A&A practice
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Accidental subdural placement of spinal cord stimulator electrodes is a rare event believed to produce unreliable results, necessitating immediate removal. We report a case of a 59-year-old man with failed back surgery syndrome previously controlled with a spinal cord stimulator, who underwent spinal cord stimulator revision during which 1 lead was inadvertently advanced into the subdural space. Modified stimulation parameters achieved excellent, persistent pain relief, representing the first case of successful long-term subdural spinal cord stimulation.
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Bronchovenous fistula (BVF) associated with adult cardiac surgery is a rarely reported life-threatening condition. We present a 75-year-old woman who developed a BVF during cardiac surgery. Dense adhesion in the pleural and pericardial cavities was noted. ⋯ Transesophageal echocardiography and hemoglobin measurement were helpful for the timely diagnosis of BVF, which was controlled by transection of the right upper pulmonary vein where a vent catheter had been inserted. Injuries around the cannulated site presumably initiated the BVF, which was worsened by high-pressure ventilation. Therefore, cannulation site might be a risk factor for BVF.
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Vagus nerve injury may complicate carotid endarterectomy (CEA). The recurrent laryngeal nerve (RLN) branches from the vagus nerve, innervating the ipsilateral vocal cord. Vagus nerve injury can cause vocal cord dysfunction. ⋯ A patient with distorted neck anatomy from radiotherapy to treat oropharyngeal cancer and resultant right vocal cord paralysis required left CEA. Anticipating difficult neck dissection risking vagus nerve damage with associate RLN malfunction, we added vocal cord electromyography (EMG) to routine CEA electroencephalography (EEG). We recommend vocal cord EMG in anatomically complex CEA to avoid vagus nerve injury.