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Abstract
ABSTRACT This is a literature review on the history of venous trauma since the 1800s, especially that to the common femoral, femoral and popliteal veins, with focus on the early 1900s, World War I, World War II, Korean War, Vietnam War, and then civilian and military reviews (1960-2020). In the latter two groups, tables were used to summarize the following: incidence of venous repair versus ligation, management of popliteal venous injuries, patency of venous repairs when assessed <30 days from operation, patency of venous repairs when assessed >30 days from operation, clinical assessment (edema or not) after ligation versus repair, incidence of deep venous thrombosis after ligation versus repair, and incidence of pulmonary embolism after ligation versus repair.There is a lack of the following in the literature on the management of venous injuries over the past 80 years: standard definition of magnitude of venous injury in operative reports, accepted indications for venous repair, standard postoperative management, and timing and mode of early and later postoperative assessment.Multiple factors have entered into the decision on venous ligation versus repair after trauma for the past 60 years, but a surgeon's training and local management protocols have the most influence in both civilian and military centers. Ligation of venous injuries, particularly those in the lower extremities, is well tolerated in civilian trauma, although there is the usual lack of short- and long-term follow-up as noted in many of the articles reviewed. LEVEL OF EVIDENCE Review article, levels IV and V.
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Affiliation(s)
- David V Feliciano
- From the Department of Surgery (D.V.F.), Shock Trauma Center, University of Maryland Medical Center, University of Maryland, Baltimore, Maryland; Division of Acute Care Surgery, Department of Surgery (M.P.K.), University of Florida Health Jacksonville Medical Center, Jacksonville, Florida; and Division of Acute Care Surgery, Department of Surgery (G.F.R.), John Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Affiliation(s)
- Matthew Kochuba
- From the Division of Acute Care Surgery, Department of Surgery, UF Health Jacksonville Medical Center (M.K.), University of Florida-Jacksonville, Jacksonville, Florida; Division of Acute Care and Adult Trauma Surgery, Department of Surgery, Johns Hopkins University School of Medicine (G.F.R.), Johns Hopkins University; and Division of Surgical Critical Care, Department of Shock Trauma Center, Shock Trauma Center (D.F.), University of Maryland Medical Center, University of Maryland, Baltimore, Maryland
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Dauer E, Yamaguchi S, Yu D, Lu X, Kelley K, Sharpe J, Manley N, Harvin JA, Taub EA, Goldenberg-Sandau A, Patel K, Omi E, Mashbari H, Hartwell J, Brocker J. Major venous injury and large volume crystalloid resuscitation: A limb threatening combination. Am J Surg 2019; 219:38-42. [PMID: 31604488 DOI: 10.1016/j.amjsurg.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Major venous injury (MVI) affecting the lower extremity can result in subsequent amputation. The contribution of intraoperative resuscitation efforts on the need for amputation is not well defined. We hypothesized that intraoperative large volume crystalloid resuscitation (LVCR) increases the risk of amputation after MVI, while massive transfusion (MT) does not. METHODS We performed a retrospective review of patients with infrarenal MVI from 2005 to 2015 at seven urban level I trauma centers. The outcome of interest was the need for secondary amputation. RESULTS 478 patients were included. 31 (6.5%) patients with MVI required amputation. LVCR(p < 0.001), combined arterial/venous injury (p = 0.001), and associated fracture (p = 0.001) were significant risk factors for amputation. MT did not significantly increase amputation risk (p = 0.44). Multivariable logistic regression model demonstrated that patients receiving ≥5L LVCR(aOR (95% CI): 9.7 (2.9, 33.0); p < 0.001), with combined arterial/venous injury (aOR (95% CI):3.6 (1.5, 8.5); p = 0.004), and with an associated fracture (aOR (95% CI):3.2 (1.5, 7.1); p = 0.004) were more likely to require amputation. CONCLUSION Patients with MVI who receive LVCR, have combined arterial/venous injuries and have associated fractures are more likely to require amputation. MT was not associated with delayed amputation.
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Affiliation(s)
- Elizabeth Dauer
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad Street, Philadelphia, PA, 19140, USA.
| | - Seiji Yamaguchi
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad Street, Philadelphia, PA, 19140, USA.
| | - Daohai Yu
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad Street, Philadelphia, PA, 19140, USA.
| | - Xiaoning Lu
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad Street, Philadelphia, PA, 19140, USA.
| | - Kathyrn Kelley
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad Street, Philadelphia, PA, 19140, USA.
| | - John Sharpe
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38163, USA.
| | - Nathan Manley
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38163, USA.
| | - John A Harvin
- Department of Surgery, University of Texas at Houston Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX, 77030, USA.
| | - Ethan A Taub
- Department of Surgery, University of Texas at Houston Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX, 77030, USA.
| | - Anna Goldenberg-Sandau
- Department of Surgery, Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ, 08103, USA.
| | - Krishan Patel
- Department of Surgery, Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ, 08103, USA.
| | - Ellen Omi
- Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL, 60453, USA.
| | - Hassan Mashbari
- Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL, 60453, USA.
| | - Jennifer Hartwell
- Department of Surgery, Indiana University School of Medicine, 1604 N. Capitol Ave, B232, Indianapolis, IN, 46202, USA.
| | - Jason Brocker
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD, 21201, USA.
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Madden A, Hopwood M, Neale J, Treloar C. Beyond interferon side effects: What residual barriers exist to DAA hepatitis C treatment for people who inject drugs? PLoS One 2018; 13:e0207226. [PMID: 30500863 PMCID: PMC6267952 DOI: 10.1371/journal.pone.0207226] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/26/2018] [Indexed: 01/14/2023] Open
Abstract
Recent advances in the efficacy and tolerability of hepatitis C treatments and the introduction of a universal access scheme for the new Direct Acting Antiviral (DAA) therapies in March 2016, has resulted in a rapid increase in the uptake of hepatitis C treatment in Australia. Despite these positive developments, recent data suggest a plateauing of treatment numbers, indicating that more work may need to be done to identify and address ongoing barriers to hepatitis C treatment access and uptake. This paper aims to contribute to our understanding of the ongoing barriers to DAA therapies, with a focus on people who inject drugs. The paper draws on participant interview data from a qualitative research study based on a participatory research design that included a peer researcher with direct experience of both hepatitis C DAA treatment and injecting drug use at all stages of the research process. The study’s findings show that residual barriers to DAA treatment exist at personal, provider and system levels and include poor venous access, DAA treatments not considered ‘core-business’ by opioid substitution treatment (OST) providers, and patients having to manage multiple health and social priorities that interfere with keeping medical appointments such as childcare and poor access to transport services. Further, efforts to increase access to and uptake of DAA hepatitis C treatment over time will require a focus on reducing stigma and discrimination towards people who inject drugs as this remains as a major barrier to care for many people.
