Arteritis de células gigantes: ¿Cómo debutan pacientes chilenos? Análisis de casos y revisión de la literatura / Giant cell arteritis. Experience in 32 patients

BACKGROUND: Giant cell Arteritis (GCA) is the most common systemic vasculitis in patients over 50 years. Diagnosis is based on clinical, laboratory, imaging and biopsy. Temporal artery biopsy (TAB) may be inconclusive in up to 40% of patients. AIM: To describe disease features of patients diagnosed with GCA. MATERIAL AND METHODS: Review of pathology reports of giant cell arteritis and clinical records of patients seen with the diagnosis between 2000 and 2019. Demographic, clinical, laboratory, histopathology, imaging, treatment and follow-up variables were analyzed. RESULTS: We fetched 32 patients with a median age at diagnosis of 70.5 years (range 57-90), 81% women. Twenty eight percent had polymyalgia. 72% had only cranial symptoms, 12% had extracranial involvement and 13% exclusive extracranial involvement. The median time from onset of symptoms to diagnosis was two months (range 0.5-8). All had elevated erythrocyte sedimentation rate and c reactive protein. A TAB was performed in 27 patients and in 17 (65.4%) it confirmed the diagnosis. Transmural inflam- mation was the most frequent finding. All patients received steroids. Follow-up information was available from 25 patients and 92% received a steroid-spa- ring agent, usually methotrexate (74%). Ninety two percent achieved clinical remission in the first year and 59% had minor relapses during steroid tapering. CONCLUSIONS: Our patients showed frequent extracranial involvement and TAB was a useful diagnostic tool.

Métodos de termometria não invasiva em comparação oa método de aferição da temperatura de cateter de artéria pulmonar: um estudo de medidas repetidas / Comparison of noninvasive methods of thermometry and the pulmonary artery, temperature method: a repeated measures study

A aferição da temperatura corporal é uma ferramenta essencial no cuidado de pacientes críticos. Para a identificação da temperatura corporal é necessário o uso de um termômetro preciso e ágil. Quando técnicas invasivas não estão sendo utilizadas, a equipe de enfermagem depende de termômetros não invasivos. Atualmente, na literatura, não há um consenso sobre a acurácia e precisão de métodos como as temperaturas oral, axilar, de membrana timpânica ou de artéria temporal. Ademais evidências acerca dos fatores que podem alterar a confiabilidade desses métodos são escassas. Por isso estudos clínicos devem ser realizados com esses métodos para respaldar o uso dessas técnicas na prática. Objetivo: Comparar a acurácia e precisão de métodos de termometria não invasivas (artéria temporal, membrana timpânica, oral e axilar) em comparação a temperatura de artéria pulmonar. Método: Foram realizados uma revisão sistemática e metanálise e um estudo clínico de medidas repetidas. A metanálise foi realizada com dados de 41 artigos pesquisados na literatura. Os dados do estudo clínico foram coletados em duas Unidades de Terapia Intensiva na cidade de Belo Horizonte. Foram incluídos pacientes adultos em uso do cateter de artéria pulmonar. As cinco temperaturas foram aferidas três vezes de cada paciente. Para análise dos dados foi realizada análise descritiva, gráficos de Bland-Altman e análises de regressão. Resultados: A acurácia e precisão das temperaturas na metanálise foram; temperatura axilar, -0,35 e 0,06; temperatura oral, -0,21 e 0,08; temperatura de membrana timpânica, -0,05 e 0,05; e temperatura de artéria temporal, -0,22 e 0,26. A acurácia e precisão após análise dos dados do estudo clínico foram, respectivamente: temperatura axilar, -0,42 e 0,59; temperatura oral, -0,30 e 0,37; temperatura de membrana timpânica, -0,21 e 0,44; e temperatura de artéria temporal, -0,25 e 0,61. Conclusão: Os termômetros não invasivos mostraram uma boa acurácia e precisão em relação a temperatura de artéria pulmonar, entretanto em pacientes com alterações da temperatura os termômetros não invasivos tornam-se pouco acurados.(AU)

