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Gluteal artery pseudoaneurysms are very rare [1]. They mostly occur after gunshot and stub wounds [2]. However, gluteal artery pseudoaneurysms can be caused by pelvic fracture [1]. Also, they can be isolated or associated with trauma of the pelvic and abdominal viscera [3]. The authors present two cases of gluteal artery pseudoaneurysms. Case 1. A 30-year-old man was treated for large swelling of the left buttock. One month previously he manifested a gunshot wound in the gluteal region. He also had symptoms of lumboischialgia with peroneal nerve paresis. The physical examination revealed a large pulsatile mass over the left buttock with an associated overlying bruit. Selective angiography of the internal iliac artery (Figure 1) revealed a large inferior gluteal artery pseudoaneurysm that caused dislocation of both external and internal iliac arteries. The patient was operated under epidural anaesthesia by the combined abdominal (extraperitoneal) and gluteal approach. By extraperitoneal approach the internal iliac artery was identified and ligated. After the closure of the wound, the patient was placed on the abdomen, and pseudoaneurysm was opened by an incision made between gluteus maximus and medius muscles. After evacuation of the parietal thrombus and pseudocapsule resection, nutrient vessels were ligated. The postoperative recovery was good, and the patient was free of neurologic symptoms two days after the operation. The late result (after 4 years) is also good. Case 2. A-53-year-old man was treated for small haematoma pulsans (Figure 2) in the right buttock. Fifteen days previously he was treated in the regional hospital by intramuscular "antirheumatic cocktails". The physical examination revealed a small pulsatile mass over the right buttock associated with overlying bruit. The selective angiography of the internal iliac artery demonstrated a small inferior gluteal artery pseudoaneurysm. The patient was operated by the procedure described. The postoperative recovery and the late result (after 6 months) were good. ⋯ According to our knowledge, only 8 cases of gluteal artery pseudoaneurysms are reported in literature in the last 11 years (including the first three months of this year) [4-8]. The lesions of the gluteal arteries, especially pseudoaneurysms, have no specific symptoms and signs. usually, they appear as haematoma pulsans and neurologic deficiency due to compression. (One of our patients). The gluteal abscess can be a differential diagnostic problem. Duplex ultrasonography, CT and selective angiography can be used in the diagnosis [5]. The standard surgical treatment of gluteal artery pseudoaneurysms consists of the ligature of the internal iliac artery (using transperitoneal or extraperitoneal approach) and pseudoaneurysmal resection and ligation of nutrient vessels by gluteal approach [9]. The second procedure is the temporary clamping of the internal iliac artery and transgluteal ligation of the nutrient vessels [7]. The microcatheter embolization of the nutrient vessels using standard invasive radiologic approaches via femoral artery is the method of choice in the treatment of gluteal artery pseudoaneurysms [10]. A buttock pulsatile mass and neurological deficiency in a patient with history of penetrating gluteal trauma, suggest the existence of gluteal artery pseudoaneurysm and require diagnostic evaluation.
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The title "Thoracic Outlet Syndrome" (TOS) was introduced by Peet in 1956 [1]. In 1958 Charles Rob defined TOS as a "set of symptoms that may exist due to compression on the brachial plexus and on subclavian vessels in the region of the thoracic outlet" [2]. Compression due to cervical rib was first described by Galenus and Veaslius in the 2nd century A.D. The first unsuccessful resection of the cervical rib in patients with TOS was performed by Coote in 1861 [4]. In 1905 Murphy first made a successful resection of the cervical rib in patients with TOS and subclavian artery aneurysm [5]. He also removed the normal first rib in patients with TOS using the supraclavicular approach for the first time [6]. In 1920 Law described ligaments and other structures originating in soft tissue associated with TOS [8], while Adson and Coffey in 1927 emphasized the role of the scalene anticus muscle in TOS [3]. Ochsner, Gage and DeBakey in 1935 named it the "scalenus anticus syndrome", and made the first successful resection of the anterior scalene muscle [9]. In 1966 David Ross introduced the transaxillary resection of the first rib to relieve TOS [11]. The aim of the paper is to describe the treatment of patients with vascular TOS. ⋯ Over a six-year-period (1990-1997) 12 patients with vascular TOS were evaluated at our Centre. Seven (58%) were female and 5 (42%) male patients, average age 33.1 years. Eleven of them had congenital TOS, and one acquired TOS after trauma at neck-shoulder region. Seven patients had arterial and 5 venous TOS. Two patients with arterial TOS had ischaemia of the upper extremity due to embolism of the brachial artery. In one of them axillary artery was completely thrombosed, and in the other postenotic dilatation of the subclavian