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Acta Otorhinolaryngologica Italica :... Feb 2018Nerve and vein preserving modification of the radical neck dissection is commonly used in the management of oral squamous cell cancers. There is limited literature...
Nerve and vein preserving neck dissections for oral cancers: a prospective evaluation of spinal accessory nerve function and internal jugular vein patency following treatment.
Nerve and vein preserving modification of the radical neck dissection is commonly used in the management of oral squamous cell cancers. There is limited literature addressing nerve function and vein patency following treatment. We prospectively analysed 65 patients with nerve conduction study using surface electromyography at baseline, 1 month and 6 months post-surgery and colour Doppler of the internal jugular vein at baseline and 1 month post-surgery. We also studied functional outcomes of nerve sparing with arm abduction test and Neck Dissection Quality of Life questionnaire. There was a statistically significant increase in mean latency of motor action potential and decrease in the mean amplitude of the motor action potential following surgery, suggesting nerve dysfunction. Following surgery, there was a significant decrease in the diameter of the vein as well as an increase in the velocity of blood flow; there was partial thrombus in 5% of individuals. In conclusion, even though nerve dysfunction compromised shoulder abduction, vein dysfunction rarely resulted in any significant clinical impact.
Topics: Accessory Nerve; Female; Humans; Jugular Veins; Male; Middle Aged; Mouth Neoplasms; Neck Dissection; Organ Sparing Treatments; Prospective Studies; Quality of Life; Vascular Patency
PubMed: 29087403
DOI: 10.14639/0392-100X-1481 -
Medical Science Monitor : International... Mar 2019BACKGROUND In the present study, we aimed to determine the effect of different positive end-expiratory pressure (PEEP) levels on the cross-sectional area (CSA) of the... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of Positive End-Expiratory Pressure on Overlap Between Internal Jugular Vein and Carotid Artery in Mechanically Ventilated Patients with Laryngeal Mask Airway (LMA) Insertion - A Prospective Randomized Trial.
BACKGROUND In the present study, we aimed to determine the effect of different positive end-expiratory pressure (PEEP) levels on the cross-sectional area (CSA) of the right internal jugular vein (RIJV) and the overlap index between the RIJV and the right common carotid artery (RCCA) in mechanically ventilated patients with laryngeal mask airway (LMA) insertion. MATERIAL AND METHODS A total of 60 patients who were scheduled for elective surgery under general anesthesia with LMA insertion were enrolled. After LMA insertion, the image of RIJV and RCCA were taken after applying 4 different PEEPs in a random order: 0 (P0), 5 (P5), 10 (P10), and 15 (P15) cm H₂O. The CSA, transverse and anteroposterior (AP) diameters of the RIJV, and the overlap index were measured. RESULTS Compared to group P0, the overlap indexes of P10 (P=0.0032) and P15 (P<0.001) were significantly increased, but without a significant trend toward further increases in group P15. PEEP at 10 and 15 cm H₂O increased CSA, transverse and AP diameter of the RIJV in comparison to group P0 (all P<0.001). There was a statistically significant increase in CSA of the RIJV in P15 compared with P10 by 12.2% (P<0.001), but did not reach the relevant cut-off value (ΔCSA ≥15%). CONCLUSIONS The application of PEEP at 10 cm and 15 cm H₂O in patients receiving mechanical ventilation with LMA insertion significantly increases the size of the RIJV. However, the overlap index between the RIJV and the RCCA increased as well.
Topics: Adult; Anesthesia, General; Carotid Arteries; Carotid Artery, Common; China; Female; Humans; Jugular Veins; Laryngeal Masks; Male; Middle Aged; Positive-Pressure Respiration; Prospective Studies; Respiration, Artificial; Ultrasonography; Ventilators, Mechanical
PubMed: 30925147
DOI: 10.12659/MSM.913595 -
Scandinavian Journal of Trauma,... Dec 2013Cervical immobilisation is commonly applied following trauma, particularly blunt head injury, but current methods of immobilisation are associated with significant... (Review)
Review
Cervical immobilisation is commonly applied following trauma, particularly blunt head injury, but current methods of immobilisation are associated with significant complications. Semi-rigid disposable cervical collars are known to cause pressure ulcers, and impede effective airway management. These collars may also exacerbate a head injury by increasing intracranial pressure as a result of external compression of the jugular veins. There is a clear imperative to find ways of effectively immobilising the cervical spine whilst minimising complications, and any assessment of existing or new devices should include a standardized approach to the measurement of tissue interface pressures and their effect on jugular venous drainage from the brain. This systematic review summarises the research methods and technologies that have been used to measure tissue interface pressure and assess the jugular vein in the context of cervical immobilisation devices. 27 papers were included and assessed for quality. Laboratory investigations and biomechanical studies have gradually given way to methods that more accurately reflect clinical care. There are numerous accounts of skin ulceration associated with cervical collars, but no standardised approach to measuring tissue interface pressure. It is therefore difficult to compare studies and devices, but a pressure of less than 30 mmHg appears desirable. Cervical collars have been shown to have a compressive effect on the jugular veins, but it is not yet certain that this is the cause of the increased intracranial pressure observed in association with cervical collar use. This is the first review of its type. It will help guide further research in this area of trauma care, and the development and testing of new cervical immobilisation devices.
