBE CAPILLARY BLOOD IS AN ALTERNATIVE TO ARTERIAL BLOOD AMMONIA

    NARCIS (Netherlands)

    HUIZENGA, [No Value; GIPS, CH; CONN, HO; JANSEN, PLM

    1995-01-01

    Blood ammonia determination is a laboratory test to diagnose hepatic encephalopathy. Arterial blood is superior to peripheral venous blood ammonia because of ammonia metabolism in muscle. We have compared capillary with arterial whole blood ammonia as capillary sampling is an attractive alternative.

  9. Coronary Artery Disease

    Science.gov (United States)

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due ...

  10. Mesenteric artery ischemia

    Science.gov (United States)

    ... medlineplus.gov/ency/article/001156.htm Mesenteric artery ischemia To use the sharing features on this page, please enable JavaScript. Mesenteric artery ischemia occurs when there is a narrowing or blockage ...

  11. Occlusive Peripheral Arterial Disease

    Science.gov (United States)

    ... off and blocks an artery downstream, if blood seeps into the lining of the artery causing a ... supply to heart muscle is adequate. Exposure to cold, which causes blood vessels to narrow (constrict) and ...

  12. Unusual bilateral origins of the deep artery of thigh and associated variations

    Directory of Open Access Journals (Sweden)

    Shankar N

    2009-08-01

    Full Text Available During routine dissection of a middle aged male cadaver, an unusual origin of the deep artery of thigh was observed bilaterally. It arose from the femoral artery less than 1 cm distal to the inguinal ligament. On both sides, its diameter was greater than that of the femoral artery. An unusually distal origin of the lateral circumflex femoral artery was observed bilaterally. An unnamed branch from the deep artery of thigh on the left side was seen coursing superolaterally towards the anterior superior iliac spine. The deep external pudendal artery arose from the medial circumflex femoral artery on either side. On the right side, the femoral nerve emerged in the femoral triangle by piercing the iliacus muscle. As the deep artery of thigh is often used in vascular reconstructive procedures and is frequently visualized by various radiological imaging techniques, anatomical variations of itself as well as its branches have significant clinical implications.

  13. Upper limb arterial thromboembolism

    DEFF Research Database (Denmark)

    Andersen, L V; Lip, Gregory Y.H.; Lindholt, J S;

    2013-01-01

    The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF).......The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF)....

  14. Coronary Artery Bypass Surgery

    Science.gov (United States)

    In coronary artery disease (CAD), the arteries that supply blood and oxygen to your heart muscle grow hardened and narrowed. You may try ... these treatments don't help, you may need coronary artery bypass surgery. The surgery creates a new ...

  15. Imaging of Dual Ophthalmic Arteries: Identification of the Central Retinal Artery

    Directory of Open Access Journals (Sweden)

    Louise Louw

    2014-01-01

    Full Text Available Identification of the origin of the central retinal artery (CRA is imperative in tailoring angiographic studies to resolve a given clinical problem. A case with dual ophthalmic arteries (OAs, characterized by different origins and distinct branching patterns, is documented for training purposes. Pre-clinical diagnosis of a 9-year-old child who presented with a sharp wire in the left-side eyeball was primarily corneal laceration. For imaging, a selected six-vessel angiographic study with the transfemoral approach was performed. Embolization was not required and the wire could be successfully removed. Right-side OA anatomy was normal, while left-side dual OAs with external carotid artery (ECA and internal carotid artery (ICA origins were seen. The case presented with a left-side meningo-ophthalmic artery (M-OA anomaly via the ECA, marked by a middle meningeal artery (MMA (origin: Maxillary artery; course: Through foramen spinosum with normal branches (i.e. anterior and posterior branches, and an OA variant (course: Through superior orbital fissure with a distinct orbital branching pattern. A smaller OA (origin: ICA; course: Through optic foramen with a distinct ocular branching pattern presented with the central retinal artery (CRA. The presence of the dual OAs and the M-OA anomaly can be explained by disturbed evolutionary changes of the primitive OA and stapedial artery during development. The surgical interventionist must be aware of dual OAs and M-OA anomalies with branching pattern variations on retinal supply, because of dangerous extracranial-intracranial anastomotic connections. It is of clinical significance that the origin of the CRA from the ICA or ECA must be determined to avoid complications to the vision.

  16. A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isolada Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Antônio Sérgio Cordeiro da Rocha

    2012-03-01

    Full Text Available OBJETIVO: Analisar os resultados da cirurgia de revascularização miocárdica (CRVM isolada com circulação extracorpórea em pacientes com idade > 70 anos em comparação àqueles com 70 anos foi fator preditivo independente para maior letalidade operatória (P=0,004 e para RRH (P=0,002, sepse (P=0,002, complicações respiratórias (P 70 anos estão sob maior risco de morte e outras complicações no pós-operatório de CRVM em comparação aos pacientes mais jovens.OBJECTIVE: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG in patients >70 years-old in comparison to patients 70 years-old and G2 (age 70-year-old was an independent predictive factor for higher in-hospital mortality (P=0.004, reexploration for bleeding (P=0.002, sepsis (P=0.002, respiratory complications (P 70 years-old were at increased risk of death and other complications in the CABG's postoperative period in comparison to younger patients.

  17. Detection of anomalous splenic artery aneurysms with three-dimensional contrast-enhanced MR angiography.

    Science.gov (United States)

    Liu, Qi; Lu, Jian Ping; Wang, Fei; Wang, Li; Jin, Ai Guo; Wang, Jian; Tian, Jian Min

    2009-11-01

    Aneurysms of the splenic artery which arise anomalously from the superior mesenteric artery are extremely rare but clinically important because of their life-threatening hemorrhage. Diagnostic imaging plays an important role in the diagnosis and conducting treatment strategy. The aim of this study was to evaluate the detection of anomalous splenic artery aneurysms with 3D contrast-enhanced MR angiography. 3D contrast-enhanced MR angiography was performed in six patients with anomalous splenic artery aneurysms. The mean diameter of six aneurysms was 3.9 cm. All of them were saccular and located at the origin of the splenic artery that arose anomalously from the root of the superior mesenteric artery. 3D contrast-enhanced MR angiography clearly demonstrated the aneurysm's location, size, morphology, visceral arterial variations, and was superior to DSA in three-dimensional display of the aneurysm and its relationship with surrounding vessels and organs. Two patients underwent open vascular surgery and three endovascular procedure. 3D contrast-enhanced MR angiography is a noninvasive and accurate technique for diagnosis of anomalous splenic artery aneurysms. Its 3D anatomic information is very helpful for treatment planning. It can be used as one of the first choice examinations for anomalous splenic artery aneurysms.

  18. [Role of angioplasty in the treatment of renal artery stenosis].

    Science.gov (United States)

    Armero, S; Bonello, L; Paganelli, F; Barragan, P; Roquebert, P-O; Commeau, P

    2011-12-01

    Atherosclerotic renal artery stenosis is frequent and is associated with a high incidence of morbidity and mortality, with a strong correlation with coronary artery disease, (Kalra et al., 2005; Cheung et al., 2002; Guo et al., 2007 [1-3]). The atherosclerotic renal artery stenosis is an independent predictive factor of death (Conlon et al., 1998 [4]). The treatment of this lesion does not have strong evidence. A lot of studies in this area suggest the angioplasty is superior in a big majority between surgery, and angioplasty with stent is superior between balloon angioplasty, but some studies fail to prove the superiority of angioplasty versus medical treatment. These studies have sadly a lot of mistakes and nowadays we don't know what is the treatment for our patients in a lot of cases. The angioplasty is indicated when there is a failure of antihypertensive medications for control of blood pressure, when it is associated with a renal insufficiency quickly progressive or when there is a lesion on each renal artery. Other studies must be organized for prove the superiority of angioplasty when there is a real stenosis, maybe with the use of fractional flow reserve.

  19. [Upper extremity arterial diseases].

    Science.gov (United States)

    Becker, F

    2007-02-01

    Compared to lower limb arterial diseases, upper limb arterial diseases look rare, heterogeneous with various etiologies and a rather vague clinical picture, but with a negligible risk of amputation. Almost all types of arterial diseases can be present in the upper limb, but the anatomical and hemodynamic conditions particular to the upper limb often confuse the issue. Thus, atherosclerosis affects mainly the subclavian artery in its proximal segment where the potential of collateral pathway is high making the symptomatic forms not very frequent whereas the prevalence of subclavian artery stenosis or occlusion is relatively high. The clinical examination and the etiologies are discussed according to the clinical, anatomical and hemodynamic context.

  20. A Rare Case of Aneurysm of Arc of Riolan Artery and Gastroduodenal Artery

    Directory of Open Access Journals (Sweden)

    Athiyappan Kumaresh

    2014-01-01

    Full Text Available Arc of Riolan is a collateral channel that connects the proximal superior mesenteric artery (SMA or its middle colic branch and the proximal inferior mesenteric artery or its left colic branch in case of stenosis of either of the arteries. A 65-year-old diabetic female presented with vague abdominal pain. Ultrasonography showed a large aneurysm within the abdomen in the left lumbar region. Computed tomography (CT angiography done showed severe diffuse atherosclerotic calcification of the abdominal aorta with complete occlusion of the celiac trunk and mild stenosis of SMA origin. The arc of Riolan was seen between the middle colic artery and the ascending branch of the left colic artery, with a large saccular aneurysm in its mid section. No evidence of rupture or hematoma was visible. Another saccular aneurysm was also seen involving the gastro-duodenal and the pancreatico-duodenal collateral arcade. As far as we know, this is the first case of arc of Riolan artery aneurysm to be reported in English literature.

  1. Paso superior en una ladera

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    Bender, O.

    1965-07-01

    Full Text Available The Redwood highway, through the Californian forest, runs on a viaduct, as it crosses a mountain slope of about 45° inclination. The firm ground is fairly deep, and as an additional constructional difficulty, it was necessary to respect the natural beauty of the countryside. A structure of portal frames were built, forming a number of short spans. These spans were bridged with metal girders, on which a 19 m wide deck was placed. The columns are hollow and have a transversal cross beam, to join each pair. There was difficulty in excavating the foundations for the columns, as it was necessary to dig through the soft top soil, and also prevent this soil from hurting the trunks of the forest trees. Another significant difficulty in the construction of this viaduct was the access to the working site, since there were no suitable platforms from which to operate the appropriate machinery. This made it necessary to do a lot of the work by manual operation. As one of the edges of the deck is very close to the mountain side, a supporting beam was erected on this side. It was made of concrete, on metal piles. The formwork for the deck structure was placed on the concrete stems of the supporting piles.La autopista denominada Redwood (California salva, con un paso superior, la ladera de un bosque cuya pendiente es del 1/1. El terreno firme se halla a bastante profundidad, añadiéndose, a los naturales problemas de la construcción, el imperativo de respetar la belleza agreste del paraje. La solución adoptada consiste en una estructura porticada, con varios tramos de pequeñas luces, salvados con vigas metálicas, sobre los que se coloca la losa del tablero, de 19 m de anchura total. Los soportes están constituidos por pórticos de dos montantes huecos (con bases de hormigón en masa por debajo del suelo, hasta el firme coronados por un cabezal. La perforación de pozos para el hormigonado de los montantes presentaba la dificultad de atravesar el terreno

  2. 5-HT is a potent relaxant in rat superior mesenteric veins

    OpenAIRE

    Watts, Stephanie W.; Darios, Emma S.; Seitz, Bridget M.; Janice M Thompson

    2015-01-01

    Serotonin (5-HT, 5-hydroxytryptamine) reduces blood pressure of the conscious rat when administered chronically (1 week). 5-HT does not directly relax isolated arteries, and microsphere experiments in 5-HT-infused rats suggested that 5-HT increased flow to the splanchnic bed. We hypothesized that 5-HT increased splanchnic flow because of direct venous relaxation; our focus was thus on the superior mesenteric vein (SMV) as an important vein in splanchnic circulation. Real-time RT-PCR, immunohi...

  3. The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: our first experience

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2016-06-01

    Full Text Available Complex cavernous sinus fistulae (CCF are still a technical challenge to neurovascular team. The most commonly performed treatment consists in endovascular embolization of the lesion through an arterial or venous approach. Not always these conventional routes are feasible, requiring alternative routes. We report a case of a 44-year-old woman with a complex indirect (Barrow D carotid cavernous sinus fistula treated by two interventional sessions that imposing a retrograde direct transvenous approach via the superior ophthalmic vein.

  4. Transradial artery coronary angioplasty.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J; de Melker, E

    1995-01-01

    This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty equipment is feasible and that no major puncture site-related complications occur because hemostasis is obtained easily and because no major structures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplasty was attempted in 122 lesions (type A n = 67 [55%], Type B n = 37 [30%], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantitative coronary analysis was performed. Radial artery function and structure were assessed clinically and with Doppler and two-dimensional ultrasound on the day of discharge. Coronary catheterization via the radial artery was successful in 94 patients (94%). The 6 remaining patients had successful PTCA via the femoral artery (n = 5) or the brachial artery (n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the total study population.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Acute arterial infarcts in patients with severe head injuries

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    Deepak Agrawal

    2012-01-01

    Full Text Available Aims and Objectives: To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Materials and Methods: Patients with severe head injury (Glasgow coma score (GCS ≤8 presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS at 1 month post-injury or at death (whichever came earlier. Results: Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1% had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3-85 years. Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1-3 was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21 in patients with severe head injury without arterial infarct. Conclusions: A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-a-vis patient without these findings.

  6. Pseudodisplacements of superior vena cava catheter in the persistent left superior vena cava

    Energy Technology Data Exchange (ETDEWEB)

    Jantsch, H.; Draxler, V.; Muhar, U.; Schlemmer, M.; Waneck, R.

    1983-01-01

    Pseudodisplacement of a left sided superior vena cava catheter in a persistent superior vena cava may be expected in adults in 0,37% and in a group of children with congenital heart disease in 2,5%. Embryology, anatomy and clinical implications is discussed on the basis of our own cases. The vena cava superior sinistra persitents is depending on a sufficient calibre a suitable vessel for a superior cava catheter.

  7. Acute occlusion of the left subclavian artery with artery dissection

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Subclavian steal syndrome is cerebral or brain stem ischemia resulting from diversion of blood flow from the basilar artery to the subclavian artery, which is caused by occlusive disease of either the subclavian artery or the innominate artery before they branch off at the vertebral artery. In the patients with subclavian steal syndrome the subclavian artery is fed by retrograde flow from the vertebral artery via the carotids and the circle of Willis.

  8. Does superior caval vein pressure impact head growth in Fontan circulation?

    Science.gov (United States)

    Trachsel, Tina; Balmer, Christian; Wåhlander, Håkan; Weber, Roland; Dave, Hitendu; Poretti, Andrea; Kretschmar, Oliver; Cavigelli-Brunner, Anna

    2016-10-01

    Patients with bidirectional cavopulmonary anastomosis have unphysiologically high superior caval vein pressure as it equals pulmonary artery pressure. Elevated superior caval vein pressure may cause communicating hydrocephalus and macrocephaly. This study analysed whether there exists an association between head circumference and superior caval vein pressure in patients with single ventricle physiology. We carried out a retrospective analysis of infants undergoing Fontan completion at our institution from 2007 to 2013. Superior caval vein pressures were measured during routine catheterisation before bidirectional cavopulmonary anastomosis and Fontan completion as well as head circumference, adjusted to longitudinal age-dependent percentiles. We included 74 infants in our study. Median ages at bidirectional cavopulmonary anastomosis and Fontan were 4.8 (1.6-12) and 27.9 (7-40.6) months, respectively. Head circumference showed significant growth from bidirectional cavopulmonary anastomosis until Fontan completion (7th (0-100th) versus 20th (0-100th) percentile). There was no correlation between superior caval vein pressure and head circumference before Fontan (R2=0.001). Children with lower differences in superior caval vein pressures between pre-bidirectional cavopulmonary anastomosis and pre-Fontan catheterisations showed increased growth of head circumference (R2=0.19). Patients with moderately elevated superior caval vein pressure associated with single ventricle physiology did not have a tendency to develop macrocephaly. There is no correlation between superior caval vein pressure before Fontan and head circumference, but between bidirectional cavopulmonary anastomosis and Fontan head circumference increases significantly. This may be explained by catch-up growth of head circumference in patients with more favourable haemodynamics and concomitant venous pressures in the lower range. Further studies with focus on high superior caval vein pressures are needed to

  9. Treatment of carotid-cavernous sinus fistulas retrograde via the superior ophthalmic vein (SOV).

    Science.gov (United States)

    Derang, J; Ying, H; Long, Y; Reifa, S; Qiming, W; Yimu, F; Guoxiang, S; Shimin, C; Lihua, X; Shi, W; Zunhua, C

    1999-09-01

    Carotid-cavernous sinus fistula is an old difficulty in neurosurgery. At present, the main way to deal with it is by embolizing the fistula via an arterial route. But if the fistula is small or supplied by several branches, it is difficult to embolize via an arterial approach. In this report, 21 patients with carotid-cavernous sinus fistulae were successfully cured by embolizing the fistula via the SOV approach. All patients were cured, and there were no serious postoperative complications. Follow-up has been carried out in 19 cases for 8 months to more than 4 years; no recurrence manifested. For carotid-cavernous sinus fistulae that cannot be embolized arterially, the superior ophthalmic vein route is an easy, safe, effective and promising approach.

