Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.562
Filtrar
1.
J Vasc Access ; 21(1): 98-102, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31232170

RESUMO

We are reporting a case of venous thoracic outlet syndrome with recurrent subclavian vein thrombosis in the setting of an ipsilateral brachiocephalic arteriovenous fistula for hemodialysis that was malfunctioning due to the central vein obstruction. The patient also had a concomitant external jugular vein origin stenosis. Given her body habitus and aversion to recovery after traditional first rib resection, we elected for an alternative treatment with an external jugular vein to internal jugular vein transposition with balloon angioplasty of the stenosed external jugular origin segment. The goal of this was to provide simultaneous relief of her outlet obstruction symptoms and salvage her dialysis access with a less invasive technique.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Veias Jugulares/cirurgia , Falência Renal Crônica/terapia , Diálise Renal , Veia Subclávia , Síndrome do Desfiladeiro Torácico/terapia , Extremidade Superior/irrigação sanguínea , Enxerto Vascular/métodos , Adulto , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/fisiopatologia , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/fisiopatologia , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/fisiopatologia
2.
Medicine (Baltimore) ; 98(46): e18007, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725671

RESUMO

Long-term venous access is usually required in patients receiving chemotherapy. We hypothesized that, out of the various central line approach techniques, the cephalic vein cut-down technique can be a safe and simple alternative in terms of surgical safety, feasibility, cost-effectiveness, and functional outcomes.We retrospectively reviewed the medical records of 569 patients who underwent implantable central venous access between January 2012 and December 2014 at our hospital.We classified our cohort according to access routes, as follows: 230 patients underwent subclavian vein access, 134 patients underwent internal jugular vein access, 25 patients underwent external jugular vein access, and 119 patients underwent cephalic vein access. The cephalic vein group had a significantly longer operation time than the subclavian group (P < .01); however, there was no difference in operation time between the internal jugular vein and cephalic vein groups (P = .59). The procedure-related complications and functional outcomes of the implanted venous port during chemotherapy were comparable between the cephalic group and other groups. Additionally, body mass index, operation time, and age did not correlate with catheter dysfunction in the multivariate logistic regression analysis (P = .53; P = .66; P = .19, respectively).We suggest that a cut-down central venous catheter insertion through the cephalic vein can be performed easily and safely with no differences in surgical and clinical outcomes compared to those of conventional percutaneous approaches. Moreover, the cephalic vein approach requires no specialized equipment, including percutaneous vascular kits, tunneling instruments, and intraoperative ultrasonography. Therefore, this technique might incur less medical expenses than conventional approaches and would be helpful for both patients and surgeons.


Assuntos
Veia Axilar/cirurgia , Cateterismo Venoso Central/métodos , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Análise Custo-Benefício , Feminino , Humanos , Veias Jugulares/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Veia Subclávia/cirurgia
3.
J Med Vasc ; 44(6): 426-431, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31761309

RESUMO

We report here the management of an acquired left carotid-jugular fistula in a 29-year-old man. This patient was referred to us for a ballistic wound of the left cheek evolving since one month with the diagnosis of a carotid pseudo-aneurysm discovered on Doppler ultrasound. The clinical presentation was marked by cervical thrill in favor of an arteriovenous fistula confirmed by computed tomography angiography. The surgical exploration by cervicotomy revealed a communication between common carotid artery and internal jugular vein that were repaired using a saphenous vein patch and a lateral suture respectively without complication. The control at five months found an asymptomatic patient with good patency of the repaired vessels.


Assuntos
Fístula Arteriovenosa/cirurgia , Artérias Carótidas/cirurgia , Lesões das Artérias Carótidas/cirurgia , Veias Jugulares/cirurgia , Veia Safena/transplante , Técnicas de Sutura , Ferimentos por Arma de Fogo/cirurgia , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/diagnóstico por imagem , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/lesões , Masculino , Resultado do Tratamento , Ferimentos por Arma de Fogo/diagnóstico por imagem
4.
Rev Port Cir Cardiotorac Vasc ; 26(2): 155-157, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476819

