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Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The subdeltoid bursa is situated between the deltoid and the rotator cuff to reduce frictional forces on the rotator cuff tendon. Blood supply is derived from the axillary artery and nerve supply from the axillary, subscapular and lateral pectoral nerves.
Latest STEMI treatment: a focus on current and upcoming devices
Published in Expert Review of Medical Devices, 2018
Elisabetta Moscarella, Salvatore Brugaletta, Manel Sabaté
The venous-arterial ECMO device is a cardiopulmonary support system that aspirates blood from the femoral vein or the internal jugular vein through a 21Fr cannula. Using an artificial membrane lung it removes carbon dioxide from and adds oxygen to venous blood, which is then returned into the arterial system via a 15- to 22-Fr outflow cannula in the femoral or axillary artery so that heart and lungs are both bypassed. One of the greatest advantages of ECMO is that it can be placed almost everywhere (in the emergency room, on the ward, in the catheterization laboratory, etc.), as it is completely transportable and fluoroscopy or echocardiography guidance is not required for successful implantation. The device provides a circulatory support up to 7 L/min, with large cannulas and contemporary rotors, in patients with circulatory and respiratory failure. However, unlike LV assist devices, V-A ECMO system cannot unload the LV. Increasing afterload progressive results in LV distention, worsening LV function, LV thrombus and intractable pulmonary edema or hemorrhage [83]. For these reasons, it should be used together with other devices. Concomitant use with IAPB [84] or Impella [85] has been proposed to lower pulmonary artery pressures and decrease LV dimensions as well as percutaneous atrial septostomy (to allow left-to-right shunting) or dobutamine administration (to improve contractility and decrease afterload). Moreover when femoral artery is chosen for the outflow cannulation attention needs to be focused on adequate retrograde oxygenation of heart and head. Absolute contraindications to ECMO implantation include aortic regurgitation, aortic dissections, severe peripheral artery disease and ethical considerations as no prospective for a bridge therapy or patient’s wish. Active bleeding is a relative contraindication because ECMO requires heparin for anticoagulation. However it has been used in high-risk patients without heparin, as it was the only strategy to save patient life [86]. Complications mainly include vascular complications as leg ischemia, compartment syndrome, major bleeding, stroke, air embolism, and significant infection [87].