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Vasile T, Farina R, Foti PV, Basile A. The Role of Ultrasound in Venous Thoracic Outlet Syndrome: Lesson Based on a Case Report. J Med Ultrasound 2023; 31:150-153. [PMID: 37576424 PMCID: PMC10413403 DOI: 10.4103/jmu.jmu_219_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/02/2022] [Accepted: 03/29/2022] [Indexed: 08/15/2023] Open
Abstract
Thoracic outlet syndrome is a rare neurovascular disease, usually caused by compression of subclavian vessels and/or brachial plexus by a cervical rib or hypertrophic scalene muscles. When the subclavian artery is compressed, it can cause perfusion deficiency with cyanosis and greater fatigue of the upper limb; if the subclavian vein is compressed, it can cause venous congestion with swelling and pain in the upper limb. When compression affects the brachial plexus, it can cause tingling or paresthesia of the upper limb. It can be mono or bilateral, congenital, or acquired. The diagnosis of vascular alterations is difficult due to the rarity, poor knowledge, and nonspecificity of symptoms. Ultrasound allows to localize and measure the vascular stenosis degree. Failure to diagnose can expose patients to serious health risks. We describe a rare case of venous compression caused by anterior scalene muscle hypertrophy.
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Affiliation(s)
- Tiziana Vasile
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
| | - Renato Farina
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiodiagnostic and Radiotherapy Unit, Catania, Italy
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Li X, Fu J, Zhou H, Dong Y, Alhaskawi A, Wang Z, Lai J, Yao C, Ezzi SHA, Kota VG, Abdulla MHAH, Guan M, Lou X, Lu H. The effects of melatonin in the treatment of acute brachial plexus compression injury in rats. Front Neurol 2023; 14:1111101. [PMID: 36937512 PMCID: PMC10015383 DOI: 10.3389/fneur.2023.1111101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction Brachial plexus injury (BPI) is one of the most destructive peripheral nerve injuries and there is still a lack of effective treatment. Methods This study was conducted to evaluate the effects of melatonin in the treatment of acute brachial plexus compression injury in rats using histopathological, histomorphometric, immunohistochemical and electrophysiological methods. Forty-eight adult male Sprague Dawley rats were randomly allocated into three groups: sham, melatonin and vehicle groups. The brachial plexus compression injury model was performed by a vascular clamp. Melatonin group received intraperitoneal injection of melatonin at doses of 10 mg/kg for 21 days after crush injury. The conduction velocity and amplitude of compound muscle action potential (CAMP) in the regenerated nerve, and nerve histomorphometry, as well as levels of myelin protein zero (P0) protein of the crush region were assessed. Results Compared with the vehicle group, the melatonin group which reported significant increased CMAP conduction velocity and amplitude also showed thicker myelin sheath and lower levels of P0 protein. Discussion Our results suggest that melatonin effectively promotes nerve regeneration and improves the function of damaged nerves. Melatonin treatment is a promising strategy for the treatment of acute brachial plexus compression injury.
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Affiliation(s)
- Xigong Li
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jing Fu
- Department of Stomatology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zewei Wang
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingtian Lai
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chengjun Yao
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Sohaib Hasan Abdullah Ezzi
- Department of Orthopaedics of the 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Vishnu Goutham Kota
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | | | - Ming Guan
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xianfeng Lou
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, Hangzhou, Zhejiang, China
- *Correspondence: Hui Lu
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Abul K, Özmen BB, Yücekul A, Zulemyan T, Yılgör Ç, Alanay A. If you look this way, you will see it: cranial shift in adolescent idiopathic scoliosis. Spine Deform 2023; 11:105-114. [PMID: 35921040 DOI: 10.1007/s43390-022-00560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Anatomical variations in the spine can be seen in each transitional border, either toward the skull as 'cranial shifts' or away as caudal shifts. Cranial shifting (CS) occurs when there is presence of occipitalization, C7 cervical costae or prominent transverse processes, thoracolumbar transitional vertebrae (TLTV) at T12 level, L5 sacralization, and sacrococcygeal fusion. We termed the coexistence of sacralization of L5 and absence or remarkable reduction of T12 rib size in AIS as Abul cranial shift (ACS). In this descriptive clinical study, primary aim was to investigate the incidence of ACS in AIS. METHODS Retrospective analysis of 187 surgically treated AIS cases was performed. Demographic data were recorded. The incidence of the specific set of anatomic variations including lumbosacral transitional vertebrae, TLTV, transverse process changes in C7 vertebrae, and posterior lumbosacral neural arch cleft formations (NACf) were evaluated in the radiological images. RESULTS 36 (19%) of 187 cases had ACS. ACS was detected in only 1 of 19 male cases (5%), while in 35 of 168 female cases (21%). Forty-one cases had sacralization of L5 (22%). There were only eleven pair of ribs in 14 (7%) of 187 cases and 10 (28%) of 36 ACS cases. Forty cases had NACf (21%). ACS and NACf coexistence were observed in 8 (22%) of 36 ACS cases. CONCLUSION Accurate spinal column assessment is critical in adolescent idiopathic scoliosis (AIS). ACS may be observed in up to one in five AIS cases and its presence should not be neglected to avoid wrong level surgery.