RESUMO

Ephitelioid Hemangioendothelioma (EHE) is a rare type of tumor with vascular and sarcomatous components. There's only another case published of an internal jugular vein (IJV) EHE. A case of a 50 years-old woman with a palpable and pulsatile mass on the left cervical area is reported. Doppler ultrasound and magnetic resonance imaging showed an IVJ' 4 cm mass. Cytology was inconclusive. Surgical treatment was therefore decided and during surgery a mass inside the left IJV, with local nonsuspicious lymph nodes, was confirmed. The mass was resected including a segmental resection of the IJV and one affected tributary vessel. Lymphadenectomy of the adjacent cervical levels was performed. Histologic examination depicted an EHE without metastatic lymph nodes. Tumor was staged as pT1bN0M0 and a multidisciplinary sarcoma group proposed surveillance. Patient remained well, without evidence of disease and without complications in a twenty-four months follow-up period.


Assuntos
Hemangioendotelioma Epitelioide/cirurgia , Veias Jugulares/cirurgia , Neoplasias Vasculares/cirurgia , Feminino , Hemangioendotelioma Epitelioide/diagnóstico , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/patologia , Excisão de Linfonodo , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Vasculares/diagnóstico
5.
Int J Infect Dis ; 88: 21-26, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31382048

RESUMO

BACKGROUND: Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. METHODS: We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. RESULTS: Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. CONCLUSION: This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. KEY POINTS: We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Cardiopatias/cirurgia , Febre Q/complicações , Adolescente , Adulto , Criança , Doxiciclina/uso terapêutico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/microbiologia , Feminino , Cardiopatias/congênito , Humanos , Hidroxicloroquina/uso terapêutico , Veias Jugulares/cirurgia , Masculino , Registros Médicos , Pessoa de Meia-Idade , Febre Q/diagnóstico , Febre Q/epidemiologia , Febre Q/microbiologia , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
7.
Zhonghua Gan Zang Bing Za Zhi ; 27(6): 440-444, 2019 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-31357760

RESUMO

Objective: To investigate the medium-term curative effect of transjugular intrahepatic portosystemic shunt (TIPS) through jugular vein with covered Viatorr stent. Methods: Data of 105 consecutive patients with covered Viatorr stent of our hospital was retrospectively analyzed. Follow-up was performed after surgery, and color Doppler was reviewed to evaluate the efficacy of TIPS. Results: Transjugular intrahepatic shunt was successfully established in all patients. The pressure gradients of portal vein before and after operation were 22.33 ± 6.4 mmHg and 9.78 ± 4.9 mmHg, respectively,P< 0.01, and the difference was statistically significant. The follow-up period ranged from 12.7 to 15.6 months, with an average of 13.09 ± 1.4 month. Total bilirubin and coagulation time increased after operation, but there was no significant difference in total bilirubin and coagulation time at 1, 3, 6 and 12 months after operation. The patency rate of shunt was 100%, 99.05%, 99.05% and 99.05% at 1, 3, 6 and 12 months after operation. The incidence of hepatic encephalopathy was 34.2%, 29.5%, 19.1% and 14.3% respectively. The recurrence rate of symptoms was 0%. Conclusion: Patients with cirrhotic portal hypertension who underwent TIPS with covered Viatorr stent had a lower rate of restenosis, improved liver function, and a lower incidence of severe hepatic encephalopathy. However, the long-term efficacy needs further observation.


Assuntos
Hipertensão Portal , Veias Jugulares , Cirrose Hepática , Derivação Portossistêmica Transjugular Intra-Hepática , Stents , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/cirurgia , Veias Jugulares/cirurgia , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
8.
World Neurosurg ; 130: 129-132, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31229748

RESUMO

BACKGROUND: Internal jugular vein stenosis (IJVS) results in poor venous outflow and can result in intracranial hypertension. Venous stenting has become a debated topic for correction of this pathology. CASE DESCRIPTION: A 49-year-old male merchant with bilateral IJVS presented with headache, dizziness, and pulsatile tinnitus. He was found to have intracranial hypertension and left IJVS caused by styloid process compression and right IJVS caused by damage of the venous intima. His symptoms improved after undergoing styloidectomy followed by left intra-internal jugular vein (IJV) balloon. However, 1 year later, the prior symptoms reoccurred. At this time, the patient underwent right intra-IJV stenting. After treatment of the contralateral side, the symptoms resolved during the following 3 months. CONCLUSIONS: The clinical practice in this case indicated that in patients with bilateral IJVS, a 2-side intervention may be necessary when unilateral correction fails. We advise a staged approach to correction of bilateral IJVS. Styloid compression-induced IJVS should be corrected by styloidectomy in combination with balloon and/or stenting, whereas IJVS induced by venous wall issues needs only stenting.


