Search

Organophosphate pesticides are one of the causes of contamination in animal feed. The cholinesterase enzyme test is used to diagnose toxic exposure due to organophosphate pesticides. Quantitative research with survey design using cross sectional design using 35 samples of cows. The study was conducted in March - September 2020. Concentration measurement on cholinesterase enzyme concentrations of blood plasma used the biosystem A15 DGKC-Colorimetric Kinetic method. This study aims to evaluate the concentration of the enzyme cholinesterase as a marker of organophosphate poisoning in cattle. Blood samples were collected from the ventrolateral neck veins of male and female cattle aged 1-7 years and collected from local cattle in the Ogan Ilir area. The results showed that the cows raised in breeders were exposed to organophosphate pesticides as indicated by a decrease in the concentration and levels of the cholinesterase enzyme in the plasma of female cows. Cholinestrase enzyme levels in female cows were 0.20 ± 0.067 U / ml and bulls were 0.27 ± 0.183 U / ml. The highest concentration of cholinesterase enzyme levels occurred in cows aged 2 years, namely 0.25 ± 0.34 U / ml and the lowest was in cows aged 7 years, namely 0.12 ± 0.04 U / ml.

The theory that multiple sclerosis is related to venous pressure has been discredited due to previous operator dependent diagnostic criteria and premature attempts at treatment. (1) An elevation in venous pressure may only be a component of the compliance changes found in MS. (2) The neck veins may only supply a component of the venous pressure elevation found intracranially. Although a more targeted approach towards neck angioplasty (both towards disease subtype and those with more favorable stenoses) may be beneficial, we would advocate caution. We encourage others to give the venous pressure theory a second chance and to replicate our work.

Introduction There is a need for simple teaching methods every teacher can adopt, which are accepted by the students and provide a sustainable outcome. The traditional teaching methods do not achieve the desired outcomes, with many students left wanting for more practice of procedural skills. Methodology MBBS Phase I students were randomly distributed into 3 groups: Group 1 (traditional method, n=30), Group 2 (Peyton’s method, n=30) and Group 3 (Modified Peyton’s method, n=30), and study duration was 6 months. Students were taught anatomy of the neck veins and were taught central venous catheterizations (CVC) into the right internal jugular vein by a single nephrologist on a mannequin. The modified Peyton’s method consists of: Demonstration and Deconstruction, Comprehension, Performance and Observation, Teacher and Peer Feedback. The students were followed up with 4-week and 12-week recall. Results The mean percentages obtained at end of 4 weeks in Groups 1, 2 and 3 were 82±10%, 86.67±7%, and 87.33±6.9% respectively. The percentages obtained at end of 12 weeks were 74.5±7.6%, 80.5±7.5% and 80.3±7.1% respectively. There was a significant decrease in percentages in all the groups (p At 4 weeks, there was significant difference between Groups 1 and 2, Groups 1 and 3 (p Conclusion This study highlights the effort of a student in turning her adversity into an opportunity to improve the educational methods.

Examination of the Neck Veins Examination of the neck veins is routinely performed to evaluate right atrial pressure and to estimate intravascular volume in patients with dyspnea, edema, or hypovol...

Introduction Venous ectasia is rare causes of neck mass. Among neck veins, ectasia of the internal jugular vein (IJV) are extremely uncommon. However, this is to be kept in mind when considering differentials for laryngocele. Objectives To recognize the similarities between laryngocele and ectasias of the IJV and the differences in their presentation and management. Study design Observational. Setting Tertiary care hospital, India. Conclusion Presenting a 7-year-old boy with a left-sided soft, non-tender neck mass that fluctuated in size with coughing and straining for the past 1 year, presentation classical of laryngocele. Computed tomography (CT) demonstrated marked asymmetrical dilatation of the left IJV in the neck. Color-flow Doppler ultrasonography revealed a solitary cystic lesion with evidence of high venous blood flow in the IJV area. The relevance of radiological evaluation in neck swelling is being highlighted. How to cite this article Ashish G, Kurien M. Venous Ectasia: A Potential Mimicker for Laryngocele Radiology Covers the Road. Int J Otorhinolaryngol Clin 2015;7(2):64-67.

