scholarly journals Constant painful point in diseases of the liver and biliary tract. Sabatini (after ref. F. Chir., 1926, no. 1)

2021 ◽  
Vol 22 (7) ◽  
pp. 865-866
Author(s):  
M. Friedland
Keyword(s):  
Biliary Tract ◽  
Diagnostic Value ◽  
Intercostal Space ◽  
Lower Point ◽  
The Right

A constant painful point in diseases of the liver and biliary tract lies, according to Sabatini (according to ref. F. Chir., 1926, No. 1), in the X or XI intercostal space of the right side between the paravertebral and scapular lines, corresponding to the "lower point of the liver". Specified point, by authorv. has an important diagnostic value, especially in subacute cholecystitis.

P2426Validating the diagnostic value of a machine learning algorithm for STEMI detection

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
C Villagran ◽  
A Frauenfelder ◽  
...  
Keyword(s):  
Medical Information ◽  
Learning Algorithm ◽  
Artery Bypass ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Diagnostic Value ◽  
Retrospective Case ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
The Right

Abstract Background We have previously reported the use of Artificial Intelligence (AI) guided EKG analysis for detection of ST-Elevation Myocardial Infarction (STEMI). To demonstrate the diagnostic value of our algorithm, we compared AI predictions with reports that were confirmed as STEMI. Purpose To demonstrate the absolute proficiency of AI for detecting STEMI in a standard12-lead EKG. Methods An observational, retrospective, case-control study. Sample: 5,087 EKG records, including 2,543 confirmed STEMI cases obtained via feedback from health centers following appropriate patient management (thrombolysis, primary Percutaneous Coronary Intervention (PCI), pharmacoinvasive therapy or coronary artery bypass surgery). Records excluded patient and medical information. The sample was derived from the International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (53,667 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVIDIA GTX 1070 GPU, 8GB RAM. Results The model yielded an accuracy of 97.2%, a sensitivity of 95.8%, and a specificity of 98.5%. Conclusion(s) Our AI-based algorithm can reliably diagnose STEMI and will preclude the role of a cardiologist for screening and diagnosis, especially in the pre-hospital setting.

The Art of the Clinician

2021 ◽  
Vol 6 (09) ◽  
pp. 612-615
Author(s):  
Rodríguez-Guerra, Miguel, MD ◽  
Pandey, Neelanjana MD ◽  
Shrestha, Elina, MD ◽  
Vittorio, Timothy J. MD
Keyword(s):  
Correct Diagnosis ◽  
Critical Time ◽  
Mitral Valve Regurgitation ◽  
Intercostal Space ◽  
Av Fistula ◽  
Severe Aortic Regurgitation ◽  
Fibrin Sheath ◽  
Diastolic Murmur ◽  
Small Perforation ◽  
The Right

Background: The promotion of clinical abilities could represent a significant factor leading the clinicians to in making the correct diagnosis in a timely matter. Case: Our patient is a 42-year-old African male with a history of Hypertension, ESRD on hemodialysis via right-sided Permcath (PC), Mastoidectomy & Right ear surgery due to trauma in childhood, AV Fistula (Needed intervention 4 times) in left upper extremity, admitted due to witnessed seizures in the setting of hypertensive emergency. The patient denied family history and toxic habits. While the patient was at the emergency room, CT head revealed stable curvilinear hyper-attenuation thought to be a thrombosed developmental vein more likely than small subarachnoid hemorrhage. He was loaded with levetiracetam, received Ativan 1mg IV and HD done as per Nephrology. The patient was transferred to the floor he was not in acute distress and was asymptomatic, the cardiovascular (CV) examination showed regular pulse, normal S1, S2, S4+ appreciated with 2/4 diastolic murmur at second right intercostal space (ICS); 2/6 pansystolic murmur at third right intercostal space left parasternal border (LPSB) radiated to the right parasternal border (RPSB) and right mid-clavicular line (MCL); 3/6 systolic murmur at 5LICS MCL radiated to the posterior axillar line (PAL). Point of maximal impulse (PMI) displaced to mid axillar line (MAL). Parasternal heave present; the neurological exam was preserved. Endocarditis was suspected and echocardiogram was expedited, it showed severe aortic regurgitation, 1.60cm x 1.68cm mass in the tip of the catheter in the right atrium, possible vegetation in the tricuspid valve with mild regurgitation, moderate mitral valve regurgitation. Later, staphylococcus epidermidis was identified in blood cultures twice, as well as the culture from the PC. The transesophageal echocardiogram found 2.41 X 0.62 cm mass appears to be a fibrin sheath, possibly remnant of a prior catheter, small perforation in the non-coronary cusp likely in the setting of healed endocarditis. Infectious disease onboard for antibiotic management. Conclusion: The art of the clinician goes beyond the available technology; it could prevent the loss of critical time as well as unnecessary studies, guiding a better assessment and treatment of our patients and potentially improving their outcomes.

