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1.
Rev. colomb. cir ; 36(3): 421-426, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1253955

ABSTRACT

Introducción. La mayoría de las lesiones de carótida cervical en nuestra institución se manejan por vía endovascular. El objetivo de este estudio fue describir los desenlaces del manejo de las lesiones de carótida cervical en un hospital de cuarto nivel en la ciudad de Cali, Colombia. Métodos. Estudio de series de casos, retrospectivo, descriptivo, en pacientes con trauma de carótida (penetrante y cerrado), admitidos en un centro de alta complejidad de la ciudad de Cali, en el periodo comprendido desde enero de 2018 hasta enero de 2020. Resultados. Se evaluaron 20 pacientes con lesión de carótida, de los cuales 90 % tenía trauma penetrante, en su mayoría por proyectil de arma de fuego. La zona más frecuentemente afectada fue la carótida interna (65 %) y el 40 % de los pacientes presentaban síntomas neurológicos al ingreso. Se realizó manejo endovascular en 13 pacientes, con un 75 % de éxito en el manejo endovascular al ingreso. La mortalidad general fue del 20 %, que en su mayoría estuvo relacionada con traumatismo en otros órganos. El 69 % de los pacientes quedaron sin secuelas neurológicas al alta y el 25 % con secuelas mínimas. Discusión. Se muestra una serie de casos con lesión de carótida donde, teniendo en cuenta las variables de mal pronóstico para hacer una selección adecuada de los pacientes candidatos a este tipo de terapia, el resultado del manejo endovascular fue exitoso


Introduction. Most cervical carotid injuries in our institution are managed by endovascular approach. The objective of this study was to describe the outcomes of the endovascular management of cervical carotid lesions in at a I Level Trauma Center in Cali, Colombia. Methods. Retrospective, descriptive case series study in patients with both penetrating and blunt carotid trauma who were admitted to a I Level Trauma Center between January 2018 and January 2020. Results. Twenty patients with carotid injury were evaluated, of which 90% had penetrating trauma, mostly from a firearm projectile. The most frequently affected area was the internal carotid (65%) and 40% of the patients had neurological symptoms on admission. Endovascular management was performed in 13 patients, with a 75% success rate in endovascular management on admission. Overall mortality was 20%, most of which was related to trauma to other organs; 69% of the patients were left without neurological sequelae at discharge and 25% with minimal sequelae.Discussion. We describe a case series of patients with cervical carotid injury, taking into account the variables of poor prognosis to make an adequate selection of patients for endovascular management, the result of endovascular management was successful


Subject(s)
Humans , Carotid Artery Injuries , Endovascular Procedures , Wounds and Injuries , Multiple Trauma , Angiography , Embolization, Therapeutic
2.
Chinese Journal of Traumatology ; (6): 368-373, 2021.
Article in English | WPRIM | ID: wpr-922705

ABSTRACT

PURPOSE@#To explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms.@*METHODS@#Eleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected.@*RESULTS@#Complete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5-2.0 years without recurrence of nosebleed and scalp lump.@*CONCLUSION@#For patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.


Subject(s)
Aneurysm, False/therapy , Angiography, Digital Subtraction , Carotid Artery Injuries/therapy , Carotid Artery, External/diagnostic imaging , Embolization, Therapeutic , Humans
3.
Braz. j. med. biol. res ; 53(1): e9085, Jan. 2020. graf
Article in English | LILACS | ID: biblio-1055483

ABSTRACT

Total Panax notoginseng saponin (TPNS) is the main bioactivity compound derived from the roots and rhizomes of Panax notoginseng (Burk.) F.H. Chen. The aim of this study was to investigate the effectiveness of TPNS in treating vascular neointimal hyperplasia in rats and its mechanisms. Male Sprague-Dawley rats were randomly divided into five groups, sham (control), injury, and low, medium, and high dose TPNS (5, 10, and 20 mg/kg). An in vivo 2F Fogarty balloon-induced carotid artery injury model was established in rats. TPNS significantly and dose-dependently reduced balloon injury-induced neointimal area (NIA) (P<0.001, for all doses) and NIA/media area (MA) (P<0.030, for all doses) in the carotid artery of rats, and PCNA expression (P<0.001, all). The mRNA expression of smooth muscle (SM) α-actin was significantly increased in all TPNS groups (P<0.005, for all doses) and the protein expression was significantly increased in the medium (P=0.006) and high dose TPNS (P=0.002) groups compared to the injury group. All the TPNS doses significantly decreased the mRNA expression of c-fos (P<0.001). The medium and high dose TPNS groups significantly suppressed the upregulation of pERK1/2 protein in the NIA (P<0.025) and MA (P<0.004). TPNS dose-dependently inhibited balloon injury-induced activation of pERK/p38MAPK signaling in the carotid artery. TPNS could be a promising agent in inhibiting cell proliferation following vascular injuries.