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Affiliation(s)
- Annie Madden
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Joanne Neale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- National Addiction Centre, Kings College London, London, United Kingdom
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- * E-mail:
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Manley NR, Magnotti LJ, Fabian TC, Cutshall MB, Croce MA, Sharpe JP. Factors Contributing to Morbidity after Combined Arterial and Venous Lower Extremity Trauma. Am Surg 2018; 84:1217-1222. [PMID: 30064592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to evaluate the impact of management of venous injury on clinical outcomes in patients with combined lower extremity arterial and venous trauma. Patients with common and external iliac, common and superficial femoral, and popliteal artery injuries were identified. Patients who underwent vein repair and those who received vein ligation were compared. The analysis was repeated for those patients who required secondary intervention for their arterial injury and those who did not require secondary intervention. Seventy patients were identified with both arterial and venous injuries: 40 underwent vein ligation and 30 received vein repair. There was no difference in ischemic time between patients undergoing vein repair compared with ligation. Vein ligation did not produce a higher incidence of muscle debridement (10% vs 15%, P = 0.72), necessity for secondary intervention (10% vs 7.5%, P = 0.99), or amputation (3.3% vs 7.5%, P = 0.63). Patients who required secondary intervention had a greater degree of shock on presentation (packed red blood cells (PRBC), 13 units vs 6 units, P = 0.02) and were more likely to require muscle debridement (50% vs 9%, P = 0.02) and amputation (33% vs 3%, P = 0.03). Vein ligation did not impact muscle ischemia or success of arterial repair in patients with combined venous and arterial trauma in the lower extremities. Patient morbidity after extremity vascular trauma is most related to degree of shock.
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Abstract
PURPOSE OF REVIEW Current guidelines recommend adrenal venous sampling (AVS) to identify the surgically curable causes of hyperaldosteronism. In contrast with this recommendation, AVS remains markedly underutilized in clinical practice, which leads to deny curative adrenalectomy, to many patients with primary aldosteronism. The purpose of this review is to challenge the views that AVS is a technically challenging, invasive and risky procedure, which moreover, is difficult to interpret. RECENT FINDINGS Several studies, including a large international survey on how AVS is being performed and used at major referral centres worldwide the AVIS-1 Study - and a randomized clinical trial comparing and AVS and a computed tomography based strategy, will be examined. SUMMARY The results of these studies have sound implications for clinical practice in that they allow to define what to do and what not to do for proper performance and interpretation of AVS and avoidance of the main concern, for example the risk of adrenal vein rupture.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED - University of Padova, Padova, Italy
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Hussami M, Grabherr S, Meuli RA, Schmidt S. Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures. Int J Legal Med 2016; 131:731-738. [PMID: 27891547 PMCID: PMC5388710 DOI: 10.1007/s00414-016-1503-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/21/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this study were to compare arterial and venous contrast medium extravasation in severe pelvic injury detected by ante- and post-mortem multi-detector CT (MDCT) and determine whether vascular injury is associated with certain types of pelvic fracture. METHODS We retrospectively included two different cohorts of blunt pelvic trauma with contrast medium extravasation shown by MDCT. The first group comprised 49 polytrauma patients; the second included 45 dead bodies undergoing multi-phase post-mortem CT-angiography (MPMCTA). Two radiologists jointly reviewed each examination concerning type, site of bleeding and pattern of underlying pelvic ring fracture. RESULTS All 49 polytrauma patients demonstrated arterial bleeding, immediately undergoing subsequent angiography; 42 (85%) had pelvic fractures, but no venous bleeding was disclosed. MPMCTA of 45 bodies revealed arterial (n = 33, 73%) and venous (n = 35, 78%) bleeding and pelvic fractures (n = 41, 91%). Pelvic fracture locations were significantly correlated with ten arterial and six venous bleeding sites in dead bodies, with five arterial bleeding sites in polytrauma patients. In dead bodies, arterial haemorrhage was significantly correlated with the severity of pelvic fracture according to Tile classification (p = 0.01), unlike venous bleeding (p = 0.34). CONCLUSIONS In severe pelvic injury, certain acute bleeding sites were significantly correlated with underlying pelvic fracture locations. MPMCTA revealed more venous lesions than MDCT in polytrauma patients. Future investigations should evaluate the proportional contribution of venous bleeding to overall pelvic haemorrhage as well as its clinical significance.
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Affiliation(s)
- Mahmoud Hussami
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne-Geneva, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Reto A Meuli
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Malaj A, Martinelli O. Surgical Management of a Ruptured Basilic Vein Aneurysm. Eur J Vasc Endovasc Surg 2016; 52:465. [PMID: 27519470 DOI: 10.1016/j.ejvs.2016.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/06/2016] [Indexed: 11/18/2022]
Affiliation(s)
- A Malaj
- Department of Vascular Surgery, Policlinico Umberto I, Rome, Italy.
| | - O Martinelli
- Department of Vascular Surgery, Policlinico Umberto I, Rome, Italy
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Jiménez Rodríguez I, Jiménez Rodríguez B, Sánchez García M. [Foreskin hematoma: rupture of a superficial vein in the penis]. Emergencias 2016; 28:205. [PMID: 29105455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | - Beatriz Jiménez Rodríguez
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, España. Servicio de Anestesiología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Manuel Sánchez García
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, España. 3Servicio de Anestesiología, Hospital Universitario Virgen de las Nieves, Granada, España
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Matsumoto N, Sogabe O, Yoshida O, Endo I, Yamamoto S, Inokawa H, Kubo M, Udaka T, Maeda H, Mizuta M. The usefulness of resuscitative endovascular balloon occlusion of the aorta in detecting the source of a hemorrhage due to abdominal blunt trauma. Am J Emerg Med 2016; 34:2057.e1-2057.e3. [PMID: 27103083 DOI: 10.1016/j.ajem.2016.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Naoya Matsumoto
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
| | - Osanori Sogabe
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
| | - Osamu Yoshida
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
| | - Izuru Endo
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
| | - Sumiharu Yamamoto
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
| | - Hidetoshi Inokawa
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
| | - Masatoshi Kubo
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
| | - Tetsunobu Udaka
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
| | - Hiroya Maeda
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
| | - Minoru Mizuta
- Department of Surgery, Mitoyo General Hospital, 708 Toyohamacho Himehama, Kanonji-shi, Kagawa, 769-1601, Japan.
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Haq AA, Restrepo CS, Lamus D, Ocazionez-Trujillo D, Vargas D. Thoracic venous injuries: an imaging and management overview. Emerg Radiol 2016; 23:291-301. [PMID: 26965007 DOI: 10.1007/s10140-016-1386-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
Abstract
Thoracic venous injuries are predominantly attributed to traumatic and iatrogenic causes. Gunshot wounds and knife stabbings make up the vast majority of penetrating trauma whereas motor vehicle collisions are the leading cause of blunt trauma to the chest. Iatrogenic injuries, mostly from central venous catheter complications are being described in growing detail. Although these injuries are rare, they pose a diagnostic challenge as their clinical presentation does not substantially differ from that of arterial injury. Furthermore, the highly lethal nature of some of these injuries provides limited literature for review and probably underestimates their true incidence. The widespread use of multi-detector computed tomography (MDCT) has increased the detection rate of these lesions in hemodynamically stable patients that survive the initial traumatic event. In this article, we will discuss and illustrate various causes of injury to each vein and their supporting CT findings while briefly discussing management. The available literature will be reviewed for penetrating, blunt, and iatrogenic injuries to the vena cava, innominate, subclavian, axillary, azygos, and pulmonary veins.
