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Sample records for accessory mental foramen

  1. Accessory mental foramen: A rare anatomical variation detected by cone-beam computed tomography

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    Torres, Marianna Guanaes Gomes; De Faro Valverde, Ludmila; Vidal, Manuela Torres Andion; Crusoe-Rebello, Ieda Margarida [Dept. of Oral Radiology, School of Dentistry, Federal University of Bahia, Salvador (Brazil)

    2015-03-15

    The mental foramen is a bilateral opening in the vestibular portion of the mandible through which nerve endings, such as the mental nerve, emerge. In general, the mental foramen is located between the lower premolars. This region is a common area for the placement of dental implants. It is very important to identify anatomical variations in presurgical imaging exams since damage to neurovascular bundles may have a direct influence on treatment success. In the hemimandible, the mental foramen normally appears as a single structure, but there are some rare reports on the presence and number of anatomical variations; these variations may include accessory foramina. The present report describes the presence of accessory mental foramina in the right mandible, as detected by cone-beam computed tomography before dental implant placement.

  2. FORAMEN MENTONIANO ACCESORIO: PRESENTACION DE UN CASO Y REVISION DE LA BIBLIOGRAFIA. Accessory mental foramen: A case report and literature review.

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    Javier Elías Fernández

    2016-11-01

    Full Text Available El foramen mentoniano accesorio es un orificio adicional al foramen mentoniano que se localiza en la cara anterolateral externa del cuerpo mandibular y que se conecta con el conducto dentario inferior.  Su ubicación es posteroinferior al foramen mentoniano.  De acuerdo a su clasificación también se lo conoce como foramen mental doble, foramen mental adicional, foramen mental múltiple, foramen mental accesorio o foramen mandibular bucal suplementario. Su frecuencia de aparición varía del 1% al 10 %, cuando son unilaterales y del 0,47% al 1,2% cuando son bilaterales.  El  foramen mentoniano accesorio es una rara variante anatómica de poca frecuencia pero de gran relevancia clínico-quirúrgica ya que está asociado a un paquete vasculonervioso por lo cual es necesario su diagnóstico radiográfico ya sea por métodos convencionales o por alta resolución para evitar posibles complicaciones en los diferentes procedimientos odontológicos. Se presenta un caso de foramen mentoniano accesorio de un paciente remitido al Servicio de Radiología de la Facultad de Odontología de la UNC. La tomografía computada constituye el estudio por imágenes de excelencia ante la presunción de un foramen accesorio ya que los diferentes cortes tomográficos y la reconstrucción 3D nos permiten localizarlo de manera precisa e inequívoca. Constituye generalmente un hallazgo radiográfico o se observa durante procedimientos quirúrgicos al quedar al descubierto por el desplazamiento de los tejidos blandos. Cuando se localiza antes de cualquier procedimiento odontológico se deben tomar todos los recaudos necesarios para evitar daño del paquete vasculonervioso y futuras complicaciones como hemorragias o parestesias, principalmente en prácticas como la colocación de implantes dentales o las apicectomías. Accessory mental foramen (AMF is defined as any openings in addition to mental foramen, with connection to the mandibular canal in the anterolateral

  3. Anatomical Position of Mental foramen: a Review

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    Vinit Aher

    2012-01-01

    Full Text Available Mental foramen is a key factor in many of the surgical as well as clinical procedures in routine clinical practice. The variations of mental foramen with respect to position, size and number dose significantly alter the clinical implications of various intraoral treatments. The accurate knowledge of the mental nerve and its position helps the clinician for delivering local anesthesia effectively also placement of implants and dentures intraorally to replace missing teeth is important in prosthetic point of view. While doing the surgical procedures in this region the position of mental nerve and its foramen is of importance to avoid intraoperative neurovascular damage and to avoid postoperative neurosensory disturbances. The ethnic and racial variations are seen in the position of mental foramen, although a gender variation in same population has not been seen. Thus the knowledge of the position of mental nerve is important for day to day clinical practice of dentistry.

  4. A Review on Anatomical Variations of Mental Foramen (Number, Location, Shape, Symmetry, Direction and Size

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    F Ezoddini-Ardakani

    2016-02-01

    Full Text Available Mental foramen is located on the anterior aspect of the mandible that permits the terminal branch of the inferior alveolar nerve and blood vessels to exit. The anatomical variations of mental foramen are of considerable importance in local anesthesia, treatment of the fractures in the parasymphysis area, orthognatic surgeries, implant placement, etc. Regarding the importance of mental foramen in dentistry (from local anesthesia to invasive surgical procedures, this study intends to review the anatomical variations of mental foramen in this study. Absence of mental foramen is rare. On the other hand, prevalence of accessory mental foramen has been estimated lower than 15% in the most studies. The position of mental foramen is normally between first and second premolar teeth or under second premolar tooth in different ethnic groups and bilateral symmetry exists in regard with location in most cases. In most studies, the ratio of distance from mental foramen to symphysis to distance from symphysis to posterior border of ramus has been reported about 1/3.5 to 1/3. Mental foramen is oval or circular in shape and its most common direction is usually posterosuperior. Its size in different studies has been estimated about 2 to 5 millimeters and asymmetry in size is possible on both sides of mandible. Due to variations of mental foramen between various ethnic groups and even different individuals in the same ethnic group, using advanced imaging techniques such as CBCT is recommended in order to gain detailed knowledge of anatomy and morphology of mental foramen before applying invasive surgeries.

  5. Radiographic Localization of the Mental Foramen and Mandibular Canal

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    Farzaneh Afkhami

    2013-01-01

    Full Text Available Objective: Accurately localizing the mental foramen and mandibular canal is important when administering local anesthesia and performing surgery; therefore, knowing the normal range of the possible locations is essential. Our purpose was to assess the location of the mental foramen and mandibular canal in an Iranian population using panoramic radiography.Materials and Methods: Standard panoramic radiographies were performed. The positions of 100 mental foramens were evaluated. The distances from the center of the mental foramen to the superior and inferior borders of the mandible and to the apexes of the first and second premolar were measured. The distance of the mental foramens from the mandibular midline and the diameter of the mandibular canal in the mental foramen connection were also measured.Results: Among 100 mental foramens, 6% were positioned under the first premolar, 24% were between the first and second premolars, 67% were under the second premolar, and the remaining 3% were behind the second premolar. The mean distance from the mental foramen to the mandibular midline was 27.77±3.20 mm. The mean diameter of the mandibular canal in the mental foramen connection was 3.09±0.69mm.Conclusion: The mental foramen was near the second premolar and the inferior border of the mandible. This information can be used to perform safer mental nerve blocks in surgical interventions.

  6. Mental foramen and lingual vascular canals of mandible on MDCT images: anatomical study and review of the literature.

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    Direk, Filiz; Uysal, Ismihan Ilknur; Kivrak, Ali Sami; Fazliogullari, Zeliha; Unver Dogan, Nadire; Karabulut, Ahmet Kagan

    2018-03-01

    The mental foramen and lingual vascular canals are related to vessels and nerves in the mandibular body. The aim of the present study was to determine the number and location of these structures and to make measurements of them. The archived Multidetector Computed Tomography images of 100 adult (15- to 70-year-old) patients were evaluated retrospectively. The diameters of the mental foramens and their distances from the front, back, upper and lower reference points were measured. The distribution of mental foramens with respect to the teeth was also researched. The presence of lingual vascular canals, and the number of median and lateral canals was determined, and the length of the median lingual vascular canals measured. All measurement parameters were analyzed by gender, side and age group. Eleven patients demonstrated a total of 15 accessory mental foramen. Median lingual vascular canals were observed in 100% of cases, with lateral lingual vascular canals determined in 32%. Significant differences were observed in the results of different gender groups (P mental foramen was determined mostly in males, and unilaterally on the right side; also, the distances of mental foramen, except the distance from the back border of the mandible (P mental foramen, as well as the presence, position and size of lingual vascular canals can be clearly investigated by multidetector computed tomography. A preoperative knowledge of the positions of neurovascular and bone structures is very important for preventing complications that may occur during or after operations.

  7. Unilateral Absence of Mental Foramen with Surgical Exploration in a Living Human Subject

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    Murat Ulu

    2016-01-01

    Full Text Available The mental foramen (MF is an important anatomic landmark of the mandible, in which the somatic afferent sensory nerve of the mandibular nerve emerges as mental nerve and blood vessels. The identification and actual location of MF are important in order to avoid sensory dysfunction or paresthesia due to mental nerve injury. In the literature there are some rare reports on the anatomical variations of the MF such as its location or presence of accessory foramina. The present report describes the absence of mental foramina on the left side of the mandible, as detected by cone-beam computed tomography before impacted tooth removal and observed directly during surgery.

  8. Roentgen-anatomic studies on the mental foramen

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    Lee, Soon Pyo; Ahn, Hyung Kyu [College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1972-11-15

    The author measured the distance from mental foramen to the occlusal plane and classified the positional frequency of mental foramen to the tooth site using topography. The results were obtained as follows; 1. Of 964 mental foramen taken, the common site was in 2nd premolar region showing 64.08 percent in right and 57.17 per cent in left site. 2. The average distance from occlusal plane to the upper border of premolar region was 23.20 mm and lower border was 25. 07 mm. 3. The positional variation of mental foramen was that 4.77 percent were located above the apex of the nearest tooth, 50.42 per cent were located at the apex of the nearest tooth and 44.81 percent were located below the apex of the nearest tooth.

  9. Roentgen-anatomic studies on the mental foramen

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    Lee, Soon Pyo; Ahn, Hyung Kyu

    1972-01-01

    The author measured the distance from mental foramen to the occlusal plane and classified the positional frequency of mental foramen to the tooth site using topography. The results were obtained as follows; 1. Of 964 mental foramen taken, the common site was in 2nd premolar region showing 64.08 percent in right and 57.17 per cent in left site. 2. The average distance from occlusal plane to the upper border of premolar region was 23.20 mm and lower border was 25. 07 mm. 3. The positional variation of mental foramen was that 4.77 percent were located above the apex of the nearest tooth, 50.42 per cent were located at the apex of the nearest tooth and 44.81 percent were located below the apex of the nearest tooth.

  10. Morphometric study on mandibular foramen and incidence of accessory mandibular foramen in mandibles of south Indian population and its clinical implications in inferior alveolar nerve block.

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    Shalini, R; RaviVarman, C; Manoranjitham, R; Veeramuthu, M

    2016-12-01

    The mandibular foramen is a landmark for procedures like inferior alveolar nerve block, mandibular implant treatment, and mandibular osteotomies. The present study was aimed to identify the precise location of the mandibular foramen and the incidence of accessory mandibular foramen in dry adult mandibles of South Indian population. The distance of mandibular foramen from the anterior border of the ramus, posterior border of the ramus, mandibular notch, base of the mandible, third molar, and apex of retromolar trigone was measured with a vernier caliper in 204 mandibles. The mean distance of mandibular foramen from the anterior border of ramus of mandible was 17.11±2.74 mm on the right side and 17.41±3.05 mm on the left side, from posterior border was 10.47±2.11 mm on the right side and 9.68±2.03 mm on the left side, from mandibular notch was 21.74±2.74 mm on the right side and 21.92±3.33 mm on the left side, from the base of the ramus was 22.33±3.32 mm on the right side and 25.35±4.5 mm on the left side, from the third molar tooth was 22.84±3.94 mm on the right side and 23.23±4.21 mm on the left side, from the apex of retromolar trigone was 12.27±12.13 mm on the right side and 12.13±2.35 mm on the left side. Accessory mandibular foramen was present in 32.36% of mandibles. Knowledge of location mandibular foramen is useful to the maxillofacial surgeons, oncologists and radiologists.

  11. A radiographic study of mental foramen in intraoral radiographs

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    Sohn, Jeong Ick; Choi, Karp Shik

    1995-01-01

    The purpose of this study was to evaluate the position and shape of mental foramen in periapical radiographs. For this study, periapical radiographs of premolar areas were obtained from the 200 adults. Accordingly, the positional and shape changes of mental foramen were evaluated. The authors obtained radiographs according to changes in radiation beam direction in periapical radiographs of premolar areas, and then evaluated the positional and shape changes of mental foramen. The following results were obtained: 1. Shapes of mental foramen were observed elliptical (34.3%), round or oval (28.0%), unidentified (25.5%) and diffuse (12.2%) type in descending order of frequency. 2, Horizontal positions of mental foramen were most frequently observed at the 2nd premolar area (55.3%), the area between the 1st premolar and 2nd premolar (39.6%), the area between the 2nd premolar and 1st molar (3.4%), the 1st premolar area (1.0%), the area between the canine and 1st premolar (0.7%) in descending order of frequency. 3. Vertical positions of mental foramen were most frequently observed at the inferior to apex (67.1%), and at apex (24.8%), overlap with apex (6.4%), superior to apex (1.7%) in descending order of frequency. 4. Shapes of mental foramen were more obviously observed at the upward 10 degree positioned periapical radiographs. And according to the changes of horizontal and vertical position, they were observed similar to normally positioned periapical radiographs.

  12. Morphological and morphometric analysis of the shape, position, number and size of mental foramen on human mandibles

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    Alma Voljevica

    2015-05-01

    Full Text Available Objective. To provide anatomical information on the position, morphological variations and incidence of mental foramen (MF and accessorymental foramen (AMF as they are important for dental surgeons, anesthetists in nerve block and surgical procedures, to avoid injury to the neurovascular bundle in the mental foramen area. Methods. Our study was conducted on 150 adult dry human mandibles from the osteological collection of the Department of Anatomy of the Faculty of Medicine, University of Sarajevo. The location and shape of the MF and the presence of the AMF were studied by visual examination. The size and position of the MF were measured using a digital vernier caliper. SPSS, version 17 software was used for the statistical analysis. Results. Bilateral mental foramina were presented in all 150 mandibles. In the majority of mandibles, the MF was located between the first and second premolar (20.3% or on the level of the root of the second premolar (60.3%, midway between the inferior margin and the alveolar margin of the mandible. Most of the mental foramina were oval in shape (83.3%. An AMF was present in four mandibles (2.7% on the right side. Conclusion. This study may be a very useful new supplement to data on variations in the incidence, position, shape and size of mental and accessory mental foramina, which may help surgeons, anaesthetists, neurosurgeons and dentists in carrying out surgical procedures successfully.

