Aneurysma verum der Arteria carotis im Kindesalter

[Thrombosed aneurysm of the subclavian vein]

Progressive growth of a thrombosed aneurysm in the venous neck vessels represents an important differential diagnosis in solitary cervical swelling. We report the case of a 72-year-old woman with a 4-month history of left cervical, supraclavicular swelling. CT showed a cystic tumour with a maximum diameter of 4.8 cm at the left jugulobrachial venous arch. Surgical removal revealed a firm elastic tumour, which arose from the subclavian vein. Histological analysis showed a thrombosed venous vessel.

[Postoperative delirium in the critically ill]

Acute confusional states (delirium) occur in up to 80% of patients in the intensive care unit. Delirium is an important independent prognostic determinant of hospital outcome, including duration of mechanical ventilation, nursing home placement, functional decline and death. Additionally, it may herald systemic diseases such as sepsis and multi-organ failure. Recently, a number of new screening instruments have been validated for the monitoring of delirium in non-communicative patients receiving mechanical ventilation. Critical care patients should be routinely assessed for delirium and treated immediately using available preventive and therapeutic measures, both pharmacological and non-pharmacological, to improve the clinical course.

Autologous repair of an internal carotid artery aneurysm by resection, caliber reduction, and external mesh tube reinforcement in a 9-year-old boy

Extracranial internal carotid artery aneurysms in children are rare, with a reported incidence of 0.5% to 1.9% in internal carotid artery aneurysm operations compared with all carotid operations in adult patients. We report a case of surgical reconstruction of an extracranial internal carotid artery aneurysm in a 9-year-old boy. Our patient complained of episodic neck pain on the left site under the mastoid process for the last year. The child was otherwise healthy. Autologous reconstruction without graft interposition was planned. Surgical repair was performed by resection of the main body of the aneurysm and restoration of the arterial continuity with end-to-end anastomosis. Because nondilated proximal and distal vessels could not be approximated, the most distal end of the aneurysm was tapered over a mandril. To prevent redilation, a tubular polyester external stent was fitted around the diseased segment.

Extracranial carotid arteries aneurysms in children: single-center experiences in 4 patients and review of the literature

BACKGROUND

Extracranial carotid artery aneurysms (ECAAs) are very rare conditions in children but carry a great potential of thromboembolic episodes and ruptures.

METHODS

To determine the clinical and therapeutic characteristics of ECAA in children in our department, we reviewed the patients' records and completed the data from phone correspondence, written survey, and clinical examination.

RESULTS

From January 1981 to June 2006, 4 patients younger than 18 years were surgically treated for ECAA in our department. They were 3 boys and 1 girl. A medical history of tonsillectomy was reported in 3 patients. The aneurysm was symptomatic in all of the patients, local signs being present in every patient. The aneurysm caused hemispheric symptoms in 1 patient and finally stroke. The aneurysms were located in the common carotid artery, in the external carotid artery, and 2 in the internal carotid artery. The cause was congenital, mycotic, and traumatic (post tonsillectomy); for 1 patient, the etiology remained unknown. Aneurysm resection and interposition with vein graft were performed in 3 patients. The external carotid artery aneurysm was resected without reconstruction. There was no perioperative death or stroke. During the early follow-up period, 1 patient had a transient dysphagia and another a transient facial palsy. The patient with preoperative stroke remained with a neurologic deficit. All these patients were followed since the operation. The patient operated on in 1981 is asymptomatic after 25 years, but the graft became occluded 3 years after the operation. The patient who had recurrent attacks is still with residual neurologic deficit. The 2 other patients are without complains; the reconstructions remain patent.

CONCLUSION

Although very rare, ECAA can be encountered even in the pediatric population. The past medical history may reveal a tonsillectomy, although the relation may not be easy to establish. Local signs may be accompanied by hemispheric thromboembolic complications, rupture, and bleeding. Therefore, surgical treatment is indicated, but can be challenging according to the anatomical location of the aneurysm.