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1.
Autops. Case Rep ; 11: e2020188, 2021. graf
Article in English | LILACS | ID: biblio-1142403

ABSTRACT

Venous aneurysm of the head and neck is a rare clinical entity due to its asymptomatic nature and tendency of clinicians to report only surgical results. Whereas the primary aneurysm of internal jugular vein (IJV) in children is being increasingly recognized, secondary aneurysms of veins of the head and neck in adults, notably the external jugular vein (EJV) aneurysm remains only in anecdotal case reports. We present the case of a 63-year-old previously healthy woman who presented with a gradually progressive right lateral neck swelling over the last 18 months. Following the evaluation, she was diagnosed as a case of isolated spontaneous right-sided EJV aneurysm and was managed by surgical excision of the aneurysm.


Subject(s)
Humans , Female , Middle Aged , Venous Thrombosis/pathology , Jugular Veins/pathology , Aneurysm/pathology
2.
Med. infant ; 27(2): 152-156, Diciembre 2020. ilus, Tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1150596

ABSTRACT

Introducción: La cateterización venosa central es un procedimiento usual en Unidades de Cuidados Intensivos (UCI). El ultrasonido (US) para guiar la cateterización, ofrece ventajas, permitiendo tener una imagen topográfica precisa del vaso, reduciendo las complicaciones, el tiempo y el número de punciones. Objetivo: determinar, si la US en la colocación de catéteres venosos centrales (CVC), podría disminuir el número de punciones y lograr la cateterización exitosa. Población y métodos: Estudio descriptivo, prospectivo de los CVC colocados mediante punción guiada por US, en una UCI polivalente del Hospital de Pediatría Juan P. Garrahan, entre el año 2018 al 2019. Población: pacientes de 1 mes a 18 años que requirieron colocación de un CVS por US. Se consideró significativo un valor de p< 0.05. Resultados: VYI en 66 pacientes (43,5%), VF fue en 86 pacientes (56,5%). 86 (56,5%) CVC, fueron insertados en el primer intento y 66 (43,5%), requirieron más de un intento. Las inserciones en VYI fueron exitosas en el primer intento en 46 pac. (53,5%) 20 pac. requirieron más de un intento (30,3%) p 0,004 OR 0,37 (IC 95% 0,18-0,78. En <6 meses los CVC colocados en VYI tuvieron menos riesgo de requerir más de un intento, con respecto a aquellos en los cuales se eligió la VF, p 0,0026 OR 0,31 (IC 95% 0,12 -0,75). 5,2% presentaron complicaciones, no hubo mortalidad relacionada al procedimiento. Conclusiones: La inserción de CVC guiados por US fue segura y significativamente exitosa en el primer intento cuando el vaso de elección fue la VYI, especialmente en < 6 meses (AU)


IIntroduction: Central venous catheterization is a common procedure in intensive care units (ICU). The use of ultrasound (US) to guide catheterization offers advantages, allowing for an accurate topographic image of the vessel, reducing complications as well as time and number of punctures. Objective: To determine whether the use of US for the placement of central venous catheters (CVCs) may decrease the number of punctures and achieve successful catheterization. Patients and methods: A descriptive, prospective study was conducted of CVCs placed by US-guided puncture at a general ICU of Hospital de Pediatría Juan P. Garrahan between 2018 and 2019. Patients from 1 month to 18 years of age who required US-guided placement of a CVC were included. A p< 0.05 was considered significant. Results: The internal jugular vein (IJV) was used in 66 (43.5%) and the femoral vein (FV) in 86 patients (56.5%). Overall, in 86 (56.5%) CVC were inserted on the first attempt and 66 (43.5%) required more than one attempt. Insertions into the VYI were successful on the first attempt in 46 (53.5%) patients and 20 (30.3%) patients required more than one attempt, p 0.004; OR 0.37 (95% CI 0.18-0.78). In patients <6 months CVCs placed in the IJV had a lower risk of requiring more than one attempt compared to those in which the FV was chosen, p 0.0026 OR 0.31 (95% CI 0.12 -0.75). Complications occurred in 5.2%; no procedure-related mortality was observed. Conclusions: US-guided insertion of CVC was safe and significantly successful on the first attempt when the vessel of choice was the IJV, especially in patients < 6 months (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Intensive Care Units, Pediatric , Ultrasonography, Interventional/instrumentation , Ultrasonography, Interventional/methods , Central Venous Catheters , Prospective Studies , Femoral Vein , Jugular Veins
3.
Braz. j. otorhinolaryngol. (Impr.) ; 86(1): 44-48, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1089370

