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The views expressed herein are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U. Vienna G. The upper extremity is an uncommon site for deep vein thrombosis and, although most of these thrombotic events are secondary to catheters or indwelling devices, venous thoracic outlet syndrome is an important жмите of primary thrombosis. Young, active, otherwise healthy individuals that engage in repetitive upper extremity exercises, such as those required by a military vocation, may be at an increased risk.

We present the case of a Naval Нажмите чтобы увидеть больше diagnosed with venous thoracic outlet syndrome whereby a multimodal approach with early surgical decompression was used.

Although thoracic outlet decompression by means of first rib resection is the standard of care, timing of first rib resection after thrombolysis is debated. With respect to the active duty service member, the optimal timing of additional postoperative interventions for residual venous defects and duration увидеть больше anticoagulation remain in question.

A more streamlined perioperative treatment regimen may benefit the military patient without jeopardizing the quality of care and allow more expeditious return to full duty. A year-old Surface Warfare Officer presented to his ship’s medical department with 5 days of right shoulder pain and arm weakness following strenuous upper body exercise in preparation for his physical readiness test.

He had previously been evaluated by multiple providers for similar symptoms and diagnosed with bicep tendonitis 2 weeks before this presentation; usa jobs government jobs login paget schroetter syndrome rib most concern to him was the new onset of nocturnal pain and inability to do push-ups.

He served as his ship’s weapons officer, but he denied consistent use of firearms preceding this event or any other repetitive occupational activities.

He had no personal or family history of thrombophilia. His review of systems was negative for chest pain or shortness of breath. Physical examination was notable for right upper extremity edema, cyanosis, and engorged venous collaterals across his shoulder, axilla, and chest.

The neurovascular examination demonstrated equally palpable upper extremity arterial pulses bilaterally with normal motor function and sensation. His skin was devoid of ulcers or wounds. He was immediately referred to the local military medical treatment facility where a duplex venous ultrasound demonstrated right subclavian and axillary vein thrombosis.

He was heparinized, admitted to the vascular surgery service, and taken for venography Fig. Using a right basilic vein approach, catheter-directed thrombolysis with tissue plasminogen activator was initiated. After approximately 24 hours, his venogram showed resolution of thrombosis but the presence of a severe subclavian vein stenosis at the level of the first rib. Percutaneous transluminal angioplasty PTA was attempted within the proximal subclavian vein with little effect Fig.

He was discharged on therapeutic subcutaneous enoxaparin as a bridge to warfarin with a plan for an elective first rib resection FRR with scalenectomy in 3 weeks. Demonstrating complete occlusion of right subclavian and axillary veins arrows.

Wire transverses occluded segment. First rib dashed lines. Venogram approximately 24 hours after successful thrombolysis.

Significant subclavian vein stenosis arrows at the level of the first rib dashed lines persists after initial продолжить чтение at percutaneous transluminal angioplasty. He was discharged by postoperative day 2 with the plan to complete a 3-month course of anticoagulation therapy. Intraoperative venogram following first rib resection circle denotes area of rib resection and percutaneous transluminal angioplasty for residual stenosis.

Although stenosis usa jobs government jobs login paget schroetter syndrome rib not clearly visualized in this unsubtracted image, the presence of venous collaterals arrows may infer a residual stenosis. Just before his final follow-up 2 usa jobs government jobs login paget schroetter syndrome rib post-FRR with intraoperative PTAthe patient complained of mild, intermittent arm swelling associated with pain that coincided with an increase in upper extremity activity.

Venography was devoid of thrombus, but showed restenosis unresponsive to serial PTA; therefore, a mm self-expanding bare metal stent was deployed across the stenotic region with restoration of flow Fig. He was continued on oral anticoagulation for an additional 2. At his 6-month follow-up, right upper extremity duplex ultrasound was negative for thrombus or wall thickening in the venous system, therefore warfarin was discontinued and he was transitioned to oral antiplatelet therapy aspirin 81 mg daily for 3 months.

Upper extremity deep vein thrombosis is an uncommon entity; although most of the thrombotic events occurring at this site are secondary to catheters, indwelling devices, and cancer, venous thoracic outlet syndrome VTOS is an important cause of primary thrombosis. VTOS is caused by extrinsic compression of the subclavian vein between the anterior scalene muscle and the junction of the first rib, clavicle, and subclavius muscle. Delayed presentation is common as distal tributaries form in response to venous congestion from luminal compression and initial thrombus; acute symptoms are hypothesized to occur after propagation of the clot obstructs these distal usa jobs government jobs login paget schroetter syndrome rib.

This condition is often misdiagnosed or underdiagnosed; prompt recognition and treatment within 14 days of the acute thrombus is one of the most important predictors of outcome. Treatment algorithms are highly varied given the relative rarity of this disease and lack of quality-randomized usa jobs government jobs login paget schroetter syndrome rib studies.

Most protocols are guided by single institutional reports, retrospective reviews, and expert opinion. One of the most commonly used operative algorithms was developed by Kunkel and Machleder in the s; this protocol included early thrombolysis and 3 months of anticoagulation before transaxillary FRR. Conservative, selective surgical algorithms have been described. For example, Lee et al from Stanford University performed rib resection only on those patients that had recurrent or persistent symptoms, had ultrasound evidence of wall thickening, or had rethrombosis after the initial clot lysis.

Furthermore, this need for FRR increased with younger age, a defining characteristic of как сообщается здесь active duty population. Not only are there disparities between surgical and nonsurgical algorithms as discussed above, but there is also a lack of consensus on the appropriate timing of FRR, PTA, and stenting.

Repeat venography was obtained at approximately 10 days postoperatively; if residual stenosis was present and not responsive to PTA, stenting was performed.

Standard postintervention oral anticoagulation duration was for 3 months. This one-stage operation was hypothesized to decrease the risk of rethrombosis and need for stent placement нажмите чтобы увидеть больше the postoperative period. The results of the venogram dictated additional management anticoagulation plus PTA or anticoagulation alone. Other literature suggest that PTA may be used before or after surgical decompression, whereas stent placement is typically reserved for residual stenosis, not responsive to PTA, only after the extrinsic compression has been removed.

Reviewing literature for other military case reports, FRR was delayed 8 months after presentation, 17 there was no mention of time course to FRR, 1819 or patients received conservative, nonsurgical management only. Presurgical intervention beyond thrombolysis providing immediate symptom relief in the acute phase may have little usa jobs government jobs login paget schroetter syndrome rib on the long-term patency and recovery as long as FRR is performed promptly.

Therefore, we could have considered thrombolysis alone followed by Продолжить during the initial hospitalization to reduce his total course of treatment. Predecompression PTA may be a superfluous attempt as the extrinsic forces on the vein have not been removed. More importantly, it may be difficult to ascertain the final disposition of the treated vein following surgery as this area can be challenging to duplex and the patient may not be active enough to induce usa jobs government jobs login paget schroetter syndrome rib of venous obstruction related to residual intrinsic defects.

