Purpose
The deep temporal vein (DTV) can be used in free flap procedures when the superficial temporal vein is inadequate. Despite its potential utility, its branching patterns have only been examined in one small anatomic study. The purpose of this study was to examine computed tomography angiography (CTA) images to determine DTV location, variation, and suitability as a microvascular recipient, to provide surgeons with a guide for its use in head and neck defects.
Methods
A retrospective chart review identified 152 patient CTA images (76 female; 76 male) in a single academic center imaging database, selected consecutively from January 2017 to April 2020. Patients under 19 years were excluded; ages ranged from 19 to 80 years (average 51.6 years). Reason for imaging, DTV caliber, laterality, distance to zygomatic arch (ZA [coronal and sagittal]), distance to lateral orbital rim (LOR), and branching pattern were recorded.
Results
The predominant reason for imaging was to rule out cerebrovascular accident (96.2%). Average caliber was 3.46 ± 1.29 mm (95% confidence interval [CI] [3.32, 3.61]; range, 1.00–10.8). Bilateral DTVs were observed in 98.7% of patients. Average distance to landmarks were as follows: ZA (coronal), 13.8 ± 5.85 mm (95% CI [13.2, 14.5]; range, 2.7–33.8); ZA (sagittal), 15.1 ± 6.12 mm (95% CI [14.1, 16.1]; range, 2.8–47.2); LOR, 47.1 ± 9.09 mm (95% CI [46.0, 48.1]; range, 10.8–62.9). Seven branching patterns were identified, including a posterior vertical variant that bypasses the superficial temporal fat pad.
Conclusions
The DTV is a “lifeboat” option for head and neck reconstruction. Its average caliber is sufficient for use in microsurgery. Knowledge of both its typical and aberrant courses allow for efficient preoperative planning and surgical dissection. CTA is a useful adjunct when planning to use the DTV for free tissue transfer.
We present the case of 30-year old primigravida female at 11 weeks’ gestation who was diagnosed to have ectopic pregnancy on obstetric ultrasound. An MRI pelvis was ordered to assess invasion into the posterior myometrium which confirmed a single right-sided broad ligament-extra uterine pelvic ectopic pregnancy with extrinsic mass effect on the right lower uterine segment without frank myometrial invasion. On an urgent basis, a uterine artery embolization (UAE) was performed by targeting the right femoral artery. Selective catheterization was performed of both uterine arteries and the right side showed a major feeder of the gestational sac. Supplied dose of methotrexate (95mg) was infused in the right uterine artery and both arteries were then embolized by gel foam slurry. Thus, prompt treatment reduced the risk of infertility and saved the patient from obstetrical emergency. Further exploration needs to be done in this field to explore conservative management options to preserve fertility.
Objective: To find out the level of depression, anxiety and stress on the basis of education among female medical and non medical students. Study Design: Cross sectional descriptive study. Study place and duration: Study was conducted at Nishtar medical college, Multan and Bahaudin Zakarya University Multan from October 2020 to October 2021. Methodology: The study was conducted on 100 medical students and 100 non medical students from two institutions of Multan. Depression and Anxiety stress scale (DASS) was used for evaluation of outcomes. SPSS version 23 was used for data analysis. T-test was applied to assess score differences of depression, anxiety and stress between medical and non medical students. Quantitative variables were presented as mean and standard deviation, whereas qualitative variables were presented as frequency and percentages. Probability value≤0.05 was considered as significant. Results: Mean age of participants was 24.2±1.80 years and 14.5% were living away from their families. Mean score for depression in medical students were: 13.96±7.289 and for depression in non medical students were: 16.02±6.374, for anxiety in medical students were: 17.15±6.936 for anxiety in non medical students were: 14.33±5.829, for stress in medical students were: 14.61±5.148 and for stress in non medical students were:14.73±6.078. Correlation of stress with depression was significant: r =.045, p<0.05, whereas correlation of stress with anxiety was non-significant r=.131, p˃0.05. Conclusion: Female medical students had low level of depression but high level of anxiety and stress as compared to non medical students. Presence of stress was correlated with presence of depression among medical and non medical students. Keywords: Depression, Anxiety, stress, Medical students, Non medical students, Pakistan
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