Annals of vascular surgery
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Reported in-hospital complications following rib resections for neurogenic thoracic outlet syndrome.
While brachial plexus injury has been described as the most common complication following thoracic outlet syndrome (TOS) operation and case series have been reported, the exact incidence rate has not been described. We conducted a retrospective analysis of 5 years (1999-2003) of the Nationwide Inpatient Sample database. Neurogenic TOS patients, rib resections, brachial plexus injuries, and vascular injuries are identified by ICD-9 diagnosis codes or procedure codes. ⋯ On hospital discharge, brachial plexus injury following rib resection for TOS occurs in <1% of cases, while vascular injuries occur in 1-2% of cases. The low complication rates suggest that the operation can be performed safely in all patients, especially at teaching hospitals, which had significantly lower rates of vascular injuries, shorter hospital lengths of stay, and lower hospital charges. The low incidence rates of these traditional clinical measures of outcome in TOS patients suggest that the appropriate measure for TOS patient outcome would be patient-reported quality of life or functional outcomes.
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Case Reports
Primary pulmonary artery sarcoma: difficult differential diagnosis from chronic pulmonary thromboembolism.
Pulmonary artery sarcoma is a rare malignant tumor. The disease is frequently misdiagnosed as chronic pulmonary thromboembolism because of the similar clinical and radiologic findings. We present a case of primary pulmonary artery sarcoma that was misdiagnosed as chronic pulmonary thromboembolism, and discuss the clinical presentation, diagnosis, and outcome.
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Comparative Study
Efficacy and vasodilatory benefit of magnesium prophylaxis for protection against spinal cord ischemia.
Prevention of paraplegia remains an imperative issue in thoracoabdominal aortic surgery. The aim of this study was to assess the efficacy of a prophylactic magnesium infusion in a rat spinal cord ischemia model and to demonstrate spinal blood flow increase caused by the infusion. The study was conducted in two parts. ⋯ In conclusion, magnesium may have potential prophylactic benefits during ischemia by exerting a neuroprotective effect through vasodilation of the spinal cord vasculature. To our knowledge, this vasodilatory effect on the spinal cord has not previously been investigated. Optimization of the treatment regimen, however, is required.
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We present preliminary results and analysis of a screening program that has been offered at a community-based hospital since July 2004. The program includes a quick carotid ultrasound study, abdominal aortic ultrasound imaging, and measurement of bilateral ankle/brachial indices (ABI). From July 2004 through January 2006, 1,719 patients were screened, including 1,094 (64%) women and 652 (36%) men. ⋯ This nonselective vascular screening program attracted many new patients into the health-care system. The open/endovascular procedure yield was low, but early disease detection was significant, causing numerous patients to be referred for additional testing and risk factor modification programs. These preliminary data suggest that community-based vascular screening programs play a key role in early vascular disease detection and provide the potential for prevention of disease progression while, at the same time, building sustainable business for hospitals and physicians.