ABSTRACT

Abstract Introduction The anatomical complexity of the jugular foramen makes surgical procedures in this region delicate and difficult. Due to the advances in surgical techniques, approaches to the jugular foramen became more frequent, requiring improvement of the knowledge of this region anatomy. Objective To study the anatomy of the jugular foramen, internal jugular vein and glossopharyngeal, vagus and accessory nerves, and to identify the anatomical relationships among these structures in the jugular foramen region and lateral-pharyngeal space. Methods A total of 60 sides of 30 non-embalmed cadavers were examined few hours after death. The diameters of the jugular foramen and its anatomical relationships were analyzed. Results The diameters of the jugular foramen and internal jugular vein were greater on the right side in most studied specimens. The inferior petrosal sinus ended in the internal jugular vein up to 40 mm below the jugular foramen; in 5% of cases. The glossopharyngeal nerve exhibited an intimate anatomical relationship with the styloglossus muscle after exiting the skull, and the vagal nerve had a similar relationship with the hypoglossal nerve. The accessory nerve passed around the internal jugular vein via its anterior wall in 71.7% of cadavers. Conclusion Anatomical variations were found in the dimensions of the jugular foramen and the internal jugular vein, which were larger in size on the right side of most studied bodies; variations also occurred in the trajectory and anatomical relationships of the nerves. The petrosal sinus can join the internal jugular vein below the foramen.


Resumo Introdução A complexidade anatômica do forame jugular torna a realização de procedimentos cirúrgicos nessa região delicada e difícil. Devido aos avanços obtidos nas técnicas cirúrgicas, as abordagens do forame jugular têm sido feitas com maior frequência, o que requer uma melhoria correspondente no conhecimento de sua anatomia. Objetivo Estudar a anatomia do forame jugular, da veia jugular interna e dos nervos glossofaríngeo, vago e acessório, assim como as relações anatômicas entre estas estruturas na região do forame jugular e no espaço parafaríngeo. Método Foram examinados 60 lados de 30 cadáveres frescos algumas horas após a morte. Os diâmetros e suas relações anatômicas foram analisados. Resultados Os diâmetros do forame jugular e da veia jugular interna foram maiores no lado direito na maioria dos espécimes estudados. O seio petroso inferior terminava na veia jugular interna até 40 mm abaixo do forame jugular, em 5% dos casos. O nervo glossofaríngeo exibiu uma relação íntima anatômica com o músculo estiloglosso após a sua saída do crânio e o nervo vago exibiu uma relação semelhante com o nervo hipoglosso. O nervo acessório passou em torno da veia jugular interna via sua parede anterior em 71,7% dos cadáveres. Conclusão Foram encontradas variações anatômicas nas dimensões do forame jugular e da veia jugular interna, que apresentaram tamanhos maiores à direita na maioria dos espécimes estudados; variações também ocorreram na trajetória e nas relações anatômicas dos nervos. O seio petroso pode se unir à veia jugular interna abaixo do forame.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Anatomic Variation/physiology , Jugular Foramina/anatomy & histology , Neck/anatomy & histology , Vagus Nerve/anatomy & histology , Dissection , Glossopharyngeal Nerve/anatomy & histology , Accessory Nerve/anatomy & histology , Jugular Veins/anatomy & histology
4.
J. bras. econ. saúde (Impr.) ; 11(2): 112-118, Agosto/2019.
Article in Portuguese | LILACS, ECOS | ID: biblio-1021040

ABSTRACT

Objetivo: Determinar a factibilidade econômica da técnica de cateterismo central em veia jugular interna guiada pelo ultrassom comparado à técnica-padrão, sob a perspectiva pagadora do Sistema Único de Saúde brasileiro. Métodos: Análise de custo-efetividade utilizando modelo de árvore de decisão sob uma população de pacientes adultos em um cenário de uma unidade terciária. Os custos diretos dos materiais e procedimentos foram estimados utilizando bancos de registros de compras nacionais. Os desfechos foram a ocorrência ou não da punção arterial acidental grave (principal complicação associada ao sítio de punção). Também foram conduzidas análises de sensibilidade determinística e probabilística, bem como curva de aceitabilidade. Resultados: A intervenção onerou o modelo em R$ 53,81. A razão de custo-efetividade incremental calculada foi de R$ 17.936,66 por complicação grave evitada e a curva de aceitabilidade evidenciou que a técnica é custo-efetiva sob uma intenção de pagar de R$ 18.125,00. Na análise de sensibilidade probabilística, 63,6% das simulações mostraram-se custo-efetivas. Conclusão: A intervenção é custo-efetiva, contribuindo para a redução das complicações graves, e o resultado pode proporcionar segurança para tomadas de decisões quanto à padronização do uso da ultrassonografia como orientador do procedimento.


