Hybrid Repair with Reversed Sequence Supra-aortic Debranching in Ruptured Arch Aneurysm

This report describes a “reversed sequence” extra-anatomical supra-aortic debranching procedure as a salvage technique performed to enable HAR. An 83-year-old woman with a history of ascending aortic replacement for type A aortic dissection, mediastinitis complicated by sternal osteomyelitis, and a chest wall reconstructed with a rectus abdominis myocutaneous flap presented with chest pain because of a contained dissecting arch aneurysm rupture. The patient underwent supra-aortic debranching from the bilateral common femoral arteries and thoracic endovascular aortic repair to the ascending aorta under cerebral near-infrared spectroscopy (NIRS) monitoring. Completion imaging by angiography demonstrated successful exclusion of the ruptured aneurysm. The regional cerebral oxygen saturation level, monitored by NIRS, did not change markedly during surgery. The patient was neurologically intact with adequate cerebral blood flow assessed postoperatively by 123I-IMP single photon emission computed tomography. Total debranching of the supra-aortic vessels from the common femoral artery for inflow is feasible and provides adequate cerebral perfusion. This procedure may offer an alternative treatment option in patients with complex conditions involving aortic arch pathology. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full t...
Source: International Journal of Angiology - Category: Cardiology Authors: Tags: Case Report Source Type: research

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Conclusions Fever may be absent in up to a quarter of pediatric patients with acute osteomyelitis. Although highly sensitive, inflammatory marker elevations were more modest than those reported previously in cases of pediatric septic arthritis.
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Original Articles Source Type: research
Conclusions One third of patients were misdiagnosed at the first consultation, which stresses the importance of a high clinical suspicion to avoid delays in diagnosis and treatment of osteoarticular infections. This study also shows a lower mean age of children with upper limb infection as compared with those with lower limb infection. All patients recovered fully with oral antibiotics.
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Original Articles Source Type: research
Yale J Biol Med. 2021 Dec 29;94(4):599-602. eCollection 2021 Dec.ABSTRACTA 67-year-old male presented to the hospital for lower back pain and left lower extremity radiculopathy. Although the patient was afebrile and white blood cell count was normal, MRI was concerning for discitis/osteomyelitis at L4-L5. Subsequently, the patient developed a right knee joint effusion and underwent an arthrocentesis that was notable for the presence of urate crystals. A systemic urate crystal arthropathy was proposed as a potential etiology for the patient's back pain and radiculopathy. Dual energy CT of the lumbar spine was performed, a t...
Source: The Yale Journal of Biology and Medicine - Category: Universities & Medical Training Authors: Source Type: research
Int J Environ Res Public Health. 2021 Nov 26;18(23):12473. doi: 10.3390/ijerph182312473.ABSTRACTSeptic ankle arthritis is a devastating clinical entity with high risks of morbidity and mortality. Prompt treatment is necessary because delayed or inadequate treatment can lead to irreversible damage that may occur on the articular surface, resulting in cartilage erosion, infective synovitis, osteomyelitis, joint deformity, and pain and joint dysfunction. An aggressive surgical approach is required when a joint infection causes severe limb-threatening arthritis. A 58-year-old woman visited our clinic with increasing pain in th...
Source: Cell Research - Category: Cytology Authors: Source Type: research
Discussion The hands are one of the most important parts of the body for interacting with the world. They are remarkably adapted having sensitive sensory receptors as well as feedback receptors for grasping, holding, and manipulating objects. Hands, especially with an opposable thumb, multiple joints within the hand, along with the wrist and elbow, allow the hand to move in multiple positions to manipulate the world. Hands also symbolize an emotional caring and sharing between individuals as hands are used to provide a true “human touch” in personal and social situations. Due to their important interactions in ...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Yoo Yoon Kim Septic ankle arthritis is a devastating clinical entity with high risks of morbidity and mortality. Prompt treatment is necessary because delayed or inadequate treatment can lead to irreversible damage that may occur on the articular surface, resulting in cartilage erosion, infective synovitis, osteomyelitis, joint deformity, and pain and joint dysfunction. An aggressive surgical approach is required when a joint infection causes severe limb-threatening arthritis. A 58-year-old woman visited our clinic with increasing pain in the right ankle, which had been present for the previous 2 months. She ...
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Case Report Source Type: research
It is crucial to consider cervical osteomyelitis as a differential diagnosis for neck pain in patients who underwent radiotherapy for early diagnosis and management, thereby preventing the development of potentially debilitating neurologic symptoms. AbstractIt is crucial to consider cervical osteomyelitis as a differential diagnosis for neck pain in patients who underwent radiotherapy for early diagnosis and management, thereby preventing the development of potentially debilitating neurologic symptoms.
Source: Clinical Case Reports - Category: General Medicine Authors: Tags: CLINICAL IMAGE Source Type: research
OSTEOMYELITIS IN CHILDREN: Osteomyelitis (OM) is defined as an infection of the bone marrow and adjacent osseous structures with potential surrounding soft tissue extent. It can occur at any age, generally in children 1 –16 years old. In children, it is predominantly caused by hematogenous spread of infection, typically bacterial. Generally, the metaphysis is involved. Transphyseal spread to the epiphysis and joint is rare but can occur in children younger than 18 months, or in older children with closed growth p lates, due to a different blood perfusion to the epiphysis. The first imaging modality of choice is conve...
Source: Journal of the Belgian Society of Radiology - Category: Radiology Source Type: research
A 12-year-old boy was admitted to the paediatric ward with a 4-month history of worsening pain and bruising to his legs, which had resulted in a progressive reduction in his mobility. He initially had had difficulty weight bearing, which had then progressed further making him wheelchair bound. On examination, there was extensive bruising (figure 1) to his oedematous legs, worse on his right leg compared with his left. His background of autism and 15q13.3 deletion, along with maternal learning difficulties, made deciphering a clear history difficult. However, there was no account of trauma, and he had been afebrile througho...
Source: Archives of Disease in Childhood - Education and Practice - Category: Pediatrics Authors: Tags: Epilogue Source Type: research
INTRODUCTION AND OBJECTIVE: Urosymphyseal fistula (UF) with osteomyelitis most commonly occurs as a result of prostate cancer and benign prostate hyperplasia (BPH) therapy. UF presentation typically includes debilitating pelvic pain exacerbated with ambulation. Traditional management required open surgical genitourinary (GU) reconstruction with pubectomy leading to significant morbidity. However, progressive utilization of robotic approaches and advances in holmium laser technology has led to a less invasive alternative.
Source: Urology - Category: Urology & Nephrology Authors: Source Type: research
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