PATENT DUCTUS ARTERIOSUS WITH REVERSAL OF FLOW

PEDIATRICS ◽  
1956 ◽  
Vol 18 (3) ◽  
pp. 410-423
Author(s):  
Ray C. Anderson ◽  
Paul Adams ◽  
Richard L. Varco
Keyword(s):  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Diagnostic Value ◽  
Successful Outcome ◽  
Exertional Dyspnea ◽  
Artery Segment ◽  
Pulmonary Arterial ◽  
The Right ◽  
Patent Ductus

Ten cases are presented of children having patent ductus arteriosus with reversal of shunt. Cyanosis, often greater in the toes, was present in all. Exertional dyspnea developed early. Murmurs were of no diagnostic value, but an accentuated pulmonic second sound was uniformly present. Right ventricular preponderance was found in all cases on the electrocardiogram. Cardiac size varied on roentgenography, but there was usually prominence of the pulmonary artery segment. Six cases showed evidence of bi-directional shunts, one showed only a reversed shunt, while data were insufficient to determine this point in the remaining three. Three patients had surgery, one with a successful outcome. The latter was a 1-year-old infant in whom lung biopsy at surgery revealed only minimal pulmonary arterial changes. Forty-five cases are reviewed from the literature. The majority of these occurred in adults. Twenty-two have been subjected to surgery, four with good results, three of the latter being children. The differential diagnosis is briefly discussed. The safest and simplest diagnostic test to perform is the determination of oxygen saturation of samples of blood obtained simultaneously from the right brachial and femoral arteries. Angiocardiography and cardiac catheterization also provided helpful information. The diagnosis will not be made unless the examiner keeps the entity in mind. The entity can no longer be considered rare. Surgical treatment of the condition has been very disappointing, especially in the adult. There is reason to believe that surgical intervention very early in life will yield a higher salvage rate.

scholarly journals A Case of Multiple Posterior Intercostal Artery Common Trunks in Conjunction with Additional Arterial Variations

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Nicholas R. Fanselow ◽  
Nolan Wallace ◽  
Daniel Sehi ◽  
Lokesh Coomar ◽  
John Martin ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Intercostal Space ◽  
Thoracic Wall ◽  
Thoracic Cavity ◽  
Arterial Variation ◽  
Arterial Variations ◽  
First Case ◽  
Male Cadaver ◽  
The Right ◽  
High Level

Several thoracic vasculature variations were observed in an 81-year-old male cadaver during routine dissection. These included 5 common trunks of posterior intercostal arteries, a descending branch of the right vertebral artery, and atypical neurovascular relationships within intercostal spaces. On the right side, two common trunks of posterior intercostal arteries were observed supplying the 4th-7th intercostal spaces and 9th-11th intercostal spaces, respectively. There was also a small accessary branch supplying the 9th intercostal space. The first three posterior intercostal spaces on the right were supplied by a descending branch of the vertebral artery. On the left side, three common trunks of posterior intercostal arteries were encountered, supplying intercostal spaces 3-5, 6-7, and 11 plus the subcostal space. An atypical neurovascular relationship was observed in the right 6th intercostal space, as well as the left 2nd, 3rd, and 6th intercostal spaces. This is the first case report that presents 5 common trunks of posterior intercostal arteries, as well as common trunks in conjunction with other arterial variation in the posterior thoracic wall. These variations carry a high level of clinical significance and may be helpful in guiding decision-making related to surgical procedures related to the posterior thoracic cavity and spine.

scholarly journals Hepatocholescintigraphy in diagnosis of functional state of biliodigestive anastomoses

2019 ◽  
Vol 24 (1) ◽  
pp. 53-60
Author(s):  
Yu. V. Kulezneva ◽  
L. V. Bondar ◽  
E. A. Vasina ◽  
M. B. Boboeva ◽  
P. M. Cholak ◽  
...  
Keyword(s):  
Biliary Tract ◽  
Functional State ◽  
Bile Flow ◽  
Bile Ducts ◽  
Diagnostic Value ◽  
Bowel Anastomosis ◽  
Biliodigestive Anastomosis ◽  
Intrahepatic Bile Ducts ◽  
Highly Effective ◽  
Flow Through

