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Materia Socio-medica 2012none declared. (Review)
Review
CONFLICT OF INTEREST
none declared.
INTRODUCTION
Varicella or chickenpox is highly contagious, childhood infectious disease caused by primary infection with varicella - zoster virus from the herpes family of viruses. Usually it has a mild clinical course, rarely with described complication, mostly affecting respiratory tract and rarely the central nervous system.
CASE REPORT
The case present 8 year old boy hospitalized eighth day of disease with clinical pictures of varicella complication. Upon receipt tachydyspnea, high fever, tachycardia, hypotensive with positive findings on lung auscultation in the sense of pneumonia. Extremely high values of non-specific inflammatory parameters are implied on bacterial infection which is treated using triple antimicrobial therapy and antiviral. A detailed clinical, laboratory and radiological evaluation is determined of clinical disease complication under a picture of MODS that required prolonged multidisciplinary treatment in ICU.
CONCLUSION
The disease had a favorable clinical outcome in terms of training completely without consequences but, with the detected congenital absence lower lobe of right lung and transposition of the brachiocephalic trunk.
PubMed: 24493991
DOI: 10.5455/msm.2012.24.s18-s19 -
EJVES Short Reports 2016A 59 year old woman presented with acute right leg ischemia. On the computed tomography scan, thrombi were seen in the brachiocephalic trunk, in the descending aorta, in...
INTRODUCTION
A 59 year old woman presented with acute right leg ischemia. On the computed tomography scan, thrombi were seen in the brachiocephalic trunk, in the descending aorta, in the infrarenal aorta, in the right deep femoral artery, and in the right crural arteries.
TECHNIQUE
To remove the risk of cerebral emboli, thrombo-aspiration of the brachiocephalic trunk was planned, with associated thrombectomy of the infrarenal aorta, the right deep femoral artery, and the right crural arteries. Because the brachiocephalic thrombus could not be visualized with angiography, the anesthetists, who were performing a trans-oesophageal ultrasound of the heart, were asked to locate the thrombus, which was easily seen on the trans-oesophageal ultrasound. The aspiration catheter Angiojet (Boston Scientific, Marlborough, MA, USA) could be positioned under ultrasound guidance. Complete aspiration of the thrombus was then confirmed with the ultrasound (see video). The thrombectomy of the infrarenal aorta and right leg was then performed by open surgery. The patient's recovery was uneventful. Despite extensive investigations no etiology was found for the thrombi.
DISCUSSION
Pre-operative trans-oesophageal ultrasound is routinely performed by anesthetists in patients with acute ischemia, to search for a cardiac source of emboli. In this case it had the added advantage of helping to locate and aspirate a thrombus in the brachiocephalic trunk.
PubMed: 28856297
DOI: 10.1016/j.ejvssr.2016.02.003 -
Frontiers in Physiology 2023Predicting the development of sporadic type B aortic dissection (TBAD) always remains a difficult issue. This study aimed to identify high-risk patients for development...
Predicting the development of sporadic type B aortic dissection (TBAD) always remains a difficult issue. This study aimed to identify high-risk patients for development of TBAD based on morphological parameters. This propensity-score-matched case-control study collected and reconstructed the computed tomography angiography of acute TBAD patients and hospital-based control participants without aortic dissection from January 2013 to December 2016. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI). Discriminant and reclassification abilities were compared between our model and a previously established model. Our study included 76 acute TBAD patients and 79 control patients (48 cases and 48 controls after propensity-score matching). The degree of question mark (aOR 1.07, 95% CI 1.04-1.11), brachiocephalic trunk diameter (aOR 1.49, 95% CI 1.20-1.85), brachiocephalic trunk angle (aOR 0.97, 95% CI 0.94-0.99), aortic root diameter (aOR 1.31, 95% CI 1.15-1.48), and aortic width (aOR 1.12, 95% CI 1.07-1.17) were associated with a significantly increased risk of TBAD formation. Similar findings were observed in the propensity-score matching and sensitivity analysis only including hyperacute TBAD patients. A novel prediction model was established based on the aforementioned parameters. The new model showed significantly improved discriminant ability compared with the previously established model (c-index 0.78 [95% CI 0.71-0.85] vs. 0.67 [95% CI 0.58-0.75], = .03), driven by increased reclassification ability in identifying TBAD patients (NRI for events 0.16, 95% CI 0.02-0.30, = .02). Morphological predictors, including the degree of question mark, aortic width, aortic root diameter, brachiocephalic trunk angle, and brachiocephalic trunk diameter, may be used to identify patients at high risk of TBAD.
