Retroesophageal right subclavian artery with persistent ductus arteriosus

We report an adult male cadaver with persistence of the ductus arteriosus and a right retroesophageal artery. The retroesophageal artery was first appreciated as a retropharyngeal mass during the dissection of this area. Both the left and right vertebral arteries originated in normal fashion. The thoracic duct of our specimen drained into the junction of the left internal jugular and left subclavian veins. We believe this to be the first report of simultaneous right retroesophageal subclavian artery and patent ductus arteriosus. The anatomy and embryology of these two anomalies in the same specimen are discussed.     

Application of the medical anti-shock trouser (MAST) increases cardiac output and tissue perfusion in simulated,mild hypovolaemia

We have studied the haemodynamic effects of the application of the medical anti-shock trouser (MAST) in 10 healthy subjects in the semi-upright position in order to simulate mild hypovolaemia. Left ventricular end diastolic dimension (EDD) was measured by M-mode echocardiography and cardiac output (CO) by the Doppler ultrasound technique. Forearm blood flow (FBF) was measured by plethysmography and blood pressure (BP) by the standard cuff technique. Systematic increases in MAST pressure of up to 80 mm Hg were applied. EDD increased to a maximum of 9.3% (p0.01) which was associated with a maximum increase in CO of 31.7% (p0.05). FBF increased by a maximum of 54.2% (p0.001) whilst BP increased by a maximum of 12% (p0.001). These results demonstrate that the application of the MAST is an effective means of transferring blood to the central circulation by compression of the capacitance vessels resulting in significant increases in cardiac output and tissue perfusion. At high pressures there was evidence of compression of resistance vessels, which may be useful in reducing blood loss. The ease and rapidity with which his suit can be applied suggests that it may be useful in the short term treatment of hypovolaemia.     

阴茎癌56例临床分析

目的 :探讨阴茎癌有效合理的治疗方法。方法 :总结分析 5 6例阴茎癌发病及治疗情况 ,其中鳞状细胞癌5 0例 ,乳头状瘤癌变 6例 ,行阴茎部分切除术 48例 ,阴茎全切并会阴部造口术 6例 ,双腹股沟淋巴清扫术 10例 ,包皮环切并血卟啉光敏治疗 2例。结果 :5 1例获得随访。行阴茎部分切除术者 5年和 10年生存率分别为83 3 %和 80 % ,行阴茎全切术者 5年生存率为 6 6 8%。结论 :包茎及包皮过长是导致阴茎癌的主要诱因。对于Ⅰ、Ⅱ期阴茎癌行阴茎部分切除术疗效确切     

The clinical utility of a decision-aid to facilitate the use of the hand in real-life activities of patients with distal radius fractures: A case study

BackgroundOccupation-based intervention (OBI) in hand therapy has shown superior benefits in patient-reported performance and physical measures; however, only a few studies have used OBI. We developed a decision-aid to promote the use of an injured hand in the real world (Aid for Decision-making in Occupation Choice for hand; ADOC-H)PurposeTo investigate the clinical utility of the ADOC-H (paper version) in patients with distal radius fractures.Study DesignA prospective case series and a clinical survey for occupational therapists.MethodsThis study comprised a prospective patient case series of 8 patients with distal radius fractures, treated using Volar locking plates, and a clinical survey of 4 experienced occupational therapists.ResultsNo patient or therapist complaints or drop-outs were reported. Active range of motion (wrist), Grip strength, and Disabilities of the Arm, Shoulder, and Hand scores improved for all patients. The ADOC-H induced 158 activities using the injured hand, with activities of daily living (69.8%) selected earlier in the treatment period, and instrumental activities of daily living (63.3%) selected later. The feedback and case studies suggested that the ADOC-H was useful for patients who were afraid of using the hand and, interestingly, patients who were able to use their hand without pain or other problems. The clinical survey showed that most therapists found the ADOC-H effective in facilitating real-life use of an injured hand.ConclusionsThe ADOC-H paper version is an useful tool that can be applied to facilitate patients with distal radius fractures to use their injured hands in real-life settings.     

Comparison of the outcomes of adipofascial and two–staged fasciocutaneous reverse sural flap in patients with lower leg trauma

BackgroundDistal one – third trauma of the lower limb is a complex condition to treat. The reverse sural flap is a time tested procedure for reconstruction of such defects especially in patients where free flaps are ruled out due to comorbidities. The purpose of this study is to compare the two modifications of the classical technique of reverse sural flap (adipofascial and fasciocutaneous) which is lacking in the literature.Material & methodsIn this study, the authors conducted a retrospective analysis of 67 patients with lower one-third leg defects reconstructed with either adipofascial reverse sural flap (Group A, n = 37) or two-staged fasciocutaneous reverse sural flap (Group B, n = 30) in a tertiary care hospital in North India between 2015 and 2019. An evaluation of the different flap characteristics of the two variants of the reverse sural flap was done and compared. Mean follow up period was 12 months.ResultsThe adipofascial group showed shorter operative time, was a single-stage and with better reach and aesthetic outcome. The complications did not differ except that for the adipofascial group was associated with unstable skin graft over the flap initially which did not require any treatment.DiscussionLower one-third defect of the lower limb has been a challenge for reconstructive surgeons all over the world. The goal of reconstruction is a functional lower limb. Although free tissue transfer is the preferred modality of treatment of such cases but it may not be possible in all cases due to various reasons. Reverse sural flap is a very lucrative local option for such reconstructions as it is easy to perform, reliable, low profile and bulk, require minimal facilities with less operative time. Adipofascial flaps represent an extremely useful modification of the reverse sural flap which is quick to perform with minimal donor site morbidity.ConclusionAdipofascial reverse sural artery flap is a good option for patients with lower limb trauma with the added advantage of being single-stage and with better donor site cosmesis as compared to the fasciocutaneous reverse sural artery flap.     

Impacto del nivel socioeconómico sobre el perfil del paciente amputado de miembro inferior por causa no traumática

IntroductionTo analyse the influence of socioeconomic status on the clinical profile of patients undergoing non-traumatic lower-limb amputation.MethodsRetrospective study of 697 lower-limb amputee patients in an Angiology and Vascular Surgery Department during a 5-year period. Patients were classified according to their socioeconomic status (low, medium and high). We analysed demographic (age and gender) and clinical variables (cause of amputation, comorbidity, cardiovascular risk factors and amputation level).ResultsMean age was 70.5 ± 11.9 years, and the median was 72 years. The low socioeconomic status group presented a higher frequency of amputations in men. Cardiovascular risks factors were more frequent in this socioeconomic group, and the difference was statistically significant for diabetes (85.8% low, 69.3% medium, 65% high; P<.01) and obesity (31.4% low, 22.6% medium, 12.5% high, P<.01). Diabetic retinopathy was the only comorbidity with a significant association with low socioeconomic status (21.1% low, 15.3% medium, 12.5% high, P<.03). Regarding the cause for amputation, there was no difference in terms of socioeconomic status. The low socioeconomic level showed a higher frequency of major amputation, which was a significant difference (63.6% low, 41.2% medium, 55% high, P<.04) and a higher predisposition for this amputation level.ConclusionsThe low socioeconomic status has been shown to determine an unfavourable vascular risk profile in lower-limb non-traumatic amputees and a higher predisposition of a major amputation. This socioeconomic level demonstrates a negative influence on these patients’ diabetes, obesity and diabetic retinopathy.