artery was present. The other 5 patients with arterial TOS demonstrated only hand pain and radial puls during hyperabduction of the arm. One of our patients with venous TOS had also symptoms and signs of hand oedema during hyperabduction, while four patients had axillary-subclavian deep venous thrombosis (DVT). All patients underwent CW-Doppler and Duplex-ultrasonographic examination. The results were positive in all patients with arterial TOS. The angiographic (selective arteriography of the subclavian artery) examination showed the same results. Diagnostic procedures were performed in normal position of the arm and during hyperabduction. The angiography also revealed: one aneurysm of the subclavian artery, one poststenotic dilatation of the subclavian artery with brachial artery embolization, and one thrombosed axillary artery with brachial artery embolization (Figure 1). In five patients the angiogram was normal in normal position of the arm, but showed arterial flow obstruction at the thoracic outlet during hyperabduction (Figures 2a and 2b). In patients with venous TOS Duplex ultrasonographic examination was performed. The cervical rib caused TOS in four of our patients and clavicle fracture calus in one case. In 7 patients bone anomalies were not found (Figure 3). The operative treatment was carried out in 3 patients with venous and 7 patients with arterial TOS. In two patients with DVT of the axillary-subclavian segment, 6 months after standard anticoagulant therapy, decompressive procedures were performed (one resection of the cervical rib, and one transauxillary resection of the first rib). In the case of venous TOS without DVT, a supraclavicular resection of the first rib was performed immediately after diagnosis. In 5 patients with arterial TOS without morphologic changes on the arterial system, a decompressive procedure was done. The following procedures were carried out: one scalenotomy, one supraclavicular and three transaxillary resections of the first rib. (ABSTRACT TRUNCATED)
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The understanding of water and electrolytes metabolism is essential in providing an adequate therapy in the treatment of low birth weight infants. In the first days of life sodium balance is negative [10, 11], since sodium renal loss is rather big and sodium peroral intake is inadequate [12]. It is not recommended to add sodium in the first 24-48 hours of life to extremely immature babies (Usher) [13]. The daily requirements of sodium in preterm infants range from 2 to 3 mmol/kg. Sodium intake should be adjusted to each patient, considering the gestational age, the severity of illness, plasma sodium concentration, sodium excretion by urine, which depends on morphological maturity and reabsorbitional capacity of the proximal tubule. ⋯ On the basis of our study we can emphasize the following findings regarding the relation between weight gain and sodium balance. In the first group three babies started with weight gain from 6th to 10th day of life. In the second group six babies started with weight gain in the same period-from 6th to 10th day. Gain weight of babies in the third group was by 3% greater in the same period compared to the birth weight, what makes a significant difference (p < 0. (ABSTRACT TRUNCAT
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The great English neurologist, Dr. John Hughlings Jackson was born in Providence Green, Yorkshire, north England, in 1835. He spent his apprenticeship in the city of York, continued his medical education at St. ⋯ This concept of interpretation af the symptoms of the nervous diseases remains applicable even today. Jackson was the first to stress the importance of ophthalmoscopy in neurology in all cases of neurologic disease, especially in cases of optic neuritis (papilloedema) which may be present even if the patient did not notice the minimized visual acuity. The way of thinking that Jackson introduced in medicine and neurology may be his most precious legacy to the generations that followed.
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Most frequently, abdominal aortic aneurysm (AAA) ruptures into retroperitoneal space. The rupture of AAA into inferior vena cava is an uncommon event. The incidence of this complication of AAA is 2 to 10%. Surgeons' awareness of this rare entity is the most important factor for the early diagnosis and treatment. In this paper we report two cases of AAA rupture into inferior vena cava. As to our knowledge, in domestic literature such cases have not been previously reported. ⋯ AC fistula as a complication of ruptured AAA was reported for the first time by Syme in 1831. The first attempt to repair this lesion was done by Lehman in 1935, but it was unsuccessful. In 1954, the first successful repair was performed by Cooley. According to Matsubara, by the end of 1989, 250 cases of this lesion were reported in England, German and French literature, and only 25 in Japanese. In 1991, Brewster et al. reported 14 new cases, while Italian authors reported 36 new cases in 1994. Retroperitoneal and intraperitoneal ruptures of AAA have different clinical presentation comparing with the rupture of AAA into inferior vena cava. (ABSTRACT TRUNCATED)