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Affiliation(s)
- Aftab A Haq
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Daniel Lamus
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | | | - Daniel Vargas
- Department of Radiology, University of Colorado, Denver, CO, USA
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Collinge CA, Ziran NM, Coons DA. Relationship Between the Superior Gluteal Vessels and Nerve at the Greater Sciatic Notch. Orthopedics 2015; 38:e929-33. [PMID: 26488790 DOI: 10.3928/01477447-20151002-62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/06/2015] [Indexed: 02/03/2023]
Abstract
Bleeding from the superior gluteal (SG) blood vessels at the greater sciatic notch is frequently encountered during acetabular fracture surgery. The purpose of this study is to define the positional anatomy of the superior gluteal vessels and nerve (SGVAN) at the greater sciatic notch. Twenty-three hemipelvi were dissected in whole human cadavers. The greater sciatic notch and SGVAN were visualized via a posterior surgical approach, identified deep in the greater sciatic notch, and traced superficially. Branches of the SGVAN and their anatomical relationship to each other were recorded. In the notch, SG arteries comprised a single vessel in 18 (78%) of 23 specimens, with all of these dividing at varying distances (1-3.5 cm) along the lateral ilium after dividing into superior and inferior branches. The SG artery branches were contiguous with periosteum of the bony notch in all specimens. More than 1 SG nerve branch was seen in the greater sciatic notch of all specimens, including an inferior branch that exited caudal or caudal-superficial to the SG vessels. The caudal-most SG nerve branch was directly adjacent to the bony notch's periosteum in 15 (65%) of 23 specimens. The SGVAN are at risk in patients undergoing acetabular fracture surgery. Individuals performing surgery along the acetabulum's posterior column would expect to encounter a major SG nerve branch (deep inferior) before encountering the SG vessels in all cases. Iatrogenic injuries to the SGVAN might be prevented by avoiding use of cautery in this area if hemorrhage is encountered.
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Krige JE, Navsaria PH, Nicol AJ. Damage control laparotomy and delayed pancreatoduodenectomy for complex combined pancreatoduodenal and venous injuries. Eur J Trauma Emerg Surg 2015; 42:225-30. [PMID: 26038043 DOI: 10.1007/s00068-015-0525-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/22/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND This single-centre study evaluated the efficacy of damage control surgery and delayed pancreatoduodenectomy and reconstruction in patients who had combined severe pancreatic head and visceral venous injuries. METHODS Prospectively recorded data of patients who underwent an initial damage control laparotomy and a subsequent pancreatoduodenectomy for severe pancreatic injuries were evaluated to assess optimal operative sequencing. RESULTS During the 20-year study period, 312 patients were treated for pancreatic injuries of whom 14 underwent a pancreatoduodenectomy. Six (five men, one woman, median age 20, range 16-39 years) of the 14 patients were in extremis with exsanguinating venous bleeding and non-reconstructable AAST grade 5 pancreatoduodenal injuries and underwent a damage control laparotomy followed by delayed pancreatoduodenectomy and reconstruction when stable. During the initial DCS, the blood loss compared to the subsequent laparotomy and definitive procedure was 5456 ml, range 2318-7665 vs 1250 ml, range 850-3600 ml (p < 0.01). The mean total fluid administered in the operating room was 11,150 ml, range 8450-13,320 vs 6850 ml, range 3350-9020 ml (p < 0.01). The mean operating room time was 113 min, range 90-140 vs 335 min, range 260-395 min (p < 0.01). During the second laparotomy five patients had a pylorus-preserving pancreatoduodenectomy and one a standard Whipple resection. Four of the six patients survived. Two patients died in hospital, one of MOF and coagulopathy and the other of intra-abdominal sepsis and multi-organ failure. Median duration of intensive care was 6 days, (range 1-20 days) and median duration of hospital stay was 29 days, (range 1-94 days). CONCLUSION Damage control laparotomy and delayed secondary pancreatoduodenectomy is a live-saving procedure in the small cohort of patients who have dire pancreatic and vascular injuries. When used appropriately, the staged resection and reconstruction allows survival in a previously unsalvageable group of patients who have severe physiological derangement.
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Affiliation(s)
- J E Krige
- Surgical Gastroenterology, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, South Africa.
- HPB Surgical Unit, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, South Africa.
- Department of Surgery, University of Cape Town Health Sciences Faculty, University of Cape Town Medical School, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| | - P H Navsaria
- Department of Surgery, University of Cape Town Health Sciences Faculty, University of Cape Town Medical School, Anzio Road, Observatory, Cape Town, 7925, South Africa
- Trauma Centre, Groote Schuur Hospital, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - A J Nicol
- Department of Surgery, University of Cape Town Health Sciences Faculty, University of Cape Town Medical School, Anzio Road, Observatory, Cape Town, 7925, South Africa
- Trauma Centre, Groote Schuur Hospital, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Abstract
INTRODUCTION Presacral venous bleeding is an uncommon but potentially life threatening complication of rectal surgery. During the posterior rectal dissection, it is recommended to proceed into the plane between the fascia propria of the rectum and the presacral fascia. Incorrect mobilisation of the rectum outside the Waldeyer's fascia can tear out the lower presacral venous plexus or the sacral basivertebral veins, causing what may prove to be uncontrollable bleeding. METHODS A systematic search of the MEDLINE(®) and Embase™ databases was performed to obtain primary data published in the period between 1 January 1960 and 31 July 2013. Each article describing variables such as incidence of presacral venous bleeding, surgical approach, number of cases treated and success rate was included in the analysis. RESULTS A number of creative solutions have been described that attempt to provide good tamponade of the presacral haemorrhage, eliminating the need for second operation. However, few cases are reported in the literature. CONCLUSIONS As conventional haemostatic measures often fail to control this type of haemorrhage, several alternative methods to control bleeding definitively have been described. We propose a practical comprehensive classification of the available techniques for the management of presacral bleeding.
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Affiliation(s)
- V Celentano
- Bradford Teaching Hospitals NHS Foundation Trust, UK
| | - JR Ausobsky
- Bradford Teaching Hospitals NHS Foundation Trust, UK
| | - P Vowden
- Bradford Teaching Hospitals NHS Foundation Trust, UK
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15
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Juric S, Flis V, Debevc M, Holzinger A, Zalik B. Towards a low-cost mobile subcutaneous vein detection solution using near-infrared spectroscopy. ScientificWorldJournal 2014; 2014:365902. [PMID: 24883388 PMCID: PMC4032719 DOI: 10.1155/2014/365902] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/11/2014] [Indexed: 11/18/2022] Open
Abstract
Excessive venipunctures are both time- and resource-consuming events, which cause anxiety, pain, and distress in patients, or can lead to severe harmful injuries. We propose a low-cost mobile health solution for subcutaneous vein detection using near-infrared spectroscopy, along with an assessment of the current state of the art in this field. The first objective of this study was to get a deeper overview of the research topic, through the initial team discussions and a detailed literature review (using both academic and grey literature). The second objective, that is, identifying the commercial systems employing near-infrared spectroscopy, was conducted using the PubMed database. The goal of the third objective was to identify and evaluate (using the IEEE Xplore database) the research efforts in the field of low-cost near-infrared imaging in general, as a basis for the conceptual model of the upcoming prototype. Although the reviewed commercial devices have demonstrated usefulness and value for peripheral veins visualization, other evaluated clinical outcomes are less conclusive. Previous studies regarding low-cost near-infrared systems demonstrated the general feasibility of developing cost-effective vein detection systems; however, their limitations are restricting their applicability to clinical practice. Finally, based on the current findings, we outline the future research direction.