  10. Variation of the Lateral Sacral Artery in relation to Sciatic Neuropathy

    Directory of Open Access Journals (Sweden)

    Waseem Al Talalwah

    2014-01-01

    Full Text Available The lateral sacral artery usually originates from the posterior trunk of the internal iliac artery. The current study of 342 specimens from 171 cadavers (79 male, 92 female investigated the origin and course of the lateral sacral artery. It was observed to arise from the posterior trunk in 79.1%. Occasionally it originated from the anterior trunk that occurred in 1%. It arose from the sciatic artery in 8.8%, from the superior gluteal artery in 16.8%, and from the inferior gluteal artery in 5.4%. Conversely, the lateral sacral artery is congenital absence in 0.3%. In addition, the lateral sacral artery was single, double, triple, and quadruple in 77.2%, 19.8%, 2.3%, and 0.3%, respectively. Consequently, variability of the lateral sacral artery origin is due to vascular demand as the lateral sacral artery plexus does arise from the earlier trunk development. With variability of the lateral sacral artery origin, there is a variability of the sciatic nerve supply. Knowing the variability of origins, surgeons have to avoid prolonged ligation of the internal iliac artery or its posterior trunk during surgical procedures which may lead to sciatic neuropathy. Therefore, the lateral sacral artery origin, course, and branches are important for clinicians to improve their knowledge and patient management.

  11. Bilateral accessory thoracodorsal artery.

    Science.gov (United States)

    Natsis, Konstantinos; Totlis, Trifon; Tsikaras, Prokopios; Skandalakis, Panagiotis

    2006-09-01

    The subscapular artery arises from the third part of the axillary artery and gives off the circumflex scapular and the thoracodorsal arteries. Although anatomical variations of the axillary artery are very common, the existence of a unilateral accessory thoracodorsal artery has been described in the literature only once. There are no reports of bilateral accessory thoracodorsal artery, in the literature. In the present study, a bilateral accessory thoracodorsal artery, originating on either side of the third part of the axillary artery, is described in a 68-year-old female cadaver. All the other branches of the axillary artery had a typical origin, course, distribution and termination. This extremely rare anatomical variation apart from the anatomical importance also has clinical significance for surgeons in this area. Especially, during the dissection or mobilization of the latissimus dorsi that is partly used for coverage problems in many regions of the body and also in dynamic cardiomyoplasty, any iatrogenic injury of this accessory artery may result in ischemia and functional loss of the graft.

  12. Superiority in value and the repugnant conclusion

    DEFF Research Database (Denmark)

    Jensen, Karsten Klint

    2007-01-01

    James Griffin has considered a weak form of superiority in value a possible remedy to the Repugnant Conclusion. In this paper, I demonstrate that, in a context where value is additive, this weaker form collapses into a stronger form of superiority. And in a context where value is non-additive, weak...... superiority does not amount to a radical value difference at all. I then spell out the consequences of these results for different interpretations of Griffin's suggestion regarding population ethics. None of them comes out very successful, but perhaps they nevertheless retain some interest....

  13. Morphology and biomechanical properties of cerebellar arteries in adults

    Directory of Open Access Journals (Sweden)

    Olga A. Fomkina

    2016-06-01

    Full Text Available The goal was to analyze the variability of a number of morphometric and biomechanical parameters of cerebellar arteries in adults aged 20-74 years. Material and Methods ― 179 samples of cerebellar arteries, obtained by autopsy of adults without acute cerebrovascular pathology have been studied; 24 preparations of arterial complexes «arterial circle – cerebral arteries» from scientific collection of Human Anatomy Department of Saratov State Medical University (Saratov, Russia have been also investigated. Research methods were: preparation, microscopy, experiments on uniaxial longitudinal stretching at a tensile testing machine Tira Test 28005 (TIRA GmbH, Germany. We studied outer diameter, angle of divergence, overall strength and maximal relative deformation of superior (SCA, anterior inferior (AICA and posterior inferior cerebellar arteries (PICA. Results and Conclusion ― It was revealed that SCA was characterized by the largest diameter and angle of divergence, the most strength and extensibility. AICA and PICA had no significant differences of the studied parameters. It was noted that AICA originated in the lower third part of basilar artery 1.5 times more likely than in the middle third part of this artery.

  14. Endovascular Treatment of a Huge Hepatic Artery Aneurysm by Coil Embolization Method: A Case Report.

    Science.gov (United States)

    Hemmati, Hossein; Karimian, Mehdi; Moradi, Habibollah; Farid Marandi, Kambiz; Haghdoost, Afrooz

    2015-07-01

    Hepatic artery aneurysms are rare but potentially life threatening. We describe a novel case of a successful endovascular coil embolization of a huge hepatic artery aneurysm. A 67-year-old woman presented with recent abdominal pain that had begun from 2 weeks before referring to our hospital. Sonographic and computerized tomographic (CT) findings revealed a huge hepatic artery aneurysm with 95 mm × 83 mm diameter. The patient underwent an endovascular technique. In aortic angiography, the celiac artery orifice and superior mesenteric artery were so narrow, so sonography was used in order to determine the exact position of the catheter in the celiac artery orifice. The aneurysm was thrombosed using coil embolization. Pulsation of the aneurysm immediately disappeared. Huge hepatic artery aneurysm can be safely treated using coil embolization.

  15. Millian superiorities and the repugnant conclusion

    DEFF Research Database (Denmark)

    Jensen, Karsten Klint

    2008-01-01

    James Griffin has considered a form of superiority in value that is weaker than lexical priority as a possible remedy to the Repugnant Conclusion. In this article, I demonstrate that, in a context where value is additive, this weaker form collapses into the stronger form of superiority. And in a ......James Griffin has considered a form of superiority in value that is weaker than lexical priority as a possible remedy to the Repugnant Conclusion. In this article, I demonstrate that, in a context where value is additive, this weaker form collapses into the stronger form of superiority...... of these results for different interpretations of Griffin's suggestion regarding population ethics. None of them comes out very successful, but perhaps they nevertheless retain some interest....

  16. Measuring Financial Gains from Genetically Superior Trees

    Science.gov (United States)

    George Dutrow; Clark Row

    1976-01-01

    Planting genetically superior loblolly pines will probably yield high profits.Forest economists have made computer simulations that predict financial gains expected from a tree improvement program under actual field conditions.

  17. Popliteal artery entrapment syndrome.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2010-01-01

    Popliteal artery entrapment syndrome is a rare abnormality of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. The following is a case report of a 19 year old female, in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically. A review of literature is also presented and provides details on how PAES is classified, diagnosed both clinically and radiologically, and treated surgically.

  18. Celiac Artery Compression Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammed Muqeetadnan

    2013-01-01

    Full Text Available Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

  19. Arterial waveform analysis.

    Science.gov (United States)

    Esper, Stephen A; Pinsky, Michael R

    2014-12-01

    The bedside measurement of continuous arterial pressure values from waveform analysis has been routinely available via indwelling arterial catheterization for >50 years. Invasive blood pressure monitoring has been utilized in critically ill patients, in both the operating room and critical care units, to facilitate rapid diagnoses of cardiovascular insufficiency and monitor response to treatments aimed at correcting abnormalities before the consequences of either hypo- or hypertension are seen. Minimally invasive techniques to estimate cardiac output (CO) have gained increased appeal. This has led to the increased interest in arterial waveform analysis to provide this important information, as it is measured continuously in many operating rooms and intensive care units. Arterial waveform analysis also allows for the calculation of many so-called derived parameters intrinsically created by this pulse pressure profile. These include estimates of left ventricular stroke volume (SV), CO, vascular resistance, and during positive-pressure breathing, SV variation, and pulse pressure variation. This article focuses on the principles of arterial waveform analysis and their determinants, components of the arterial system, and arterial pulse contour. It will also address the advantage of measuring real-time CO by the arterial waveform and the benefits to measuring SV variation. Arterial waveform analysis has gained a large interest in the overall assessment and management of the critically ill and those at a risk of hemodynamic deterioration.

  20. 腹壁下动脉超声探查在腹股沟疝鉴别诊断中的意义%The significance of ultrasound exploration for inferior epigastric arteries in the differ ential diagnoses of inguinal hernias

    Institute of Scientific and Technical Information of China (English)

    徐晓航; 王兴祥

    2001-01-01

    目的 探讨腹壁下动脉超声探查在腹股沟疝鉴别诊断中的价值.方法 用彩色多谱勒超声诊断仪探查105例腹股沟疝患者的双侧腹壁下动脉,并根据疝囊颈和疝囊位于腹壁下动脉内侧还是外侧确定患者为直疝抑或斜疝.结果 (1)102例患者的腹壁下动脉超声探查能清楚显示,另3例显示不清;(2)根据超声探查结果诊断16例患者为直疝,86例为斜疝,与手术结果相符.结论 腹壁下动脉超声探查是鉴别诊断腹股沟直疝、斜疝一种简便、准确、可行的方法 ,值得临床推广应用.

  1. Anatomical variation of the origin of the left vertebral artery

    Directory of Open Access Journals (Sweden)

    Patasi B

    2009-08-01

    Full Text Available This paper presents and describes the anatomical variation of the left vertebral artery originating from the arch of aorta as a case report. This variation was found in one of the cadavers at the Division of Clinical and Functional Anatomy, Faculty of Medicine, University of Ottawa. During routine dissection of a male cadaver, in the superior mediastinum and the neck we observed an atypical origin of the left vertebral artery. Atypical origin was compared to the typical origin of the left vertebral artery in the anatomical literature. We compared our findings with different possible variations of the origin of the left vertebral artery reported in the literature. The clinical importance of the variation is discussed.

  2. Superior oblique surgery: when and how?

    Directory of Open Access Journals (Sweden)

    Taylan Şekeroğlu H

    2013-08-01

    Full Text Available Hande Taylan Şekeroğlu,1 Ali Sefik Sanac,1 Umut Arslan,2 Emin Cumhur Sener11Department of Ophthalmology, 2Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, TurkeyBackground: The purpose of this paper is to review different types of superior oblique muscle surgeries, to describe the main areas in clinical practice where superior oblique surgery is required or preferred, and to discuss the preferred types of superior oblique surgery with respect to their clinical outcomes.Methods: A consecutive nonrandomized retrospective series of patients who had undergone superior oblique muscle surgery as a single procedure were enrolled in the study. The diagnosis, clinical features, preoperative and postoperative vertical deviations in primary position, type of surgery, complications, and clinical outcomes were reviewed. The primary outcome measures were the type of strabismus and the type of superior oblique muscle surgery. The secondary outcome measure was the results of the surgeries.Results: The review identified 40 (20 male, 20 female patients with a median age of 6 (2–45 years. Nineteen patients (47.5% had Brown syndrome, eleven (27.5% had fourth nerve palsy, and ten (25.0% had horizontal deviations with A pattern. The most commonly performed surgery was superior oblique tenotomy in 29 (72.5% patients followed by superior oblique tuck in eleven (27.5% patients. The amount of vertical deviation in the fourth nerve palsy and Brown syndrome groups (P = 0.01 for both and the amount of A pattern in the A pattern group were significantly reduced postoperatively (P = 0.02.Conclusion: Surgery for the superior oblique muscle requires experience and appropriate preoperative evaluation in view of its challenging nature. The main indications are Brown syndrome, fourth nerve palsy, and A pattern deviations. Superior oblique surgery may be effective in terms of pattern collapse and correction of vertical deviations in primary

  3. Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Bilhim, Tiago [Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon (Portugal); Hospital Saint Louis, Interventional Radiology, Lisbon (Portugal); Pisco, Joao M. [Hospital Saint Louis, Interventional Radiology, Lisbon (Portugal); Universidade Nova de Lisboa, Departamento Universitario de Radiologia, Faculdade de Ciencias Medicas, Lisbon (Portugal); Furtado, Andrea; Casal, Diogo; Pais, Diogo; O' Neill, Joao E.G. [Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon (Portugal); Campos Pinheiro, Luis [Universidade Nova de Lisboa, Departamento Universitario de Urologia, Faculdade de Ciencias Medicas, Lisbon (Portugal)

    2011-05-15

    To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA). DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides. The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%). Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation. (orig.)

  4. Anomalous origin of right coronary artery from pulmonary artery

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    Rajat Gupta

    2012-01-01

    Full Text Available Anomalous origin of coronary artery from the pulmonary artery is a rare anomaly that most frequently involves the left coronary artery and very rarely the right coronary artery. These lesions can be missed on echocardiography unless carefully looked for. We describe a case of isolated anomalous origin of right coronary artery from pulmonary artery diagnosed on echocardiography and confirmed by computed tomography (CT angiography.

  5. Volume-rendered hemorrhage-responsible arteriogram created by 64 multidetector-row CT during aortography: utility for catheterization in transcatheter arterial embolization for acute arterial bleeding.

    Science.gov (United States)

    Minamiguchi, Hiroki; Kawai, Nobuyuki; Sato, Morio; Ikoma, Akira; Sanda, Hiroki; Nakata, Kouhei; Tanaka, Fumihiro; Nakai, Motoki; Sonomura, Tetsuo; Murotani, Kazuhiro; Hosokawa, Seiki; Nishioku, Tadayoshi

    2014-01-01

    Aortography for detecting hemorrhage is limited when determining the catheter treatment strategy because the artery responsible for hemorrhage commonly overlaps organs and non-responsible arteries. Selective catheterization of untargeted arteries would result in repeated arteriography, large volumes of contrast medium, and extended time. A volume-rendered hemorrhage-responsible arteriogram created with 64 multidetector-row CT (64MDCT) during aortography (MDCTAo) can be used both for hemorrhage mapping and catheter navigation. The MDCTAo depicted hemorrhage in 61 of 71 cases of suspected acute arterial bleeding treated at our institute in the last 3 years. Complete hemostasis by embolization was achieved in all cases. The hemorrhage-responsible arteriogram was used for navigation during catheterization, thus assisting successful embolization. Hemorrhage was not visualized in the remaining 10 patients, of whom 6 had a pseudoaneurysm in a visceral artery; 1 with urinary bladder bleeding and 1 with chest wall hemorrhage had gaze tamponade; and 1 with urinary bladder hemorrhage and 1 with uterine hemorrhage had spastic arteries. Six patients with pseudoaneurysm underwent preventive embolization and the other 4 patients were managed by watchful observation. MDCTAo has the advantage of depicting the arteries responsible for hemoptysis, whether from the bronchial arteries or other systemic arteries, in a single scan. MDCTAo is particularly useful for identifying the source of acute arterial bleeding in the pancreatic arcade area, which is supplied by both the celiac and superior mesenteric arteries. In a case of pelvic hemorrhage, MDCTAo identified the responsible artery from among numerous overlapping visceral arteries that branched from the internal iliac arteries. In conclusion, a hemorrhage-responsible arteriogram created by 64MDCT immediately before catheterization is useful for deciding the catheter treatment strategy for acute arterial bleeding.