Background The presence of abnormal anatomy and flow in neck veins has been recently linked to neurological diseases. The precise impact of extra-cranial abnormalities such as stenoses remains unexplored. Methods Pressure and velocity fields in the full cardiovascular system are computed by means of a global mathematical model that accounts for the relationship between pulsating cerebral blood flow and intracranial pressure. Results Our model predicts that extra-cranial strictures cause increased pressure in the cerebral venous system. Specifically, there is a predicted pressure increase of about 10% in patients with a 90% stenoses. Pressure increases are related to significant flow redistribution with flow reduction of up to 70% in stenosed vessels and consequent flow increase in collateral pathways. Conclusions Extra-cranial venous strictures can lead to pressure increases in intra-cranial veins of up to 1.3 mmHg, despite the shielding role of the Starling resistor. The long-term clinical implications of the predicted pressure changes are unclear.

We present a novel application of strain-gauge plethysmography that is suitable to detect blood volume variations in the human venous system. The plethysmography system uses capacitive sensors that are electrically connected to a portable electronic unit to record changes of blood volume over time. Such system has been developed within a project that aimed to monitor the cerebral venous return of the astronaut during an experiment on the International Space Station. In this work, we describe the novel solution in which measurement of elongation is directly obtained by charging the sensor capacitance with a constant current. We also report the full characterization of the plethysmography system and an example of the experimental protocol that has been performed in microgravity condition. Remarkably, the system we propose is able to detect cross-sectional area variations of neck veins with enough sensitivity to be useful for studies concerning cardiac oscillations.

Os aneurismas venosos raramente são responsáveis por tumefações cervicais, e em relação às veias do pescoço, os aneurismas da veia jugular externa são extremamente raros, sendo poucos os casos descritos na literatura. Embora na maioria assintomáticos, podem causar dor, complicar com trombose ou mesmo rotura. Os exames de imagem têm papel no diagnóstico e no planeamento cirúrgico desta patologia. Enfatizando-se o contributo dos meios de imagem, os autores apresentam o caso de um aneurisma da veia jugular externa, inicialmente assintomático mas que posteriormente se complicou por trombose.Palavras-chave: Veias Jugulares; Aneurisma; Trombose; Tomografia Computorizada; Ecografia.

Diverticula of the vascular system are rare. A diverticulum involving the retromandibular vein has not been described to date. We describe the imaging findings and a novel therapeutic strategy for the management of this rare diverticulum. A 25-year-old male presented with complaints of swelling behind the angle of mandible that enlarged on straining. On imaging, a retromandibular vein diverticulum was seen. The diverticulum was punctured percutaneously with the patient performing Valsalva maneuver and injected with sclerosant microfoam. There was no sclerosant reflux into the normal neck veins. At 6-month follow-up, the patient had complete resolution of his symptoms. We also have done a review of literature for patients with venous diverticula in the head and neck region treated by endovascular techniques.

Venous occlusion following permanent central venous catheter (CVC) insertion by open cutdown or the landmark percutaneous technique has been reported between up to 25 %. However, there are no published data on the equivalent rate following ultrasound-guided percutaneous CVC insertion. The purpose of this study was to document the rate of venous occlusion associated with ultrasound-guided percutaneous CVC insertion in children. From 1 April 2010 to 1 December 2011, all children having elective or emergency removal of a Hickman line by the vascular access team had a Doppler ultrasound of their neck veins. Only Hickman lines inserted by the ultrasound-guided percutaneous route were included. Internal jugular, innominate and subclavian veins were scanned and recorded as patent, reduced or absent. We identified 100 consecutive children. Median age was 6 years (range 21 days to 16 years). Indication for insertion was chemotherapy (60), parenteral nutrition (15), blood products (12), renal replacement (3) and other indications (10). Three children had absent flow at the time of line removal (median age 4 months, range 3–6 months), with 2 out of 3 requiring removal for infection. The venous occlusion rate following ultrasound-guided insertion of CVC is 3 % in our study. We conclude that (1) complete venous occlusion is associated with younger age and CVC infection. (2) In our study, the venous occlusion rate of 3 % is significantly lower than the published series of either open cutdown or the landmark technique.