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Affiliation(s)
- Simon Juric
- Advanced ICT Research Group (AIRG), Farmadent Pharm., 2000 Maribor, Slovenia
- Laboratory of Geometric Modelling and Multimedia Algorithms, Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia
| | - Vojko Flis
- Department of Vascular Surgery, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Matjaz Debevc
- Institute for Media Communication, Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia
| | - Andreas Holzinger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
- Institute of Information Systems and Computer Media, Graz University of Technology, Inffeldgasse 16c, 8010 Graz, Austria
| | - Borut Zalik
- Laboratory of Geometric Modelling and Multimedia Algorithms, Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia
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Abstract
OBJECTIVES The purpose of this study was to compare sonographically guided vascular access using standard and echo-enhanced needles in a variety of tissue-simulating vascular phantoms. METHODS We conducted a prospective single-blinded observational study at an academic medical center. All participants performed real-time sonographically guided vascular access using both a standard 18-gauge needle and an echo-enhanced needle in both in-plane and out-of plane approaches on 3 different vascular access phantoms. The outcome measures included time to dye flash, first-pass success, visibility of the needle tip at the time of puncture, total number of attempts, number of redirections, and incidence of posterior wall penetration. RESULTS A total of 408 sonographically guided cannulations were performed by 34 participants. The time from needle stick to dye flash, first-pass success, and the total number of attempts were not significantly different between the two needles (P> .05). The tip of the needle was seen at the time of puncture in 79% of attempts with the standard needle (95% confidence interval [CI], 68%-86%) and in 86% of attempts with the echo-enhanced needle (95% CI, 76%-92%), although this difference was not significant (P= .103). The posterior wall was penetrated with the standard needle in 14% of attempts (95% CI, 9.6%-20%) and in 6% of attempts with the echo-enhanced needle (95% CI, 3.5%-11%), and the difference was significant (P < .02). CONCLUSIONS Echo-enhanced needles decreased the incidence of posterior wall punctures when compared to standard needles during sonographically guided vascular access. However, there were no significant differences in other sonographically guided vascular access metrics.
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Affiliation(s)
- Todd Crum
- MS, Department of Emergency Medicine, University of Arizona Medical Center, PO Box 245057, Tucson, AZ 85724 USA.
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17
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Li F, Song X, Liu C, Liu B, Zheng Y. Endovascular stent-graft treatment for a traumatic vertebrovertebral arteriovenous fistula with pseudoaneurysm. Ann Vasc Surg 2013; 28:489.e11-4. [PMID: 24200138 DOI: 10.1016/j.avsg.2012.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/17/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022]
Abstract
The rarely occurring vertebrovertebral arteriovenous fistula (VVAVF) is characterized by abnormal direct communications between the vertebral artery or its branches and the neighboring venous system. We present our experience using a stent graft to occlude a chronic, traumatic VVAVF. A 40-year-old woman with dizziness and loud bruits from the occiput underwent digital subtraction angiography (DSA), which revealed a VVAVF with pseudoaneurysm at the C5-C6 level, with retrograde flow from the right vertebral artery. A stent graft was placed across the fistula after balloon dilation. The fistula and pseudoaneurysm disappeared immediately. After 9 months, the patient remained asymptomatic with a patent stent.
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Affiliation(s)
- Fangda Li
- Department of Vascular Surgery, Peking, Beijing Union Medical College Hospital, Beijing, China
| | - Xiaojun Song
- Department of Vascular Surgery, Peking, Beijing Union Medical College Hospital, Beijing, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking, Beijing Union Medical College Hospital, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking, Beijing Union Medical College Hospital, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking, Beijing Union Medical College Hospital, Beijing, China.
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18
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Abstract
BACKGROUND Complications resulting from venipuncture include vein and nerve damage, hematoma, and neuropathic pain. Although the basic procedures are understood, few analyses of actual data exist. It is important to improve the safety standards of this technique during venipuncture. This study aimed to obtain data on actual needle movement during vacuum venipuncture in order to develop appropriate educational procedures. METHODS Six experienced nurses were recruited to collect blood samples from 64 subjects. These procedures were recorded using a digital camera. Software was then used to track and analyze motion without the use of a marker in order to maintain the sterility of the needle. Movement along the X- and Y-axes during blood sampling was examined. RESULTS Approximately 2.5 cm of the needle was inserted into the body, of which 6 mm resulted from advancing or moving the needle following puncture. The mean calculated puncture angle was 15.2°. Given the hazards posed by attaching and removing the blood collection tube, as well as by manipulating the needle to fix its position, the needle became unstable whether it was fixed or not fixed. CONCLUSION This study examined venipuncture procedures and showed that the method was influenced by increased needle movement. Focusing on skills for puncturing the skin, inserting the needle into the vein, and changing hands while being conscious of needle-tip stability may be essential for improving the safety of venipuncture.
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Affiliation(s)
- Chieko Fujii
- Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan.
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19
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Kim JY, Kim MD, Cho JH, Park SI, Lee MS, Lee MS. Uterine artery embolization for symptomatic adenomyosis in a patient with uterus didelphys. J Vasc Interv Radiol 2011; 22:1489-91. [PMID: 21961985 DOI: 10.1016/j.jvir.2011.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 06/22/2011] [Accepted: 06/23/2011] [Indexed: 11/29/2022] Open
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20
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Simsek A, Kurt O, Verim L, Onol SY. Rupture of superficial dorsal vein of penis. Arch Ital Urol Androl 2011; 83:102-104. [PMID: 21826884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Penile fracture is a remarkable but under reported urologic injury. Coitus and penile manipulations are common predisposing factors. Rupture of the superficial vein of penis is an uncommon situation that makes differential diagnosis with other penile lesions. The diagnosis in such cases is mostly after exploration. We report the cases of 34 and 49-year-old male patients with a painless hematoma after intercourse. Conservative or surgery intervention are the alternative mode of treatment.
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Affiliation(s)
- Abdulmuttalip Simsek
- Department of Urology, Bezm-i Alem Valide Sultan Vakif Gureba Research and Education Hospital, Istanbul, Turkey.
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21
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Mazaĭshvili KV, Stoĭko IM, Khlevtova TV, Kutidze IA, Morenko DN. [Venous wall perforations as the leading reason of a painful syndrome after endovenous laser ablation]. Angiol Sosud Khir 2011; 17:79-83. [PMID: 22027525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article deals with the problem of venous wall perforation during endovenous laser ablation (EVLA). The sinusoidal type of painful syndrome which arises on 4-7 days after EVLA was shown. A series experiments on the isolated veins using two different lasers were performed. It was demonstrated that vein is squeezed around the fiber during injection of tumescent liquid, which leads to the formation of isolated intimal sinuses. When the blood closed in such sinuses is exposed to laser radiation, it is released of large amounts of gas, which in turn leads to the rupture of the venous wall. Of the earlier idea of perforation of the venous wall with over heated fibre tip has not received confirmation.
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Charavel M, Veyrat E, Ripart J. [Puncture of the radial vein: a forgotten complication]. Ann Fr Anesth Reanim 2010; 29:818-820. [PMID: 21051180 DOI: 10.1016/j.annfar.2010.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 06/15/2010] [Indexed: 05/30/2023]
Abstract
The superficial radial vein at the lateral edge of the inferior third of the forearm and of the wrist has strong anatomical relationship with the sensory superficial branch of the radial nerve. At this level, any venous puncture may be responsible for a lesion of this superficial part of the radial nerve. We report two cases of dysesthesia in the radial territory after this kind of puncture. This risk should not be neglected and venous puncture should be avoided in this area.
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Affiliation(s)
- M Charavel
- Polyclinique du Grand Sud, 480, avenue St-André-de-Codols, 30000 Nîmes, France.