The identification of body temperature is an essential tool in critical care nursing. The use of a reliable and agile thermometer is necessary to identify the real body temperature. When available, invasive thermometer are indicated for its precision. Although, when not available, the nursing staff must rely in noninvasive thermometers. Nowadays, in the literature, there isn´t a consensus about the reliability of noninvasive temperature techniques, such as axillary, oral, tympanic membrane and temporal artery. Furthermore, there is a lack of knowledge about factors that alters the reliability of those thermometers. Clinical studies must be developed to back these techniques in nursing care. Aim: Compare the accuracy and precision of noninvasive techniques (axillary, oral, tympanic membrane and temporal artery) with the pulmonary artery temperature. Methods: An Systematic review/Metanalysis and a Cross-sectional Repeated measure clinical study were developed. The Metanalysis used data from 41 published articles. The data for the clinical study were collected in two intensive care units of two hospitals in Belo Horizonte. Patients with pulmonary artery catheter were included. The five temperatures were measured three times in each patient. Descriptive analyses were made, Bland-Altmann graphics were plotted and a four regression models were developed. Results: The accuracy and precision identified in the Metanalysis were: axillary, -0,35 and 0,06; oral, -0,21 and 0,08; tympanic membrane, -0,05 and 0,05; and temporal artery, -0,22 and 0,26. The accuracy and precision of the noninvasive thermometers and the pulmonary artery temperature identified in the clinical study were: axillary -0,42 and 0,59; oral -0,30 and 0,37; tympanic membrane -0,21 and 0,44; and temporal artery -0,25 and 0,61. Conclusion: The noninvasive thermometers showed a good accuracy and precision when compared with the pulmonary temperature, However, in non-normothermic patients the reliability of the thermometers is poor.(AU)

Arteritis de células gigantes en el sistema vertebrobasilar, isquemias cerebelo-occipitales y parálisis III par: caso clínico / Giant cell arteritis of the vertebrobasilar system, posterior ischemia and palsy of the third nerve: report of one case

Giant cell arteritis is the most common vasculitis in patients aged over 50 years. We report an 89-year-old woman with significant weight loss and persistent frontal-occipital headaches lasting two months. The neurological examination at admission identified a decrease in visual acuity of the left eye, paralysis of the third cranial nerve of the right eye and alterations of body motility without objective signs of damage of the motor or sensitive pathways. Magnetic resonance imaging showed changes of the temporal artery wall and in both vertebral arteries, as well as bilateral cerebellar and occipital ischemic lesions. The Doppler ultrasound of the temporal arteries was compatible with Giant cell arteritis. Treatment with steroids was started. While receiving oral prednisone, the patient suffered new infarcts of the posterior territory, documented with a CAT scan.

STA-Distal ACA Bypass Using a Contralateral STA Interposition Graft for Symptomatic ACA Stenosis

Intracranial arterial stenosis usually occurs due to atherosclerosis and is considered the most common cause of stroke worldwide. Although the effectiveness of bypass surgery for ischemic stroke is controversial, the superficial temporal artery to the middle cerebral artery bypass for ischemic stroke is a common procedure. In our report, a 50-year-old man presented with sudden-onset left side weakness and dysarthria. An angiogram showed significant stenosis in the junction of the right cavernous-supraclinoid internal carotid artery and right pericallosal artery. Symptoms altered between improvement and deterioration. Magnetic resonance imaging showed a repeated progression of anterior cerebral artery (ACA) infarction despite maximal medical therapy. We performed a STA-ACA bypass with contralateral STA interposition. Postoperative course was uneventful with no further progression of symptoms. Thus, bypass surgery may be considered in patients with symptomatic stenosis or occlusion of the ACA, especially when patients present progressive symptoms despite maximal medical therapy.

Diagnostic Accuracy of Temporal Artery Temperatures Measurements / 임상간호연구

PURPOSE: This study compared the temporal artery temperature (TAT) measured by infrared temporal artery thermometers to the axillary temperature (AT) measured by standard mercury-in-glass thermometers, and evaluated accuracy of the TAT measurement for clinical practice. METHODS: A total of 247 adult inpatients in general wards in a tertiary medical center located in Seoul participated in the study. The TAT was measured within one minute after the AT measurement. Data were analyzed using descriptive statistics, paired t-test, Pearson correlation coefficient, linear regression, and the Bland-Altman plot. RESULTS: There was a significant difference in mean temperature between AT and TAT, 36.89℃ (SD=0.70) versus 37.35℃ (SD=0.72). The Bland-Altman plots demonstrated the difference between the AT and TAT as −1.29 to +0.33. The specificity and sensitivity of the TAT in detecting fever were high. The positive predictive values were 57.5% and 71.0% when the AT were higher than 38.0℃ and the TAT fever cutoff levels were 38.0℃ and 38.3℃ respectively. CONCLUSION: TAT and AT were highly correlated and agreeable, indicating that TAT is as accurate as AT. The findings suggested that TAT measurement can be used in clinical practice. For accurate communication between medical personnel, medical institutions need to provide guidelines for temperature measurement, especially for the use of thermometer and measurement sites.