Objective: To determine the economic feasibility of the central catheterization technique in the internal jugular vein guided by the ultrasound compared to the standard technique, under the perspective of the Brazilian Unified Health System. Methods: Cost-effectiveness analysis using decision tree model under a population of adult patients in a tertiary unit scenario. The direct costs of the materials and procedures were estimated using banks of national procurement records. The outcomes were the occurrence or not of severe accidental arterial puncture (the main complication associated with the puncture site). Analyzes of deterministic and probabilistic sensitivity were also conducted, as well as acceptability curve. Results: The intervention cost the model in R$ 53.81. The calculated incremental cost-effectiveness ratio was R$ 17,936.66 due to a serious complication avoided and the acceptability curve showed that the technique is cost-effective under an intention to pay R$ 18,125.00. In the probabilistic sensitivity analysis, 63.6% of the simulations were cost-effective. Conclusion: The intervention is cost-effective, contributing to the reduction of severe complications and the result can provide security for decision making regarding the standardization of the use of ultrasonography as a guideline of the procedure


Subject(s)
Humans , Catheterization, Central Venous , Ultrasonography, Interventional , Cost-Effectiveness Evaluation , Jugular Veins
5.
Rev. bras. anestesiol ; 69(4): 413-416, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1042008

ABSTRACT

Abstract Background and objectives Ultrasound-guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life-threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm. Case report We describe a case of the successful endovascular repair of right subclavian artery injury in a 75-year-old woman. Subclavian artery was injured secondary to ultrasound-guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery. Conclusion Under general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.


Resumo Justificativa e objetivos A cateterização da veia jugular interna guiada por ultrassom é um procedimento comum e geralmente seguro em sala cirúrgica. No entanto, a punção inadvertida de uma artéria não compressível, como a artéria subclávia, embora rara, pode estar associada a sequelas e risco para vida, incluindo hemomediastino, hemotórax e pseudoaneurisma. Relato de caso Descrevemos um caso bem-sucedido da correção endovascular de lesão da artéria subclávia direita em uma paciente de 75 anos. A artéria subclávia foi lesionada após cateterização guiada por ultrassom da veia jugular interna direita sob anestesia geral para cirurgia ortopédica. Conclusão Sob anestesia geral, vários fatores, como a hipotensão, podem mascarar os sinais de lesão da artéria subclávia. Este relato de caso indica que os médicos devem estar cientes das complicações da cateterização venosa central e tomar medidas imediatas.


Subject(s)
Humans , Female , Aged , Subclavian Artery/injuries , Catheterization, Central Venous/adverse effects , Vascular System Injuries/etiology , Endovascular Procedures/methods , Catheterization, Central Venous/methods , Ultrasonography, Interventional/methods , Orthopedic Procedures/methods , Jugular Veins/diagnostic imaging
7.
Rev. Assoc. Med. Bras. (1992) ; 65(5): 592-595, May 2019. graf
Article in English | LILACS | ID: biblio-1012953

ABSTRACT

SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the consequence may be symptoms and signs of heart failure (HF). Hepatojugular reflux (HJR), described as a sign of regurgitation of the tricuspid valve, may reflect structural and functional changes of the LV in the hypertensive patient. The signal may be present in the presence of HF. Case: male, 49 years old with uncontrolled blood pressure. Physical examination showed jugular turgescence, HJR, and elevated blood pressure. Complementary exams showed signs of atrial and left ventricular overload in the electrocardiogram and, the echocardiogram showed left atrium volume increase, concentric LV hypertrophy and signs of grade I diastolic dysfunction. DISCUSSIO: The HJR present correlates with pulmonary artery pressure and probably reflect the increase in central blood volume.


RESUMO A hipertensão pode cursar com disfunção diastólica de ventrículo esquerdo (VE) e a consequência disso pode ser sintomas e sinais de insuficiência cárdica (IC). O refluxo hepatojugular (RHJ), descrito como sinal de regurgitação da valva tricúspide, pode refletir alterações estruturais e funcionais do VE no paciente hipertenso. O sinal pode estar presente na vigência de IC. Caso: homem, 49 anos compressão arterial não controlada. Ao exame físico apresentou turgência jugular, RHJ e pressão arterial elevada. Os exames complementares mostraram sinais de sobrecarga atrial e de ventrículo esquerdo no eletrocardiograma, e no ecocardiograma foi evidenciado aumento do volume do átrio esquerdo, hipertrofia concêntrica do VE e sinais de disfunção diastólica grau I. DISCUSSÃO: RHJ presente correlaciona-se com a pressão da artéria pulmonar e provavelmente reflete o aumento do volume sanguíneo central.