Subject(s)
Animals , Male , Rats , Saponins/pharmacology , Carotid Artery Injuries/prevention & control , p38 Mitogen-Activated Protein Kinases/metabolism , Panax notoginseng/drug effects , Neointima/pathology , Immunohistochemistry , Signal Transduction , Up-Regulation , Rats, Sprague-Dawley , Carotid Artery Injuries/etiology , Real-Time Polymerase Chain Reaction , Hyperplasia
4.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 172-177, 2019. ilus, tab
Article in English | LILACS | ID: biblio-1015180

ABSTRACT

Introduction: Acute carotid blowout syndrome (aCBS) is a severe complication of head and neck cancer (HNC). It can be defined as a rupture of the extracranial carotid arteries, or one of their branches, that causes life-threatening hemorrhage, and which nowadays can be treated with urgent endovascular intervention. Objective: We retrospectively evaluate the endovascular management of aCBS and its outcome in years of survival. Methods: Retrospectively, we describe our experience with endovascular control of aCBS in patients treated for HNC. We review the characteristics, pathology, endovascular treatment and morbidity and assess the gain in life years. Results: Nine individuals were included in this study. Four patients had been previously diagnosed with laryngeal squamous cell carcinoma (SCC), one with paranasal SCC, one with nasopharyngeal carcinoma and three with oral or maxillary adenocarcinoma. All subjects underwent radiotherapy and surgical excision to different extents. Twelve endovascular procedures were performed for injuries to the internal carotid artery (n = 3; 25%), external carotid artery (n = 1; 7%) or one of their branches (n = 8; 67%). Deconstructive methods were used in nine procedures, and three procedures were mainly reconstructive with deployment of covered stents. Total control of bleeding was achieved in all individuals with no intraprocedural complications. Conclusion: Endovascular therapy is an effective alternative for the management of exsanguinating CBS. In our series, this palliative therapy increased the overall patient survival by an estimated 9 months (AU)


Subject(s)
Middle Aged , Aged , Carotid Artery Injuries/surgery , Endovascular Procedures , Angiography , Reconstructive Surgical Procedures , Carotid Artery Injuries/etiology , Balloon Occlusion , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/radiotherapy
5.
Rev. Hosp. Clin. Univ. Chile ; 30(2): 140-150, 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1052714

ABSTRACT

Deep neck infections (DNIs) are special entities among infectious diseases for their versatility and potential for severe complications. Complex head and neck anatomy often makes early recognition of DNIs challenging, and a high index of suspicion is necessary to avoid any delay in treatment. The diagnosis is made by clinical history, physical examination findings and imaging studies. The treatment consists in securing the airway, intravenous antibiotics and surgical drainage, when needed. To make decisions the surgeon must understand the anatomy of the region, the etiology of infection, appropriate diagnostic tools, and medical and surgical management. This article provides a review of these pertinent topics. (AU)


Subject(s)
Humans , Male , Female , Neck/anatomy & histology , Neck/physiopathology , Neck/microbiology , Fasciitis, Necrotizing , Carotid Artery Injuries , Lemierre Syndrome , Mediastinitis
6.
Arq. bras. cardiol ; 111(4): 562-568, Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-973770

ABSTRACT

Abstract Background: Restenosis after percutaneous coronary intervention in coronary heart disease remains an unsolved problem. Clusterin (CLU) (or Apolipoprotein [Apo] J) levels have been reported to be elevated during the progression of postangioplasty restenosis and atherosclerosis. However, its role in neointimal hyperplasia is still controversial. Objective: To elucidate the role Apo J in neointimal hyperplasia in a rat carotid artery model in vivo with or without rosuvastatin administration. Methods: Male Wistar rats were randomly divided into three groups: the control group (n = 20), the model group (n = 20) and the statin intervention group (n = 32). The rats in the intervention group were given 10mg /kg dose of rosuvastatin. A 2F Fogarty catheter was introduced to induce vascular injury. Neointima formation was analyzed 1, 2, 3 and 4 weeks after balloon injury. The level of Apo J was measured by real-time PCR, immunohistochemistry and western blotting. Results: Intimal/medial area ratio (intimal/medial, I/M) was increased after balloon-injury and reached the maximum value at 4weeks in the model group; I/M was slightly increased at 2 weeks and stopped increasing after rosuvastatin administration. The mRNA and protein levels of Apo J in carotid arteries were significantly upregulated after rosuvastatin administration as compared with the model group, and reached maximum values at 2 weeks, which was earlier than in the model group (3 weeks). Conclusion: Apo J served as an acute phase reactant after balloon injury in rat carotid arteries. Rosuvastatin may reduce the neointima formation through up-regulation of Apo J. Our results suggest that Apo J exerts a protective role in the restenosis after balloon-injury in rats.


