Arteria lusoria: Developmental anatomy, clinical, radiological and surgical aspects

The left aortic arch with an aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occuring in 0.5-2.5% of individuals. Four vessels arise sequentially from the aortic arch: the right common carotid artery, the left common carotid artery, the left subclavian artery and the aberrant right subclavian artery, which crosses upwards and to the right in the posterior mediastinum. It results from a disruption in the complex remodelling of the paired branchial arches, typically of the right dorsal aorta distal to the sixth cervical intersegmental artery. The diagnosis and differentiation of arch anomalies is based on findings at chest radiography in association with those at esophagography. It is usually asymptomatic. When symptomatic, it produces dysphagia lusoria or dyspnea and chronic coughing. Treatment is indicated for symptomatic relief of dysphagia lusoria and for prevention of complications due to aneurysmal dilatation.     

电针配合中频电治疗椎动脉型颈椎病40例观察

目的：观察电针配合中频电治疗椎动脉型颈椎病的疗效。方法：将80例椎动脉型颈椎病患者随机分为电针配合中频电治疗组和药物治疗对照组,观察其疗效和疼痛眩晕症状改善情况。结果：电针配合中频电治疗组有效率为95．0％,药物治疗对照组有效率为82．5％。疼痛眩晕症状两组都有改善,观察组更为明显,经统计学处理,两组差异有显著性意义（P〈0．05）。结论：电针配合中频电治疗椎动脉型颈椎病疗效优于药物治疗对照组,头痛和眩晕症状明显改善。     

The importance of investigating the internal thoracic artery before coronary artery surgery in Leriche's syndrome

Frequently, both peripheral and coronary artery disease are present in the same patient. In patients with abdominal aortic occlusion (i.e., Leriche's syndrome) or femoroiliac occlusion, collateral circulation to the lower extremities can originate in branches of the abdominal aorta or even in the internal thoracic artery (depending on the level of the occlusion). It is important to identify the origin of this circulation during diagnostic procedures, especially in patients who may need to undergo coronary revascularization surgery since, in cases where the majority of the collateral circulation originates in the internal thoracic artery, using the artery as a coronary graft could lead to acute ischemia of the lower extremities. We present three patients with Leriche's syndrome in whom the internal thoracic artery was the origin of the collateral circulation to the ipsilateral femoral artery.     

盐酸拓扑替康区域灌注治疗宫颈癌的护理

目的总结宫颈癌患者腹壁下动脉插管行区域灌注化疗药治疗宫颈癌的护理措施效果,预防和减少不良事件及化疗并发症的发生。方法对我科2007年11月至2010年11月,49例腹壁下动脉插管患者行盐酸拓扑替康区域灌注治疗的护理进行回顾性分析。结果 49例宫颈癌患者全部完成1～3疗程动脉化疗,发生骨髓Ⅰ度抑制31例,Ⅱ度抑12例,Ⅲ度抑制2例,严重胃肠道反应5例,未发生一例导管不良事件。结论加强对患者的健康教育,提高护士的专业知识,对患者的病情变化做到早发现,早处理是使病人顺利完成治疗的关键。     

Long insular artery damage might be a key sign for predicting functional prognosis of putaminal hemorrhage

ObjectiveAlthough the putamen is the most common area of spontaneous intracerebral hemorrhage, previous reports about the effects of surgery are limited. We sometimes experience a poor prognosis in patients in whom there is no damage to the internal capsule, but with injury in the long insular artery (LIA) region. The purpose of this study was to confirm the relationship between LIA damage and patient prognosis following surgery for putaminal hemorrhage.MethodsWe retrospectively collected data of 287 surgical cases who presented with putaminal hemorrhage between January 2004 and March 2022. Among them, we chose patients without initial damage to the posterior limb of the internal capsule, and divided these patients into two groups, those without (Group A) and with (Group B) final damage in the LIA region. We compared positivity rates of final manual muscle test (MMT) scores ≥ 3 and related factors.ResultsSixty-three of the 287 patients were included in this study. Of them, 11 cases in Group A were positive for MMT scores ≥ 3 (68.8%) and 9 cases (19.1%) in Group B had MMT scores ≥ 3 seven days after surgery. Group A thus had a significantly higher rate of MMT scores ≥ 3 than group B (p = 0.00).ConclusionIn patients without initial damage to the internal capsule, LIA injury might be a key sign for predicting the functional prognosis of putaminal hemorrhage.     

When Arteria lusoria meets Truncus bicaroticus: one of the rarest combinations of aortic arch anomalies

The Arteria lusoria or aberrant right subclavian artery (ARSA) constitutes one of the rarest malformations of the aortic arch, it can be associated with other congenital anomalies of the heart and large vessels, in particular the bi-carotid trunk or common origin of the carotid arteries (COCA) which is the presence of a single branch from the aorta giving off both right and left common carotid arteries. We report the case of a patient followed for severe mitral stenosis, and hospitalized for an ischemic cerebral vascular accident, a chest CT scan was performed in front of her clinical and biological degradation, which allowed the fortuitous discovery of an Arteria lusoria (aberrant retro-esophagealartery) associated with a Truncus bicaroticus.     

Neurovascular structures in the lateral recess of the sphenoid sinus. A computed tomography evaluation

Introduction and objectivesAnatomical variations of the lateral recess of the sphenoid sinus and its relations with the adjacent neurovascular structures should be preoperatively evaluated to plan an adequate surgical approach and avoid iatrogenic injuries. This study aims to analyze the patterns of pneumatization of the lateral recess of the sphenoid sinus and their association with the presence of protrusion and dehiscence of the optic canal, carotid canal, vidian canal, and maxillary nerve.Materials and methodsA retrospective evaluation of 320 sphenoid sinuses by computed tomography was performed. Studied variables included type of lateral recess, and protrusion, and dehiscence of the optic and carotid canal, and vidian and maxillary nerve.ResultsThe mean age was 45.67 ± 17.43. A total of 55.6% (n = 178) of the evaluated sphenoid sinuses corresponded to male subjects. Protrusion of the carotid canal, maxillary nerve, and vidian canal was associated with a type 3 lateral recess pneumatization, while dehiscence of these structures was most commonly observed in a type 2 lateral recess (p = < 0.001).ConclusionsProtrusion or dehiscence of neurovascular structures surrounding the sphenoid sinus has been associated with the extent of pneumatization of the lateral recess, increasing the risk of intraoperative injury. Preoperative identification of anatomical variations is mandatory to select the best approach for skull base lesions and avoid iatrogenic injuries.