  13. Cone-Beam Computed Tomography Evaluation of Mental Foramen Variations: A Preliminary Study

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    Sheikhi, Mahnaz; Karbasi Kheir, Mitra; Hekmatian, Ehsan

    2015-01-01

    Background. Mental foramen is important in surgical operations of premolars because it transfers the mental nerves and vessels. This study evaluated the variations of mental foramen by cone-beam computed tomography among a selected Iranian population. Materials and Methods. A total number of 180 cone-beam computed tomography projections were analyzed in terms of shape, size, direction, and horizontal and vertical positions of mental foramen in the right and left sides. Results. The most common shape was oval, opening direction was posterior-superior, horizontal position was in line with second premolar, and vertical position was apical to the adjacent dental root. The mean of foremen diameter was 3.59 mm. Conclusion. In addition to the most common types of mental foramen, other variations exist, too. Hence, it reflects the significance of preoperative radiographic examinations, especially 3-dimensional images to prevent nerve damage

  14. Radiographic evaluation of the mental foramen in a selected Iranian population

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    Haghanifar Sina

    2009-01-01

    Full Text Available Background: Information on the position of the mental foramen is important for dental surgeons. Variations in its position can be a cause of complications during local anesthesia or surgical procedures. The usual position of the mental foramen in an Iranian population has not been previously reported. Aims: The purpose of this study was to determine the most common location of the mental foramen in an Iranian population. We also analyzed gender differences and the symmetry of location within individuals. Materials and Methods : 400 panoramic radiographs were evaluated with regard to the location and symmetry of the mental foramina in male and female subjects. Results : We found that the mental foramen was located between the first and second premolars in 47.2% of patients and in line with the second premolar in 46%. In 49.2% of males, the mental foramen was in line with the second premolar. In 50.9% of females it was between the first and second premolars. It was symmetrical in 85.7%. Conclusions : Based on this study it appears that the most common position of mental foramen is either between the two premolars or in line with the second premolar. This is in concordance with previous studies.

  15. A radiographic study of the position and shape of mental foramen in panoramic radiographs

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    Choi, Karp Shik; Kim, Dong Youn; Sohn, Jeong Ick; Bae, Yong Chul

    1997-01-01

    The purpose of this study was to evaluate the position and shape of mental foramen in panoramic radiographs. For this study, panoramic radiographs were obtained from the 200 adults and evaluated the position and shape of mental foramen. According to various positional changes in panoramic radiographs of the patients, the author also obtained panoramic radiographs from the 100 adults and then evaluated the positional and shape changes of mental foramen. The following results were obtained : 1. Shapes of mental foramen were observed elliptical (43.3%), round or oval (42.5%), unidentified (7.5%) and diffuse (6.7%) type in descending order of frequency. 2. Horizontal position of mental foramen were most frequently observed at the 2nd premolar area (54.2%), and area between the 1st premolar and 2nd premolar (43.1%), area between the 2nd premolar and 1st molar (2.7%), and at apex (9.7%), overlap with apex (1.9%), superior of apex (0.2%) in descending order of frequency. 4. According to various positional changes in panoramic radiographs of the patients, shape changes of mental foramen were more obviously observed at the forward 10 mm and chin down 10 degree positioned panoramic radiographs, And changes of horizontal and vertical position were observed in similar to compared with normal positioned panoramic radiographs.

  16. A study of angle of mandibular canal and mental foramen on the panoramic radiograph

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    Choi, Hang Moon

    2009-01-01

    To assessment the angle between mandibular canal and occlusal plane at each posterior tooth region and location of mental foramen on the panoramic radiographs. This study analysed 46 half-mandibles of panoramic radiographs. Inferior border of mandibular canal was traced. Occlusal plane was drawn from lingual cusp tip of the first premolar to distolingual cusp tip of the second molar. Perpendicular line from occlusal plane was drawn at each tooth region and then tangential lines were drawn from the crossing points at canal. The angle between occlusal plane and tangential line was measured. The location of mental foramen was also studied. According to the location of mental foramen, radiographs were divided into M (mesial) group and D (distal) group on the basis of the second premolar. and then inter-group analysis about mandibular canal angle was done. The angles of mandibular canals were -17.7 .deg. C, -9.5 .deg. C, 8.2 .deg. C, 22.3 .deg. C, and 39.2 .deg. C at first premolar, second premolar, first molar, second molar, and third molar, respectively. The commonest position of the mental foramen was distal to the second premolar. Inter-group comparison showed statistically significant difference at the second premolar and the first molar (p<0.001). The acknowledgement of mandibular canal angulation and location of mental foramen can help understanding the course of mandibular canal.

  17. Study of the inferior alveolar canal and mental foramen on digital panoramic images.

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    Pria, Carlos M; Masood, Farah; Beckerley, Joy M; Carson, Robert E

    2011-07-01

    To study the radiographic location of the mental foramen and appearance of the inferior alveolar canal and the relationship between image gray values and the clarity of inferior alveolar canal on the digital panoramic images and to evaluate if the histogram equalization of the digital image would improve the visualization of the inferior alveolar canal outline on the digital panoramic images in the mandible. Five hundred digital panoramic images were evaluated by two examiners using a specific inclusion criteria. Only the right side of the mandible was studied. Chi-square analyses were used for comparisons of distributions. Mean and median pixel values were analyzed separately with a one-way analysis of variance. Also, percentages were calculated to report the usefulness of the histogram equalization for visualization of canal. RESULTS show variation in location of mental foramen. Most frequent location of the mental foramen was reported as first and second premolar region. Chi-square analysis showed that the frequency of occurrence of the mental foramen was equally probable for any of the three locations. The study did not find significant usefulness of the gray values obtained from the histogram equalization in predicting the clarity of inferior alveolar canal outlines. Knowing the normal relationship and the anatomical variation of the maxillofacial structures for each patient is important for surgical implant treatment planning to avoid future complications. It is also important to be familiar with the advantages and limitations of diagnostic aids available before making treatment planning decisions based on such findings. Digital imaging, Panoramic, Inferior alveolar canal, Mental foramen. How to cite this article: Pria CM, Masood F, Beckerley JM, Carson RE. Study of the Inferior Alveolar Canal and Mental Foramen on Digital Panoramic Images. J Contemp Dent Pract 2011;12(4):265-271. Source of support: Nil Conflict of interest: None declared.

  18. The Ultrasonographic Determination of the Position of the Mental Foramen and its Relation to the Mandibular Premolar Teeth.

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    Laher, Abdullah Ebrahim; Motara, Feroza; Moolla, Muhammed

    2016-06-01

    The position of the mental foramen has been well researched in cadaver specimens, radiographically as well as intraoperatively. To our knowledge, this landmark study is the first to make use of ultrasonography in a study population to determine the position of the mental foramen in relation to the mandibular premolar teeth. Ultrasonography has great potential to further revolutionize the practice of medicine and dento-maxillofacial surgery. To make use of ultrasound to determine the position of the mental foramen and its relation to the mandibular premolar teeth. One hundred Black and Caucasian subjects were enrolled. A high frequency (8MHz) transducer (PLF.805ST) of a diagnostic ultrasound system (model SSA-510A) was applied above the inferior border of the mandible, just lateral to the mentum. With the marker of the transducer pointing cranially, the position of the mental foramen in relation to the closest mandibular premolar tooth was determined. The position was compared across race, sex and age groups. All mental foramina (100%) were visualised. Overall the most frequent position of the mental foramen was in line with the long axis of the second premolar on the right (44%) and between the first and second premolars on the left (44%). There were no statistical differences (p >0.05) between race groups, sex and age groups with regard to the position of the mental foramen in relation to the mandibular premolars. However, in Blacks, the most frequent position of the mental foramen was in line with the long axis of the second premolar and in Caucasians the most common position was between the first and second premolars. The most frequent position of the mental foramen in females was in line with the long axis of the second premolar on the right and between the first and second premolars on the left. In males, the most frequent position of the mental foramen was in line with the long axis of the second premolar bilaterally. The most common position of the mental

  19. Visibility of the mandibular canal and the mental foramen in panoramic radiography

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    Jeong, Seon Jin; Choi, Eui Hwan; Kim, Jae Duk

    2001-01-01

    To determine the head position that the superior border of the mandibular canal as well as mental foramen can be more clearly visualized in panoramic radiography. Ten dry mandibles were radiography bilaterally using PM 2002 CC panoramic machine. A 20 mm thick aluminium filter was added to the slit collimator to obtain radiographs with acceptable density. The specimens were tilted by 2, 4, 6, 8 and 10 degrees downward with and without radiopaque markers. Radiopaque markers were inserted into the mandibular canals and the mental canals of each side of the specimens to serve as reference image when assessing the radiographs. The obtained results were analyzed statistically. Mandibular canals were significantly more clearly visible in the radiographs with 4 and 6 degree downward position on both sides (P<0.05). Mental foramen were significantly more clearly visible in the was not significant difference between right and left sides. Panoramic radiographs with 4 to 6 degree downward tilting could be valuable in locating the mandibular canal as well as the mental foramen

  20. Position of the Mental Foramen in Panoramic Radiography and Its Relationship to Age in a Selected Iranian Population

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    Dehghani

    2016-02-01

    Full Text Available Background The position of the mental foramen is critical for surgery and local anesthesia. Objectives This study was conducted to assess the position of the mental foramen and its relationship to age in a selected Iranian population. Materials and Methods This was a cross-sectional descriptive study. Three hundred panoramic radiographs were assessed. Three variables were assessed for each radiograph: anterior-posterior position, superior-inferior position, and radiographic appearance. The position and appearance of the mental foramen were recorded according to gender and age. The results were analyzed using Chi-square and Fisher’s exact tests. Results Considering the anterior-posterior position, the mental foramina were located in the following positions: between premolars (41.5%, at the apex of the second premolars (31.7%, in the posterior area of the second premolars (19.2%, in the anterior area of the first premolars (4.3%, and at the apex of the first premolars (3.3%.The superior-inferior position of the mental foramina were below, above, and at the level of the apices of the premolars in 78.8%, 2.5%, and 18.7% of cases, respectively. The appearance of the mental foramen was continuous in relation to the mandibular canal in 55.9% of cases, while it was separated, diffuse, and unidentified in 29.5%, 9.7%, and 5% of cases, respectively. Age was found to affect the position and appearance of mental foramen. Conclusions The mental foramina were most commonly located between the first and second premolars and below the apex. A continuous appearance was the most common appearance for the mental foramen, which was similar in males and females.

  1. Anthropometrics of mental foramen in dry dentate and edentulous mandibles in Coastal Andhra population of Andhra Pradesh State

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    Srinivas Moogala

    2014-01-01

    Full Text Available Aim: The aim of this study is to determine the morphological features and morphometrics of mental foramen with reference to surrounding anatomical landmarks in Coastal Andhra population of Andhra Pradesh State. Materials and Methods: Two-hundred and nineteen dry dentate and edentulous mandibles are examined in this study. Out of these 127 were dentate and 92 were edentulous. Various morphological and morphometrical parameters were measured by using digital Vernier caliper, metallic wire and metallic scale on both the right and left sides. Results: In the present study, the distance between most anterior margin of mental foramen and posterior border of ramus of the mandible is [MF-PR], MF-PR is 69.61 ± 6.03 mm on the right side and is 69.17 ± 6. 0 mm on left side in dentate mandible. In edentulous type, MF-PR is 68.39 ±6.4 mm on right side and 68.81 ± 6.55 mm on left side. In the present study, the distance between symphysis menti and most anterior margin of mental foramen [MF-SM] in dentate mandible is 28.24 ± 5.09 mm on right side and is 27.45 ± 3.7 mm on left side. In edentulous mandible (MF-SM is 28.51 ± 4.5 mm on right side and on left side is 27.99 ± 4.50 mm. Conclusion: Acquiring the knowledge and importance of anatomy of mental foramen is helpful in avoiding neurovascular complications, during regional anesthesia, peri apical surgeries, nerve repositioning and dental implant placement.

  2. Anatomical relationship between mental foramen, mandibular teeth and risk of nerve injury with endodontic treatment.

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    Chong, Bun San; Gohil, Kajal; Pawar, Ravikiran; Makdissi, Jimmy

    2017-01-01

    The objective of the present study was to evaluate the anatomical relationship between mental foramen (MF), including the incidence of the anterior loop of the inferior alveolar nerve (AL), and roots of mandibular teeth in relation to risk of nerve injury with endodontic treatment. Cone-beam computed tomography (CBCT) images, which included teeth either side of the MF, were randomly selected. The anonymised CBCT images were reconstructed and examined in coronal, axial and sagittal planes, using three-dimensional viewing software, to determine the relationship and distance between MF and adjacent mandibular teeth. The actual distance between the root apex and MF was calculated mathematically using Pythagoras' theorem. If present, the incidence of an AL in the axial plane was also recorded. The root apex of the mandibular second premolar (70 %), followed by the first premolar (18 %) and then the first molar (12 %), was the closest to the MF. Ninety-six percent of root apices evaluated were >3 mm from the MF. An AL was present in 88 % of the cases. With regards to endodontic treatment, the risk of nerve injury in the vicinity of the MF would appear to be low. However, the high incidence of the AL highlights the need for clinicians to be aware and careful of this important anatomical feature. The risk of injury to the MN with endodontic treatment would appear to be low, but given the high incidence, it is important to be aware and be careful of the AL.

  3. Assessment of the Horizontal and Vertical Position of Mental Foramen in Indian Population in Terms of Age and Sex in Dentate Subjects by Pano-ramic Radiographs: A Retrospective Study with Review of Literature.

