Anomalous origin of superior laryngeal artery from external carotid artery – A case report.

During routine dissection in Anatomy Department, KMC Manipal, anomalous origin of superior laryngeal artery arising from external carotid artery was observed on the right side in an adult male cadaver. Superior laryngeal artery normally is a branch of superior thyroid artery. It supplies laryngeal muscles, mucosa and glands. The origin of lingual and facial arteries from external carotid artery was normal. The courses of nerves in the carotid triangle are also normal No variations were observed in the left carotid arterial system. Variations in the origin of the superior laryngeal artery are very rare. It may arise from lingual, facial, ascending pharyngeal, external carotid artery or even from the common carotid artery. There are reports of rare variation of the common trunk of origin of superior laryngeal and inferior thyroid artery from the external carotid artery at the same level as origin of common linguofacial trunk. Though embryogenesis of this variation is not clear, but may be important for reconstruction surgery of the larynx, laryngeal transplantation and it will also be useful to the surgeons in minimizing the post-operative complications in a bloodless surgery. Clinicians must be aware of these variations in the super selective intra arterial chemotherapy for laryngeal and hypo laryngeal cancers.

The Multi-imaging Diagnostic Values of Aortic Diverticulum With the Comparison of Clinical Application / 中国循环杂志

Objective: To investigate the multi-imaging diagnostic values, especially MSCT technology in patients with congenital aortic diverticulum with its clinical application. Methods: The MSCT ifndings in 12 patients with congenital aortic diverticulum were retrospectively analyzed. Results: There were 9 patients with right aortic arch and 1 with left aortic arch, all of them having coexisted aberrant subclavian artery which initially dilated like aneurysm by diverticulum changing (Kommerell diverticulum), and there was 1 patient with incomplete double aortic arch with atresia of left arch combining retro-esophageal aortic diverticulum (RAD) and 1 patient with ducts diverticulum. Echocardiogram only made the suggestive diagnosis of speeding up blood lfow or right aortic arch in 4 patients. While MSCT accurately displayed the diverticulum for the location, morphology and with or without other complications. The post-eroanterior chest radiograph indicated “double aortic node” as the special sign in 8 patients. The echocardiogram, X-ray and MSCT for correctly diagnosing the aortic diverticulum were as 0, 72.7% and 100% respectively. Conclusion: MSCT is a rather ideal non-invasive diagnosing method for aortic diverticulum, meanwhile X-ray could also make suggestive diagnosis; if MSCT and X-ray joint with echocardiogram examination may provide the effective supplement for valve structure and hemodynamics condition in relevant patients.

Safety and Feasibility of Self-Expandable Metallic Stent Insertion for the Right-Side Colonic Malignant Obstruction and Its Clinical Benefits

PURPOSE: The efficacy of stenting for the right-side colonic malignant obstruction is unknown. The purpose of this study was to evaluate the safety and feasibility of self-expandable metallic stent insertion for the right-side colonic malignant obstruction and its clinical benefits. METHODS: We retrospectively reviewed clinical data from 460 patients who underwent right hemicolectomy for right-side colon cancer from January 2006 to January 2014 at Korea University Anam Hospital. Twenty four patients who developed malignant obstruction in the right -side colon were identified and analyzed. RESULTS: Self-expandable metallic stent insertion was attempted in 14 patients, and initial technical success was achieved in 13 patients (92.9%). No immediate stent-related complications were reported. Complete relief of obstruction was achieved in all of the 13 patients. Eleven patients who failed stenting underwent emergency operation. All of the 13 patients with stent underwent laparoscopic surgery and only one case was converted to open. Only three patients in the emergency group underwent laparoscopic surgery but one was converted. Operative time and number of retrieved lymph nodes did not differ between the two groups. Postoperative hospital stay (9.8+/-3.2 in stent group vs. 16.3+/-10.9 days in emergency group, p=0.082) tended to be shorter in the stent group. Estimated blood loss (38.5+/-138.7 in stent group vs. 381.8+/-411.9 in emergency group, p=0.010) and duration for resuming diet (3.2+/-2.2 in stent group vs. 6.6+/-7.0 days in emergency group, p=0.017) were significantly better in the stent group. CONCLUSION: Self-expandable metallic stent appears to be safe and feasible in the right-side colonic malignant obstruction. It facilitates minimally invasive surgery and may result in better short-term surgical outcome.

Right sided congenital diaphragmatic defect with liver hernia: A case report.

