Innominate Artery Compression of the Trachea in Infants with Reflex Apnea

1980 ◽  
Vol 89 (5) ◽  
pp. 401-405 ◽  
Author(s):  
Joseph M. Ardito ◽  
Robert H. Ossoff ◽  
Gabriel F. Tucker ◽  
Serafin Y. deLeon
Keyword(s):  
Innominate Artery ◽  
Vascular Anomaly ◽  
Respiratory Arrest ◽  
Surgical Correction ◽  
Memorial Hospital ◽  
Tracheal Compression ◽  
History Of ◽  
Rule Out

Compression of the trachea by an anomalous innominate artery in association with reflex apnea is a frequent cause of respiratory arrest in infants. Once considered, tracheoscopy is mandatory to rule out this disorder. Surgical correction of this condition by innominate arteriopexy has proven to be a very effective method of management. Seventy-eight patients with tracheal compression by an anomalous innominate artery managed by the authors at The Children's Memorial Hospital in Chicago between January 1977 and December 1979 are presented. In this series, 28 patients had a history of one or more episodes of reflex apnea; all of these patients underwent an innominate arteriopexy. A complete review of this syndrome and methods of its diagnosis are scrutinized. We agree with previous authors that reflex apnea is a definite indication for surgical correction of this vascular anomaly causing tracheal compression, but other indications are delineated.

Innominate Artery Compression of the Trachea: Diagnosis and Treatment by Anterior Suspension a 25-Year Experience

1995 ◽  
Vol 104 (12) ◽  
pp. 924-927 ◽  
Author(s):  
Stephen C. Adler ◽  
Glenn Isaacson ◽  
Rohinton K. Balsara
Keyword(s):  
Operative Procedure ◽  
Innominate Artery ◽  
Infants And Children ◽  
Morbidity And Mortality ◽  
Diagnosis And Treatment ◽  
Anastomotic Site ◽  
Reliable Operation ◽  
Tracheal Compression ◽  
Minimal Morbidity ◽  
History Of

Suspension of the innominate artery to the sternum has been a widely accepted therapy for the relief of tracheal compression. Recently, reimplantation of the innominate artery has been advocated as a superior operative procedure. While generally successful, arterial transfer carries the risk of early bleeding and stroke, and the potential for late stenosis at the anastomotic site. Between 1969 and 1994, 25 infants and children at our institution received diagnoses of innominate artery compression and were treated by anterior suspension. All presented with stridor and one third had a history of suspected or proven apnea. Twenty-four children had excellent results, while 1 required resuspension after stridor returned. There were no major complications. Our series strongly supports the belief that anterior suspension of the innominate artery is a successful and reliable operation with minimal morbidity and mortality. More complex procedures are rarely indicated.

Innominate Artery Compression of the Trachea in Infants

1994 ◽  
Vol 103 (5) ◽  
pp. 347-350 ◽  
Author(s):  
Dwight T. Jones ◽  
Richard A. Jonas ◽  
Gerald B. Healy
Keyword(s):  
Innominate Artery ◽  
Respiratory Arrest ◽  
Feeding Problems ◽  
Tracheal Compression ◽  
Feeding Difficulties ◽  
The Past ◽  
Proper Patient Selection ◽  
Follow Up Care ◽  
Before And After

Innominate artery compression of the trachea in infants can cause severe biphasic stridor, cyanosis, and respiratory arrest. These episodes are sometimes referred to as “dying spells.” In the past, aortopexy has been used for the treatment of this problem, but since many have questioned its success, its use has not been popularized or generally accepted. Over the past 4 years, 12 children have been successfully treated for innominate artery compression of the trachea with aortopexy. These children all initially presented with significant respiratory and/or feeding difficulties. Preoperative and postoperative videos were obtained to document the degree of tracheal compression and/or lumen size before and after surgery. Since treatment, all patients have been without further feeding problems or cyanosis. When performed in selected patients, aortopexy is successful in relieving tracheal obstruction from innominate artery compression. This article discusses proper patient selection, operative technique, and follow-up care. The management of compression in patients with less severe symptoms will also be addressed.