Pressure on the neck is one of the oldest and controversial types of death. However, the only hypoxia as the cause of speed death is not always correct. Many victims die immediately without classic symptoms of respiratory failure (Shirzad & Gharedaghi, 2007). Most of the deaths which occur in less than one to three minutes are falls in this category. Pressure on the neck leads to airway obstruction, neck veins obstruction, blocking the carotid arteries, and affect the nerves. A variety of causes is associated with fatal pressure on the neck, including strangulation by hand, strangulation with a ligature, and hanging. Hanging is the method used maximally in suicide as compared to other methods of suicide (Graham et al., 2000; Gould & Kramer, 2001). Including Iran, it is the most common method adopted for suicide in Asian countries (Morovatdar et al., 2013; Shojaei et al., 2014), especially adopted by men, older and especially illeterate people (Pridmore & Walter, 2013).

SUMMARY The treatment of colonised Holter shunts, used in the management of hydrocephalus, is discussed and 57 patients are reviewed. The ‘classical’ delayed shunt replacement is compared with ‘immediate’ shunt replacement. The advantages of immediate shunt replacement (the avoidance of ventricular taps with possible and potentially serious complications, the preservation of valuable neck veins and the reduced period of hospitalisation) would appear to justify this method in which the failure rate is only 8 7 per cent. The method of immediate shunt replacement is only possible if the CSF is sterile and the colonising organism is Staph, albus. RESUME Remplacement immediat du shunt dans le traitement des valves de Holier infectes Le traitement de valve de Holter infectee au cours de la correction de l'hydrocephale est discute et cinquante sept cas sont etudies. Le remplacement retarde, ‘classique’, du shunt est compare au remplacement ‘immediat’. Les avantages du remplacement immediat (evitant une fuite ventriculaire avec complications possibles et potentiellement graves, preservant les veines du cou utiles et reduisant la periode d'hospitalisation) apparaissent justifier cette methode dans laquelle le taux d'echecs est de 8,7 %. Cependant cette methode de remplacement immediat n'est possible que si le LCR est sterile et que le germe infectant est du staphylocoque blanc. ZUSAMMENFASSUNG Sofortiger Shuntersatz bei der Behandlung von bakteriell besiedelten Holter-Klappen Die Behandlung von infizierten Holter Shunts in der Uberwachung von Patienten mit Hydrocephalus wird diskutiert und 57 Patienten werden besprochen. Der ‘klassische’ verspatete Shunt–Ersatz wird mit dem ‘sofortigen’ verglichen. Die Vorteile des sofortigen Shunt-Ersatzes–Vermeidung von Ventrikelzapfen mit moglichen und unter Umstanden ernsten Komplikationen, Erhaltung guter Halsvenen und kiirzerer Krankenhausaufenthalt –scheinen diese Methode zu rechtfertigen, bei der die Versagensrate nur 8,7% betragt. Die Methode des sofortigen Klappenersatzes ist nur moglich, wenn die CSF steril ist und Staphylococcus albus der besiedelnde Keim ist. RESUMEN Cambio inmediato del sistema derivativo en el tratamiento de la colonizacion bacteriana de la vdlvulas de Holter Se discute el tratamiento de la colonizacion de las valvulas de Holter y se revisan 57 pacientes. Se compara el ‘clasico’ reemplazamiento retrasado de la valvula con el ‘inmediato’. Las ventajas del reemplazamiento inmediato (el evitar obstrucciones ventriculares con posibles y potenciales complicaciones graves, la preservation de valiosas venas cervicales y el reducido periodo de hospitalization) parecen justificar este metodo en que el fallo alcanza solo el 8,7 por ciento. El reemplazamiento inmediato es solo posible si el l.c.r. es esteril y el agente colonizador es el Estafilococo Blanco.

