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Renal Failure Nov 2019The aim of this study was to evaluate and compare the severity of acute kidney injury (AKI) induced by iodine contrast agent injection via the renal artery, ear vein,...
OBJECTIVES
The aim of this study was to evaluate and compare the severity of acute kidney injury (AKI) induced by iodine contrast agent injection via the renal artery, ear vein, and femoral artery in a rabbit model.
METHODS
Blood oxygenation level-dependent (BOLD) magnetic resonance (MR) scans were performed at 24 h prior to contrast injection and 1, 24, 48, and 72 h after injection. Iodixanol injection dose was 1.0, 1.5, 2.0, and 2.5 g iodine/kg, respectively. Hypoxia-inducible factor-1α (HIF-1α) expression was determined, and the BOLD-MRI parameter R2* was used to express tissue oxygenation. Increases in R2* levels reflect reductions in tissue oxygenation. Analyses including R2* value, dose response, histology, and HIF-1α were conducted.
RESULT
Injection of 1.0 g iodine/kg into the left renal artery resulted in significant increases in renal R2* values after 24 h. This was equivalent to the change of R2* after 2.0 g iodine/kg femoral artery injection. Renal injury scores and HIF-1α expression scores were significantly increased at 24 h. The R2* values exhibited a positive linear correlation with histological injury scores. The maximum effects occurred 24 h after iodixanol injection and returned to baseline levels within 72 h.
CONCLUSIONS
The renal injury induced by 1.0 g iodine/kg iodixanol through renal artery injection was more significant than that caused by the same dose of femoral artery and auricular vein injection, while similar to that caused by 2.0 g iodine/kg femoral artery injection.
Topics: Acute Kidney Injury; Animals; Contrast Media; Disease Models, Animal; Ear Auricle; Femoral Artery; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Injections, Intra-Arterial; Injections, Intravenous; Kidney; Magnetic Resonance Imaging; Male; Oxygen; Rabbits; Renal Artery; Severity of Illness Index; Triiodobenzoic Acids
PubMed: 31057054
DOI: 10.1080/0886022X.2019.1604382 -
Archives of Craniofacial Surgery Jun 2021Arteriovenous malformation (AVM) which is a high-blood-flow lesion with connections between arteries and veins without an intervening capillary bed, is difficult to...
BACKGROUND
Arteriovenous malformation (AVM) which is a high-blood-flow lesion with connections between arteries and veins without an intervening capillary bed, is difficult to manage. The ear is the second most common site of extracranial AVM. However, studies regarding the management of this condition remain lacking. The purpose of this study was to share managing experiences in our center and to investigate the treatment effect through a retrospective analysis of cases.
METHODS
Among 265 patients with AVM treated in our vascular anomalies center between January 2008 and January 2021, 10 patients with auricular AVM were included in the study to investigate the lesion distribution, clinical stage, and treatment methods by performing a retrospective evaluation.
RESULTS
Among 10 patients, five patients had AVMs distributed in the upper half of the ear, one patient in the lower half of the ear, and four patients in whole ear, respectively. Seven patients had Schobinger stage II, and three had stage III. One patient received surgical treatment only, four patients received sclerotherapy only, and five patients received both surgical treatment and sclerotherapy. The posttreatment status was checked as controlled in two patients, improved in seven patients, persistent in one patient. There were no worsening patients.
CONCLUSION
Auricular AVM is a disease that is difficult to manage by one specific department, thus requiring a collaborative management effort from multidisciplinary team.
PubMed: 34225405
DOI: 10.7181/acfs.2021.00192 -
Journal of Neuroendovascular Therapy 2022We treated a case of scalp arteriovenous malformation (sAVM) by transvenous embolization using Onyx.
OBJECTIVE
We treated a case of scalp arteriovenous malformation (sAVM) by transvenous embolization using Onyx.