Resumo Fundamento: A reestenose após intervenção coronária percutânea (ICP) após doença coronariana continua um problema não solucionado. Estudos relataram que os níveis de clusterina (CLU), também chamada de apolipoproteína (Apo) J, encontram-se elevados na progressão da reestenose pós-angioplastia e na aterosclerose. Contudo, seu papel na hihperplasia neointimal ainda é controverso. Objetivo: Elucidar o papel da Apo J na hiperplasia neointimal na artéria carótida utilizando um modelo experimental com ratos in vivo, com e sem intervenção com rosuvastatina. Métodos: ratos Wistar machos foram divididos aleatoriamente em três grupos - grupo controle (n = 20), grupo modelo (n = 20), e grupo intervenção com estatina (n = 32). Os ratos no grupo intervenção receberam 10 mg/kg de rosuvastatina. Um cateter Fogarty 2 F foi introduzido para induzir lesão vascular. A formação de neoíntima foi analisada 1, 2, 3 e 4 semanas após lesão com balão. Concentrações de Apo J foram medidas por PCR em tempo real, imuno-histoquímica e western blotting. Resultados: A razão área íntima/média (I/M) aumentou após a lesão com balão e atingiu o valor máximo 4 semanas pós-lesão no grupo modelo; observou-se um pequeno aumento na I/M na semana 2, que cessou após a administração de rosuvastatina. Os níveis de mRNA e proteína da Apo J nas artérias carótidas aumentaram significativamente após administração de rosuvastatina em comparação ao grupo modelo, atingindo o máximo na semana 2, mais cedo em comparação ao grupo modelo (semana 3). Conclusão: A Apo J atuou como reagente de fase aguda após lesão com balão nas artérias carótidas de ratos. A rosuvastatina pode reduzir a formação de neoíntoma por aumento de Apo J. Nossos resultados sugerem que a Apo J exerce um papel protetor na reestenose após lesão com balão em ratos.


Subject(s)
Animals , Male , Angioplasty, Balloon, Coronary/adverse effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Carotid Artery Injuries/drug therapy , Coronary Restenosis/drug therapy , Clusterin/drug effects , Anticholesteremic Agents/pharmacology , Time Factors , Enzyme-Linked Immunosorbent Assay , Immunohistochemistry , Carotid Arteries/drug effects , Carotid Arteries/pathology , Random Allocation , Blotting, Western , Reproducibility of Results , Treatment Outcome , Tunica Media/drug effects , Tunica Media/pathology , Tunica Intima/drug effects , Tunica Intima/pathology , Rats, Wistar , Protective Agents/pharmacology , Carotid Artery Injuries/etiology , Carotid Artery Injuries/pathology , Coronary Restenosis/etiology , Coronary Restenosis/pathology , Clusterin/analysis , Real-Time Polymerase Chain Reaction , Rosuvastatin Calcium/pharmacology
7.
Rev. cuba. med. mil ; 47(3): 1-6, jul.-set. 2018. ilus
Article in Spanish | LILACS | ID: biblio-985539

ABSTRACT

El pseudoaneurisma cardíaco es una entidad poco frecuente, que se produce cuando existe una rotura incompleta de la pared del corazón y el pericardio sella dicha rotura. Se desarrolla una neocavidad comunicada con la cavidad ventricular por un orificio estrecho. El objetivo del presente trabajo es reportar un caso de pseudoaneurisma ventricular izquierdo, entidad muy poco frecuente. Se presenta un paciente masculino de 69 años, con antecedentes de infarto del miocardio tres años previos al ingreso, que acude al cuerpo de guardia por dolor torácico y disnea. Se le realiza radiografía de tórax, vista póstero-anterior, donde se observa imagen radiopaca con tendencia nodular que borra el contorno cardiaco izquierdo, se complementa con ecografía transtorácica y tomografía helicoidal computarizada, se visualiza una imagen sacular por adición en la pared lateral del ventrículo izquierdo, con trombo mural en su interior, que comunicaba con este a través de cuello estrecho. Se llegó a la conclusión de que se trataba de un pseudoaneurisma ventricular izquierdo. Esta es una entidad que presenta una alta mortalidad, por lo que es necesario realizar un diagnóstico oportuno, a fin de tomar la conducta adecuada para prevenir las complicaciones(AU)