One or several syncopes were the reason for hospitalization in 31 of 155 in-patients with proven pulmonary embolism. In all of them there were at least two further pointers to acute pulmonary embolism: all had tachypnoea, 28 had dyspnoea, 25 had sinus tachycardia (more than 100 beats/min), 24 had congested neck veins and 16 had deep leg-vein thrombosis. In 21 patients the ECG had signs of right heart strain, in 15 of 20 in whom it was measured the arterial oxygen partial pressure was below 70 mm Hg. In 23 patients the chest X-ray was largely unremarkable despite dyspnoea. In 23 patients there had been a massive embolus and 16 patients had died. Although syncope is only rarely caused by pulmonary embolism, its ominous significance in this connection should stimulate a search for further diagnostic pointers to such an occurrence.

The major components and merits of the physical examination of patients with heart failure are presented. A staging of the physical examination practiced by most heart failure specialists is proposed based on the information needed at the time of the encounter. The challenges to our subspecialty regarding this diagnostic tool are the prevention of its extinction during an era of seemingly limitless comprehensive laboratory testing, the promotion of its widespread use, and, over the years, the subjection of its components to the rigors of blinded controlled studies. Part I addresses the staging of the physical examination in heart failure, general observation of the patient, vital signs, and assessment of arterial pulse and neck veins.

V okviru diplomskega dela smo razvili razširitev aplikacije za prikaz žil s podporo za uporabo dveh dodatnih navigacijskih naprav (3D-miška Connexion Space navigator in brezdotična navigacijska naprava Leap Motion), ki sta predstavljali razširitev možnih vhodnih naprav poleg miške in tipkovnice za manipulacijo pogleda na 3D-model ožilja. Poleg same implementacije podpore za napravi v aplikacijo smo izpeljali uporabniško študijo, s katero smo ocenili primernost in enostavnost uporabe naprav v aplikaciji. Rezultate smo zbirali s podatki, ki so bili računalniško zajeti med interakcijo uporabnikov z napravami, ko so reševali različne manipulacijske naloge ter z reševanjem vprašalnikov SUS (System Usability Scale), ki predstavljajo enega izmed orodij, s katerim lahko ocenjujemo uporabniške vmesnike. Analiza rezultatov je potrdila, da je 3D-miška v takšnem okolju bolj uporabna ter tudi izpostavila nekatere pomanjkljivosti brezdotične navigacijske naprave Leap Motion. As part of the thesis we have developed applications for the extension of the vein display with support for two additional navigation devices (3D Connexion Space Navigator Mouse and hand gesture based navigation device Leap Motion) which represented an extension of possible input devices besides the keyboard and a mouse to manipulate the view of 3D model of neck veins. In addition to the implementation of support for the device in the application we carried out a user study in which we assessed the usability and ease of use of devices in the application. The results consisted from data we collected from the users' experience while they solved various manipulation tasks and the answers received from questionnaires SUS (System Usability Scale) which constitute one of the tools with which we can assess interfaces. Analysis of the results confirmed that the 3D mouse is more useful in such an environment and also highlighted some shortcomings of the hands free navigation device Leap Motion.

A pyolaryngocele is an uncommon complication of a laryngocele that has become infected. We present a case of a pyolaryngocele that was probably due to repeated injections in the neck veins. The pathogenesis, clinical features and management are discussed in detail.

The estimation of central venous pressure (CVP) by inspection of the neck veins is regarded as a quintessential example of effective bedside cardiovascular examination because it is virtually cost-free and requires minimal time and no equipment. In the upright position, venous drainage from the head

We describe the technique for identification of innominate veins, azygos vein, and left subclavian and internal jugular veins during transesophageal echocardiography. Validation was provided with contrast echocardiography.

There is controversy as to whether or not the heart works against gravity in the arteries to the head in the upright position. One view is that the gravitational effects in the neck arteries are counterbalanced by the gravitational effects in the veins of the neck and the heart does not do extra pressure work. This concept has been challenged by others who claim that the heart works against gravity based on the notion that the jugular vein is collapsed and gravitational effects on jugular blood are inoperative, similar to the "free" fall of liquids. The present study supports the view that blood flow in the collapsible jugular vein of the giraffe is not a "free" fall and that the heart does not spend extra energy to raise the blood to the head.

Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) is a medical condition where deoxygenated blood flows from the veins surrounding the brain and spine is slowed down or blocked in its return to the heart. The diagnosis and severity of CCSVI can be assessed by investigating the possible presence and the extent of such reflux and/or blockage in neck veins and intracranial veins, with the patient in both sitting and supine positions. During such examinations, B-Mode and Color Doppler ultrasound are not always capable of accurately detect the flow behavior in all subjects.

Brachial plexus injury during central venous catheter insertion is uncommon. Understanding the anatomy and the relationship between the brachial plexus and the neck veins and arteries is highly important. The brachial plexus, stellate ganglion, vagus, accessory, hypoglossal and phrenic nerves are all closely associated with the internal jugular vein. Any of these structures may be injured during cannulation attempts, with the most common complication occurring when local anesthetic injected at the time of cannulation transiently blocks these nerves.

Doppler ultrasonography was used to examine 198 neck-vein systems (67 right, 131 left) in 148 patients. The vessel lumen is usually echo-free: the veins are supple, and the internal jugular and sometimes the subclavian veins can be compressed. The venous confluence is Y-shaped. Blood flow was symmetrical and biphasic in 57% of cases, continuous in 29% of cases, and monophasic in 13% of cases. Blood flow velocity was less than 1 m/s in all cases and varied with respiration and heart rate. Color Doppler allows flow imaging and increases the speed and reliability of the procedure. This investigation is useful for following-up patients with indwelling venous catheters and is the investigation of choice whenever pathology of the neck veins is suspected.

Almost all cerebral arteriovenous malformations in the fetus involve the vein of Galen, although occasionally they may involve the frontal area of the brain instead. In all reported cases arteriovenous malformations have presented some time after 30 weeks as a sonolucent oval lesion located in the midline behind the third ventricle. Previous scans have been normal. Evidence of high output failure such as cardiomegaly, enlarged neck veins, or hydrops predicts a poor outcome.

La particular estructura de la región cervical de la llama (Lama glama) se traduce en numerosas diferencias anátomo-funcionales respecto de otros mamíferos domésticos. Entre ellas merece destacarse un distintivo circuito venoso, cuya descripción es el objetivo de este trabajo. Para el presente estudio, se utilizaron diez llamas, machos, adultos y de aptitud lanera. Para resaltar las venas del cuello se procedió a la repleción de las mismas y, posteriormente, se disecaron los vasos utilizando técnicas e instrumental convencional. Se describe la morfología particular de un circuito venoso, en el cual las venas yugular externa, vertebral e intervertebrales son las principales protagonistas. El hecho destacado radica en las anastomosis establecidas entre las citadas venas, uniones dispuestas en forma metamérica, formando un circuito o by pass yugular-vertebral. La existencia de comunicaciones o shunts venosos, permite definir un circuito de circulación colateral derivando la sangre principalmente hacia la vena yugular externa. La longitud del cuello y los hábitos de pastoreo indican que esta disposición vascular es un hecho facilitador del retorno venoso, en cuanto a su dinámica y al control regional del flujo sanguíneo. The neck región of the Llama (Lama glama) has several structural and functional particularities in comparison to the same región of other domestic mammals. Among them, it is noticeable a distinctive venous circuit whose descnption is the purpose of this study.In order to perform the study, the veins of the neck of ten adult, male, wool type llamas were dissected with conventional technique. Previously to dissection, the veins were filled with a repletive substance.The authors describe the morphology of a venous circuit in which external jugular vein (v. jugularis externa), vertebral vein (v. vertebralis), and intervertebral veins (vv. Intervertebrales) are the main participating vessels. The distinctive feature is the fact that the metameric anastomoses between the forenamed veins leads to a jugular-vertebral by pass.The existence of venous shunts provides a circuit of collateral circulation, diverting the blood mainly towards the external jugular vein. Grazing habits and the length of the neck suggest that the vascular structure previously described facilitates the venous return, contributing to the regional blood stream control.