CASE PRESENTATION
We describe the case of a 17-year-old woman with a pulsatile mass at the right temporal area. DSA identified sAVM with the venous pouch between the right occipital artery (OA) and the right two occipital veins (OVs), which was also fed by multiple branches of the right posterior auricular artery (PAA) and superficial temporal artery (STA). The shunts were completely occluded by the reverse pressure cooker technique (RPCT), which involves navigating the balloon catheters just distal to the shunt point in the OVs approaching from the right external jugular vein (EJV) and injecting Onyx to each feeder retrogradely with balloons inflated.
CONCLUSION
This technique may be useful for treating sAVM with venous angioarchitecture enabling a transvenous approach.
PubMed: 37502025
DOI: 10.5797/jnet.tn.2020-0175 -
Laryngoscope Investigative... Oct 2022In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when...
BACKGROUND
In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when performing parotidectomy. However, further clinical study is critically needed before this landmark could be applied in clinical practice.
METHODS
For 31 patients enrolled, we tried to identify the FN by the guide of the PAA during parotidectomy. Additionally, the FN function was evaluated during follow-up.
RESULTS
PAA could be exposed in 28 out of 31 (90.3%) patients during parotidectomy. Moreover, the FN trunk could be identified by the guide of the PAA in all these 28 patients with identifiable PAA. Furthermore, no iatrogenic FN damage happened in this study and the transient FN dysfunction rate was 5.7%.
CONCLUSION
The PAA is an ideal landmark for early identification of the FN trunk when performing parotidectomy.
PubMed: 36258872
DOI: 10.1002/lio2.894 -
Clinica E Investigacion En... 2022One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known...
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.
Topics: Arteriosclerosis; Cardiovascular Diseases; Heart Disease Risk Factors; Humans; Risk Factors
PubMed: 35090775
DOI: 10.1016/j.arteri.2021.11.003 -
Plastic and Reconstructive Surgery.... Apr 2021Facial thread-lifting has been popular because of its ease and safety with short down time. However, many physicians perform the procedure in cosmetic clinics, which can...
Facial thread-lifting has been popular because of its ease and safety with short down time. However, many physicians perform the procedure in cosmetic clinics, which can result in several complications. This report describes the surgical treatment of iatrogenic superficial temporal artery pseudoaneurysm (STAP) following thread-lifting. A 27-year-old man developed a painless, pulsating soft mass in the pre-auricular region after undergoing a thread-lift in a private cosmetic clinic 3 months before being referred to the authors' hospital. The mass was diagnosed as a STAP, using magnetic resonance imaging. The pseudoaneurysm was resected completely, and the superficial temporal artery was microsurgically reconstructed. Although there are some surgical procedures for treating STAP, such as surgical resection and embolization, the former is considered the first choice. Physicians should be trained before performing thread-lifting and must know the possibility of an iatrogenic STAP appearing after the procedure and the face and neck anatomy to prevent complications.
PubMed: 33868876
DOI: 10.1097/GOX.0000000000003524 -
Medicine and Pharmacy Reports Jan 2020Information in ultrasonography about reference values of nerves, particularly of those located in the neck is limited. The aim of the study is to demonstrate the...
BACKGROUND AND AIM
Information in ultrasonography about reference values of nerves, particularly of those located in the neck is limited. The aim of the study is to demonstrate the feasibility of direct visualization of the vagus, hypoglossal and greater auricular nerves, testing the method on healthy volunteers and estimate the reference values for two perpendicular diameters and cross-sectional area (CSA).
METHODS
A prospective study was carried out on 21 healthy volunteers (12 women and 9 men), recording their demographic characteristics. A 13 MHz transducer was used on a Hitachi EUB-8500 machine. The vagus nerve was measured at the bifurcation of common carotid artery (CCA) and at the intersection of the internal jugular vein with omohyoid muscle. The hypoglossal nerve was identified as it crosses the posterolateral border of the mylohyoid muscle in the submandibular space. The auricular nerve was identified on the superficial surface of the sternocleidomastoid muscle at 1 cm from its posterior margin. The mean CSA on axial scans, nerve width and thickness were determined. The side-to-side and gender differences of the estimated reference values and their correlations with the weight, height, and body mass index (BMI) were evaluated.
