Management of highly vascular carotid body tumors can involve pre-operative percutaneous embolization before definitive surgical resection. This step reduces tumor size, reduces operative blood loss, and makes for a less hazardous dissection with the goal of reducing morbidity and mortality. The effectiveness of a recently described technique of interrupting vascular supply via covered stent placement in the external carotid artery is further described in a series of three recent cases. This technique may be useful for large tumors with a primary blood supply from the external carotid since it avoids the intracranial embolic risk of coils used for this purpose.
Abstract, Muscular actions that cause specific intrinsic distortions of the erec~ pharynx have not been described in detail. This anatomical study utilized three fresh cadaver specimens to determine specific deformations of the larynx and pharynx caused by simultaneous traction oriented along the long a~is Ofspecific paired muscles. Two specimens were axially transected at the midchest to allow the cephalic portion to stand erect. The first spccimen was dissected, distracted, and photographed. Individual muscles of the final specimen were minireally dissected to disturb soft tissue relationships as little as possible. Radiographs in the lateral posleroa~terior projections of the barium-coated pharynx of the final specimen were then obtained during maximum distraction of each muscle pair.Tracings of the pharyngeal outlines were made from these radiographs.Key words: Pharynx, amttomy -Pharynx, physiology ~ Swallowing, rehabilitation.The pharyngeal space is a tube lined by mucosa, Surrounded hy muscle, and supported from the skull base by the mandible, ligaments, multiple Pairedsome "enmUscles" , the. hyoid, and the larynx [I 6]. the "h~ eric ~aesertptions of muscle actions upon .,. ~ arynx exist, with limited descriptions of the ~tcect of COntractions upon the laryngopharynx [2, This study was designed to examine the deformity caused by manual traction upon paired musclcs of thc pharyngeal tube in the erect fresh cadaver, to obtain a better understanding of the effect of individual muscular actions during the normal swallow to complement existing electromyographic data [11]. It is hoped this study will assist in the diagnosis and therapy of specific dysfunctions in the pharynx. Materials and MethodsThree fresh, previously frozen cadaver specimens were variously dissected after thawing. The first was dissected to familiarize us with the normal relalionships and responsiveness of fresh tissue to deforroation in the supine position. The second specimen was dissected following axia{ torso transection at the upper chest level. The specimen was photographed in the erect position while muscle action of matched muscle pairs was simulated using surgical forceps to provide maximal traction oriented along the muscle tiber axis (Fig. II. The third specimen was also axially transsected at the upper chest to allow it to stand upright. Lateral erect radiographs were obtained with the head supported in mild hyperextenskm. The dermis and platysma were then removed and additional lateral radiographs were obtained with the specimen in the tni/dy extended erect position. The remaining intrathoracic structures (trachea, lung, great vessels) were removed to reduce gravitational resistance to pull and, hence, more realistically simulate the {iving condition by which the inflated lungs and diaphram support the trachea. I.aterul radiographs were then obtained while maximal traction using surgical clamps ~vas applied to each muscle pair toward the muscle origin along the fiber orientation (Fig. 2). The mouth and pharynx were then coated wit...
The authors encountered a patient with an indwelling central venous catheter who presented with pulmonary edema after the catheter hub was disconnected. Pulmonary arteriography demonstrated diffuse peripheral vasoconstriction, decreased arterial-to-venous transit time, and arterial occlusions. The former two findings allowed the authors to prospectively suggest the diagnosis of pulmonary air embolism.
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