The cardiac pseudoaneurysm is a rare entity, which occurs when there is an incomplete rupture of the heart wall and the pericardium seals the rupture. A neocavity develops communicating with the ventricular cavity through a narrow orifice. The objective of this study is to report a rare case of left ventricular pseudoaneurysm. We present a 69-year-old male patient with a history of myocardial infarction three years prior to admission. The patient goes to the emergency room for chest pain and dyspnea. He underwent chest X-rays for rear-anterior view showing a radiopaque image with nodular tendency that erases the left cardiac line. Transthoracic ultrasound and computerized helical tomography are used to complement the examination. A saccular image is shown by adding to the lateral wall of the left ventricle with wall thrombus inside, a communicating narrow neck. It was concluded that it was a left ventricular pseudoaneurysm. This is an entity that presents high mortality, so it is necessary to make timely diagnosis, in order to take the appropriate medical behavior for preventing complications(AU)


Subject(s)
Humans , Male , Aged , Carotid Artery Injuries/diagnostic imaging , Tomography, Spiral Computed/methods , Myocardial Infarction/etiology
8.
Autops. Case Rep ; 8(1): e2018010, Jan.-Mar. 2018. ilus
Article in English | LILACS | ID: biblio-905431

ABSTRACT

Central nervous system (CNS) ischemic events, besides being a common and devastating disease, are accompanied by severe disability and other morbidities. The cause of such events is not always that simple to diagnose, and among the young, a broad spectrum of possibilities should be considered. We present the case of a young man who presented two episodes of CNS ischemia with a 1 year gap between them, which occurred in the same situation while he was walking and carrying a heavy backpack. The second event first presented as a transient ischemic attack followed by a stroke the day after. The diagnostic work-up showed an indentation of the greater cornu of the hyoid bone over the internal carotid artery, which injured the media and intimal layers. At the arterial injury site, a micro thrombus was found, which explained the source of the embolic event to the CNS. The patient was operated on, and the procedure included the resection of the posterior horn of the hyoid bone, the resection of the injured segment of the internal carotid artery followed by carotid­carotid bypass with the great saphenous vein. The postoperative period and the recovery were uneventful as was the 5-month follow-up. We call attention to this unusual cause of stroke and present other cases reported in the literature.


Subject(s)
Humans , Male , Adult , Brain Ischemia/complications , Carotid Artery Injuries/etiology , Hyoid Bone/blood supply , Stroke/complications , Carotid Artery Injuries/diagnosis , Carotid Artery Thrombosis/etiology , Carotid Artery, Internal , Surgical Procedures, Operative
9.
Clinics ; 73: e161, 2018. graf
Article in English | LILACS | ID: biblio-890761

ABSTRACT

OBJECTIVES: Erythropoietin may have neuroprotective potential after ischemia of the central nervous system. Here, we conducted a study to characterize the protective effects of erythropoietin on retinal ganglion cells and gliotic reactions in an experimentally induced oligemia model. METHODS: Rats were subjected to global oligemia by bilateral common carotid artery occlusion and then received either vehicle or erythropoietin via intravitreal injection after 48 h; they were euthanized one week after the injection. The densities of retinal ganglion cells and contents of glial fibrillary acidic protein (astrocytes/Müller cells) and cluster of differentiation 68 clone ED1 (microglia/macrophages), assessed by fluorescence intensity, were evaluated in frozen retinal sections by immunofluorescence and epifluorescence microscopy. RESULTS: Retinal ganglion cells were nearly undetectable one week after oligemia compared with the sham controls; however, these cells were partially preserved in erythropoietin-treated retinas. The contents of glial fibrillary acidic protein and cluster of differentiation 68 clone ED1, markers for reactive gliosis, were significantly higher in retinas after bilateral common carotid artery occlusion than those in both sham and erythropoietin-treated retinas. CONCLUSIONS: The number of partially preserved retinal ganglion cells in the erythropoietin-treated group suggests that erythropoietin exerts a neuroprotective effect on oligemic/ischemic retinas. This effect could be related to the down-modulation of glial reactivity, usually observed in hypoxic conditions, clinically observed during glaucoma or retinal artery occlusion conditions. Therefore, glial reactivity may enhance neurodegeneration in hypoxic conditions, like normal-tension glaucoma and retinal ischemia, and erythropoietin is thus a candidate to be clinically applied after the detection of decreased retinal blood flow.


