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PubMed1974

[A case of abnormal venous drainage of the whole left lung into the left innominate venous trunk].

In this case, the drainage of all the left lung veins of gathered in a common trunk into the left innominate venous trunk was combined with an atrial septal defect and partition of the left atrium. The rarity of such cases in the literature is due to the fact that it is an uncommon anatomical anomaly and that very often it is symptomless, and therefore does not induce the subjects with this anomaly to seek medical advice. In the case reported, surgical treatment consisted in closing the atrial septal defect, resecting the abnormal left atrial partition and in re-establishing the drainage of the left lung veins into the left atrium through a wide latero-lateral anastomosis with ligature of the abnormal left pulmonary venous trunk as its junction with the left innominate venous trunk.

Adult↗

PubMed1984

Autoradiographic analysis of cell proliferation and protein synthesis in the pulmonary trunk of rats during the early development of hypoxia-induced pulmonary hypertension.

The results of this study indicate that both cell proliferation and increased synthesis of extracellular matrix protein contribute to hypertrophy of the rat pulmonary trunk during the early development of hypoxia-induced pulmonary hypertension. As determined by autoradiography after 3H-thymidine injection, pulmonary hypertension results in increased labelling in all cell compartments of the pulmonary trunk wall, the most dramatic response occurring in the adventitia following 3 days' hypoxic exposure. Autoradiography also demonstrated differences in the degree of incorporation of 3H-proline into extracellular protein between hypoxic (3 and 21 days) and control rats. The major focus of 3H-proline incorporation shifted from the adventitia at 3 days to the tunica media at 21 days, although incorporation was significantly higher at 3 compared to 21 days in all wall compartments. The patterns of hyperplasia and matrix protein synthesis in the extrapulmonary arteries of the rat, as reported here, are distinctly different from those seen in many large elastic arteries during development of systemic hypertension. For example, the hyperplastic response of arterial vessels follows a similar temporal sequence in pulmonary and systemic hypertension. However, the adventitia is the region of the pulmonary trunk with highest cell proliferation in pulmonary hypertension while the media is most affected by systemic hypertension. The relevance of the changing patterns of cell proliferation and protein synthesis in the wall of the pulmonary trunk of chronically hypoxic rats to the structural and biochemical properties of this vessel during the early development of pulmonary hypertension is discussed.

Animals↗

PubMed1982

Mesectodermal capabilities of the trunk neural crest of birds.

Orthotopic transplantation experiments have shown that in birds, under normal conditions, mesectodermal capabilities seem restricted to the cephalic neural crest down to the level of the 5th somite. In the present study the mesectodermal capabilities of trunk and lumbar neural crest were investigated at early stages of development by heterotopic, heterospecific transplantation of the neural primordium. The quail-chick nuclear marker system was used to identify the grafted cells. Mesectodermal cells did not arise from the trunk neural crest when this was implanted orthotopically, even though the neural primordium was taken early in development at the level of unsegmented plate mesoderm just anterior to Hensen's node. Mesectodermal derivatives (connective tissues, dermis and muscle but no cartilage or bone) developed from the same trunk neural crest fragments when they were heterotopically grafted at the cephalic level and mixed with host cephalic neural crest cells. These host cephalic neural crest cells emigrated from the contralateral neural primordium when the graft was unilateral or from the fringe area of the operation in cases of bilateral transplantations. As a control, unsegmented paraxial mesoderm was inserted alongside the cephalic neural tube; its cell did not migrate ventrally in the neural crest-derived area and they differentiated in the dorsal region of the host. These results indicate that mesectodermal capabilities, thought reduced, exist in the trunk neural crest at early stages of development but the differentiation of these mesectodermal derivatives is largely dependent upon environmental influences which may be found in early cephalic levels.

Animals↗

PubMed1980

[Clinical and morphological comparisons in extravasal stenosis of the celiac trunk].

The results of clinico-morphological examinations of 155 patients (of them 118 operated on) with extravasal stenosis of the celiac trunk due to the squeezing of the celiac plexus by the median arcuate ligament, cruses of the diaphragm, and neurofibrous tissue are presented. All the patients had the symptoms typical of "abdominal angina". The tissues taking part in the squeezing of the celiac trunk: the sympathetic ganglion (27 patients), nerve trunks (66 patients), and the surrounding connective tissue (48 patients) were all characterized by inflammatory and sclerotic alterations. Alterations in the form of manifestations of the peptic and duodenal ulcer were found in 18.7% of the patients and various variants of chronic gastritis in 95.4%. Morphological investigations of the liver condition (78 patients) revealed changes in this organ (increased content of lipofuscin, sclerosis, protein and fatty dystrophy, infiltration). The clinical manifestations and morphological alterations are caused by the blood flow disturbance in the celiac trunk due to its stenosis.