Efficacy of superficial temporal artery pressure-guided selective cerebral perfusion during deep hypothermic circulatory arrest in patients undergoing aortic arch surgery / 中华麻醉学杂志

Objective To evaluate the efficacy of superficial temporal artery(STA)pressure-guided selective cerebral perfusion(SCP)during deep hypothermic circulatory arrest(DHCA)in patients undergoing aortic arch surgery.Methods Ninety-six patients of both sexes,aged 35-64 yr,with body mass index of 19-23kg/m2,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,undergoing aortic arch surgery,were divided into STA pressure group(group A)and clinical experience group(group B)using a random number table,with 48 patients in each group.In group A,STA catheterization was performed after tracheal intubation,and arterial pressure was monitored.SCP flow was adjusted to maintain the target value of STA pressure between 30 and 40mmHg during DHCA in group A.SCP flow rate was set at 5-10ml·kg-1·min-1 according to clinical experience in group B.The volume of fluid perfused during SCP,emergence time,extubation time and duration of intensive care unit stay were recorded.Neurological function was evaluated during length of hospitalization after surgery,and the development of permanent and transient neurological dysfunction and mortality in hospital were recorded.Results Compared with group B,the volume of fluid perfused during SCP was significantly decreased,the emergence time,extubation time and duration of intensive care unit stay were shortened,the incidence of permanent and transient neurological dysfunction(2% and 4%,respectively)was decreased(P 0.05).Conclusion Maintaining STA pressure at 30-40mmHg is a reliable method for guiding SCP during DHCA in patients undergoing aortic arch surgery.

Traumatic arteriovenous fistula associated to pseudoaneurysm of the superficial temporal artery in a child: case report and literature review / Fístula arteriovenosa traumática associada a pseudoaneurisma da artéria temporal superficial em uma criança: relato de caso e revisão da literatura

As fístulas arteriovenosas (FAVs) e os pseudoaneurismas traumáticos extracranianos são malformações incomuns e, em sua maioria, estão associadas a traumatismo craniano fechado com lesão contusa de forte intensidade. O diagnóstico em geral é clínico, porém o exame de escolha para o diagnóstico definitivo é a angiografia. Nos casos em que a lesão é pequena, é possível abordá-la com embolização via endovascular com sucesso. A excisão cirúrgica, no entanto, ainda é o método de escolha para o tratamento. É relatado um caso de um paciente do sexo masculino, com 9 anos de idade, diagnosticado com FAV, acometendo o ramo frontal da artéria temporal superficial, secundária a trauma craniano contundente ocorrido três anos antes do diagnóstico.

The arteriovenous fistulae (AVFs) and the extracranial traumatic pseudoaneurysms are uncommon malformations and in the majority of the cases are associated to closed head trauma with high intensity blunt lesion. The diagnosis is generally clinical, though the exam of choice for definitive diagnosis is an angiography. In minor lesion cases it's possible to successfully approach it with endovas-cular embolization. The surgical excision though, is the method of choice for the treatment. Here is reported a case of a 9-year-old male patient, diagnosed with AVF involving the frontal branch of the superficial temporal artery, secondary to blunt head trauma occurred three years before diagnosis.

Ultrasound Guided Local Endovascular Coiling of an Iatrogenic Superficial Temporal Artery Pseudoaneurysm

Pseudoaneurysms of the superficial temporal artery are rare and may be treated by manual compression, surgical intervention, coil embolization, or percutaneous thrombin injection. We present a novel technique of local ultrasound guided low-profile coil embolization of the superficial temporal artery with both satisfactory cosmetic and surgical results.