  6. Medial Pancreatectomy for a Neuroendocrine Tumor Invading the Splenic Artery and Vein

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    Abdelmounaim Ait-Ali

    2010-01-01

    Full Text Available Context Pancreatic tumors in the midportion have traditionally been treated by an extended right or left pancreatectomy. A medial or central pancreatectomy is an alternative technique for benign or low-grade malignant neoplasms located to the left of the gastroduodenal artery and close to the splenomesenteric confluence. Case report A 38-year-old woman with no previous surgical history presented with epigastric abdominal pain. A computed tomography scan showed a 4 cm heterogeneous lesion within the pancreatic body. This tumor invaded the splenic artery and vein. There was no postoperative diabetes mellitus or exocrine insufficiency. The patient continues to be well after a 10-month follow-up without pancreatic insufficiency or local recurrence, and CT has demonstrated splenic perfusion by the collateral vessels. Conclusion We believe that a medial or central pancreatectomy may be a safe procedure where there is involvement of the large splenic vessels by a low grade malignant pancreatic tumor and that a systematic splenectomy is not justified.

  7. Artery by Neuropeptides

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    Esmeralda Sofia Costa Delgado

    2012-01-01

    Methods. Isolated rabbit eyes (n=12 were perfused in situ with tyrode through the external ophthalmic artery. Effects of intra-arterial injections of NPY 200 μg/ml (Group A; n=6 and VIP 200 μg/ml (Group B; n=6 on the recorded pressure were obtained. For statistical analysis, Student's paired t-test and Fast Fourier Transform were used. Results. Spontaneous oscillations were observed before any drug administration in the 12 rabbit models. NPY produced an increase in total vascular resistance and a higher frequency and amplitude of oscillations, while VIP evoked the opposite effects. Conclusions. This study provides evidence of vasomotion in basal conditions in rabbit external ophthalmic artery. Concerning drug effects, NPY increased arterial resistance and enhanced vasomotion while VIP produced opposite effects which demonstrates their profound influence in arterial vasomotion.

  8. Arterial hypoxaemia in cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Hillingsø, Jens; Christensen, E

    1998-01-01

    BACKGROUND: Although low arterial oxygen tension (Po2) has been claimed to occur in one to two thirds of patients with cirrhosis, hypoxaemia appears to be rare in clinical practice. AIMS: To assess the frequency of arterial hypoxaemia in cirrhosis in relation to clinical and haemodynamic......%, 96%, 96%, and 93% (NS). So2 was below the lower limit of 92% in 0%, 9%, 7%, and 24% (p arterial carbon dioxide tension, a low systemic vascular...... resistance, and a low indocyanine green clearance (p arterial hypoxaemia in cirrhosis is about 22% in patients without encephalopathy, but it varies from 10-40% depending on the degree of hepatic dysfunction. Arterial hypoxaemia in patients with cirrhosis of differing...

  9. Whisker-related afferents in superior colliculus.

    Science.gov (United States)

    Castro-Alamancos, Manuel A; Favero, Morgana

    2016-05-01

    Rodents use their whiskers to explore the environment, and the superior colliculus is part of the neural circuits that process this sensorimotor information. Cells in the intermediate layers of the superior colliculus integrate trigeminotectal afferents from trigeminal complex and corticotectal afferents from barrel cortex. Using histological methods in mice, we found that trigeminotectal and corticotectal synapses overlap somewhat as they innervate the lower and upper portions of the intermediate granular layer, respectively. Using electrophysiological recordings and optogenetics in anesthetized mice in vivo, we showed that, similar to rats, whisker deflections produce two successive responses that are driven by trigeminotectal and corticotectal afferents. We then employed in vivo and slice experiments to characterize the response properties of these afferents. In vivo, corticotectal responses triggered by electrical stimulation of the barrel cortex evoke activity in the superior colliculus that increases with stimulus intensity and depresses with increasing frequency. In slices from adult mice, optogenetic activation of channelrhodopsin-expressing trigeminotectal and corticotectal fibers revealed that cells in the intermediate layers receive more efficacious trigeminotectal, than corticotectal, synaptic inputs. Moreover, the efficacy of trigeminotectal inputs depresses more strongly with increasing frequency than that of corticotectal inputs. The intermediate layers of superior colliculus appear to be tuned to process strong but infrequent trigeminal inputs and weak but more persistent cortical inputs, which explains features of sensory responsiveness, such as the robust rapid sensory adaptation of whisker responses in the superior colliculus. Copyright © 2016 the American Physiological Society.

  10. RELATIONSHIP BETWEEN THE FACIAL ARTERY AND SUB MANDIBULAR SALIVARY GLAND

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    S.V.Venugopal,

    2014-09-01

    Full Text Available Knowledge of relationship between the facial artery and submandibular salivary gland is essential for the surgeon operating in the submandibular region. This study has been under taken to have the knowledge of this relationship. Submandibular region has been dissected on 20 male cadavers in the Department of Anatomy, Sree Narayana Institute of Medical Sciences, Kerala. The course of the facial artery and its relationship to submandibular salivary gland has been followed carefully. The standard description of ascent of the facial artery along the entire length of posterior border of the submandibular salivary gland was seen in 15 out of the 20 sides studied. In 4 out of 20 sides dissected the facial artery reached only the upper part of the posterior border of the gland. The facial artery arose high on the external carotid artery near the angle of the mandible in one specimen. It reached the gland only at its postero-superior angle, pierced through the gland and emerged on the upper part of the lateral surface of the gland. Our study shows that only 1/5 of instances facial artery courses along the posterior border of the gland. In 4/5 of instances it reaches only the upper part of the posterior border.

  11. Segmental arterial mediolysis accompanied by renal infarction and pancreatic enlargement: a case report

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    Ito Nobuhisa

    2012-09-01

    Full Text Available Abstract Introduction Due to recent advances in imaging diagnostic techniques, there are an increasing number of case reports of segmental arterial mediolysis. However, there are only a limited number of reports on segmental arterial mediolysis-related abnormalities of abdominal organs other than the intestine. This report describes a case of segmental arterial mediolysis accompanied by abnormalities of abdominal organs without clinical symptoms. Case presentation A 52-year-old Japanese man with hematuria and no prior medical history was referred to a urologist and was diagnosed as having urinary bladder cancer. He underwent trans-urethral resection of the bladder tumor and intra-vesical instillation therapy, which was followed by observation. During follow-up, although no abdominal symptoms were observed, an abdominal computed tomography scan revealed a dissection of the superior mesenteric artery. A false lumen partially occluded by a thrombus was located distal to this occlusion. The lumen was irregularly shaped with narrow and wide sections. Similar irregularities were also observed in the wall of the inferior mesenteric artery. Arterial dissection with thromboembolism in the left renal artery and renal infarction was also observed. Follow-up computed tomography after two months revealed an enlargement of the pancreatic tail adjacent to the splenic artery. Follow-up three-dimensional computed tomography showed gradual re-expansion of the true lumen of the superior mesenteric artery, improvement in arterial wall irregularities, and a reduction in the pancreas enlargement and renal infarction. Over the following 15 months, these changes gradually normalized. On the basis of the vascular changes in multiple arterial systems that resolved spontaneously, we considered that the lesions were associated with segmental arterial mediolysis. Conclusions We present a rare case of segmental arterial mediolysis accompanied by abnormalities of abdominal

  12. Superior-subordinate relations as organizational processes

    DEFF Research Database (Denmark)

    Asmuss, Birte; Aggerholm, Helle Kryger; Oshima, Sae

    Since the emergence of the practice turn in social sciences (Golsorkhi et al. 2010), studies have shown a number of institutionally relevant aspects as achievements across time and by means of various resources (human and non-human) (Taylor & van Every 2000, Cooren et al. 2006). Such a process view...... on organizational practices relates closely to an increased focus on communication as being constitutive of the organization in general and the superior-subordinate relationship in specific. The current study aims to contribute to this line of research by investigating micro-practices involved in establishing...... superior-subordinate relations in a specific institutionalized setting: performance appraisal interviews (PAIs). While one main task of PAIs is to manage and integrate organizational and employee performance (Fletcher, 2001:473), PAIs are also organizational practices where superior-subordinate relations...

  13. Lake Superior Aquatic Invasive Species Complete Prevention Plan

    Science.gov (United States)

    The Lake Superior Aquatic Invasive Species Complete Prevention Plan is an expression of the best professional judgment of the members of the Lake Superior Task Force as to what is necessary to protect Lake Superior from new aquatic invasive species.

  14. Endovascular treatment of superior vena cava syndrome

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Andersen, Poul Erik

    2011-01-01

    Abstract AIM: The aim of this study was to report our experience with palliative stent treatment of superior vena cava syndrome. METHODS: Between January 2008 and December 2009, 30 patients (mean age 60.7 years) were treated with stents because of stenosed superior vena cava. All patients presented...... there was an immediate clinical improvement with considerable reduction in the edema of upper extremities and head. There was, however, continous dyspnea in five patients (17%) and two patients (7%) had persistent visible collateral venous circulations on the upper chest. There were no stent associated complications...

  15. 5-hydroxytryptamine (5-HT) reduces total peripheral resistance during chronic infusion: direct arterial mesenteric relaxation is not involved.

    Science.gov (United States)

    Davis, Robert Patrick; Pattison, Jill; Thompson, Janice M; Tiniakov, Ruslan; Scrogin, Karie E; Watts, Stephanie W

    2012-05-06

    Serotonin (5-hydroxytryptamine; 5-HT) delivered over 1 week results in a sustained fall in blood pressure in the sham and deoxycorticosterone acetate (DOCA)-salt rat. We hypothesized 5-HT lowers blood pressure through direct receptor-mediated vascular relaxation. In vivo, 5-HT reduced mean arterial pressure (MAP), increased heart rate, stroke volume, cardiac index, and reduced total peripheral resistance during a 1 week infusion of 5-HT (25 µg/kg/min) in the normotensive Sprague Dawley rat. The mesenteric vasculature was chosen as an ideal candidate for the site of 5-HT receptor mediated vascular relaxation given the high percentage of cardiac output the site receives. Real-time RT-PCR demonstrated that mRNA transcripts for the 5-HT2B, 5-HT1B, and 5-HT7 receptors are present in sham and DOCA-salt superior mesenteric arteries. Immunohistochemistry and Western blot validated the presence of the 5-HT2B, 5- HT1B and 5-HT7 receptor protein in sham and DOCA-salt superior mesenteric artery. Isometric contractile force was measured in endothelium-intact superior mesenteric artery and mesenteric resistance arteries in which the contractile 5- HT2A receptor was antagonized. Maximum concentrations of BW-723C86 (5- HT2B agonist), CP 93129 (5-HT1B agonist) or LP-44 (5-HT7 agonist) did not relax the superior mesenteric artery from DOCA-salt rats vs. vehicle. Additionally, 5-HT (10-9 M to 10-5 M) did not cause relaxation in either contracted mesenteric resistance arteries or superior mesenteric arteries from normotensive Sprague- Dawley rats. Thus, although 5-HT receptors known to mediate vascular relaxation are present in the superior mesenteric artery, they are not functional, and are therefore not likely involved in a 5-HT-induced fall in total peripheral resistance and MAP.

  16. Emborrhoid: A New Concept for the Treatment of Hemorrhoids with Arterial Embolization: The First 14 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Vidal, V., E-mail: vincent.vidal@ap-hm.fr [Hôpital de la Timone, Department of Radiology (France); Sapoval, M., E-mail: marc.sapoval@gmail.com [Hopital Européen Georges Pompidou, Department of Radiology (France); Sielezneff, Y., E-mail: igor.sielezneff@ap-hm.fr [Hôpital de la Timone, Department of Digestive and General Surgery (France); Parades, V. De, E-mail: v.deparades@gmail.com [Hopital Saint Joseph, Department of Proctology (France); Tradi, F., E-mail: farouk.tradi@ap-hm.fr; Louis, G., E-mail: guillaume.louis@ap-hm.fr; Bartoli, J. M., E-mail: jean-michel.bartoli@ap-hm.fr [Hôpital de la Timone, Department of Radiology (France); Pellerin, O., E-mail: olivier.pellerin@egp.aphp.fr [Hopital Européen Georges Pompidou, Department of Radiology (France)

    2015-02-15

    PurposeThe ‘emborrhoid’ technique consists of the embolization of the hemorrhoidal arteries. The endovascular arterial occlusion is performed using coils placed in the terminal branches of the superior rectal arteries. The emborrhoid technique has been modeled after elective transanal Doppler-guided hemorrhoidal artery ligation which has been shown to be effective in hemorrhoidal disease. We report the first 14 cases of our experience with emborrhoid technique.Materials and MethodsFourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique (3 women, 11 men). The stage of the hemorrhoidal disease was II (10 patients), III (3), and IV (1). This treatment was decided by a multidisciplinary team (proctologist, visceral surgeon, and radiologist). Seven patients underwent previous proctological surgery. Ten patients had coagulation disorders (anticoagulants or cirrhosis). Superior rectal arteries were embolized with pushable microcoils (0.018).ResultsTechnical success of the embolization procedure was 100 %. Clinical success at 1 month was 72 % (10/14). Of the 4 patients who experienced rebleeding, two underwent additional embolization of the posterior rectal arteries with success. No pain or ischemic complications were observed in 13 patients. One patient experienced a temporary painful and edematous, perianal reaction.ConclusionOur case studies suggest that coil embolization of the superior rectal arteries is technically feasible, safe and well tolerated. Additional studies are needed to evaluate the efficacy of this new ‘emborrhoid’ technique in the management of hemorrhoidal disease.

  17. Concomitant Superior Mesenteric, Celiac, Renal, and Aortoiliac Aneurysm; Ultrasonography, CT and MRA Findings in A Case Report

    Directory of Open Access Journals (Sweden)

    S. A. Nabavizadeh

    2008-01-01

    Full Text Available Introduction: Visceral artery aneurysms are rare vas-cular diseases whose pathogenesis and natural history remain incompletely understood. Herein we describe an 80 year-old man with concomitant superior mes-enteric, celiac, renal, and aorto-iliac aneurysms. To the best of our knowledge this constellation of arte-rial aneurysms has not been described yet."nCase Presentation: An 80-year-old man was referred to our institution due to presence of tarry stool and one episode of vomiting of coffee ground material. The patient underwent an upper GI endoscopy which revealed esophageal varicosities. Due to presence of esophageal varicosities and clinical suspicion of portal vein thrombosis an ultrasonographic Doppler study of portal venous system was performed in this patient which revealed normal diameter and flow in portal and splenic veins with no evidence of thrombosis; however incidentally aneurismal dilatation of celiac and superior mesenteric arteries and lower part of abdominal aorta and both iliac arteries were found during the ultrasonographic examination. Abdominal CT scan was performed in this patient, which re-vealed aneurismal dilatation of main celiac artery and its main branches. There was also aneurismal dilata-tion of superior mesenteric artery. Aneurismal dilata-tion of distal abdominal aorta with extension to both side common, external, and internal iliac arteries was also seen. MRA of abdomen was also performed which revealed the previous findings plus apparent dilatation of proximal part of right main renal artery which was not considered in previous abdominal CT scan. Since then; he has remained asymptomatic and stable, with no evidence of further expansion of his aneurysms in routine sonographic examinations."nDiscussion: Our patient was a hypertensive hyperlip-idemic old man with history of previous TIA and atherosclerotic carotid plaques, so the most important predisposing factor seemed to be atherosclerosis. Sev-eral work

  18. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography*

    Science.gov (United States)

    Araujo Neto, Severino Aires; Franca, Henrique Almeida; de Mello Júnior, Carlos Fernando; Silva Neto, Eulâmpio José; Negromonte, Gustavo Ramalho Pessoa; Duarte, Cláudia Martina Araújo; Cavalcanti Neto, Bartolomeu Fragoso; Farias, Rebeca Danielly da Fonseca

    2015-01-01

    Objective To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials and Methods Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS. PMID:26811552

  19. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Severino Aires Araujo Neto

    2015-12-01

    Full Text Available Abstract Objective: To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT branches and hepatic arterial system (HAS, as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials and Methods: Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results: The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5% and 2 (3.3% patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08. A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion: The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS.