RESULTS
The mean ultrasound-estimated CSA was measured for the vagus nerve at CCA bifurcation (2.14 ± 0.79 on the left 2.86 ± 1.27 on the right), vagus nerve at the level of omohyoid muscle (2.10 ± 0.06 on the left and 2.43 ± 0.08 on the right), hypoglossal nerve (1.71 ± 0.08 on the left, 1.24 ± 0.06 on the right) and greater auricular nerve (0.90 ± 0.53 on the left and 0.79 ± 0.71 on the right). The vagus nerve was significantly larger on the right side compared to the left side. Larger hypoglossal nerve was observed in men compared to women. Significant correlations were observed between weight and CSA of the greater auricular nerve.
CONCLUSION
Direct visualization of the vagus, greater auricular nerve and hypoglossal nerves is feasible. Reference values for the size of the studied nerves at specific anatomic landmarks were established. Side, gender and body weight differences of the nerves CSA were noted.
PubMed: 32133445
DOI: 10.15386/mpr-1273 -
Journal of the American Association For... May 2021Flumazenil, a competitive GABA receptor antagonist, is commonly used in rabbits to shorten sedation or postanesthetic recovery after benzodiazepine administration....
Flumazenil, a competitive GABA receptor antagonist, is commonly used in rabbits to shorten sedation or postanesthetic recovery after benzodiazepine administration. However, no combined pharmacokinetic (PK) and pharmacodynamic (PD) data are available to guide its administration in this species. In a prospective, randomized, blinded, crossover study design, the efficacy of IV flumazenil (FLU; 0.05 mg/kg) or saline control (SAL; equal volume) to reverse the loss of righting reflex (LORR) induced by IV midazolam (1.2 mg/kg) was investigated in 15 New Zealand white rabbits (2.73 to 4.65 kg, 1 y old). Rabbits were instrumented with arterial (central auricular artery) and venous (marginal auricular vein) catheters. After baseline blood sampling, IV midazolam was injected (T0). Flumazenil or saline (FLU/SAL) was injected 30 s after LORR. Arterial blood samples were collected at 1 and 3 min after midazolam injection, and at 1, 3, 6, 10, 15, 21, 28, 36, 45 and 60 min after injection with flumazenil. Plasma samples for midazolam, 1-OH-midazolam and flumazenil were analyzed using high performance liquid chromatography-high-resolution mass spectrometry and the time to return of righting reflex (ReRR) was compared between groups (Wilcoxon test). FLU terminal half-life, plasma clearance and volume of distribution were 26.3 min [95%CI: 23.3 to 29.3], 18.74 mL/min/kg [16.47 to 21.00] and 0.63 L/kg [0.55 to 0.71], respectively. ReRR was 25 times faster in rabbits treated with FLU (23 [8 to 44] s) compared with SAL (576 [130 to 1141] s; 95%CI [425 to 914 s]). Return of sedation (lateral recumbency) occurred in both groups (7/13 in FLU; 12/13 in SAL) with return of LORR in a few animals (4/13 in FLU; 7/13 in SAL) at 1540 [858 to 2328] s. In the population and anesthesia protocol studied, flumazenil quickly and reliably reversed sedation induced by midazolam injection. However, the potential return of sedation after flumazenil administration warrants careful monitoring in the recovery period.
Topics: Animals; Rabbits; Administration, Intravenous; Cross-Over Studies; Flumazenil; Midazolam; Prospective Studies
PubMed: 33673881
DOI: 10.30802/AALAS-JAALAS-20-000084 -
British Journal of Anaesthesia Apr 2023Activation of central autonomic pathways, including those regulating the arterial baroreflex, might reduce acute pain. We tested the hypothesis that transcutaneous... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Activation of central autonomic pathways, including those regulating the arterial baroreflex, might reduce acute pain. We tested the hypothesis that transcutaneous auricular nerve stimulation (TAN) reduces pain after orthopaedic trauma surgery through autonomic modulation.