Abdomen↗

PubMed1994

[The clinical picture of stenoses of the trunk of the left coronary artery].

In 1991-1993 the authors made at the Second Medical Clinic of the Faculty Hospital in Hradec Králové 651 coronarographic examinations: in 460 patients they detected ischaemic heart disease, of the latter 44 (9.6%) suffered from stenosis of the trunk of the left coronary. During the premorbid period the authors evaluated the grade of stenocardia according to the Canadian cardiovascular classification and also the incidence, number of coronary attacks and reason for indicating coronarography. In 29 patients (66%) the authors made an ergometric examination--in 82.8% the finding was positive and in 17.2 negative. The loading test was unequivocally positive only in complete obstruction of the left coronary, in case of multiarterial affection almost in all cases. Coronarography revealed only in 4 patients (9%) isolated stenosis of the trunk of the left coronary, most frequently the finding was also on two other (36.4%) or 3 (34.1%) arteries. Complete occlusion of the trunk of the left coronary was recorded in 6.8%. An ejection fraction of 50% or more was recorded in 75% of the patients. Surgical revascularization was performed in 35 patients. Twenty-nine patients are followed up after operation on a long-term basis (on average for 7.8 months), 23 of the patients report improvement of their complaints (65.7%). The investigation provided evidence that stenosis of the trunk of the left coronary is a relatively frequent finding in the patient population with ischaemic heart disease and that it is most frequently associated with affection of two and three arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗

PubMed1994

Isokinetic trunk testing and employment.

Isokinetic trunk testing is often performed to evaluate ability to perform job tasks. The purpose of this study was to evaluate the effectiveness of isokinetic trunk testing in identifying people with limited functional lifting capability and likely future injury potential. Two hundred thirty work applicants for heavy labor in a steel mill underwent job-related lifting ability and isokinetic trunk evaluation. There was no difference between the isokinetic scores of women who did not meet the job lifting criteria and those who did meet the lifting criteria. There was no difference between the isokinetic scores of workers who experienced occupational low back injury and those workers who did not over almost a 6-year follow-up period. In this study isokinetic trunk evaluation was of no value in employee selection.

Adolescent↗

PubMed1993

[Arterial anatomy of the celiac trunk and the superior mesenteric artery with computerized tomography].

A hundred patients with different conditions underwent CT and the results were retrospectively reviewed to evaluate the visibility of the celiac trunk, of its branches and of the superior mesenteric artery. Thirty-six patients underwent angiography too, which allowed the anatomical variants suspected on CT to be demonstrated, according to Kuhns' criteria. The other 64 patients were consecutively selected and only aneurysmal changes were not included. All examinations were performed using a General Electric 9800 Advantage scanner, with 2 second scanning time and 10 mm-thick contiguous scans. In 20 patients 5 mm contiguous scans were performed. All examinations followed i.v. injections of contrast agents which were given with an automatic injector. The cases with suspected anatomical variants on CT but with no angiographic confirmation were not considered. A hundred CT exams were retrospectively reviewed: the celiac trunk and the common hepatic artery were demonstrated in all of them. Visibility of the other branches was 40% for the hepatic artery, 53% for the right branch of the hepatic artery and 39% for its left branch, 70% for the gastroduodenal artery, 82% for the left gastric artery, 97% for the splenic artery and 100% for the superior mesenteric artery. As for the 36 patients who underwent both CT and angiography, right hepatic artery from the superior mesenteric artery was seen in 19% of cases with both modalities; common hepatic artery arising from the superior mesenteric artery was detected in 2% of cases. In both instances, these anatomical variants appeared as a vessel running posterior to the portal vein. The careful investigation of axial CT scans showed the level of origin of the artery from the superior mesenteric artery. These results are in agreement with the angiographic data reported in the literature. Our study demonstrated that the celiac trunk and its variants are always depicted by the new CT scanner. The knowledge of these variants may be useful in the patients to submit to liver surgery. The celiac trunk and its variants are demonstrated with conventional 10 mm slices. The use of 5 mm slices improves the visibility of thin anatomical branches but is not essential to recognize the major vessels and anatomical variants.

Celiac Artery↗

PubMed1995

Medullary and gangliar regeneration after unilateral removal of a segment of spinal cord of the trunk and corresponding ganglion in adult newts.