  20. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Araujo Neto, Severino Aires; Franca, Henrique Almeida; Mello Junior, Carlos Fernando de; Silva Neto, Eulampio Jose; Negromonte, Gustavo Ramalho Pessoa; Duarte, Claudia Martina Araujo; Cavalcanti Neto, Bartolomeu Fragoso; Farias, Rebeca Danielly da Fonseca, E-mail: severinoaires@hotmail.com [Universidade Federal da Paraiba (UFPB), Joao Pessoa, PB (Brazil)

    2015-11-15

    Objective: To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials And Methods: Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results: The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion: The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS. (author)

  1. Magnetic resonance imaging evaluation of meniscoid superior labrum: normal variant or superior labral tear*

    Science.gov (United States)

    Simão, Marcelo Novelino; Vinson, Emily N.; Spritzer, Charles E.

    2016-01-01

    Objective The objective of this study was to determine the incidence of a "meniscoid" superior labrum. Materials and Methods This was a retrospective analysis of 582 magnetic resonance imaging examinations of shoulders. Of those 582 examinations, 110 were excluded, for a variety of reasons, and the final analysis therefore included 472 cases. Consensus readings were performed by three musculoskeletal radiologists using specific criteria to diagnose meniscoid labra. Results A meniscoid superior labrum was identified in 48 (10.2%) of the 472 cases evaluated. Arthroscopic proof was available in 21 cases (43.8%). In 10 (47.6%) of those 21 cases, the operative report did not include the mention a superior labral tear, thus suggesting the presence of a meniscoid labrum. In only one of those cases were there specific comments about a mobile superior labrum (i.e., meniscoid labrum). In the remaining 11 (52.4%), surgical correlation demonstrated superior labral tears. Conclusion A meniscoid superior labrum is not an infrequent finding. Depending upon assumptions and the requirement of surgical proof, the prevalence of a meniscoid superior labrum in this study was between 2.1% (surgically proven) and 4.8% (projected). However, superior labral tears are just as common and are often confused with meniscoid labra. PMID:27777474

  2. Coronary Artery Bypass

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    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  3. Coronary artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Koischwitz, D.; Harder, T.; Schuppan, U.; Thurn, P.

    1982-04-01

    Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

  4. A 6-year experience with radial artery conduit for myocardial revascularization

    Directory of Open Access Journals (Sweden)

    A Sadeghpour-Tabaee

    2007-07-01

    Full Text Available Background: Excellent long-term patencies of arterial grafts are considered, superior to those of vein grafts. In this study, we present our 6 years experience in using radial artery as a conduit for myocardial revascularization. The aim of the present study was to assess the safety and early and mid term results of using radial artery in coronary artery bypass graft. Methods: The radial artery used as a conduit in 308 cases was evaluated during past 6 years, and the results obtained were processed and analyzed. Results: The operative morbidity comprised re-operation for bleeding in 3.2%, MI in 5%, with paresthesis and stitch abscess of the hand in 10% in and 3.5% respectively. Hospital mortality included 2 patients, one case being directly due to complication of harvesting radial artery.Conclusion: The results of present study were satisfactory with acceptable morbidity and mortality and favored the application of this conduit to CABG patients.

  5. Postprandial lower limb pain: An unusual presentation of visceral arteries occlusion.

    Science.gov (United States)

    Patelis, Nikolaos; Papoutsis, Konstantinos; Liakopoulos, Dimitrios; Koutsoumpelis, Andreas; Bakogiannis, Christos; Georgopoulos, Sotirios

    2015-06-01

    This case report describes an atypical and unique presentation of mesenteric arteries occlusive disease. The patient presented with typical symptoms of chronic mesenteric ischemia, as well as with an atypical new symptom; postprandial buttock and lower limbs pain. Pain followed the time curve of the postprandial abdominal discomfort, starting 30 min after meals and gradually resolving within 2 h. The patient had been tolerating the signs of chronic mesenteric ischemia quite well by adjusting the quantity of food per meal to relieve symptoms. Angiography showed that the celiac artery, the superior mesenteric artery, and distal aorta were occluded, leaving the inferior mesenteric artery as the only feeding vessel of all abdominal viscera and both the lower limbs. Since an English medical literature search returned only one marginally similar case, we consider this case of iliac arteries' "steal syndrome" from the inferior mesenteric artery unique.

  6. Pulmonary Arterial Hypertension

    Science.gov (United States)

    Pulmonary Arterial Hypertension What Is Pulmonary Hypertension? To understand pulmonary hypertension (PH) it helps to understand how blood ows throughout your body. While the heart is one organ, it ...

  7. Neonatal pulmonary artery thrombosis

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    Mangesh Jadhav

    2012-01-01

    Full Text Available Pulmonary artery thrombosis in neonates is a rare entity. We describe two neonates with this diagnosis; their presentation, evaluation, and management. These cases highlight the importance of this differential diagnosis when evaluating the cyanotic neonate.

  8. Renal arteries (image)

    Science.gov (United States)

    A renal angiogram is a test used to examine the blood vessels of the kidneys. The test is performed ... main vessel of the pelvis, up to the renal artery that leads into the kidney. Contrast medium ...

  9. Microsurgical anatomy of the anterior cerebral artery in Indian cadavers

    Directory of Open Access Journals (Sweden)

    Shweta Kedia

    2013-01-01

    Full Text Available Background: The microanatomy features of cerebral arteries may be variable and may be different in different ethnic groups. Aim: To study the anterior cerebral artery (ACA anatomy in North-West Indian cadavers. Materials and Methods: Microanatomy features of the ACA were studied in 15 formalin fixed human cadaveric brains under microscope. The outer diameter, length, and number of perforating branches with respective anomalies were measured for each of the following vessels: ACA (proximal A1 segment to distal A2 segment, anterior communicating artery (ACoA, Recurrent artery of Heubner (RAH, and callosomarginal artery and photographed for documentation. Results: The mean length and external diameter of right and left A1 segment was 12.09 mm and 12.0 mm and 2.32 mm and 2.36 mm respectively. Narrowing, duplication, and median ACA were seen in 6.6%, 3.3% and 6.6% of the vessels respectively. Complex ACoA type was seen in 40% cadavers. RAH originated at an average point of 0.2 mm distal to ACoA, but in one cadaver it arose 5 mm proximal to ACoA. Double RAH was found in 26.6%. The course of RAH in relation to A1 was superiorly in 60%, in anteriorly 30% and posteriorly in 10% of cadavers. The orbitofrontal artery (OFA and frontopolar artery (FPA arose from A2 in 83.3% to 40% respectively. The mean distance of OFA and FPA from ACoA was 4.17 mm and 8.5 mm respectively. After giving rise to central, callosal and cortical branches, pericallosal artery terminated near the splenium of the corpus callosum or on the precuneus as the inferomedial parietal artery. Conclusion: Knowledge of the microvascular anatomy is indispensable and it is mandatory to be aware of the possible variations in the anomalies to minimize morbidity.

  10. Heritability of cilioretinal arteries

    DEFF Research Database (Denmark)

    Taarnhøj, Nina Charlotte; Munch, Inger C; Kyvik, Kirsten O;

    2005-01-01

    PURPOSE: To determine whether the presence of one or more cilioretinal arteries, a distinct element of the pattern of fundus vessels, is genetically programmed, influenced by environmental factors, or the result of random mechanisms of vascular development. METHODS: The fundi of 112 pairs...... environmental factors. CONCLUSIONS: The presence or absence of one or more cilioretinal arteries in healthy persons is markedly influenced by genetic factors....

  11. Patient-Reported Assessment of Functional Gait Outcomes following Superior Gluteal Artery Perforator Reconstruction

    Directory of Open Access Journals (Sweden)

    Kevin Hur, BA

    2013-08-01

    Conclusions: SGAP flap surgery causes no statistically significant differences in overall LEFS. However, SGAP patients did report donor-site morbidity with decreased ability to perform certain activities and increased fatigue and pain in the longer follow-up period. We feel that patients should be educated regarding gait issues and undergo physical therapy during the early postoperative period.

  12. De novo superior cerebellar artery aneurysm following radiosurgery for trigeminal neuralgia.

    Science.gov (United States)

    Chen, Joseph C T; Chao, Kuo; Rahimian, Javad

    2017-04-01

    Stereotactic radiosurgery is a commonly used method for treatment of trigeminal neuralgia. Radiation has been known to be a factor in the later development of aneurysms. Aneurysms have been reported to occur after radiation delivered in a variety of methods including both externally delivered radiation radiosurgery and brachytherapy. We report here an incidence of a de novo aneurysm presenting following radiosurgery treatment for trigeminal neuralgia. The patient was treated using frame-based LINAC radiosurgery receiving 90Gy to the mid cisternal extent of the nerve via a 4mm conical collimator. The patient presented with progressive hypoesthesia 11years after treatment. Imaging evaluation demonstrated the presence of an aneurysm abutting the treated trigeminal nerve. The aneurysm was successfully coil embolized. The patient's facial hypoesthesia, however, did not improve following embolization. We believe that this is the first report of such an aneurysm occurring after radiosurgery for trigeminal neuralgia. De novo aneurysms are a recognized long term complication of radiotherapy and radiosurgery treatment. This report shows such aneurysms can occur with very small treatment volumes. Late sensory changes following radiosurgery for trigeminal neuralgia should prompt workup for de novo aneurysms as well as other late adverse radiation effects. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. ANATOMICAL VARIATIONS IN CONDUIT OF VERTEBRAL ARTERY IN ATLAS

    Directory of Open Access Journals (Sweden)

    Krishna

    2013-10-01

    Full Text Available ABSTRACT : BACKGROUND: The 1 st cervical vertebra is named as atlas. It differs from all the other vertebrae in having no body and no spine. The atlas consists of two bulky lateral masses, connected to each other in front by a short anterior arch, and behind by a long curved posterior arch it thus forms a ring of bone. The posterior arch forms three - fifths of the atlantal ring. At the r oot of the arch the superior surface of posterior arch bears a wide groove for the vertebral artery, venous plexus and the C1 nerve immediately behind the lateral mass. In few cases this groove is converted into the completely or partially posterior/latera l vertebral artery foramen. AIM : This study was carried out to know the variations in posterior vertebral artery groove in atlas vertebra for clinical and surgical purpose. MATERIALS AND METHODS: The present study is based on the observation of the 300 mac erated Human atlas vertebrae of North Indian present in the Anthropology Museum of Department of Anatomy, GSVM Medical College, Kanpur. The atlases were randomly selected the age and sex were not taken into consideration. RESULTS: We observed the complete posterior vertebral artery foramen in 8% specimen (2.33% bilateral and 5.67% unilateral. In 3.33% it was found on left side and 2.33% on right side. Incidence of incomplete posterior vertebral artery foramen was observed in 9.33% (1.33% bilateral and 8% u nilateral. In 5% it was found on left side and 3% on right side. The bilateral presence of complete or incomplete lateral vertebral artery foramen was nil. The unilateral presence of complete or incomplete lateral vertebral artery foramen was found equal in frequency i.e. 0.67%. The unilateral presence of complete lateral vertebral artery foramen on either side was found in 0.33% specimen whereas the incomplete lateral vertebral artery foramen was found only on left side (0.67%. CONCLUSION : The presence o f complete/incomplete posterior or lateral

  14. secondary Prevention of Coronary Events by Coronary Artery Bypass Surgery

    OpenAIRE

    2003-01-01

    Coronary artery bypass surgery has shown its superiority on other therapeutic options in specific but frequent indications such as left main lesions, multivessel disease with alteration of ventricular function, proximal lesions of the LAD, and multivessel diseases in diabetic patients. After reviewing the epidemiology of coronary artherosclerosis, we emphasize the efficacy of the surgical treatment compared to medical or interventional therapy for preventing ischemic events. The results deriv...

  15. Fractional flow reserve-guided PCI for stable coronary artery disease

    DEFF Research Database (Denmark)

    De Bruyne, Bernard; Fearon, William F; Pijls, Nico H J

    2014-01-01

    BACKGROUND: We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy. METHODS: In 1220 patients with stable coronary artery disease, we......-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; Pratio, 0.23; 95% CI, 0.14 to 0.38; P

  16. Spiral CT angiography of renal arteries: comparison with angiography

    Energy Technology Data Exchange (ETDEWEB)

    Wittenberg, G.; Kenn, W.; Tschammler, A.; Sandstede, J.; Hahn, D. [Inst. fuer Roentgendiagnostik der Universitaet Wuerzburg (Germany)

    1999-04-01

    A prospective study was carried out to determine the accuracy of spiral CT angiography (CTA) in the detection of renal artery stenosis (RAS). Eighty-two patients with arterial hypertension underwent CTA and digital subtraction angiography (DSA) to exclude RAS. For CTA a contrast medium bolus of 100-150 ml (flow rate 3 ml/s) was injected. A 24 or 40 s CTA was started at the origin of the superior mesenteric artery after a delay time determined by test bolus injection (collimation = 2 mm, pitch = 1/1.5). For stenosis detection transverse images supported by maximum intensity projections (MIP) or multiplanar reconstruction projections were used. Of 197 renal arteries examined (including 33 accessory arteries), 34 RAS were visualized using DSA. With CTA, one hemodynamic RAS was missed and one additional hemodynamic RAS was found. Sensitivity/specificity was calculated to be 94 %/98 %. For hemodynamically relevant RAS (> 50 %) the sensitivity/specificity was 96 %/99 %. CTA additionally depicted five adrenal masses. The high accuracy rate of RAS detection thus allows the use of CTA as a screening method in patients with arterial hypertension to exclude a renovascular cause. (orig.) With 2 figs., 1 tab., 25 refs.

  17. Placement of Endovascular Stent across the Branching Arteries: Long-term Serial Evaluation of Stent-tissue Responses Overlying the Arterial Orifices in an Experimental Study

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Il; Chung, Jin Wook, E-mail: chungjw@snu.ac.kr [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of); Kim, Hyun Beom [National Cancer Center of Korea, Department of Radiology and Center for Liver Cancer, Research Institute and Hospital (Korea, Republic of); Park, Jae Hyung [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of); Seo, Jeong Wook [Seoul National University College of Medicine, Department of Pathology (Korea, Republic of); Kim, Hyo-Cheol; Jae, Hwan Jun; Lee, Whal [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of)

    2012-10-15

    PurposeThis study was designed to investigate the effects of stenting across the branching arteries on the patency and stent-tissue responses over the branching arterial orifices. Methods: Thirteen dogs were observed after placing aortic stents across the celiac arteries (CA), superior mesenteric arteries (SMA), and renal arteries (RA). The animals were grouped according to stent types: large-cell group (n = 6) and small-cell group (n = 7). Angiography was performed to evaluate the branching artery patency at 2, 6, and 12 months after stent insertion, and the stent-tissue responses covering the orifices were evaluated on histopathologic examination. Results: All branching arteries were patent on follow-up angiography; however, three patterns of stent-tissue responses over the orifices were observed: neointimal layering, bridging septa, and papillary hyperplasia. Although neointimal layering and bridging septa were evenly observed, severe papillary hyperplasia was more frequent at SMA and CA than RA. Four RA showed less than 50% ostial patency, and localized infarct was observed in six kidneys (24%). The ostial patency tended to decrease with small-cell stent during the follow-up period. Conclusions: Various stent-tissue responses over the branching artery orifices are induced by the aortic stent covering the branching arteries and may not be easily detected by conventional angiography. Subclinical renal infarct also may occur despite patent renal angiography.

  18. Superior-subordinate relations as organizational processes

    DEFF Research Database (Denmark)

    Asmuss, Birte; Aggerholm, Helle Kryger; Oshima, Sae

    Since the emergence of the practice turn in social sciences (Golsorkhi et al. 2010), studies have shown a number of institutionally relevant aspects as achievements across time and by means of various resources (human and non-human) (Taylor & van Every 2000, Cooren et al. 2006). Such a process view...... superior-subordinate relations in a specific institutionalized setting: performance appraisal interviews (PAIs). While one main task of PAIs is to manage and integrate organizational and employee performance (Fletcher, 2001:473), PAIs are also organizational practices where superior-subordinate relations...... are shaped, (re)confirmed and re-evaluated. This paper pursues the better understanding of the latter aspect by looking at one substantial and recurrent activity in PAIs: the evaluation of employee performance. One resource for doing the evaluation work is making assessments (e.g. Goodwin & Goodwin, 1987...