Diagnosis value of high frequency ultrasonography and MRI in giant cell arteritis / 中华超声影像学杂志

Objective To study the diagnosis value of giant cell temporal arteritis with high frequency ultrasonography and magnetic resonance imaging.Methods The total of 29 cases testified as giant cell temporal arteritis clinically were assessed by high frequency ultrasonography and magnetic resonance imaging.The 29 cases were assessed by high frequency ultrasonography,the 11 cases were assessed by magnetic resonance imaging,mural thickness and lumen diameter of temporal arteries were examined,and were compared with the biopsy specimens.Meanwhile 30 healthy volunteers were randomly selected as control group,the ultrasonography of normal temporal arteries were analyzed.Results All temporal arteries were diaplayed clearly.27 cases were diagnosed for giant cell temopral arteritis by high frequency ultrasonography in 29 cases,the diagnostic accuracy was 93.1％.The 11 cases were diagnosed by magnetic resonance imaging,the diagnostic accuracy was 100％.The imaging features were mural thickness,the lumen stenosis,and partial temporal arteries occluded,the mural was contrasted by Gd-DTPA.Conclusions High frequency ultrasonography and magnetic resonance imaging are noninvasive methods for giant cell temporal arteritis diagnosis,it is important clinical value for therapy.

The Anatomy of the Superficial Temporal Artery in Adult Koreans Using 3-Dimensional Computed Tomographic Angiogram: Clinical Research

OBJECTIVE: The increased use of bypass surgery in the treatment of ischemic cerebrovascular diseases requires a better understanding of the superficial temporal artery (STA) anatomy. This study is to describe the gross anatomy of STA in adult Korean population with respect to cranial surgery and to provide basic anatomic data for bypass surgery. METHODS: The study evaluated retrospectively 35 patients who visited the neurosurgery department at a single institution. For each patient, both the left and right STA (70 vessels) were evaluated by a 3-dimensional computed tomographic angiogramfor diameter and anatomic relationships to external landmarks. RESULTS: Of 70 STAs, 69 had a bifurcation. Among these, 57 (82.6%) were above the superior margin of the zygomatic arch. The STA bifurcation was 53.2 +/- 5.9 mm posterior to the keyhole, 9.5 +/- 5.3 mm anterior to the posterior margin of condylar process of the mandible, and 21.7 +/- 15.8 mm superior to the superior margin of the zygomatic arch. The inner diameter of the STA was 1.8 +/- 0.5 mm at the superior margin of the zygomatic arch, and 1.4 +/- 0.4 mm and 1.4 +/- 0.5 mm for frontal and parietal branches, respectively. The 75.7% of frontal and 66.7% of parietal branches were suitable for microvascular anastomosis. CONCLUSION: This present study demonstrated the STA in Korean adults, which may benefit the clinician in dealing with the surgical procedures related to this STA.

The Anatomy of the Superficial Temporal Artery in Adult Koreans Using 3-Dimensional Computed Tomographic Angiogram: Clinical Research

OBJECTIVE: The increased use of bypass surgery in the treatment of ischemic cerebrovascular diseases requires a better understanding of the superficial temporal artery (STA) anatomy. This study is to describe the gross anatomy of STA in adult Korean population with respect to cranial surgery and to provide basic anatomic data for bypass surgery. METHODS: The study evaluated retrospectively 35 patients who visited the neurosurgery department at a single institution. For each patient, both the left and right STA (70 vessels) were evaluated by a 3-dimensional computed tomographic angiogramfor diameter and anatomic relationships to external landmarks. RESULTS: Of 70 STAs, 69 had a bifurcation. Among these, 57 (82.6%) were above the superior margin of the zygomatic arch. The STA bifurcation was 53.2 +/- 5.9 mm posterior to the keyhole, 9.5 +/- 5.3 mm anterior to the posterior margin of condylar process of the mandible, and 21.7 +/- 15.8 mm superior to the superior margin of the zygomatic arch. The inner diameter of the STA was 1.8 +/- 0.5 mm at the superior margin of the zygomatic arch, and 1.4 +/- 0.4 mm and 1.4 +/- 0.5 mm for frontal and parietal branches, respectively. The 75.7% of frontal and 66.7% of parietal branches were suitable for microvascular anastomosis. CONCLUSION: This present study demonstrated the STA in Korean adults, which may benefit the clinician in dealing with the surgical procedures related to this STA.