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    Parnami, Priyanka; Gupta, Deepak; Arora, Vishal; Bhalla, Saurabh; Kumar, Adarsh; Malik, Rashi

    2015-01-01

    To familiarize new criteria to access vertical position of mental foramen in panoramic radiographs. Furthermore, to determine and compare the position and symmetry of mental foramen in horizontal as well as in vertical plane in Indian population and to compare the results with those reported for other populations in the literature. Further gender differences in mental foramen position were also accessed to comment on the reliability of panoramic radiographs for sex determination. Methods and Material : Six hundred digital panoramic radiographs were selected and studied regarding the location and symmetry of mental foramen. They were also compared with the other studies in the literature. The method employed is similar to that described by Al Jasser and Nwoku for horizontal position and Fishal et al. for vertical position of mental foramen. Certain modifications were carried out in Fishal's criteria for vertical position assessment. Results : The commonest position of the mental foramen in horizontal plane was in line with the longitudinal axis of the second premolar (61.0%) while in vertical plane it was found to be located inferior to the apex of second premolar (72.2%). Conclusion : Mental foramen exists in different locations and possesses many variations. Hence, Individual, gender, age, race and assessing technique largely influence these variations. It suggests that the clinicians should carefully identify these anatomical landmarks, by analyzing all influencing factors, prior to their diagnostic or the other dental, surgical and implant operation.

  4. MORPHOMETRIC ANALYSIS OF MANDIBULAR FORAMEN AND INCIDENCE OF ACCESSORY MANDIBULAR FORAMINA IN ADULT HUMAN MANDIBLES OF AN INDIAN POPULATION. Análisis morfométrico del foramen mandibular e incidencia de la foramina mandibular accesoria en mandíbulas adult

    Directory of Open Access Journals (Sweden)

    Prajna Paramita Samanta

    2016-03-01

    Full Text Available El foramen mandibular es un importante hito anatómico. Para procedimientos como el bloqueo alveolar inferior del nervio, el tratamiento con implantes y osteotomías mandibulares, un profundo conocimiento de la ubicación del foramen mandibular (MF y el foramen mandibular accesorio (AMF es un requisito previo. Hay pocas referencias en la literatura con respecto a la localización anatómica exacta del foramen mandibular. Por lo tanto, el presente estudio tuvo como objetivo identificar la ubicación exacta de la MF y la incidencia de la AMF alrededor MF en una población india. Sesenta (60 mandíbulas humanas adultas fueron estudiadas para determinar la distancia del LV de la los anteriores, bordes posteriores de la rama mandibular, maxilar inferior categoría y el ángulo de la mandíbula. AMF todo el MF también fueron estudiados por su presencia y números. La distancia media de MF del borde anterior de rama mandibular fue 15,72 ±2,92 mm(lado derecho, 16,23 ±2,88 mm(lado izquierdo, de borde posterior fue 13,29 ±1,74 mm(lado derecho y 12,73 ±2,04 mm(a la izquierda lado. La MF se encuentra 22,70 ±3 mm(lado derecho y 22, 27 ± 2,62 mm(lado izquierdo de la muesca mandibular. La distancia de MF de ángulo de la mandíbula fue 21,54 ±2,92 mm(lado derecho y 21,13 ±3.43 mm(lado izquierdo. AMF estuvieron presentes en el 16, 66% de las mandíbulas. En 10% de las mandíbulas una sola AMF estaba presente y en el 6,66% hubo dos agujeros presentes. La ubicación del MF y AMF es importante para evitar compli-caciones como hemorragia y parestesia durante los procedimientos quirúrgicos orales y también para los radioterapeutas en la planificación de la radioterapia.  The mandibular foramen is an important anatomical land mark. For procedures like inferior alveolar nerve block, implant treatment and mandibular osteotomies, a thorough knowledge of the location of the mandibular foramen (MF and accessory mandibular foramina (AMFs is a prerequisite

  5. The appearance of foramen in the internal aspect of the mental region of mandible from japanese cadavers and dry skulls under macroscopic observation and three-dimensional CT images

    International Nuclear Information System (INIS)

    Yoshida, Shunji; Kawai, Taisuke; Okutsu, Koichiro; Yosue, Takashi; Sunohara, Masataka; Sato, Iwao; Takamori, Hitoshi

    2005-01-01

    The lingual canal with foramen displays different appearances on the internal surfaces of mandible as confirmed by macroscopic observation and computerized tomography (CT). The lingual canal was observed in the inside of mental region run to the outside of lingual foramen, which is extend internally from mandibular canal in right and left sides of the mandible in cadavers (13 sides out of 88 sides) and in dry skulls (43 out of 94 sides) examined. The spinal foramen connected with mental canal occurred at the midline of mandible in 6 cases (6 out of 47 cases) in dry skulls. In this small foramen, the inferior alveolar artery give some branches to the inside of mental region at the anterior mandible and which may be run pass through the lingual canal to the lingual foramen, where they emerge to enter the mylohyoid or anterior belly of digastric muscles. The observations of these are important considerations for surgical placement of dental implants in the region in the mandible. (author)

  6. DIVIDED FORAMEN TRANSVERSARIUM

    OpenAIRE

    Suba; Reena; Ravi

    2013-01-01

    The cervical vertebrae are seven in number. They are the smallest of the vertebrae and can be identified by the presence of a foramen in each transverse process. The dorsal and ventral roots terminate laterally as dorsal and ventral tubercles. The roots are connected lateral to the foramen by an intertubercular lamella. The vertebral artery which arises from the superoposterior aspect of the first part of the subclavian ar...

  7. IL-1 receptor accessory protein-like 1 associated with mental retardation and autism mediates synapse formation by trans-synaptic interaction with protein tyrosine phosphatase δ.

    Science.gov (United States)

    Yoshida, Tomoyuki; Yasumura, Misato; Uemura, Takeshi; Lee, Sung-Jin; Ra, Moonjin; Taguchi, Ryo; Iwakura, Yoichiro; Mishina, Masayoshi

    2011-09-21

    Mental retardation (MR) and autism are highly heterogeneous neurodevelopmental disorders. IL-1-receptor accessory protein-like 1 (IL1RAPL1) is responsible for nonsyndromic MR and is associated with autism. Thus, the elucidation of the functional role of IL1RAPL1 will contribute to our understanding of the pathogenesis of these mental disorders. Here, we showed that knockdown of endogenous IL1RAPL1 in cultured cortical neurons suppressed the accumulation of punctate staining signals for active zone protein Bassoon and decreased the number of dendritic protrusions. Consistently, the expression of IL1RAPL1 in cultured neurons stimulated the accumulation of Bassoon and spinogenesis. The extracellular domain (ECD) of IL1RAPL1 was required and sufficient for the presynaptic differentiation-inducing activity, while both the ECD and cytoplasmic domain were essential for the spinogenic activity. Notably, the synaptogenic activity of IL1RAPL1 was specific for excitatory synapses. Furthermore, we identified presynaptic protein tyrosine phosphatase (PTP) δ as a major IL1RAPL1-ECD interacting protein by affinity chromatography. IL1RAPL1 interacted selectively with certain forms of PTPδ splice variants carrying mini-exon peptides in Ig-like domains. The synaptogenic activity of IL1RAPL1 was abolished in primary neurons from PTPδ knock-out mice. IL1RAPL1 showed robust synaptogenic activity in vivo when transfected into the cortical neurons of wild-type mice but not in PTPδ knock-out mice. These results suggest that IL1RAPL1 mediates synapse formation through trans-synaptic interaction with PTPδ. Our findings raise an intriguing possibility that the impairment of synapse formation may underlie certain forms of MR and autism as a common pathogenic pathway shared by these mental disorders.

  8. Observations on the bony bridging of the jugular foramen in man.

    Science.gov (United States)

    Dodo, Y

    1986-02-01

    The anatomical nature and pattern of incidence of bony bridging of the jugular foramen was investigated using 64 fetal crania aged nine months to term and 222 adult crania of Japanese. In addition, the region of the jugular foramen of an adult cadaver was carefully dissected in order to clarify the relationship between the cranial nerves passing through the jugular foramen and the intrajugular processes of the jugular foramen. The general conclusions concerning the anatomical nature of the bony bridging of the jugular foramen were as follows. (1) The intrajugular process of the temporal bone is situated posterior to the triangular depression (as described in Gray's Anatomy) of the petrous part. (2) The bony bridging of the jugular foramen is established by the contact of the intrajugular process of the temporal bone with the bony process of the occipital bone projecting either from just above the hypoglossal canal (Type I) or from posterior to the hypoglossal canal (Type III). (3) If both the processes of the occipital bone reach the intrajugular process of the temporal bone simultaneously, the jugular foramen is divided into three compartments. (4) In the case of Type I bridging, the anteromedial compartment transmits the glossopharyngeal nerve, while the posterolateral compartment gives passage to the vagus nerve, the accessory nerve and the internal jugular vein. (5) In the case of Type II bridging, the anteromedial compartment contains the glossopharyngeal, vagus and accessory nerves, and the posterolateral compartment transmits the internal jugular vein. (6) When tripartite division of the jugular foramen occurs, the anteromedial compartment transmits the glossopharyngeal nerve, the middle compartment contains the vagus and accessory nerves, and the posterolateral compartment transmits the internal jugular vein. Concerning the pattern of incidence of jugular foramen bridging in the Japanese fetal and adult cranial series, this is similar to that of the bony

  9. Spinal Accessory Motor Neurons in the Mouse: A Special Type of Branchial Motor Neuron?

    Science.gov (United States)

    Watson, Charles; Tvrdik, Petr

    2018-04-16

    The spinal accessory nerve arises from motor neurons in the upper cervical spinal cord. The axons of these motor neurons exit dorsal to the ligamentum denticulatum and form the spinal accessory nerve. The nerve ascends in the spinal subarachnoid space to enter the posterior cranial fossa through the foramen magnum. The spinal accessory nerve then turns caudally to exit through the jugular foramen alongside the vagus and glossopharyngeal nerves, and then travels to supply the sternomastoid and trapezius muscles in the neck. The unusual course of the spinal accessory nerve has long prompted speculation that it is not a typical spinal motor nerve and that it might represent a caudal remnant of the branchial motor system. Our cell lineage tracing data, combined with images from public databases, show that the spinal accessory motor neurons in the mouse transiently express Phox2b, a transcription factor that is required for development of brain stem branchial motor nuclei. While this is strong prima facie evidence that the spinal accessory motor neurons should be classified as branchial motor, the evolutionary history of these motor neurons in anamniote vertebrates suggests that they may be considered to be an atypical branchial group that possesses both branchial and somatic characteristics. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

  10. Small Engine & Accessory Test Area

    Data.gov (United States)

    Federal Laboratory Consortium — The Small Engine and Accessories Test Area (SEATA) facilitates testaircraft starting and auxiliary power systems, small engines and accessories. The SEATA consists...

  11. Arcuate foramen and its clinical significance

    International Nuclear Information System (INIS)

    Cakmark, O.; Gurdal, E.; Cavdar, S.; Ekinci, G.; Yildiz, E.

    2005-01-01

    The present study determines the degree of ossification of the posterior atlanto-occipital membrane in dry bone, plane lateral cervical spine radiographs and computer tomography (CT). The average length, width and the area of the arcuate foramen were measured on dry bone and on cervical CT. Further, age, gender and complaints of the patients of shoulder and arm pain, neck pain, headache, vertigo, and lacrimation in relation to the presence of bony complete or incomplete arcuate foramen were evaluated. From February 2004 to January 2005 60 dry atlases were obtained from the Anatomy Department, University of Marmara, Istanbul, Turkey and 416 lateral cervical spine radiographs were obtained from the Radiology department for neurological and orthopedic evaluations. Each complete arcuate foramen was calculated with the aid of Clemex Vision PE demo version computer program. Among the 60 dry atlases examined 7 (11.7%) had complete and 2 (3.3 %) had incomplete bony bridge formation. Of the 416 plane lateral cervical spine radiographs examined, 30 (7.2%) had complete and 26 (6.25%) had incomplete bony bridge formation. Of the 30 complete arcuate foramen 24 (80%) were females and 6 (20%) were males. The frequency of having a complete arcuate foramen in females was 8.45%, and in males it was 4.55%. Further, of the 26 incomplete arcuate foramen 20 (76.9%) were females and 6 (23.1%) were males. The frequency of having an incomplete arcuate foramen in females was 7%, and in males was 4.55%. The statistical evaluations showed that patients with complete arcuate foramen had significant complaints of shoulder-arm pain (p=0.0072), neck pain (p=0.0072) and vertigo (p=0.0598) compared to patients with incomplete arcuate foramen. The patients with complete arcuate foramen had a headache ratio of 12:30 and this ratio was 2:26 in patients with incomplete arcuate foramen and the difference between complete and incomplete arcuate foramen was statistically significant (p=0.0062). Further

  12. The painful accessory navicular

    International Nuclear Information System (INIS)

    Lawson, J.P.; Ogden, J.A.; Sella, E.; Barwick, K.W.

    1984-01-01

    The accessory navicular is usually considered a normal anatomic and roentgenographic variant. The term may refer to two distinct patterns. First, a sesamoid bone may be present within the posterior tibial tendon (Type 1); this is anatomically separate from the navicular. Second, an accessory ossification center may be medial to the navicular (Type 2). During postnatal development this is within a cartilaginous mass that is continuous with the cartilage of the navicular. At skeletal maturity the accessory center usually fuses with the navicular to form a curvilinear bone. The Type 2 pattern may be associated with a painful foot, particularly in the athletic adolescent, and should not be arbitrarily dismissed as a roentgenologic variant in the symptomatic patient. The clinical, radiologic, pathologic, and surgical findings in ten cases are reviewed. Roentgenographically the ossicle is triangular or heartshaped. sup(99m)Tc MDP imaging may be of value when the significance of the ossicle is uncertain. Even when the roentgenographic variant is bilateral, increased radionuclide activity occurs only on the symptomatic side. Histologic examination of surgically excised specimens reveals inflammatory chondro-osseous changes in the navicular-accessory navicular synchondrosis compatible with chronic trauma and stress fracture. Nonsurgical treatment with orthotics or cast immobilization produces variable results and resection of the accessory navicular may be the treatment of choice. (orig.)