Assuntos
Constrição Patológica/cirurgia , Cefaleia/etiologia , Hipertensão Intracraniana/cirurgia , Veias Jugulares/cirurgia , Constrição Patológica/complicações , Constrição Patológica/diagnóstico , Cefaleia/diagnóstico , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Veias Jugulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Stents/efeitos adversos
9.
BMC Anesthesiol ; 19(1): 78, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101080

RESUMO

BACKGROUND: This study investigated the effect of different degrees of passive leg raising (PLR) on the internal jugular vein (IJV) cross-sectional area (CSA) and on the success rate of IJV cannulation in patients waiting for thoracic surgery, to analyze whether body mass index (BMI), gender, age, fasting time and preoperative rehydration have any impact on changes in the IJV CSA. METHODS: Eighty-two patients scheduled for selective thoracic surgery were enrolled in this study. Patients were randomly assigned based on a computer-generated randomization sequence into 3 groups: 0, 30, and 50 degrees (n = 32, 25, and 25 patients, respectively). The right IJV CSA in the sequence of 0-degree (supine position), 30-degree and 50-degree PLR positions was recorded in all patients using an ultrasound probe. The relationship of BMI, gender, age, fasting time and preoperative rehydration to the IJV CSA was analyzed. Then, each patient was returned to a supine position. After waiting for at least 5 min, patients were placed in a PLR position at 0, 30, or 50 degrees, and then IJV cannulation was performed without ultrasound guidance. The success rate of IJV catheterization at different PLR angles was compared. RESULTS: The average CSA of the right IJV in the supine position, 30-degree PLR position and 50-degree PLR position was 1.39 ± 0.63 cm2, 1.65 ± 0.73 cm2, and 1.68 ± 0.71 cm2, respectively. These results showed gradual increases in the IJV CSA of 18.5% (30-degree PLR) and 20.2% (50-degree PLR) when compared to that in the supine position (P = 0.045 and 0.025, respectively). However, only fasting time had a significant impact on the increase in the right IJV CSA at different PLR angles (P = 0.026). Other factors, such as BMI, gender, age and preoperative rehydration, had no significant effects. The success rates of IJV catheterization at angles of 0, 30 and 50 degrees were 84.3, 88 and 92%, respectively; however, there were no significant differences among the three groups (P = 0.674). CONCLUSIONS: PLR increases the CSA of the right IJV, especially for patients with long fasting times before thoracic surgery. The effect of the 30-degree PLR position is similar to that of the 50-degree PLR position. However, the success rate of right IJV catheterization was not enhanced in this study using landmark-guided puncture, even though the CSA of the right IJV was increased. TRIAL REGISTRATION: Clinical trial registration number: ChiCTR1800015051 . Date of registration: March 2018.


Assuntos
Cateterismo Venoso Central/métodos , Veias Jugulares/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Terapia Passiva Contínua de Movimento/métodos , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Veias Jugulares/fisiologia , Veias Jugulares/cirurgia , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
10.
J Pharmacol Toxicol Methods ; 98: 106584, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31100450

RESUMO

INTRODUCTION: The pig is one of the most valuable in vivo models in biomedical research, however with only a few well-accessible veins suitable for venipuncture. Moreover, most of the known methods of blood collection are suitable only for a limited time period. The aim of the study was to verify an improved method of long-term catheterization of the jugular vein in pigs. METHODS: A 420 mm polyurethane catheter 16G tube was surgically inserted using the Seldinger technique. The part of the tube that was not inserted into the vein was threaded through a subcutaneously introduced trocar into the occipital area, where it was well accessible and well protected from damage. The catheters were flushed with sterile 0.9% saline solution and locked with 4% citrate between frequent blood samplings, or with 30% citrate at intervals of 1-2-days. Once a week, the catheters were locked with 4% citrate containing taurolidine for 24 h in order to prevent infection. The method was verified in 14 pigs. RESULTS: The catheters were fully functional for up to 11 weeks and no infection or thrombus was observed. DISCUSSION: This method of catheterization and catheter care allows the realization of long-term experiments with comfortable and stress-free blood sampling.