Subject(s)
Animals , Male , Retinal Ganglion Cells/drug effects , Erythropoietin/pharmacology , Neuroprotective Agents/pharmacology , Glial Fibrillary Acidic Protein/drug effects , Retinal Diseases/pathology , Cell Count , Hematopoietic Cell Growth Factors/pharmacology , Rats, Wistar , Carotid Artery, Common/surgery , Carotid Artery Injuries/surgery , Disease Models, Animal , Ectodysplasins/drug effects
10.
Article in English | WPRIM | ID: wpr-691364

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the effect and potential mechanisms of rutaecarpine (Rut) in a rat artery balloon-injury model.</p><p><b>METHODS</b>The intimal hyperplasia model was established by rubbing the endothelia with a balloon catheter in the common carotid artery (CCA) of rats. Fifty rats were randomly divided into five groups, ie. sham, model, Rut (25, 50 and 75 mg/kg) with 10 rats of each group. The rats were treated with or without Rut (25, 50, 75 mg/kg) by intragastric administration for 14 consecutive days following injury. The morphological changes of the intima were evaluated by hematoxylin-eosin staining. The expressions of proliferating cell nuclear antigen (PCNA) and smooth muscle (SM) α-actin in the ateries were assayed by immunohistochemical staining. The mRNA expressions of c-myc, extracellular signal-regulated kinase 2 (ERK2), MAPK phosphatase-1 (MKP-1) and endothelial nitric oxide synthase (eNOS) were determined by real-time reverse transcription-polymerase chain reaction. The protein expressions of MKP-1 and phosphorylated ERK2 (p-ERK2) were examined by Western blotting. The plasma contents of nitric oxide (NO) and cyclic guanosine 3',5'-monophosphate (cGMP) were also determined.</p><p><b>RESULTS</b>Compared with the model group, Rut treatment significantly decreased intimal thickening and ameliorated endothelial injury (P<0.05 or P<0.01). The positive expression rate of PCNA was decreased, while the expression rate of SM α-actin obviously increased in the vascular wall after Rut (50 and 75 mg/kg) administration (P<0.05 or P<0.01). Furthermore, the mRNA expressions of c-myc, ERK2 and PCNA were downregulated while the expressions of eNOS and MKP-1 were upregulated (P<0.05 or P<0.01). The protein expressions of MKP-1 and the phosphorylation of ERK2 were upregulated and downregulated after Rut (50 and 75 mg/kg) administration (P<0.05 or P<0.01), respectively. In addition, Rut dramatically reversed balloon injury-induced decrease of NO and cGMP in the plasma (P<0.05 or P<0.01).</p><p><b>CONCLUSION</b>Rut could inhibit the balloon injury-induced carotid intimal hyperplasia in rats, possibly mediated by promotion of NO production and inhibiting ERK2 signal transduction pathways.</p>


Subject(s)
Actins , Metabolism , Animals , Carotid Arteries , Metabolism , Pathology , Carotid Artery Injuries , Drug Therapy , Genetics , Pathology , Cyclic GMP , Blood , Disease Models, Animal , Gene Expression Regulation , Hyperplasia , Indole Alkaloids , Pharmacology , Therapeutic Uses , Male , Nitric Oxide , Blood , Phosphorylation , Proliferating Cell Nuclear Antigen , Metabolism , Quinazolines , Pharmacology , Therapeutic Uses , RNA, Messenger , Genetics , Metabolism , Rats, Sprague-Dawley , Tunica Intima , Pathology
11.
Chinese Journal of Traumatology ; (6): 118-121, 2018.
Article in English | WPRIM | ID: wpr-691031

ABSTRACT

Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup.


Subject(s)
Carotid Artery Injuries , Diagnostic Imaging , General Surgery , Carotid Artery, Common , General Surgery , Computed Tomography Angiography , Humans , Male , Neck Injuries , Diagnostic Imaging , General Surgery , Wounds, Penetrating , Diagnostic Imaging , General Surgery , Young Adult
12.
Braz. j. otorhinolaryngol. (Impr.) ; 83(6): 653-658, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-889327

ABSTRACT

Abstract Introduction: Carotid blowout syndrome is an uncommon complication for patient treated by head and neck tumors, and related to a high mortality rate. Objective: The aim of this study was to study the risk of carotid blowout in a large cohort of patients treated only by larynx cancer. Methods: Retrospective analysis of patients older than 18 years, treated by larynx cancer who developed a carotid blowout syndrome in a tertiary academic centre. Results: 197 patients met the inclusion criteria, 192 (98.4%) were male and 5 (1.6%) were female. 6 (3%) patients developed a carotid blowout syndrome, 4 patients had a carotid blowout syndrome located in the internal carotid artery and 2 in the common carotid artery. According to the type of rupture, 3 patients suffer a type I, 2 patients a type III and 1 patient a type II. Five of those patients had previously undergone radiotherapy and all patients underwent total laryngectomy. We found a statistical correlation between open surgical procedures (p = 0.004) and radiotherapy (p = 0.023) and the development of a carotid blowout syndrome. Conclusion: Carotid blowout syndrome is an uncommon complication in patients treated by larynx tumours. According to our results, patient underwent radiotherapy and patients treated with open surgical procedures with pharyngeal opening have a major risk to develop this kind of complication.