Subject(s)
Humans , Male , Stroke Volume/physiology , Tricuspid Valve Insufficiency/physiopathology , Ventricular Dysfunction, Left/physiopathology , Heart Failure/physiopathology , Jugular Veins/physiopathology , Tricuspid Valve Insufficiency , Echocardiography , Electrocardiography , Heart Failure/pathology , Hypertension/physiopathology , Jugular Veins/pathology , Middle Aged
8.
Arq. bras. cardiol ; 112(1): 3-10, Jan. 2019. graf
Article in English | LILACS | ID: biblio-973840

ABSTRACT

Abstract Background: Vein graft restenosis has an adverse impact on bridge vessel circulation and patient prognosis after coronary artery bypass grafting. Objectives: We used the extravascular supporter α-cyanoacrylate (α-CA), the local application rapamycin/sirolimus (RPM), and a combination of the two (α-CA-RPM) in rat models of autogenous vein graft to stimulate vein graft change. The aim of our study was to observe the effect of α-CA, RPM, and α-CA-RPM on vein hyperplasia. Methods: Fifty healthy Sprague Dawley (SD) rats were randomized into the following 5 groups: sham, control, α-CA, RPM, and α-CA-RPM. Operating procedure as subsequently described was used to build models of grafted rat jugular vein on carotid artery on one side. The level of endothelin-1 (ET-1) was determined by enzyme-linked immunosorbent assay (ELISA). Grafted veins were observed via naked eye 4 weeks later; fresh veins were observed via microscope and image-processing software in hematoxylin-eosin (HE) staining and immunohistochemistry after having been fixed and stored" (i.e. First they were fixed and stored, and second they were observed); α-Smooth Muscle Actin (αSMA) and von Willebrand factor (vWF) were measured with reverse transcription-polymerase chain reaction (RT-PCR). Comparisons were made with single-factor analysis of variance and Fisher's least significant difference test, with p < 0.05 considered significant. Results: We found that intimal thickness of the α-CA, RPM, and α-CA-RPM groups was lower than that of the control group (p < 0.01), and the thickness of the α-CA-RPM group was notably lower than that of the α-CA and RPM groups (p < 0.05). Conclusion: RPM combined with α-CA contributes to inhibiting intimal hyperplasia in rat models and is more effective for vascular patency than individual use of either α-CA or RPM.


Resumo Fundamento: Reestenose de enxertos venosos tem um impacto adverso na circulação de pontagens e no prognóstico de pacientes após a cirurgia de revascularização miocárdica. Objetivos: Nós utilizamos α-cianoacrilato (α-CA) como suporte extravascular, rapamicina/sirolimus (RPM) como aplicação local e a combinação dos dois (α-CA-RPM) em modelos de enxerto venoso autógeno em ratos para estimular mudança no enxerto venoso. O objetivo do nosso estudo foi observar o efeito de α-CA, RPM e α-CA-RPM na hiperplasia venosa. Métodos: Cinquenta ratos Sprague Dawley (SD) saudáveis foram randomizados nos 5 grupos seguintes: sham, controle, α-CA, RPM e α-CA-RPM. O procedimento operacional descrito subsequentemente foi utilizado para construir modelos de enxertos da veia jugular na artéria carótida em ratos, em um lado. O nível de endotelina-1 (ET-1) foi determinado por ensaio de imunoabsorção enzimática (ELISA). As veias enxertadas foram observadas a olho nu 4 semanas após; as veias frescas foram observadas via microscópio e software de processamento de imagem com coloração hematoxilina-eosina (HE) e imuno-histoquímica depois de serem fixadas e armazenadas; α-actina do músculo liso (αSMA) e o fator de von Willebrand (vWF) foram medidos com reação em cadeia da polimerase-transcriptase reversa (RT-PCR). Realizaram-se as comparações com análise de variância de fator único (ANOVA) e o teste de diferença mínima significativa (LSD) de Fisher, com p < 0,05 sendo considerado estatisticamente significante. Resultados: Nós achamos que a espessura intimal nos grupos α-CA, RPM e α-CA-RPM era menor que no grupo controle (p < 0,01) e a espessura no grupo α-CA-RPM era notavelmente menor que nos grupos α-CA e RPM (p < 0,05). Conclusão: A combinação de RPM e α-CA contribui à inibição de hiperplasia em modelos em ratos e é mais efetivo para patência vascular que uso individual de α-CA ou RPM.


