There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-ye...There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-year-old male with suspected left lung cancer (lt.U, S<sup>3</sup>, 20 × 20 mm, P0, E0, D0, PM0, N0, T1aN0M0, c-stage IA). Preoperatively, we did not recognize the existence of the common trunk of the left pulmonary vein. After the open thoracotomy, due to a severe intrathoracic adhesion, we omitted releasing the adhesion of the lower lobe. We did not exactly confirm the location of the inferior pulmonary vein (IPV). After cutting the interlobular pulmonary arterial branchies, we resected the superior pulmonary vein (SPV) using auto sutures. After division of the lung parenchyma and incomplete fissures using auto sutures, we intended to resect the upper bronchus. However, we could not find an IPV at the normal IPV site. A thin IPV was found to be returned to the peripheral site of the resected SPV. The SPV and IPV formed a common trunk at the normal site of the SPV. Although we considered reconstructing the resected common trunk, we finally made a decision of performing an incidental pneumonectomy in order to prevent any postoperative complications on the reconstruction of the IPV such as thrombus occlusion at the anastomosis site and venous return congestion. Retrospectively, we confirmed the preoperative images of the computed tomographic scanning, which showed a narrow IPV that returned to the peripheral site of the SPV. It is important to confirm both accurate locations of the SPV and IPV when performing a lobectomy.展开更多
BACKGROUND We report a rare case of numbness in the right hand,finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and ...BACKGROUND We report a rare case of numbness in the right hand,finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and explain the cause of these diseases.CASE SUMMARY The patient was a 65-year-old woman.She complained of dizziness,numbness and weakness of the right hand for 6 mo.She was diagnosed with bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome by ultrasound,enhanced computed tomography,computed tomography angiography and other examinations.Considering the surgical risks,the patient refused the aberrant right subclavian artery stent implantation and was discharged.We hypothesize that these two kinds of deformity and right subclavian steal syndrome may not occur by accident and result from multiple malformations.CONCLUSION Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome is rare.This case reminds interventional radiologists of the possibility of these abnormalities before surgery.展开更多
We show a brief report of two common arterial trunk cases(CAT)with different arrhythmias and discuss anatomy,clinical and diagnostic management.The burden of volume and pressure overload of this cardiac malformation m...We show a brief report of two common arterial trunk cases(CAT)with different arrhythmias and discuss anatomy,clinical and diagnostic management.The burden of volume and pressure overload of this cardiac malformation may predispose to different types of arrhythmia before and after surgical repair.Because of labile hemodynamic state in this group of patients,prompt diagnosis of any arrhythmia is mandatory as the devastating factor on prognosis.The first patient with a diagnosis of CAT Type II Collett and Edwards(CE)had a particular history with HIV seropositive mother assuming antiretroviral therapy during pregnancy,who presented hyperbilirubinemia and liver dysfunction at birth,and re-entry atrial tachycardia after repair.The second patient had CAT Type I CE with a partial anomalous venous connection of left superior pulmonary vein and uncommon type of atrial tachycardia with dual AV nodal physiology.展开更多
Background: Surgical treatment of upper mesocolic organs is improved by preoperative diagnosis of anatomical variants of celiac trunk. According to the literature, these anatomical variants are little known in sub-Sah...Background: Surgical treatment of upper mesocolic organs is improved by preoperative diagnosis of anatomical variants of celiac trunk. According to the literature, these anatomical variants are little known in sub-Saharan Africa. Purpose: To evaluate the prevalence of anatomical variants of celiac trunk in relation to its branching. Materials and methods: This was a cross-sectional study of descriptive type. It retrospectively evaluated 160 abdominal contrast enhanced CT-scan, from patients attending Yalgado OUEDRAOGO teaching hospital, from 1 January 2015 to 30 September 2016. Patients with a history of heavy abdominal surgery were excluded. Images obtained by 64-row CT-scan were analyzed for anatomical variants of the celiac trunk. Results: One hundred and twenty-eight patients (80%) had a classic anatomical configuration of celiac trunk, while thirty-two (20%) had at least one anatomical variant. Two anatomical variants were found in fifteen patients (9.4%) while five other patients (3.1%) had more than two variants. The most frequent anatomical variant was the hepato-splenic bifurcation, found in fourteen patients (8, 8%). It was followed by common celiac and mesenteric trunk, and then collateral arteries, in particular left hepatic artery and right lower diaphragmatic artery, each with three patients (1.9%). Conclusion: Anatomical variants related to celiac trunk branching, are as frequent in our study as in the literature. However, the two most common anatomical variants were hepato-splenic bifurcation and common celiac and mesenteric trunk.展开更多
There have been rapid developments in gastroenterology(GE)over the last decade.Up until the late 1980s,GE-training was incorporated in Internal Medicine training.The introduction of endoscopy has necessitated the need...There have been rapid developments in gastroenterology(GE)over the last decade.Up until the late 1980s,GE-training was incorporated in Internal Medicine training.The introduction of endoscopy has necessitated the need for additional training.Around the world different national boards have developed their own curricula which will be discussed in this paper. Emphasis will be placed on the curriculum recently introduced in The Netherlands.The internal medicine component has become a two-year requirement (Common Trunk)and the duration of training in GE has been extended to four years.Because of the growing complexity of GE,there are now four subspecialties:Interventional Endoscopy,Neuromotility, Oncology and Hepatology that trainees can choose from.These subspecialties each have predefined specific requirements.The World Gastroenterology Organization has drawn up a standard curriculum which can be of help to the boards in different countries. The curriculum emphasizes the knowledge and skill components.The curriculum also defines the training recommendations,the requirements of training facilities and competence evaluation of fellows and facilities,while less is said about research,finance and the number of gastroenterologists required.In the coming decades the curriculum will need to be revised continuously.Personalization of the curriculum will be the next challenge for the years to come.展开更多
文摘There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-year-old male with suspected left lung cancer (lt.U, S<sup>3</sup>, 20 × 20 mm, P0, E0, D0, PM0, N0, T1aN0M0, c-stage IA). Preoperatively, we did not recognize the existence of the common trunk of the left pulmonary vein. After the open thoracotomy, due to a severe intrathoracic adhesion, we omitted releasing the adhesion of the lower lobe. We did not exactly confirm the location of the inferior pulmonary vein (IPV). After cutting the interlobular pulmonary arterial branchies, we resected the superior pulmonary vein (SPV) using auto sutures. After division of the lung parenchyma and incomplete fissures using auto sutures, we intended to resect the upper bronchus. However, we could not find an IPV at the normal IPV site. A thin IPV was found to be returned to the peripheral site of the resected SPV. The SPV and IPV formed a common trunk at the normal site of the SPV. Although we considered reconstructing the resected common trunk, we finally made a decision of performing an incidental pneumonectomy in order to prevent any postoperative complications on the reconstruction of the IPV such as thrombus occlusion at the anastomosis site and venous return congestion. Retrospectively, we confirmed the preoperative images of the computed tomographic scanning, which showed a narrow IPV that returned to the peripheral site of the SPV. It is important to confirm both accurate locations of the SPV and IPV when performing a lobectomy.