Assuntos
Cateterismo/métodos , Veias Jugulares/cirurgia , Animais , Coleta de Amostras Sanguíneas/métodos , Feminino , Masculino , Suínos , Taurina/administração & dosagem , Taurina/análogos & derivados , Tiadiazinas/administração & dosagem
11.
World Neurosurg ; 127: e809-e817, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30954756

RESUMO

OBJECTIVE: This 3-dimensional histologic study aimed to provide a precise description of the meningeal structures in the jugular foramen. METHODS: 22 posterior skull base tissue blocks containing the jugular foramen region were obtained from 11 human cadaveric heads. These blocks were plastinated and cut into serial sections. After staining, these sections were examined under an optical microscope and used to reconstruct a 3-dimensional visualization model. RESULTS: At the intracranial orifice of the jugular foramen, the meningeal dura formed 2 separate dural perforations: the glossopharyngeal meatus and the vagal meatus. The arachnoid extended into 2 dural meatuses and terminated at the inferior ganglion of the glossopharyngeal nerve in the glossopharyngeal meatus and the superior ganglion of the vagus nerve in the vagal meatus. At the intraforaminal part of the jugular foramen, the meningeal dura encased the glossopharyngeal nerve to form a dural sheath while encasing the vagus and accessory nerves to form a dural network. At the extracranial orifice of the jugular foramen, the dural wall of the jugular bulb extended downward to form a dense connective tissue sheath. The initial end of the internal jugular vein invaginated into this sheath and fused with the jugular bulb. CONCLUSIONS: Knowledge of the anatomy of the meningeal architecture of the jugular foramen can be helpful in avoiding surgical complications of the lower cranial nerves when this complex area is approached.


Assuntos
Nervo Glossofaríngeo/patologia , Meninges/patologia , Nervo Vago/patologia , Nervo Acessório/cirurgia , Idoso , Idoso de 80 Anos ou mais , Nervos Cranianos/patologia , Nervos Cranianos/cirurgia , Feminino , Nervo Glossofaríngeo/cirurgia , Humanos , Veias Jugulares/patologia , Veias Jugulares/cirurgia , Masculino , Bulbo/cirurgia , Meninges/cirurgia , Pessoa de Meia-Idade , Base do Crânio/patologia , Base do Crânio/cirurgia , Nervo Vago/cirurgia
12.
J Craniofac Surg ; 30(6): e487-e489, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30865123

RESUMO

Internal jugular vein thrombosis (IJVT) is a rare complication of cervical necrotizing fasciitis (CNF) which may lead to life threat. This article reports a patient with severe CNF complicated with IJVT, and combined with the literature to analyze the diagnosis and treatment of CNF and IJVT.


Assuntos
Fasciite Necrosante/diagnóstico por imagem , Veias Jugulares/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Fasciite Necrosante/etiologia , Feminino , Humanos , Veias Jugulares/cirurgia , Pessoa de Meia-Idade , Pescoço , Trombose Venosa/complicações , Trombose Venosa/cirurgia
13.
J Craniofac Surg ; 30(4): e352-e353, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30817514

RESUMO

OBJECTIVES: Congenital jugular vein aneurysm in an adult patient is a rare condition. CLINICAL REPORT: A 17-year-old patient presented to the authors' clinic with left neck swelling. The clinical and radiological findings were appropriate with the internal jugular vein aneurysm. The authors detailed their experience in the surgical treatment of this true saccular aneurysm. CONCLUSION: Jugular venous aneurysm is a rare benign venous pathology and it can be easily confused with other neck pathologies. Its surgical excision can be sometimes difficult and troublesome than expected.


