THROMBOEMBOLISM OF THE SUBCLAVIAN ARTERY TO THE VERTEBRAL ARTERY WITH HAEMORRHAGIC TRANSFORMATION - A CASE...
Subclavian artery aneurysms are relatively rare; there are few cases of aneurysms at the subclavian-vertebral junction mentioned in the literature [1, 2]. One of the possible complications is thromboembolism to the vertebral artery. These aneurysms may be symptomatic [1, 2] or asymptomatic . The objective of the current study is to report the case of thromboembolism of an aneurysm at the subclavian-vertebral artery junction as the first manifestation of disease that evolved into a stroke that transformed from ischaemic to haemorrhagic with the use of anticoagulation.
SYSTOLIC PRESSURE IN WOUND SCARRING
The recommended goal of a systolic pressure under 13 mmHg in hypertensive diabetic patients results in a significant drop in blood pressure that often has caused conflicts in respect to maintaining a minimum systolic pressure for wound scaring in patients with peripheral artery disease. This, as long as the patient remains asymptomatic, is no problem, however if the patient has a peripheral wound, the low systolic pressures may affect scarring.
SURGICAL MORTALITY IN CRITICAL ISCHEMIA
Peripheral arterial disease (PAD), one of the most common causes of disability, loss of work, and lifestyle changes in the United States, is defined as the obstruction of blood flow into an arterial tree excluding the intracranial or coronary circulations . Atherosclerosis is recognized as a chronic inflammatory disease occurring within the artery wall and responsible for myocardial infarction, strokes and peripheral vascular disease . Critical limb ischemia is the end stage of peripheral arterial occlusive disease, with a deep impact in patient\\\'s quality of life [3,4]. Estimates of the prevalence of intermittent claudication vary by population from 0.6% to nearly 10%; the rate increases dramatically with age. Approximately 20% to 25% of patients will require bypass surgery, while fewer than 5% will progress to critical limb ischemia . The goals of treatment are to prevent progression of systemic atherosclerosis and its associated morbidity and mortality, to prevent limb loss, and to improve functional capacity for symptomatic patients . Risk factors for atherosclerosis should be monitored beginning in childhood, even in asymptomatic patients. Modifiable factors (e.g., blood pressure, smoking, serum lipids) and nonmodifiable factors (e.g., age, family history) are important in the overall assessment . The patient has a good chance to improve the natural course of his disease by changing his lifestyle. In this regard, physical exercise, weight loss and smoking cessation should be mentioned first . Revascularization is most beneficial for patients with lifestyle limiting symptoms, acute or chronic limb ischemia with resting pain or non-healing ulcers . One study showed mortality rates related to major leg amputations of 5.7% on the surgical ward, 15.7% within the first month after the procedure, 44% within the first year, 50% within two years and 72% within six years after amputation [10-14]. The objective of this study was to evaluate surgical mortality in critical leg ischemia comparing bypass surgery with major amputations.
REPERFUSION SYNDROME AFTER AN ENDOVASCULAR PROCEDURE IN LOW BIRTH WEIGHT NEWBORN
The placement of long-term central venous catheters (CVC) plays a vital role in providing continuous venous access for therapy in children. CVC line fractures are most commonly seen during removal after long periods of therapy.¹ There are many reports on the complications that occur at the time of insertion and during the life of central venous indwelling catheters. However, there are few publications that describe the complications that occur at the time of removal of these lines.²
MINIMUM SYSTOLIC BRAIN PERFUSION IN THE CONTROL OF SYSTEMIC HYPERTENSION
The recommended goal of a systolic pressure under 130 mmHg in hypertensive diabetic patients results in a significant drop in blood pressure that often causes neurological symptoms, a condition not always considered in the clinical practice. A controlled reduction in blood pressure should be achieved by using antihypertensive drugs to reach the minimum pressure without symptoms. Although in this evaluation the main variable must be the systolic pressure, the diastolic pressure should not be ignored.
EPIDEMIOLOGICAL CHARACTERISTICS AND MORTALITY OF PATIENTS AFTER LEG AMPUTATIONS FOR ANAEROBIC INFECTIONS
Gas gangrene is a necrotizing soft tissue infection characterized by muscular necrosis and the formation of gas. It develops quickly and can cause septic shock and death. In adults, gas gangrene used to be a well-known complication of war wounds . Clostridium perfringens and Clostridium septicum are the major etiological agents of traumatic and spontaneous gas gangrene, respectively . There are a number of factors that predispose to the spread of these soft tissue infections, such as delays in diagnosis, immune suppression, diabetes mellitus and advanced age . Reduced tissue perfusion leading to tissue ischemia is a central component of the pathogenesis of myonecrosis caused by Clostridium perfringens . Characterized by extensive tissue necrosis and an absence of accompanying leukocyte infiltration and tissue inflammatory response, the histopathological picture of clostridial gas gangrene is distinctly different from other bacterial infections . Poor blood flow due to arterial occlusion exacerbates the anaerobic condition .