  13. Painful accessory navicular

    Energy Technology Data Exchange (ETDEWEB)

    Lawson, J.P.; Ogden, J.A.; Sella, E.; Barwick, K.W.

    1984-11-01

    The accessory navicular is usually considered a normal anatomic and roentgenographic variant. The term may refer to two distinct patterns. First, a sesamoid bone may be present within the posterior tibial tendon (Type 1); this is anatomically separate from the navicular. Second, an accessory ossification center may be medial to the navicular (Type 2). During postnatal development this is within a cartilaginous mass that is continuous with the cartilage of the navicular. At skeletal maturity the accessory center usually fuses with the navicular to form a curvilinear bone. The Type 2 pattern may be associated with a painful foot, particularly in the athletic adolescent, and should not be arbitrarily dismissed as a roentgenologic variant in the symptomatic patient. The clinical, radiologic, pathologic, and surgical findings in ten cases are reviewed. Roentgenographically the ossicle is triangular or heartshaped. sup(99m)Tc MDP imaging may be of value when the significance of the ossicle is uncertain. Even when the roentgenographic variant is bilateral, increased radionuclide activity occurs only on the symptomatic side. Histologic examination of surgically excised specimens reveals inflammatory chondro-osseous changes in the navicular-accessory navicular synchondrosis compatible with chronic trauma and stress fracture. Nonsurgical treatment with orthotics or cast immobilization produces variable results and resection of the accessory navicular may be the treatment of choice.

  14. The mandible and its foramen: anatomy, anthropology, embryology and resulting clinical implications.

    Science.gov (United States)

    Lipski, M; Tomaszewska, I M; Lipska, W; Lis, G J; Tomaszewski, K A

    2013-11-01

    The aim of this paper is to summarise the knowledge about the anatomy, embryology and anthropology of the mandible and the mandibular foramen and also to highlight the most important clinical implications of the current studies regarding anaesthesia performed in the region of the mandible. An electronic journal search was undertaken to identify all the relevant studies published in English. The search included MEDLINE and EMBASE databases and years from 1950 to 2012. The subject search used a combination of controlled vocabulary and free text based on the search strategy for MEDLINE using key words: 'mandible', 'mandibular', 'foramen', 'anatomy', 'embryology', 'anthropology', and 'mental'. The reference lists of all the relevant studies and existing reviews were screened for additional relevant publications. Basing on relevant manuscripts, this short review about the anatomy, embryology and anthropology of the mandible and the mandibular foramen was written.

  15. Endoscope-assisted resection of cavernous angioma at the foramen of Monro: a case report.

    Science.gov (United States)

    Matsumoto, Yuji; Kurozumi, Kazuhiko; Shimazu, Yousuke; Ichikawa, Tomotsugu; Date, Isao

    2016-01-01

    Intraventricular cavernous angiomas are rare pathological entities, and those located at the foramen of Monro are even rarer. We herein present a case of cavernous angioma at the foramen of Monro that was successfully treated by neuroendoscope-assisted surgical removal, and review the relevant literature. A 65-year-old woman had experienced headache and vomiting for 10 days before admission to another hospital. Magnetic resonance imaging (MRI) showed a mass at the foramen of Monro, and obstructive hydrocephalus of both lateral ventricles. The patient was then referred to our hospital. Neurological examination on admission to our hospital showed memory disturbance (Mini-Mental State Examination 20/30) and wide-based gait. A cavernous angioma at the foramen of Monro was diagnosed based on the typical popcorn-like appearance of the lesion on MRI. The lesion was completely removed by neuroendoscope-assisted transcortical surgery with the Viewsite Brain Access System (Vycor Medical Inc., Boca Raton, FL), leading to a reduction in the size of the ventricles. The resected mass was histologically confirmed to be cavernous angioma. The patient's symptoms resolved immediately and there were no postoperative complications. Minimally invasive neuroendoscope-assisted surgery was used to successfully treat a cavernous angioma at the foramen of Monro.

  16. Occurrence of the Retromolar Foramen in Dry Mandibles of South-Eastern Part of India: A Morphological Study with Review of the Literature

    Science.gov (United States)

    Potu, Bhagath Kumar; Kumar, Vinod; Salem, Abdel-Halim; Abu-Hijleh, Marwan

    2014-01-01

    The retromolar foramen (RMF) is a rare anatomical structure situated in the retromolar fossa behind the third molar tooth. When it is present, the foramen is connected with the mandibular canal and is believed to transmit neurovascular structures that provide accessory source to the mandibular molars and the buccal area. Reports from the literature show that the presence of RMF could pose a challenge in complete blockage of the inferior alveolar nerve during mandibular surgeries. We report the incidence of retromolar foramen from ninety-four dry mandibles of south-eastern part of Karnataka State, India. The foramen was observed in 11 mandibles out of 94 included in the study (11.7%). In three mandibles, the foramen was present bilaterally (3.2%) and in three it was on the left side (3.2%) and in five it was on the right side (5.3%). For the first time, we also measured the dimensions of the retromolar area and distance of the foramen from third molar tooth to understand its risks during the surgical extraction of the lower third molar tooth. A thorough review of the literature has also been done to compare the present findings with the studies reported from the various populations. PMID:25489487

  17. Foramen magnum position in bipedal mammals.

    Science.gov (United States)

    Russo, Gabrielle A; Kirk, E Christopher

    2013-11-01

    The anterior position of the human foramen magnum is often explained as an adaptation for maintaining balance of the head atop the cervical vertebral column during bipedalism and the assumption of orthograde trunk postures. Accordingly, the relative placement of the foramen magnum on the basicranium has been used to infer bipedal locomotion and hominin status for a number of Mio-Pliocene fossil taxa. Nonetheless, previous studies have struggled to validate the functional link between foramen magnum position and bipedal locomotion. Here, we test the hypothesis that an anteriorly positioned foramen magnum is related to bipedalism through a comparison of basicranial anatomy between bipeds and quadrupeds from three mammalian clades: marsupials, rodents and primates. Additionally, we examine whether strepsirrhine primates that habitually assume orthograde trunk postures exhibit more anteriorly positioned foramina magna compared with non-orthograde strepsirrhines. Our comparative data reveal that bipedal marsupials and rodents have foramina magna that are more anteriorly located than those of quadrupedal close relatives. The foramen magnum is also situated more anteriorly in orthograde strepsirrhines than in pronograde or antipronograde strepsirrhines. Among the primates sampled, humans exhibit the most anteriorly positioned foramina magna. The results of this analysis support the utility of foramen magnum position as an indicator of bipedal locomotion in fossil hominins. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Perineural tumor extension through the foramen ovale

    International Nuclear Information System (INIS)

    Laine, F.J.; Braun, I.F.; Jensen, M.E.; Nadel, L.

    1988-01-01

    The third division of the trigeminal nerve exists through the foramen ovale and supplies extensive superficial and deep facial structures. As such, it is a common route of perineural spread of head and neck tumors. Perineural tumor extension through basal foramina is well documented pathologically and has been described with multiple radiologic modalities. The authors present seven patients with transforaminal lesions evaluated with MR imaging. Clinical findings referable to the two dimensions of V 3 are correlated with the images. This paper focuses on the normal anatomy and pathologic findings in and around the foramen ovale

  19. Rhabdovirus accessory genes.

    Science.gov (United States)

    Walker, Peter J; Dietzgen, Ralf G; Joubert, D Albert; Blasdell, Kim R

    2011-12-01

    The Rhabdoviridae is one of the most ecologically diverse families of RNA viruses with members infecting a wide range of organisms including placental mammals, marsupials, birds, reptiles, fish, insects and plants. The availability of complete nucleotide sequences for an increasing number of rhabdoviruses has revealed that their ecological diversity is reflected in the diversity and complexity of their genomes. The five canonical rhabdovirus structural protein genes (N, P, M, G and L) that are shared by all rhabdoviruses are overprinted, overlapped and interspersed with a multitude of novel and diverse accessory genes. Although not essential for replication in cell culture, several of these genes have been shown to have roles associated with pathogenesis and apoptosis in animals, and cell-to-cell movement in plants. Others appear to be secreted or have the characteristics of membrane-anchored glycoproteins or viroporins. However, most encode proteins of unknown function that are unrelated to any other known proteins. Understanding the roles of these accessory genes and the strategies by which rhabdoviruses use them to engage, divert and re-direct cellular processes will not only present opportunities to develop new anti-viral therapies but may also reveal aspects of cellar function that have broader significance in biology, agriculture and medicine. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

  20. Anatomical structure of lingual foramen in cone beam computed tomography

    International Nuclear Information System (INIS)

    Ki, Min Woo; Hwang, Eui Hwan; Lee, Sang Rae

    2004-01-01

    To evaluate whether cone beam computed tomography can depict the distribution, position, frequency, relative vertical dimension, and the diameter of the lingual foramen and direction of lingual bone canal. Cone beam computed tomography of mandible was performed on 25 males and 25 females with no history of any orthodontic treatments or any other dental surgeries. A statistical comparison was done on the mean values of males and females. In the location and distribution of lingual foramina, median lingual foramen was found in all subjects and lateral lingual foramen in 58%. In the lateral lingual foramen, bilateral type was found in 28% and unilateral type in 30%. In the number of lingual foramina, median lingual foramen had two foramina and lateral lingual foramen had one foramen, mostly. In the relative mean vertical dimension of lingual foramina, median lingual foramen was 0.03 ± 0.08, and both lateral lingual foramina was 0.20 ± 0.04. The mean diameter of lingual foramina, median lingual foramen was 0.9 mm ± 0.28, right lateral lingual foramen was 0.92 mm ± 0.23, and left lateral lingual foramen was 0.88 mm ± 0.27. The most frequent direction of the lingual bone canals, median lingual bone canal proceeded in anteroinferior direction and lateral lingual bone canal in anterosuperolateral direction. Cone beam computed tomography can be helpful for surgery and implantation on the mandibular area. Radiologist should be aware of this anatomical feature and its possible implications.

  1. Anatomical structure of lingual foramen in cone beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ki, Min Woo; Hwang, Eui Hwan; Lee, Sang Rae [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

    2004-07-15

    To evaluate whether cone beam computed tomography can depict the distribution, position, frequency, relative vertical dimension, and the diameter of the lingual foramen and direction of lingual bone canal. Cone beam computed tomography of mandible was performed on 25 males and 25 females with no history of any orthodontic treatments or any other dental surgeries. A statistical comparison was done on the mean values of males and females. In the location and distribution of lingual foramina, median lingual foramen was found in all subjects and lateral lingual foramen in 58%. In the lateral lingual foramen, bilateral type was found in 28% and unilateral type in 30%. In the number of lingual foramina, median lingual foramen had two foramina and lateral lingual foramen had one foramen, mostly. In the relative mean vertical dimension of lingual foramina, median lingual foramen was 0.03 {+-} 0.08, and both lateral lingual foramina was 0.20 {+-} 0.04. The mean diameter of lingual foramina, median lingual foramen was 0.9 mm {+-} 0.28, right lateral lingual foramen was 0.92 mm {+-} 0.23, and left lateral lingual foramen was 0.88 mm {+-} 0.27. The most frequent direction of the lingual bone canals, median lingual bone canal proceeded in anteroinferior direction and lateral lingual bone canal in anterosuperolateral direction. Cone beam computed tomography can be helpful for surgery and implantation on the mandibular area. Radiologist should be aware of this anatomical feature and its possible implications.

  2. Meningioma of Foramen Magnum Causing Drop Attacks

    Directory of Open Access Journals (Sweden)

    Amit Mahore

    2015-01-01

    Full Text Available A 52-year-old female presented with frequent episodes of falls without loss of consciousness. These episodes lasted for brief period followed by full neurological recovery. Magnetic resonance imaging (MRI of the brain showed foramen magnum meningioma encasing left vertebral artery. The patient had dramatic improvement after excision of the tumor.

  3. Retrospective Morphometric Analysis of the Infraorbital Foramen ...

    African Journals Online (AJOL)

    2017-10-26

    Oct 26, 2017 ... prevent the damage of the neurovascular structures during maxillofacial surgery ... Infraorbital nerve passes through infraorbital sulcus and infraorbital canal and extended to the skull via the infraorbital foramen (IOF).[1]. Infraorbital nerve block is used in regional ...... Trigeminal nerve peripheral branch.

  4. Congenital constriction of the foramen of Monro

    International Nuclear Information System (INIS)

    Marions, O.; Boethius, J.

    1986-01-01

    We report two cases of hydrocephalus in adults. The radiological investigations and direct inspection during surgery in one of the cases indicate that the hydrocephalus is caused in both cases by a benign stricture in the region of the foramen of Monro and that this constriction is congenital. This origin of hydrocephalus has not been reported previously in adults. (orig.)

  5. Retrospective Morphometric Analysis of the Infraorbital Foramen ...

    African Journals Online (AJOL)

    Objective: The aim of our study is to examine the morphometric characteristics of the infraorbital foramen (IOF) and its anatomic localization by using conebeam computerized tomography (CBCT). Materials and Methods: In our study, the anatomic characteristics of the IOF were identified by studying retrospectively the CBCT ...