Assuntos
Aneurisma , Veias Jugulares , Adolescente , Adulto , Aneurisma/diagnóstico , Aneurisma/patologia , Aneurisma/cirurgia , Humanos , Veias Jugulares/patologia , Veias Jugulares/cirurgia
14.
Pak J Pharm Sci ; 32(1(Special)): 453-457, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30852484

RESUMO

The paper discuss the surgical techniques and clinical curative effects of CEA (Carotid Endarterectomy, CEA) under a microscope via anterior cervical triangle posterior vena jugularisinterna approach combining with suspended carotid artery on the treatment of high level and complex carotid artery stenosis. Retrospective analysis was conducted on the clinical data of 21 cases of patients. The far end of carotid artery stenosis section is located above the lower edge of the second cervical vertebra centrum. The carotid artery stenosis section of three cases is located at the middle lower edge of the first cervical vertebrae. Clinical evaluation was performed from surgical process, time of postoperative drainage tube removal, perioperative complications and follow-up survey on the serious numbness at the surgical site one month, three months and six months after the surgery. There are 0 cases of postoperative death, 0 cases of cerebral hemorrhage cerebral infarction, 1 case of myocardial infarction, 2 cases of Hypoglossal nerve temporary injury, 0 case of infection of incisional wound and incidence rates of serious numbness in postoperative follow-up surgical area one month, 3 months and 6 months are 23.81%, 19.05% and 9.52% respectively. The cranial nerves and surrounding muscle groups at the far end of carotid artery stenosis and carotid artery can be fully disposed via anterior cervical triangle posterior vena jugularisinterna by utilizing microsurgery-technique and suspended carotid artery technology conveniently and completely to avoid cutting the corresponding branches of vena jugularisinterna and too much anatomy of anterior triangle lymph fatty tissue to properly avoid postoperative edema at the surgical area, cranial nerve injuries and other complications. It is a convenient, efficient, safe and effective CEA approach. .


Assuntos
Artérias Carótidas/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Veias Jugulares/cirurgia , Idoso , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Blood Purif ; 48(1): 1-9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30763936

RESUMO

BACKGROUND: Central venous catheter (CVC) is commonly used to provide access for hemodialysis (HD) when arteriovenous access is not available. The misplacement of CVC into azygos vein (AV) is a rare but a potential serious complication. Previous reports communicated the opinion that left-sided catheterization predisposed to AV misplacement, but these reports concentrated on peripherally inserted CVCs, placed for indications rather than HD. Unintended AV misplacement of HD catheters (HDCs) has not been well studied. We seek to investigate factors associated with inadvertent AV miscannulation during HDC placement. METHODS: We are to present a case of unintentional misplacement of a tunneled HD catheter (tHDC) into the azygos arch from right internal jugular vein (RIJV) despite real-time fluoroscopy guidance. Additionally, we have undertaken a systematic literature search in Pubmed to study the anatomical and other factors related to unintended AV misposition in HD setting. RESULTS: From 2005 to August 31, 2018, a total of 11 articles containing 16 cases of misplacement of HDCs into AV were identified. Of the 17 cases of unintentional AV misposition including ours, the majority of the misguided HDCs (94.1%, 16/17) were tHDCs and only 1 case was related to a temporary (non-tunneled) catheter. Most catheter misplacements (88.2%, 15/17) were performed without real-time radiological guidance. The reported incidence of inadvertent AV cannulation from different institutions varied between 0.6% and 3.8%. Among the 16 misplaced tHDCs, the rates of AV misposition that arose from RIJV and left internal jugular vein (LIJV) insertion are even at 50%. CONCLUSIONS: Based upon anatomical and case studies, we have found that AV may join posterior aspect of superior vena cava at different directions and levels. Hence, this might explain why AV misplacement might occur whether an HDC is inserted from the LIJV or RIJV approach. By raising the awareness of this potential complication and how we may minimize it, we hope to reduce the future complication of AV misposition.