Reported symptomatology and physical examination alone have been shown to be an inaccurate usa jobs government jobs login paget schroetter syndrome rib of determining venous patency.

Therefore, accurate and early postoperative imaging is key; routine venography, as described by the Johns Hopkins series, has been justified in the absence of symptoms and has been proclaimed as best practice for long-term success. Although, we did perform a routine ultrasound at his 6-month follow-up to support discontinuation of oral anticoagulation, we should additionally consider a routine ultrasound at the month mark.

Diagnosis and treatment of VTOS is a clinical challenge. Primary care providers in the Fleet must maintain a high index of suspicion when a patient presents with upper extremity complaints related to продолжить vigorous exercise. To avoid long-term disability in this unique patient population, recognition and prompt referral for specialized surgical intervention is paramount. Immediate or early decompression with FRR should be considered as this has shown to reduce the risk of pulmonary embolism, rethrombosis, and the debilitating sequelae of post-thrombotic syndrome.

Routine ultrasound examination should usa jobs government jobs login paget schroetter syndrome rib performed in the asymptomatic patient up to 12 months postsurgery.

VG Katana and JS Weiss had full access to all the data in the study and take responsibility for the integrity of the data, and VG Katana and JS Weiss interpreted the data and take responsibility for the accuracy of the data analysis. Drafting of the manuscript and critical revision of the manuscript for important intellectual content was performed by VG Katana and JS Weiss.

Phlebology ; 30 10 : — Google Scholar. Curr Opin Cardiol ; 25 6 : — Vasc Med ; 20 2 : — 9. Curr Treat Options Cardiovasc Med ; 4 3 : — Acute Paget-Schroetter syndrome: does the first rib routinely need to be removed after thrombolysis? Ann Vasc Surg ; 29 6 : — 7. A staged, multidisciplinary approach. Arch Surg ; 10 : — 8. J Invasive Cardiol ; 27 9 : — 8. J Vasc Surg ; 43 6 : — J Vasc Surg ; 60 4 : — 7. Vascular thoracic outlet syndrome: successful outcomes with multimodal therapy.

Cardiovasc Surg ; 9 1 : 11 — 5. Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg ; 40 4 : — A decade of excellent outcomes after surgical intervention in patients with thoracic outlet syndrome.

J Am Coll Surg ; 5 : — 9. Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome. Surgery ; 5 : — 7. Vasc Endovascular Surg ; 46 1 : 15 — J Vasc Surg ; 52 3 : — Arch Surg usa jobs government jobs login paget schroetter syndrome rib 1 : 54 — 7.

J R Army Med Corps ; 4 : — J Orthop Sports Phys Ther ; 44 4 : Mil Med ; 12 : — 2. Ann Acad Med Singap ; 40 4 : — 6. J Am Board Fam Pract ; 18 4 : — 9. Mil Med ; 10 : — 3. Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide.

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This case report serves to create awareness about the existence of the syndrome and to highlight the potential morbidity due to clinical misdiagnosis. Thoracic meningocele in lumbo-costo-vertebral syndrome in a child: possible enlargement with repeated motion by anchoring to the diaphragm. Lumbo-costo-vertebral syndrome LCVS is a rare disorder in children that is characterized by hemivertebrae, congenital absence of ribs, meningocele, and hypoplasia of the truncal and abdominal wall presenting as a congenital lumbar hernia.

An otherwise healthy month-old girl was referred to the authors’ hospital with soft swelling on her left middle back; scoliosis had been present since birth. Imaging revealed a thoracic meningocele, ectopia of the spleen suggesting lumbar hernia, multiple anomalies of the thoracic vertebral columns, and defects of the ribs; thus, LCVS was diagnosed. Surgical observation revealed that the meningocele was firmly anchored to part of the diaphragm, which created stretching tension in the meningocele continuously with exhalation.

Once detached, the meningocele shrank spontaneously and never developed again after cauterization. In this case, continuous or pulsatile pressure in the presence of a vertebral defect was thus considered to be an important factor for formation of the thoracic meningocele.

Posterior reversible encephalopathy syndrome following a thoracic discectomy-induced dural leak: case report. Posterior reversible encephalopathy syndrome PRES is a clinicoradiological syndrome characterized by headaches, altered mental status, seizures, and visual disturbances. Classic MRI findings include white matter changes of the parieto-occipital regions. While the pathogenesis of the disorder is unclear, vasoconstriction and hypoperfusion leading to brain ischemia and vasogenic edema have been implicated as potential mechanisms.

The authors present, to the best of their knowledge, the first case of PRES following a thoracic spinal surgery-induced dural leak noted on resection of the fifth rib during a thoracotomy for a T discectomy. Brain MRI revealed large areas of increased FLAIR and T2 hyperintensity in the superior posterior frontal lobes, superior and medial parietal lobes, and bilateral occipital lobes.

Following repair of the CSF leak, the patient’s symptoms resolved. Spinal surgeons should be alert to the potentially life-threatening condition of PRES, especially in a hypertensive patient who experiences surgery-induced dural leakage.

The development of a severe positional headache with neurological signs is a red flag that suggests the presence of PRES. Prompt attention to the diagnosis and treatment of this condition by repairing the dural leak via surgery or expeditious blood patch increases the likelihood of a favorable outcome.

Loeys-Dietz syndrome is a rare form of connective tissue disorder, whose clinical features can resemble those of Marfan syndrome , but with a more unpolished appearance. Recently brought out, this pathology remains little known; however, its consequences may be dramatic. We report on the case of a 4-year-old girl followed for a congenital hip dislocation, in which a systematic exam found increased cutaneous elasticity and a bifid uvula, suggesting a connective tissue disorder.

Symptoms were unpolished, as the child’s height was normal, without any positive cardiac, rheumatological, or ophthalmological family history. Sheet C-1, September, File no. Paget Schroetter Syndrome : A case study of the chiropractor’s role in recognizing and comanaging an important condition. To emphasize the importance for health care professionals to be knowledgeable of a relatively rare form of thoracic outlet syndrome , known as Paget Schroetter syndrome.

The etiology, key signs and symptoms, and the importance of immediate referral are highlighted and an introduction to manual therapists’ role within a multidisciplinary team is provided. Manual therapists have a role in recognizing, referring, and providing symptomatic relief with soft tissue therapy, correcting abnormal biomechanics, manipulations, mobilizations, and a rehabilitative program, as seen in this case report.

Early recognition and referral of Paget Schroetter syndrome are essential for optimal recovery. Manual therapists may prove to have a role in decreasing the need for surgical decompression and accelerating resumption of regular activities.

