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BMC Oral Health Jan 2024This study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap...
OBJECTIVE
This study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap reconstruction of soft tissue for postoperative defects.
MATERIALS AND METHODS
A retrospective review was conducted on 11 cases of soft tissue flap reconstruction for postoperative defects following the resection of malignant tumors in the parotid region. Statistical analysis was performed based on clinical data.
RESULTS
Among the 11 cases of malignant tumors in the parotid region, there were 2 cases of secretory carcinoma (SC) of the salivary gland, 2 cases of squamous cell carcinoma (SCC), 2 cases of carcinosarcoma, 1 case of mucoepidermoid carcinoma (MEC), 1 case of epithelial-myoepithelial carcinoma (EMC), 1 case of salivary duct carcinoma (SDC), 1 case of basal cell carcinoma (BCC), and 1 case of osteosarcoma. Among these cases, 4 were initial diagnoses and 7 were recurrent tumors. The defect repairs involved: 8 cases with anterolateral thigh free flap (ALTF), 2 cases with pectoralis major muscle flaps, and 1 case with forearm flap. The size of the flaps ranged from approximately 1 cm × 3 cm to 7 cm × 15 cm. The recipient vessels included: 4 cases with the facial artery, 4 cases with the superior thyroid artery, and 1 case with the external carotid artery. The ratio of recipient vein anastomosis was: 57% for branches of the internal jugular vein, 29% for the facial vein, and 14% for the external jugular vein. Among the 8 cases that underwent neck lymph node dissection, one case showed lymph node metastasis on pathological examination. In the initial diagnosis cases, 2 cases received postoperative radiotherapy, and 1 case received I seed implantation therapeutic treatment after experiencing two recurrences. Postoperative follow-up revealed that 2 cases underwent reoperation due to local tumor recurrence, and there were 2 cases lost to follow-up. The survival outcomes after treatment included: one case of distant metastasis and one case of death from non-cancerous diseases.
CONCLUSION
Immediate soft tissue flap reconstruction is an important and valuable option to address postoperative defects in patients afflicted with malignant tumors in the parotid region.
Topics: Humans; Skin Transplantation; Parotid Region; Neoplasm Recurrence, Local; Carcinoma, Squamous Cell; Algorithms
PubMed: 38238723
DOI: 10.1186/s12903-024-03872-z -
Cureus Dec 2023Lemierre syndrome is characterized by thrombophlebitis of the internal jugular vein (IJV) secondary to bacterial pharyngitis or tonsillitis. Though antibiotic use has...
Lemierre syndrome is characterized by thrombophlebitis of the internal jugular vein (IJV) secondary to bacterial pharyngitis or tonsillitis. Though antibiotic use has made this a rarer syndrome, it can nevertheless manifest in patients presenting with pharyngitis. Herein, we describe a 20-year-old male patient with no relevant medical history presenting with signs concerning for pneumonia and was ultimately diagnosed with Lemierre syndrome with bacteremia. Complications included IJV thrombus with presumed septic emboli to the lungs. The patient was discharged on ampicillin/sulbactam with plans to transition to amoxicillin/clavulanate.
PubMed: 38222167
DOI: 10.7759/cureus.50580 -
Ear, Nose, & Throat Journal Oct 2023Tumors arising from the upper parapharyngeal space (UPPS) may have intimate relationships with the internal carotid artery (ICA) and the internal jugular vein (IJV)....
Tumors arising from the upper parapharyngeal space (UPPS) may have intimate relationships with the internal carotid artery (ICA) and the internal jugular vein (IJV). The significance of the ICA in UPPS has been sufficiently articulated, whereas the relevance of the IJV has not been addressed. This study aimed to assess the anatomical variations of the IJV within the UPPS, and to explore its implications for surgical procedures. An endoscopic dissection of the IJV was performed on 10 cadaveric specimens. In addition, 30 patients who underwent transoral or transcervical resection of UPPS tumors were retrospectively reviewed to characterize the IJV and its relation to the tumor. On the cadaveric specimens, the IJV was located at the posteromedial and posterolateral aspects of the styloid process in 13 (65%) and 7 (35%) sides, respectively. In our clinical series, the IJV was not encountered in 18 patients with pre-styloid tumors. In 12 patients harboring retro-styloid tumors, the IJV was partially (n = 5) or completely (n = 7) compressed and was displaced into the posterolateral aspect of the tumor. The IJV was injured intraoperatively in 1 patient, requiring an immediate conversion to an open transcervical corridor that allowed its exposure and ligation without difficulty. This study characterizes the IJV and its relationship with adjacent neurovascular structures in the UPPS, which may provide further safeguards during transoral and transcervical procedures in the UPPS.
