PubMed · 12063812
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Thach Nguyen, Shigeru Saito, Cindy Grines. 2002. Vascular access.. https://doi.org/10.1111/j.1540-8183.2002.tb01049.x
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Our case report details the clinical course and management of a neonate with acute life-threatening respiratory distress presenting soon after birth. She needed intubation and ventilation. A pericardial cyst was diagnosed after a CT scan and 2D echo investigation. As a temporizing procedure the fluid was tapped and the child was electively operated. Postoperatively she made an uneventful and complete recovery. We have reviewed the literature for this rare and often asymptomatic lesion.
The technique of submental intubation in patients with multiple facial fractures and skull base fracture was originally described by Altemir. This technique provides a secure airway and allows intermaxillary fixation while avoiding the complications of nasotracheal intubation or tracheostomy. However, when the endotracheal pilot balloon and endotracheal tube are pulled through the submental incision site using this technique, soft tissues or blood may enter the endotracheal tube and trauma may result in the surrounding tissues. To overcome these problems, we carried out a modification of submental orotracheal intubation using the blue cap on the end of the thoracic catheter in a patient with mandibular fractures and injury to the skull base and found that this modification resulted in a safer and less traumatic intubation.
OBJECTIVE: It is widely recognized that hemodynamic and wall mechanical forces are involved in the initiation and development of atherosclerosis. In the coronary vasculature, these forces are likely mediated by arterial dynamics and geometry. This research examines the hypothesis that coronary artery motion and geometry affect the local predisposition to disease, presumably through their influence on the stresses at and in the artery wall. METHODS AND RESULTS: The dynamics of a human right coronary artery and the variation of wall thickness along its length were characterized from biplane cineangiograms and intravascular ultrasound records, respectively. The dynamic geometry parameters were distance along the vessel, cyclic displacement, axial strain, curvature, and torsion. Multiple regression analyses using principal components show that (1) no single dynamic geometry parameter has a dominant influence on wall thickness, (2) linear combinations of such parameters predict wall thickness measures with high confidence (P<0.001; R2 between 0.17 and 0.44), and (3) both the time-average values of curvature and torsion and their excursion during the cardiac cycle are positively correlated with maximum wall thickness and cross-sectional asymmetry. CONCLUSIONS: The relationships seen here support the hypothesis that dynamic geometry plays a role in the localization of early coronary artery thickening.