Thoracic aortic aneurysms have been historically considered to be caused by etiologic factors similar to those implied in abdominal aortic aneurysms. Moreover, the presence of congenital anomalies, such as bicuspid aortic valve, may have a unique common genetic underlying cause. Finally, also sporadic forms have been found to be potentially associated with genetic disorders, as highlighted by the analysis of rare variants and expression of specific microRNAs. We therefore sought to perform a comprehensive review of the role of genetic causes in the development of thoracic aortic aneurysms, by analyzing in detail the current evidence of genetic alterations in syndromes such as Marfan, Loeys-Dietz, and Ehler-Danlos, familial or sporadic forms, or forms associated with bicuspid aortic valve.

Endoscopic thoracic sympathicotomy for the treatment of complex regional pain syndrome. Complex regional pain syndrome CRPS is a neurological syndrome that usually affects one or more extremities, and can cause chronic pain and permanent deformities. Seven patients four males and three females; mean age The sympathetic chain was severed over the ribs from T2 to T5, along with the communicating rami of these segments, including the Kuntz nerve.

The ETS was performed bilaterally in four patients. Pain was assessed using a visual analogic scale VAS from 0 to Analgesics were no longer needed after surgery. All patients had their quality of life improved. Piriformis syndrome. Pseudosciatica; Wallet sciatica; Hip socket neuropathy; Pelvic outlet syndrome ; Low back pain – piriformis Sciatica is the main symptom of piriformis syndrome. Other symptoms include: Tenderness or a dull ache in Investigation of pulsatile flowfield in healthy thoracic aorta models.

Cardiovascular disease is the primary cause of morbidity and mortality in the western world. Complex hemodynamics plays a critical role in the development of aortic dissection and atherosclerosis, as well as many other diseases.

Since fundamental fluid mechanics are important for the understanding of the blood flow in the cardiovascular circulatory system of the human body aspects, a joint experimental and numerical study was conducted in this study to determine the distributions of wall shear stress and pressure and oscillatory WSS index, and to examine their correlation with the aortic disorders, especially dissection.

Experimentally, the Phase-Contrast Magnetic Resonance Imaging PC-MRI method was used to acquire the true geometry of a normal human thoracic aorta, which was readily converted into a transparent thoracic aorta model by the rapid prototyping RP technique.

The thoracic aorta model was then used in the in vitro experiments and computations. The unsteady boundary conditions at the inlet and the outlet of the aortic flow were specified from the measured flowrate and pressure results during in vitro experiments. For the code validation, the predicted axial velocity reasonably agrees with the PC-MRI experimental data in the oblique sagittal plane of the thoracic aorta model.

The predicted locations of the maxima of WSS and the wall pressure can be then correlated with that of the thoracic aorta dissection, and thereby may lead to a useful biological significance. The numerical results also suggest that the effects of low WSS and high OSI tend to cause wall thickening occurred along the inferior wall of the aortic arch and the. Multi-detector thoracic CT findings in cerebro-costo-mandibular syndrome : rib gaps and failure of costo-vertebral separation.

Cerebro-costo-mandibular syndrome CCMS describes a triad of mandibular hypoplasia, brain dysfunction and posterior rib defects „rib gaps”. We present the CT imaging for a 2-year-old girl with CCMS that highlights the rib gap defects and shows absent transverse processes with abnormal fusion of the ribs directly to the vertebral bodies.

We argue that this is likely to relate to abnormal lateral sclerotome development in embryology, with the failure of normal costo-vertebral junctions compounding impaired thoracic function.

The case also highlights the use of CT for specific indications in skeletal dysplasia. Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia.

Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma.

The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection.

Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

Large thoracic tumor without superior vena cava syndrome. A 62 year-old male with long-standing smoking history presented with hemoptysis. Plain chest x-ray showed abnormal findings proximate to the right pulmonary hilum. Contrast-enhanced chest CT demonstrated a 7. Despite the tumor constricting the right superior vena cava, no signs of superior vena cava syndrome were present.

PLSVC is the most common thoracic venous anomaly with an incidence of 0. In the majority of cases PLSVC drains directly into the coronary sinus, but less frequently it drains into the left atrium or the left superior pulmonary vein. The patient usually remains asymptomatic and PLSVC is an incidental finding during radiographic imaging or medical procedures. When the PLSVC drains into the left atrium or the left superior pulmonary vein, a right-to-left shunt is formed; a condition usually asymptomatic.

In some reported cases this. Neurogenic thoracic outlet syndrome nTOS is characterized by arm and hand pain, paresthesias, and sometimes weakness resulting from compression of the brachial plexus within the thoracic outlet. Furthermore, patient selection for surgical treatment can be challenging as symptoms may be vague and ambiguous, and diagnostic studies may be equivocal. Herein, we describe some approaches to aid in identifying patients who would be expected to benefit from surgical intervention for nTOS.

We describe the role of physical examination, physical therapy, and imaging in the evaluation and diagnosis of nTOS. Giant multilevel thoracic hemangioma with spinal cord compression in a patient with Klippel-Weber-Trenaunay syndrome : case report. Case report and clinical discussion. We intend to report a very rare case of a giant spinal hemangioma causing myelopathy.

Multilevel symptomatic spinal hemangiomas causing acute neurologic symptoms are rare disorders. We found only sporadic reports in English literature. We describe a very rare case in which Klippel-Trenaunay-Weber syndrome is associated with a multisegmental vertebral hemangioma causing a rapidly progressing thoracic myelopathy. Because of the extension of the disease, surgical intervention was not feasible, the patient was treated by radiotherapy.

The patient showed a complete regression of symptoms with stable condition after 3 months. In extensive spinal hemangiomas, radiotherapy may represent a safe treatment modality with rapid clinical improvement even in cases with spinal cord compression.

This report contributes to a wide range of known vascular abnormalities in Klippel-Trenaunay-Weber syndrome and supports the need for a careful multisystemic evaluation of these patients. Marfan syndrome MFS is a hereditary disorder of the connective tissue that causes life-threatening aortic aneurysm, which initiates at the aortic root and can progress into the ascending portion. However, analysis of ascending aorta reactivity in animal models of MFS has remained elusive.

Epidemiologic evidence suggests that although MFS is equally prevalent in men and women, men are at a higher risk of aortic complications than non-pregnant women. Nevertheless, there is no experimental evidence to support this hypothesis. Ascending and descending thoracic aorta reactivity was evaluated by wire myography. MFS differently altered reactivity in the ascending and descending thoracic aorta by either increasing or decreasing phenylephrine contractions, respectively.

When mice were separated by sex, contractions to phenylephrine increased progressively from 3 to 6 months of age in MFS ascending aortas of males, whereas contractions in females were unchanged. Endothelium-dependent relaxation was unaltered in the MFS ascending aorta of either sex; an effect related to augmented endothelium-dependent hyperpolarization-type dilations.

