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The Mediastinum (including pre-and para-spinal lines, neural tumours, and pneumomediastinum).
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Angiography was used in some cases before the advent of CT to define thymic tumours. Gothlin et al. (1977): performed angiography via the internal mammary artery in 30 patients. In thymomas there was an increase in the size of the thymic artery and the branches were localised in the periphery or cortex of the visualised mass, rather than in their centres. With carcinomas, there tended to be several feeding vessels from the internal mammary artery, and the increased vascularity spread into the tumour.
Lymphatic anatomy: lymphatics of the breast and axilla
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
The internal mammary artery medially (65%) and the lateral thoracic artery (35%) supply blood to the breast (Figure 7.1). The cephalic vein serves as a landmark separating the pectoralis major muscle from the deltoid muscle. The vein travels through the deltopectoral triangle and pierces the clavipectoral fascia, joining the axillary vein. Branches of the brachial plexus are located throughout the course of the axilla. The long thoracic nerve is located on the medial wall of the axilla, arising in the neck from the fifth, sixth, and seventh roots of the brachial plexus. It innervates the serratus anterior muscle, which permits raising the arm above the shoulder. The intercostobrachial nerve is the lateral cutaneous branch of the second intercostal nerve and the joining of the medial cutaneous nerve of the arm, supplying the skin of the floor of the axilla and the upper medial aspect of the arm.
Paper 2
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Which one of the following statements is not true about coronary artery bypass graft operations? The patient can drive after 2 months.Is an option if anti-anginal medication fails.Is an option if there is left main stem disease.The patient’s own saphenous vein can be used.The patient’s own internal mammary artery can be used.
CT findings in aggressive Takayasu arteritis
Published in Acta Cardiologica, 2022
Benjamín Roque Rodríguez, Luis Enrique Lezcano Gort, María Victoria Mogollón Jiménez, Ignacio Díaz Villalonga, Sergio Moyano Calvente, Zineb Kounka
A 52-year-old woman was referred to our hospital with grade-2 dyspnoea without intermittent claudication. She complained of self-limiting episodes of fever, asthenia, and myalgias since the adolescence. Physical examination revealed a loud panfocal systolic murmur (IV/VI), and large inter-arm blood pressure difference (180/80-120/70 mmHg in right and left arm respectively). Treponema pallidum serological-test and autoantibodies were negative, and acute phase reactants were normal. Doppler echocardiogram reveals doubtful patent ductus arteriosus. CT angiography with multiplanar (Figure 1, panels 1 and 4) and volumen-rendered reformatted images (Figure 1, panels 2 and 3) showed severe narrowing of the middle segment of the descending thoracic/abdominal aorta (a), and both iliac arteries, with intima-media thickening in all of them (b). Collaterals have been developed, like a huge and tortuous right internal mammary artery which anastomoses with branches of the epigastric arteries (c). We found severe stenosis in common carotid arteries (critical in left common carotid artery) (d) and in both subclavian arteries at the ostia of vertebral arteries(e). On the basis of clinical and angiographic abnormalities, the diagnosis of Takayasu arteritis (TA) was made. TA is a large-vessel granulomatous vasculitis that primarily affects the aorta and its primary branches, specially supraaortic trunk and subclavian artery. It principally affects young women. The patient refused to take any treatment or perform new tests. Actually, she remains asymptomatic.
An unusual “venous circle” of the internal mammary vein encountered during microvascular anastomosis and implications for practice
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
S. Samaras, M. A. McKelvie, G. Oni, C. M. Malata
Internal mammary vein anatomy has been widely studied and is highly variable both in terms of number and patterns of division/confluence [2,3,6,7]. Four patterns of IMV anatomy were described by Arnez classifying the relationship of the vein to the internal mammary artery (IMA) [3]. In the most common arrangements (Arnez Type I & II) the vein is found running medial to the artery, making up 95% of cases. In Type I subjects, the vein is formed by the confluence of the two venae commitantes of the IMA, at the level of the third costal cartilage, continuing cranially as a single vein in 85% of cases [3]. These findings are consistent with our in-vivo study of the IM vessels anatomy of the 2nd and 3rd ICS. We identified a single vein cranially to the 3rd rib in more than 80% of the cases which was almost always (92%) lying medial to the artery [8]. The rib-preservation method for vessel exposure, first described by Parrett et al. in 2008 [9] and subsequently adopted and refined by the senior author [10], is widely seen as an easy, safe and reliable method of IMV exposure. Its advantages over the traditional rib-sacrificing method – whereby the second and/or third rib is resected parasternally to facilitate exposure of the recipient vessels – include faster recovery times, reduced analgesic requirements post-operatively and better preservation of normal chest wall contour [11–14].
Coronary artery bypass grafting vs. drug-eluting stent implantation in patients with end-stage renal disease requiring dialysis
Published in Renal Failure, 2020
Zhi Wang, Yanjun Gong, Fangfang Fan, Fan Yang, Lin Qiu, Tao Hong, Yong Huo
We identified 112 dialysis-dependent CKD patients who underwent either CABG or DES-PCI for CAD at Peking University First Hospital from 1 April 2007 to 1 June 2017. Dialysis-dependent CKD was defined as estimated glomerular filtration rate <15 mL/min/1.73 m2 which was calculated by the simplified MDRD equation, and all patients had been on dialysis for at least 1 month before revascularization. The revascularization strategy was decided after coronary angiography and was depend on discussion of the heart team and the willing of the family. The PCI procedure was performed by skilled operators using DES. During the CABG procedure, internal mammary artery grafts were preferentially utilized, and complete revascularization was always attempted. Clinical data, coronary artery characteristics, and procedural data were collected for all patients. Follow-up was conducted in outpatient clinics and by phone-calls. This study was approved by the Ethics Committee of Peking University First Hospital with the approval number 2019 (research) 324.