Aim. To identify diagnostic value of hepatocholescintigraphy for evaluation of functional state of biliodigestive anastomoses (BDA).Material and methods. 99mTc-IDA hepatocholescintigraphy was applied in 52 patients to evaluate function of biliodigestive anastomoses.Results. Scintigraphic signs of “bowel-anastomosis” and/or “BDA-intrahepatic bile ducts” reflux were revealed in 14 (27%) cases. Obstruction of biliodigestive anastomosis occurred in 3 (5.7%) patients. Normal bile flow through BDA was observed in 10 (19.2%) patients, impaired passage – in 21 (40.3%) cases. Tracer delay in intrahepatic bile ducts was noted in 21 (25.0%) cases, signs of adhesive process near deferent bowel – in 3 (3.8%) cases.Conclusion. Hepatocholescintigraphy is highly effective method to assess biliary tract in patients after Roux-en-Y biliodigestive anastomoses formation.

scholarly journals Diagnosis and surgical treatment of liver echinococcosis

2021 ◽  
Vol 26 (4) ◽  
pp. 113-117
Author(s):  
V.O. Shaprinskyi  ◽  
O.O. Vorovskyi ◽  
O.A. Kaminskyi ◽  
Ya.M. Pashynskyi
Keyword(s):  
Blood Loss ◽  
Pleural Cavity ◽  
Abdominal Cavity ◽  
Diagnostic Value ◽  
Results Of Treatment ◽  
Before And After ◽  
Residual Cavity ◽  
Right Lobe ◽  
The Right ◽  
Duration Of Operation

The results of treatment of 72 patients with echinococcosis of the liver were analyzed, women – 62 (86.2%), men – 10 (13.8%). Primary echinococcosis was detected in 69 (95.8%) patients, secondary – in 3 (4.2%). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 63 (87.5%) patients, multiple – in 9 (12.5%). Among patients with solitary cysts, the right lobe was more often affected than the left – 48 (66.7%) vs 24 (33.3%) cases. Echinococcosis of central localization was less common and was noted in 8 (11.1%) cases. Echinococcosis complications were observed in 16 (22.2%) patients. Among them, most often there were suppurations of the cyst – in 13 (18.1%); a bursting of the cyst into the free abdominal cavity – in 1 (1.4%), in the pleural cavity – 1 (1.4%), in the biliary tract – in 1 (1.4%). Partial or complete liming of the hand was observed in 12 (16.7%) patients. In 20 (27.8%) cases, the operation was performed from the upper median access, in 42 (58.3%) – from oblique hypochondria accesses by Kocher or by Fedorov. Pericystectomy was performed in 48 (66.7%) patients, in 8 (11.1%) patients underwent resections of liver segments with an echinococcal cyst, in 4 (5.6%) – cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (16.7%) patients. In the postoperative period complications were observed in 16 (22.2%) patients. The use of the welding electrocoagulator EK-300M "Swarmed" in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from 2200±210 ml to 250±50 ml. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0.0001); duration of operation – 2 times (р<0.05), stay in hospital – 3.3 times (р=0.002). There were no fatal outcomes. Before and after operation antirelapse antiparasitic therapy with albendazole (Vormil) was performed in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was calculated at a rate of 15 mg/kg/day. There were 2 (2.8%) cases of relapse, there was no mortality.

Sternotomy Sparing Thoratec Heartmate 3 Implantation via Bilateral Minithoracotomy

2018 ◽  
Vol 13 (1) ◽  
pp. 74-76 ◽  
Author(s):  
Julia Riebandt ◽  
Dominik Wiedemann ◽  
Guenther Laufer ◽  
Daniel Zimpfer
Keyword(s):  
Left Ventricular ◽  
Ascending Aorta ◽  
Intercostal Space ◽  
Implantation Technique ◽  
Thromboembolic Complications ◽  
Short Term ◽  
Short Term Mortality ◽  
Transplant Candidates ◽  
The Right ◽  
Outflow Graft

A novel sternotomy sparing implantation technique for the Thoratec HeartMate 3 is described. Cannulation of the left ventricular apex is performed via a minithoracotomy in the left fourth or fifth intercostal space. The outflow graft is advanced through the pericardium to a second minithoracotomy in the right second intercostal space and then anastomosed to the ascending aorta. This approach was performed in three patients so far with no need for conversion. We did not observe any perioperative adverse events, such as bleeding or thromboembolic complications, as well as no short-term mortality. This technique is especially appealing in multimorbid and frail patients, future transplant candidates, and patients with impaired right ventricular function.