In MFS mice of both sexes, the non-selective nitric oxide synthase inhibitor L-NAME revealed negative feedback of nitric oxide on phenylephrine contractions, which was associated with upregulation of eNOS in females. Finally, MFS. Finally, MFS ascending. Cerebro-facio- thoracic dysplasia Pascual-Castroviejo syndrome : Identification of a novel mutation, use of facial recognition analysis, and review of the literature.

Cerebro-facio- thoracic dysplasia CFTD is a rare, autosomal recessive disorder characterized by facial dysmorphism, cognitive impairment and distinct skeletal anomalies and has been linked to the TMCO1 defect syndrome. To describe two siblings with features consistent with CFTD with a novel homozygous p. We conducted a literature review and summarized the clinical features and laboratory results of two siblings with a novel pathogenic variant in the TMCO1 gene. Facial recognition analysis was utilized to assess the specificity of facial traits.

The novel homozygous p. Facial recognition analysis allows unambiguous distinction of this syndrome against controls. Glutathione system participation in thoracic aneurysms from patients with Marfan syndrome. Aortic dilatation in Marfan syndrome MFS is progressive. It is associated with oxidative stress and endothelial dysfunction that contribute to the early acute dissection of the vessel and can result in rupture of the aorta and sudden death.

We evaluated the participation of the glutathione GSH system, which could be involved in the mechanisms that promote the formation and progression of the aortic aneurysms in MFS patients. Aortic aneurysm tissue was obtained during chest surgery from eight control subjects and 14 MFS patients.

Alcohol outlets , social disorganization, and robberies: accounting for neighborhood characteristics and alcohol outlet types. We estimated spatially lagged regression and spatial regime models to determine if the variation in total, on-premise, and off-premise alcohol outlet 1 density is related to robbery density, while controlling for direct and moderating effects of social disorganization. Total alcohol outlet density and off-premise alcohol outlet density were significantly associated with robbery density when social disorganization variables were included separately in the models.

However, when social disorganization levels were captured as a four item index, only the association between off-premise alcohol outlets and robbery density remained significant. More work is warranted in identifying the role of off-premise alcohol outlets and their characteristics in robbery incidents. Thoracic CT. Thoracic radiology.

Murray and Nadel’s Textbook of Respiratory Medicine. Philadelphia, PA: Elsevier A technical report on video-assisted thoracoscopy in thoracic spinal surgery. Preliminary description. This report is a preliminary description of the efficacy of video-assisted thoracoscopic surgery in thoracic spinal procedures that otherwise require open thoracotomy. This report sought to describe the efficacy of video-assisted thoracoscopic surgery in thoracic spinal procedures that otherwise require open thoracotomy.

In a landmark study that compared video-assisted thoracoscopic surgery for peripheral lung lesions with thoracotomy, video-assisted thoracoscopic surgery reduced postoperative pain, improved early shoulder girdle function, and shortened hospital stay. Video-assisted thoracoscopic surgery was performed in 12 thoracic spinal patients herniated nucleus pulposus, infection, tumor, or spinal deformity and is described in detail in this report.

Video-assisted thoracoscopic surgery in thoracic spinal surgery resulted in little postoperative pain, short intensive care unit and hospital stays, and little or no morbidity.

In the short follow-up period, there was no post-thoracotomy pain syndrome nor neurologic sequelae in these patients. Operative time decreased dramatically as experience was gained with the procedure. Given consistently improving surgical skills, a number of thoracic spinal procedures using video-assisted thoracoscopic surgery, including thoracic discectomy, internal rib thoracoplasty, anterior osteotomy, corpectomy, and fusion, can be performed safely with no additional surgical time or risk to the patient.

Thoracic aortic aneurysm: How to counsel, when to refer. Thoracic aortic aneurysm TAA is usually clinically silent and progresses slowly until a tipping point is reached, after which the aortic diameter can expand more rapidly and the condition can potentially end in aortic dissection or rupture. Causes include bicuspid aortic valve and genetic syndromes Marfan, Loeys-Dietz, and Ehlers-Danlos syndromes and familial associations, but many cases are idiopathic.

Clinicians should therefore be alert for clues on chest imaging, and consider screening in first-degree relatives of patients known to have aortic disease.

Early referral to a cardiologist specializing in aortic disease is key. Biomechanical properties of the thoracic aorta in Marfan patients. Background Marfan syndrome MFS , a genetic disorder of the connective tissue, has been strongly linked to dilation of the thoracic aorta, among other cardiovascular complications.

As a result, MFS patients frequently suffer from aortic dissection and rupture, contributing to the high rate of mortality and morbidity among MFS patients.

Despite the significant effort devoted to the investigation of mechanical and structural properties of aneurysmal tissue, studies on Marfan aneurysmal biomechanics are scarce. Ex vivo mechanical characterization of MFS aneurysmal tissue can provide a better insight into tissue strength outside the physiologic loading range and serve as a basis for improved risk assessment and failure prediction. Planar biaxial tensile testing and uniaxial failure testing were utilized to characterize the mechanical and failure properties of the tissue, respectively.

Results MFS tissue was found to have age-dependent but diameter-independent mechanical, structural, and morphological properties, also showing extensive elastin fiber degradation. Moreover, non-MFS thoracic aneurysmal mechanics resembled closely the mechanics of older healthy human tissue.

Younger MFS tissue Regional interdependence and manual therapy directed at the thoracic spine. Thoracic spine manipulation is commonly used by physical therapists for the management of patients with upper quarter pain syndromes. The theoretical construct for using thoracic manipulation for upper quarter conditions is a mainstay of a regional interdependence RI approach.

The RI concept is likely much more complex and is perhaps driven by a neurophysiological response including those related to peripheral, spinal cord and supraspinal mechanisms. Recent evidence suggests that thoracic spine manipulation results in neurophysiological changes, which may lead to improved pain and outcomes in individuals with musculoskeletal disorders.

Treatment utilizing both thrust and non-thrust thoracic manipulation has been shown to result in improvements in pain, range of motion and disability in patients with upper quarter conditions. Research has yet to determine optimal dosage, techniques or patient populations to which the RI approach should be applied; however, emerging evidence supporting a neurophysiological effect for thoracic spine manipulation may negate the need to fully answer this question.

Certainly, there is a need for further research examining both the clinical efficacy and effectiveness of manual therapy interventions utilized in the RI model as well as the neurophysiological effects resulting from this intervention. Regional interdependence and manual therapy directed at the thoracic spine.

The size of the supraspinatus outlet during elevation of the arm in the frontal and sagittal plane: a 3-D model study. To quantify the size of the supraspinatus outlet as it is dictated by both the three-dimensional geometry of the shoulder and the relative orientation of the humerus with respect to the scapula during motions of the arm.

