ABSTRACT
The cervical aortic arch (CAA) is an uncommon congenital anomaly in aortic development, characterized by an elongated aortic arch extending at or above the medial ends of the clavicles. Our objective was to examine the clinical and surgical characteristics of this infrequent condition in the adult population. PubMed, ScienceDirect, SciELO, DOAJ, and Cochrane Library databases were searched until December 2023 for case reports describing the presence of a cervical aortic arch in patients aged ≥18 years. Case reports and series were included if the following criteria were met: (1) description of the cervical aortic arch, (2) age ≥18 years, and (3) English language. The literature search identified 2,325 potentially eligible articles, 61 of whom met our inclusion criteria and included a combined number of 71 patients. Mean age was 38.6 ± 15.4 years, with a female prevalence of 67.1% (47/70). Two-thirds of the CAA were left-sided (48/71, 67.6%), and 62.0% (44/71) of patients presented a concomitant arch aneurysm. Asymptomatic patients were 45.7% (32/70), while of those that were symptomatic, 60.5% (23/38) had symptoms related to vascular-induced compression of trachea and esophagus. Surgery was performed in 42 patients (62.7%) among 67 cases that reported the patient's treatment, and 5 patients (11.9%) among those surgically treated underwent the procedure through an endovascular approach. CAA is an uncommon congenital abnormality that presents challenges in diagnosis and treatment due to its high anatomical variability, diverse clinical manifestations, and presence of concomitant diseases. Surgery seems to be a safe and effective option for the resolution of symptoms.
Subject(s)
Aorta, Thoracic , Humans , Aorta, Thoracic/abnormalities , Aorta, Thoracic/surgery , Aorta, Thoracic/diagnostic imaging , Adult , Disease Management , FemaleABSTRACT
In men with advanced carcinoma of the prostate being treated with androgen deprivation therapy (ADT), hot flashes can be a significant side effect of the treatment. In this paper we describe using acupuncture as a complementary alternative therapy for treatment of hot flashes in men.
Subject(s)
Acupuncture Therapy/methods , Hot Flashes/therapy , Prostatic Neoplasms/drug therapy , Androgen Antagonists/adverse effects , Antineoplastic Agents, Hormonal/adverse effects , Hot Flashes/chemically induced , Humans , Male , Orchiectomy/adverse effectsABSTRACT
Patients with a uretero-iliac artery fistula (UIAF) are at an elevated risk of life-threatening hemorrhage. Identification and treatment of the fistula may be challenging, and requires the combined expertise of a urologist and endovascular specialist. This manuscript provides a list of equipment needed and describes our technique for diagnosing and treating a UIAF.
Subject(s)
Endovascular Procedures/methods , Iliac Artery/surgery , Ureteral Diseases/surgery , Urinary Fistula/surgery , Urologic Surgical Procedures/methods , Vascular Fistula/surgery , Endovascular Procedures/instrumentation , Hematuria/etiology , Humans , Stents , Ureteral Diseases/diagnosis , Urinary Fistula/diagnosis , Urologic Surgical Procedures/instrumentation , Vascular Fistula/diagnosisABSTRACT
STUDY OBJECTIVE: Access to automated external defibrillators and cardiopulmonary resuscitation (CPR) training are key determinants of cardiac arrest survival. State police officers represent an important class of cardiac arrest first responders responsible for the large network of highways in the United States. We seek to determine accessibility of automated external defibrillators and CPR training among state police agencies. METHODS: Contact was attempted with all 50 state police agencies by telephone and electronic mail. Officers at each agency were guided to complete a 15-question Internet-based survey. Descriptive statistics of the responses were performed. RESULTS: Attempts were made to contact all 50 states, and 46 surveys were completed (92% response rate). Most surveys were filled out by police leadership or individuals responsible for medical programs. The median agency size was 725 (interquartile range 482 to 1,485) state police officers, with 695 (interquartile range 450 to 1,100) patrol vehicles ("squad cars"). Thirty-three percent of responding agencies (15/46) reported equipping police vehicles with automated external defibrillators. Of these, 53% (8/15) equipped less than half of their fleet with the devices. Regarding emergency medical training, 78% (35/45) of state police agencies reported training their officers in automated external defibrillator usage, and 98% (44/45) reported training them in CPR. CONCLUSION: One third of state police agencies surveyed equipped their vehicles with automated external defibrillators, and among those that did, most equipped only a minority of their fleet. Most state police agencies reported training their officers in automated external defibrillator usage and CPR. Increasing automated external defibrillator deployment among state police represents an important opportunity to improve first responder preparedness for cardiac arrest care.