Topics: Airway Management; Cervical Vertebrae; Humans; Immobilization; Jugular Veins; Pressure; Regional Blood Flow
PubMed: 24299024
DOI: 10.1186/1757-7241-21-81 -
Genetics and Molecular Research : GMR Oct 2016Neo-intima development and atherosclerosis limit the long-term use of vein grafts for revascularization of ischemic tissues. Recently, studies have confirmed that...
Neo-intima development and atherosclerosis limit the long-term use of vein grafts for revascularization of ischemic tissues. Recently, studies have confirmed that proliferating cell nuclear antigen (PCNA) plays an important role in cell proliferation. Our research confirmed that 28 days after vein transplantation, PCNA expression increases significantly. Using rabbits, rather than rodents, for a more representative model of human vein grafts, we aimed to establish a time course of changes in cell proliferation and apoptosis using morphometric and immunohistochemical analyses, western blot, terminal deoxynucleotidyl transferase dUTP nick end labeling, and transmission electron microscopy (TEM). The external jugular veins of 42 healthy purebred male New Zealand white rabbits were grafted onto their common carotid arteries. The rabbits were divided into seven groups, with vein grafts being harvested before surgery, and at 1, 3, 7, 14, 28, and 90 days afterwards. The extent of stenosis and apoptosis, PCNA protein levels, and TEM morphology were subsequently examined. Intimal thickness was slightly decreased 1 day following surgery, but then increased continuously until the 90th day. Western blot and immunohistochemistry both indicated lowered PCNA expression on day 1, although levels subsequently increased, peaking at 7 days post-surgery. After surgery, apoptosis was lowest on day 7, and remained low thereafter. TEM revealed signs of apoptosis as vein graft restenosis progressed. Proliferation and apoptosis co-occurred following grafting, indicating that both processes were involved in vein graft remodeling. Apoptosis levels were highest between days 1 and 3 after surgery, whereas proliferation culminated on the 7th day.
Topics: Animals; Apoptosis; Blood Vessel Prosthesis; Cell Proliferation; Immunohistochemistry; In Situ Nick-End Labeling; Jugular Veins; Male; Rabbits
PubMed: 27808365
DOI: 10.4238/gmr.15048701 -
The American Journal of Case Reports Aug 2021BACKGROUND Eagle syndrome is a vascular compression syndrome that is caused by a very elongated styloid process and/or calcification of the stylohyoid ligament...
BACKGROUND Eagle syndrome is a vascular compression syndrome that is caused by a very elongated styloid process and/or calcification of the stylohyoid ligament compressing the vascular or nerve structures of the neck, resulting in vascular congestion, thrombosis, or neurological symptoms (eg, dysphagia, neck pain, ear pain). Stylo-jugular venous compression syndrome is a subtype of Eagle syndrome and is caused by compression of the internal jugular vein. Treatment varies according to the symptoms and the severity of the compression, and it can be pharmacological or surgical, with vascular stenting and/or removal of the styloid process. We describe a rare case of left cerebral venous sinus thrombosis and ipsilateral internal jugular vein stenosis sustained by excessive length of the left styloid process. CASE REPORT A 36-year-old woman presented with recurrent episodes of drug-resistant headache and recent memory disturbances. She underwent cerebral and neck multidetector computed tomography-angiography and Doppler ultrasound of the epiaortic vessels that respectively revealed thrombosis of the left cerebral venous sinus and left internal jugular vein stenosis due to a very long styloid process. The patient was treated with anticoagulant drugs and experienced a gradual remission of symptoms. CONCLUSIONS Compression of the jugular vein by the styloid process is a rare entity, and it often goes undiagnosed when it is asymptomatic. Doppler ultrasound is a sensitive method for identifying jugular vein stenosis and can provide an estimated degree of stenosis, which is useful for treatment planning. Doppler ultrasound should be combined with multidetector computed tomography-angiography to rule out compression of other vascular structures and other causes of compression. Failure to treat these patients could have serious health consequences for them.