Previously obtained data of shoulder kinematics were brought into a geometrical model of the shoulder, derived from a cadaver study. Knowledge of the parameters dictating the size of the supraspinatus outlet is essential for a better understanding of the impingement syndrome of the shoulder.

A geometrical model, based on fitting spheres to various anatomical items of the shoulder was derived from three-dimensional position data of the gleno-humeral joint and coraco-acromial arch of 32 cadaver shoulders. Kinematical data were collected from 10 healthy volunteers. The geometrical and kinematical data were combined to study the supraspinatus outlet during elevation of the humerus in the frontal and sagittal plane.

No single geometry parameter correlated significantly with the initial size of the outlet. During arm elevation, the greater tuberosity was moved away from the coraco-acromial arch quite effectively resulting in narrowing of the outlet during elevation in the frontal plane from 60 degrees to degrees only. Deviations from the average were quite substantial. This was caused by kinematical and especially geometrical variability. The size of the outlet is dictated by both the geometry and kinematics of the gleno-humeral joint.

Assessment of the individual susceptibility to impingement requires three-dimensional viewing techniques including three-dimensional movements of both the scapula and humerus. Little is known about etiology and pathogenesis of various shoulder disorders such as the impingement syndrome. The supraspinatus outlet plays probably a key role.

More knowledge on the architecture of the outlet is required for a better understanding. Receptacle outlets. Video-Assisted Thoracic Sympathectomy for Hyperhidrosis. By the s, endoscopy was in use by some groups in sympathetic denervation of the upper limbs with vascular indications. Low morbidity, cosmetic results, reduction in the incidence of Horner syndrome , and the shortened time in hospital made video-assisted thoracic sympathectomy VATS better accepted by those undergoing treatment for hyperhidrosis.

Over the last 25 years, this surgical procedure has become routine in the treatment of hyperhidrosis, leading to a significant increase in the number of papers on the subject in the literature. Late recurrent peripheral upper limb ischemia after non-union of a clavicle fracture. A year-old woman was referred to our hospital due to recurrent episodes of upper limb ischemia.

Her past medical history included a clavicle non-union developed after a clavicle midshaft fracture that had occurred 30 years previously. After a long asymptomatic period, she started showing symptoms of chronic ischemia to the left arm that were misdiagnosed. In case of clavicle non-union, local instability plays a key role in determining the initial injury to the vessels and the recurrence of symptoms.

Restoration of local bone stability and anatomy, obtained by compression plating and autologous bone grafting, combined with an appropriate vascular surgery, is essential to achieve a clinical resolution of symptoms and to avoid the recurrence of symptomatology as seen in the herein case.

Alcohol outlets and clusters of violence. Background Alcohol related violence continues to be a major public health problem in the United States. In particular, there is substantial evidence of an association between alcohol outlets and assault.

However, because the specific geographic relationships between alcohol outlets and the distribution of violence remains obscured, it is important to identify the spatial linkages that may exist, enhancing public health efforts to curb both violence and morbidity.

Methods The present study utilizes police-recorded data on simple and aggravated assaults in Cincinnati, Ohio. Addresses of alcohol outlets for Cincinnati, including all bars, alcohol-serving restaurants, and off-premise liquor and convenience stores were obtained from the Ohio Division of Liquor Control and geocoded for analysis.

A combination of proximity analysis, spatial cluster detection approaches and a geographic information system were used to identify clusters of alcohol outlets and the distribution of violence around them.

Results A brief review of the empirical work relating to alcohol outlet density and violence is provided, noting that the majority of this literature is cross-sectional and ecological in nature, yielding a somewhat haphazard and aggregate view of how outlet type s and neighborhood characteristics like social organization and land use are related to assaultive violence. The results of the statistical analysis for Cincinnati suggest that while alcohol outlets are not problematic per se, assaultive violence has a propensity to cluster around agglomerations of alcohol outlets.

This spatial relationship varies by distance and is also related to the characteristics of the alcohol outlet agglomeration. Specifically, spatially dense distributions of outlets appear to be more prone to clusters of assaultive violence when compared to agglomerations with a lower density of outlets.

Conclusion With a more thorough understanding of the spatial relationships between alcohol outlets and the. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report.

To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. A year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. He completed that match and 1 additional match that day with mild symptoms.

Evaluation by a certified athletic trainer 6 days postinjury showed radiculopathy in the C7 distribution of his left upper extremity. He was evaluated further by the team physician, a primary care physician, and a neurosurgeon. The patient initially underwent nonoperative management with ice, heat, massage, electrical stimulation, shortwave diathermy, and nonsteroidal anti-inflammatory drugs without symptom resolution. Cervical spine radiographs were negative for bony pathologic conditions.

Magnetic resonance imaging showed evidence of T1-T2 disc herniation. The patient underwent surgery to resolve the symptoms and enable him to participate for the remainder of the wrestling season. Whereas brachial plexus radiculopathy commonly is seen in collision sports, a postfixed brachial plexus in which the T2 nerve root has substantial contribution to the innervation of the upper extremity is a rare anatomic variation with which many health care providers are unfamiliar.

The injury sustained by the wrestler appeared to be C7 radiculopathy due to a brachial plexus traction injury. However, it ultimately was diagnosed as radiculopathy due to a T1-T2 thoracic intervertebral disc herniation causing impingement of a postfixed brachial plexus and required surgical intervention.

Athletic trainers and physicians need to be aware of the anatomic variations of the brachial plexus when evaluating and caring for patients with suspected brachial plexus radiculopathies. A case report: a young waiter with Paget-Schroetter syndrome.

Paget-Schroetter syndrome PSS is a rare presentation of primary axillary subclavian vein thrombosis that classically occurs in young men with a degree of underlying thoracic outlet syndrome after a period of upper extremity exertion. The primary complication of PSS is post-thrombotic syndrome , a result of chronic venous hypertension. To educate Emergency Physicians on this condition to potentiate timely diagnosis and appropriate disposition.

A year-old right-handed restaurant waiter presented with 3 days of non-painful, gradual-onset right upper extremity swelling with normal vital signs. The patient’s history was otherwise notable for subjective fevers and a right forearm abrasion. Upon examination, the right upper extremity was neurovascularly intact and remarkable for uniform edema and erythema extending distally from the level of the mid-humerus.

The primary differential diagnoses were deep venous thrombosis DVT vs. Venous phase contrast computed tomography did not reveal evidence of underlying soft tissue infection and was inconclusive regarding a DVT. Ultrasound demonstrated a right subclavian vein DVT. The patient was admitted and underwent thrombolysis, venolysis, and first rib resection and initiation of warfarin.