PubMed: 36818449
DOI: 10.3389/fphys.2023.1065805 -
Clinics in Orthopedic Surgery Oct 2023In the cervicothoracic junction (CTJ), there is limited working space to perform the posterior-only approach. Therefore, a combined anterior approach is required in some...
BACKGROUND
In the cervicothoracic junction (CTJ), there is limited working space to perform the posterior-only approach. Therefore, a combined anterior approach is required in some cases. However, the great vessels and sternum obstruct the anterior corridor and make the anterior approach difficult. We analyzed relevant anatomical structures encountered during the anterior approach in the CTJ and evaluated the feasibility of previously reported surgical corridors.
METHODS
We retrospectively examined 49 patients who underwent neck computed tomography angiography between January 2015 and May 2020. Using the coronal images, we measured the intercarotid artery angle (ICAA), intercarotid artery distance (ICAD), shape of the brachiocephalic trunk (BCT), and position of the BCT base. We then measured the most cranial level requiring manubriotomy for the anterior approach (ML), the most caudal level accessible through the superior corridor (SC), and the most caudal level through the inferior corridor (IC) according to the surgeon's line of sight using the sagittal axis image.
RESULTS
The mean ICAA and ICAD were 50.83° ± 15.23° and 33.38 ± 12.11 mm, respectively. Notably, BCT shape was of the convex type in most cases (42.9%), followed by the straight type (36.7%). In addition, the base of BCT was most commonly located inside the body (49%). Moreover, ICAA and ICAD were significantly greater in men. Although men mostly had the BCT base inside the body (64.3%), female mostly had it on the edge of the body (47.6%). Notably, ML showed the highest frequency (16.3%) in the T1 lower and upper bodies. Furthermore, through SC and IC, it was possible to approach the T4 lower body and T6 midbody, respectively. SC showed the highest frequency (16.3%) in the T3 lower body, and IC showed the highest frequency (20.4%) in the T5 midbody.
CONCLUSIONS
ICAA and ICAD were larger and higher in men. BCT was convex and located inside the body in most cases. The accessible level of ML, SC, and IC were T1, T3, and T5, respectively. For the anterior approach in the CTJ, preoperative vascular and accessible level analysis of corridors is essential to decide on the appropriate corridor and reduce complications.
Topics: Male; Humans; Female; Retrospective Studies; Cervical Vertebrae; Thoracic Vertebrae; Tomography, X-Ray Computed; Orthopedic Procedures
PubMed: 37811505
DOI: 10.4055/cios22394 -
Bulletin of the New York Academy of... Sep 1985
Topics: Angiography; Arm; Arteries; Brachiocephalic Trunk; Carotid Artery Injuries; Humans; Leg; Postoperative Care; Subclavian Artery; Wounds and Injuries
PubMed: 3899233
DOI: No ID Found -
Annals of Cardiac Anaesthesia 2018Visualization of aortic arch branches by transesophageal echocardiography has been technically challenging. Visualizing these vessels helps in identifying the extent of... (Review)
Review
Visualization of aortic arch branches by transesophageal echocardiography has been technically challenging. Visualizing these vessels helps in identifying the extent of dissection of the aorta, assessing the severity of carotid artery stenosis, presence of atheromatous plaques, patency of the left internal mammary artery graft, confirmation of subclavian artery cannulation, confirming holodiastolic flow reversal in the left subclavian artery by spectral Doppler imaging in case of severe aortic regurgitation, and confirming the optimal position of the intraaortic balloon perioperatively. The information obtained is helpful for diagnosis, monitoring, and decision-making during aortic surgery.
Topics: Aorta, Thoracic; Brachiocephalic Trunk; Carotid Artery, Common; Echocardiography, Transesophageal; Humans; Subclavian Artery
PubMed: 29336392
DOI: 10.4103/aca.ACA_109_17 -
Interactive Cardiovascular and Thoracic... Feb 2022Aortic arch type is a readily recognizable and obtainable morphological feature of the aorta that does not require complex measurements. The goal of this study was to...
OBJECTIVES
Aortic arch type is a readily recognizable and obtainable morphological feature of the aorta that does not require complex measurements. The goal of this study was to evaluate whether aortic arch type is a comparable and alternative morphological parameter for predicting acute type B aortic dissection (aTBAD) by comparing the prognostic value of the aortic arch type with that of other morphological parameters such as aortic length, angulation and tortuosity index.
METHODS
The patients with aTBAD (n = 216) were matched 1:1 with a control group (n = 263) by propensity score matching. The morphological data of the ascending aorta and the aortic arch, which included diameter, length, angulation and tortuosity index, were collected on a three-dimensional aortic model using 3mensio Vascular software. The aortic arch type was identified by the vertical distance from the origin of the brachiocephalic trunk to the top of the arch. The binary logistic regression models were analysed to determine the independent geometric variables related to the aTBAD. The nonparametric approach was performed to assess whether there were statistical differences between the area under the receiver operating characteristic curves (AUC) of the models.
RESULTS
After propensity score matching, 151 matched pairs of patients were selected. The diameters at the sinotubular junction and the mid-ascending aorta, the ascending aorta length and the ascending aorta angulation in the aTBAD group were significantly greater than those of the controls. Compared with the control group, the diameters at the proximal aortic arch, mid-aortic arch and distal aortic arch, the angulation and the tortuosity index of the aortic arch were significantly greater in the aTBAD group. The proportion of the type III arch in the patients with aTBAD is higher than that of the type I arch and the type II arch (χ2 = 70.187; P < 0.001). Binary logistic regression analysis showed that the diameter at the mid-aortic arch, the ascending aorta length, the aortic arch angulation and the tortuosity index were independently related to the aTBAD with an AUC value of 0.887. Another binary logistic regression analysis indicated that the diameter at the mid-aortic arch and the aortic arch type were independent correlative variables associated with the aTBAD with an AUC of 0.874. No significant difference was observed in the prognostic value of receiver operating characteristic curves between the 2 models (P = 0.716).
CONCLUSIONS
The type III arch, which has the characteristics of aortic elongation, incremental angulation and tortuosity index, is a comparable and alternative identifier for patients at high risk for aTBAD.
Topics: Aortic Dissection; Aorta; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Brachiocephalic Trunk; Humans; Retrospective Studies
PubMed: 34935037
DOI: 10.1093/icvts/ivab359 -
European Journal of Vascular and... Dec 2020
Topics: Brachiocephalic Trunk; Carotid Artery Diseases; Carotid Artery, Internal; Humans; Vascular Diseases
PubMed: 32741676
DOI: 10.1016/j.ejvs.2020.07.001 -
Medicina Intensiva May 2013
Topics: Aged, 80 and over; Brachiocephalic Trunk; Female; Humans; Radiography; Trachea
PubMed: 22305200
DOI: 10.1016/j.medin.2011.09.009 -
Annals of Surgery Aug 1965
Topics: Aneurysm; Aneurysm, False; Angiography; Brachiocephalic Trunk; Carotid Artery Diseases; Diagnosis, Differential; Humans; Hypertension; Obesity; Vascular Diseases
PubMed: 14327000
DOI: 10.1097/00000658-196508000-00006