Assuntos
Veia Ázigos , Cateterismo Venoso Central , Cateteres Venosos Centrais , Erros Médicos , Diálise Renal , Idoso , Veia Ázigos/cirurgia , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/normas , Cateteres Venosos Centrais/normas , Humanos , Veias Jugulares/cirurgia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Radiografia Torácica , Diálise Renal/normas
16.
Radiology ; 291(2): 513-518, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30747596

RESUMO

Background Patients who require long-term central venous access can present for port placement with depressed immune function as a result of their treatment or disease process. At present, there is no consensus regarding whether neutropenia at the time of port placement confers a higher risk for early infection-related port removal. Purpose To compare the incidence of early infection-related chest port removal in adults when placed in neutropenic versus nonneutropenic patient groups. Materials and Methods This retrospective cohort study examined 2580 port placements in 1081 men (41.9%) and 1499 women (58.1%) at a single tertiary medical center between June 2007 and July 2017. Mean patient age ± standard deviation was 56 years ± 14 (range, 18-91 years). The electronic medical record was used to identify neutropenia (absolute neutrophil count <1500 cells/mm3) at the time of port placement and incidence of infection-related port removal. Electronic medical record follow-up was conducted for 30 days following port placement. End points were infection-related port removal or death related to port infection within 30 days. Statistical analysis compared the neutropenic (n = 159) and nonneutropenic (n = 2421) patient groups by using a χ2 test for categorical data and a Student t test for continuous variables, with a Fisher exact test to compare incidence of port removal and death related to port infection. Results Ports placed in patients with neutropenia had an infection-related removal rate of 3.8% (six of 159) versus 0.91% (22 of 2421) in patients without neutropenia (P = .003). Patients with neutropenia had a port infection-related death rate of 0.63% (one of 159) versus 0.12% (three of 2421) for patients without neutropenia (P = .22). Conclusion Neutropenia in adults at the time of implantable subcutaneous chest port placement was associated with a higher risk for early infection-related port removal. There was no difference in the incidence of death related to port infection in neutropenic or nonneutropenic populations. © RSNA, 2019 See also the editorial by Johnson in this issue.


Assuntos
Infecções Relacionadas a Cateter , Cateteres Venosos Centrais/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Neutropenia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/complicações , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/mortalidade , Cateterismo Venoso Central/efeitos adversos , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/cirurgia , Masculino , Pessoa de Meia-Idade , Neutropenia/complicações , Neutropenia/epidemiologia , Neutropenia/mortalidade , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Tórax/diagnóstico por imagem , Adulto Jovem
17.
Otol Neurotol ; 40(2): 192-199, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30624401

RESUMO

OBJECTIVE: To discuss the possible pathophysiologic mechanism of pulsatile tinnitus (PT) perception due to high jugular bulb with bony dehiscence (HJBD) and its improvement after the dehiscent jugular bulb (JB) resurfacing using bone cement, and to describe the efficacy of an objective measure of PT using transcanal sound recording and spectro-temporal analysis (TSR/STA). STUDY DESIGN: Retrospective case series study. SETTING: A university-based, tertiary care cancer center. PATIENTS: Three PT patients with HJBD. MAIN OUTCOME MEASURE(S): All patients underwent transtympanic resurfacing after the source of PT was confirmed by temporal bone imaging and TSR/STA. Improvement of symptom and the changes in the TSR/STA were analyzed. RESULTS: In the first case, a revision operation was performed due to slightly improved but persistent PT after initial resurfacing with bone pate and a piece of conchal cartilage. Revision transtympanic JB resurfacing was performed in this case using bone cement, and PT resolved immediately after the surgery. In the second and third cases, PT resolved completely, or was much abated, immediately after transtympanic resurfacing with bone cement. The TSR/STA also revealed improvement of PT. The median follow-up duration was 28 months, and all three patients remained asymptomatic or much improved compared with their preoperative status. CONCLUSIONS: Transtympanic resurfacing with bone cement, reinforcing the dehiscent JB to reduce focal turbulent flow, is a simple and effective surgical treatment option in patients with PT due to HJBD. In patients with HJBD, the objective measurement of PT by TSR/STA may be of help in selecting appropriate surgical candidates and objective evaluation of the treatment outcome.