PSS is a rare presentation of upper-extremity DVT occurring classically in patients without commonly recognized pro-thrombotic risk factors. PSS carries the potential of significant morbidity in the form of post-thrombotic syndrome and pulmonary embolism. Current literature suggests that optimal outcomes are achieved when treatment is initiated within 6 weeks of onset.

The treatment paradigm calls for thrombolysis and, frequently, a first rib resection. Kariya, Shuji, E-mail: kariyas hirakata. PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route. MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery.

Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct andmore » leakage site.

Thoracic duct embolization TDE was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate NBCA mixed with lipiodol — The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct.

In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped. ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

Thoracic myelopathy with alkaptonuria. A case of thoracic myelopathy with alkaptonuria ochronotic spondyloarthropathy is presented. To present and review the first reported case of an alkaptonuric patient with concomitant thoracic myelopathy.

Alkaptonuria, a rare hereditary metabolic disease, is characterized by accumulation of homogentistic acid, ochronosis, and destruction of connective tissue resulting in degenerative spondylosis and arthritis. Despite the high incidence of intervertebral disc diseases among patients with alkaptonuria, neurologic symptoms caused by spinal disease are rare. Thoracic myelopathy in a patient with alkaptonuria has not been previously reported. The clinical course, radiologic features, pathology, and treatment outcome of an alkaptonuria patient with thoracic myelopathy was documented.

Myelopathy of the patient was caused by rupture of a thoracic intervertebral disc. The neurologic symptoms of the patient were markedly improved after surgery. We have reported for the first time, that an alkaptonuria patient showed thoracic myelopathy caused by rupture of a thoracic intervertebral disc. Decompression followed by the instrumented fusion of the thoracic spine was effective for improving the neurologic symptoms.

Thoracic and diaphragmatic endometriosis: Single-institution experience using a novel broadened diagnostic criteria. We present a retrospective series of consecutive patients affected by pathology-proven TED, treated at our institution, during a period of 7 years. Five women were included.

One patient had not thoracic symptoms, and diaphragmatic endometriosis was found during gynecologic laparoscopy for pelvic endometriosis. Endometriosis was histologically confirmed in all cases. After follow-up all patients remain asymptomatic.

Multidisciplinary, minimally invasive surgery is effective and safe, but should be reserved to tertiary referral centers. Endovascular repair of the thoracic aorta has been adopted as the first-line therapy for much pathology.

Initial results from the early-generation endografts have highlighted the potential of this technique. Newer-generation endografts have now been introduced into clinical practice and careful assessment of their performance should be mandatory. This study describes the initial experience with the Valiant endograft and makes comparisons with similar series documenting previous-generation endografts.

Data were retrospectively collected on patients treated with the Valiant endograft at seven European centers between March and October The patient cohort consisted of 66 patients with thoracic aneurysms, 22 withmore » thoracoabdominal aneurysms, 19 with an acute aortic syndrome , 52 with aneurysmal degeneration of a chronic dissection, and 21 patients with traumatic aortic transection.

The overall day mortality for the series was 7. Subgroup analysis demonstrated that mortality differed significantly between different indications; thoracic aneurysms 6. Comparison with a series of earlier-generation grafts demonstrated a significant increase in complexity of procedure as assessed by graft implantation site, number of grafts and patient comorbidity. The data demonstrate acceptable results for a new-generation endograft in series of patients with diverse thoracic aortic pathology.

Comparison of clinical outcomes between different endografts poses considerable challenges due to differing case complexity. In this review, the present and future of thoracic surgery are discussed. With the creation of the Thoracic Domain, thoracic surgery has been strengthened and made clearly visible within the general EACTS structure. A clearly identified thoracic track is provided during the Annual Congress.

Specific working groups have been created that deal with varying topics of thoracic surgery and diseases of the chest. The European School of Cardiothoracic Surgery has been restructured, providing not only theoretical but also practical education in thoracic surgery. At national and international levels, interdisciplinary cooperation is encouraged. Harmonization of thoracic training within Europe is necessary to allow better exchange between different countries. Guidelines dealing with specific thoracic procedures should be further developed.

The Thoracic Domain of EACTS will remain a key player in promoting thoracic surgery in Europe and internationally, and in providing high-level scientific output, education and training in thoracic surgery and diseases of the chest, which requires continuous, close cooperation between thoracic and cardiothoracic surgeons.

Audit of tobacco retail outlets in Hangzhou, China. To determine the prevalence of tobacco advertisements and warning messages at points of sale as well as to examine the density of tobacco retail outlets in neighbourhoods and around schools in Hangzhou, China. Tobacco advertisements and warning messages were assessed with an audit, and stores’ addresses were recorded with Global Positioning System coordinates.

The distances 1 between all pairs of tobacco retail outlets 2 between each tobacco retail outlet and 15 middle schools were calculated to assess the density of tobacco retail outlets in neighbourhoods and around schools. Among the tobacco retail outlets , outlets , the nearest distances to other tobacco retail outlets were outlets within a m radius.

Tobacco advertisement in retail outlets is prevalent and the density of tobacco retail outlets is high in Hangzhou, China. Signs indicating 'no sales to minors’ and tobacco warning signs are almost non-existent. These findings point to an urgent need for the enforcement of regulations on display of 'no sales to minors’ and a new density standard for tobacco retail outlets based on protecting the public’s health. Spine deformities in rare congenital syndromes : clinical issues.

A focused review of the literature with regard to the important system abnormalities of patients with spinal deformities associated with exotic congenital syndromes with additional data from the author’s own experience in assessment of patients with rare syndromes treated for thoracic insufficiency syndrome.

The objectives of this study are to emphasize important medical considerations that influence the choice of surgical treatment of spinal deformity in patients with exotic congenital syndromes and point out preoperative strategies that reduce treatment morbidity and mortality of these patients.

Individual experience is limited in the treatment of spine abnormality in rare exotic syndromes and the medical aspects of these syndromes that may impact spinal treatment are seldom discussed in detail in the orthopedic literature. For a successful outcome in the treatment of spinal deformity in these unique patients, a working knowledge of the unique pitfalls in their medical care is necessary in order to avoid morbidity and mortality during their treatment. The literature was reviewed for 6 exotic congenital syndromes with known or unreported spinal abnormalities and the author’s personal years experience of the treatment of thoracic insufficiency syndrome in the relevant congenital syndromes was summarized.

Children with Marfan syndrome and spinal deformity may have serious cardiac abnormalities. Spontaneous dissection of the aortic root is a clear danger and patients should be monitored by serial echocardiograms. Prophylactic cardiac surgery may be necessary before spinal surgery is to be performed.

Patients with Jeune syndrome have a high rate of proximal cervical stenosis and should undergo screening with cervical spine films at birth. Significant stenosis or instability may require decompression and cervical-occipital fusion. Arthrogryposis may be associated with a severe scoliosis and jaw contracture may make intubation difficult. Larsen syndrome may have. Field validation of secondary data sources for enumerating retail tobacco outlets in a state without tobacco outlet licensing.