Retalho pediculado temporofrontal para reconstrução de defeitos em cabeça e pescoço / Pedicle temporofrontal flap for head and neck reconstruction

Objetivo: Os retalhos livres, considerados o padrão-ouro na cirurgia reparadora, não podem ser utilizados na reconstrução de todos os defeitos pós-excisionais cervicofaciais, principalmente naqueles pacientes portadores de severas comorbidades clínicas. Dessa forma, retalhos pediculados clássicos, como o retalho temporofrontal, ainda representam uma alternativa ao cirurgião de cabeça e pescoço. Este trabalho teve por objetivo descrever nossa experiência com a utilização do retalho temporofrontal, baseado na artéria temporal superficial para a reconstrução de defeitos pós-excisionais em cabeça e pescoço. Método: Foi realizado um estudo retrospectivo de cinco casos consecutivos de pacientes portadores de neoplasias malignas do território da cabeça e pescoço, tratados entre 2000 e 2009, nos quais foi utilizado o retalho temporofrontal. Nos cinco pacientes, os retalhos livres estavam contraindicados devido a comorbidades clínicas ou à falta de condições técnicas para a realização de microcirurgia. Resultados: Não foi observada perda total do retalho em nenhum caso. Houve integração completa do enxerto de pele na área doadora nos cinco casos. Todos os pacientes receberam alta precoce, sem complicações imediatas. Os objetivos da reconstrução foram alcançados em quatro dos cinco pacientes. Conclusão: Analisando os nossos resultados, observamos que o retalho temporofrontal apresentou boa evolução na maioria dos casos, com reabilitação funcional satisfatória em quatro dos cinco pacientes. Em função das limitações da microcirurgia em nosso meio, a utilização de retalhos loco-regionais pediculados, como o retalho temporofrontal, deve fazer parte da formação do cirurgião de cabeça e pescoço.

Objective: The free flaps are considered the gold standard for surgical reconstruction. However, this technique cannot be employed to the reconstruction of all cervicofacial post-excision defects, principally in those patients with serious clinical comorbidities. Hence, classical pedicle flaps, like the forehead flap, are still an option for the head and neck surgeon. The aim of this paper was to describe our experience with the use of the forehead flap, based on the superficial temporal artery for post-excision head and neck defects reconstruction. Method: We performed a retrospective study of five consecutive cases, from 2000 to 2009, in which the pedicle forehead flap was utilized to treat head and neck cancer patients. In these five cases, the free flaps were contraindicated due to clinical comorbidities or the lack of technical condition for the employment of microsurgery. Results: There were no total flap losses. The skin graft was entirely integrated to the donor area in all cases. All patients were discharged in a few days without early complications. The objectives of the reconstruction were achieved in four of five patients. Conclusion: The pedicle forehead flap presented a good outcome in most of the cases, with acceptable functional rehabilitation in four of five patients. Due to the limitations of microsurgery, the employment of pedicle loco-regional flaps, like the forehead flap, must be part of professional formation of head and neck surgeons.

Galeal flap based on superficial temporal vessels for oral cavity and pharynx reconstruction: an anatomical study

PURPOSE: Despite the advances in microvascular free tissue transfer for intraoral reconstruction, this surgery is not recommended for all patients. In specific cases, the pedicled temporoparietal galeal flap may be an option for reconstructive procedures in the head and neck regions. The objective of this paper is to present the anatomical aspects of a galeal flap based on the superficial temporal vessels and to test its potential for reconstructing diverse sites of the oral cavity and pharynx. METHODS: We performed 40 dissections on 34 fresh adult cadavers. The flap vascular anatomy was studied by injecting latex into the superficial temporal vessels. A standardized square-shape flap measuring 10 x 10 cm², pedicled on the superficial temporal vessels, was raised. Oral cavity and oropharynx reconstruction simulations were performed after flap transposition into the mouth by passing it under the zygomatic arch. Hypopharyngeal reconstruction was tested by transposing the flap to the neck under the facial nerve. RESULTS: After latex injection, a rich vascular network over the temporoparietal galea was observed directly from the superficial temporal artery, and a well-vascularized flap based on this vessel was raised. In the reconstruction simulations, the flap was shown to be suitable for the coverage of hypothetical defects in most oral cavity and pharyngeal sites, mainly the retromolar trigone, tonsil area, and buccal mucosa. CONCLUSIONS: A galeal flap based on the superficial temporal vessels presents favorable anatomical characteristics for oral cavity and pharyngeal reconstruction.

Traumatic Pseudoaneurysm of the Superficial Temporal Artery / 대한이비인후과학회지

Pseudoaneurysm of the superficial temporal artery is very rare and can potentially be a critical cause of facial masses. Most pseudoaneurysms form as a result of blunt trauma and present as painless, pulsatile tumors that may be associated with neuropathic findings and enlarged size. They can be accurately diagnosed through physical examination alone. The treatment of choice is surgical ligation and resection. We present a case of traumatic pseudoaneurysm of the superficial temporal artery caused by blunt injury and discuss pertinent diagnosis and treatment option.