PubMed: 37786236
DOI: 10.1177/01455613231197730 -
Italian Journal of Pediatrics Nov 2023The purpose of this study was to summarize the early clinical results and surgical experience of repairing the right common carotid artery and the right internal jugular...
BACKGROUND
The purpose of this study was to summarize the early clinical results and surgical experience of repairing the right common carotid artery and the right internal jugular vein after ECMO treatment in neonates.
METHODS
We retrospectively collected the clinical data of 16 neonates with circulatory and respiratory failure who were treated with ECMO via the right common carotid artery and the right internal jugular vein in our hospital from June 2021 to December 2022. The effects of repairing the common carotid artery and internal jugular vein were evaluated.
RESULTS
All 16 patients successfully underwent right cervical vascular cannulation, and the ECMO cycle was successfully established. Twelve patients were successfully removed from ECMO. The right common carotid artery and the right internal jugular vein were successfully repaired in these 12 patients. There was unobstructed arterial blood flow in 9 patients, mild stenosis in 1 patient, moderate stenosis in 1 patient and obstruction in 1 patient. There was unobstructed venous blood flow in 10 patients, mild stenosis in 1 patient, and moderate stenosis in 1 patient. No thrombosis was found in the right internal jugular vein. Thrombosis was found in the right common carotid artery of one patient.
CONCLUSION
Repairing the right common carotid artery and the right internal jugular vein after ECMO treatment in neonates was feasible, and careful surgical anastomosis techniques and standardized postoperative anticoagulation management can ensure early vascular patency. However, long-term vascular patency is still being assessed in follow-up.
Topics: Infant, Newborn; Humans; Extracorporeal Membrane Oxygenation; Jugular Veins; Retrospective Studies; Constriction, Pathologic; Carotid Artery, Common
PubMed: 37950294
DOI: 10.1186/s13052-023-01556-y -
BMC Veterinary Research Oct 2023Cattle strongly mask their pain, making the recognition and assessment of pain difficult. Different subjective and objective parameters to assess pain have been...
BACKGROUND
Cattle strongly mask their pain, making the recognition and assessment of pain difficult. Different subjective and objective parameters to assess pain have been described. Substance P (SP), which is a neurotransmitter, is used to objectively evaluate nociception in cattle. However, SP concentrations have mainly been described in diseased animals, or animals subjected to painful procedures. To this day, no evaluation of SP in healthy adult cattle has been published. The objectives of this pilot study were to 1) assess the SP concentrations in healthy adult German Simmental cattle in the blood plasma, 2) compare the concentrations between the blood of the jugular and the tail vein, and 3) assess the concentrations in the blood of the tail vein every 6 h over a period of 24 h. A total of 52 healthy cattle of the German Simmental breed were included in this study. Animals were 5.0 ± 1.3 (mean ± SD) years old and between 117 and 239 (175.0 ± 34.1) days in milk. Blood samples were taken from the jugular vein (BJV, 07:45 a.m.) and the tail vein (TV1, 08:00 a.m.) each. Additional blood samples were taken every 6 h over the course of 24 h from the tail vein (TV2 - TV5). SP concentrations were analyzed using a commercial ELISA kit.
RESULTS
Mean (± SD) and median SP concentrations were 1.087 ± 436 pg/ml and 984 pg/ml for BJV (range 502 - 2,337 pg/ml), and 920 ± 402 pg/ml and 818 pg/ml for TV1 (range 192 - 2,531 pg/ml), respectively. There was a significantly positive correlation between SP concentrations of BJV and TV1. SP concentrations between BJV and TV1 were significantly different, as were SP concentrations in the tail vein between sampling times over the course of 24 h.
CONCLUSIONS
The results of this study show that blood samples to assess SP concentrations in cattle can be taken from the jugular as well as from the tail vein. There are high variations in concentrations between animals, and it is hard to define reference ranges for SP in healthy animals. Repeated blood samples should not be taken by repeated punctation of a vein but by use of a jugular vein catheter, which is a major limitation of the present study.