Identifying tobacco retail outlets for U. FDA compliance checks or calculating tobacco outlet density is difficult in the 13 States without tobacco retail licensing or where licensing lists are unavailable for research. This study uses primary data collection to identify tobacco outlets in three counties in a non-licensing state and validate two commercial secondary data sources. We calculated sensitivity and positive predictive values PPV to examine the evidence of validity for two secondary data sources, and conducted a geospatial analysis to determine correct allocation to census tract.

ReferenceUSA had almost perfect sensitivity 0. Commercial databases appear to provide a reasonably accurate way to identify tobacco outlets for enforcement operations and density estimation. Noonan syndrome is a genetic condition that can present with complex thoracic defects, the management of which often presents a surgical challenge. Race, Ethnicity, and Exposure to Alcohol Outlets. Prior studies suggest that Black and Hispanic minority populations are exposed to greater concentrations of alcohol outlets , potentially contributing to health disparities between these populations and the White majority.

We tested the alternative hypothesis that urban economic systems cause outlets to concentrate in low-income areas and, controlling for these effects, lower demand among minority populations leads to fewer outlets. Market potential for alcohol sales, a surrogate for demand, was estimated from survey and census data across census block groups for 50 California cities. Hierarchical Bayesian conditional autoregressive Poisson models then estimated relationships between observed geographic distributions of outlets and the market potential for alcohol, income, population size, and racial and ethnic composition.

Market potentials were significantly smaller among lower income Black, Hispanic, and Asian populations. Block groups with greater market potential and lower income had greater concentrations of outlets. When we controlled for these effects, the racial and ethnic group composition of block groups was mostly unrelated to outlet concentrations.

Health disparities related to exposure to alcohol outlets are primarily driven by distributions of income and population density across neighborhoods. Towards the evaluation of the pathological state of ascending thoracic aneurysms: integration of in-vivo measurements and hemodynamic simulations.

Ascending thoracic aortic aneurysms are cardiovascular diseases consisting in a dilation of the ascending thoracic aorta. Since indicating a weakness of the arterial wall, they can lead to major complications with significant mortality rate.

Clinical decisions about surgery are currently based on the maximum aortic diameter, but this single index does not seem a reliable indicator of the pathological state of the aorta. Numerical simulations of the blood flow inside the aneurysm may give supplementary information by quantifying important indices that are difficult to be measured, like the wall shear stress.

Our aim is to develop an efficient platform in which in-vivo measurements are used to perform the hemodynamic simulations on a patient-specific basis. Stochastic analysis was also performed, to evaluate how uncertainties in the boundary parameters affect the main hemodynamic indicators, by considering both rigid and deformable walls.

Stochastic calibration of numerical parameters against clinical data is in progress and results will be possibly shown.

Complex Greenland outlet glacier flow captured. The Greenland Ice Sheet is losing mass at an accelerating rate due to increased surface melt and flow acceleration in outlet glaciers.

Quantifying future dynamic contributions to sea level requires accurate portrayal of outlet glaciers in ice sheet simulations, but to date poor knowledge of subglacial topography and limited model resolution have prevented reproduction of complex spatial patterns of outlet flow. Here we combine a high-resolution ice-sheet model coupled to uniformly applied models of subglacial hydrology and basal sliding, and a new subglacial topography data set to simulate the flow of the Greenland Ice Sheet.

Flow patterns of many outlet glaciers are well captured, illustrating fundamental commonalities in outlet glacier flow and highlighting the importance of efforts to map subglacial topography. Success in reproducing present day flow patterns shows the potential for prognostic modelling of ice sheets without the need for spatially varying parameters with uncertain time evolution. Aim This study examined how community alcohol outlet density may be associated with drinking among youths.

Methods Longitudinal data were collected from adolescents aged 14—16 at baseline recruited from 50 zip codes in California with varying levels of alcohol outlet density and median household income. Findings When all other factors were controlled, higher initial levels of drinking and excessive drinking were observed among youths residing in zip codes with higher alcohol outlet densities. Growth in drinking and excessive drinking was on average more rapid in zip codes with lower alcohol outlet densities.

The relation of zip code alcohol outlet density with drinking appeared to be mitigated by having friends with access to a car. Conclusion Alcohol outlet density may play a significant role in initiation of underage drinking during early teen ages, especially when youths have limited mobility. Youth who reside in areas with low alcohol outlet density may overcome geographic constraints through social networks that increase their mobility and the ability to seek alcohol and drinking opportunities beyond the local community.

Objective: Prior studies suggest that Black and Hispanic minority populations are exposed to greater concentrations of alcohol outlets , potentially contributing to health disparities between these populations and the White majority. Method: Market potential for alcohol sales, a surrogate for demand, was estimated from survey and census data across census block groups for 50 California cities. Results: Market potentials were significantly smaller among lower income Black, Hispanic, and Asian populations.

Conclusions: Health disparities related to exposure to alcohol outlets are primarily driven by distributions of income and population density across neighborhoods. Endometrial tissues most commonly involve the pelvic region.

However, after the pelvis, the lungs are most frequently involved. Thoracic endometriosis should always be suspected in young women presenting with CP. A computerized tomography CT scan of the abdomen and pelvis was performed, which showed an incidental finding of a large right-sided pneumothorax. A right-sided chest tube was placed, and after the procedure, a chest X-ray image showed expansion of the right lung.

The patient was readmitted for elective resection of an umbilical mass and was again incidentally found to have a recurrent pneumothorax on the right side. She underwent videothoracoscopic pleurodesis with pathology, establishing the diagnosis of catamenial pneumothorax. Treatment options still under debate include endoscopic resection and videothoracoscopic pleurodesis followed by gonadotrophin-releasing hormone GnRH therapy to reduce the rate of postoperative recurrence.

To investigate the short-term effects of thoracic spine manipulation TSM on pain, function, scapular kinematics, and scapular muscle activity in individuals with shoulder impingement syndrome. Randomized controlled trial with blinded assessor and patient. Scapular kinematics and muscle activity were measured at day 1 baseline, before the first intervention , day 2 preintervention before second intervention , day 2 postintervention after the second intervention , and day 3 follow-up.

Shoulder pain and function were assessed by the Disability of the Arm, Shoulder and Hand questionnaire and Western Ontario Rotator Cuff Index at baseline, day 2 preintervention, and follow-up. An assessor blinded to group assignment measured all outcomes. Pain decreased by 0. Scapular upward rotation increased during arm lowering P Off-premise alcohol outlet characteristics and violence.

There is considerable evidence of an association between alcohol outlet density and violence. Although prior research reveals the importance of specific characteristics of bars on this association and that the relationship between bar density and violence may be moderated by these characteristics, there are few similar studies of the characteristics of off-premise outlets e. We examined whether immediate environment, business practice, staff, and patron characteristics of off-premise alcohol outlets are associated with simple and aggravated assault density.