Topics: Adult; Female; Humans; Jugular Veins; Ossification, Heterotopic; Syndrome; Temporal Bone; Ultrasonography
PubMed: 34428194
DOI: 10.12659/AJCR.932035 -
Minerva Anestesiologica May 2002Pulse-oximeter is described as the most important technological proceeding for monitoring the patients' safety during anesthesia, after surgery and in emergency. This... (Review)
Review
Pulse-oximeter is described as the most important technological proceeding for monitoring the patients' safety during anesthesia, after surgery and in emergency. This opinion was widely confirmed in the 1990s when pulse-oximeter has been definitively introduced in the standard for base monitoring in the OR and has been proposed for routinary use also in the ICU. In this paper we consider the importance, in the cardiovascular, respiratory and brain parameters monitoring, of continuous oximetry of mixed venous blood (SVO2) and blood venous saturation in the internal jugular vein (SjvO2).
Topics: Anesthesia; Critical Care; Humans; Jugular Veins; Monitoring, Intraoperative; Monitoring, Physiologic; Oximetry; Oxygen
PubMed: 12029270
DOI: No ID Found -
AJNR. American Journal of Neuroradiology Aug 2017To date, research on extracranial venous collaterals has been focused on structure, with relatively little attention paid to hemodynamics. We addressed this limitation...
BACKGROUND AND PURPOSE
To date, research on extracranial venous collaterals has been focused on structure, with relatively little attention paid to hemodynamics. We addressed this limitation by quantitatively comparing collateral flow in patients with multiple sclerosis and healthy controls by using phase-contrast MR imaging. We hypothesize that patients with MS with structurally anomalous internal jugular veins will have elevated collateral venous flow compared with healthy controls.
MATERIALS AND METHODS
The sample consisted of 276 patients with MS and 106 healthy controls. We used MRV to classify internal jugular veins as stenotic and nonstenotic based on an absolute cross-sectional area threshold in 276 patients with MS and 60 healthy controls; 46 healthy controls lacked this imaging. Individual and total vessel flows were quantified by using phase-contrast MR imaging on all patients. Veins were classified by extracranial drainage type: internal jugular veins (I), paraspinal (II), and superficial (III). Differences among healthy controls, patients with MS, nonstenotic patients, and stenotic subgroups in total venous flow by vessel type were evaluated in a general linear model for statistical analysis.
RESULTS
In the MS group, 153 patients (55%) evidenced stenosis, whereas 12 (20%) healthy controls were classified as stenotic ( < .001). Compared with healthy controls, the MS group showed lower type I flow and increased type II flow. Stenosis was associated with reduced flow in the type I vessels [(1272) = 68; < .001]. The stenotic MS group had increased flow in the type II vessels compared with the nonstenotic MS group [(1272) = 67; < .001].
CONCLUSIONS
Compared with healthy controls, patients with MS exhibit reduced venous flow in the main extracerebral drainage vein (internal jugular vein). In contrast, flow in the paraspinal venous collaterals is elevated in patients with MS and exacerbated by venous stenosis. Collateral drainage may be a compensatory response to internal jugular vein flow reduction.
Topics: Adult; Aged; Anatomy, Cross-Sectional; Collateral Circulation; Constriction, Pathologic; Female; Humans; Image Processing, Computer-Assisted; Jugular Veins; Magnetic Resonance Angiography; Male; Middle Aged; Multiple Sclerosis; Venous Insufficiency
PubMed: 28546249
DOI: 10.3174/ajnr.A5219 -
IEEE Transactions on Bio-medical... Jun 2009We describe a fully automated ultrasound analysis system that tracks and identifies the common carotid artery (CCA) and the internal jugular vein (IJV). Our goal is to...
