Use of a Javid™ shunt in the management of axillary artery injury as a complication of fracture of the surgical neck of the humerus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Axillary artery injury is a rare but severe complication of fractures of the surgical neck of the humerus.</p> <p>Case presentation</p> <p>We present a case of axillary artery pseudoaneurysm secondary to such a fracture, in a 82-year-old white woman, presenting 10 weeks after the initial injury, successfully treated with subclavian to brachial reversed vein bypass together with simultaneous open reduction and internal fixation of the fracture. We discuss the use of a Javid™ shunt during combined upper limb revascularisation and open reduction and internal fixation of the fractured humerus.</p> <p>Conclusion</p> <p>This case highlights the usefulness of a Javid™ shunt, over other forms of vascular shunts, in prompt restoration of blood flow to effect limb salvage. It can be considered as a temporary measure whilst awaiting definitive revascularisation which can be performed following fracture fixation.</p

Secondary Endoleak Management Following TEVAR and EVAR.

Endovascular abdominal and thoracic aortic aneurysm repair and are widely used to treat increasingly complex aneurysms. Secondary endoleaks, defined as those detected more than 30 days after the procedure and after previous negative imaging, remain a challenge for aortic specialists, conferring a need for long-term surveillance and reintervention. Endoleaks are classified on the basis of their anatomic site and aetiology. Type 1 and type 2 endoleaks (EL1 and EL2) are the most common endoleaks necessitating intervention. The management of these requires an understanding of their mechanics, and the risk of sac enlargement and rupture due to increased sac pressure. Endovascular techniques are the main treatment approach to manage secondary endoleaks. However, surgery should be considered where endovascular treatments fail to arrest aneurysm growth. This chapter reviews the aetiology, significance, management strategy and techniques for different endoleak types

Symptom clustering in subjects with and without diabetes mellitus: A population-based study of 15,000 Australian adults

OBJECTIVES: GI symptoms form distinct symptom clusters in community samples when factor and cluster analysis is applied. However, this has not been studied in diabetic populations, despite clear evidence that GI complaints are common in patients with diabetes mellitus (DM). This study aimed to describe clustering of GI symptoms among individuals with and without diabetes mellitus, and to describe associations of symptom clustering in diabetes mellitus, with self-reported glucose control and treatment. METHODS: A large population survey (n = 15,000) was used to identify a cohort with diabetes mellitus. Items assessing therapy and quality of glycemic control were included, as were those assessing 16 common GI symptoms. Latent GI symptom factors were extracted by factor analysis and used in a k-means cluster analysis. The latter serves to group individuals according to commonalities in symptom profiles. The association of cluster group membership to glycemic control and diabetic treatment was described by logistic regression. RESULTS: Factor analysis identified four latent symptom factors, which accounted for 69.3% of the total variance. These were labeled Upper GI/Dysmotility, Diarrhea, Constipation, and Vomiting/Nausea. The k-means analysis produced a five-cluster solution, which included a "health" group and four "diseased" groups, each identified by a predominant symptom: Upper GI/Dysmotility symptoms, Nausea/Vomiting, Diarrhea, and Constipation. After adjustment for age and gender, poor glycemic control predicted membership in all disease clusters, when compared separately with the health group. Oral hypoglycemic drugs predicted membership in the Nausea/Vomiting cluster (OR = 5.13) when used alone, and membership in the Nausea/Vomiting (OR = 10.12) and Upper GI/Dysmotility cluster (OR = 10.12) when used in combination with insulin. CONCLUSIONS: Diabetes can be grouped according to common GI symptoms. Glycemic control and treatment for DM predict membership of symptom clusters.Johann Hammer, Stuart Howell, Peter Bytzer, Michael Horowitz, and Nicholas J. Talle