Guidewire insertion into the vertebral vein during right internal jugular vein central venous catheterization -A rare case report-

Background Internal jugular veins are the most frequently accessed site for central venous catheterization in patient management, whereas complications involving vertebral veins are a rare occurrence. Case A 73-year-old male suspected to have a urothelial carcinoma was scheduled for elective left nephroureterectomy. During central venous catheterization using the anatomic landmark technique to target the internal jugular vein, a guidewire is inadvertently inserted into the suspected vertebral vein. Following the correction of the catheterization, a radiologist reviewed the preoperative enhanced computed tomography and confirmed that the initially punctured vessel was the vertebral vein. On the third day after surgery, the central venous catheter was removed, and the patient did not exhibit any complications, such as bleeding, swelling, and neurological symptoms. Conclusions The use of ultrasonography during central venous catheterization is recommended to evaluate the anatomy of the puncture site and prevent misinsertion of the catheter, which can lead to several complications

GENERALIZATION OF FUNDAMENTAL CITY SPATIAL MODEL FOR THE DATA GENERATION SATISFIED WITH USER’S REQUIREMENTS

As the Geospatial Technology (GT) grows, the generation and utilization of 3D city spatial model are actively studied. In some applications, the fundamental model is too detail comparing with the level of detail (LOD) actually needed by users, which make it difficult for users to process, analyze and visualize the model efficiently. In this study, the goal is to develop a generalization procedure to generate a tailored city spatial model tailored to user’s specific requirements from an existing fundamental model of higher resolution. This study consists of two stages; one is the generation of the fundamental city spatial model and the other is the generation of a tailored city spatial model through the generalization of the fundamental model. Here, the model generated in the first stage is the model of the best quality in aspects of accuracy, resolution, and detail that can be derived from the original sensory data, such as the aerial and terrestrial images. The model in the second stage is the model that is tailored to user’s requirements for a specific application. 1

Asymptomatic Type 2 Perioperative Myocardial Infarction Detected before Anesthetic Induction in a Patient Undergoing Non-Cardiac Surgery—A Case Report

Background: Perioperative myocardial infarction (PMI) is a life-threatening complication in major non-cardiac surgeries (NCS) and constitutes the most common cause of postoperative morbidity and mortality. A PMI that is associated with prolonged oxygen supply–demand imbalance and its etiology is defined as a type 2 MI. Asymptomatic myocardial ischemia can occur in patients with stable coronary artery disease (CAD), especially those with comorbidities such as diabetes mellitus (DM), hypertension, or, in some cases, without any risk factors. Case: We report a case of asymptomatic PMI in a 76-year-old patient with underlying hypertension and DM without a previous history of CAD. During the induction of anesthesia, abnormal electrocardiography was discovered, and the surgery was postponed after further studies revealed almost completely occluded three-vessel CAD and type 2 PMI. Conclusions: Anesthesiologists should closely monitor and evaluate the associated cardiovascular risk, including cardiac biomarkers of each patient before surgery, to minimize the possibility of PMI

Zolpidem use and risk of fatal motor vehicle collisions

In a simulation study evaluating the residual effects of taking a single night-time dose of hypnotics among health individuals on collision anticipation capacities in the next morning, investigators found no residual effect by having taken a capsule of zolpidem. In a real world, however, zolpidem is frequently consumed not only by sleep disorder patients without any other comorbidities, but also patients with multiple chronic diseases. A post-marketing study of zolpidem revealed the incidence of the residual daytime sedation being 3.7%, which was reported to be unlikely based on various experimental circumstances with selected participants demonstrating negligible impairments. In fact, several studies with real world settings have reported positive relationship between the zolpidem and the traffic accident. while evidence among Asian population is scant.  Recent analysis of national health insurance data of Taiwan showed use of zolpidem at night of the previous day might be associated with an increased risk of motor vehicle collision (MVC) related hospitalization. The study used 1 million patient sample data of whole Taiwan population to identified hospitalized drivers with MVCs and prescription record of the zolpidem before the hospitalization. However, the inclusion of MVC leading to only hospitalization might have led to underrepresentation of fatal cases that had no admission record. Moreover, the study was limited by lack of control for important confounders, because no information on detailed context of MVCs or alcohol consumptions was available. We aimed to evaluate the risk of fatal MVCs by use of zolpidem considering the context of the MVCs