Assuntos
Cimentos para Ossos , Veias Jugulares/patologia , Veias Jugulares/cirurgia , Zumbido/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Zumbido/etiologia , Zumbido/patologia , Resultado do Tratamento
18.
J Neurointerv Surg ; 11(6): 598-602, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30626626

RESUMO

BACKGROUND AND PURPOSE: We evaluated the inferior petrosal sinus (IPS) and adjacent cerebellopontine angle (CPA) cistern as a potential implantation site for a novel venous endovascular transdural CSF shunt concept to treat communicating hydrocephalus. We analyzed the dimensions of the IPS, CPA cistern, and distances to adjacent neurovascular structures. MATERIALS AND METHODS: Gadolinium enhanced T1 weighted brain MRI datasets of 36 randomly selected patients, aged 20-80 years, were analyzed with three-dimensional multiplanar reconstruction to measure IPS diameter and length, CPA cistern depth, and IPS proximity to the vertebrobasilar arteries and brainstem. Statistical analysis was used to assess gender, sidedness, and age dependence. RESULTS: Mean IPS diameter ranged from 2.27 mm to 3.31 mm at three axial levels, with >90% larger than 1.46 mm. CPA cistern adjacent to the IPS exhibited a mean depth of 3.86 mm to 7.39 mm between the dura and brainstem at corresponding axial levels. There was no side dependence except for a longer distance from the IPS to the basilar artery on the left compared with the right (9.72 vs 7.28, P<0.019). Linear regression analysis showed that the distance from the IPS to the brainstem was statistically significantly increased with age (P<0.0002) and was greater in men, with little side variation (P=0.524). CONCLUSION: Our results demonstrate sufficient CSF CPA cisternal space adjacent to the IPS and support the feasibility of an endovascular catheter delivered transdural implantable shunt. Such a device could serve to mimic the function of the arachnoid granulation by establishing a regulated path for CSF flow from the intracranial subarachnoid space to the venous system and provide a treatment for communicating hydrocephalus.


Assuntos
Seio Cavernoso/anatomia & histologia , Seio Cavernoso/diagnóstico por imagem , Ângulo Cerebelopontino/anatomia & histologia , Ângulo Cerebelopontino/diagnóstico por imagem , Derivações do Líquido Cefalorraquidiano/métodos , Procedimentos Endovasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Seio Cavernoso/cirurgia , Ângulo Cerebelopontino/cirurgia , Derivações do Líquido Cefalorraquidiano/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Veias Jugulares/anatomia & histologia , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Adulto Jovem
20.
Acta Neurochir Suppl ; 125: 175-178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610320

RESUMO

BACKGROUND: The extreme lateral approach is a direct lateral approach which allows a good control of the entire length of the vertebral artery (VA), the jugular foramen, the lowest cranial nerves, and the jugular-sigmoid complex. Herein we try to exploit the variants of the approach and we identify indications, advantages, and disadvantages. METHODS: All phases of the study were conducted at the Institute of Public Health Section of Legal Medicine and Insurance of the University. We performed the extreme lateral approach in four subjects, who died between 24 and 48 h before in non-traumatic circumstances (three men and one woman). RESULTS: The great auricular nerve, the spinal accessory, the branches of the first ventral spinal nerves, the jugular vein, and the vertebral artery were identified in all the cadavers. In all cases the right VA exited from the transverse foramen of C1. The site of SCM piercing the accessory nerve was at a distance from the tip of the mastoid between 3 and 4 cm (3.3 in one case, 3.4 in 2 cases, and 3.7 in one case). No vessels and nerves have been damaged after being identified and isolated. CONCLUSIONS: Extradural lesions at the ventro-lateral aspect of the CVJ may require an extreme lateral approach, a procedure more aggressive comparing with far lateral approach, which represents a reasonable option for large anterior and anterolateral lesions when greater exposure is required.


Assuntos
Vértebras Cervicais/anatomia & histologia , Veias Jugulares/anatomia & histologia , Procedimentos Neurocirúrgicos/métodos , Nervos Periféricos/anatomia & histologia , Artéria Vertebral/anatomia & histologia , Cadáver , Vértebras Cervicais/cirurgia , Feminino , Humanos , Veias Jugulares/cirurgia , Masculino , Nervos Periféricos/cirurgia , Crânio/cirurgia , Artéria Vertebral/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA