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Introduction: Vascular access for transvenous pacemaker and cardioverter defibrillator implants is frequently obtained by using the cephalic cutdown technique. sometimes anatomical variations may limit insertion of one or several leads. We describe a case of a patient with an anomalous supraclavicular course of the left cephalic vein. case report: A 61-year-old male with background of ischemic heart disease, hypertension, diabetes mellitus, obstructive sleep apnea and dyslipidemia, was referred to our institution after four months of recurrent syncopal episodes. A bradycardiatachycardia syndrome was diagnosed and decided to proceed with permanent pacemaker implantation. through a cutaneous incision in the left deltopectoral groove, we dissected the tissue planes until the left cephalic vein became visible. Fluoroscopy in anterior-posterior projection showed clear supraclavicular course of the cephalic vein. this access was abandoned by removing both wires and ligating the proximal

The purpose of this study was to assess the outcomes of patients with nasal trauma during a long period of time and determine factors predisposing to complications after nasal trauma treatment. A retrospective cohort study was conducted that included all patients who were attended for a nasal trauma between January and December 2010. In 2015, the charts were retrospectively reviewed and the patients were prospectively followed up looking for outcomes after treatment of nasal trauma. A univariate analysis between complications and risk factors was performed and a logistic regression model was used to explore the prognostic role of the variables considered to have clinical relevance and to estimate the odds ratio for the occurrence of postoperative complications. A total of 220 consecutive patients with nasal trauma were included in the study. The mean follow-up was 44.3 ± 10.3 months (3–67) with 10% of lost patients. The most important factors determining complications after nasal trauma treatment were male gender, acute septal injury, chronic septal deviation, displaced or comminuted fractures in the radiologic study, and late nasal reduction surgery. A decision-making algorithm is proposed based on the fact that nasal bone fracture is not a minor problem and that closed nasal bone reduction is not the treatment of choice for all patients with nasal trauma.

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of changes in its design that resulted in a new prostheses, the FlowSecure artificial sphincter. The FlowSecure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure. A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the FlowSecure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence.

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