Resumo Introdução: A síndrome da ruptura da carótida é uma complicação incomum no paciente em tratamento para tumores de cabeça e pescoço, relacionada com uma alta taxa de mortalidade. Objetivo: O objetivo deste estudo foi estudar o risco de ruptura da carótida em uma grande coorte de pacientes tratados isoladamente por um câncer de laringe. Método: Análise retrospectiva de pacientes com mais de 18 anos, tratados por câncer de laringe em um centro de assistência terciária, que desenvolveram a síndrome da ruptura da carótida. Resultados: Ao todo, 197 pacientes atenderam aos critérios de inclusão, 192 (98,4%) eram do sexo masculino e 5 (1,6%) eram do sexo feminino. 6 (3%) desenvolveram síndrome da ruptura da carótida, 4 tiveram síndrome da ruptura da carótida localizada na artéria carótida interna e 2 na artéria carótida comum. De acordo com o tipo de ruptura, 3 pacientes apresentaram síndrome da ruptura da carótida tipo I, 2 pacientes, síndrome da ruptura da carótida Tipo III e um tipo II. Cinco desses pacientes haviam sido previamente tratados com radioterapia e todos os pacientes foram submetidos a laringectomia total. Encontrou-se uma correlação estatística entre procedimentos cirúrgicos abertos (p = 0,004) e radioterapia (p = 0,023) e o desenvolvimento de síndrome da ruptura da carótida. Conclusão: A síndrome de ruptura da carótida é uma complicação rara em pacientes tratados para tumores de laringe. De acordo com nossos resultados, pacientes submetidos a radioterapia e pacientes tratados com procedimentos cirúrgicos abertos com abertura da faringe apresentam um risco maior de desenvolver essa complicação.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/complications , Laryngeal Neoplasms/complications , Carotid Artery Injuries/etiology , Neck Dissection/adverse effects , Syndrome , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/radiotherapy , Laryngeal Neoplasms/surgery , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/radiotherapy , Retrospective Studies , Risk Factors , Carotid Artery Injuries/surgery , Endovascular Procedures , Neoplasm Staging
13.
Pakistan Journal of Medical Sciences. 2017; 33 (5): 1291-1293
in English | IMEMR | ID: emr-189793

ABSTRACT

A 33-year male with history of penetrating trauma to left upper chest in 2006, presented through Medical unit to Radiology Department with complain of hemoptysis. Chest X-ray showed a soft tissue lesion in left upper lobe with a linear metallic foreign body. Contrast enhanced CT scan of chest and later CTA was performed which showed a saccular aneurysm arising from mediastinal part of left common aortic artery surrounded by thrombosis with a cylindrical linear metallic foreign body. He was planned for endovascular repair with stenting which he could not afford due to financial constraints. He is currently on conservative follow up. Vascular lesions can be serious complications resulting from blunt or penetrating trauma, when presenting with hemoptysis due to pseudaoneurysms formation even after so many years of trauma


Subject(s)
Humans , Male , Adult , Carotid Artery, Common , Carotid Artery Injuries , Wounds and Injuries , Foreign Bodies
14.
Article in English | WPRIM | ID: wpr-812096

ABSTRACT

The aims of the present study were to determine the effects of heparin-derived oligosaccharides (HDOs) on vascular intimal hyperplasia (IH) in balloon-injured carotid artery and to elucidate the underlying mechanisms of action. An animal model was established by rubbing the endothelia within the common carotid artery (CCA) in male rabbits. The rabbits were fed a high-cholesterol diet. Arterial IH was determined by histopathological changes to the CCA. Serum lipids were detected using an automated biochemical analysis. Expressions of mRNAs for vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), vascular cell adhesion molecule-1 (VCAM-1), monocyte chemoattractant protein-1 (MCP-1), scavenger receptor class B type I (SR-BI), and ATP-binding cassette transporter A1 (ABCA-1) were analyzed using reverse transcription polymerase chain reaction assays. Expressions of VEGF, VCAM-1, MCP-1, SR-BI and ABCA-1 proteins were analyzed by Western blotting. Enzyme-linked immunosorbent assays were used to quantify expression levels of VEGF and bFGF. Our results showed that administration of HDO significantly inhibited CCA histopathology and restenosis induced by balloon injury. The treatment with HDOs significantly decreased the mRNA and protein expression levels of VEGF, bFGF, VCAM-1, MCP-1, and SR-BI in the arterial wall; however, ABCA-1 expression level was elevated. HDO treatment led to a reduction in serum lipids (total cholesterol, triglycerides, high-density and low-density lipoproteins). Our results from the rabbit model indicated that HDOs could ameliorate IH and underlying mechanism might involve VEGF, bFGF, VCAM-1, MCP-1, SR-BI, and ABCA-1.