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Affiliation(s)
- Kadir Abul
- Department of Orthopedics and Traumatology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey.
| | - Berk Barış Özmen
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Altuğ Yücekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey
| | - Çağlar Yılgör
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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Theerth KA. Pseudohypoglycaemia in a case of bilateral cervical rib. Indian J Anaesth 2022; 66:742-744. [PMID: 36437977 PMCID: PMC9698299 DOI: 10.4103/ija.ija_1040_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023] Open
Affiliation(s)
- Kaushic A Theerth
- Department of Anaesthesiology and Critical Care, Medical Trust Hospital, Ernakulam, Kerala, India
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Ramasamy K, Saniasiaya J, Gani NA. A hard left supraclavicular mass in a young boy-is it cancer? MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:53-55. [PMID: 32843947 PMCID: PMC7430310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- K Ramasamy
- MBBS (Malaya) MRCSI (ENT) Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Tuanku Ja'afar Seremban Malaysia E-mail:
| | - J Saniasiaya
- MMed (ORL-HNS)(USM) Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Tuanku Ja'afar Seremban Malaysia
| | - N A Gani
- MMed (ORL-HNS)(UKM) Department of OtorhinolaryngologyHead & Neck Surgery, Hospital Tuanku Ja'afar Seremban Malaysia
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Partiot C, Guillon M, Peressinotto D, Castex D, Maureille B. Cervical ribs in human early life: morphological variability and first identification as a morbidity criterion in a past population. J Anat 2020; 237:119-132. [PMID: 32187701 DOI: 10.1111/joa.13178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/16/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
Abstract
Despite the medical literature on supernumerary cervical ribs in extant adult samples, little is known about their development and occurrence in early infancy. The documentation of cervical ribs in modern samples of fetuses and neonates is indeed affected by ethical as well as technical limitations. The aim of the present study was to investigate their frequencies and morphological variability in the first known archaeological collection of very young children with this anatomical variant. The study sample comes from the 8B-51 necropolis on the Saï island (Sudan) and dates to the Classic Kerma Period (XVIIIe-XVIe centuries BC). It consists of 64 individuals deceased between 24 weeks of amenorrhoea and 2 years of age. Bilateral or unilateral cervical ribs were found in 27 individuals. A total of 43 cervical ribs were identified, 38 of which are fully preserved. According to these observations, at least 42% of the individuals have unilateral or bilateral cervical ribs, with an average maximum length of < 1 cm. This frequency is very high compared to those observed in contemporary adult samples (up to 3%). First, the comparison of our results with biological and genetic research demonstrating the link between the occurrence of cervical ribs and a reduced chance of survival during infancy allows the first identification of this trait as an indicator of morbidity in an archaeological collection, a morbidity to which a genetic homogeneity or even endogamy could contribute. Second, the number of ribs studied makes it possible to propose a morphological classification based on the general shape and the shape of the articular facets, classification that can be used tos refine the analyses of the trait in future samples.
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Affiliation(s)
- Caroline Partiot
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
| | - Mark Guillon
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France.,Inrap, Boulevard de Verdun, Le Grand Quevilly, France
| | - David Peressinotto
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France.,Hades Archéologie, Balma, France
| | - Dominique Castex
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
| | - Bruno Maureille
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
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Thoracic outlet syndrome: a rare case with bilateral cervical ribs and bilateral anterior scalene hypertrophy. J Ultrasound 2019; 24:331-336. [PMID: 31834601 DOI: 10.1007/s40477-019-00418-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022] Open
Abstract
Thoracic outlet syndrome (TOS) is a rare neurovascular disorder generally caused by the presence of a cervical rib or hypertrophic scalene anterior muscle that can compress the brachial plexus and/or subclavian vessels. In the vascular form, the symptoms are caused by the compression of the artery and/or the subclavian vein. In the first case, the compression is caused by the cervical rib and leads to hypo-perfusion with cooling and cyanosis of the upper limb, while in the second case, the compression is caused by the anterior scalene muscle and leads to congestion, cyanosis, swelling and pain in the higher limb. In this paper, we describe a case with the simultaneous presence of a bilateral cervical rib and bilateral hypertrophy of the anterior scalene muscle. TOS diagnosis is based on neurological, clinical and instrumental tests, such as chest radiography and color Doppler ultrasonography. The treatment of these patients can be surgical or conservative.
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