  6. Anatomic study on mental canal and incisive nerve canal in interforaminal region in Chinese population.

    Science.gov (United States)

    Xu, Yun; Suo, Ning; Tian, Xiufen; Li, Fei; Zhong, Guangxin; Liu, Xiaoran; Bao, Yongxing; Song, Tao; Tian, Hua

    2015-08-01

    This study was aimed to detect the positions of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region in Chinese population to supply the reference data of the surgical safe zone in chin for clinicians. A total of 80 formalin-fixed semi-mandibles of Chinese adult cadavers were dissected, the positions and courses of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region were measured. The mental foramina were present in all cases (100 %), and most of them were located below 2nd premolar (58.75 %). Accessory mental foramina were observed in 5 %. The anterior end of mandibular canal, extending along the course of 7.37 ± 1.10 mm above the lower border of mandible to interforaminal region about 3.54 ± 0.70 mm medial to the mental foramen, most often ended below between the two premolars (73.75 %), where it continued as the incisive nerve canal (100 %) and the mental canal (96.25 %). Mental canal, with the wall formed by compact bone, being 2.60 ± 0.60 mm in diameter and 4.01 ± 1.20 mm in length, opened into mental foramen. Incisive nerve canal, with the wall formed by thin compact bone and/or partly or completely by spongy bone, being 1.76 ± 0.27 mm in diameter and 24.87 ± 2.23 mm in length, extended to the incisor region along the course of 9.53 ± 1.43 mm above the lower border of mandible, and most often ended below the lateral incisor (70.00 %). This research recommended for chin operations in Chinese population: the surgical safe zone could be set in the region about over 4 mm anterior to the mental foramen, and over 12 mm above inferior border of mandible for anterior alveolar surgery, or within 9 mm above inferior border of mandible for genioplasty.

  7. Patent Foramen Ovale: Is Stroke Due to Paradoxical Embolism?

    Science.gov (United States)

    Ranoux, D.; Cohen, A.; Cabanes, L.; Amarenco, P.; Bousser, M. G.; Mas, J. L.

    1993-01-01

    Background and Purpose: A patent foramen ovale has been reported to be significantly more frequent in young stroke patients than in matched control subjects, and paradoxical embolism has been suggested as the main mechanism of stroke in-this situation. The present study was designed to test this hypothesis. Methods: Sixty-eight consecutive patients under 55 years of age presenting with an ischemic stroke had an extensive workup, including transesophageal echocardiography with contrast. We compared the prevalence of criteria for the diagnosis of paradoxical embolism in patients with and without a patent foramen ovale. Results: A patent foramen ovale was found in 32 patients (47%). A Valsalva-provoking activity was present at stroke onset in six patients with a patent foramen ovale and in eight patients with no patent foramen ovale (X(sup 2)=0.1, nonsignificant). Clinical/radiological features suggestive of an embolic mechanism were not more frequent in patients with a patent foramen ovale. Clinical evidence of deep vein thrombosis was present in one patient with a patent foramen ovale and in none of the others. No occult venous thrombosis was found in a subgroup of patients with a patent foramen ovale and no definite cause for stroke who underwent venography (n=13). Conclusions. Our results do not support the hypothesis that paradoxical embolism is the primary mechanism of stroke in patients with a patent foramen ovale. (Stroke 1993;24:31-34) KEY WORDS e cerebral ischemia e embolism foramen ovale, patent

  8. Accessory Proteins at ERES

    DEFF Research Database (Denmark)

    Klinkenberg, Rafael David

    membrane targeting and association with ERES. We determine the localization of Sec16B by transient expression in HeLa cells, and find that the protein is evenly distributed throughout the cell except the nucleus at 37°C, as is also observed with mSec16A. When the temperature is lowered to 15°C, mSec16B...... proteins. Together these components co‐operate in cargo‐selection as well as forming, loading and releasing budding vesicles from specific regions on the membrane surface of the ER. Coat components furthermore convey vesicle targeting towards the Golgi. However, not much is known about the mechanisms...... that regulate the COPII assembly at the vesicle bud site. This thesis provides the first regulatory mechanism of COPII assembly in relation to ER‐membrane lipid‐signal recognition by the accessory protein p125A (Sec23IP). The aim of the project was to characterize p125A function by dissecting two main domains...

  9. Microcomputed tomography analysis of mesiobuccal orifices and major apical foramen in first maxillary molars.

    Science.gov (United States)

    Spagnuolo, Gianrico; Ametrano, Gianluca; D'Antò, Vincenzo; Formisano, Anna; Simeone, Michele; Riccitiello, Francesco; Amato, Massimo; Rengo, Sandro

    2012-01-01

    Aim of the study was to determined by microcomputed tomography (µCT) the horizontal distance between the main (MB1) and the second mesiobuccal canal (MB2) orifices, the vertical distance between the MB1 and MB2 orifices planes, and the distance between the anatomic apex and major apical foramen (AF). Furthermore, we characterized the entire internal and external anatomy of the MB, distalbuccal (DB) and palatal (P) maxillary first molars roots. Twenty-two intact extracted first maxillary molars were scanned by X-ray computed transaxial µCT and then 2D and 3D images were processed and analyzed. The results showed that 77.27% of the mesiobuccal (MB) roots presented a second MB canal, and 29.41% of the MB2 were independent from the MB1 canals. In 15 teeth, there were three root canal orifices on the chamber floor, and 10 of these teeth presented MB2 canals. The mean vertical distance between the MB1 and MB2 planes was 1.68 ± 0.83 mm. Seven teeth had four orifices. The mean horizontal interorificial distance between the MB1 and MB2 orifices was 1.21 ± 0.5 mm. Accessory canals were observed in 33.33% of the roots, loops in 6.06%, while isthmuses were found in 15 of the 22 MB roots. Of the total roots, 74.24% presented one foramen, while all of the roots showed a major apical foramen that was not coincident with the anatomic apex. Our µCT analysis provided interesting features on the horizontal and vertical distance between the MB1 and MB2 orifices and on the distance of AF and anatomic apex. These results have an important clinical value because might support the endodontist in the recruitment, negotiation and obturation of maxillary first molar canal system.

  10. Patent foramen ovale and migraine attacks: a systematic review.

    Science.gov (United States)

    Lip, Philomena Z Y; Lip, Gregory Y H

    2014-05-01

    Migraine headache and the presence of a patent foramen ovale have been associated with each other, although the precise pathophysiological mechanism(s) are uncertain. The purpose of this systematic review was to identify the extent of patent foramen ovale prevalence in migraineurs and to determine whether closure of a patent foramen ovale would improve migraine headache. An electronic literature search was performed to select studies between January 1980 and February 2013 that were relevant to the prevalence of patent foramen ovale and migraine, and the effects of intervention(s) on migraine attacks. Of the initial 368 articles presented by the initial search, 20 satisfied the inclusion criteria assessing patent foramen ovale prevalence in migraineurs and 21 presented data on patent foramen ovale closure. In case series and cohort studies, patent foramen ovale prevalence in migraineurs ranged from 14.6% to 66.5%. Case-control studies reported a prevalence ranging from 16.0% to 25.7% in controls, compared with 26.8% to 96.0% for migraine with aura. The extent of improvement or resolution of migraine headache attack symptoms was variable. In case series, intervention ameliorated migraine headache attack in 13.6% to 92.3% of cases. One single randomized trial did not show any benefit from patent foramen ovale closure. The data overall do not exclude the possibility of a placebo effect for resolving migraine following patent foramen ovale closure. This systematic review demonstrates firstly that migraine headache attack is associated with a higher prevalence of patent foramen ovale than among the general population. Observational data suggest that some improvement of migraine would be observed if the patent foramen ovale were to be closed. A proper assessment of any interventions for patent foramen ovale closure would require further large randomized trials to be conducted given uncertainties from existing trial data. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Assessment of the anterior loop of mental nerve in an Iranian population using cone beam computed tomography scan

    Directory of Open Access Journals (Sweden)

    Mitra Karbasi Kheir

    2017-01-01

    Conclusion: Great care is required when placing implants in proximity to mental foramen to avoid anterior loop injury. Because of the variations of anterior loop length in each patient, a fixed distance anterior to the mental foramen is not safe, and the anterior loop length should be determined for each individual. The use of CBCT provides accurate measurements of the length of anterior loop.

  12. Accessory hepatic vein: MR imaging

    International Nuclear Information System (INIS)

    Lee, Chang Hee; Rho, Tack Soo; Cha, Sang Hoon; Park, Cheol Min; Cha, In Ho

    1995-01-01

    To evaluate the MR appearance of the accessory hepatic veins. The study included 87 consecutive patients for whom abdominal MR images were obtained. The subjects who had liver lesion or hepatic vascular abnormalities were excluded. Couinaud classified accessory hepatic veins into inferior and middle right hepatic veins. Our major interests were evaluation of the incidence, morphology, and location of the accessory hepatic vein. Inferior right hepatic vein was demonstrated in 43 out of 87 patients (49%). The morphology was linear in 35 patients (80.5%), and V-shaped in 8 patients (19.5%). In 40 patients (93%), the inferior right hepatic vein was located in the posteroinferior aspect of the right lobe. Middle right hepatic vein was demonstrated in 7 out of 87 patients (8%). All were single linear in morphology, combined with the inferior right hepatic vein, and located between the right hepatic vein and inferior right hepatic vein. The accessory hepatic vein was demonstrated in 49% among the Korean adult population, and was located in posteroinferior portion of the liver, in 93%

  13. A long slanted transseptal accessory pathway

    Directory of Open Access Journals (Sweden)

    Hui-Min Wang

    2011-05-01

    Full Text Available A 63-year-old male with Wolff-Parkinson-White syndrome was admitted for ablation of accessory pathway. Intracardiac electrogram revealed a left-side accessory pathway during tachycardia, which was successfully ablated from the right posterior tricuspid annulus because of a long slanted transseptal accessory pathway (2.2 cm.

  14. Building iPhone OS Accessories

    CERN Document Server

    Maskrey, Ken

    2010-01-01

    This book provides a serious, in-depth look at Apple's External Accessory Framework and the iPhone Accessories API. You'll learn how to create new, integrated solutions that combine iPhone apps with dedicated hardware. The iPhone OS Accessories API expands the opportunities for innovative iPhone developers, allowing you to control and monitor external devices, whether you've built them yourself or obtained them from a third party. What you'll learn * Develop accessories and apps for the iPhone and iPod touch. * Use Apple's External Accessory Framework to create hardware/software interaction. *

  15. Accessory tragus: a dentist's perspective

    OpenAIRE

    Khandelwal, Vishal; Banda, Naveen Reddy; Nayak, Ullal Anand; Banda, Vanaja Reddy

    2013-01-01

    Accessory tragus (AT) also referred as preauricular tag is a rudimentary tag of ear tissue This paper presents two specific cases: one hereditary and another sporadic case of AT. A general clinical description of AT, its associated syndromes, embryology aetiopathogenesis and management is discussed. A dentist can play an important role in spotting the AT during their head and neck examination. The presence of this defect can be correlated to other congenital defects of first branchial arch. O...

  16. Symptomatic Patent Foramen Ovale with Hemidiaphragm Paralysis

    Directory of Open Access Journals (Sweden)

    Hussain Ibrahim

    2017-01-01

    Full Text Available Dyspnea accounts for more than one-fourth of the hospital admissions from Emergency Department. Chronic conditions such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Asthma are being common etiologies. Less common etiologies include conditions such as valvular heart disease, pulmonary embolism, and right-to-left shunt (RLS from patent foramen ovale (PFO. PFO is present in estimated 20–30% of the population, mostly a benign condition. RLS via PFO usually occurs when right atrium pressure exceeds left atrium pressure. RLS can also occur in absence of higher right atrium pressure. We report one such case that highlights the importance of high clinical suspicion, thorough evaluation, and percutaneous closure of the PFO leading to significant improvement in the symptoms.

  17. Complete morphometric analysis of jugular foramen and its clinical implications

    Directory of Open Access Journals (Sweden)

    Sushant Swaroop Das

    2016-01-01

    Conclusion: This study gives knowledge about the various parameters, anatomical variations of jugular foramen in both sexes of an adult Indian population, and its clinical impact on the surgeries of this region.

  18. Hypochondroplasia with Foramen Magnum Stenosis: a Case Report

    Directory of Open Access Journals (Sweden)

    Nazik Aşılıoğlu

    2011-09-01

    Full Text Available Hypochondroplasia was first reported in the English literature by Beals (1969. The features are similar to those of achondroplasia but are less severe and are usually reported not to involve the skull. The foramen magnum and whole spinal canal are reduced in diameter in achondroplasia, but less so in hypochondroplasia. In this study, we present an unique case of a seven month old child with hypochondroplasia with symptomatic foramen magnum stenosis which required surgical decompression. This 7-month-old child with hypochondroplasia presented with hypotonia and severe respiratory disabilities, including apneic episodes requiring continuous positive airway pressure. Magnetic resonance imaging revealed marked foramen magnum stenosis. Foramen magnum decompression was performed. Postoperatively, steady motor improvement has been observed and the patient no longer requires ventilatory support. To the our knowledge, this is the first report of hypochondroplasia and symptomatic foramen magnum stenosis. In this case we wish to emphasize the necessity of the radiological imaging of foramen magnum and spinal cord for the patient who has respiratory distress and hypotonia with skeletal dysplasia.

  19. Complete Cranial Iliac Osteotomy to Approach the Lumbosacral Foramen

    Directory of Open Access Journals (Sweden)

    Barbara Dyall

    2017-05-01

    Full Text Available An approach using a complete cranial iliac osteotomy (CCIO to access the lumbosacral (LS foramen in dogs from lateral was developed using cadavers and applied in a clinical patient with degenerative lumbosacral stenosis (DLSS. The foraminal enlargement in the cadavers and the patient was documented on postoperative CT scans. The preoperative CT scan of the patient showed moderate cranial telescoping of the sacral roof and a moderate central disk protrusion, leading to moderate to severe compression of the cauda equina. In addition, there was lateral spondylosis with consequential stenosis of the right LS foramen. The right L7 nerve had lost its fat attenuation and appeared thickened. After a routine L7S1 dorsal laminectomy with a partial discectomy, a CCIO was performed, providing good access to the LS foramen and the adhesions around the proximal L7 nerve caudoventral to the foramen. The osteotomy was stabilized with a locking plate and a cerclage wire. The dog recovered well from the procedures and after 36 h, the dog walked normally and was discharged from the hospital. Eight and 16 weeks later, the signs of the DLSS had markedly improved. From these data, it can be concluded that the CCIO is a useful approach to the LS foramen and intervertebral disk in selected patients with DLSS, giving good access to the structures around the LS foramen.