Cross-sectional design using aggregate data from 65 census block groups in a non-metropolitan college town, systematic social observation, and spatial modeling techniques. We found limited effects of immediate environment, business practice, staff, and patron characteristics on simple assault density and no effect on aggravated assault density. Only two out of 17 characteristics were associated with simple assault density i. This is the first study to examine the association between several off-premise alcohol outlet characteristics and assault.

Our findings suggest that where the off-premise outlets are located, how well the immediate environment is maintained, what types of beverages the outlets sell, who visits them, and who works there matter little in their association with violence. This suggests the importance of outlet density itself as a primary driver of any association with violence. Public policies aimed at reducing alcohol outlet density or clustering may be useful for reducing violence.

Socioeconomic determinants of exposure to alcohol outlets. Alcohol outlets tend to be located in lower income areas, exposing lower income populations to excess risks associated with alcohol sales through these establishments.

The objective of this study was to test two hypotheses about the etiology of these differential exposures based on theories of the economic geography of retail markets: a outlets will locate within or near areas of high alcohol demand, and b outlets will be excluded from areas with high land and structure rents. Data from the National Drug Strategy Household Survey were used to develop a surrogate for alcohol demand i. Market potentials were greatest in areas with larger older age, male, English-speaking, high-income populations.

Independent of zoning characteristics, greater numbers of outlets appeared in areas with greater market potentials and the immediately surrounding areas. Greater income excluded outlets in local and surrounding areas.

These findings are consistent with the hypothesis that alcohol outlets are located in areas with high demand and are excluded from high-income areas. These processes appear to take place at relatively small geographic scales, encourage the concentration of outlets in specific low-income areas, and represent a very general economic process likely to take place in communities throughout the world. Carpal tunnel syndrome assessment with ultrasonography: value of inlet-to- outlet median nerve area ratio in patients versus healthy volunteers.

A hypercoagulable state was unlikely as initial pro-thrombotic screen was negative. PSS if diagnosed early, allows early institution of medical and surgical treatment, with good resultant outcome and prognosis. Conventional treatment usually involves anticoagulation and thrombolysis.

Skeletal abnormality causing thoracic outlet and hence venous obstruction should also be addressed. Our patient was referred to the vascular surgeons for definitive treatment. Although uncommon, PSS may result in life-threatening sequelae such as pulmonary embolism. As such, there should be a high index of suspicion for PSS in any case of upper limb swelling with a preceding history of repetitive exercises.

Laboratory investigations should include complete blood counts and complete pro-thrombotic work up to exclude secondary causes. A brief screen for any thoracic outlet syndrome on physical examination will also be helpful in determining causative factors for PSS.

PSS if diagnosed and treated early, usually results in excellent outcome and prognosis. No source of funding is involved in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

Study is a case report without any added intervention hence exempted for ethical approval from research board of institution. Kein Boon Poon -consultant involved in management of patient, main guidance for write up. Not required as no added intervention done for purpose of study. Int J Surg Case Rep. Published online Jun Author information Article notes Copyright and License information Disclaimer. Vipul Garg: moc. Received Apr 10; Accepted May Abstract Background Paget-Schrotter Syndrome PSS also known as „effort thrombosis” is a form of primary thrombosis in the subclavian vein at the costoclavicular junction is usually seen in younger patients after repeated strenuous activity of the shoulders and arms.

Case Presentation We report a rare case of unusual left axillo-subclavian vein thrombosis following narrowing of thoracic outlet due to stress injury of rib fracture likely during gym activity in absence of other clear risk factors and a negative hypercoagulable workup in a year-old man who was admitted as left deltoid rupture 5 days after his usual gym. Conclusion In addition to the unusual location in the left upper extremity in our case, the absence of common etiologic factors makes our case of Paget-Schroetter Syndrome a very unique one.

Keywords: Deep vein thrombosis, Paget-schrotter syndrome, Axillary-subclavian venous thrombosis, Pulmonary embolism, Thrombosis, Upper extremity deep vein thrombosis. Introduction Spontaneous effort-induced upper extremity deep vein thrombosis, also known as Paget-Schroetter syndrome PSS , is a rare phenomenon first described by Cruveilhier in , with the first elaborate account provided by James Paget in [ 1 , 2 ]. Open in a separate window.

Picture 1. Picture 3. MRI showing left subclavian vein thrombosis and old fracture of the left 1st rib. Picture 4. Picture 5. Table 1 Case reports of PSS and associated physical activity.

Conclusion Although uncommon, PSS may result in life-threatening sequelae such as pulmonary embolism. Conflicts of interest None of the authors have conflict of interest. Sources of funding No source of funding is involved in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

Ethical approval Study is a case report without any added intervention hence exempted for ethical approval from research board of institution. Consent Informed consent taken before writing this report.

Author contribution Garg Vipul -Principal author, Glenys Poon-review of lit and write up, Aprine Tan — data collection and patient managment, Kein Boon Poon -consultant involved in management of patient, main guidance for write up.

Registration of research studies Not required as no added intervention done for purpose of study. Guarantor Kein Boon Poon. References 1. Cruveilhier L. Bailliere; Paris: Doctoral thesis. Kucher N. Deep-vein thrombosis of the upper extremities.

Chandra V. Thoracic outlet syndrome in high-performance athletes. Klitfod L. Deep venous thrombosis of the upper extremity. A review. Pinar M. Deep vein thrombosis in upper limb in a weightlifter.

Open Access Maced. Mall N. Sports Health. Toya N. Push-up exercise induced thrombosis of the subclavian vein in a young woman: report of a case. Urschel H. Roche-Nagle G. Effort thrombosis of the upper extremity in a young sportsman: paget schroetter syndrome. Sports Med. Alla V. Paget Schroetter syndrome: review of pathogenesis and treatment of effort thrombosis.

West J. Yagi S. Paget-Schroetter syndrome in a baseball pitcher.


Usa jobs government jobs login paget schroetter syndrome rib.Paget-Schroetter syndrome: A contemporary review of the controversies in management

We report a rare case of unusual left axillo-subclavian vein thrombosis following narrowing of thoracic outlet due to stress injury of rib. This “effort thrombosis,” also known as Paget-Schroetter Syndrome, classically occurs in the dominant arm of young, active individuals.3 VTOS.


Paget Schroetter Syndrome – StatPearls – NCBI Bookshelf.

We report a rare case of unusual left axillo-subclavian vein thrombosis following narrowing of thoracic outlet due to stress injury of rib. This “effort thrombosis,” also known as Paget-Schroetter Syndrome, classically occurs in the dominant arm of young, active individuals.3 VTOS.

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