Case Exercise: Toxic Exposure-Related Illness: Causation, Diagnosis, and Permanent Impairment

2007 ◽  
Vol 12 (2) ◽  
pp. 4-8
Author(s):  
Frederick Fung
Keyword(s):  
Concentration Level ◽  
Treatment Plan ◽  
Toxic Exposure ◽  
Dose Response Relationship ◽  
Specialty Board ◽  
History Of ◽  
Subjective Complaints ◽  
Based Medicine ◽  
Illness Causation ◽  
Rule Out

Abstract A diagnosis of toxic-related injury/illness requires a consideration of the illness related to the toxic exposure, including diagnosis, causation, and permanent impairment; these are best performed by a physician who is certified by a specialty board certified by the American Board of Preventive Medicine. The patient must have a history of symptoms consistent with the exposure and disease at issue. In order to diagnose the presence of a specific disease, the examiner must find subjective complaints that are consistent with the objective findings, and both the subjective complaints and objective findings must be consistent with the disease that is postulated. Exposure to a specific potentially causative agent at a defined concentration level must be documented and must be sufficient to induce a particular pathology in order to establish a diagnosis. Differential diagnoses must be entertained in order to rule out other potential causes, including psychological etiology. Furthermore, the identified exposure at the defined concentration level must be capable of causing the diagnosis being postulated before the examiner can conclude that there has been a cause-and-effect relationship between the exposure and the disease (dose-response relationship). The evaluator's opinion should make biological and epidemiological sense. The treatment plan and prognosis should be consistent with evidence-based medicine, and the rating of impairment must be based on objective findings in involved systems.

scholarly journals Cleft lip: The historical perspective

2009 ◽  
Vol 42 (S 01) ◽  
pp. S4-S8
Author(s):  
S. Bhattacharya ◽  
V. Khanna ◽  
R. Kohli
Keyword(s):  
19Th Century ◽  
Historical Perspective ◽  
Cleft Lip ◽  
Wedge Resection ◽  
Surgical Correction ◽  
Bilateral Cleft Lip ◽  
History Of ◽  
Evil Spirits ◽  
The 19Th Century ◽  
Two Sides

ABSTRACTThe earliest documented history of cleft lip is based on a combination of religion, superstition, invention and charlatanism. While Greeks ignored their existence, Spartans and Romans would kill these children as they were considered to harbour evil spirits. When saner senses prevailed Fabricius ab Aquapendente (1537–1619) was the first to suggest the embryological basis of these clefts. The knowledge of cleft lip and the surgical correction received a big boost during the period between the Renaissance and the 19th century with the publication of Pierre Franco's Petit Traité and Traité des Hernies in which he described the condition as “lièvre fendu de nativitè” (cleft lip present from birth). The first documented Cleft lip surgery is from China in 390 BC in an 18 year old would be soldier, Wey Young-Chi. Albucasis of Arabia and his fellow surgeons used the cautery instead of the scalpel and Yperman in 1854 recommended scarifying the margins with a scalpel before suturing them with a triangular needle dipped in wax. The repair was reinforced by passing a long needle through the two sides of the lip and fixing the shaft of the needle with a figure-of-eight thread over the lip. Germanicus Mirault can be credited to be the originator of the triangular flap which was later modified by C.W. Tennison in 1952 and Peter Randall in 1959. In the late 50s, Ralph Millard gave us his legendary ‘cut as you go’ technique. The protruding premaxilla of a bilateral cleft lip too has seen many changes throughout the ages OE from being discarded totally to being pushed back by wedge resection of vomer to finally being left to the orthodontists.

Attempted suicide attention at an emergency room: A hospital-based descriptive approach

2016 ◽  
Vol 33 (S1) ◽  
pp. S603-S603
Author(s):  
D. Torres ◽  
G. Martinez-Ales ◽  
M. Quintana ◽  
V. Pastor ◽  
M.F. Bravo
Keyword(s):  
Emergency Room ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Psychiatric Hospitalization ◽  
Study Results ◽  
History Of ◽  
Competing Interest ◽  
Reported Data ◽  
Medium Cost ◽  
Rule Out