  19. Exploring the word superiority effect using TVA

    DEFF Research Database (Denmark)

    Starrfelt, Randi

    Words are made of letters, and yet sometimes it is easier to identify a word than a single letter. This word superiority effect (WSE) has been observed when written stimuli are presented very briefly or degraded by visual noise. It is unclear, however, if this is due to a lower threshold...... for perception of words, or a higher speed of processing for words than letters. We have investigated the WSE using methods based on a Theory of Visual Attention. In an experiment using single stimuli (words or letters) presented centrally, we show that the classical WSE is specifically reflected in perceptual...... processing speed: words are simply processed faster than single letters. It is also clear from this experiment, that the word superiority effect can be observed at a large range of exposure durations, from the perceptual threshold to ceiling performance. Intriguingly, when multiple stimuli are presented...

  20. The Rome III criteria for the diagnosis of functional dyspepsia in secondary care are not superior to previous definitions.

    Science.gov (United States)

    Ford, Alexander C; Bercik, Premysl; Morgan, David G; Bolino, Carolina; Pintos-Sanchez, Maria Ines; Moayyedi, Paul

    2014-04-01

    Although the Rome III criteria for functional dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population. We analyzed complete symptom, upper gastrointestinal (GI) endoscopy, and histology data from 1452 consecutive adult patients with GI symptoms at 2 hospitals in Hamilton, Ontario, Canada. Assessors were blinded to symptom status. Individuals with normal upper GI endoscopy and histopathology findings from analyses of biopsy specimens were classified as having no organic GI disease. The reference standard used to define the presence of true functional dyspepsia was epigastric pain, early satiety or postprandial fullness, and no organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), were calculated. Of the 1452 patients, 722 (49.7%) met the Rome III criteria for functional dyspepsia. Endoscopy showed organic GI disease in 170 patients (23.5%) who met the Rome III criteria. The Rome III criteria identified patients with functional dyspepsia with 60.7% sensitivity, 68.7% specificity, a positive LR of 1.94 (95% CI, 1.69-2.22), and a negative LR of 0.57 (95% CI, 0.52-0.63). In contrast, the Rome II criteria identified patients with functional dyspepsia with 71.4% sensitivity, 55.6% specificity, a positive LR of 1.61 (95% CI, 1.45-1.78), and a negative LR of 0.51 (95% CI, 0.45-0.58). The area under a receiver operating characteristics curves did not differ significantly for any of the diagnostic criteria for functional dyspepsia. In a validation study of 1452 patients with GI symptoms, the Rome III criteria performed only modestly in identifying those with functional dyspepsia, and were not significantly superior to previous definitions. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  1. Coronary anomaly: the single coronary artery

    Institute of Scientific and Technical Information of China (English)

    QIN Xu-guang; XIONG Wei-guo; LU Chun-peng; GONG Cheng-jie; SHANG Li-hua

    2010-01-01

    @@ Single coronary artery (SCA), defined as an artery that arises from the arterial trunk and nourishes the entire myocardium, is rare. We report two cases of SCA, one is the right coronary artery (RCA) originating from the middle of left descending artery (LAD), and the other is the left main coronary artery (LMCA) arising from the proximal right coronary artery.

  2. Coronary Artery and Pulmonary Artery Fistula Originated from Significant Stenosis in the Left Anterior Descending Artery

    Directory of Open Access Journals (Sweden)

    Alper Sami Kunt

    2013-01-01

    Full Text Available Coronary artery fistula (CAF is defined as a rare anomalous connection between a coronary artery and a major vessel or a cardiac chamber. We report a case of a left anterior descending coronary (LAD stenosis and coronary artery fistula between the LAD coronary artery and the pulmonary artery (PA. CAF is often diagnosed by coronary angiogram. We describe our diagnostic approach and review the literature on the epidemiology, the pathophysiology, the diagnostic modalities, and the treatment options.

  3. Resolution of superior oblique myokymia with memantine.

    Science.gov (United States)

    Jain, Saurabh; Farooq, Shegufta J; Gottlob, Irene

    2008-02-01

    We describe a novel treatment of superior oblique myokymia. A 40-year-old woman was treated with gabapentin for this disorder with partial success and reported significant side effects including loss of libido and weight gain. After a drug holiday, memantine therapy was initiated resulting in a substantial improvement in her symptoms with far fewer side effects and stability on long-term maintenance therapy.

  4. Locked Superior Dislocation of the Acromioclavicular Joint

    Directory of Open Access Journals (Sweden)

    Salma Eltoum Elamin

    2013-01-01

    Full Text Available Acromioclavicular (AC joint injuries account for approximately 3–5% of shoulder girdle injuries (Rockwood et al., 1998. Depending on severity of injury and direction of displacement these are classified using Rockwood classification system for AC joint dislocation. We present an unusual case presenting with locked superior dislocation of the AC joint highlighting the presentation and subsequent successful surgical management of such case. To our knowledge this has not been reported previously in literature.

  5. [Mitral surgery by superior biatrial septotomy].

    Science.gov (United States)

    Saade, A; Delepine, G; Lemaitre, C; Baehrel, B

    1995-01-01

    The superior biatrial septotomy approach consists of two semicircular right atrial and septal incisions joined at the superior end of the interatrial septum and extended across the dome of the left atrium, allowing exposure of the mitral valve by reflecting the ventricular side using stay sutures. From 1991 to 1993, 81 patients underwent mitral valve surgery by this technic. Mitral valve operation was combined with other cardiac procedures in 30 patients (37%) and was performed as a second operation in 21 patients (25.9%). Duration of cardiopulmonary bypass and aortic occlusion was not significantly different from that of patients operated via a conventional left atrial approach. The five hospital deaths (6.2%) were not related to this operative approach. Only 2 patients (3.3%) with preoperative in sinus rythm were discharged in atrial fibrillation after operation. In one patient (1.6%), atrioventricular block appeared at late follow-up. There were no cases of bleeding, atrioventricular nodal dysfunction or intra-atrial shunting related to the approach. This approach provides excellent exposure of the mitral valve even in unfavorable situations such as a small left atrium, dense adhesions from previous procedures or a previously implanted aortic prosthesis, without damage to various cardiac structures due to excessive traction. No retractor or vena cava repair are required. These data support a wide application of the superior biatrial septotomy approach in mitral valve surgery.

  6. A comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital.

    Science.gov (United States)

    Lagares-Borrego, A; Gacto-Sanchez, P; Infante-Cossio, P; Barrera-Pulido, F; Sicilia-Castro, D; Gomez-Cia, T

    2016-02-01

    Postmastectomy breast reconstruction involves the use of large amounts of hospital resources. This study provides comparative data on the clinical results and long-term economic costs of two methods of breast reconstruction in a public hospital. A prospective cohort study was performed to evaluate the costs incurred by delayed unilateral breast reconstruction performed using either the two-stage sequence expander/prosthesis (E-P) or autologous deep inferior epigastric flap (DIEP) method during 2005-2013 in 134 patients. The major evaluated variables included previous clinical records, history of radiotherapy, and number of surgical procedures. Total costs accounted for both direct intra- and extra-hospital costs derived from the initial reconstruction and those resulting from associated reoperations due to aesthetic retouches and/or complications. Patients undergoing E-P reconstruction required a higher number of surgery sessions to complete the reconstruction (3.07 vs. 2.32, p breast reconstruction using the DIEP method is more cost-effective and involves fewer serious complications that result in reconstruction failure or undesirable aesthetic results. E-P reconstruction presents a higher number of complications that may cause surgical failure or poor outcomes. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Distal basilar artery aneurysms: conditions for safe and secure clipping.

    Science.gov (United States)

    Nakagomi, Tadayoshi

    2014-01-01

    In general, vertebro-basilar aneurysms are good indications for endovascular treatment. However, basilar artery (BA) bifurcation aneurysms, BA-superior cerebellar artery (SCA) aneurysms, and sometimes mid-basilar aneurysms are also good indications for clipping. In this paper, conditions for safe and secure clipping for distal basilar aneurysms are discussed.There are several tips for the clipping of distal BA aneurysms. Among them, the following are very important: patency of the perforators, posterior cerebral artery (P1), and SCA must always be maintained. Several modalities including micro-Doppler ultrasonography and indocyanine green video-angiography (ICGVA) should be used to confirm the patency of these vessels. Each confirmation of patency of the vessels after clipping must be compared to those from before the clipping. Intra-operative digital subtraction angiography (DSA) is needed for large or giant aneurysms.

  8. Application of 64 slice spiral CT in evaluating the patency of coronary artery after stent implantation

    Institute of Scientific and Technical Information of China (English)

    Yong-Shu Gao; Xing-Can Ma

    2015-01-01

    Objective:To explore the feasibility and effectiveness of 64 slice spiral CT in evaluating the patency of coronary artery after stent implantation.Methods:The 64 slice spiral CT image data of 125 patients after coronary artery stent implantation were collected, meanwhile, the image data of 25 patients underwent coronary angiography were also collected. The feasibility and accuracy of 64 slice spiral CT coronary artery stent imaging were comparatively analyzed. Results: The 64 slice spiral CT imaging quality with a stent diameter greater than 3.00 mm was significantly superior to that with a diameter of 2.25-3.00 mm. The CT imaging quality in the left main coronary artery and anterior descending artery was significantly higher than that in the left circumflex coronary artery. The CT imaging quality in the left main coronary artery was significantly higher than that in the right coronary artery. The CT reconstruction imaging quality in the drug coating stent was significantly superior to that in the bare metal stent. The sensitivity of 64 slice spiral CT was 100.00%, and the accuracy was 100.00%. In detecting the coronary artery with occlusion and stenosis (stent stenosis greater than 50%), the sensitivity was 90.00%, the false negative rate was 10.00%, and the positive predicative value was 100.00%.Conclusions:The effect of 64 slice spiral CT coronary imaging in evaluating the patency of coronary artery after stent implantation is highly consistent with that by coronary angiography, with a simple operation, less risk, and low cost, and thus, it can be completely taken as the imaging method in evaluating the patency of coronary artery after stent implantation.

  9. Traumatic Distal Ulnar Artery Thrombosis

    Directory of Open Access Journals (Sweden)

    Ahmet A. Karaarslan

    2014-01-01

    Full Text Available This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases.

  10. Coronary Artery Imaging in Children

    Science.gov (United States)

    2015-01-01

    Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy. PMID:25741188

  11. Preservation of venous outflow improves transverse rectus abdominis musculocutaneous flap survival following vascular delay.

    Science.gov (United States)

    Tsoutsos, D; Gravvanis, A; Kakagia, D; Ghali, S; Papalois, A

    2009-01-01

    The rat abdominal island model has proved to be a reliable and reproducible model for the study of surgical delay procedures. It has been customary to simultaneously divide both the artery and the accompanying vein to obtain maximum survival of the rat TRAM flap undergoing delay procedure. This study evaluates the effect of selective arterial interruption compared to standard vascular delay on flap survival in the rat TRAM flap model. Thirty-six Wistar rats were randomly assigned to three groups (n=12), depending on the vascular ligation selected for the initial experimental delay stage. In group A (control group) no vessels were ligated. In group B the right deep inferior epigastric vessels were preserved and the right superior and left inferior and superior deep vessels were ligated. In group C the right inferior epigastric vessels and the left inferior epigastric vein were preserved while superior epigastric vessels and the left inferior epigastric artery were ligated. For the second stage one week later, TRAM flaps were elevated based on the right deep inferior epigastric vessels, re-inset in their original position and digitally photographed. Skin island viability was determined 96 hours later using digital photography and image-analysis software SigmaScan (SPSS, Inc., Chicago, IL). The percentage of flap survival in control group A was 50+/-6%, in group B 60+/-4% and in group C 85+/-4%. The occlusion of the three vascular pairs in group B improved the survival percentage in comparison to the control group A, but this did not achieve statistical significance. In contrast, the percentage of flap survival in control group C was statistically significant compared to groups A and B (p<0.05, ANOVA). Zone IV exhibited no necrosis in any group C animals. This indicates that delay with preservation of the venous outflow of zone IV results in increased blood supply.

  12. Left Coronary Artery-Pulmonary Artery Fistula in Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Orhan Veli Doğan

    2012-08-01

    Full Text Available Coroner artery fistula which is rare and congenital or acquired arise from whole coroner artery drainage all of cardiac chamber and great artery. Although coroner artery fistula is uncommon, it can cause significant mortality and morbidity rates. The article is presented which coroner artery disease and coroner-pulmonary artery fistula was accomplishment committed. Sixty three year-old male patient admitted to the hospital with chest pain. Non-ST myocardial infarction was diagnosed in the examinations. After coroner angiography, it was found coronary artery disease in addition between LAD proximal portion and main pulmonary artery fistula. Fistula repair and coronary bypass were performed successfully under cardiopulmonary bypass. Without hemodynamic problem in intensive care and service follow-up, the patient was discharged from the hospital in the seventh postoperative day. We think that surgical treatment of coronary fistulas in patients with coronary artery lesion is done at the earliest time would enable improvement in mortality and morbidity rates.

  13. A benign gastric ulcer eroding into a splenic artery pseudoaneurysm presenting as a massive upper gastrointestinal bleed.

    Science.gov (United States)

    Syed, Shareef M; Moradian, Simon; Ahmed, Mohammed; Ahmed, Umair; Shaheen, Samuel; Stalin, Vasanth

    2014-11-20

    Upper gastrointestinal (UGI) bleeding secondary to a ruptured splenic artery (SA) pseudoaneurysm into the stomach is a rare but a life-threatening condition. Owing to the low prevalence, it remains a diagnostic and therapeutic challenge. A frail 77-year-old Caucasian female presented with epigastric pain and hematemesis. Endoscopy was non-diagnostic for an etiology. She then underwent diagnostic angiography that revealed an SA pseudoaneurysm with active contrast extravasation into the stomach. Subsequent transcatheter arterial coil embolization was conducted of the SA. The patient was subsequently taken for a partial gastrectomy, distal pancreatectomy and splenectomy. She had an uncomplicated postoperative course. Diagnosis of an UGI bleeding secondary to a ruptured SA pseudoaneurysm into the stomach remains difficult. However, we report that in a hemodynamically stable patient, a multidisciplinary approach can be taken, with interval optimization of the patient prior to definitive surgery for a satisfactory outcome. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2014.

  14. Idiopathic pulmonary artery aneurysm.

    Science.gov (United States)

    Kotwica, Tomasz; Szumarska, Joanna; Staniszewska-Marszalek, Edyta; Mazurek, Walentyna; Kosmala, Wojciech

    2009-05-01

    Pulmonary artery aneurysm (PAA) is an uncommon lesion, which may be associated with different etiologies including congenital cardiovascular diseases, systemic vasculitis, connective tissue diseases, infections, and trauma. Idiopathic PAA is sporadically diagnosed by exclusion of concomitant major pathology. We report a case of a 56-year-old female with an idiopathic pulmonary artery dilatation identified fortuitously by echocardiography and confirmed by contrast-enhanced computed tomography. Neither significant pulmonary valve dysfunction nor pulmonary hypertension and other cardiac abnormalities which might contribute to the PAA development were found. Here, we describe echocardiographic and computed tomography findings and review the literature on PAA management.