Regeneration of the spinal cord, segmental nerves and sensory ganglia takes place after tail amputation in the newt. Many histological and immunocytochemical observations provide evidence that the ependymal tube is the source not only of new neurons and glial cells in the spinal cord, but also of some cells that go on to participate in the formation of the spinal ganglia of the regenerating tail. In previous experiments involving the removal of the spinal ganglia of the trunk, no regeneration was observed and it is thought that the trunk region differs from the tail region with regard to the ability to regenerate sensory ganglia. However, in these experiments the spinal cord of the trunk was not damaged. In the present work involving adult newts (Triturus carnifex Laur.), unilateral ablation of a segment of the spinal cord of the trunk in addition to removal of a corresponding spinal ganglion was performed. In these experimental conditions, regeneration of a rudimentary spinal ganglion near the regenerated side of the spinal cord segment was observed in several cases. Histological observations carried out 2, 4, 6 and 13 months after the operation support the view that some cells migrating from the lateroventral part of the regenerating side of the spinal cord via the developing ventral root could participate in the formation of the rudimentary spinal ganglion.

Amputation, Surgical↗

PubMedDate not supplied

Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial.

OBJECTIVES: To study the relative efficacy of three different treatment for chronic low back pain (CLBP). Two preplanned comparisons were made: (a) Spinal manipulative therapy (SMT) combined with trunk strengthening exercises (TSE) vs. SMT combined with trunk stretching exercises, and (b) SMT combined with TSE vs. nonsteroidal anti-inflammatory drug (NSAID) therapy combined with TSE. STUDY DESIGN: Interdisciplinary, prospective, observer-blinded, randomized clinical trial with a 1-yr follow-up period. The trial evaluated therapies in combination only and was not designed to test the individual treatment components. SETTING: Primary contact, college out-patient clinic. PATIENTS: In total, 174 patients aged 20-60 yr were admitted to the study. MAIN OUTCOME MEASURES: Patient-rated low back pain, disability, and functional health status at 5 and 11 wk. INTERVENTIONS: Five weeks of SMT or NSAID therapy in combination with supervised trunk exercise, followed by and additional 6 wk of supervised exercise alone. RESULTS: Individual group comparisons after 5 and 11 wk of intervention on all three main outcome measures did not reveal any clear clinically important or statistically significant differences. There seemed to be a sustained reduction in medication use at the 1-yr follow-up. in the SMT/TSE group. Continuance of exercise during the follow-up year, regardless of type, was associated with a better outcome. CONCLUSION: Each of the three therapeutic regimens was associated with similar and clinically important improvement over time that was considered superior to the expected natural history of long-standing CLBP. For the management of CLBP, trunk exercise in combination with SMT or NSAID therapy seemed to be beneficial and worthwhile. The magnitude of nonspecific therapeutic (placebo) effects, cost-effectiveness and relative risks of side effects associated with these types of therapy need to be addressed in future studies.

Adult↗

PubMed1997

Basal cell carcinoma of trunk and extremities.

BACKGROUND: Basal cell carcinoma is the most common malignancy in Caucasians. Information about basal cell carcinoma in the Mexican population is scarce. OBJECTIVE: To determine the epidemiologic and clinical characteristics and treatment results of basal cell carcinoma located on the trunk and extremities of patients seen at the Instituto Nacional de Cancerología of Mexico. METHODS: A retrospective study was performed of patients with confirmed diagnosis of basal cell carcinoma located on the trunk and extremities seen at the Instituto Nacional de Cancerología of Mexico between 1966 and 1993. RESULTS: Ninety-one patients with basal cell carcinoma located on the trunk and extremities were found (6% of all patients with diagnosis of basal cell carcinoma). The median age was 64 years; 52% of the patients were women and 48% were men. A total of 119 basal cell carcinomas at these locations were diagnosed. The size of the skin tumor ranged from 0.3 to 22 cm (mean, 3.9 cm). Treatment results were evaluated in 62 patients (follow-up ranged from 24 to 240 months; mean, 80 months). Overall tumor control was accomplished in 95% of cases. Three patients died as a result of basal cell carcinoma. CONCLUSIONS: Basal cell carcinoma in the Mexican population is not as infrequent as previously thought, although it is less commonly located on the trunk and extremities than in Caucasians.

Adult↗

PubMed1998

A new classification of molar furcation involvement based on the root trunk and horizontal and vertical bone loss.

This study presents a new classification of molar furcation involvement based on the root trunk and horizontal and vertical attachments, and relates them to guidelines in diagnosis, prognosis, and treatment of molar furcation involvements. The type of root trunk were classified on the basis of the ratio of vertical dimension of root trunk to root length as types A, B, and C. Based on the results of this study, the authors conclude that consideration of the root trunk type as well as the horizontal and vertical attachment loss in the classification of molar furcation involvements may facilitate prognosis, diagnosis, and treatment planning.