Congenital diaphragmatic hernia is a rare entity occurring in 1 in 2000-4000 live births and accounts for 8% of all major congenital anomalies. Congenital diaphragmatic hernia (CDH) is a major surgical emergency in new-borns because the key to survival depends on the prompt diagnosis and treatments. We reported here a case of right sided congenital diaphragmatic defect with liver hernia in a 7 month old baby, who came to seek medical care at a tertiary care centre in Navi Mumbai for on and off cold and cough with breathlessness after feeds. The baby was tachypneic on examination. Immediately chest X-ray and CT scan of thorax and abdomen was done to assess symptomatically and clinically suspected case of congenital diaphragmatic hernia. It was a case of right sided congenital diaphragmatic hernia.

A Rare Case of Stridor with a Right Sided Aortic Arch in a Libyan Patient.

A rare case of stridor with a right sided aortic arch is presented showing minimal or no change in circulatory pattern excepting for noisy breathing.

Right ventricular failure in congenital heart disease / 소아과

Despite developments in surgical techniques and other interventions, right ventricular (RV) failure remains an important clinical problem in several congenital heart diseases (CHD). RV function is one of the most important predictors of mortality and morbidity in patients with CHD. RV failure is a progressive disorder that begins with myocardial injury or stress, neurohormonal activation, cytokine activation, altered gene expression, and ventricular remodeling. Pressure-overload RV failure caused by RV outflow tract obstruction after total correction of tetralogy of Fallot, pulmonary stenosis, atrial switch operation for transposition of the great arteries, congenitally corrected transposition of the great arteries, and systemic RV failure after the Fontan operation. Volume-overload RV failure may be caused by atrial septal defect, pulmonary regurgitation, or tricuspid regurgitation. Although the measurement of RV function is difficult because of many reasons, the right ventricle can be evaluated using both imaging and functional modalities. In clinical practice, echocardiography is the primary mode for the evaluation of RV structure and function. Cardiac magnetic resonance imaging is increasingly used for evaluating RV structure and function. A comprehensive evaluation of RV function may lead to early and optimal management of RV failure in patients with CHD.

Right side fixation of sigmoid colon with a hepato-sigmoidocolic fistula in patient with hepatocellular carcinoma and midgut malrotation / 대한외과학회지

The location of the sigmoid colon varies within the abdominal cavity, but its mesocolon is fixed to the left side. Right side fixation of the sigmoid colon is a very rare congenital positional anomaly. In addition, it has been reported that hepatocolic fistula is also a very rare disease that may present lower gastrointestinal bleeding. Here, the authors describe a case of a 71-year-old man who underwent surgery for hepato-sigmoidocolic fistula complicated by hepatocellular carcinoma and the right side fixation of the sigmoid colon.

Tracheobronchial compression by right-sided aortic arch in a middle aged male.

Exertional dyspnoea is a common symptom among middle-aged population. Diagnostic evaluation of such patients is often challenging and confusing. We report a patient presenting with exertional dyspnoea and an obstructive ventilatory defect on spirometry that was refractory to bronchodilator therapy. Careful review of the chest radiograph and spirometry pointed towards variable intra-thoracic airways obstruction as a cause of dyspnoea. Contrast enhanced computed tomography (CECT) of the thorax and bronchoscopy established the diagnosis of a right-sided aortic arch resulting in tracheobronchial compression and tracheomalacia.

Endocardite infecciosa em câmaras direitas: discrepância entre evolução clínica e ecocardiográfica: relato de caso / Right-side infective endocarditis: discrepancy between clinical and echocardiographic evolution: case report

A endocardite infecciosa é uma patologia relativamente rara na prática clínica, e, apesar dos avanços em seu diagnóstico e tratamento, sua morbi-mortalidade ainda é significativa. Muitas vezes é difícil a identificação de suas complicações e a conduta frente a elas, ocorrendo com freqüência a dissociação entre a evolução clínica e os achados de exames complementares - principalmente ecocardiográficos. A decisão clínica torna-se ainda mais difícil frente às manifestações atípicas da doença, como a endocardite de câmaras direitas. Este é o relato de um caso raro de endocardite de câmaras direitas em uma paciente renal crônica, cuja piora dos achados ecocardiográficos se opunha à evolução clínica favorável. Esta situação pode suscitar dificuldade quanto aos critérios para indicação cirúrgica e a segurança do tratamento conservador.