Unusual giant pleural lipomas: imaging features

2021 ◽  
Vol 14 (6) ◽  
pp. e238870
Author(s):  
Dipin Sudhakaran ◽  
Sheragaru Hanumanthappa Chandrashekhara ◽  
Sunil Kumar ◽  
Mohamed Sulaiman
Keyword(s):  
Intercostal Space ◽  
Parietal Pleura ◽  
Imaging Features ◽  
Thoracic Cavity ◽  
Evolutionary Potential ◽  
The Right

Pleural lipomas are rarely encountered in the thoracic cavity. Sometimes, they infiltrate the intercostal space to have a component on either side of the intercostal space forming a hourglass configuration. They are generally solitary, small and asymptomatic. We present the case of a 49-year-old man with two giant pleural lipomas, both originating from the right parietal pleura, and one of which was passing through the intercostal space giving rise to a hourglass-shaped configuration. When they occur, although benign, considering the evolutionary potential, excision is recommended.

scholarly journals Evaluation of clinical risk factors for developing pleural empyema secondary to liver abscess

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Eunjue Yi ◽  
Tae Hyung Kim ◽  
Jun Hee Lee ◽  
Jae Ho Chung ◽  
Sungho Lee
Keyword(s):  
Risk Factors ◽  
Pleural Effusion ◽  
Liver Abscess ◽  
Biliary Tract ◽  
Clinical Manifestation ◽  
Pyogenic Liver Abscess ◽  
Pleural Empyema ◽  
Patient Characteristics ◽  
Group 2 ◽  
The Right

Abstract Background The aim of this study was to investigate the clinical manifestation and predictive risk factors of pleural empyema developing during treatment of the pyogenic liver abscess. Methods Medical records of patients with the liver abscess in our institution were reviewed retrospectively. Enrolled patients were classified into four groups; Group 1: patients without pleural effusion, Group 2: patients with pleural effusion and who were treated noninvasively, Group 3: patient with pleural effusion and who were treated with thoracentesis, and Group 4: patients with pleural effusion that developed into empyema. Patient characteristics, clinical manifestation, and possible risk factors in development of empyema were analyzed. Results A total of 234 patients was enrolled in this study. The incidence rate of empyema was 4.27% (10 patients). The mean interval for developing pleural effusion was 5.6 ± 6.35 days. In multivariate analysis, risk factors for developing pleural effusion included the location of the liver abscess near the right diaphragm (segment 7 and 8, OR = 2.30, p = 0.048), and larger diameter of the liver abscess (OR = 1.02, p = 0.042). Among patients who developed pleural effusions, presences of mixed microorganisms from culture of liver aspirates (OR = 10.62, p = 0.044), bilateral pleural effusion (OR = 46.72, p = 0.012) and combined biliary tract inflammation (OR = 21.05, p = 0.040) were significantly associated with the need for invasive intervention including surgery on effusion. Conclusion The location of the liver abscess as well as pleural effusion, elevated inflammatory markers, and combined biliary tract inflammation may be important markers of developing pleural complication in patients with pyogenic liver abscess.

scholarly journals Early Response after Catheter Ablation of the Epicardial Substrate in a Patient with Brugada Syndrome Can Be Predicted by High Precordial Leads

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Yae Min Park ◽  
Mi Sook Cha ◽  
Hanul Choi ◽  
Woong Chol Kang ◽  
Seung Hwan Han ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Brugada Syndrome ◽  
Low Voltage ◽  
Early Stage ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Early Response ◽  
Intercostal Space ◽  
The Right ◽  
Fourth Intercostal Space

A 52-year-old male with Brugada syndrome presented with repeated and appropriate shock from an implantable cardioverter defibrillator (ICD). Catheter ablation for substrate elimination targeting low-voltage, complex, and fractionated electrocardiograms and late potentials in the epicardial right ventricular outflow tract was successfully performed. Brugada phenotype in the right precordial leads from the third intercostal space disappeared in the early stage after catheter ablation and that from the standard fourth intercostal space disappeared later. He remained free from ventricular fibrillation over the next fourteen months. We suggest that this novel ablation strategy is effective in Brugada syndrome patients with ICD, and early response after catheter ablation can be predicted by high precordial leads.

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