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23
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Rasouli MR, Moini M, Khaji A, Heidari P, Anvari A. Traumatic vascular injuries of the lower extremity: report of the Iranian National Trauma Project. ULUS TRAVMA ACIL CER 2010; 16:308-312. [PMID: 20849045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND This study aimed to determine the pattern of traumatic lower extremity vascular injuries in Iran. METHODS Patients with vascular injury of the lower extremity were selected from the Iranian National Trauma Project. This project was conducted in eight major cities during 2000-2004 and consisted of more than 17000 patients. RESULTS Sixty-three subjects (54 men) with a total of 92 vascular injuries of the lower extremity were identified. Mean age of the patients was 25.87 +/- 13.37 years. Blunt trauma was more frequent than penetrating (62% vs. 38%). In 36 cases (57%), road traffic crash (RTC) was the cause of injury. In 21% of the patients (n=24), vascular injury resulted from occupational trauma. Workers (n=23, 20%) were the most frequently affected group. Three patients (5%) died due to severity of the associated injuries. CONCLUSION Our results revealed that RTC is the most frequent cause of lower extremity vascular injuries in Iran. Our findings also showed that occupational injuries have considerable prevalence. Establishment of preventive strategies to reduce the frequency of these injuries is recommended.
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Affiliation(s)
- Mohammad R Rasouli
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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24
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Szułdrzyński K, Zalewski J, Machnik A, Zmudka K. Elevated levels of 8-iso-prostaglandin F2alpha in acute coronary syndromes are associated with systemic and local platelet activation. Pol Arch Med Wewn 2010; 120:19-24. [PMID: 20150840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Oxidative stress is an important causative factor in atherosclerosis. Isoprostanes are derivatives of arachidonate oxidized by reactive oxygen species (ROS). Oxidized lipids are markers of oxidative stress, important mediators of atherosclerosis, and activators of platelets. 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha) is a stable isoprostane and reliable marker of oxidative stress in vivo. OBJECTIVES The aim of the study was to determine the level of oxidative stress in acute coronary syndromes (ACS) and its correlations with the para meters of hemo stasis. PATIENTS AND METHODS Fourty-nine patients aged 46 to 76 years, including 28 with ACS and 25 with stable coronary artery disease (CAD), were enrolled to the study. The levels of 8-iso-PGF2alpha, soluble CD40 ligand (sCD40L), P-selectin (P-sel), beta-thromboglobulin, and the thrombin-antithrombin complex (TAT) in the plasma of venous blood were determined. A microvascular injury model was also used to evaluate TAT generation and sCD40L levels in blood collected every 60 seconds at the site of standardized microvascular injury. RESULTS 8-iso-PGF2alpha levels were significantly higher in ACS compared to CAD patients (363.2 +/-45.94 vs. 328.2 -/+31.96 pg/ml, P = 0.011) and correlated with venous plasma levels of P-sel and beta-thromboglobulin in the ACS (r = 0.66; P = 0.0005 and r = 0.62; P = 0.001, respectively) and CAD groups (r = 0.46; P = 0.02 and r = 0.49; P = 0.01, respectively). In the microvascular injury model, the maximum concentrations of sCD40L in the ACS group were associated with plasma 8-iso-PGF2alpha levels (r = 0.50, P = 0.01). No correlations between 8-iso-PGF2alpha and markers of thrombin generation in venous blood and microvascular injury model were observed. CONCLUSIONS Plasma levels of 8-iso-PGF2alpha are significantly higher in ACS compared with stable CAD and correlate with platelet activation.
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Smith HS, Racz GB, Heavner JE. Peri-venous counter spread - be prepared. Pain Physician 2010; 13:1-6. [PMID: 20119457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Chen Z, Yang X, Ning N, Yin H, Zhang Q, Cheng W. [Experimental study on hydrogel dressing in vein injury prevention and treatment]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009; 23:1114-1117. [PMID: 19817301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To observe the efficacy of hydrogel dressings in preventing and treating vein injury of rabbits so as to provide a experimental evidence for clinical application. METHODS Twenty-four healthy large-eared Japanese rabbits (48 ears) were chosen, weighing (2.15 +/- 0.15) kg, and divided into 3 groups randomly. The vein injury models were made by intravenously infusing 20% mannite (2.5 mL/kg). The sites of puncture were treated with hydrogel dressings (group A, n=8) and 25% MgSO4 (group B, n=8) 5 minutes after infusion. The sites of puncture were not treated as a blank control (group C, n=8). The tissue specimens were collected from the auricular veins at 24 hours after mannite infusion for histological observation by HE staining. The injury of the vessel wall, hemorrhage around the vessels, infiltration of inflammatory cells, and disturbance of circulation were observed to evaluate the injury degree of vein. RESULTS There existed redness and congestion in the injured veins of each group. HE staining showed that in both groups A and B, the vessel wall was slightly injured and hemorrhage around the vessel was mild. There existed infiltration of inflammatory cells in the vessel wall and surrounding tissues. There also existed congestion and thrombus in the vessel lumen in these two groups. While in group C, the injury of vessel wall was severe, and schistic bleeding in the surrounding tissue of the vessel was existed. The severe congestion and thrombus in the vessel lumen was observed. There was no significant difference among three groups in the extent of vein wall injury and hemorrhage around the vessel (P > 0.05). The degree of infiltration of inflammatory cells and circulatory disturbance in both groups A and B were significantly less than that of group C (P < 0.05); but there was no significant difference between groups A and B (P > 0.05). CONCLUSION Hydrogel dressing is helpful to prevent vein injury of rabbits induced by mannite.
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Affiliation(s)
- Zhonglan Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China
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Napoli C, De Nigris F, Pignalosa O, Lerman A, Sica G, Fiorito C, Sica V, Chade A, Lerman LO. In vivo veritas: Thrombosis mechanisms in animal models. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 66:407-27. [PMID: 16901851 DOI: 10.1080/00365510600763319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Experimental models have enhanced our understanding of atherothrombosis pathophysiology and have played a major role in the search for adequate therapeutic interventions. Various animal models have been developed to simulate thrombosis and to study in vivo parameters related to hemodynamics and rheology that lead to thrombogenesis. Although no model completely mimics the human condition, much can be learned from existing models about specific biologic processes in disease causation and therapeutic intervention. In general, large animals such as pigs and monkeys have been better suited to study atherosclerosis and arterial and venous thrombosis than smaller species such as rats, rabbits, and dogs. On the other hand, mouse models of arterial and venous thrombosis have attracted increasing interest over the past two decades, owing to direct availability of a growing number of genetically modified mice, improved technical feasibility, standardization of new models of local thrombosis, and low maintenance costs. To simulate rupture of an atherosclerotic plaque, models of arterial thrombosis often involve vascular injury, which can be achieved by several means. There is no animal model that is sufficiently tall, that can mimic the ability of humans to walk upright, and that possesses the calf muscle pump that plays an important role in human venous hemodynamics. A number of spontaneous or genetically engineered animals with overexpression or deletion of various elements in the coagulation, platelet, and fibrinolysis pathways are now available. These animal models can replicate important aspects of thrombosis in humans, and provide a valuable resource in the development of novel concepts of disease mechanisms in human patients.
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Affiliation(s)
- C Napoli
- Department of General Pathology, Division of Clinical Pathology and Excellence Research Center on Cardiovascular Diseases, II University of Naples, Naples, Italy.
