RESUMO
We report the case of a 68-year-old patient, operated on in our department of a quadruple coronary bypass grafting. The grafting strategy consisted initially on harvesting the left internal thoracic artery and the left radial artery. The harvest of this latter failed because of a rare anatomical variation of the radial artery, which rose from the confluence of two branches: a superficial and a deep radial artery at the proximal third of the forearm approximately 10cm below the elbow.
Assuntos
Variação Anatômica , Ponte de Artéria Coronária/efeitos adversos , Artéria Radial/anormalidades , Idoso , Ponte de Artéria Coronária/métodos , Antebraço/irrigação sanguínea , Humanos , Artéria Radial/transplanteRESUMO
The purpose of this study was to assess the inter-observer and intra-observer reproducibility of the interpretation of CT arthrography and plain X-rays for scapholunate advanced collapse (SLAC), scaphoid non-union advanced collapse (SNAC) and scaphoid chondrocalcinosis advanced collapse (SCAC) wrist conditions, as well as the clinical relevance of these imaging modalities. The CT and X-rays images were reviewed twice in a blinded and randomized manner by two experienced orthopedic surgeons specialized in hand surgery, two orthopedic surgery residents and two experienced radiologists specialized in bone and joint imaging. Cohen's kappa and Fleiss' kappa coefficients were used to analyze the reproducibility of interpretation of the radiological examinations. With CT arthrography, the overall diagnosis was often a problem, in terms of both inter- or intra-observer reproducibility. The assessment of the joint line appeared to be fairly reproducible for each observer but was poorly reproducible between different observers. Plain X-rays are not sufficient to assess cartilage quality in degenerative wrist disease. CT arthrography is a reliable examination, but its interpretation is not always standardized. Diagnostic arthroscopy may be justified in doubtful cases.
Assuntos
Artrografia/métodos , Condrocalcinose/diagnóstico por imagem , Osso Semilunar/diagnóstico por imagem , Radiografia , Osso Escafoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Humanos , Osso Semilunar/lesões , Variações Dependentes do Observador , Distribuição Aleatória , Reprodutibilidade dos Testes , Osso Escafoide/lesões , Traumatismos do Punho/classificaçãoAssuntos
Neoplasias Ósseas/diagnóstico , Dor Lombar/etiologia , Pelve/patologia , Sarcoma de Ewing/diagnóstico , Ciática/etiologia , Adulto , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/radioterapia , Feminino , Humanos , Pelve/inervação , Período Periparto , Período Pós-Parto , Gravidez , Sarcoma de Ewing/tratamento farmacológico , Sarcoma de Ewing/radioterapia , Resultado do Tratamento , Adulto JovemAssuntos
Neoplasias Ósseas/diagnóstico , Processamento de Imagem Assistida por Computador , Linfangioma Cístico/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Cintilografia , Neoplasias Esplênicas/diagnóstico , Tomografia Computadorizada por Raios X , Biópsia por Agulha , Neoplasias Ósseas/patologia , Osso e Ossos/patologia , Pré-Escolar , Feminino , Humanos , Linfangioma Cístico/patologia , Neoplasias Primárias Múltiplas/patologia , Osteólise/diagnóstico , Osteólise/patologia , Baço/patologia , Neoplasias Esplênicas/patologiaAssuntos
Coxa da Perna , Angiografia , Biópsia , Humanos , Imuno-Histoquímica , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sarcoma Alveolar de Partes Moles/diagnóstico , Sarcoma Alveolar de Partes Moles/diagnóstico por imagem , Sarcoma Alveolar de Partes Moles/genética , Sarcoma Alveolar de Partes Moles/patologia , Sarcoma Alveolar de Partes Moles/cirurgia , Coxa da Perna/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Adulto JovemRESUMO
We report a case of calcified aortic stenosis revealed by an ischemic stroke. An 81-year-old man with hyperlipidemia, hypertension and renal function impairment presented with acute onset of right-sided hemiparesis and aphasia. Head CT scan revealed a rounded calcified high-density mass within the distal segment of the left anterior cerebral artery, consistent with a calcified cerebral embolus, and an infarct in the left paracentral lobule. Transesophageal echocardiography demonstrated a sclerotic aortic valve. The patient was discharged from hospital on aspirin and atorvastatin, and the outcome was favorable. Calcified embolus remains a rare event and it has been not yet reported in the territory of anterior cerebral artery. It may be observed in aortic and mitral valve diseases, calcified plaques of the internal carotid artery and aortic arch. Renal failure promotes their development and is the cause of cardiovascular diseases. To date, aortic valve calcification is not considered as a marker of stroke risk, except when associated with severe stenosis or left ventricular hypertrophy.
Assuntos
Estenose da Valva Aórtica/diagnóstico , Calcinose/diagnóstico , Embolia Intracraniana/diagnóstico , Acidente Vascular Cerebral/etiologia , Idoso de 80 Anos ou mais , Artéria Cerebral Anterior , Valva Aórtica , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/tratamento farmacológico , Aspirina/uso terapêutico , Atorvastatina , Calcinose/complicações , Ácidos Heptanoicos/uso terapêutico , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/tratamento farmacológico , Masculino , Pirróis/uso terapêutico , Acidente Vascular Cerebral/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
PURPOSE OF THE STUDY: We aimed to highlight a rare anatomical variation involving the recurrent laryngeal nerve, and to emphasise its implications for thyroid surgery. MATERIALS AND METHODS: Over a period of 13 years, 993 patients underwent thyroid surgery; 1557 recurrent laryngeal nerves (887 on the right side) were exposed. RESULTS: Three non-recurrent laryngeal nerves were found on the right side, associated with a retro-oesophageal subclavian artery. One case was suspected before surgery. DISCUSSION: Several variations in the path and branches of the recurrent laryngeal nerve have been reported in the literature. The frequency of occurrence of a non-recurrent laryngeal nerve is about 1 per cent, for patients undergoing thyroid surgery. Other surgically relevant anatomical variations of the recurrent laryngeal nerve include associations with the inferior thyroid artery and the presence of nerve branches. CONCLUSION: The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.
Assuntos
Nervos Laríngeos/cirurgia , Nervo Laríngeo Recorrente/cirurgia , Glândula Tireoide/cirurgia , Tireoidectomia , Idoso , Idoso de 80 Anos ou mais , Feminino , Bócio/diagnóstico por imagem , Bócio/cirurgia , Humanos , Nervos Laríngeos/anormalidades , Masculino , Pessoa de Meia-Idade , Radiografia , Nervo Laríngeo Recorrente/anatomia & histologia , Artéria Subclávia/diagnóstico por imagem , Glândula Tireoide/diagnóstico por imagem , Resultado do TratamentoAssuntos
Anticoagulantes/administração & dosagem , Veias Cerebrais/efeitos dos fármacos , Heparina/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Adulto , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/patologia , Diagnóstico Precoce , Feminino , Cefaleia/etiologia , Humanos , Injeções Intravenosas , Recuperação de Função Fisiológica/efeitos dos fármacos , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Vômito/etiologiaRESUMO
Emergency departments frequently encounter pathology resulting from injury to the foot and ankle, with approximately 6000 case per day in France. In an ankle sprain, 85% of the lesions involve the lateral collateral ligament. Many other, much rarer, types of lesion with different therapeutic consequences can present, however. Interpretation of the initial conventional radiographs is vital to establishing the type lesion and to proposing adapted and rapid treatment. The objective of this article is to review the various osteoarticular and ligament injuries encountered in the foot and the ankle.