Subject(s)
ATP Binding Cassette Transporter 1 , Animals , Carotid Artery Injuries , Drug Therapy , Pathology , Chemokine CCL2 , Heparin , Therapeutic Uses , Hyperplasia , Male , Oligosaccharides , Therapeutic Uses , Rabbits , Tunica Intima , Pathology , Vascular Cell Adhesion Molecule-1 , Vascular Endothelial Growth Factor A
15.
Article in English | WPRIM | ID: wpr-106733

ABSTRACT

Carotid artery dissection is a significant cause of stroke in young patients. It may be asymptomatic and go undiagnosed, or minimal transient manifestations may follow, commanding a higher index of suspicion than ordinarily exists to avoid misdiagnosis. Reported herein is a 27-year-old man who suffered extracranial internal carotid artery dissection while practicing a Brazilian Jiu-Jitsu submission maneuver. The patient's condition suddenly deteriorated one week later due to distal embolization and stroke. Despite endovascular treatment, with stenting of the cervical carotid artery, neurologic deficits remained. Of note, the objective in martial arts, which is to kill or incapacitate, has yet to be fully tempered in transitioning to sport. Brazilian Jiu-jitsu, a relatively new and fast-growing form of martial art, places emphasis on submission maneuvers. Related injuries are not common knowledge and are poorly described in the literature. This account is intended to shed light on the risk of this discipline. Through education and improved supervision, vascular injuries of this nature and the potentially lethal or disabling consequences may thus be prevented in young athletes.


Subject(s)
Adult , Athletes , Carotid Arteries , Carotid Artery Injuries , Carotid Artery, Internal , Carotid Artery, Internal, Dissection , Diagnostic Errors , Education , Humans , Martial Arts , Neurologic Manifestations , Organization and Administration , Sports , Stents , Stroke , Vascular System Injuries
16.
Article in English | WPRIM | ID: wpr-330448

ABSTRACT

Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.


Subject(s)
Adult , Carotid Artery Injuries , Diagnostic Imaging , General Surgery , Carotid Artery, Common , Diagnostic Imaging , General Surgery , Humans , Ligation , Male , Neck Injuries , Diagnostic Imaging , General Surgery , Subclavian Artery , Diagnostic Imaging , Wounds and Injuries , Tomography, X-Ray Computed , Wounds, Gunshot , Diagnostic Imaging , General Surgery
17.
Rev. cuba. cir ; 55(1): 0-0, ene.-mar. 2016. ilus
Article in Spanish | LILACS | ID: lil-781191

ABSTRACT

Se presenta un paciente masculino de 25 años de edad que recibe herida por proyectil de arma de fuego de baja velocidad que le ocasionó lesión de estructuras de la boca y el cuello, así como oclusión trombótica de la arteria carótida interna derecha, que se expresó por hemiparesia izquierda. El lesionado recibió tratamiento quirúrgico de urgencia. El paciente egresó vivo con la secuela neurológica ya descrita y fue enviado a centro de rehabilitación. Se realiza una revisión del tema a propósito de este caso(AU)


A 25-year-old male patient is received with a closed vascular lesion caused by a low-speed gunshot to the mouth and neck area, which provoked a stroke 48 hours after the lesion due to the right carotid artery thrombotic occlusion expressed by left hemiparesis. The patient received surgical treatment and was discharged with the previously mentioned neurologic deficit. He continued treatment in a rehabilitation center. This subject was reviewed from the occurrence of this case(AU)


Subject(s)
Humans , Male , Adult , Carotid Artery Injuries/surgery , Mouth/injuries , Neck Injuries/therapy , Wounds, Gunshot , Review
18.
Article in Korean | WPRIM | ID: wpr-227110

ABSTRACT

Horner syndrome is characterized by miosis, partial blepharoptosis and anhidrosis on the affected side of the face. This syndrome develops when the oculosympathetic nerve pathways to the eye and face are interrupted by various causes such as tumor in the brain, intrathoracic region or neck, surgery, drugs, trauma, carotid artery dissection, and others. It is referred to as painful Horner syndrome when Horner syndrome is accompanied by hemifacial pain. Pain is probably related to trigeminal nerve injury. Horner syndrome is a rare complication of thyroidectomy. Here, we report the case of a patient who experienced ipsilateral painful Horner syndrome after total thyroidectomy and unilateral neck dissection for thyroid cancer.