Topics: Female; Cattle; Animals; Substance P; Tail; Pilot Projects; Plasma; Pain
PubMed: 37864162
DOI: 10.1186/s12917-023-03768-0 -
Plastic and Reconstructive Surgery.... Dec 2023In head and neck reconstructions, venous anastomosis of the free flap to the internal jugular vein system is a common procedure. However, in some cases, postoperative...
In head and neck reconstructions, venous anastomosis of the free flap to the internal jugular vein system is a common procedure. However, in some cases, postoperative complications such as internal jugular vein thrombosis can occur. In this report, we present a case where postoperative internal jugular vein thrombosis was identified after venous anastomosis of the free flap to the internal jugular vein system. In this case, preserving the external jugular vein allowed for retrograde flow of venous blood in the internal jugular vein to enter the external jugular vein, serving as an alternative drainage pathway. This finding highlights the potential benefits of preserving the external jugular vein in head and neck surgery involving free flap venous anastomosis to mitigate the adverse effects of internal jugular vein thrombosis. Further investigations are warranted to better understand the underlying mechanisms and optimize surgical approaches for improved patient outcomes.
PubMed: 38115835
DOI: 10.1097/GOX.0000000000005501 -
Cureus Nov 2023The incidence of retropharyngeal abscesses has been decreasing since the introduction of antibiotic therapy, and it is currently a rare diagnosis in adults, although...
The incidence of retropharyngeal abscesses has been decreasing since the introduction of antibiotic therapy, and it is currently a rare diagnosis in adults, although there are some recent cases in the literature. Given its seriousness, if not treated promptly, the infection can progress rapidly and its complications can be fatal, making it a serious health problem. A 79-year-old woman presented at her primary care center with complaints of persistent odynophagia for about two weeks and rapidly progressive dysphagia in five days, initially for solids and later for solids and liquids. On observation, she had difficulty swallowing saliva and presented a painful mass in the bilateral anterior submental and anterior cervical region. Due to the rapid progression of symptoms and the findings of the physical examination, the patient was referred to the emergency department for a suspected abscess or cervical mass. In the emergency department, a cervical CT scan was performed, which revealed a retropharyngeal abscess measuring approximately 7 x 6 x 4 cm, involving the right carotid artery and internal jugular vein, with compression of the internal jugular vein. The patient was admitted to the otorhinolaryngology department, where intravenous antibiotic therapy with third-generation cephalosporin and clindamycin was initiated. She underwent exploration in the operating room to determine the cause of the abscess and transoral drainage of the already spontaneously draining abscess. After completing antibiotic therapy, a follow-up CT scan showed complete resolution of the abscess without suggestive masses of neoplasm or foreign bodies, therefore, the cause of the abscess has not been identified. The most frequent cause of retropharyngeal abscess in adults is dental septic foci and another commonly described cause is the ingestion of foreign bodies such as fish bones or chicken bones. Early diagnosis of this condition is crucial, as delays in treatment initiation can lead to the progression of infection into the deep cervical spaces, resulting in serious complications such as mediastinitis, pericarditis, jugular vein thrombosis, sepsis, laryngeal edema, conditions with a high degree of morbidity and mortality. Therefore, it is important for any doctor to be aware of warning signs and symptoms in patients who present such symptoms, especially primary care doctors, who are the first gateway to health services and to whom patients often turn first. This case report shows the importance of suspicion and subsequent referral for timely diagnosis and treatment.
PubMed: 38058317
DOI: 10.7759/cureus.48293 -
Thrombosis Journal Sep 2023Lemierre's Syndrome is a severe medical condition that can result from oropharyngeal infection, typically caused by Fusobacterium necrophorum, leading to sepsis,...
BACKGROUND
Lemierre's Syndrome is a severe medical condition that can result from oropharyngeal infection, typically caused by Fusobacterium necrophorum, leading to sepsis, internal jugular vein thrombosis, and metastatic septic emboli. However, there is limited literature on this syndrome caused by Streptococcus anginosus, and few previous cases have been reported to have deep neck space infection. We present the first case of Lemierre's Syndrome caused by Streptococcus anginosus with deep neck abscess.
