Surgical and radiologic anatomy : SRA
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In emergency departments, focused assessment for sonographic examination of trauma patients (FAST) accurately detects hemoperitoneum in unstable patients. Currently, only an approximation of the volume of free intraperitoneal fluid (FIPF) can be done using ultrasound (US) and CT scans. We previously reported a new method developed on an experimental cadaveric model using US examination of the abdomen and applying a mathematic formula to effusion measurements to evaluate the exact volume of FIPF. The aim of this prospective study is to extrapolate this method in a clinical practice and apply it to CT measurements of the same area. ⋯ This new linear function can be used to measure the exact volume of FIPF. This evaluation can help surgical decisions, especially when abdominal trauma is associated with other haemorrhagic lesions.
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Infraorbital nerve block is used for intraoperative and postoperative analgesia in nasal and oral surgery procedures, as well as in the chronic pain settings. Ultrasound guidance has not been described in the literature. The aim of the study was to assess the quality of ultrasound imaging of the infraorbital foramen and develop an "in-plane" technique of the block using a skull model. ⋯ This experimental study suggests that the infraorbital foramen is easily located using ultrasound and an "in-plane" ultrasound-guided technique for infraorbital nerve blockade is feasible on the model.
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Double aortic arch is a rare variation of the aortic arch that may cause tracheal and esophageal compression. Two postnatal cases of double aortic arch and their outcomes are reported. ⋯ The left subclavian artery and left common carotid artery arose separately from the left aortic arch. Both patients underwent corrective surgery and made an uneventful recovery.
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Case Reports
Complex anomalies of type 1 proatlantal intersegmental artery and aortic arch variations.
We report a case of type 1 proatlantal intersegmental artery (PIA) associated with multiple anomalies of the aortic arch, and discuss the possible embryonic mechanism and clinical importance of the multiple cerebrovascular variants in this patient. ⋯ To our knowledge, this is the first report of a type 1 PIA associated with multiple vascular anomalies of the aortic arch, such as ARSA and origin of the left VA from the arch. In cases of persistent anastomoses between the carotid and vertebrobasilar arteries, such as PIAs, imaging examination should include the aortic arch to identify associated vascular variations.
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The lumbar sympathetic trunk's (LST) distance to two anatomical landmarks, the costal process and medial margin of the psoas muscle, was assessed due to its use as landmarks for lumbar sympathetic blocks: the costal process for fluoroscopic guided techniques and the psoas major for CT- and MRI-guided techniques. Based on the measurements, we evaluate the trunk's visibility in MR and CT images for accurate positioning of the needle. ⋯ The costal process is a usable landmark for fluoroscopic guidance and the psoas major for CT- and MRI-guided techniques. The LST is clearly visible in MR and CT images, which gives both techniques a decisive advantage over fluoroscopy concerning the block of the LST due to a visible target.