ABSTRACT
Though there are common variations of the internal jugular vein (IJV), fenestrations are extremely rare. The lateral branch of the accessory nerve classically goes through the fenestration. We report a case of an empty fenestration of the IJV that was discovered during clearance of cervical lymph nodes. Original operative and radiographic images are shown.
Subject(s)
Anatomic Variation , Jugular Veins/pathology , Accessory Nerve/pathology , Carcinoma, Squamous Cell/surgery , Carotid Sinus/pathology , Face/blood supply , Female , Humans , Hyoid Bone/pathology , Middle Aged , Neck Dissection/methods , Neck Muscles/blood supply , Neck Muscles/innervation , Subclavian Vein/pathology , Thyroid Gland/blood supply , Tongue Neoplasms/surgery , Veins/pathologySubject(s)
Facial Bones/injuries , Maxillary Fractures/diagnostic imaging , Maxillary Fractures/surgery , Female , Humans , Male , RadiographyABSTRACT
Anatomical variations of the stylohyoid apparatus are frequent. Two types can occur: an elongation of the stylohyoid ligament, from a long styloid process to a complete ossified structure connecting the skull base to the lesser horn of the hyoid bone, or the existence of supernumerary bones in the stylohyoid fibrous matrix, which sometimes resembles phalanges. These variations are in the majority of cases bilateral and symmetrical. The authors report the case of a 43-year-old male patient who presented with an unusual unilateral complete ossification of the stylohyoid apparatus, associated with vertebral and laryngeal calcifications. Original latest generation CT scan and three-dimensional MRI imagery are provided to illustrate this rare case.
Subject(s)
Hyoid Bone/diagnostic imaging , Hyoid Bone/pathology , Ossification, Heterotopic/diagnostic imaging , Ossification, Heterotopic/pathology , Temporal Bone/diagnostic imaging , Temporal Bone/pathology , Adult , Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: The purpose of our study was to evaluate the feasibility and the safety of transjugular intrahepatic portosystemic shunts (TIPS) with a new expanded-polytetrafluoroethylene-covered stent and the influence of the covering on occlusion rate. SUBJECTS AND METHODS: Twenty cirrhotic patients (57 +/- 11 years old) admitted with a history of esophageal variceal bleeding (n = 11), refractory ascites (n = 5), or both (n = 4) were included. Five of the patients were treated for TIPS revision, and 15 as de novo TIPS placements. The endoprostheses used were composed of a 2-cm noncovered nitinol stent and a 4- to 8-cm expanded-polytetrafluoroethylene graft covering, and were placed from the portal vein to the ostium of the hepatic vein. Patients underwent Doppler sonography at discharge and again at 1, 3, 6, 9, 12, and 15 months and underwent venography with portosystemic pressure gradient measurement at 6 months and whenever necessary. RESULTS: At the time of this writing, complications included three TIPS restenoses and one recurrent ascites successfully treated by balloon dilation, two cases of segmentary liver ischemia, and one patient with encephalopathy that required shunt reduction. After TIPS placement, the portosystemic pressure gradient dropped from 18 +/- 5 to 5 +/- 4 mm Hg. Primary and secondary patency rates were 80% and 100%, respectively, at 387 days. CONCLUSION: These results clearly show the feasibility of TIPS placement with the Gore TIPS endoprosthesis stent-graft and its improved patency compared with results in the literature for bare stents. These preliminary results must be certified further with randomized comparative trials between covered and noncovered TIPS stents.
Subject(s)
Coated Materials, Biocompatible , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/therapy , Liver Cirrhosis/therapy , Polytetrafluoroethylene , Portasystemic Shunt, Transjugular Intrahepatic/instrumentation , Stents , Adult , Aged , Alloys , Esophageal and Gastric Varices/diagnosis , Feasibility Studies , Female , Gastrointestinal Hemorrhage/diagnosis , Humans , Liver Cirrhosis/diagnosis , Male , Middle Aged , Portal Pressure/physiology , Portography , Treatment Outcome , Ultrasonography, DopplerABSTRACT
OSCE for evaluating clinical competence still remains limited in France. This study presents the results of the first experimental use of an OSCE as a formative assessment of French general practice trainees. Fifty trainees rotated through a circuit of 15 standardized patient-based OSCE cases. Differences in scores were determined by analysis of variance. Reliability was calculated with the coefficient alpha. Pearson correlations were used to determine the relationship between station scores and overall OSCE score. Written questionnaires based on Likert-type scales were used to measure OSCE feasibility. No difference was found between total session scores. Significant item-total score correlations were found for 12 of the 15 clinical problems. The reliability of the examination was 0.58. Most participants agreed that the clinical situations were realistic, simulated patients were believable and sampling of cases was representative of general practice. These data confirm the feasibility of OSCE in assessing performance of general practice trainees. Optimal training of observers should improve examination reliability. This study warrants further development to confirm its usefulness as a summative assessment tool.