Subject(s)
Animals , Male , Female , Tunica Intima/drug effects , Tunica Intima/pathology , Sirolimus/pharmacology , Cyanoacrylates/pharmacology , Hyperplasia/prevention & control , Time Factors , Enzyme-Linked Immunosorbent Assay , Carotid Arteries/pathology , Carotid Arteries/transplantation , Random Allocation , Coronary Artery Bypass/adverse effects , Reproducibility of Results , Actins/analysis , Treatment Outcome , Rats, Sprague-Dawley , Endothelin-1/blood , Reverse Transcriptase Polymerase Chain Reaction , Cell Proliferation/drug effects , Disease Models, Animal , Drug Combinations , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/pathology , Graft Occlusion, Vascular/prevention & control , Jugular Veins/pathology , Jugular Veins/transplantation
9.
Arq. neuropsiquiatr ; 77(1): 3-9, Jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-983878

ABSTRACT

ABSTRACT The risk of recurrence of new amnesia events in patients having previously experienced transient global amnesia (TGA) ranges between 2.9-23.8%. Objective: Our objective was to search for recurrence predictors in TGA patients. Methods: Retrospective analysis to identify recurrence predictors in a cohort of 203 TGA patients from a single center in Buenos Aires, Argentina, diagnosed between January 2011 and March 2017 Clinical features and complementary studies (laboratory results, jugular vein Doppler ultrasound and brain MRI) were analyzed. Comparison between patients with recurrent versus single episode TGA was performed, applying a multivariate logistic regression model. Results: Mean age at presentation was 65 years (20-84); 52% were female. Median time elapsed between symptom onset and ER visit was two hours, with the average episode duration lasting four hours. Mean follow-up was 22 months. Sixty-six percent of patients referred to an identifiable trigger. Jugular reflux was present in 66% of patients; and 22% showed images with hippocampus restriction on diffusion-weighted MRI. Eight percent of patients had TGA recurrence. Patients with recurrent TGA had a more frequent history of migraine than patients without recurrence (37.5% vs. 14%; p = 0.03). None of the other clinical characteristics and complementary studies were predictors of increased risk of recurrence. Conclusions: Patients with migraine may have a higher risk of recurrent TGA. None of the other clinical characteristics evaluated allowed us to predict an increased risk of recurrence. Although the complementary studies allowed us to guide the diagnosis, they did not appear to have a significant impact on the prediction of recurrence risk.


RESUMEN El riesgo de recurrencia de nuevos eventos de amnesia en pacientes que han experimentado previamente Amnesia Global Transitoria (AGT) oscila entre el 2.9-23.8%. Objetivo: Nuestro objetivo fue buscar predictores de recurrencia en pacientes con AGT. Métodos: Análisis retrospectivo de una cohorte de 203 pacientes con AGT de un único centro en Buenos Aires, Argentina, diagnosticados entre enero-2011 y marzo-2017 Se analizaron las características clínicas y los estudios complementarios (laboratorio, Doppler de vena yugular y RM encéfalo). Se comparó el grupo de AGT recurrente versus episodio único, aplicando un modelo de regresión logística multivariada. Resultados: la edad promedio de presentación fue de 65 años (20-84); 52% mujeres. La mediana del tiempo transcurrido entre el inicio de los síntomas y la visita a la sala de emergencia fue de 2 horas, con una duración promedio del episodio de 4 horas. El seguimiento medio fue de 22 meses. 66% de los pacientes tuvieron un desencadenante identificable. El reflujo yugular estuvo presente en el 66% de los pacientes y el 22% mostró imágenes restrictivas en DWI a nivel hipocampal. 8% de los pacientes presentaron recurrencia. Los pacientes con AGT recurrente tuvieron un historial de migraña más frecuente (37.5% vs. 14%; p=0.03). Ninguna de las otras características clínicas y estudios complementarios fueron predictores de mayor riesgo de recurrencia. Conclusiones: los pacientes con migraña pueden tener un mayor riesgo de recurrencia de AGT. Ninguna de las otras características clínicas evaluadas nos permitió predecir un mayor riesgo de recurrencia. Aunque los estudios complementarios nos permitieron orientar el diagnóstico, no pareció tener un impacto significativo en la predicción del riesgo de recurrencia.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Amnesia, Transient Global/etiology , Prognosis , Recurrence , Logistic Models , Retrospective Studies , Risk Factors , Amnesia, Transient Global/physiopathology , Amnesia, Transient Global/diagnostic imaging , Jugular Veins/physiopathology , Migraine Disorders/complications , Migraine Disorders/physiopathology
10.
Article in Korean | WPRIM | ID: wpr-766748

ABSTRACT

Hemodialysis patients rarely experience neurologic symptoms related to their vascular accesses. However, occlusion of venous drainage induces extreme venous hypertension and in rare cases cause intracranial venous congestion. We report a patient with cerebral venous infarction resulting from reflux flow into the cranium induced by an arteriovenous jump graft to the internal jugular vein. Clinicians should take into account the possibility of neurologic deficit related to intracranial venous hypertension in hemodialysis patients.