  20. Mechanical accessories for mobile teleoperators

    International Nuclear Information System (INIS)

    Feldman, M.J.; Herndon, J.N.

    1985-01-01

    The choice of optimum mechanical accessories for mobile teleoperators involves matching the criteria for emergency response with the available technology. This paper presents a general background to teleoperations, a potpourri of the manipulator systems available, and an argument for force reflecting manipulation. The theme presented is that the accomplishment of humanlike endeavors in hostile environments will be most successful when man model capabilities are utilized. The application of recent electronic technology to manipulator development has made new tools available to be applied to emergency response activities. The development activities described are products of the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory. 13 refs., 7 figs

  1. Variations in the accessory structures of the clavicle: findings at chest radiographs and dry bones

    International Nuclear Information System (INIS)

    Chung, Min Suk; Suh, Kyung Jin; Joo, Kang; Chung, In Hyuk

    1995-01-01

    To evaluate normal variations and thus to avoid confusion in differentiation from lesions of the accessory structures (rhomboid fossa, foramen for supraclavicular nerve, conoid tubercle) of the clavicle in chest radiographs. We studied the variations of the clavicle in 300 chest radiographs (134 men, 166 women) and 355 dry bones (right 166, left 189;151 men, 74 women, 130 unknown sex). In chest radiographs, the incidence of the depressed rhomboid fossa was 229 cases (39.5%; male 52.0%, female 29.9%); the flat type was 329 cases (56.9%; male 45.7%, female 65.7%); and the elevated type was 20 cases (3.5%;male 2.4%, female 4.3%). In the dry bones, the incidence of the depressed rhomboid fossa was 129 cases (57.3%; male 59.6%, female 52.7%); the flat type was 65 cases (28.9%; male 24.5%, female 37.8%); and the elevated type was 31 cases (13.8%; male 15.9%, female 9.5%). The incidence of the foramen for supraclavicular nerve was 0.8% in chest radiographs, and 1.4% in the dry bones. The incidence of the elevated conoid tubercle was 65.1% (male 64.0%, female 65.9%) in chest radiographs, and 96.9% (male 95.4%, female 100.0%) in the dry bones. The incidence of the depressed rhomboid fossa in chest radiographs was higher in men and the right clavicle. The incidence of flat rhomboid fossa in chest radiographs decreased according to increase of age. The foramen for supraclavicular nerve was occasionally found ( 0.8% in chest radiographs; 1.4% in the dry bones)

  2. Cone-beam tomographic analysis of canalis sinuosus accessory intraosseous canals in the maxilla

    Directory of Open Access Journals (Sweden)

    Ghandourah, Abdalmalik O.

    2017-12-01

    Full Text Available The aim of this study was to assess the frequency, location and width of accessory canals (AC of canalis sinuosus (CS using cone beam computed tomography and compare our findings with recent literature. Additionally, intraosseous canals (IOC in the sinus wall other than the CS were noted. A retrospective analysis of 219 scans from our university department was conducted. The registered parameters were age, sex, location and width of canals. Group A consisted of 201 (85 males and 116 females adults ranged from 19 to 99 years of age (mean age = 47.5 years. A total of 136 patients (67.6% presented at least 1 AC, of which 55 cases showed a foramen width greater than 1 mm (27.4%. Group B had a sample size of 18 adolescents (7 males and 11 females with a range of age from 7 to 18 years (mean age = 15.8 years. Eight cases (44.4% presented at least one AC, of which only 3 had a foramen width greater than 1 mm (3.6%. ACs were found to occur predominantly at central incisors region (Group A and the left lateral incisor and canine as well as the central incisors regions (Group B. Adolescents showed a lower prevalence of accessory canals compared to adults. These findings supplement earlier reports on the anatomical variations of the intraosseous vessel and nerve conduits of the maxilla. Surgical interventions in this area can be planned more precisely, taking into account the three-dimensional imaging, thus possibly protecting these sensitive structures.

  3. Acute headache attributed to whiplash in arcuate foramen and non-arcuate foramen subjects.

    Science.gov (United States)

    Ríos, Luis; Mata-Escolano, Federico; Blanco-Pérez, Esther; Llidó, Susanna; Bastir, Markus; Sanchis-Gimeno, Juan A

    2017-04-01

    To test the association between arcuate foramen (AF) in the first cervical vertebra with acute headache attributed to whiplash. Retrospective study of 128 patients that suffered a whiplash. The presence or absence of AF was recorded after a radiographic study, as well as the presence or absence of acute headache after the whiplash. The frequency of AF was 17.2%. Patients with bilateral AF presented a significant (p = 0.000, Fisher's test) increase in the frequency of acute headache (90.9%) in comparison with the non-AF group (5.7%). The ratio between the presence and absence of acute headache was 166.6 times higher (IC 95% 18.2-1526.22) in subjects with bilateral AF in comparison with non-AF subjects. The presence of bilateral AF is associated to an increased frequency of acute headache after suffering a whiplash, information of interest for the attention to these patients.

  4. 47 CFR 15.27 - Special accessories.

    Science.gov (United States)

    2010-10-01

    ... manual is provided only in a form other than paper, such as on a computer disk or over the Internet, the... requiring special accessories is installed by or under the supervision of the party marketing the device, it...

  5. Obturator foramen dissection for excision of symptomatic transobturator mesh.

    Science.gov (United States)

    Reynolds, W Stuart; Kit, Laura Chang; Kaufman, Melissa R; Karram, Mickey; Bales, Gregory T; Dmochowski, Roger R

    2012-05-01

    Groin pain after transobturator synthetic mesh placement can be recalcitrant to conservative therapy and ultimately requires surgical excision. We describe our experiences with and technique of obturator foramen dissection for mesh excision. The records of 8 patients treated from 2005 to 2010, were reviewed. Obturator dissection was performed via a lateral groin incision over the inferior pubic ramus at the level of the obturator foramen, typically in conjunction with orthopedic surgery. Five patients had transobturator mid urethral sling surgery for stress urinary incontinence, 2 had mid urethral sling and trocar based anterior vaginal wall mesh kits with transobturator passage of mesh arms for stress urinary incontinence and pelvic organ prolapse, and 1 had an anterior vaginal wall mesh kit for pelvic organ prolapse. Patients had 0 to 2 prior transvaginal mesh excisions before obturator surgery. All patients presented with intractable pain in the area of the obturator foramen and/or medial groin for which conservative treatment measures had failed. Six patients underwent concurrent vaginal and obturator dissection and 2 underwent obturator dissection alone. In all cases residual mesh (3 to 11 cm) was identified and excised from the obturator foramen. Mesh was closely associated to or traversing the adductor longus muscle and tendon with significant fibrous reaction in all cases. Postoperatively 5 patients were cured of pain and/or infection, and 3 reported no or some improvement at a mean followup of 6 months (range 1 to 12). Our experience suggests that surgical excision of residual mesh can alleviate many of the symptoms in many patients. In all cases mesh remnants were identified and removed, and typically involved neuromuscular structures adjacent to the obturator foramen. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. Foramen Tympanicum or Foramen of Huschke: A Bioarchaeological Study on Human Skeletons from an Iron Age Cemetery at Tabriz Kabud Mosque Zone.

    Science.gov (United States)

    Rezaian, Jafar; Namavar, Mohammad Reza; Vahdati Nasab, Hamed; Hojabri Nobari, Ali Reza; Abedollahi, Ali

    2015-07-01

    The foramen tympanicum is an anatomical variation that is created in the tympanic plate of temporal bone during the first year of life. The tympanic plate grows and foramen tympanicum is gradually closed by about the fifth postnatal year. However, due to a defect in normal ossification, foramen tympanicum sporadically remains throughout life. The construction of a shopping center in Tabriz, northwest of Iran, led to the discovery of an Iron Age cemetery (1500-500 BC). Several tombs have been uncovered below one meter of sterile soil so far and a thick level of architectural debris from the medieval city has been discovered. Up to now, no bioarchaeological data has been gathered about the burials in this area. Thus, the present study aimed to evaluate the prevalence of foramen tympanicum in this area. In this study, 45 skeletons were studied and the prevalence of this foramen was about 4.4% bilaterally. We also reported on two babies with fused and un-fused squamotympanic fissure. The persistence of this foramen is a possible risk factor for otologic complications after arthroscopy of the temporomandibular joint and salivary gland fistula through this foramen. The closure of this foramen could be also used for age estimation in sub-adult individuals. The incidence of this trait in this study was similar to other available studies on modern skeletons.

  7. Foramen Tympanicum or Foramen of Huschke: A Bioarchaeological Study on Human Skeletons from an Iron Age Cemetery at Tabriz Kabud Mosque Zone

    Directory of Open Access Journals (Sweden)

    Jafar Rezaian

    2015-07-01

    Full Text Available The foramen tympanicum is an anatomical variation that is created in the tympanic plate of temporal bone during the first year of life. The tympanic plate grows and foramen tympanicum is gradually closed by about the fifth postnatal year. However, due to a defect in normal ossification, foramen tympanicum sporadically remains throughout life. The construction of a shopping center in Tabriz, northwest of Iran, led to the discovery of an Iron Age cemetery (1500-500 BC. Several tombs have been uncovered below one meter of sterile soil so far and a thick level of architectural debris from the medieval city has been discovered. Up to now, no bioarchaeological data has been gathered about the burials in this area. Thus, the present study aimed to evaluate the prevalence of foramen tympanicum in this area. In this study, 45 skeletons were studied and the prevalence of this foramen was about 4.4% bilaterally. We also reported on two babies with fused and un-fused squamotympanic fissure. The persistence of this foramen is a possible risk factor for otologic complications after arthroscopy of the temporomandibular joint and salivary gland fistula through this foramen. The closure of this foramen could be also used for age estimation in sub-adult individuals. The incidence of this trait in this study was similar to other available studies on modern skeletons.

  8. Clinical anatomy and clinical significance of the cervical intervertebral foramen: a review.

    Science.gov (United States)

    Sioutas, G; Kapetanakis, S

    2016-01-01

    The aim of this paper is to summarise the knowledge about the anatomy of the cervical intervertebral foramen as a whole. Such reviews are rare in the literature. The intervertebral or neural foramen is the opening between the spinal canal and the extraspinal region. It is located between the vertebral pedicles at all spinal levels. A number of structures pass through the foramen: nerves, vessels and ligaments. We describe the bony borders and dimensions of the foramen, the adjacent ligaments, the arteries and veins passing through or neighbouring it, and the neural components. Many procedures are performed in the area of the cervical intervertebral foramen. Knowledge of the anatomy of the foramen is essential in order to operate to the area and to minimize iatrogenic injuries.

  9. Surgical Treatment for Thrombus Straddling a Patent Foramen Ovale

    Directory of Open Access Journals (Sweden)

    Marcos Aurélio Barboza de Oliveira

    Full Text Available Abstract We present a case of a 41-year-old female with deep vein thrombosis after abdominal surgery. The patient quickly developed severe pulmonary embolism and stroke representative of paradoxical embolism. Echocardiography showed a thrombus straddling a patent foramen ovale, which was confirmed intraoperatively. An accurate diagnosis and rapid treatment decisions are crucial for preventing patient deterioration in the form of new pulmonary embolisms or stroke.

  10. POSITION OF CEREBELLAR TONSILS IN REFERENCE TO FORAMEN MAGNUM: AN MRI STUDY

    OpenAIRE

    Lakshmi

    2015-01-01

    Normal position of the cerebellar tonsils is described to be at or above the foramen magnum. Western studies have shown the cerebellar tonsils to be below the foramen magnum. Position of tonsils is of great importance in assessing the hind brain deformity–Chiari malformation. There are no Indian studies to corroborate the findings. Hence, we proposed a basic study to find out the existence of tonsillar ectopia (Position of tonsils below the foramen magnum) in normal population. Ou...

  11. AN ANATOMICAL PERSPECTIVE OF HUMAN OCCIPITAL CONDYLES AND FORAMEN MAGNUM WITH NEUROSURGICAL CORRELATES

    OpenAIRE

    Gaurav; Divya; Abha

    2014-01-01

    AIMS: Knowledge of condylar anatomy helps the surgeon in making important decisions regarding extent and direction of condylar drilling and minimizing injury and retraction of neural structures. Important preoperative information includes length, width, axis/directions and overriding of occipital condyle in foramen magnum, relationships of condyles to foramen magnum and to hypoglossal canal. The antero-posterior and transverse diameters of foramen magnum and amount of over...

  12. Lumbar Nerve Root Occupancy in the Foramen in Achondroplasia

    Science.gov (United States)

    Modi, Hitesh N.; Song, Hae-Ryong; Yang, Jae Hyuk

    2008-01-01

    Lumbar stenosis is common in patients with achondroplasia because of narrowing of the neural canal. However, it is unclear what causes stenosis, narrowing of the central canal or foramina. We performed a morphometric analysis of the lumbar nerve roots and intervertebral foramen in 17 patients (170 nerve roots and foramina) with achondroplasia (eight symptomatic, nine asymptomatic) and compared the data with that from 20 (200 nerve roots and foramina) asymptomatic patients without achondroplasia presenting with low back pain without neurologic symptoms. The measurements were made on left and right parasagittal MRI scans of the lumbar spine. The foramen area and root area were reduced at all levels from L1 to L5 between the patients with achondroplasia (Groups I and II) and the nonachondroplasia group (Group III). The percentage of nerve root occupancy in the foramen between Group I and Group II as compared with the patients without achondroplasia was similar or lower. This implied the lumbar nerve root size in patients with achondroplasia was smaller than that of the normal population and thus there is no effective nerve root compression. Symptoms of lumbar stenosis in achondroplasia may be arising from the central canal secondary to degenerative disc disease rather than a true foraminal stenosis. Level of Evidence: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18259829

  13. Surgical experience with skull base approaches for foramen magnum meningioma.

    Science.gov (United States)

    Marin Sanabria, Elio Arnaldo; Ehara, Kazumasa; Tamaki, Norihiko

    2002-11-01

    The surgical treatment of patients with foramen magnum meningioma remains challenging. This study evaluated the outcome of this tumor according to the evolution of surgical approaches during the last 29 years. A retrospective analysis of medical records, operative notes, and neuroimages of 492 meningioma cases from 1972 to 2001 identified seven cases of foramen magnum meningioma (1.4%). All patients showed various neurological symptoms corresponding with foramen magnum syndrome. The tumor locations were anterior in five cases and posterior in two. Surgical removal was performed through a transoral approach in one patient, the suboccipital approach in three, and the transcondylar approach in two. Total removal was achieved in all patients, except for one who refused any surgical treatment. The major complications were tetraparesis and lower cranial nerve paresis for tumors in anterior locations, and minor complications for posterior locations. One patient died of atelectasis and pneumonia after a long hospitalization. The transcondylar approach is recommended for anterior locations, and the standard suboccipital approach for posterior locations.