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Undas A, Stepień E, Branicka A, Wołkow P, Zmudka K, Tracz W. Thrombin formation and platelet activation at the site of vascular injury in patients with coronary artery disease treated with clopidogrel combined with aspirin. Kardiol Pol 2009; 67:591-598. [PMID: 19618315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Data on the effects of oral antiplatelet agents on blood coagulation in vivo are conflicting. The platelet glycoprotein (GP) IIIa PlA2 allele has been suggested to modulate antithrombotic actions of clopidogrel. AIM We investigated whether clopidogrel combined with aspirin affects local thrombin formation and platelet activation triggered by vascular injury. METHOD We studied patients with stable coronary artery disease on chronic aspirin therapy randomised to addition of clopidogrel 75 mg/d (n = 30) or continuation of aspirin 100 mg/d (n = 30) for 4 weeks. Markers of thrombin generation [thrombin-antithrombin complexes (TAT) and prothrombin 1.2 fragments (F1.2)] and markers of platelet activation [soluble CD40 ligand (sCD40L) and P-selectin] were determined in the supernatant of blood samples obtained from a microvascular injury site. RESULTS Total amounts of thrombin markers produced at the site of injury were similar before and after addition of clopidogrel, whereas platelet release of sCD40L and P-selectin was lower during treatment with aspirin + clopidogrel by 33.8% and 27.8% (p < 0.001), respectively. Patients in the highest tertile of reduction in platelet activation had previous myocardial infarction and peripheral arterial disease and released the highest amounts of sCD40L and P-selectin at baseline. TAT and F1.2 generation as well as sCD40L or P-selectin release were not influenced by the presence of the PlA2 allele. CONCLUSION Our study shows that clopidogrel combined with aspirin does not reduce thrombin formation following vascular injury, but attenuates platelet sCD40L and P-selectin release.
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Affiliation(s)
- Anetta Undas
- Instytut Kardiologii, Uniwersytet Jagielloński Collegium Medicum, ul. Pradnicka 80, 31-202 Krakow, Poland.
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Kuliczkowski W. [Basic examination before clinical examination. That is why it is worthwhile to return to the laboratory]. Kardiol Pol 2009; 67:599-600. [PMID: 19852089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
A NUMBER OF SERIOUS COMPLICATIONS can arise from malpositioned central venous catheters (CVCs), including cardiac tamponade and perforation, pleural effusions, and infusion into the vertebral venous system anywhere along the spinal column. Figure 1 is an x-ray of a premature infant taken after insertion of a 2.0 Silastic peripherally inserted central catheter (PICC), demonstrating the catheter entering the left ascending lumbar vein (ALV). Routine contrast injection of 0.3 mL of iothalamate meglumine 60 percent (Conray, Covidien Imaging Solutions, Hazelwood, Missouri) at the time of the PICC-placement film demonstrated that the contrast material extended into the vertebral venous plexus. The catheter was immediately withdrawn before intravenous fluid was administered, and the infant experienced no complications.
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Affiliation(s)
- Carol W Trotter
- University of Missouri-Kansas City, Kansas City, Missouri, USA
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Guasch E, Almogueraa J, Gilsanz F. [Convulsions after a test dose of ropivacaine and negative aspiration test for combined spinal-epidural analgesia for cesarean section]. Rev Esp Anestesiol Reanim 2008; 55:123-124. [PMID: 18383977 DOI: 10.1016/s0034-9356(08)70522-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
BACKGROUND We report on an exploratory qualitative study investigating drug injectors' narratives of vein damage and groin (femoral vein) injection associated with the injection of crack-heroin speedball. METHODS We undertook 44 in-depth qualitative interviews among injectors of crack-heroin speedball in Bristol and London, England, in 2006. FINDINGS The data suggest an emerging culture of crack-based speedball injection. Injectors' narratives link speedball injection with shifts towards groin injection articulated as an acceptable risk, and not merely as a last resort in the face of increased vein deterioration associated with speedball. Accounts of vein damage linked to speedball emphasize 'missed hits' related to the local anaesthetic action of crack, the excess use of citric in the preparation of speedball injections and 'flushing' when making a hit. We find that groin injection persists despite an awareness of health risks and medical complications. CONCLUSIONS We emphasize an urgent need for reviewing harm reduction in relation to vein care in the context of shifts to crack-based speedball injection, and the use of the femoral vein, among UK injectors. There is an additional need for interventions to promote safer groin and speedball injecting as well as to prevent transitions toward groin and crack injection.
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Affiliation(s)
- Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK.
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Lotfi M, Nabavizadeh SA, Abbasi HR, Geramizadeh B. Iatrogenic venous pseudoaneurysm following venipuncture: case report and review of the literature. J Clin Ultrasound 2007; 35:521-3. [PMID: 17471580 DOI: 10.1002/jcu.20340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We report the case of a venous pseudoaneurysm that developed after a venipuncture made during a blood donation in an otherwise healthy 43-year-old man. The patient presented 3 years later with a mass in the antecubital fossa that was successfully treated with surgical resection. The clinical features of this exceptionally rare lesion are discussed.
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Affiliation(s)
- Mehrzad Lotfi
- Department of Radiology, Namazi Hospital, Namazi Square, Shiraz, Iran
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Hudorovic N. ICVTS on-line discussion A Venous war injuries. Interact Cardiovasc Thorac Surg 2007; 6:650-1. [PMID: 17884857 DOI: 10.1510/icvts.2007.158014a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yavuz S. ICVTS on-line discussion B Traumatic venous injury: ligation or repair? Interact Cardiovasc Thorac Surg 2007; 6:651. [PMID: 17884858 DOI: 10.1510/icvts.2007.158014b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Senol Yavuz
- Bursa Yüksek Ihtisas Education and Research Hospital, Bursa 16330, Turkey
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Perlmutter AE, Roberts L, Farivar-Mohseni H, Zaslau S. Ruptured superficial dorsal vein of the penis masquerading as a penile fracture: case report. Can J Urol 2007; 14:3651-2. [PMID: 17784989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Acute onset of pain, swelling, and ecchymosis of the penis during sexual intercourse indicate a penile fracture until proven otherwise. However, there have been few case reports of isolated injuries to the dorsal penile artery or dorsal vein mimicking a penile fracture. Presented herein is a rare case of a patient who ruptured his superficial dorsal vein during intercourse.
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Affiliation(s)
- Adam E Perlmutter
- Division of Urology, West Virginia University, Morgantown, West Virginia 26506, USA
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Abstract
OBJECTIVES Reports on venous trauma are relatively sparse. Severe venous trauma is manifested by hemorrhage, not ischemia. Bleeding may be internal or external and rarely may lead to hypovolemic shock. Repair of major extremity veins has been a subject of controversy and the current teaching is to avoid venous repair in an unstable or multi-trauma patient. The aim of the current paper is to present our recent experience in major venous trauma during the Lebanon conflict, means of diagnosis and treatment in a level I trauma center. METHODS All cases of major venous trauma, either isolated or combined with arterial injury, admitted to the emergency room during the 33-day conflict were reviewed. RESULTS Out of 511 wounded soldiers and civilians who were admitted to our service over this period, 12 (2.3%) sustained a penetrating venous injury either isolated (5) or combined with arterial injury (7). All injuries were secondary to high velocity penetrating missiles or from multiple pellets stored in long-range missiles. All injuries were accompanied by additional insult to soft tissue, bone and viscera. The mean injury severity score was 15. Severe external bleeding was the presenting symptom in three cases of isolated venous injury (jugular, popliteal and femoral). The diagnosis of a major venous injury was made by a CTA scan in five cases, angiography in one and during surgical exploration in six cases. All injured veins were repaired: three by venous interposition grafts, four by end to end anastomosis, three by lateral suture and two by endovascular techniques. None of the injuries was treated by ligation of a major named vein. Immediate postoperative course was uneventful in all patients and the 30-day follow-up (by clinical assessment and duplex scan) has demonstrated a patent repair with no evidence of thrombosis. CONCLUSIONS Without contradicting the wisdom of ligating major veins in the setup of multi-trauma or an unstable patient, our experience indicates that a routine repair of venous trauma can be safely and effectively performed in young patients. Postoperative course is not compromised and late sequelae of venous interruption may be prevented.