Subject(s)
Arteriovenous Fistula , Drainage , Humans , Hyperemia , Hypertension , Infarction , Jugular Veins , Neurologic Manifestations , Renal Dialysis , Skull , Transplants , Veins
11.
Article in English | WPRIM | ID: wpr-763999

ABSTRACT

Jugular bulb diverticulum is an irregular extension of the jugular bulb into the temporal bone that may be symptomatic or asymptomatic. The jugular bulb has rarely been reported to extend into the occipital condyle; such extension is termed a condylar jugular diverticulum and is characterized as a defect in the occipital condyle contiguous with the jugular bulb. This report details 3 cases of condylar jugular diverticulum. Extension of the jugular bulb into the ipsilateral occipital condyle was noted as an incidental finding on cone-beam computed tomographic (CBCT) images of 3 patients. All 3 patients were asymptomatic, and this finding was unrelated to the initial area of interest. CBCT use is becoming ubiquitous in dentistry, as it allows 3-dimensional evaluation, unlike conventional radiography. Proper interpretation of the entire CBCT is essential, and recognition of the indicators of condylar jugular diverticulum may prevent misdiagnosis of this rare entity.


Subject(s)
Cone-Beam Computed Tomography , Dentistry , Diagnostic Errors , Diverticulum , Growth and Development , Humans , Incidental Findings , Jugular Veins , Radiography , Temporal Bone
12.
Article in English | WPRIM | ID: wpr-762708

ABSTRACT

The primary site for a hemodialysis catheter insertion is the right internal jugular vein (IJV) followed by the left IJV and subclavian vein. In cases when veins of the upper extremities are exhausted, femoral veins are an alternative insertion location. Femoral catheter insertions should only be used for short periods because of the increased risk of infection. There is a percutaneous technique to recanalize occluded central veins for hemodialysis catheter insertion. We experienced success with a cut-down method for permcath through a completely occluded IJV. We, therefore, find surgical recanalization to be better than percutaneous method in terms of cost and safety.


Subject(s)
Catheters , Femoral Vein , Humans , Jugular Veins , Methods , Renal Dialysis , Subclavian Vein , Upper Extremity , Veins
13.
Article in English | WPRIM | ID: wpr-762252

ABSTRACT

A 58-year-old male patient with situs inversus totalis, a rare congenital malformation characterized by all asymmetric organs being formed as the mirror images of their normal morphologies, underwent mitral valve repair due to mitral valve prolapse. This case was reported to suggest that anesthesiologists should thoroughly understand the anatomy of these types of patients before providing cardiac anesthesia that often requires advanced monitoring and rely on their accurate interpretation. Accordingly, a few key points will be discussed with emphasis on reversing lead placement during electrocardiogram monitoring, using the left internal jugular vein for pulmonary artery catheterization, and firmly comprehending mirror image heart morphology to better conduct transesophageal echocardiography.


Subject(s)
Anesthesia , Catheterization, Swan-Ganz , Echocardiography, Transesophageal , Electrocardiography , Heart , Humans , Jugular Veins , Male , Middle Aged , Mitral Valve , Mitral Valve Prolapse , Situs Inversus , Thoracic Surgery
14.
Article in Korean | WPRIM | ID: wpr-760119

ABSTRACT

Intravenous pyogenic granuloma (IVPG), also known as intravenous lobular capillary hemangioma, is an extremely rare form of vascular tumor which derives from the lumen of a vein of the head and neck and upper extremities. The treatment of choice is complete local excision of a small portion of the vein. Since first report in 1979, IVPG has been reported in no more than 60 reports abroad. To our knowledge, IVPG originating in the external jugular vein has never been reported in Korea but has important clinical implication. Accurate preoperative diagnosis of neck mass originating in jugular vein is important to plan operative procedures to avoid vascular injury, excessive bleeding, or incomplete excision. Preoperative radiologic examinations such as ultrasonography, computed tomography are useful as first-line diagnostic tools for differential diagnosis of movable neck mass. With a review of literature, the author reports a case of IVPG arising from the left external jugular vein in a 31-year-old male who complained about a palpable neck mass. This patient was successfully managed by ligation and excision of the vein without any complication and no recurrence was found after 6 months.


