A 52-year-old motorbike driver was struck by a trailer. His left shoulder was swollen and no pulse was evident at his left wrist. In the emergency room, a scapulothoracic dissociation with subclavian artery dissection and a complex fracture of the humerus were evident (Fig. 1). Carotido-subclavian bypass restored blood flow with preservation of the arm in follow-up (Fig. 2). Fig. 1. 3D-computer...

The purpose of the present study was to examine whether patency times, including complications of subcutaneous venous chest port insertion using ultrasonography (US) guidance, differ between jugular and subclavian venous access. Between December 2008 and July 2010, subcutaneous venous chest ports were placed in 347 patients by an experienced team. All single-lumen port catheters were placed int...

BACKGROUND Epicardial pacemaker implantation is the favored approach in children weighing <10 kg in many units. The high incidence of premature failure and fractures with earlier epicardial leads led our unit to undertake transvenous pacemaker implantation in neonates and infants from 1987. To date there have been no long-term follow-up reports of what is for many a controversial strategy. ME...

Implantation of a single-chamber pacemaker was planned in an 83-year-old woman with sick-sinus syndrome causing dizziness, bradycardia and tachycardia. After puncture of the right subclavian vein it proved impossible to advance a guide-wire into the superior vena cava, under fluoroscopy the wire always being seen to coil in the left subclavian vein and hence passing into a caudally directed vei...

A 28-year-old man presented with transient speech disturbance and right hemiplegia. Computed tomography of the brain revealed a low-density area in the right cerebellum. A ventilation/perfusion lung scintiscan detected multiple perfusion defects in the both lungs and catheterization revealed pulmonary hypertension. Venography of the upper extremities revealed obstruction of the left subclavian ...

The equipment required are (1) a bedside cardiac monitor (2) a defibrillator (3) an ECG machine preferably powered by battery (4) three crocodile clips (5) external pulse generator (6) temporary pacing electrodes and (7) a cutdown set. The cutdown set may include various cannulae introducer systems. We are only describing here the system where the cannula supplied with the temporary electrodes ...

OBJECTIVES To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation. DATA SOURCES 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature. DESIGN Systematic review and meta-analysis of randomised controlled trials. Populations Patients scheduled for central venous access. INTERVEN...

Purpose: Historically the classification of Thoracic Outlet Syndrome (TOS) has been based on symptoms rather than underlying pathology. Therefore, TOS classified into Neurogenic (NTOS), Venous (VTOS or Paget Schroetter Syndrome) and Arterial (ATOS) subgroups. This resulted in confusion among medical practitioners, difficulty making diagnosis, poor results with surgical intervention. Methods: Th...

A 69-year-old woman with obstructive nephropathy required emergent hemodialysis. The initial placement of a catheter into the right jugular vein was not successful as it was not possible to establish adequate blood flow. The second catheter introduced into the right subclavian vein failed too. Therefore, there was a need to place a catheter in the left jugular vein. However, chest radiography s...

Case Presentation A 90-year-old woman who underwent coronary artery bypass graft surgery 15 years ago was brought to the Emergency Department from her assisted living facility after developing chest pain, dyspnea, and diaphoresis. On arrival, she continued to have chest pain and exhibited signs of congestive heart failure. Her ECG revealed 2-mm ST-segment depressions across the precordium assoc...