  15. Pelvic Arterial Anatomy Relevant to Prostatic Artery Embolisation and Proposal for Angiographic Classification

    Energy Technology Data Exchange (ETDEWEB)

    Assis, André Moreira de, E-mail: andre.maa@gmail.com; Moreira, Airton Mota, E-mail: motamoreira@gmail.com; Paula Rodrigues, Vanessa Cristina de, E-mail: vanessapaular@yahoo.com.br [University of Sao Paulo Medical School, Interventional Radiology and Endovascular Surgery Department, Radiology Institute (Brazil); Harward, Sardis Honoria, E-mail: sardis.harward@merit.com [The Dartmouth Center for Health Care Delivery Science (United States); Antunes, Alberto Azoubel, E-mail: antunesuro@uol.com.br; Srougi, Miguel, E-mail: srougi@usp.br [University of Sao Paulo Medical School, Urology Department (Brazil); Carnevale, Francisco Cesar, E-mail: fcarnevale@uol.com.br [University of Sao Paulo Medical School, Interventional Radiology and Endovascular Surgery Department, Radiology Institute (Brazil)

    2015-08-15

    PurposeTo describe and categorize the angiographic findings regarding prostatic vascularization, propose an anatomic classification, and discuss its implications for the PAE procedure.MethodsAngiographic findings from 143 PAE procedures were reviewed retrospectively, and the origin of the inferior vesical artery (IVA) was classified into five subtypes as follows: type I: IVA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery (SVA); type II: IVA originating from the anterior division of the IIA, inferior to the SVA origin; type III: IVA originating from the obturator artery; type IV: IVA originating from the internal pudendal artery; and type V: less common origins of the IVA. Incidences were calculated by percentage.ResultsTwo hundred eighty-six pelvic sides (n = 286) were analyzed, and 267 (93.3 %) were classified into I–IV types. Among them, the most common origin was type IV (n = 89, 31.1 %), followed by type I (n = 82, 28.7 %), type III (n = 54, 18.9 %), and type II (n = 42, 14.7 %). Type V anatomy was seen in 16 cases (5.6 %). Double vascularization, defined as two independent prostatic branches in one pelvic side, was seen in 23 cases (8.0 %).ConclusionsDespite the large number of possible anatomical variations of male pelvis, four main patterns corresponded to almost 95 % of the cases. Evaluation of anatomy in a systematic fashion, following a standard classification, will make PAE a faster, safer, and more effective procedure.

  16. Radiological Findings of Prostatic Arterial Anatomy for Prostatic Arterial Embolization: Preliminary Study in 55 Chinese Patients with Benign Prostatic Hyperplasia.

    Directory of Open Access Journals (Sweden)

    Guodong Zhang

    Full Text Available To describe the prostatic arterial supply using Cone-beam computed tomography (CT and digital subtraction angiography (DSA before prostatic arterial embolization (PAE for benign prostatic hyperplasia (BPH.In a retrospective study from January 2012 to January 2014, 55 male patients (110 hemipelves with BPH who underwent PAE were evaluated by Cone-beam CT in addition to pelvic DSA during embolization planning. Each hemipelvis was evaluated regarding the number of prostatic arteries (PA and their origins, diameters, territorial perfusion, and anastomoses with adjacent arteries.A total of 114 PAs were identified in 110 hemipelves. There was one PA in 96.4% of the hemipelves (n=106, and two independent PAs in the other 3.6% (n=4. The PA was found to originate from the anterior trunk of the internal iliac artery in 39.5% of cases (n=45 , from the superior vesical artery in 32.6% (n=37, and from the internal pudendal artery in 27.9% of cases (n=32. Extra-prostatic anastomoses between PA and adjacent arteries were found in 39.1% of hemipelves (n=43. Intra-prostatic anastomoses between PAs and contra-lateral prostatic branches were found in 61.8% of hemipelves (n=68. In 67.3% of our study population (n=37, the prostate was dominantly supplied via a unilateral PA.The prostatic vascularization is complex with frequent anatomic variations. Knowledge of the vascular anatomy of the prostate may provide indications for planning PAE and avoiding nontarget embolization.

  17. Pulmonary arterial hypertension in children after neonatal arterial switch operation

    NARCIS (Netherlands)

    Zijlstra, Willemijn Mh; Elmasry, Ola; Pepplinkhuizen, Shari; Ivy, D Dunbar; Bonnet, Damien; Lévy, Marilyne; Gavilan, Jose Luis; Torrent-Vernetta, Alba; Mendoza, Alberto; Del Cerro, Maria Jesus; Moledina, Shahin; Berger, Rolf M. F.

    2017-01-01

    OBJECTIVES: Paediatric pulmonary arterial hypertension (PAH) after neonatal arterial switch operation (ASO) for transposition of the great arteries (TGA) is a clinically recognised entity with an estimated incidence of 0.6%-1.0%. Nevertheless, a clinical characterisation is lacking. We present an in

  18. Left Anterior Descending Artery-Pulmonary Artery Fistula

    Directory of Open Access Journals (Sweden)

    Turan Ege

    2011-12-01

    Full Text Available Despite the fact that coronary arteriovenous fistulas constitute approximately half (48% of coronary artery anomalies, they are rarely seen anomalies. In this report,we aim to present a coronary arteriovenous fistula case detected during a coronary angiography between left anterior descending artery and pulmonary artery.

  19. Exploring the word superiority effect using TVA

    DEFF Research Database (Denmark)

    Starrfelt, Randi

    Words are made of letters, and yet sometimes it is easier to identify a word than a single letter. This word superiority effect (WSE) has been observed when written stimuli are presented very briefly or degraded by visual noise. It is unclear, however, if this is due to a lower threshold for perc...... simultaneously we find a different pattern: In a whole report experiment with six stimuli (letters or words), letters are perceived more easily than words, and this is reflected both in perceptual processing speed and short term memory capacity....

  20. de educación media superior

    Directory of Open Access Journals (Sweden)

    Enrique Cerón Ferrer

    2007-01-01

    Full Text Available El trabajo presenta los resultados obtenidos en relación al conocimiento y manejo que sobre matemáticas tienen los estudiantes de educación media superior, de los Centros de Estudios Tecnológicos y de Servicios del Distrito Federal, de diferentes carreras que se imparten en estos centros escolares, durante el año 2005. El instrumento de análisis es un cuestionario que contestaron los alumnos, la metodología utilizada es de tipo longitudinal y comparativa.

  1. Mesenteric resistance arteries in type 2 diabetic db/db mice undergo outward remodeling.

    Directory of Open Access Journals (Sweden)

    Flavia M Souza-Smith

    Full Text Available OBJECTIVE: Resistance vessel remodeling is controlled by myriad of hemodynamic and neurohormonal factors. This study characterized structural and molecular remodeling in mesenteric resistance arteries (MRAs in diabetic (db/db and control (Db/db mice. METHODS: Structural properties were assessed in isolated MRAs from 12 and 16 wk-old db/db and Db/db mice by pressure myography. Matrix regulatory proteins were measured by Western blot analysis. Mean arterial pressure and superior mesenteric blood flow were measured in 12 wk-old mice by telemetry and a Doppler flow nanoprobe, respectively. RESULTS: Blood pressure was similar between groups. Lumen diameter and medial cross-sectional area were significantly increased in 16 wk-old db/db MRA compared to control, indicating outward hypertrophic remodeling. Moreover, wall stress and cross-sectional compliance were significantly larger in diabetic arteries. These remodeling indices were associated with increased expression of matrix regulatory proteins matrix metalloproteinase (MMP-9, MMP-12, tissue inhibitors of matrix metalloproteinase (TIMP-1, TIMP-2, and plasminogen activator inhibitor-1 (PAI-1 in db/db arteries. Finally, superior mesenteric artery blood flow was increased by 46% in 12 wk-old db/db mice, a finding that preceded mesenteric resistance artery remodeling. CONCLUSIONS: These data suggest that flow-induced hemodynamic changes may supersede the local neurohormonal and metabolic milieu to culminate in hypertrophic outward remodeling of type 2 DM mesenteric resistance arteries.

  2. Mesenteric Resistance Arteries in Type 2 Diabetic db/db Mice Undergo Outward Remodeling

    Science.gov (United States)

    Souza-Smith, Flavia M.; Katz, Paige S.; Trask, Aaron J.; Stewart, James A.; Lord, Kevin C.; Varner, Kurt J.; Vassallo, Dalton V.; Lucchesi, Pamela A.

    2011-01-01

    Objective Resistance vessel remodeling is controlled by myriad of hemodynamic and neurohormonal factors. This study characterized structural and molecular remodeling in mesenteric resistance arteries (MRAs) in diabetic (db/db) and control (Db/db) mice. Methods Structural properties were assessed in isolated MRAs from 12 and 16 wk-old db/db and Db/db mice by pressure myography. Matrix regulatory proteins were measured by Western blot analysis. Mean arterial pressure and superior mesenteric blood flow were measured in 12 wk-old mice by telemetry and a Doppler flow nanoprobe, respectively. Results Blood pressure was similar between groups. Lumen diameter and medial cross-sectional area were significantly increased in 16 wk-old db/db MRA compared to control, indicating outward hypertrophic remodeling. Moreover, wall stress and cross-sectional compliance were significantly larger in diabetic arteries. These remodeling indices were associated with increased expression of matrix regulatory proteins matrix metalloproteinase (MMP)-9, MMP-12, tissue inhibitors of matrix metalloproteinase (TIMP)-1, TIMP-2, and plasminogen activator inhibitor-1 (PAI-1) in db/db arteries. Finally, superior mesenteric artery blood flow was increased by 46% in 12 wk-old db/db mice, a finding that preceded mesenteric resistance artery remodeling. Conclusions These data suggest that flow-induced hemodynamic changes may supersede the local neurohormonal and metabolic milieu to culminate in hypertrophic outward remodeling of type 2 DM mesenteric resistance arteries. PMID:21829729

  3. What's the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply?

    Science.gov (United States)

    Zhang, Yi; Wang, Tingliang; Wei, Jiao; He, Jinguang; Wang, Tao; Liu, Ying; Xu, Hua; Dong, Jiasheng

    2017-01-01

    We developed a novel pedicled DIEP flap model in rat to explore the possible remedy for the distal necrosis of the flap. A deep inferior epigastric perforator (DIEP) flap, based on the second right cranial perforator (P2) as the main pedicle, was elevated in 48 Sprague-Dawley rats. The rats were randomized into 4 groups: group I, the left P2 remaining intact as supercharging; group II, the left P2 artery alone kept as supercharging; group III, the left P2 vein alone kept as supercharging; group IV, no supercharging. Transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) were measured immediately after flap elevation, protein level of Hif-1a was measured 48 hours later, and flap survival was assessed 7 days postoperatively. Blockade of artery led to significantly lower TcPO2, higher TcPCO2, and higher expression level of Hif-1a in the distal side of the flap in group III and group IV, than those of group I and group II. At 7 days post surgery, significantly lower flap survival rates were observed in group III (81.9 ± 5.7%) and group IV (78.4 ± 6.5%), compared to observed in group I (97.2 ± 3.0%) and group II (94.2 ± 6.2%). It might be arterial insufficiency, not venous congestion, which mainly caused the distal necrosis of the DIEP flap in rat. Arterial instead of venous supercharging might be a more effective procedure that improves circulation to zone IV of the flap.

  4. What’s the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply?

    Science.gov (United States)

    Wei, Jiao; He, Jinguang; Wang, Tao; Liu, Ying; Xu, Hua; Dong, Jiasheng

    2017-01-01

    Background We developed a novel pedicled DIEP flap model in rat to explore the possible remedy for the distal necrosis of the flap. Methods A deep inferior epigastric perforator (DIEP) flap, based on the second right cranial perforator (P2) as the main pedicle, was elevated in 48 Sprague-Dawley rats. The rats were randomized into 4 groups: group I, the left P2 remaining intact as supercharging; group II, the left P2 artery alone kept as supercharging; group III, the left P2 vein alone kept as supercharging; group IV, no supercharging. Transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) were measured immediately after flap elevation, protein level of Hif-1a was measured 48 hours later, and flap survival was assessed 7 days postoperatively. Results Blockade of artery led to significantly lower TcPO2, higher TcPCO2, and higher expression level of Hif-1a in the distal side of the flap in group III and group IV, than those of group I and group II. At 7 days post surgery, significantly lower flap survival rates were observed in group III (81.9 ± 5.7%) and group IV (78.4 ± 6.5%), compared to observed in group I (97.2 ± 3.0%) and group II (94.2 ± 6.2%). Conclusions It might be arterial insufficiency, not venous congestion, which mainly caused the distal necrosis of the DIEP flap in rat. Arterial instead of venous supercharging might be a more effective procedure that improves circulation to zone IV of the flap. PMID:28187214

  5. Pharmacological modulation of arterial stiffness.

    LENUS (Irish Health Repository)

    Boutouyrie, Pierre

    2011-09-10

    Arterial stiffness has emerged as an important marker of cardiovascular risk in various populations and reflects the cumulative effect of cardiovascular risk factors on large arteries, which in turn is modulated by genetic background. Arterial stiffness is determined by the composition of the arterial wall and the arrangement of these components, and can be studied in humans non-invasively. Age and distending pressure are two major factors influencing large artery stiffness. Change in arterial stiffness with drugs is an important endpoint in clinical trials, although evidence for arterial stiffness as a therapeutic target still needs to be confirmed. Drugs that independently affect arterial stiffness include antihypertensive drugs, mostly blockers of the renin-angiotensin-aldosterone system, hormone replacement therapy and some antidiabetic drugs such as glitazones. While the quest continues for \\'de-stiffening drugs\\

  6. Pulmonary arterial hypertension : an update

    NARCIS (Netherlands)

    Hoendermis, E. S.

    2011-01-01

    Pulmonary arterial hypertension (PAH), defined as group 1 of the World Heart Organisation (WHO) classification of pulmonary hypertension, is an uncommon disorder of the pulmonary vascular system. It is characterised by an increased pulmonary artery pressure, increased pulmonary vascular resistance

  7. [Incidentally detected bronchial artery aneurysm with combined operation for mitral regurgitation;report of a case].

    Science.gov (United States)

    Sato, Hisashi; Oteki, Hitoshi; Naito, Kozo; Yunoki, Junji

    2015-02-01

    A 77-year-old woman was admitted to the hospital for heart failure with orthopnea. Echocardiography revealed massive mitral regurgitation. During preoperative cardiac catheterization, an aneurysm was indentified incidentally just below the tracheal carina. Three dimensional computed tomography showed three bronchial artery aneurysms behind the pulmonary artery and the left atrium. The proximal aneurysm was the largest and was 22 mm in diameter. It was resected by retracting the ascending aorta to the left, the superior vana cava to the right and right pulmonary artery cranially under cardiopulmonary bypass, and mitral valve plasty was performed. We believed that resection of the proximal aneurysm would cause thrombotic occlusion of the other 2 aneurysms. Bronchial artery aneurysm is a rare entity that is observed in fewer than 1% of those who undergo selective bronchial arteriography. In addition, because bronchial artery aneurysm is a potentially life-threatening lesion, it should be treated promptly when diagnosed.

  8. Right atrium and superior vena cava pressure measurements in a novel animal model to study one and a half ventricle repair as compared to Fontan type procedure

    Directory of Open Access Journals (Sweden)

    Anil Bhattarai

    2017-01-01

    Full Text Available Background & Objectives: To evaluate the advantages of the one and a half ventricle repair on maintaining a low pressure in the inferior vena cava district. Also evaluate the competition of flows at the superior vena cava – right pulmonary artery anastomosis site, in order to understand the hemodynamic interaction of a pulsatile flow in combination to a laminar one. Materials & Methods: Adult rabbits (n=30 in terminal anaesthesia with a follow up of 8 h were used, randomly distributed in three experimental groups: Group 1: animals with an anastomosis between superior vena cava and right pulmonary artery, as a model of one and one half ventricle repair; Group 2: animals with the cavopulmonary anastomosis followed by clamping of the right pulmonary artery proximal to the anastomosis; and Group 3: sham animals. Pressures of superior vena cava and pulmonary arteries were afterwards measured, in a resting condition as well as after induced pharmacological stress test.Results: In Group 1, superior vena cava pressure was significantly higher, while venous pressure in the inferior vena cava – right atrium district was constant or lower in comparison with the other groups. After stress test, the pressure in the superior vena cava and the heart rate both increased further, but the right ventricular, right atrial and pulmonary artery pressures remained similar to the values in a resting condition. This proved that the inferior vena cava return was well-preserved, and no venous hypertension was present in the inferior vena cava district even after stress test (good exercise tolerance.Conclusion: One and one half ventricle repair can be considered a good surgical strategy for maintaining a low pressure in the inferior vena cava district with potential for right ventricle growth, restoring the more physiological circulation in borderline or failing right ventricle conditions. The experiment presented a positive finding in favour of one and one half

  9. Primary angioplasty for infarction due to isolated right ventricular artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Anwar; A; Chahal; Min-Young; Kim; Alexander; N; Borg; Yahya; Al-Najjar

    2014-01-01

    We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery(RCA), successfully treated by balloon angioplasty. A 58-yearold gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4 R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient’s blood pressure dropped to 80/40 mm Hg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient’s symptoms. Repeat echocardiography showed complete resolution of theST-elevation in leads V4 R and V5 R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d inpatient stay without any complications.