Infective endocarditis is a relatively rare disease in clinical practice, with significant morbidity and mortality despite the improvements on its diagnosis and treatment. It is often difficult to identify its complications and define strategies for them. Dissociation between the clinical evolution and the findings from complementary tests (especially echocardiographic tests) is common. Clinical decisions become even more difficult when there are atypical manifestations of the disease, such as right-side endocarditis. This report is about a rare case of right-side endocarditis in a patient with chronic renal disease, in which there was a contradiction between worsening of the echocardiographic findings and clinical improvement. This situation may lead to difficulties regarding the criteria for indicating surgery and the safety of conservative clinical treatment.

Cases Report of Kumi-binro-to / 日本東洋医学雑誌

Kumi-binro-to is a Kampo formulation produced by Sohaku Asada. It has been used for patients with stasis of body fluids presenting beriberi-like symptoms. The cases in this report where Kumi-binro-to was effective had symptoms similar to the cases where it was ineffective, but they had different distributions of tympanic sound in the abdomen.<br>We investigated the efficacy of four weeks of treatment with Kumi-binro-to in 30 cases having both symptoms of stasis of body fluids and tympanic sound in the abdomen. Kumi-binro-to was effective in 20 of 25 cases that had the tympanic sound in the right iliac, flank and subphrenic regions. However, Kumi-binro-to was not effective in 5 cases where the tympanic sound was restricted to the epigastrium, left iliac, flank and subphrenic regions. Tympanic sound on the right side of the abdomen might be one of the indications for Kumi-binro-to.

Right-side Bochdalek Hernia with Unusual Kidney Herniation in an Old Patient / 대한내과학회지

Bochdalek hernia through Bochdalek foramen, defect at the posterolateral side of the diaphragm is one of the congenital diaphragmatic hernias. It usually occurs in infants, but very rare in old age and also on the right side. We experienced the right-side Bochdalek hernia including kidney herniation in 68 years old man man ifested by hemoptysis. CT scan revealed diaphragmatic defect and herniated liver, colon and kidney. Thoracotomy was performed and the 10 cm-sized large defect was closed with patch. After then, the patient has been well without symptom.

Effective Approaches to Successful Target Sites in Catheter Ablation of the Right-side Accessory Pathways / 대한내과학회지

BACKGROUND: Although radiofrequency catheter ablation (CA) of the accessory pathway (AP) is very effective and safe, it has been reported that CA is more difficult in the right-side AP than the left-side AP, requiring the refinement of the conventional CA technique for the right-side AP. This study was, therefore, aimed to develop an effective technique for CA of the right-side AP. METHODS: Fifty right-side APs in 45 patients which underwent CA were included in this study. The locations of APs were divided into 8 regions (anteroseptal, mid septal, posteroseptal, posterior, posterolateral, lateral, anterolateral, and anterior). After localizing APs, CA of the APs was attempted via the inferior vena cava (IVC) in all patients. If CA attempt via the IVC for more than 1 hour was failed, then CA was tried via the superior vena cava (SVC). Successful CA was defined as permanent loss of AP conduction even during infusion of isoproterenol (1-4microg/min). The ways of approaching the ablation catheter to the successful target sites were classified into over-the-tricuspid valve approach (OV) via the IVC (IVC-OV), OV via the SVC (SVC-OV), under-the-tricuspid valve (UV) approach via the IVC (IVC-UV), and UV via the SVC (SVC-UV) and evaluated according to the AP locations. RESULTS: The locations of the APs were anteroseptal in 5 APs, mid septal in 6, posteroseptal in 12, posterior in 3, posterolateral in 5, right lateral in 11, anterolateral in 4, and anterior in 4. Forty-eight (96.0%) of 50 APs were successfully ablated; 35 (70.0%) with primary IVC approaches and 13 (26.0%) with secondary SVC approaches. As a successful approach, IVC-OV was 26 (54.2%); IVC-UV, 9 (18.8%); SVC-OV, 4 (8.3%), and SVC-UV, 9 (18.8%). Secondary SVC approaches were required 7 (70.0%) in the lateral APs, 2 (50.0%) in the anterolateral APs, 1 (25.0%) of the posterolateral APs, 1 (25.0%) in the anterior APs, 1 (20.0%) of the anteroseptal APs, and 1 (8.3%) in the posteroseptal APs but none in the midseptal and posterior APs. SVC-UV approach was used in 9 (69.2%) in 13 APs which were ablated with SVC approach. CONCLUSIONS: The ways of approach to successful target site in CA of the right-side APs are different according to the location and SVC approaches are frequently required in ablation of the lateral or anterolateral APs. Therefore, SVC approaches should be considered in these locations if the initial IVC approaches are not successful.