CASE PRESENTATION
A 53-year-old male patient with no significant medical history presented with right neck pain after accidentally swallowing a fish bone one month ago. Laryngoscopy did not reveal any abnormalities. Five days prior to admission, the patient developed high fever. Imaging studies showed internal jugular vein thrombosis and a neck abscess surrounding the carotid artery sheath. Blood culture results were positive for Streptococcus anginosus infection, and the patient was diagnosed with Lemierre's syndrome. The patient underwent surgical drainage and received antibiotics and anticoagulant therapy, and had satisfactory clinical progress. He was discharged after a 16-day hospitalization.
CONCLUSIONS
Although Lemierre's syndrome is rare, it needs attention because it can lead to serious complications and requires timely treatment. Deep neck space infections can be life-threatening and doctors must be aware of its potential severity.
PubMed: 37715238
DOI: 10.1186/s12959-023-00543-x -
Cureus Apr 2024The response of jugular venous pressure (JVP) to increased preload with inspiration has been recognized as a method of stratifying risk in the management of heart...
BACKGROUND
The response of jugular venous pressure (JVP) to increased preload with inspiration has been recognized as a method of stratifying risk in the management of heart failure (HF). Whether the JVP response to inspiration may be more effective than other simple approaches in this setting remains unclear.
METHODS
This study enrolled 79 patients with stable HF. JVP was assessed from the right internal jugular vein in the sitting position and was considered high if visible above the right clavicle at rest. JVP responses to inspiration, the five-repetition sit-to-stand test (5-STS), and squatting were also evaluated. The primary outcome was a composite of all-cause death and hospitalization for worsening HF.
RESULTS
JVP assessment after 5-STS and during squatting was not conducted in two and 14 HF patients, respectively, due to physical limitations. During a mean follow-up of 837 days, the primary outcome was associated with a high JVP at rest (hazard ratio, 2.47; 95% confidence interval [CI], 1.09 to 5.60; P <0.05), with inspiration (hazard ratio, 2.53; 95% CI, 1.17 to 5.46; P <0.05), after 5-STS (hazard ratio, 2.61; 95% CI, 1.23 to 5.97; P <0.05), and during squatting (hazard ratio, 2.40; 95% CI, 1.03 to 6.06; P <0.05). Among patients without a high JVP at rest, the specificity of the primary outcome at one year was greater for the JVP response to inspiration (89%) and squatting (92%) than for the response to 5-STS (80%).
CONCLUSIONS
JVP response to increased preload with inspiration may be a simple and practical method for risk assessment in patients with stable HF.
PubMed: 38765383
DOI: 10.7759/cureus.58423 -
Platelets Dec 2023Platelets play many roles in the vasculature ensuring proper hemostasis and maintaining integrity. These roles are facilitated, in part, by cargo molecules released from...
Platelets play many roles in the vasculature ensuring proper hemostasis and maintaining integrity. These roles are facilitated, in part, by cargo molecules released from platelet granules via oluble SF ttachment rotein eceptor (SNARE) mediated membrane fusion, which is controlled by several protein-protein interactions. Chaperones have been characterized for t-SNAREs (. Munc18b for Syntaxin-11), but none have been clearly identified for v-SNAREs. α-Synuclein has been proposed as a v-SNARE chaperone which may affect SNARE-complex assembly, fusion pore opening, and thus secretion. Despite its abundance and that it is the only isoform present, α-synuclein's role in platelet secretion is uncharacterized. In this study, immunofluorescence showed that α-synuclein was present on punctate structures that co-stained with markers for α-granules and lysosomes and in a cytoplasmic pool. We analyzed the phenotype of α-synuclein mice and their platelets. Platelets from knockout mice had a mild, agonist-dependent secretion defect but aggregation and spreading were unaffected. Consistently, thrombosis/hemostasis were unaffected in the tail-bleeding, FeCl carotid injury and jugular vein puncture models. None of the platelet secretory machinery examined, . the v-SNAREs, were affected by α-synuclein's loss. The results indicate that, despite its abundance, α-synuclein has only a limited role in platelet function and thrombosis.
Topics: Animals; Mice; alpha-Synuclein; Blood Platelets; Cytoplasmic Granules; Exocytosis; Mice, Knockout; Platelet Activation; Protein Isoforms; SNARE Proteins; Thrombosis
PubMed: 37927048
DOI: 10.1080/09537104.2023.2267147