IntroductionSuicide causes 1.4% of deaths worldwide. Twenty times more frequent, suicide attempts entail an important source of disability and of psychosocial and medical resources use.ObjectiveTo describe main socio-demographical and psychiatric risk factors of suicide attempters treated in a general hospital's emergency room basis.AimsTo identify individual features potentially useful to improve both emergency treatments and resource investment.MethodsA descriptive study including data from 2894 patients treated in a general hospital's emergency room after a suicidal attempt between years 2006 and 2014.ResultsSixty-nine percent of the population treated after an attempted suicide were women. Mean age was 38 years old. Sixty-six percent had familiar support; 48.5% had previously attempted a suicide (13% did not answer this point); 72.6% showed a personal history of psychiatric illness. Drug use was present in 38.3% of the patients (20.3% did not answer this question); 23.5% were admitted to an inpatient psychiatric unit. Medium cost of a psychiatric hospitalization was found to be 4900 euros.ConclusionThis study results agree with previously reported data. Further observational studies are needed in order to bear out these findings, rule out potential confounders and thus infer and quantify causality related to each risk factor.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Osteoporosis-Related Simultaneous Four Joints Fractures and Dislocation after a Seizure: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-4
Author(s):  
Abdullah S. AlOmran
Keyword(s):  
Vitamin D ◽  
Case Report ◽  
Clinical Examination ◽  
Epileptic Seizures ◽  
Antiresorptive Therapy ◽  
Multiple Fractures ◽  
Steroid Use ◽  
Skeletal Injury ◽  
History Of ◽  
Rule Out

A case of steroid-induced osteoporosis-related multiple fractures and dislocations are described after a seizure is reported. Patient had two years history of steroid use with no supplement or antiresorptive therapy. There was a delay in the diagnosis which affected an otherwise good outcome in such situations. It is recommended that patients on steroid should be given calcium, vitamin D, and an antiresorptive. Furthermore, a meticulous clinical examination is required in patients who are on steroids and suffer epileptic seizures to rule out skeletal injury.

scholarly journals The boundary between the domains of the Kosaca and the Brankovic south of the Tara river

Balcanica ◽  
2004 ◽  
pp. 91-158
Author(s):  
Milos Lukovic
Keyword(s):  
Nineteenth Century ◽  
River Valley ◽  
Historical Sources ◽  
Accurate Identification ◽  
Long Period ◽  
Feudal Lord ◽  
History Of ◽  
The Moment ◽  
The Village ◽  
Rule Out

With the partitioning in 1373 of the domain of Nikola Altomanovic, a Serbian feudal lord, the old political core of the Serbian heartland was shattered and the feudal Bosnian state considerably extended to the east. The region was crossed by the Tara river, mostly along the southeast-northwest "Dinaric course". Although the line along which Altomanovic?s domain was partitioned has been discussed on several occasions and over a comparatively long period, analyses show that the identification of its section south of the Tara is still burdened by a number of unanswered questions, which are the topic of this paper. An accurate identification of this historical boundary is of interest not only to historiography, but also to archaeology ethnology, philology (the history of language and dialectology in particular) and other related disciplines. The charters of Alphonse V and Friedrich III concerning the domain of herceg Stefan Vukcic Kosaca, and other historical sources relating to the estates of the Kosaca cannot reliably con?rm that the zupa of Moraca belonged to the Kosaca domain. The castrum Moratsky and the civitate Morachij from the two charters stand for the fortress near the village of Gornje Morakovo in the zupa of Niksic known as Mrakovac in the nineteenth century, and as Jerinin Grad/Jerina?s Castle in recent times. The zupa of Moraca, as well as the neighbouring Zupa of Brskovo in the Tara river valley, belonged to the domain of the Brankovic from the moment the territory of zupan Nikola Altomanovic was partitioned until 1455, when the Turks ?nally conquered the region thereby ending the 60-year period of dual, Serbian-Turkish, rule. Out of the domain of the Brankovic the Turks created two temporary territorial units: Krajiste of Issa-bey Ishakovic and the Vlk district (the latter subsequently became the san?ak of Vucitrn). The zupa of Moraca became part of Issa-bey Ishakovic?s domain, and was registered as such, although the fact is more di?cult to see from the surviving Turkish cadastral record. The zupa of Moraca did not belong to the vilayet of Hersek, originally established by the Turks within their temporary vilayet system after most of the Kosaca domain had been seized. It was only with the establishing of the San?ak of Herzegovina that three nahiyes which formerly constituted the Zupa of Moraca (Donja/Lower Moraca, Gornja/Upper Moraca and Rovci) were detached from Issa-bey?s territory and included into the San?ak of Hercegovina. It was then that they were registered as part of that San?ak and began to be regarded as being part of Herzegovina.

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