Although physicians began associating conspicuous neck veins with heart disease almost three centuries ago, the jugular venous pulse remains an often ignored component of the physical examination. Many physicians have not invested in the necessary understanding of the technique, and there is a misconception that its examination is difficult and of limited clinical value. When performed properly, evaluation of the jugular venous pulse can be extremely useful in distinguishing the cause of dyspnea and edema. The normal jugular venous pulse is reviewed, and pulse wave abnormalities are described, including ways in which they can provide clues to the diagnosis of certain disease states, ranging from pericardial disease to conduction disturbances. The jugular venous pulse provides a window into the right heart and an occasional glimpse of left heart hemodynamics. By peering through this window, clinicians can gain valuable information in the diagnostic evaluation of the cardiovascular patient.

Some patients need their ER doc to be a lover, not a fighter. I provide “customer service,” hold hands, and reassure. Not this time. It’s Monday night in my emergency department (ED) when the paramedic radio goes off. The battle begins. “A 22-year-old man with severe asthma. Tight wheezing, can’t talk, breathing at 40, pressure 160/120, heart rate 120 sinus, saturating 94 percent on nonrebreather oxygen. Albuterol and Atrovent are not helping. He is tiring. Do you want steroids and magnesium? Should we intubate? ETA 5 minutes.” I fire back, “Solu-Medrol 125, a gram of magnesium and intramuscular epinephrine 0.3 mg.” Intubating a critical asthmatic patient would not address the main problem: getting the air out. I pace the floor. A deep breath and my pulse slows to 50. A trick from high school wrestling. You feel nervous until contact with the opponent. Go in calm. Let the training take over. First period: The doors burst open and I see him panting; exhausted. His neck veins bulge as he tripods in desperation. Beads of his sweat spray over my goggles. His lungs wail. Epinephrine is not working. This means something. “More fluids, Ativan 2 mg, magnesium 1 g, initiate BIPAP.” I watch his therapies, his vitals, his mortal struggle. The respiratory therapist gets the blood gas, the nurse refills the nebulizer, the techs hold him in the bed. The radiograph shows clear lungs full of stale air. Another shot of epinephrine. His carbon dioxide is sky high. Hanging by a thread. Second period: Nothing beats this opponent. Need a strategy. Intubate him. Now. But rapid sequence paralysis will lose ground on the CO2 front. Mechanical ventilation could cause air buildup and blow a lung; deadly. But deeper acidosis means arrhythmias. Maybe tube him with ketamine and pour in albuterol? Perhaps. When both options kill the patient, I want a plan C. His parents tremble in the corner. From the mat side, they watch me fighting for their son. Introductions and clammy handshakes and I admit the stalemate, acknowledge uncertainty. Intubation is near imminent and risky. I probe about recent events. A new antibiotic was started yesterday. They cry and beg. I respond with resolve they need to see. “I will do everything possible.” p

We report here a case of severe ovarian hyperstimulation syndrome with massive ascites in a 25-year-old woman with a history of primary infertility after an IVF-ET cycle. At the 9th gestational week she presented with neck pain and dyspnea and duplex Doppler sonographic examination of the neck veins revealed bilateral jugular venous thrombosis. Despite prompt administration of low-molecular weight heparin, pulmonary emboli developed a few days later.

To investigate the value of Doppler ultrasound scan (USS) assessment of internal jugular vein (IJV) patency after previous open central-venous cannulation (CVC), a prospective study of 66 consecutive children (median age 4.5 years; range 4 months-17 years) who had previously undergone open insertion of at least one indwelling IJV line and required further CVC for completion of therapy was undertaken. All underwent Doppler USS examination prior to surgery. Where patency of the previously cannulated vein was suggested ultrasonographically, the accuracy of this finding was confined at open surgical exploration. Initial CVCs were in situ for a median of 9 months (1 month-4 years) prior to removal. The median interval to repeated CVC was 11 months (3 weeks-45 months). In 79 Doppler USS, 70 (88.6%) veins appeared patent, 3 (4.2%) stenosed, and 6 (7.6%) obliterated. Of the 70 "USS patent" veins, 66 were explored. Patency was confirmed surgically in 59 (89.4%) and a new CVC successfully inserted. Seven (10.6%) apparently patent veins on USS were found to be obliterated at open exploration. Review of USS images in these cases suggested that enlarged collateral veins were usually responsible. Overall, successful recannulation was possible in 74.6% of all previously accessed veins. In children requiring repeated CVC, Doppler USS of neck veins is a valuable but not entirely reliable guide to the presence of underlying vessel patency and should be interpreted with caution. At least three-fourths of previously cannulated IJVs remain patent after catheter removal and can be reused for CVC.

