EditorÐHaving read the case report 1 and related study of neck vessel anatomy by Shlugman and colleagues, we wish to add our own experience and offer a further anatomical basis for the practice of ultrasound scanning before percutaneous dilatational tracheostomy (PDT). It was previously not our practice to scan patients before PDT until we experienced a single case of profound arterial bleeding requiring surgical intervention. The vessel responsible was identi®ed as a`thyroid ima' artery (lowest thyroid artery/Naubauer's artery), which exists in 2±12% of the population. This normal variant of neck anatomy may, if not identi®ed, lead to signi®cant morbidity. The importance of considering this vessel is increased in the Asian population, in whom anatomical studies have identi®ed a higher incidence. 2 It is now our practice to scan for vessels before PDT and speci®cally exclude a thyroid ima artery.
Figure.The larynx of a 33-year-old fe male professional singer shows what might be interpreted as severe leukoplakia of the true vocal folds, arytenoids, and some supraglotti c structures. It is actually candidiasis.
Hexadimethrine bromide was used for the neutralization of heparin during cardiac surgery in the late 1950s. For some years, this institution has used it for patients who may be allergic to protamine. In view of the recent renewal of interest in hexadimethrine, we present four cases outlining its use during cardiac procedures in such patients. Other drugs for reversing the action of heparin such as heparinase or platelet factor IV are not yet widely available.
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