Subject(s)
Intussusception , Adolescent , Adult , Aged , Colonic Diseases , Female , Humans , Intussusception/diagnosis , Intussusception/etiology , Intussusception/therapy , Male , Middle AgedABSTRACT
Hepatic artery aneurysm is a rare vascular disease associated with high mortality caused by massive hemorrhage or by complications following surgical treatment. Over the past twenty-five years it has been managed surgically with increasing success. Eighty reported cases of hepatic artery aneurysms ruptured into the biliary tree were reviewed and the etiology, clinical signs, diagnosis, and treatment of such an aneurysm are discussed. A personal case with an aneurysm of the right hepatic artery ruptured into the common hepatic duct is reported. The diagnosis was made before surgery by arteriography and the aneurysm was successfully managed by ligation of the right hepatic artery both proximal and distal to the aneurysm, closure of the communication between the common hepatic duct and the aneurysm, and choledochal drainage. Hemobilia secondary to hepatic artery aneurysm must be considered in thedifferential diagnosis of unexplained gastrointestinal hemorrhage.
Subject(s)
Aneurysm/complications , Biliary Tract , Gastrointestinal Hemorrhage/etiology , Hepatic Artery , Female , Hepatic Artery/diagnostic imaging , Hepatic Artery/surgery , Humans , Radiography , Rupture, SpontaneousABSTRACT
The surgeon planning a thyroidectomy must be prepared to find variations in three important structures in the neck. He must be prepared to find ectopic thyroid nodules above, below or lateral to the normally located thyroid gland. Any unattached nodule should be considered malignant until proved otherwise. He must identify and preserve parathyroid glands that may not lie in the typical location. He must be prepared to encounter recurrent laryngeal nerves that do not recur. The surgeon who remembers the embryology of the structures in the neck may occasionally be astonished, but never surprised.
Subject(s)
Laryngeal Nerves/embryology , Parathyroid Glands/embryology , Recurrent Laryngeal Nerve/embryology , Thyroid Diseases/surgery , Thyroid Gland/embryology , Humans , Parathyroid Glands/anatomy & histology , Recurrent Laryngeal Nerve/anatomy & histology , Thyroid Gland/anatomy & histologyABSTRACT
Nonrecurrence and variations in the ascending course of the recurrent laryngeal nerves make it essential to identify the nerve to avoid injury to it during thyroidectomy. We believe that visual identification of the nerve without undue handling is all that is necessary. The recurrent nerve is no more delicate than other similar nerves. Unilateral injury to the recurrent nerve may result in temporary hoarseness which will improve with time. Some restriction of the airway during exertion may be present. Bilateral injury to the recurrent nerves may produce initially a loss of voice without airway constriction. Later the voice may return, accompanied by serious respiratory embarrassment on exertion.
Subject(s)
Laryngeal Nerve Injuries , Recurrent Laryngeal Nerve Injuries , Humans , Recurrent Laryngeal Nerve/anatomy & histology , Thyroid Diseases/surgery , Thyroidectomy/adverse effectsABSTRACT
Injury to the internal (sensory) branch of the superior laryngeal nerve during thyroidectomy is unlikely. Signs of injury are loss of sensation in the upper larynx, resulting in choking and aspiration of swallowed fluids. Injury to the external (motor) branch of the superior laryngeal nerve produces no problem of respiration, but may result in changes in the quality of the voice or even voicelessness. Injury to the external branch can be avoided if the anatomical variations are kept in mind during ligation of upper pole vessels.
Subject(s)
Laryngeal Nerve Injuries , Humans , Laryngeal Nerves/anatomy & histology , Thyroid Diseases/surgery , Thyroidectomy/adverse effectsABSTRACT
Ten cases of vascular compression of the duodenum are presented, and 125 cases in the literature since 1962 are reviewed. More common in women than in men, the lesion may result from supine immobilization, wearing body cast, or a rapid weight loss. In about one third of the patients, no predisposing factor can be found. Diagnosis is best made by cinefluoroscopy. Although conservative measures will provide relief in a few patients, most will require surgery. Section of the suspensory muscle and relocation of the duodenojejunal junction will relieve the symptoms in many patients. Duodenojejunostomy will be required in some others. Complete relief can be expected in all but a very few patients. Those who have developed neurotic eating habits from years of discomfort may not show immediate improvement. Untreated vascular compression of the duodenum may be chronic or may become acute with fatal results.