This article describes a simple, new technique using ultrasound (US) to estimate central venous pressure (CVP). The sonographic patterns of the internal jugular vein (IJV) with a low, normal, and elevated CVP are also described. Although bedside visual inspection of the height of the jugular veins as an estimate of CVP has been an integral part of the physical examination, its major limitation has been that the jugular veins are not always observable. In obese patients, a layer of fat often obscures the jugular pulsations. US has proven to be a powerful tool to noninvasively visualize neck veins in the emergency department. Bedside US of the IJV, performed by emergency physicians, provides immediate, important information that cannot be obtained without invasive catheters.

While the history of formal hemodynamic monitoring is relatively brief [2], an appreciation for the qualitative aspects of monitoring dates back to ancient times [1]. In one sense, hemodynamic monitoring is a natural extension of the physical examination, quantifying the various aspects of the physical assessment. For instance, methods to assess central venous pressure by examination of the neck veins were developed long before the routine use of central venous catheters. However, in the modern ICU’s of today, hemodynamic monitoring is not used merely as a tool for the validation of the physical exam or for the periodic detailed assessment, but instead, on a continuous basis. Indeed, it is this feature that accounts for much of the utility of hemodynamic monitoring.

Certain phrases in the medical language have lost their meaning and in some cases now suggest the exact opposite of the facts. These are "anemia of chronic disease," "liver function tests," "the prevalence," "S1 was present," "S1 is normal," "neurologic syncope," "orthostatic hypotension," "the neck veins were distended," "hospital-acquired pneumonia," and "right-sided backward failure." I suggest a different and more clinically useful way of looking at these phrases.

Time of flight, reduced matrix (64 × 256) MR angiography of the neck veins was performed in four normal subjects and four patients with neck vein thrombosis, either from indwelling catheters (n = 3) or intravenous drug abuse (n = 1). In each case, satisfactory images were acquired. Typical examination times of 3–6 min were required. MR angiography of neck veins gives a unique display of venous anatomy, including collateral veins and occlusions.

Report by Rupert Jackson, Specialist Registrar in Emergency Medicine Checked by Steve Jones, Specialist Registrar in Emergency Medicine A 76 year old man is brought in to the emergency department in a collapsed state. He has a history of ischaemic heart disease. He is agitated, tachypnoeic and sweating profusely. His neck veins are distended and there are widespread coarse crepitations in his …

Report by Rupert Jackson, Specialist Registrar Search checked by Simon Carley, Specialist Registrar A 76 year old man is brought into accident and emergency in a collapsed state. He has a history of ischaemic heart disease. He is agitated, tachypnoeic and sweating profusely. His neck veins are distended and there are widespread coarse crepitations in his chest. He has a …

Two cases of air embolism associated with changing a right internal jugular introducer to a triple lumen catheter over a wire are presented. Both cases involved thin patients who were in the supine position for the procedure. The introducer catheter’s large diameter leaves a large opening in the skin upon its withdrawal. In a thin patient, there may not be enough tissue to collapse around the catheter to prevent air from entering the venous system. We recommend avoidance of guidewire changes with introducers in the neck veins unless the Trendelenberg is used.

Jeffrey S. Flier, M.D., Editor Lisa H. Underhill, Assistant Editor So that the coming together depends on the going apart; the systole depends on the diastole; the flow depends on the ebb. — D.H. Lawrence The terms "heart failure" and "congestive heart failure" are often used interchangeably, emphasizing the importance of congestion in the clinical presentation of patients with heart failure. Congestive manifestations, such as pulmonary or peripheral edema, distended neck veins, dyspnea, and orthopnea, almost invariably indicate elevated right or left ventricular filling pressures. These increased filling pressures may result from primary systolic failure, with passive backup of blood . . .