  10. Radiation treatment of superior sulcus lung carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Millar, J.; Ball, D.; Worotniuk, V.; Smith, J.; Crennan, E.; Bishop, M. [Peter MacCallum Cancer Inst., East Melbourne, VIC (Australia)

    1996-02-01

    The survival of patients with superior sulcus lung carcinoma and the effects of treatment were reviewed. From a prospective database of 4123 consecutive new patients with lung carcinoma, 131 (3.2%) cases of superior sulcus lung carcinoma were identified. Seventy-four patients were planned to receive radiation with palliative intent, 53 radical radiotherapy and one was observed only. The remaining three patients, with small-cell carcinoma, were treated with chemotherapy with or without radiotherapy. Of the 53 radically treated patients, nine were treated with pre-operative radiation prior to intended radical resection. Analysis was carried out on the effect on survival of performance status, nodal involvement, weight loss, vertebral body or rib involvement, treatment intent and radical combined modality treatment compared with radical radiation alone. The estimated median survival for the whole group was 7.6 months; for those treated radically it was 18.3 months, while for the palliatively treated patients it was 3.7 months. Radically treated patients with no initial nodal involvement had an estimated median survival of 22 months, while radically treated patients with nodal involvement had an estimated median survival of 8.4 months (P = 0.003). There were no statistically significant differences in survival between radically treated patients grouped according to initial weight loss, performance status, or vertebral body and rib involvement. Patients treated with pre-operative radiation did not survive significantly longer than patients treated with radiation alone, although the numbers are small. 33 refs., 2 tabs., 4 figs.

  11. Studies on zooplankton of Lago Paione Superiore

    Directory of Open Access Journals (Sweden)

    Patrizia COMOLI

    1999-08-01

    Full Text Available We report here the results of a three year study on the zooplankton of Lago Paione Superiore, an acid sensitive lake above the tree line in the Italian Alps. The research was carried out within MOLAR, an EC-founded Project on “Measuring and Modeling the dynamic response of remote mountain lakes ecosystems to environmental change”. This study comes after a series of investigations on the effects of acidification, in which we documented the changes occurred with decreasing water pHs, by comparing the recent situation with that in the literature of the 40s, and reconstructed the beginning of anthropogenic disturbance through an analysis of the past cladocera assemblages archived in the lake sediments. A characteristic pattern in seasonal periodicity is a transition from a community dominated by small zooplankton (August to a community where the large particle-feeder Daphnia longispina dominates. This is a typical pattern observed in fishless, copepod-cladocera lakes. Regardless from which food is able to exploit, Daphnia population of Lago Paione Superiore is composed by well-fed organisms, visually rich in lipids, able to produce more than one generation/ year of parthenogenetic females at density levels which are rather high in an oligotrophic high mountain lake.

  12. Popliteal artery entrapment syndrome

    DEFF Research Database (Denmark)

    Altintas, Ümit; Helgstrand, Ulf Johan Vilhelm; Hansen, Marc A;

    2013-01-01

    The purpose of this study was to report our experience with popliteal artery entrapment syndrome (PAES) with special emphasis on the applicability of duplex ultrasound scanning (DUS) when diagnosing PAES. In addition to examining the correlation between DUS and intraoperative findings...

  13. Intracranial artery dissection

    NARCIS (Netherlands)

    Sikkema, T.; Uyttenboogaart, Maarten; Eshghi, O.; De Keyser, J.; Brouns, R.; van Dijk, J.M.C.; Luijckx, G. J.

    2014-01-01

    The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be

  14. Intracranial artery dissection

    NARCIS (Netherlands)

    Sikkema, T.; Uyttenboogaart, Maarten; Eshghi, O.; De Keyser, J.; Brouns, R.; van Dijk, J.M.C.; Luijckx, G. J.

    The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be

  15. Arterial Emboli Complicating Cisplatin Therapy

    OpenAIRE

    Tait, Campbell D.; Rankin, Elaine M

    2012-01-01

    We report three cases of arterial emboli in patients with lung cancer treated with cisplatin chemotherapy. All three patients were managed without surgical intervention but subsequent oncological treatment was complicated by the sequelae of arterial emboli. We discuss the issues surrounding these patients and the importance of identifying patients at risk of arterial embolic phenomena with cisplatin treatment.

  16. Cerebral Arterial Fenestrations

    Science.gov (United States)

    Cooke, Daniel L; Stout, Charles E; Kim, Warren T; Kansagra, Akash P; Yu, John Paul; Gu, Amy; Jewell, Nicholas P; Hetts, Steven W; Higashida, Randall T; Dowd, Christopher F; Halbach, Van V

    2014-01-01

    Summary Arterial fenestrations are an anatomic variant with indeterminate significance. Given the controversy surrounding fenestrations we sought their prevalence within our practice along with their association with other cerebrovascular anomalies. We retrospectively reviewed 10,927 patients undergoing digital subtraction angiography between 1992 and 2011. Dictated reports were searched for the terms “fenestration” or “fenestrated” with images reviewed for relevance, yielding 228 unique cases. A Medline database search from February 1964 to January 2013 generated 304 citations, 127 cases of which were selected for analysis. Cerebral arterial fenestrations were identified in 228 patients (2.1%). At least one aneurysm was noted in 60.5% of patients, with an aneurysm arising from the fenestration in 19.6% of patients. Aneurysmal subarachnoid hemorrhage or non-aneurysmal subarachnoid hemorrhage were present in 60.1% and 15.8%, respectively. For the subset of patients with an aneurysm arising directly from a fenestration relative to those patients with an aneurysm not immediately associated with a fenestration, the prevalence of aneurysmal subarachnoid hemorrhage was 66.7% vs. 58.6% (p = 0.58). Fenestrations were more often within the posterior circulation (73.2%) than the anterior circulation (24.6%), though there was no difference in the prevalence of aneurysms within these groups (61.1% vs. 60.7%, p = 1.0). Cerebral arterial fenestrations are an anatomic variant more often manifesting at the anterior communicating arterial complex and basilar artery and with no definite pathological relationship with aneurysms. PMID:24976087

  17. Cochlear implant outcomes in patients with superior canal dehiscence

    NARCIS (Netherlands)

    Puram, Sidharth V.; Roberts, Daniel S.; Niesten, Marlien E F; Dilger, Amanda E.; Lee, Daniel J.

    2015-01-01

    Objective: To determine whether adult cochlear implant (CI) users with superior canal dehiscence syndrome (SCDS) or asymptomatic superior semicircular canal dehiscence (SCD) have different surgical, vestibular, and audiologic outcomes when compared to CI users with normal temporal bone anatomy. Meth

  18. Immediate breast reconstruction with a deep inferior epigastric perforator flap.%应用腹壁下动脉穿支皮瓣即刻乳房重建

    Institute of Scientific and Technical Information of China (English)

    栾杰; 张保宁; 穆大力; 宣立学; 穆兰花; 辛敏强; 刘霞

    2011-01-01

    Objective To summarize the experiences of immediate breastreconstruction with deep inferior epigastric perforator ( DIEP) flap and to evaluate indications and advantages of the technique. Methods From April 2003 to June 2009. immediate breast reconstruction following mastectomy using DIEP flap was performed in 21 patients who had received mastectomy for stage Ⅰ andⅡ breast cancer ( radical mastectomy in 6 cases and modified radical mastectomy in 15 ). Before the operation the location of DIEP was determined by using MDCT ( multidetector computed tomography) angiography and Doppler perfusion flowmeter. When mastectomy was completed DIEP was dissected to obtain DIEP flap simultaneously. And the deep inferior epigastric vessels were anastomosed to the thoracodorsal vessel for immediate breast reconstruction. Results The follow-up time was 6months to 6 years. Among the 21 patients 20 had their flaps completely survived postoperatively , fat necrosis of the distal part ( 1/3 ) occurred in one. One case suffered from hematoma in recipient site. No complications such as abdominal hernia and bulge or fat necrosis in donor sites were found. The reconstructed breasts were well-shaped. Conclusion Immediate breast reconstruction using DIEP flap possesses the advantages of satisfactory recipient condition. abundant tissue volume and minimal donor site injury.%目的 总结乳腺癌切除同时应用腹壁下动脉穿支(DIEP)皮瓣行即刻乳房重建的手术经验,探讨DIEP皮瓣即刻乳房重建的适应证及优点.方法 2003年4月~2009年6月,中国医学科学院肿瘤医院乳腺中心接受乳腺癌切除术患者21例(根治术6例,改良根治术15例),术前应用多排螺旋CT(MDCT)血管造影及多普勒血流仪探明穿支位置,乳腺癌切除的同时,解剖腹壁下动脉穿支,形成腹壁下动脉穿支蒂皮瓣,与患侧胸背血管吻合,进行即刻乳房重建.结果 术后随访6个月至6年.21例患者中,20例皮瓣全部存活,1

  19. Laser thermal probe recanalization of occluded arteries.

    Science.gov (United States)

    White, R A; White, G H

    1989-04-01

    Applications of laser energy for treatment of vascular disease have recently received much attention; metal-tipped laser probes are being investigated as a device for recanalization of occluded arteries, especially as an adjunct to balloon dilatation. Developments in instrumentation and techniques have reduced the incidence of complications, notably perforation, to an acceptable level. Initial data show that recanalization of iliac, femoral, and popliteal lesions can be accomplished in a majority of cases, with the chance of success being inversely proportional to the length of occlusion. Results in the tibial vessels are disappointing. Patency of the treated vessels at 12 months appears to be superior to that of percutaneous transluminal angioplasty for similar lesions but inferior to that of surgical bypass for all occlusions greater than 3 cm in length.

  20. The Superior Transvelar Approach to the Fourth Ventricle and Brainstem

    OpenAIRE

    Ezer, Haim; Banerjee, Anirban Deep; Bollam, Papireddy; Guthikonda, Bharat; Nanda, Anil

    2012-01-01

    Objective The superior transvelar approach is used to access pathologies located in the fourth ventricle and brainstem. The surgical path is below the venous structures, through the superior medullary velum. Following splitting the tentorial edge, near the tentorial apex, the superior medullary velum is split in the cerebello-mesencephalic fissure. Using the supracerebellar infratentorial, transtentorial or parietal interhemispheric routes, the superior medullary velum is approached. Splittin...

  1. 14 CFR 385.7 - Exercise of authority by superiors.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Exercise of authority by superiors. 385.7... Exercise of authority by superiors. Any assignment of authority to a staff member other than the Chief... Department's principle of management responsibility, the superior may choose to exercise the assigned power...

  2. Endothelial dysfunction, carotid artery plaque burden, and conventional exercise-induced myocardial ischemia as predictors of coronary artery disease prognosis

    Directory of Open Access Journals (Sweden)

    Ishihara Masayuki

    2008-12-01

    Full Text Available Abstract Background While both flow-mediated vasodilation (FMD in the brachial artery (BA, which measures endothelium-dependent vasodilatation, and intima-media thickness (IMT in the carotid artery are correlated with the prognosis of coronary artery disease (CAD, it is not clear which modality is a better predictor of CAD. Furthermore, it has not been fully determined whether either of these modalities is superior to conventional ST-segment depression on exercise stress electrocardiogram (ECG as a predictor. Thus, the goal of the present study was to compare the predictive value of FMD, IMT, and stress ECG for CAD prognosis. Methods and Results A total of 103 consecutive patients (62 ± 9 years old, 79 men with clinically suspected CAD had FMD and nitroglycerin-induced dilation (NTG-D in the BA, carotid artery IMT measurement using high-resolution ultrasound, and exercise treadmill testing. The 73 CAD patients and 30 normal coronary patients were followed for 50 ± 15 months. Fifteen patients had coronary events during this period (1 cardiac death, 2 non-fatal myocardial infarctions, 3 acute heart failures, and 9 unstable anginas. On Kaplan-Meier analysis, only FMD and stress ECG were significant predictors for cardiac events. Conclusion Brachial endothelial function as reflected by FMD and conventional exercise stress testing has comparable prognostic value, whereas carotid artery plaque burden appears to be less powerful for predicting future cardiac events.

  3. Systemic-pulmonary artery shunts in infants: modified Blalock-Taussig and central shunt procedures.

    Science.gov (United States)

    Brooks, Andre

    2014-01-01

    Access is gained through a midline sternotomy, the thymus partially excised and the superior part of the pericardium is opened. The innominate vein is retracted and the innominate artery is mobilized up to the bifurcation. The aorta is retracted to the left, the superior vena cavae to the right and the right atrial appendage inferiorly. The adventitia around the right pulmonary artery (PA) is dissected, taking care to incise the bulky pericardial reflection between the superior vena cavae and the trachea. Heparin is administrated. An occlusive clamp is applied to the right PA to test for haemodynamic tolerance prior to proceeding with the interposition of a suitable size artificial vascular prosthesis, based on the weight of the patient, between the innominate artery, or proximal subclavian artery and the right PA. Alternatively, if a sufficient main PA is present and adequate flow from a patent ductus arteriosus an end-to-side interposition shunt may be constructed between the ascending aorta and the main PA, provided the patient is stable with the test occlusion of the main PA. The management of the patent arterial ductus depends on whether or not there is forward flow through the PA.

  4. Superiority: China Mobile in the competition

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The market share between China Mobile and China Unicom has stabilized since 2002.It is found that China Mobile has the superiority in the competition, for example, the scissors movement between its revenue and cost indicates that it has a strong profit generating ability and there is enough room for it to reduce the price.The ratio between its price (marginal income) and marginal cost indicates that there is a very distant limit for it to reduce the price.Its demand is obviously flexible with the price, but it does not use the price weapon abundantly.The reason for the stabilization of the market is that China Mobile withdrew from the competition.

  5. MRI manifestations of enlarged superior ophthalmic vein

    Institute of Scientific and Technical Information of China (English)

    WEI Rui-li; MA Xiao-ye; CAI Ji-ping; ZHU Huang

    2002-01-01

    Objective:To assess MRI in the evaluation of enlarged superior ophthalmic vein (SOV). Methods: MRI manifestations and etiology of forty-six patients with enlarged SOV were analyzed. Results: SOV enlargement was noted to occur in carotid-cavernous fistula, ophthalmic Graves'disease, Tolosa-Hunt syndrome, inflammation at the apex of the orbit, orbital pseudotumor and thrombosis of cavernous sinus. The dilated vein appeared as signal void tubular shadows on both T1 and T2 weighted images. The diameter of the enlarged vein was 3.5-6.0 mm. Extraocular muscle enlargement, orbital pathologies, enlarged carotid cavernous sinus etc were also revealed by MRI. Conclusion: The dilated SOV may be well demonstrated by MRI. The etiological diagnosis of enlarged SOV can be made in combination with the associated findings.

  6. Lightning activity during the 1999 Superior derecho

    Science.gov (United States)

    Price, Colin G.; Murphy, Brian P.

    2002-12-01

    On 4 July 1999, a severe convective windstorm, known as a derecho, caused extensive damage to forested regions along the United States/Canada border, west of Lake Superior. There were 665,000 acres of forest destroyed in the Boundary Waters Canoe Area Wilderness (BWCAW) in Minnesota and Quetico Provincial Park in Canada, with approximately 12.5 million trees blown down. This storm resulted in additional severe weather before and after the occurrence of the derecho, with continuous cloud-to-ground (CG) lightning occurring for more than 34 hours during its path across North America. At the time of the derecho the percentage of positive cloud-to-ground (+CG) lightning measured by the Canadian Lightning Detection Network (CLDN) was greater than 70% for more than three hours, with peak values reaching 97% positive CG lightning. Such high ratios of +CG are rare, and may be useful indicators of severe weather.