METHODS
A total of 86 participants aged >18 yr were randomly assigned to 50 min of either sham or active bilateral TAN, undertaken before, and again 24 h after, surgery for orthopaedic trauma. The primary outcome was absolute change in pain 24 h postoperatively, comparing the 100 mm visual analogue scale (VAS) before and after TAN. Secondary outcomes included the minimal clinically important difference in pain (>10 mm increase or reduction in VAS) before/after surgery, using intention-to-treat analysis. Holter monitoring, the analysis of which was masked to allocation, quantified autonomic modulation of heart rate.
RESULTS
From June 22, 2021 to July 7, 2022, 79/86 participants (49 yr; 45% female) completed TAN before and after surgery. For the primary outcome, the mean reduction in VAS was 19 mm (95% confidence interval [CI]: 12-26) after active TAN (n=40), vs 10 mm (95% CI: 3-17) after sham TAN (n=39; P=0.023). A minimally clinically important reduction in postoperative pain occurred in 31/40 (78%) participants after active TAN, compared with 15/39 (38%) allocated to sham TAN (odds ratio 5.51 [95% CI: 2.06-14.73]; P=0.001). Only active TAN increased heart rate variability (log low-frequency power increased by 0.19 ms [0.01-0.37 ms]). Prespecified adverse events (auricular skin irritation) occurred in six participants receiving active TAN, compared with two receiving sham TAN.
CONCLUSION
Bilateral TAN reduces perioperative pain through autonomic modulation. These proof-of-concept data support a non-pharmacological, generalisable approach to improve perioperative analgesia.
Topics: Humans; Female; Male; Single-Blind Method; Pain, Postoperative; Acute Pain
PubMed: 36822987
DOI: 10.1016/j.bja.2022.12.025 -
IBRO Neuroscience Reports Jun 2023The aim of this study was to characterize cardiovascular autonomic responses during two constant current intensities below sensory threshold of transcutaneous auricular...
OBJECTIVES
The aim of this study was to characterize cardiovascular autonomic responses during two constant current intensities below sensory threshold of transcutaneous auricular nerve stimulation (taNS). On this basis, a protocol for taNS with autonomic modulatory potential could be proposed.
SUBJECTS AND METHODS
We included 26 men and 24 women, mean age 26. Data were collected during three randomly allocated 20-minute right tragus stimulation sessions - a) no-stimulation (sham), b) 90 µA (arbitrary), and c) 130 µA (near the lowest sensory threshold in majority). Stimulation was 20 Hz, rectangular pulse width of 2 ms, duty cycle 2-second on/off. To assess autonomic responses, we continuously recorded ECG, non-invasive arterial blood pressure (BP) and thoracic impedance cardiography data. Ten-minute data were compared. Fast Fourier transform of RR intervals was performed on 10-minute recordings as well. Low frequency and high frequency power spectra were calculated. Friedman test or one-way ANOVA for repeated measurements and Mann-Whitney or Wilcoxon's signed-rank test, or t-test were carried out. P < 0.05 was considered significant.
RESULTS
At 130 µA stimulation, cardiac output significantly decreased (p < 0.05), driven by significant heart rate drop in women, and stroke volume and contractility drop in men, pointing to a gender-related autonomic responses. We observed no significant changes in BP, or variability parameters. Significantly higher body size and BP were found in men, as expected.
CONCLUSIONS
It seems that tested taNS protocol has a potential for cardiac autonomic modulation in majority of young healthy men as well as women. Further studies are however needed to prove the therapeutic potential of this stimulation protocol in different patient groups.
PubMed: 36824666
DOI: 10.1016/j.ibneur.2023.01.010