Subject(s)
Adult , Diagnosis , Diagnosis, Differential , Granuloma, Pyogenic , Head , Hemorrhage , Humans , Jugular Veins , Korea , Ligation , Male , Neck , Recurrence , Surgical Procedures, Operative , Ultrasonography , Upper Extremity , Vascular System Injuries , Veins
15.
Article in English | WPRIM | ID: wpr-719571

ABSTRACT

BACKGROUND: The curved sectional planes of the human body can provide a new approach of surface anatomy that the classical horizontal, coronal, and sagittal planes cannot do. The purpose of this study was to verify whether the curved sectional planes contribute to the morphological comprehension of anatomical structures. METHODS: By stacking the sectioned images of a male cadaver, a volume model of the right half body was produced (voxel size 1 mm). The sectioned images with the segmentation data were also used to build another volume model. The volume models were peeled and rotated to be screen captured. The captured images were loaded on user-friendly browsing software that had been made in the laboratory. RESULTS: The browsing software was downloadable from the authors' homepage (anatomy.co.kr). On the software, the volume model was peeled at 1 mm thicknesses and rotated at 30 degrees. Since the volume models were made from the cadaveric images, actual colors of the structures were displayed in high resolution. Thanks to the segmentation data, the structures on the volume model could be automatically annotated. Using the software, the sternocleidomastoid muscle and the internal jugular vein in the neck region, the cubital fossa in the upper limb region, and the femoral triangle in the lower limb region were observed to be described. CONCLUSION: For the students learning various medical procedures, the software presents the needed graphic information of the human body. The curved sectional planes are expected to be a tool for disciplinary convergence of the sectional anatomy and surface anatomy.


Subject(s)
Anatomy, Cross-Sectional , Cadaver , Comprehension , Education , Human Body , Humans , Imaging, Three-Dimensional , Jugular Veins , Learning , Lower Extremity , Male , Neck , Upper Extremity , Visible Human Projects
16.
Article in Korean | WPRIM | ID: wpr-787534

ABSTRACT

Lemierre's syndrome is rare disease characterized by anaerobic sepsis, internal jugular vein thrombosis, septic emboli that resulted from head and neck infection. Lemierre's syndrome has significant morbidity, so immediate, accurate diagnosis and treatment is needed. It is necessary to perform contrast-enhanced computed tomography (CT) for diagnosis. Systemic antibiotics is recommended, and surgical interventions, anticoagulation may beis considered for treatment. We report misdiagnosed case as a simple deep neck infection on initial ultrasonography with simultaneous abscess aspiration but finally diagnosed and treated internal jugular vein thrombophlebitis (Lemierre's syndrome) on CT scan.We report a case of a 45-year-old patient, who was diagnosed with a simple deep neck infection and treated with simultaneous abscess aspiration, but finally diagnosed and treated internal jugular vein thrombophlebitis (Lemierre's syndrome) on CT scan.


Subject(s)
Abscess , Anti-Bacterial Agents , Diagnosis , Head , Humans , Jugular Veins , Lemierre Syndrome , Middle Aged , Neck , Rare Diseases , Sepsis , Thrombophlebitis , Thrombosis , Tomography, X-Ray Computed , Ultrasonography
17.
Article in Korean | WPRIM | ID: wpr-758455

ABSTRACT

OBJECTIVE: Stroke volume (SV) measurements have been used to guide fluid management. Noninvasive, indirect, and convenient measurements of the SV for fluid therapy are required for most patients during spontaneous breathing (SB). On the other hand, the preferred method for an indirect prediction of the SV is unclear. This study examined the best of the indirect and predictable parameters responding to a SV variation during SB. METHODS: Hemodynamic parameters, such as collapsibility of the inferior vena cava (cIVC), peak velocity variation in the common carotid artery (pvvCCA), collapsibility of the internal jugular vein (cIJV), and end-tidal carbon dioxide (ETCO₂) were measured 180 times (6 different positions each in 30 normal subjects). The variables changed with the SV at the upper body elevation of 60°and 30°, in the supine position, at the lower body elevation of 60°and 30°, and lumbar elevation. RESULTS: The SV showed the highest value at 30°of lower body elevation. Following fixed position changes, the ETCO₂ during SB was the factor most correlated with the SV when compared to cIVC, cIJV, and pvvCCA (β coefficient, 2.432 vs. −0.41, −0.033, and −0.654; P=0.004). The adjusted ETCO₂ showed a significant change with the SV, even though the change in ETCO₂ was not large. CONCLUSION: ETCO₂ was less influenced by the SB than cIVC, pvvCCA, and cIJV because the ETCO₂ change was in accordance but the variations of the other blood vessels did not coincide with a SV change. Therefore, ETCO₂ monitoring for predicting the SV would be more important than the variations in the vessels during SB.