  7. Analgesia em modelo animal superior para ortopedia

    OpenAIRE

    Oliveira MT, Maria Teresa; Potes, José Alberto; Queiroga, Cristina; Castro, José António; Pereira, Alfredo; Reis, Joana

    2015-01-01

    O teste de novos biomateriais para aplicações clínicas em ortopedia, ou noutras áreas da medicina, em modelos animais vivos e sencientes, em prol do benefício humano, deve ser objecto de planeamento cuidado e ponderado, dado o conflito ético que se coloca. Compete-nos a nós, enquanto investigadores, garantir que as condições de vida, saúde e bem-estar são asseguradas. O uso de ovinos como modelo superior pré-clínico, para investigação em Ortopedia, tem-se evidenciado devido às suas caracterís...

  8. Superior vena cava syndrome in hemodialysis patient

    Directory of Open Access Journals (Sweden)

    Azeb Molhem

    2011-01-01

    Full Text Available Obstruction of blood flow in the superior vena cava (SVC results in symptoms and signs of SVC syndrome. SVC obstruction can be caused either by invasion or external compression of the SVC by contagious pathologic processes involving the right lung, lymph nodes, and other mediastinal structures, or by thrombosis of blood within the SVC. Occasionally, both mechanisms co-exist. We hereby report a case of a 28-year-old male, Saudi patient who was diagnosed with end-stage renal disease and was maintained on regular hemodiaysis via right jugular vein dual lumen catheter for ten months. Three years later, the patient presented with signs and symptoms suggestive of SVC obstruction that was successfully managed with SVC stenting.

  9. [Surgical treatment of superior thoracic outlet syndrome].

    Science.gov (United States)

    Gaibov, A D; Kakhorov, A Z; Sadriev, O N; Yunusov, Kh A

    2015-01-01

    The authors present immediate and long-term results of treatment of 117 patients with superior thoracic outlet syndrome (STOS). There were different reasons for compression of neu- rovascular fascicle in outlet of the thorax. The costaclavicular syndrome was a reason in 48 patients, additional cervical ribs had 36 patients. Skalenus syndrome was noted in 26 cases, rudimentary cervical ribs or hypertrophy of cervical vertebrae C7 had 7 patients. Raynaud's syndrome took place in 19 cases. The required volume of diagnostic procedures and surgical treatment of STOS were determined according to the cause of the syndrome. Differentiated approach to the different forms of STOS was used in relation to dominant symptoms of the disease and reasons for compression of neurovascular fascicle. This allowed getting positive results in majority of patients (90,4%) in long- term period.

  10. ANATOMIC RESEARCH OF SUPERIOR CLUNIAL NERVE TRAUMA

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    In order to find the mechanism of superior clunial nerve (SCN) trauma, we dissected and revealed SCN from 12 corpses (24 sides). Combining 100 sides of SCN trauma, we inspected the course of SCN, the relation between SCN and it's neighbour tissues with the situation of SCN when being subjected to force. We found that the following special anatomic characteristics and mechanical elements such as the course of SCN, it's turning angles, the bony fibrous tube at the iliac crest, the posterior layer of the lumbodorsal fascia and SCN neighbour adipose tissue, are the causes of external force inducing SCN trauma. The anatomic revealment is the guidance of SCN trauma treatment with edged needle.

  11. Superiorization: An optimization heuristic for medical physics

    CERN Document Server

    Herman, G T; Davidi, R; Censor, Y

    2012-01-01

    Purpose: To describe and mathematically validate the superiorization methodology, which is a recently-developed heuristic approach to optimization, and to discuss its applicability to medical physics problem formulations that specify the desired solution (of physically given or otherwise obtained constraints) by an optimization criterion. Methods: The underlying idea is that many iterative algorithms for finding such a solution are perturbation resilient in the sense that, even if certain kinds of changes are made at the end of each iterative step, the algorithm still produces a constraints-compatible solution. This property is exploited by using permitted changes to steer the algorithm to a solution that is not only constraints-compatible, but is also desirable according to a specified optimization criterion. The approach is very general, it is applicable to many iterative procedures and optimization criteria used in medical physics. Results: The main practical contribution is a procedure for automatically p...

  12. Superior calcium homeostasis of extraocular muscles.

    Science.gov (United States)

    Zeiger, Ulrike; Mitchell, Claire H; Khurana, Tejvir S

    2010-11-01

    Extraocular muscles (EOMs) are a unique group of skeletal muscles with unusual physiological properties such as being able to undergo rapid twitch contractions over extended periods and escape damage in the presence of excess intracellular calcium (Ca(2+)) in Duchenne's muscular dystrophy (DMD). Enhanced Ca(2+) buffering has been proposed as a contributory mechanism to explain these properties; however, the mechanisms are not well understood. We investigated mechanisms modulating Ca(2+) levels in EOM and tibialis anterior (TA) limb muscles. Using Fura-2 based ratiometric Ca(2+) imaging of primary myotubes we found that EOM myotubes reduced elevated Ca(2+) ˜2-fold faster than TA myotubes, demonstrating more efficient Ca(2+) buffering. Quantitative PCR (qPCR) and western blotting revealed higher expression of key components of the Ca(2+) regulation system in EOM, such as the cardiac/slow isoforms sarcoplasmic Ca(2+)-ATPase 2 (Serca2) and calsequestrin 2 (Casq2). Interestingly EOM expressed monomeric rather than multimeric forms of phospholamban (Pln), which was phosphorylated at threonine 17 (Thr17) but not at the serine 16 (Ser16) residue. EOM Pln remained monomeric and unphosphorylated at Ser16 despite protein kinase A (PKA) treatment, suggesting differential signalling and modulation cascades involving Pln-mediated Ca(2+) regulation in EOM. Increased expression of Ca(2+)/SR mRNA, proteins, differential post-translational modification of Pln and superior Ca(2+) buffering is consistent with the improved ability of EOM to handle elevated intracellular Ca(2+) levels. These characteristics provide mechanistic insight for the potential role of superior Ca(2+) buffering in the unusual physiology of EOM and their sparing in DMD.

  13. STEREO Superior Solar Conjunction Mission Phase

    Science.gov (United States)

    Ossing, Daniel A.; Wilson, Daniel; Balon, Kevin; Hunt, Jack; Dudley, Owen; Chiu, George; Coulter, Timothy; Reese, Angel; Cox, Matthew; Srinivasan, Dipak; hide

    2017-01-01

    With its long duration and high gain antenna (HGA) feed thermal constraint; the NASA Solar-TErestrial RElations Observatory (STEREO) solar conjunction mission phase is quite unique to deep space operations. Originally designed for a two year heliocentric orbit mission to primarily study coronal mass ejection propagation, after 8 years of continuous science data collection, the twin STEREO observatories entered the solar conjunction mission phase, for which they were not designed. Nine months before entering conjunction, an unforeseen thermal constraint threatened to stop daily communications and science data collection for 15months. With a 3.5 month long communication blackout from the superior solar conjunction, without ground commands, each observatory will reset every 3 days, resulting in 35 system resets at an Earth range of 2 AU. As the observatories will be conjoined for the first time in 8 years, a unique opportunity for calibrating the same instruments on identical spacecraft will occur. As each observatory has lost redundancy, and with only a limited fidelity hardware simulator, how can the new observatory configuration be adequately and safely tested on each spacecraft? Without ground commands, how would a 3-axis stabilized spacecraft safely manage the ever accumulating system momentum without using propellant for thrusters? Could science data still be collected for the duration of the solar conjunction mission phase? Would the observatories survive? In its second extended mission, operational resources were limited at best. This paper discusses the solutions to the STEREO superior solar conjunction operational challenges, science data impact, testing, mission operations, results, and lessons learned while implementing.

  14. Levobupivacaine induces vasodilatation, but not vasoconstriction, in rat mesenteric artery

    Directory of Open Access Journals (Sweden)

    Liciane dos Santos MENEZES

    Full Text Available Abstract Introduction Levobupivacaine (LEVO can replace analgesia because it exhibits low toxicity and causes minor vasoconstriction, enabling its use in patients in whom vasoconstrictors are contraindicated. Objective We aimed to evaluate the effects of LEVO in isolated rat superior mesenteric artery by using the vascular reactivity technique and compare its effect to that of lidocaine. Material and method Arterial rings were obtained from the mesenteric artery of male Wistar rats and kept in organ baths. For recording isometric contractions, each ring was suspended by cotton threads from a force transducer, which was connected to a data acquisition system. Result Both lidocaine and LEVO did not show a vasoconstrictor effect on the basal tone of the arterial rings with functional endothelium. However, when the rings were pre-contracted with phenylephrine, both drugs were able to induce concentration-dependent vasodilatation. The vasodilator effect induced by LEVO did not change after removal of the endothelium, or with the addition of tetraethylammonium (1 mM, a non-selective K+ channel blocker. In the rings without functional endothelium, which were pre-contracted with depolarizing Tyrode’s solution (KCl 80 mM, LEVO-induced vasodilatation was not significantly different from that observed in the rings pre-contracted with phenylephrine. Moreover, it did not show a significant additional vasodilator effect compared to the maximal vasodilator effect of nifedipine. Conclusion This study demonstrated that LEVO produces a vasodilator effect in the rat superior mesenteric artery in an endothelium-independent manner. This effect seems to be mediated via Ca2+ channel blockade in the vascular smooth muscle cells.

  15. Association of Secondary Hyperparathyroidism with Coronary Artery Disease in Patients on Regular Hemodialysis

    Directory of Open Access Journals (Sweden)

    Azar BARADARAN

    2011-12-01

    Full Text Available Objective: To understand the association of parathormone excess due to secondary hyperparathyroidism and hyperphosphatemia with coronary artery disease, a study was designed on a group of stable hemodialysis (HD patients. Methods: This cross-sectional study was carried out on patients undergoing maintenance HD. Blood samples were collected after overnight fasting for serum calcium, phosphorus, and intact serum parathormone (iPTH. The presence of cardiac chest pain was confirmed through the complaint of heart burn or epigastric pain, retrosternal discomfort and chest compression was confirmed by symmetrical depressed T wave at that time on a 12-lead ECG by means of a 12-channel and also reliving the pain after taking sublingual Trinitroglycerine pearls (TNG. Results: A sample of 36 stable HD patients was investigated. The mean age of patients was 46.5±17 years. The length of the time patients have been on hemodialysis were 32± 36 months (Median = 19 months. About 21% of patients had chest pain. Mean±SD of intact PTH of patients was 434±455 pg/ml (Median = 309 pg/ml. In this study, there was a significant difference of hemodialysis duration (p = 0.009, hemodialysis amount (p = 0.029 and also serum phosphorus (p = 0.013 between patients with and without cardiac chest pain. There was also a significant difference of iPTH (p = 0.026 between male hemodialysis patients with and without cardiac chest pain. Conclusion: Our data supported the importance of better control of serum phosphorus and also treatment of parathormone excess as the responsible factors promoting the coronary artery disease in hemodialysis patients.

  16. Caliber-Persistent Artery

    Directory of Open Access Journals (Sweden)

    Sabrina Araújo Pinho Costa

    2015-01-01

    Full Text Available Caliber-persistent artery (CPLA of the lip is a common vascular anomaly in which a main arterial branch extends to the surface of the mucous tissue with no reduction in its diameter. It usually manifests as pulsatile papule, is easily misdiagnosed, and is observed more frequently among older people, suggesting that its development may involve a degenerative process associated with aging; CPLA is also characterized by the loss of tone of the adjacent supporting connective tissue. Although the diagnosis is clinical, high-resolution Doppler ultrasound is a useful noninvasive tool for evaluating the lesion. This report describes the case of a 58-year-old male patient who complained of a lesion of the lower lip with bleeding and recurrent ulceration. The patient was successfully treated in our hospital after a diagnosis of CPLA and is currently undergoing a clinical outpatient follow-up with no complaints.

  17. Renal Artery Stent Outcomes

    Science.gov (United States)

    Murphy, Timothy P.; Cooper, Christopher J.; Matsumoto, Alan H.; Cutlip, Donald E.; Pencina, Karol M.; Jamerson, Kenneth; Tuttle, Katherine R.; Shapiro, Joseph I.; D’Agostino, Ralph; Massaro, Joseph; Henrich, William; Dworkin, Lance D.

    2016-01-01

    BACKGROUND Multiple randomized clinical trials comparing renal artery stent placement plus medical therapy with medical therapy alone have not shown any benefit of stent placement. However, debate continues whether patients with extreme pressure gradients, stenosis severity, or baseline blood pressure benefit from stent revascularization. OBJECTIVES The study sought to test the hypothesis that pressure gradients, stenosis severity, and/or baseline blood pressure affects outcomes after renal artery stent placement. METHODS Using data from 947 patients with a history of hypertension or chronic kidney disease from the largest randomized trial of renal artery stent placement, the CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) study, we performed exploratory analyses to determine if subsets of patients experienced better outcomes after stent placement than the overall cohort. We examined baseline stenosis severity, systolic blood pressure, and translesion pressure gradient (peak systolic and mean) and performed interaction tests and Cox proportional hazards analyses for the occurrence of the primary endpoint through all follow-up, to examine the effect of these variables on outcomes by treatment group. RESULTS There were no statistically significant differences in outcomes based on the examined variables nor were there any consistent nonsignificant trends. CONCLUSIONS Based on data from the CORAL randomized trial, there is no evidence of a significant treatment effect of the renal artery stent procedure compared with medical therapy alone based on stenosis severity, level of systolic blood pressure elevation, or according to the magnitude of the transstenotic pressure gradient. (Benefits of Medical Therapy Plus Stenting for Renal Atherosclerotic Lesions [CORAL]; NCT00081731) PMID:26653621

  18. Case Report: Coronary arterial spasm in single right coronary artery

    Institute of Scientific and Technical Information of China (English)

    En-zhi JIA; Qi-jun SHAN; Zhi-jian YANG; Tie-bing ZHU; Lian-sheng WANG; Ke-jiang CAO; Wen-zhu MA

    2009-01-01

    We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.

  19. Extended TRAM flap: feasibility study on fresh human cadavers.

    Science.gov (United States)

    Zenn, Michael R; Heitmann, Christoph

    2003-03-01

    The purpose of this study was to investigate the feasibility of a superiorly based TRAM flap for breast reconstruction with its superior border abutting the inframammary fold. This flap would have a primary blood supply from the superior epigastric vessels, similar to a free flap attached to the mammary system. This flap, however, would not require microsurgery. Instead, it would have its superior epigastric pedicle lengthened by partial rib resection. Donor site closure would be accomplished by reverse abdominoplasty and the donor scar hidden in the inframammary fold. The surgical anatomy of such an extended TRAM flap (eTRAM) was investigated by cannulation of the internal mammary artery (IMA) in 10 fresh human cadavers bilaterally, injection with latex, and then dissection throughout its intrathoracic course. At the level of the third intercostal space, the mean external diameters of the right and left IMA were found to be 2.5 mm and 2.3 mm, respectively. The diameter of the vessel decreased until the IMA bifurcated into the superior epigastric artery and the musculophrenic artery, usually at the sixth intercostal space. The superior epigastric artery, having a mean diameter of 1.6 mm at its origin, descended caudally behind the seventh costal cartilage and could be followed until it entered the posterior rectus sheath and the rectus abdominis muscle. On its downward course, it was not embedded in the diaphragm muscle and was easily separated without violation of the thoracic cavity. From this anatomic study, it seems to be possible to raise an eTRAM after partial rib resection. Some technical considerations of such a flap are discussed. This modification of the TRAM would be helpful to surgeons commonly performing pedicled TRAM flaps and might extend its applicability beyond breast reconstruction to chest wall, intrathoracic, and head and neck reconstruction.

  20. Coronary Artery Anomalies in Animals

    Directory of Open Access Journals (Sweden)

    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.