  14. Surface Projection of Interosseous Foramen of the Leg: Cadaver Study

    Directory of Open Access Journals (Sweden)

    Eric Arguello

    2016-01-01

    Full Text Available Purpose. This study was conducted to identify the surface projection of the interosseous foramen and associated structures of the proximal leg using the average clinician’s thumb width as a quick measurement to assist in differential diagnosis and treatment. Methods. Twelve cadavers (5 males and 7 females, age range = 51–91 years, and mean age = 76.9 were dissected for analysis. Location and size of interosseous foramen, location of anterior tibial artery, location of deep fibular nerve, and corresponding arterial branches were measured and converted into thumb widths. Results. Mean thumb width measured among the cadavers was 17.94±3.9 mm. The interosseous foramen measured was approximately 1 thumb width vertically (18.47±3.0 mm and 1/2 thumb width horizontally (7.32±2.1 mm and was located approximately 1 thumb width distally to the tibial tuberosity (20.81±6.8 mm and 2 thumb widths (37.47±4.7 mm lateral to the tibial ridge. The anterior tibial artery and deep fibular nerve converged approximately 4 thumb widths (74.31±14.8 mm inferior to the tibial tuberosity and 2 thumb widths (33.46±4.9 mm lateral to the tibial ridge. Conclusion. Clinicians may identify anatomical structures of the proximal leg with palpation using the thumb width for measurement.

  15. Percutaneous closure of patent foramen ovale in cryptogenic embolism.

    Science.gov (United States)

    Meier, Bernhard; Kalesan, Bindu; Mattle, Heinrich P; Khattab, Ahmed A; Hildick-Smith, David; Dudek, Dariusz; Andersen, Grethe; Ibrahim, Reda; Schuler, Gerhard; Walton, Antony S; Wahl, Andreas; Windecker, Stephan; Jüni, Peter

    2013-03-21

    The options for secondary prevention of cryptogenic embolism in patients with patent foramen ovale are administration of antithrombotic medications or percutaneous closure of the patent foramen ovale. We investigated whether closure is superior to medical therapy. We performed a multicenter, superiority trial in 29 centers in Europe, Canada, Brazil, and Australia in which the assessors of end points were unaware of the study-group assignments. Patients with a patent foramen ovale and ischemic stroke, transient ischemic attack (TIA), or a peripheral thromboembolic event were randomly assigned to undergo closure of the patent foramen ovale with the Amplatzer PFO Occluder or to receive medical therapy. The primary end point was a composite of death, nonfatal stroke, TIA, or peripheral embolism. Analysis was performed on data for the intention-to-treat population. The mean duration of follow-up was 4.1 years in the closure group and 4.0 years in the medical-therapy group. The primary end point occurred in 7 of the 204 patients (3.4%) in the closure group and in 11 of the 210 patients (5.2%) in the medical-therapy group (hazard ratio for closure vs. medical therapy, 0.63; 95% confidence interval [CI], 0.24 to 1.62; P=0.34). Nonfatal stroke occurred in 1 patient (0.5%) in the closure group and 5 patients (2.4%) in the medical-therapy group (hazard ratio, 0.20; 95% CI, 0.02 to 1.72; P=0.14), and TIA occurred in 5 patients (2.5%) and 7 patients (3.3%), respectively (hazard ratio, 0.71; 95% CI, 0.23 to 2.24; P=0.56). Closure of a patent foramen ovale for secondary prevention of cryptogenic embolism did not result in a significant reduction in the risk of recurrent embolic events or death as compared with medical therapy. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT00166257.).

  16. Accessory caudal axial and pelvic ribs

    International Nuclear Information System (INIS)

    Bohutova, J.; Kolar, J.; Vitovec, J.; Vyhnanek, L.

    1980-01-01

    Accessory caudal ribs are reported as an extremely curious anomaly in five patients. Once the fracture of this rib was a source of pains after injury. The different shapes of the ribs are documented in this clinical survey which is the most extensive in the present literature. Anomalous ribs arise due to inappropriate segmentation during the embryonal development of the axial skeleton. (orig.) [de

  17. Accessory tragi in three successive generations

    Directory of Open Access Journals (Sweden)

    Vora N

    1996-01-01

    Full Text Available A 40-year-old man presented with clinical and histopathological features of accessory tragi. His father and 3 sons and 1 daughter had similar lesions. In view of this vertical transmission through 3 successive generations involving both the sexes, an autosomal dominant mode of inheritance is suggested.

  18. 21 CFR 876.5820 - Hemodialysis system and accessories.

    Science.gov (United States)

    2010-04-01

    ... system and accessories. (a) Identification. A hemodialysis system and accessories is a device that is used as an artificial kidney system for the treatment of patients with renal failure or toxemic... system, and accessories. Blood from a patient flows through the tubing of the extracorporeal blood system...

  19. 21 CFR 868.5860 - Pressure tubing and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pressure tubing and accessories. 868.5860 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5860 Pressure tubing and accessories. (a) Identification. Pressure tubing and accessories are flexible or rigid devices intended to...

  20. 21 CFR 878.4700 - Surgical microscope and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgical microscope and accessories. 878.4700 Section 878.4700 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... microscope and accessories. (a) Identification. A surgical microscope and accessories is an AC-powered device...

  1. 21 CFR 872.3980 - Endosseous dental implant accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Endosseous dental implant accessories. 872.3980... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3980 Endosseous dental implant accessories. (a) Identification. Endosseous dental implant accessories are manually powered devices intended...

  2. 21 CFR 876.5900 - Ostomy pouch and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ostomy pouch and accessories. 876.5900 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5900 Ostomy pouch and accessories. (a) Identification. An ostomy pouch and accessories is a device that consists of a bag that is...

  3. 21 CFR 878.3925 - Plastic surgery kit and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Plastic surgery kit and accessories. 878.3925... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3925 Plastic surgery kit and accessories. (a) Identification. A plastic surgery kit and accessories is a device intended to...

  4. 19 CFR 10.537 - Accessories, spare parts, or tools.

    Science.gov (United States)

    2010-04-01

    ... parts, or tools will be taken into account as originating or non-originating materials, as the case may... 19 Customs Duties 1 2010-04-01 2010-04-01 false Accessories, spare parts, or tools. 10.537 Section... Free Trade Agreement Rules of Origin § 10.537 Accessories, spare parts, or tools. Accessories, spare...

  5. 21 CFR 872.4120 - Bone cutting instrument and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bone cutting instrument and accessories. 872.4120... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4120 Bone cutting instrument and accessories. (a) Identification. A bone cutting instrument and accessories is a metal device intended for use...

  6. Another look at the foramen magnum in bipedal mammals.

    Science.gov (United States)

    Russo, Gabrielle A; Kirk, E Christopher

    2017-04-01

    A more anteriorly positioned foramen magnum evolved in concert with bipedalism at least four times within Mammalia: once in macropodid marsupials, once in heteromyid rodents, once in dipodid rodents, and once in hominoid primates. Here, we expand upon previous research on the factors influencing mammalian foramen magnum position (FMP) and angle with four new analyses. First, we quantify FMP using a metric (basioccipital ratio) not previously examined in a broad comparative sample of mammals. Second, we evaluate the potential influence of relative brain size on both FMP and foramen magnum angle (FMA). Third, we assess FMP in an additional rodent clade (Anomaluroidea) containing bipedal springhares (Pedetes spp.) and gliding/quadrupedal anomalures (Anomalurus spp.). Fourth, we determine the relationship between measures of FMP and FMA in extant hominoids and an expanded mammalian sample. Our results indicate that bipedal/orthograde mammals have shorter basioccipitals than their quadrupedal/non-orthograde relatives. Brain size alone has no discernible effect on FMP or FMA. Brain size relative to palate size has a weak influence on FMP in some clades, but effects are not evident in all metrics of FMP and are inconsistent among clades. Among anomaluroids, bipedal Pedetes exhibits a more anterior FMP than gliding/quadrupedal Anomalurus. The relationship between FMA and FMP in hominoids depends on the metric chosen for quantifying FMP, and if modern humans are included in the sample. However, the relationship between FMA and FMP is nonexistent or weak across rodents, marsupials, and, to a lesser extent, strepsirrhine primates. These results provide further evidence that bipedal mammals tend to have more anteriorly positioned foramina magna than their quadrupedal close relatives. Our findings also suggest that the evolution of FMP and FMA in hominins may not be closely coupled. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Establishment of a porcine model of patent foramen ovale

    International Nuclear Information System (INIS)

    Jiang Weijian; Xiao Xiangsheng

    2007-01-01

    Objective: To investigate the feasibility of developing an animal model of patent foramen ovale (PFO) in piglets by percutaneous atrial septal puncture and balloon dilation. Methods: A standardized percutaneous atrial trans-septal puncture and balloon dilation was conducted in eleven healthy piglets under general anesthesia. A Rups-100 system inserted through a femoral vein was used for the trans-septal puncture, and subsequent balloon dilatation was performed at the puncture site to imitate a PFO. Euthanasia and autopsy were performed on day-1 in 1 piglet (early autopsy), and on day-21 in the remaining 10 piglets (late autopsy). Results: Artificial PFO was successfully created in all piglets and verified by fluoroscopy. No major technical difficulty or complication was encountered except in one which developed mild hemopericardium. In the piglet which had early autopsy, the artificial foramen was measured 0.8 cm x 0.7 cm in cross-section and aggregates of erythrocytes were revealed over its rim under light microscopy. In the late autopsy group (n=10), 7 piglets had the created foramens healed and sealed off; while the other 3 showed relatively small residual lumens measuring 0.1 cm x 0.2 cm, 0.2 cm x 0.2 cm and 0.1 cm x 0.3 cm in cross-section respectively. Histological examination of specimens from the late autopsy group showed variable neointima hyperplasia, loss of neointima, infiltration of lymphocytes, focal hydropic degeneration of cardiac muscle, and focal fibrosis of interstitium at the immediate vicinity of regardless of the course of healing. Conclusion: Artificial creation of PFO in piglets is feasible by percutaneous atrial septal puncture and balloon dilation. This protocol may serve as a research model for PFO-related stroke in human. (authors)

  8. Sex Prediction using Foramen Magnum and Occipital Condyles Computed Tomography Measurements in Sudanese Population

    Directory of Open Access Journals (Sweden)

    Usama Mohamed El-Barrany

    2016-12-01

    Full Text Available Sex determination is important in establishing the identity of an individual. The foramen magnum is an important landmark of the skull base. The present research aimed to study the value of foramen magnum measurements to determine sex using computed tomography (CT among Sudanese individuals. Foramen magnum CT scans of 400 Sudanese individuals (200 males and 200 females aged 18 - 83 years were included in this study. Foramen magnum (length and width, right occipital condyle (length and width, left occipital condyle (length and width, minimum intercondylar distance, maximum bicondylar distance and maximum medial intercondylar distance were measured. All data were subjected to discriminant functions analysis. All nine measurements were significantly higher in males than females. Among these measurements, the right condyle length, minimum intercondylar distance, and foramen magnum width were able to determine sex in Sudanese individuals with an accuracy rate of 83 %.

  9. Foramen Magnum Meningioma: a Case Report and Review of Literature.

    Science.gov (United States)

    Jurinovic, Pavao; Bulicic, Ana Repic; Marcic, Marino; Mise, Nikolina Ivica; Titlic, Marina; Suljic, Enra

    2016-02-01

    Meningiomas are slow-growing benign tumors that arise at any location where arachnoid cells reside. Although meningiomas account for a sizable proportion of all primary intracranial neoplasms (14.3-19%), only 1.8 to 3.2% arise at the foramen magnum. Their indolent development at the craniocervical junction makes clinical diagnosis complex and often leads to a long interval between onset of symptoms and diagnosis. We report a case of a 79-year-old male patient, presented with ataxia and sense of threatening fainting during verticalization. Magnetic resonance imaging revealed the presence of meningioma in the right side of craniospinal junction.

  10. Transcatheter Closure of Patent Foramen Ovale: Devices and Technique.

    Science.gov (United States)

    Price, Matthew J

    2017-10-01

    Transcatheter closure of a patent foramen ovale (PFO) reduces the risk of recurrent cryptogenic stroke compared with medical therapy. PFO closure is a prophylactic procedure, and will not provide the patient with symptomatic improvement, except in cases of hypoxemia due to right-to-left shunt or possibly migraine headaches. Therefore, appropriate patient selection is critical, and procedural safety is paramount. Herein, we review key characteristics of the devices currently available for transcatheter PFO closure within the United States, and highlight key technical aspects of the PFO closure procedure that will maximize procedural success. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. A thrombus in transit through a patent foramen ovale.