CAUSES OF RE-HOSPITALIZATION OF PATIENTS WITH PERIPHERAL ARTERIOSCLEROSIS
Peripheral arterial disease (PAD), a major cause of disability, loss of work, and lifestyle changes in the United States, is defined as the obstruction of blood flow into an arterial tree excluding the intracranial or coronary circulations. Atherosclerosis is now recognized as a chronic inflammatory disease occurring within the artery wall and ultimately responsible for myocardial infarction, stroke and peripheral vascular disease. Critical limb ischemia is the end stage of peripheral arterial occlusive disease, with a profound impact on the patient’s quality of life[3,4]. Estimates of the prevalence of intermittent claudication vary from 0.6% to nearly 10% depending on the population; the rate increases dramatically with age. Between 20% and 25% of patients will require re-vascularization, while fewer than 5% will progress to critical limb ischemia. The goals of treatment are to prevent the progression of systemic atherosclerosis and its associated morbidity and mortality, to prevent limb loss, and to improve functional capacity of symptomatic patients. Risk factors for atherosclerosis should be monitored beginning in childhood, even in asymptomatic patients. Modifiablefactors(e.g., blood pressure, smoking, serum lipids) and non-modifiablefactors(e.g., age, family history) are important in the overall assessment. Patients have a good chance to improve the natural course of their disease by changing their lifestyle. In this regard, physical exercise, weight loss and smoking cessation should be mentioned first. Re-vascularization is most beneficial for patients with lifestyle limiting symptoms, acute or chronic limb ischemia, with pain at rest or non-healing ulcers. One study showed that the mortality rates linked to major leg amputation were 5.7% on the surgical ward, 15.7% within the first month after the procedure, 44% within the firstyear, 50% in the second and 72% in the sixth year after amputation. Additionally, the procedure seriously affected the quality of life of patients[10-12]. Inflammation is now considered to be a critically important determinant of outcome following acute injury to the central nervous system, potentially contributing to the development of secondary injury.
ASSOCIATION OF HYPERTENSION WITH ERECTILE FUNCTION IN CHRONIC PERIPHERAL ARTERIAL INSUFFICIENCY PATIENTS
Erectile dysfunction (ED) is a common condition; it affects 18 million men and their sexual partners in the United States and is generally related to changes in blood flow to the penis . Decreased arterial elasticity, high resting heart rate and metabolic syndrome are important cardiovascular risk markers associating arteriosclerosis, a disease associated to, among other things, ED . A vascular etiology, with disease of the small vessels (microcirculation) as in diabetes mellitus and of the macrocirculation, is identified in up to 60% of patients with ED . The most important risk factors for the development of advanced chronic arterial disease (CAD) include diabetes, smoking, hypertension, dyslipidemia, age over 65 years, obesity and an ankle-brachial index (ABI) < 0.7 [4-6]. Another symptom of CAD is ED, which is characterized by a persistent inability of a man to achieve or maintain an erection sufficient for satisfactory sexual intercourse . Research correlating CAD and ED using the international index of erectile function (IIEF) and the ABI found that ED is an independent predictive factor of CAD; there is a positive correlation between the two diseases . Another study reports that high blood pressure in patients with early stage CAD exerts a protective effect on ED . The aim of this study was to assess the effect of systemic hypertension on ED in patients with CAD.
ANOMALOUS BRANCH OF THE RIGHT COMMON CAROTID ARTERY
The right common carotid artery (CCA) originates from the brachiocephalic trunk. It follows ascending passage for the lateral region of the neck, deep to the sternocleidomastoid, sternohyoid, and sternothyroid muscles. The right CCA follows until near the upper border to the thyroid cartilage in the transverse process of the 4th thoracic vertebra, where divides into an internal and an external carotid artery. The common carotid does not emit ramification and keeps its constant bore, approximately 8 mm, since the origin until the bifurcation, where it is dilated and divided1. The inferior thyroid artery (ITA) arises from the subclavian artery (troncotireocervical), divides in a medial branch and a lateral that anastomoses with the superior thyroid artery2-3. This branch supplies the isthmus and inferior pole of the thyroid gland4. We report a case of a patient with ITA as an anomalous branch of common carotid artery.