Subject(s)
Blood Vessels , Carbon Dioxide , Carbon , Cardiac Output , Carotid Artery, Common , Fluid Therapy , Hand , Hemodynamics , Humans , Jugular Veins , Methods , Respiration , Stroke Volume , Stroke , Supine Position , Ultrasonography , Vena Cava, Inferior
18.
Article in English | WPRIM | ID: wpr-739209

ABSTRACT

BACKGROUND: Tongue reconstruction is challenging with the unique function and anatomy. Goals for reconstruction differ depending on the extent of reconstruction. Thin and pliable flaps are useful for tongue tip reconstruction, for appearance and mobility. This study reports lateral arm free flap (LAFF) as a safe and optimal option for hemi-tongue reconstruction, especially for tongue tip after hemiglossectomy. METHODS: Thirteen LAFFs were performed for hemi-tongue reconstruction after hemiglossectomy from 1995 to 2018. Of the 13 patients, seven were male and six were female, age varying from 24 to 64 years. RESULTS: All flaps healed uneventfully without complications. Donor sites were closed primarily. The recipient vessels for microvascular anastomosis were mainly superior thyroidal artery, external jugular vein. All patients returned to normal diet, with no complaints regarding reconstructed tongue and donor site. CONCLUSION: The LAFF is hairless, thin (especially with lateral epicondyle approach), and potentially sensate. They are advantageous features for tongue tip and hemi-tongue reconstruction. Donor site sacrifices the inessential posterior radial collateral artery, and the scar is hidden under short sleeve shirts. We believe that LAFF can be considered as the first choice flap for hemitongue reconstruction, over radial forearm free flaps.


Subject(s)
Arm , Arteries , Cicatrix , Diet , Female , Forearm , Free Tissue Flaps , Humans , Jugular Veins , Male , Reconstructive Surgical Procedures , Surgical Flaps , Thyroid Gland , Tissue Donors , Tongue
19.
Article in Korean | WPRIM | ID: wpr-740692

ABSTRACT

Most sharp force fatalities are attributed to homicide or suicide, with only a few accidental cases reported to date. Broken glass accounts for most of these accidental fatalities. We herein report an unusual accidental death caused by a broken glass cup. A 21-year-old woman was found dead on the floor of her studio apartment. The studio was a duplex consisting of one room and a bathroom, with a stepped drawer leading to the second floor. She was lying face down with her legs spread apart in a large pool of blood, surrounded by many pieces of broken glass. There was an oblique cut measuring 9 cm in length in the right sternocleidomastoid region just above the right clavicle. The surface of the cut wound showed irregular edges and the internal jugular vein was severed in the depth of the wound. She appeared to have fallen down the steps onto the ground floor and been fatally injured in the neck by a piece of broken glass.


Subject(s)
Clavicle , Deception , Female , Glass , Homicide , Humans , Jugular Veins , Leg , Neck , Neck Injuries , Suicide , Wounds and Injuries , Young Adult
20.
J. vasc. bras ; 18: e20180026, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1002493

ABSTRACT

Hemangioma é um tumor frequente, geralmente diagnosticado em crianças, constituindo quase 10% das neoplasias benignas. Um hemangioma com crescimento na parede de um vaso é extremamente raro, e deve ser diferenciado de outras malformações vasculares de mesma origem. Apresentamos um caso raro de hemangioma de veia jugular externa e discutimos sua propedêutica e manejo


Hemangioma is a common tumor, normally diagnosed in children, and accounting for almost 10% of benign neoplasms. A hemangioma arising from the wall of a vessel is rare, and must be differentiated from other vascular malformations of the same origin. We report a rare case of a hemangioma arising from the wall of an external jugular vein and discuss diagnostic work-up and management


Subject(s)
Humans , Female , Adult , Head and Neck Neoplasms/diagnostic imaging , Hemangioma/therapy , Jugular Veins , Surgical Procedures, Operative/methods , Thrombosis/diagnostic imaging , Diagnostic Imaging/methods , Echocardiography/methods , Rivaroxaban/therapeutic use
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