Alveolar Bone Loss↗

PubMed1998

A variation of coeliac trunk.

The anatomical variations of the coeliac trunk are due to developmental changes in the ventral splanchnic arteries. This report describes a case in which the left inferior phrenic artery and left gastric artery arose from the long coeliac trunk (4.3 cm.) via a common trunk. The arterial variations, like other anatomical variations, cannot be ignored during the operative procedures in abdomen. Therefore the different forms of variations concerning the coeliac trunk should be kept in mind during both surgical and non-surgical evaluations.

Aged↗

PubMed1998

Fatal car trunk entrapment involving children--United States, 1987-1998.

During July-August 1998, at least 11 U.S. children died in three separate incidents of car trunk entrapment. This report summarizes these three incidents, describes characteristics of car trunk entrapment incidents involving children since 1987, and reviews measures to prevent children from becoming trapped in car trunks. The findings indicate that at least nine incidents of fatal car trunk entrapment involving children occurred during 1987-1998, that all incidents occurred in hot weather and involved children aged < or =6 years, and that these deaths were preventable.

Accidents↗

PubMed1998

Feasibility of intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk.

OBJECTIVE: We sought to evaluate the feasibility and results of intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk. PATIENTS AND METHODS: Between May 1993 and October 1996, we treated eight patients with local stenosis of the innominate artery. Seven lesions were situated in the proximal and one in the middle third of the brachiocephalic trunk. Five patients were men and three were women, with ages ranging from 55 to 72 years (mean 59.5 years). All stenoses provoked severe blood flow reduction and caused clinical symptoms. Procedures were performed in an operating suite with fluoroscopic imaging capabilities. Through an anterolateral cervical approach the right common carotid artery was surgically exposed and then clamped to avoid atheroembolization during the subsequent procedure. Retrograde catheterization was performed to reach the stenosis of the brachiocephalic trunk. The lesion was dilated with a balloon catheter and successively stented. Follow-up examinations (color-coded duplex sonography, accompanied by clinical inspection and systolic blood pressure) were scheduled every 6 months. RESULTS: In all patients the dilation of the stenosis of the innominate artery and the stent placement were successful without any side effects. No embolic events or other complications occurred. The postintervention angiography showed successfully dilated stenoses and patent stents in all cases. The technical success rate was 100%. CONCLUSIONS: On the basis of our preliminary data, we believe that, in selected patients, intraoperative balloon angioplasty of stenosis of the innominate artery with stent placement from the right common carotid artery approach is a safe and effective alternative to conventional operations.

Aged↗

PubMed1995

Extrathoracic reconstruction of arterial occlusive disease involving the supraaortic trunks.

PURPOSE: The purpose of this study was to review the various extrathoracic reconstruction options in patients with occlusive disease of the supraaortic trunks and to define the efficacy of these procedures in maintaining graft patency and relieving symptoms. METHODS: Forty-four consecutive patients underwent 47 extrathoracic bypass procedures of the supraaortic trunks for correction of symptomatic subclavian (SCA), common carotid (CCA) or innominate (INA) artery occlusive disease between July 1975 and May 1994. SCA stenosis (n = 27) was associated with upper extremity claudication (55%), vertebrobasilar insufficiency (15%), or both (30%). CCA stenosis (n = 14) was accompanied by hemispheric symptoms in 86% and global ischemia in 14%, whereas INA stenosis (n = 3) was associated with transient ischemic attacks (67%) and right arm ischemia (33%). RESULTS: SCA revascularization included carotid-subclavian or carotid-axillary bypass (n = 19), axilloaxillary bypass (n = 8), and subclavian-carotid transposition (n = 3). CCA reconstructions included subclavian-carotid (SC) bypass (n = 13) and carotid-carotid bypass (n = 1). INA procedures included three axilloaxillary bypasses. Six patients had an associated carotid endarterectomy, and three underwent concomitant vertebral artery transpositions. Intraluminal shunts were not routinely used. Vein was used as a conduit in five procedures, and a prosthetic graft (23 Dacron, 16 polytetrafluoroethlyene) was used in the remainder. The average postoperative intensive care unit and hospital and hospital stay were 1 and 5 days, respectively. Follow-up was available in 43 of 44 patients (mean = 26.2 months). The perioperative mortality rate was 2.2% (one axilloaxillary). There were five graft occlusions in procedures involving the axillary artery (3 of 11 axilloaxillary, 2 of 7 carotid-axillary) as compared with one of 29 thromboses when the operation was confined to the supraclavicular fossa (p < 0.05) Relief of symptoms was achieved in all patients with patent grafts. There were no perioperative strokes in the series. Other complications included one brachial plexus neuropraxia (axilloaxillary) and four patients with phrenic nerve neuropraxia. CONCLUSION: Extrathoracic revascularization of the supraaortic trunks is well tolerated and durable when operations are confined to the supraclavicular fossa and do not involve the axillary artery.