We describe a fully automated ultrasound analysis system that tracks and identifies the common carotid artery (CCA) and the internal jugular vein (IJV). Our goal is to prevent inadvertent damage to the CCA when targeting the IJV for catheterization. The automated system starts by identifying and fitting ellipses to all the regions that look like major arteries or veins throughout each B-mode ultrasound image frame. The spokes ellipse algorithm described in this paper tracks these putative vessels and calculates their characteristics, which are then weighted and summed to identify the vessels. The optimum subset of characteristics and their weights were determined from a training set of 38 subjects, whose necks were scanned with a portable 10 MHz ultrasound system at 10 frames per second. Stepwise linear discriminant analysis (LDA) narrowed the characteristics to the five that best distinguish between the CCA and IJV. A paired version of Fisher's LDA was used to calculate the weights for each of the five parameters. Leave-one-out validation studies showed that the system could track and identify the CCA and IJV with 100% accuracy in this dataset.
Topics: Adult; Algorithms; Carotid Artery, Common; Data Interpretation, Statistical; Discriminant Analysis; Fourier Analysis; Humans; Image Processing, Computer-Assisted; Jugular Veins; Middle Aged; Reproducibility of Results; Ultrasonography
PubMed: 19272982
DOI: 10.1109/TBME.2009.2015576 -
British Journal of Anaesthesia Aug 2017Central venous catheters (CVCs) are frequently used for monitoring haemodynamic status and rapidly delivering fluid therapy during the peri- and postoperative periods.... (Observational Study)
Observational Study
BACKGROUND
Central venous catheters (CVCs) are frequently used for monitoring haemodynamic status and rapidly delivering fluid therapy during the peri- and postoperative periods. Indwelling CVCs are typically used 7-14 days postoperatively for additional monitoring and treatment, but patients may develop asymptomatic catheter-related thrombosis, leading to life-threatening pulmonary embolism and death. Early detection helps to avoid such complications.
METHODS
This prospective observational study investigated the risk factors associated with catheter-related right internal jugular vein thrombosis in patients undergoing chest surgery. The study enrolled 24 patients who were scheduled to receive chest surgeries during which catheters were needed. To detect thrombus formation, Doppler ultrasound examinations from the thyroid cartilage level to the supraclavicular region were used after CVC placement and on each of the following days until the catheter was removed.
RESULTS
No thrombosis was found in patients before surgery, but it appeared in 75% (18/24) after surgery. The risks of thrombosis increased with a longer duration of anaesthesia, greater amounts of bleeding, and use of postoperative ventilator support.
CONCLUSIONS
Earlier catheter removal may reduce the risk of catheter-related thrombosis and avoid possibly fatal complications after catheter-related thrombosis.
Topics: Adult; Aged; Central Venous Catheters; Female; Humans; Jugular Veins; Male; Middle Aged; Prospective Studies; Thoracic Surgical Procedures; Ultrasonography; Venous Thrombosis
PubMed: 28655186
DOI: 10.1093/bja/aex133 -
Journal of Biomechanics Jun 2017Veins are often subjected to torsion and twisted veins can hinder and disrupt normal blood flow but their mechanical behavior under torsion is poorly understood. The...
Veins are often subjected to torsion and twisted veins can hinder and disrupt normal blood flow but their mechanical behavior under torsion is poorly understood. The objective of this study was to investigate the twist deformation and buckling behavior of veins under torsion. Twist buckling tests were performed on porcine internal jugular veins (IJVs) and human great saphenous veins (GSVs) at various axial stretch ratio and lumen pressure conditions to determine their critical buckling torques and critical buckling twist angles. The mechanical behavior under torsion was characterized using a two-fiber strain energy density function and the buckling behavior was then simulated using finite element analysis. Our results demonstrated that twist buckling occurred in all veins under excessive torque characterized by a sudden kink formation. The critical buckling torque increased significantly with increasing lumen pressure for both porcine IJV and human GSV. But lumen pressure and axial stretch had little effect on the critical twist angle. The human GSVs are stiffer than the porcine IJVs. Finite element simulations captured the buckling behavior for individual veins under simultaneous extension, inflation, and torsion with strong correlation between predicted critical buckling torques and experimental data (R=0.96). We conclude that veins can buckle under torsion loading and the lumen pressure significantly affects the critical buckling torque. These results improve our understanding of vein twist behavior and help identify key factors associated in the formation of twisted veins.
Topics: Aged, 80 and over; Animals; Finite Element Analysis; Humans; Jugular Veins; Pressure; Saphenous Vein; Stress, Mechanical; Swine; Torque
PubMed: 28526174
DOI: 10.1016/j.jbiomech.2017.04.018