Subject(s)
Blepharoptosis , Brain , Carotid Artery Injuries , Horner Syndrome , Humans , Hypohidrosis , Miosis , Neck , Neck Dissection , Thyroid Neoplasms , Thyroidectomy , Trigeminal Nerve Injuries
19.
J. vasc. bras ; 14(4): 356-359, out.-dez. 2015. graf
Article in English | LILACS | ID: lil-767705

ABSTRACT

A tonsilectomia é um dos procedimentos mais realizados por otorrinolaringologistas e possui como principal complicação a hemorragia. Alguns casos podem se manifestar tardiamente e se relacionam com a formação de pseudoaneurismas. Apesar de rara, essa é uma complicação grave e pode levar ao óbito se não tratada devidamente. Em casos de sangramento significativo, as reintervenções cirúrgicas são necessárias, sendo as 3 formas mais comuns: sutura, cauterização ou por tratamento endovascular. O nosso estudo tem por objetivo apresentar o histórico de uma paciente de 28 anos, sexo feminino, com sangramento maciço pós tonsilectomia no 31º dia de pós-operatório. Foi realizada abordagem endovascular e diagnosticada lesão em artéria facial esquerda. O tratamento definitivo foi por embolização seletiva de artéria facial com micromola e partículas de polivinil álcool (P.V.A.) 500 μm, nessa ordem de utilização, a fim de evitar-se embolização distal. O método endovascular mostrou-se seguro, definitivo e seletivo.


Tonsillectomy is one of the most common procedures that otorhinolaryngologists perform. Hemorrhages are the principal complication. Some cases of hemorrhage can have delayed onset and these are related to formation of pseudoaneurysms. While this complication is rare, it is serious and can be fatal if it is not treated correctly. In cases with significant bleeding, surgical reintervention is needed and the 3 most common methods are suture, cauterization and endovascular treatment. The objective of this article is to report on the case of a 28-year-old female patient with massive post-tonsillectomy bleeding 31 days after the operation. An endovascular approach was taken and an injury to a left facial artery was diagnosed. Definitive treatment was achieved by selective embolization of the facial artery with microcoils and 500 μm particles of polyvinyl alcohol (P.V.A.), in that sequence, in order to avoid distal embolization. The endovascular method proved to be safe, selective and definitive.


Subject(s)
Humans , Female , Adult , Carotid Artery Injuries/complications , Carotid Artery Injuries , Endovascular Procedures/rehabilitation , Tonsillectomy/rehabilitation , Angiography , Embolization, Therapeutic
20.
Article in English | WPRIM | ID: wpr-30208

ABSTRACT

Neointimal proliferation after vascular injury is a key mechanism of restenosis, a major cause of percutaneous transluminal angioplasty failure and artery bypass occlusion. Emodin, an anthraquinone with multiple physiological activities, has been reported to inhibit proliferation of vascular smooth muscle cells (VSMCs) that might cause intimal arterial thickening. Thus, in this study, we established a rat model of balloon-injured carotid artery and investigated the therapeutic effect of emodin and its underlying mechanism. Intimal thickness was analyzed by hematoxylin and eosin staining. Expression of Wnt4, dvl-1, beta-catenin and collagen was determined by immunohistochemistry and/or western blotting. The proliferation of VSMC was evaluated by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay and electron microscopy. MicroRNA levels were quantified by real-time quantitative PCR. Emodin relieved injury-induced artery intimal thickness. Results of western blots and immunohistochemistry showed that emodin suppressed expression of signaling molecules Wnt4/Dvl-1/beta-catenin as well as collagen protein in the injured artery. In addition, emodin enhanced expression of an artery injury-related microRNA, miR-126. In vitro, MTT assay showed that emodin suppressed angiotensin II (AngII)-induced proliferation of VSMCs. Emodin reversed AngII-induced activation of Wnt4/Dvl-1/beta-catenin signaling by increasing expression of miR-126 that was strongly supported by transfection of mimic or inhibitor for miR-126. Emodin prevents intimal thickening via Wnt4/Dvl-1/beta-catenin signaling pathway mediated by miR-126 in balloon-injured carotid artery of rats.


Subject(s)
Adaptor Proteins, Signal Transducing/metabolism , Animals , Carotid Arteries/drug effects , Carotid Artery Injuries/drug therapy , Cell Proliferation/drug effects , Emodin/therapeutic use , Male , MicroRNAs/metabolism , Phosphoproteins/metabolism , Rats , Rats, Sprague-Dawley , Signal Transduction/drug effects , Tunica Intima/drug effects , Wnt4 Protein/metabolism , beta Catenin/metabolism
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