Adult↗

PubMed1999

Cervical reconstruction of the supra-aortic trunks: a 16-year experience.

PURPOSE: The purpose of this study was to review 182 consecutive cervical reconstructions of supra-aortic trunks, which were performed over a 16-year period. METHODS: A total of 182 innominate, common carotid, or subclavian arteries were reconstructed with a cervical approach in 173 patients aged 23 days to 83 years. Indications included hemispheric (n = 79), vertebrobasilar (n = 56), upper extremity (24), and internal mammary/cardiac ischemia (n = 5), asymptomatic severe common carotid disease (n = 33), or other (n = 3). Primary atherosclerotic innominate (n = 6), common carotid (n = 84), and subclavian (n = 66) lesions underwent reconstruction. Thirty-one operations were performed for multiple trunk involvement, recurrent disease, arteritis, infection, dissection, coarctation, or aneurysm. There were 122 bypass grafting procedures (98 ipsilateral, 24 contralateral) and 60 arterial transpositions. RESULTS: One death (0.5%) and 7 nonfatal strokes (3.8%) occurred, none in patients who were asymptomatic. Perioperative morbidity included four asymptomatic occlusions (2%), 6 myocardial infarctions (3%), 10 pulmonary complications (5%), and 2 graft infections (1%). Follow-up periods ranged from 1 to 190 months (mean, 53 +/- 5 months). Nineteen patients (10%) were lost to follow-up. Fifty-seven late deaths occurred, most from cardiac causes. Seven reconstructions necessitated late revision. The cumulative primary patency rate at 5 and 10 years was 91% +/- 2% and 82% +/- 5%, respectively. The survival rate at 5 years was 72% +/- 4% and at 10 years was 41% +/- 6%. The stroke-free survival rate was 92% +/- 2% at 5 years and 84% +/- 2% at 10 years. CONCLUSION: Cervical reconstruction of symptomatic and asymptomatic supra-aortic trunk lesions carries acceptable death and stroke rates and provides a long-term patient benefit. This should be the preferred approach for asymptomatic lesions and for patients with significant comorbidity because it carries less morbidity than direct transmediastinal aortic-based reconstruction.

Adolescent↗

PubMed2006

Floating thrombus in the brachio-cephalic trunk.

Floating thrombus in a non-aneurysmal and non-atherosclerotic brachio-cephalic trunk is an extremely rare event with potentially catastrophic complications. There is a risk of both peripheral and cerebral embolization. We present a very rare case of floating thrombus in the brachio-cephalic trunk that presented with advanced ischaemia of the right upper limb. Confirmation of the diagnosis was done by CT angiogram. The upper limb symptoms were relieved by thrombectomy, supported by anticoagulation. For floating thrombus in the brachiocephalic trunk, the patient was started on aggressive anticoagulation therapy and there was significant resolution after two weeks and complete resolution after one month.

Adult↗

PubMed1999

Reconstruction of the supra-aortic trunks.

OBJECTIVE: To review our 10-year experience of reconstruction of the supra-aortic trunks. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 47 patients who required reconstruction of the supra-aortic trunks for stenotic or occlusive disease between April 1987 and May 1997. INTERVENTIONS: Right-sided bifurcation graft through a sternotomy (n = 25), left-sided thoracotomy (n = 1), and extra-anatomic bypass (n = 21). MAIN OUTCOME MEASURES: Morbidity, mortality, and long term patency. RESULTS: 3 patients died (6%); 7 (15%) developed major complications (leak from the brachiocephalic stump, n = 2, and acute occlusion of the bypass graft, n = 5) all of which were successfully treated by immediate reoperation; and 9 (19%) developed minor complications, all of which resolved within 3 months. The median follow up was 36 months (range 1-108), and the 3-year patency rate was 80%. No patient died during the follow up period, but a further 3 were lost to follow up. The remaining 41 were all assessed by duplex scanning or angiography, and 3 required further operation for recurrent symptoms; 33 remained completely free of symptoms. CONCLUSION: Symptomatic stenotic or occlusive lesions of the supra-aortic trunks can be treated with acceptable morbidity and mortality, giving long term benefit to patients.

Arterial Occlusive Diseases↗