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Affiliation(s)
- Samy S Nitecki
- Department of Vascular Surgery, Rambam Medical Center, P.O. Box 9602, Haifa 36091, Israel.
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Abstract
INTRODUCTION Penile fracture is a rare injury, bearing potential impairment of erectile function if not treated. Patients with clinical presentation of a penile fracture commonly undergo early surgical exploration with the intention to repair a tunica albuginea tear. AIM We present a group of men who presented with a penile hematoma following trauma to the erect penis. Exploration revealed an intact tunica albuginea and a dorsal vein tear. METHODS Eighteen men (mean age 38 years, range 20-55) presented with suspected penile fracture during an 8-year period. One man presented twice. Two of the patients were managed expectantly and the remaining 16 patients underwent 17 immediate surgical explorations. Explorations were performed under general anesthesia, using a circumferential subcoronal incision and degloving of the penile skin. The tunica albuginea of both penile sides as well as the penile urethra were examined for injuries. MAIN OUTCOME MEASURES Medical records were retrospectively reviewed for etiology, symptoms, signs of physical examination, and information on findings of surgical exploration. Data on erectile function, medical treatment for erectile dysfunction, and penile curvature were obtained during follow-up. RESULTS In nine of the 17 procedures the tunica albuginea was intact and the only pathological finding was a ruptured dorsal vein. One procedure was negative for both tunical and vascular injury. A tunical tear was detected in the remaining seven procedures. At a mean follow-up of 40 months (range 4-91), five patients required medical treatment for erectile dysfunction, including the two who were managed expectantly, two with a tunical tear, and one with a venous tear. CONCLUSIONS Dorsal vein tears may mimic penile fracture. Suggestive findings following trauma to the erect penis prompted exploration for suspected tunica albuginea tear. In less than half of the men was the diagnosis of penile fracture established and treated at surgery.
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Affiliation(s)
- Yuval Bar-Yosef
- Department of Urology, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Abstract
Extravasation injuries in the neonatal intensive care unit are not rare during parenteral hyperalimentation. There have been many different methods of management. We report five premature infants with wounds of hyperalimentation fluid extravasation managed by the antibacterial ointment (Terramycin ophthalmic ointment and sesame oil and a antiinflammatory herbal mixture (MEBO).) The mean gestational age of patients was 31(+2) weeks (range, 28(+4) to 35(+6) weeks), and the mean weight at extravasation was 1,930 g (range, 1,140 to 2,680 g). Extravasation occurred within the mean of 32 days (range, 17 to 50 days). The method of dressing was application of a thick layer of this mixture covered by vaseline and wet gauze renewed at an interval of 8-12 hr after irrigating the wounds thoroughly with normal saline. The mean duration of dressing was 30 days (range, 20-50 days). The wounds had healed completely leaving a small size of contracture without functional abnormality. We conclude that this therapy may be considered for an alternative treatment and warrants clinical trials for the confirmation of the local management of extravasation injury.
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Affiliation(s)
- Ky Young Cho
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
| | - Soo Jung Lee
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin Sik Burm
- Department of Plastic Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun Ae Park
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
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Abstract
We report five cases of blunt cardiac rupture seen in our hospital during the last 6 years. All these patients sustained blunt chest trauma due to motor vehicle or motorcycle accidents, and all had vital signs on arrival at the emergency department. We suspected cardiovascular injuries from the findings of echocardiography and CT scans, and all five cases were operated on 2-6 h after injury. Four had a median sternotomy, and one had a lateral thoracotomy. During the operations, we found that two patients had pericardium injuries and all five patients had right chamber injuries, which included multiple, ventricle, and large venous injuries in three patients. The tears were repaired using simple suture or ligation techniques for all patients, with cardiopulmonary bypass in three patients. One patient died during the operation, and four patients survived, therefore the survival rate was 80%. We believe that patients with cardiac rupture who are alive when they reach hospital can often be saved by prompt diagnosis and immediate, adequate surgical repairs.
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Affiliation(s)
- Asako Namai
- Department of Cardiovascular Surgery, National Hospital Organization Sendai Medical Center, 2-8-8 Miyagino, Miyagino-ku, Sendai 983-8520, Japan
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Meyer M, Graveleau N, Hardy P, Landreau P. Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. Arthroscopy 2007; 23:529-36. [PMID: 17478285 DOI: 10.1016/j.arthro.2006.12.022] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 12/16/2006] [Accepted: 12/29/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this anatomic cadaveric study was to determine with trocars in situ the relationships of 12 shoulder arthroscopic portals frequently used with the adjacent musculotendinous and neurovascular structures. METHODS Twelve shoulders of embalmed cadavers installed in a beach-chair position were dissected. Twelve different portals were established by using their authors' description: posterior "soft point," central posterior, anterior central, anterior inferior, anterior superior, 5 o'clock portal, Neviaser, superolateral, transrotator cuff approach, Port of Wilmington, anterolateral, and posterolateral. Six of these portals were placed on each shoulder so that each portal was studied 6 times. Dissections were conduced with trocars in situ to take into account their volume. The distance to the adjacent relevant neurovascular structures at risk (axillar and suprascapular nerves, axillar and suprascapular arteries, and cephalic vein) were measured, arm at side, by using a calliper. Musculotendinous structures crossed by portals were noticed. RESULTS The cephalic vein was injured twice by anterior portals. The 5 o'clock portal is at most risk of neurovascular injury. It is located at mean distances to the axillar artery and nerve of 13 and 15 mm, respectively. Other anterior, posterior, superior, and lateral portals are safe with mean distances higher than 20 mm. No musculotendinous rupture nor large injury occurred. CONCLUSIONS The present study shows that the trocars placement of the studied portals did not create, except for the cephalic vein, any lesion of the neurovascular adjacent structures. CLINICAL RELEVANCE This study suggests, except for the 5 o'clock portal, the safety of the shoulder arthroscopic portals tested regarding to the neurovascular adjacent structures.
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Affiliation(s)
- Matthieu Meyer
- Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris-Ouest University, Boulogne, France.
