Subject(s)
Arteriovenous Shunt, Surgical/adverse effects , Ischemia/etiology , Kidney Failure, Chronic/therapy , Myalgia/etiology , Peripheral Nervous System Diseases/etiology , Radial Artery/surgery , Upper Extremity/blood supply , Embolization, Therapeutic , Female , Humans , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/therapy , Kidney Failure, Chronic/diagnosis , Myalgia/diagnosis , Myalgia/physiopathology , Myalgia/therapy , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/physiopathology , Peripheral Nervous System Diseases/therapy , Physical Therapy Modalities , Radial Artery/diagnostic imaging , Radial Artery/physiopathology , Recovery of Function , Renal Dialysis , Treatment Outcome , Young AdultABSTRACT
A patient with a total laryngectomy and tracheoesophageal voice prosthesis presented with tracheobronchial aspiration of a Phillips-head screw that was swallowed inadvertently and aspirated around a loose-fitting prosthesis. A modified esophagram showed a screw in the right lung and free leakage of barium from the cervical esophagus around the prosthesis into the tracheobronchial tree. Chest radiographs and CT confirmed a screw in a right lower lobe bronchus with postobstructive pneumonia. When this complication occurs, it is important to extract the foreign body and, if necessary, to adjust or remove the prosthesis to prevent future aspiration pneumonias or foreign body aspiration.
Subject(s)
Esophagus , Foreign Bodies , Laryngectomy/adverse effects , Larynx, Artificial/adverse effects , Prosthesis Failure/adverse effects , Respiratory Aspiration/etiology , Respiratory System/pathology , Bronchi , Humans , Larynx , Lung , Male , Middle Aged , Pneumonia, Aspiration , TracheaABSTRACT
OBJECTIVE: The purpose of this retrospective investigation is to characterize and illustrate the appearances of celiomesenteric trunk (CMT) and hepatosplenomesenteric trunk (HSMT) using CT with three-dimensional volume-rendering with attention to the proximal branching patterns. We also correlate our results with an embryologic model and assess the accuracy of radiologists in recognizing these entities. METHODS: CT studies on 36 adult subjects with CMT and 10 with HSMT were analyzed to determine the proximal branching patterns and lengths of the common vascular trunks. The official reports in appropriately selected cases were reviewed to ascertain if the interpreting radiologists recognized the anomalies. RESULTS: Two types of CMT were found. In 29 of 36 cases (81%), the CMT bifurcated into the celiac trunk and superior mesenteric artery (Type A CMT), while in 7 cases the left gastric artery (LGA) arose from the CMT proximal to the hepatosplenic trunk and superior mesenteric artery (Type B CMT). Type A trunks (mean length = 10.4 mm) were significantly shorter (p = 0.007) than Type B trunks (mean length = 17.8 mm). Short common trunks (less than 1.0 cm) were only seen with Type A CMT. Branching patterns in all 10 cases of HSMT were identical with no short common trunks. The CMT was not mentioned in the radiology reports in 88% of the cases assessed. CONCLUSION: The location of the LGA origin distinguishes the two variants of CMT and differentiates CMT from HSMT. These anomalies are easily overlooked during evaluation of routine clinical cases.
Subject(s)
Celiac Artery/diagnostic imaging , Hepatic Artery/diagnostic imaging , Mesenteric Arteries/diagnostic imaging , Splenic Artery/diagnostic imaging , Vascular Malformations/diagnostic imaging , Adult , Aged , Aged, 80 and over , Celiac Artery/abnormalities , Female , Hepatic Artery/abnormalities , Humans , Imaging, Three-Dimensional , Male , Mesenteric Arteries/abnormalities , Middle Aged , Retrospective Studies , Splenic Artery/abnormalities , Stomach/blood supply , Tomography, X-Ray Computed , Young AdultABSTRACT
Craniotomies are among the oldest neurosurgical procedures, as evidenced by early human skulls discovered with holes in the calvaria. Though devices change, the principles to safely transgress the skull are identical. Modern neurosurgeons regularly use electric power drills in the operating theater; however, nonelectric trephining instruments remain trusted by professionals in certain emergent settings in the rare instance that an electric drill is unavailable. Until the late Middle Ages, innovation in craniotomy instrumentation remained stunted without much documented redesign. Jacopo Berengario da Carpi's (c. 1457-1530 CE) text Tractatus de Fractura Calvae sive Cranei depicts a drill previously unseen in a medical volume. Written in 1518 CE, the book was motivated by defeat over the course of Lorenzo II de'Medici's medical care. Berengario's interchangeable bit with a compound brace ("vertibulum"), known today as the Hudson brace, symbolizes a pivotal device in neurosurgery and medical tool design. This drill permitted surgeons to stock multiple bits, perform the craniotomy faster, and decrease equipment costs during a period of increased incidence of cranial fractures, and thus the need for craniotomies, which was attributable to the introduction of gunpowder. The inspiration stemmed from a school of thought growing within a population of physicians trained as mathematicians, engineers, and astrologers prior to entering the medical profession. Berengario may have been the first to record the use of such a unique drill, but whether he invented this instrument or merely adapted its use for the craniotomy remains clouded.