基金Supported by Fujian Province Medical Innovation Project,No.2016-CXB-13
文摘BACKGROUND We report a rare case of numbness in the right hand,finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and explain the cause of these diseases.CASE SUMMARY The patient was a 65-year-old woman.She complained of dizziness,numbness and weakness of the right hand for 6 mo.She was diagnosed with bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome by ultrasound,enhanced computed tomography,computed tomography angiography and other examinations.Considering the surgical risks,the patient refused the aberrant right subclavian artery stent implantation and was discharged.We hypothesize that these two kinds of deformity and right subclavian steal syndrome may not occur by accident and result from multiple malformations.CONCLUSION Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome is rare.This case reminds interventional radiologists of the possibility of these abnormalities before surgery.
文摘We show a brief report of two common arterial trunk cases(CAT)with different arrhythmias and discuss anatomy,clinical and diagnostic management.The burden of volume and pressure overload of this cardiac malformation may predispose to different types of arrhythmia before and after surgical repair.Because of labile hemodynamic state in this group of patients,prompt diagnosis of any arrhythmia is mandatory as the devastating factor on prognosis.The first patient with a diagnosis of CAT Type II Collett and Edwards(CE)had a particular history with HIV seropositive mother assuming antiretroviral therapy during pregnancy,who presented hyperbilirubinemia and liver dysfunction at birth,and re-entry atrial tachycardia after repair.The second patient had CAT Type I CE with a partial anomalous venous connection of left superior pulmonary vein and uncommon type of atrial tachycardia with dual AV nodal physiology.
文摘Background: Surgical treatment of upper mesocolic organs is improved by preoperative diagnosis of anatomical variants of celiac trunk. According to the literature, these anatomical variants are little known in sub-Saharan Africa. Purpose: To evaluate the prevalence of anatomical variants of celiac trunk in relation to its branching. Materials and methods: This was a cross-sectional study of descriptive type. It retrospectively evaluated 160 abdominal contrast enhanced CT-scan, from patients attending Yalgado OUEDRAOGO teaching hospital, from 1 January 2015 to 30 September 2016. Patients with a history of heavy abdominal surgery were excluded. Images obtained by 64-row CT-scan were analyzed for anatomical variants of the celiac trunk. Results: One hundred and twenty-eight patients (80%) had a classic anatomical configuration of celiac trunk, while thirty-two (20%) had at least one anatomical variant. Two anatomical variants were found in fifteen patients (9.4%) while five other patients (3.1%) had more than two variants. The most frequent anatomical variant was the hepato-splenic bifurcation, found in fourteen patients (8, 8%). It was followed by common celiac and mesenteric trunk, and then collateral arteries, in particular left hepatic artery and right lower diaphragmatic artery, each with three patients (1.9%). Conclusion: Anatomical variants related to celiac trunk branching, are as frequent in our study as in the literature. However, the two most common anatomical variants were hepato-splenic bifurcation and common celiac and mesenteric trunk.
文摘There have been rapid developments in gastroenterology(GE)over the last decade.Up until the late 1980s,GE-training was incorporated in Internal Medicine training.The introduction of endoscopy has necessitated the need for additional training.Around the world different national boards have developed their own curricula which will be discussed in this paper. Emphasis will be placed on the curriculum recently introduced in The Netherlands.The internal medicine component has become a two-year requirement (Common Trunk)and the duration of training in GE has been extended to four years.Because of the growing complexity of GE,there are now four subspecialties:Interventional Endoscopy,Neuromotility, Oncology and Hepatology that trainees can choose from.These subspecialties each have predefined specific requirements.The World Gastroenterology Organization has drawn up a standard curriculum which can be of help to the boards in different countries. The curriculum emphasizes the knowledge and skill components.The curriculum also defines the training recommendations,the requirements of training facilities and competence evaluation of fellows and facilities,while less is said about research,finance and the number of gastroenterologists required.In the coming decades the curriculum will need to be revised continuously.Personalization of the curriculum will be the next challenge for the years to come.