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Gelber PE, Reina F, Caceres E, Monllau JC. A comparison of risk between the lateral decubitus and the beach-chair position when establishing an anteroinferior shoulder portal: a cadaveric study. Arthroscopy 2007; 23:522-8. [PMID: 17478284 DOI: 10.1016/j.arthro.2006.12.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 12/13/2006] [Accepted: 12/21/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess, using a technique that minimally distorts the normal anatomy, the risk of injury when establishing a 5 o'clock shoulder portal in the lateral decubitus versus beach-chair position. METHODS The anteroinferior portal was simulated with Kirschner wires (K-w) drilled orthogonally at the 5 o'clock position in 13 fresh frozen human cadaveric shoulders. The neighboring neurovascular structures were identified through an anteroinferior window made in the inferior glenohumeral ligament. Their relations to the K-w and surrounding structures were recorded in both positions. RESULTS The median distance from the musculocutaneous nerve to the K-w was shorter in the lateral decubitus position than in the beach chair position (13.16 mm v 20.49 mm, P = .011). The cephalic vein was closer to the portal in the beach-chair position than in the lateral decubitus position (median 8.48 mm v 9.93 mm, P = .039). The axillary nerve was closer to the K-w in the lateral decubitus position than in the beach-chair position (median 21.15 mm v 25.54 mm, P = .03). No differences in the distances from the K-w to the subscapular and anterior circumflex arteries were found when comparing both positions. The mean percentage of subscapular muscle height from its superior border to the K-w was 53.03%. CONCLUSIONS This study showed the risk of injury establishing a transubscapular portal in either position. The musculocutaneous nerve and the cephalic vein are the most prone to injury. In general, the beach-chair position proved to be safer. CLINICAL RELEVANCE Inserting anchor devices orthogonally would permit stronger fixation but presents the risk of damaging neurovascular structures. This study focused on showing the neurovascular risk of performing full orthogonal insertion. Considering the good results reported with the usual superior-anterior portals, we do not recommend performing a transubscapular portal in routine shoulder arthroscopy.
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Affiliation(s)
- Pablo Eduardo Gelber
- Department of Orthopaedic Surgery, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Rosenfeldt F, He GW, Roubos N. Vein graft neointimal hyperplasia: prevention is better than cure. J Thorac Cardiovasc Surg 2007; 133:1118; author reply 1119. [PMID: 17382675 DOI: 10.1016/j.jtcvs.2006.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 09/28/2006] [Indexed: 11/30/2022]
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Komiyama Y. [Phlebotomy-related complications. Introduction]. Rinsho Byori 2007; 55:237-40. [PMID: 17441467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Recently, management of the central phlebotomy station by the clinical laboratory has become the norm and phlebotomy is a routine job for many medical technologists. Although venipuncture-related accidents, such as nerve injury, unfortunately happen in a low but fixed ratio, there is little information to avoid this risk. This topic consists of three excellent reviews: Dr. Tanabe reviewed "Iatrogenic peripheral nerve injury; mechanism and therapy", Dr. Ohnishi reviewed "effective methods to prevent nerve injury at venipuncture", and Dr. Kitamura reviewed "An effective and efficient method of painless venipuncture in children". I believe these three articles will be of great help to many medical technologists and clinical laboratory physicians to perform phlebotomy safely.
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Affiliation(s)
- Yutaka Komiyama
- Department of Clinical Sciences and Laboratory Medicine, Kansai Medical University, Moriguchi
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Ohnishi H. [How to prevent phlebotomy-related nerve injury]. Rinsho Byori 2007; 55:251-6. [PMID: 17441469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Phlebotomy-related nerve injury is relatively rare but could be a serious complication of venipuncture; however, widely recognized and effective methods to prevent nerve injury at venipuncture have not been established. By considering the anatomical features of peripheral nerves and veins of the arm, several techniques may be feasible. To prevent median nerve injury, which is the most serious among the nerve injuries in the arm, the following order of vein selection is recommended: (1) radial vein (2) median cubital vein (3) basilic vein (4) forearm veins (5) veins of the back of the hands. However, this order should be changed according to the status of the actual veins of the patient. To avoid the needle from being inserted too deeply, short needles such as butterfly needles may be preferred. Although probing is a very dangerous procedure which must be avoided, re-direction of the needle is an acceptable procedure if it is performed once per venipuncture. In addition to these technical efforts, it is critical to ask each patient before venipuncture whether he or she has experienced nerve injury during previous phlebotomy in order to avoid unnecessary repetitive nerve injuries in the same patient. In order to avoid such situations, we have established a computer-based system to alert phlebotomists to the complications which patients have experienced during venipuncture. These and other methods should be tested in many institutes and data should be systematically collected to investigate whether phlebotomy-related nerve injury can be effectively prevented.
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Affiliation(s)
- Hiroaki Ohnishi
- Department of Laboratory Medicine, Kyorin University School of Medicine, Mitaka
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48
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Abyshov NS, Aliev EN. [Results of surgical treatment of combined trauma of extremities vessels and bones]. Khirurgiia (Mosk) 2007:54-58. [PMID: 18231099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Results of diagnosis and treatment of 127 patients with combined trauma of extremities vessels and bones are analyzed. Amputations were performed at 11 (8,7%) patients, 3 (2,4%) patients died. Long-term results were evaluated at 82 patients followed-up from 12 months to 5 years after surgery. The poor results were revealed at 7 (8,5%), satisfactory -- at 53 (64,7%), good -- at 22 (26,8%) patients. The tactics of surgical treatment is described in details.
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Chauhan AK, Kisucka J, Lamb CB, Bergmeier W, Wagner DD. von Willebrand factor and factor VIII are independently required to form stable occlusive thrombi in injured veins. Blood 2006; 109:2424-9. [PMID: 17119108 PMCID: PMC1852205 DOI: 10.1182/blood-2006-06-028241] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
von Willebrand factor (VWF) protects factor VIII (FVIII) from proteolysis and mediates the initial contact of platelets with the injured vessel wall, thus playing an important role in hemostasis and thrombosis. VWF is crucial for the formation of occlusive thrombi at arterial shear rates. However, with only a few conflicting studies published, the role of VWF in venous thrombosis is still unclear. Using gene-targeted mice, we show that in ferric chloride-injured veins platelet adhesion to subendothelium is decreased and thrombus growth is impaired in VWF(-/-) mice when compared with wild type (WT). We also observed increased embolization in the VWF(-/-) mice, which was due to lower FVIII levels in these mice as recombinant factor VIII (r-FVIII) restored thrombus stability. Despite normalization of blood clotting time and thrombus stability after r-FVIII infusion, the VWF(-/-) venules did not occlude. Transgenic platelets lacking the VWF receptor GPIbalpha extracellular domain showed decreased adhesion to injured veins. But, after a delay, all the injured venules occluded in these transgenic mice. Thus, VWF likely uses other adhesion receptors besides GPIbalpha in thrombus growth under venous shear conditions. Our studies document crucial roles for VWF and FVIII in experimental thrombosis under venous flow conditions in vivo.
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Affiliation(s)
- Anil K Chauhan
- CBR Institute for Biomedical Research, Harvard Medical School, Boston, MA-02115, USA
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50
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Vasina T, Sonský E, Antos F, Hledík E, Kaspar M. [Venous injuries during a ten-year follow up, including vascular injuries managed in the Bulovka Surgical Department IPVZ]. Rozhl Chir 2006; 85:545-8. [PMID: 17323545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The authors analyze twenty cases of vascular reconstructions, completed upon management of 118 vascular traumas, over a 10-year period. The traumas were, predominantly, of iatrogenic origin. The following trunks were treated: v. cava inferior, v. mesenterica superior, pelvic, femoral and popliteal veins. In most cases, the reconstruction included a direct vascular suture technique. Furthermore, in addition to the direct vascular suture technique, analogous vein-graft patches or interponates were used. In a single case, a thin-walled PTFE prosthesis was applied. Out of the patient study group, one patient exited as a result of septic complications of his traumas, connected to the v. cava inferior injury. In three cases, femoral and popliteal reconstructions were affected with thrombosis. Non of the reconstructions resulted in a lower extremity amputation.
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Affiliation(s)
- T Vasina
- Chirurgická klinika IPVZ a 1. LF UK, FN Bulovka, Praha.
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