ABSTRACT
SUMMARY: Variations in the origin of the right coronary artery have an incidence between 0.09 % and 0.92 %. Herein, we report a rare case of a coronary artery anomaly in which the right coronary artery originates from the left main coronary artery. This variant was found during routine coronarography, combined with an artificial aortic valve. Despite their rare occurrence, some variations in the origins of the coronary arteries can be life threatening and are associated with a higher risk of sudden cardiac death. They can also pose serious technical challenges and predispose to complications during coronary angiographic procedures. Thus, knowledge of such anomalies is paramount for managing the patients correctly.
Las variaciones en el origen de la arteria coronaria derecha tienen una incidencia entre el 0,09 % y el 0,92 %. En este documento, informamos un caso raro de una anomalía de la arteria coronaria en la que la arteria coronaria derecha se originaba en la arteria coronaria izquierda. Esta variante se encontró durante una coronariografía de rutina, combinada con una válvula aórtica artificial. A pesar de su rara aparición, algunas variaciones en los orígenes de las arterias coronarias pueden poner en peligro la vida y se asocian con un mayor riesgo de muerte súbita cardíaca. También pueden plantear serios desafíos técnicos y predisponer a complicaciones durante los procedimientos angiográficos coronarios. Por tanto, el conocimiento de dichas anomalías es fundamental para el manejo correcto de los pacientes.
Subject(s)
Humans , Female , Middle Aged , Coronary Angiography , Coronary Vessel Anomalies/diagnostic imaging , Anatomic VariationABSTRACT
SUMMARY: A sesamoid bone in the elbow joint is a rare anatomical variation described as a Patella cubiti. Although this variation has been known for centuries its exact etiology is still unclear. Congenital, developmental, and traumatic hypotheses have been proposed. It seldom causes clinical manifestations than elbow stiffness or hypomobility. Herein, we present a case of a 31-year-old patient admitted to our department with complaints of swelling and erythema in the right elbow. An X-ray image revealed a triangular accessory bone with rounded edges, which was diagnosed as a Patella cubiti in combination with olecranon bursitis. Knowledge of this rare elbow abnormality is paramount for orthopedic surgeons and roentgenologists in their daily medical practice.
Un hueso sesamoideo en la articulación del codo es una rara variación anatómica descrita como Patella cubiti. Aunque esta variación se conoce desde hace siglos, su etiología exacta aún no está clara. Se han propuesto hipótesis congénitas, de desarrollo y traumáticas. Rara vez causa manifestaciones clínicas que no sean rigidez o hipomovilidad del codo. Presentamos el caso de un paciente de 31 años que ingresó en nuestro servicio por presentar tumefacción y eritema en el codo derecho. Una imagen de rayos X reveló un hueso accesorio triangular con márgenes redondeados, que se diagnosticó como una Patella cubiti en combinación con bursitis del olécranon. El conocimiento de esta rara anomalía del codo es fundamental para los cirujanos ortopédicos y los médicos radiólogos en su práctica médica diaria.
Subject(s)
Humans , Female , Adult , Sesamoid Bones/abnormalities , Sesamoid Bones/diagnostic imaging , Elbow Joint/abnormalities , Elbow Joint/diagnostic imaging , Olecranon Process/abnormalities , Olecranon Process/diagnostic imagingABSTRACT
The aim of this study was to determine the in-depth anatomical location of the neurovascular structures important for nerve block. Forty fresh specimens from 22 adult Korean cadavers were used for this study. The average angle and depth of the bifurcation point of the sciatic nerve (BC) was 18.7±3.6° and 20.6±7.1 mm, respectively. The point where the nerve branching point out for the muscles on the posterior compartment of leg were expressed in percentage distance relative to the vertical distance from popliteal crease to BC. The medial and lateral sural cutaneous nerve for 129.0% and 116.4%, medial and lateral head of gastrocnemius for 137.2% and 141.9%, the soleus for 179.5%, the deep compartment of leg for 167.0%. Our results provide detailed anatomical information to guide optimal nerve block.
El objetivo fue determinar en profundidad la localización anatómica de las estructuras neurovasculares importantes para el bloqueo del nervio poplíteo. Se utilizaron cuarenta muestras de 22 cadáveres coreanos adultos frescos. El ángulo medio y la profundidad del sitio de bifurcación del nervio ciático (BC) fue 18,7±3,6° y 20,6±7,1 mm, respectivamente. El punto en el que se identifica la ramificación del nervio para los músculos del compartimento posterior de la pierna se expresó en porcentaje de distancia relativa a la distancia vertical desde el pliegue poplíteo a BC. La distancia relativa de los nervios cutáneos sural medial y lateral fue 129,0% y 116,4%, respectivamente; de las cabezas medial y lateral del músculo gastrognemio fue 137,2% y 141,9%, del músculo sóleo fue 179,5%, y del compartimento profundo de la pierna fue 167,0%. Nuestros resultados proporcionan información anatómica detallada para guiar en forma óptima el bloqueo del nervio.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Peripheral Nerves , Injections/methods , Nerve Block/methods , CadaverABSTRACT
Aims: Kyphoplasty is a minimally invasive treatment used to reduce pain, restore vertebral height and improve mobility in patients with painful spinal VCF. Pain from vertebral compression fractures (VCF) comprises an important health issue with significant social and economic impact, particularly in elderly patients with osteoporosis where treatment options are limited. We assessed outcomes in patients with VCF who failed conservative management and underwent kyphoplasty. Study Design: Prospective and retrospective case series. Place and Duration of Study: At a single neurosurgical practice February 2003 and September 2012. Methodology: A total of 203 patients with 288 treated vertebral body fractures treated with kyphoplasty were enrolled. The Visual Analog Scale (VAS) was used to prospectively measure back pain before and after surgery. Pre and post operative disability and quality of life were retrospectively measured with the Roland Morris Disability Index (RMDI) and EuroQol 5-Domain scale (EQ5D), respectively, via patient survey. Pre and post-operative narcotic analgesic usage and incidence of subsequent fractures were recorded. Results: There was a statistically significant improvement (P < .001) in each of the assessed measures following surgery. The post-operative rate of narcotic use was reduced from 63% to 17%. Eight patients (4.2%) developed and underwent repair of an adjacent fracture with a mean time between surgeries of 461 days. Conclusion: Following kyphoplasty, patients experienced significant, rapid, and sustained reduction of back pain, improved quality of life, and reduced disability with a low complication rate. Timely repair of VCF is indicated, not only to prevent complications associated with prolonged inactivity but also for effective treatment of severe pain in the acute setting.