    Science.gov (United States)

    Ibebuogu, Uzoma N; Khouzam, Rami N; Sharma, Gyanendra; Thornton, John W; Robati, Roshanak; Silverman, David

    2014-10-01

    Patent foramen ovale (PFO) is a congenital heart defect that may first be diagnosed in adulthood and has a prevalence of 25% to 30%. Although many patients with PFO are asymptomatic and do not require treatment, paradoxical embolism can cause stroke or myocardial infarction. The authors report an unusual case of PFO with a transversing thrombus in an 80-year-old man. The patient's initial presentation appeared clinically as acute coronary syndrome, but he was subsequently diagnosed with a massive thrombus in transit via a PFO and pulmonary embolus leading to right-sided heart failure.

  12. Suitability of foramen magnum measurements in sex determination and their clinical significance.

    Science.gov (United States)

    Tellioglu, A Metin; Durum, Y; Gok, M; Karakas, S; Polat, A G; Karaman, C Z

    2018-01-01

    The foramen magnum provides a transition between fossa cranii posterior and canalis vertebralis. Medulla oblongata, arteria vertebralis and nervus accessorius spinal part pass through the foramen magnum. In this study, we aimed to make the morphometric measurements of the foramen magnum on computed tomography (CT) and to determine the feasibility of sex determination based on these measurements. Besides sex determination, from a clinical aspect, it is important to know the measurements of the foramen magnum in the normal population in terms of diseases characterised by displacement of the posterior fossa structures through foramen magnum to upper cervical spinal canal such as Chiari malformations and syringomyelia. All the data for our study was obtained retrospectively from 100 patients (50 males, 50 females) who had a CT scan of the head and neck region in Adnan Menderes University Hospital, Department of Radiology. To examine the foramen magnum in each and every occipital bone, we measured the foramen magnum's anteroposterior diameter, transverse diameter, the area of the foramen magnum and its circumference. We found that men have a higher average value than women in our study. According to Student's t-test results; in all measured parameters, there is significant difference between the genders (p discriminant function test is performed for all four measurements, the discrimination rate is 64% for all women, 70% for all men and 67% for both genders. As a result of our study, the metric data we obtained will be useful in cases where the skeletons' sex could not be determined by any other methods. We believe that, our study may be useful for other studies in determining of sex from foramen magnum. Our measurements could give some information of the normal ranges of the foramen magnum in normal population, so that this can contribute to the diagnosis process of some diseases by imaging. (Folia Morphol 2018; 77, 1: 99-104).

  13. Echocardiographic Follow-Up of Patent Foramen Ovale and the Factors Affecting Spontaneous Closure.

    Science.gov (United States)

    Yildirim, Ali; Aydin, Alperen; Demir, Tevfik; Aydin, Fatma; Ucar, Birsen; Kilic, Zubeyir

    2016-11-01

    The aim of the present study was to evaluate the echocardiographic follow-up of patent foramen ovale, which is considered a potential etiological factor in various diseases, and to determine the factors affecting spontaneous closure. Between January 2000 and June 2012, records of 918 patients with patent foramen ovale were retrospectively reviewed. Patency of less than 3 mm around the fossa ovalis is called patent foramen ovale. Patients with cyanotic congenital heart diseases, severe heart valve disorders and severe hemodynamic left to right shunts were excluded from the study. The patients were divided into three groups based on age; 1 day-1 month in group 1, 1 month-12 months in group 2, and more than 12 months in group 3. Of the 918 patients, 564 (61.4%) had spontaneous closure, 328 (35.8%) had patent foramen ovale continued, 15 (1.6%) patients had patent foramen ovale enlarged to 3-5 mm, 6 patients were enlarged to 5-8 mm, and in one patient patent foramen ovale reached to more than 8 mm size. Defect was spontaneously closed in 65.9% of the patients in group 1, 66.7% of the patients in group 2, and 52.3% of the patients in group 3. There was a negative correlation between the age of diagnosis and spontaneous closure (p patent ductus arteriosus and atrial septal aneurysm did not have any effect on spontaneous closure of patent foramen ovale (p > 0.05). However, ventricular septal defect and spontaneous closure of patent foramen ovale had a positive correlation (p closure rate of patent foramen ovale is high. Furthermore, a positive correlation was found between spontaneous closure of patent foramen ovale with early diagnosis and small defect size.

  14. Instruments and accessories for neutron scattering research

    International Nuclear Information System (INIS)

    Ishii, Yoshinobu; Morii, Yukio

    2000-04-01

    This report describes neutron scattering instruments and accessories installed by four neutron scattering research groups at the ASRC (Advanced Science Research Center) of the JAERI and the recent topics of neutron scattering research using these instruments. The specifications of nine instruments (HRPD, BIX-I, TAS-1 and PNO in the reactor hall, RESA, BIX-II, TAS-2, LTAS and SANS-J in the guide hall of the JRR-3M) are summarized in this booklet. (author)

  15. Accessory mineral records of tectonic environments? (Invited)

    Science.gov (United States)

    Storey, C.; Marschall, H. R.; Enea, F.; Taylor, J.; Jennings, E. S.

    2010-12-01

    Accessory mineral research continues to gather momentum as we seek to unleash their full potential. It is now widely recognised that robust accessory minerals, such as zircon, rutile, titanite, allanite and monazite, are archives of important trace elements that can help deduce metamorphic reaction history in metapelites, metabasites and other rock types. Moreover, they are important carriers of certain trace elements and govern or influence the products of partial melting and of fluid-rock interaction (e.g. magmas and mineralisation) in settings like subduction zones and hydrothermal systems. Perhaps most importantly, they can often be dated using the U-Th-Pb system. More recently, radiogenic (Lu-Hf, Sm-Nd, Rb-Sr) and stable (O) isotope systems have been applied and have further pushed the utility of accessory mineral research. In this talk I will discuss some of these advances towards one particular aim: the use of detrital accessory minerals for fingerprinting tectonic environments. This is a particularly laudable aim in Precambrian rocks, for which the preservation potential of orogenic belts and fossil subduction zones and their diagnostic metamorphic rocks is low. The implication is that our understanding of plate tectonics, particularly in the Archaean, is biased by the preserved in-tact rock record. An analogy is that Jack Hills zircons record evidence of Earth’s crust some 400 Ma before the preserved rock record begins. I will focus on some recent advances and new data from rutile and also the mineral inclusion record within zircon, which shows great promise for petrologic interpretation.

  16. MRI findings of spinal accessory neuropathy

    International Nuclear Information System (INIS)

    Li, A.E.; Greditzer, H.G.; Melisaratos, D.P.; Wolfe, S.W.; Feinberg, J.H.; Sneag, D.B.

    2016-01-01

    Aim: To characterise the magnetic resonance imaging (MRI) appearance of patients with spinal accessory nerve (SAN) denervation. Material and methods: Twelve patients who had SAN denervation on electromyography (EMG) were included. The sternocleidomastoid and trapezius muscles and the SAN were assessed using MRI. Results: Trapezius muscle atrophy was seen in 11 (92%), and of those patients, T2/short tau inversion recovery (STIR) signal hyperintensity was also demonstrated in seven (58%). All three patients with prior neck surgery had scarring around the SAN, and one of these patients demonstrated a neuroma, which was confirmed surgically. Conclusion: Features of SAN neuropathy on MRI include atrophy and T2/STIR signal hyperintensity of the trapezius, and in patients who have had posterior triangle neck surgery, scarring may be seen around the nerve. - Highlights: • Spinal accessory nerve injury is most commonly the result of neck surgery. • MRI findings include trapezius muscle atrophy and T2 signal hyperintensity. • In cases of suspected injury, the course of the spinal accessory nerve should be assessed on MRI.

  17. Enlarged thalamostriate vein causing unilateral Monro foramen obstruction. Case report.

    Science.gov (United States)

    Leonardo, Jody; Grand, Walter

    2009-06-01

    Causes of unilateral hydrocephalus resulting from an obstruction at the Monro foramen include foraminal atresia, tumors, gliosis, contralateral shunting, and infectious and inflammatory conditions. However, few reports in the literature cite vascular lesions as the cause of the obstruction. To their knowledge, the authors present the first report of unilateral hydrocephalus occurring due to an abnormally enlarged thalamostriate vein independent of an arteriovenous malformation or developmental venous angioma. The condition was treated successfully by endoscopic septum pellucidum fenestration. A 28-year-old man was referred for evaluation due to a 10-year history of chronic headaches that worsened in severity over the past year. A CT scan of the head revealed unilateral right ventricular dilation. Cranial MR imaging with and without contrast administration showed a dilated right thalamostriate-internal vein complex without any evidence of associated arteriovenous malformation or venous angioma. Endoscopic exploration of the right lateral ventricle showed an enlarged subependymal thalamostriate vein obstructing the Monro foramen. An endoscopic fenestration of the septum pellucidum was performed, resulting in alleviation of the patient's symptoms. Abnormally enlarged venous structures may cause obstructive unilateral hydrocephalus and can be a rare cause of chronic, intermittent headaches in adults. Endoscopic fenestration of the septum pellucidum is an effective treatment.

  18. Isolated spinal accessory neuropathy and intracisternal schwannomas of the spinal accessory nerve

    Directory of Open Access Journals (Sweden)

    Abdullah M. Al-Ajmi

    2015-03-01

    Full Text Available We report a 40-year-old female patient presenting with isolated left spinal accessory neuropathy that developed insidiously over 6 years. She complained of ill-defined deep neck and shoulder pain. On examination, prominent sternocleidomastoid and trapezoid muscle weakness and atrophy, shoulder instability, and lateral scapular winging were observed. MRI identified a small mass of the cisternal portion of the spinal accessory nerve. Its appearance was typical of schwannoma. Surgical treatment was not offered because of the small tumor size, lack of mass effect and the questionable functional recovery in the presence of muscular atrophy.

  19. USE OF CT FOR ANALYSIS OF THE VERTEBRAL FORAMEN IN THE HOSPITAL OF QUERÉTARO

    Directory of Open Access Journals (Sweden)

    JESÚS CISNEROS LÁMBARRI

    Full Text Available ABSTRACT Objective: To determine the morphology of the vertebral foramen and its distance to the midline. Methods: Twenty cervical CT scans from the radiographic record of 12 men and 8 women, 18 to 74 years old, of C1 to C6 segments were evaluated, measuring the foramen diameter and its distance to the midline. We look for anomalies of vertebral foramen morphology, using Philips Ingenuity CT equipment with Philips IntelliSpace Portal software. Results: The mean age was 47 years; the segment with the most anomalies was C1, with 10% (increase in foramen diameter, followed by C2 and C6, with 5% (vertebral foramen hypotrophy; the mean diameter of the C1 to C6 segment was 6.081 mm, and the median distance from the midline to the vertebral foramen of C2 to C6 was 13.215 mm. The largest diameter of the vertebral foramen was C2, with a mean of 6.67 mm and the smallest was C4, with a mean of 5.75 mm; the greatest distance from the midline to the vertebral foramen was C1, with a mean of 22.59 mm and the shortest was C4, with a mean of 12.13 mm. Conclusions: The mean diameter of the vertebral foramen and its distance to the midline was determined, setting a safety region for procedures. In our city, there is no study that determines the means of the vertebral foramina diameters, the distance from the midline and its anomalies. It is necessary to rely on CT scans and to make a preoperative plan to avoid complications associated with morphological alterations.

  20. MR imaging of accessory muscles of the ankle

    International Nuclear Information System (INIS)

    Mondello, Eduardo; Nazar, Miguel E.; Martin, Eduardo

    2001-01-01

    Purpose: The purpose of this work is to describe the normal anatomy and the characteristics in MRI of the accessory muscles of the posterior ankle: the accessory soleus, accessory flexor digitorum longus, peroneus quartus, tibiocalcaneus internus and peroneocalcaneus internus. Material and methods: There were evaluated 280 symptomatic patients between 18 and 40 years old (85 % males). MR was performed in High Field Magnetic Resonance Units (1.5 T y 1.0 T) and multiplanar sequences. Results: We found 2 peroneus quartus (0.7%), 2 accessory soleus muscles (0.7%), 3 accessory flexor digitorum longus (1.07%) and 1 peroneocalcaneus internus (0.35%). Conclusion: The knowledge of the accessory muscles of the posterior ankle allow to explain different painful pathologies with instability or tendinous tears, which are difficult to diagnose if the muscle are not adequately recognized. (author)

  1. Value of transoperative scintigraphy in the detection of accessory spleens

    International Nuclear Information System (INIS)

    Sezeur, A.; Goujard, F.; Labriolle-Vaylet, C.L. de; Wioland, M.; Douay, L.; Desmarquet, J.

    1990-01-01

    A case of accessory spleen, 1 cm in diameter, responsible for recurrence of an idiopathic thrombocytopenic purpura after splenectomy is reported. This case is original in that the accessory spleen could only be detected by transoperative scintigraphy. Transoperative scintigraphy is a simple method to be used when one or several unrecognized accessory spleens are responsible for recurrence of a blood disease after excision of the principal spleen [fr

  2. Spinal Accessory Nerve Duplication: A Case Report and Literature Review

    OpenAIRE

    Papagianni, Eleni; Kosmidou, Panagiota; Fergadaki, Sotiria; Pallantzas, Athanasios; Skandalakis, Panagiotis; Filippou, Dimitrios

    2018-01-01

    Aim of the present study is to expand our knowledge of the anatomy of the 11th cranial nerve and discuss the clinical importance and literature pertaining to accessory nerve duplication. We present one case of duplicated spinal accessory nerve in a patient undergoing neck dissection for oral cavity cancer. The literature review confirms the extremely rare diagnosis of a duplicated accessory nerve. Its clinical implication is of great importance. From this finding, a further extension to our k...

  3. The accessory magnocellular neurosecretory system of the rostral human hypothalamus

    DEFF Research Database (Denmark)

    Møller, Morten; Busch, Johannes R.; Jacobsen, Christina

    2018-01-01

    magnocellular neurons were often located along the blood vessels and projections of some of these neurons penetrated the vascular endothelium. The accessory magnocellular cell bodies expressed either neurophysin I or neurophysin II immunoreactivity. Summarizing, the accessory magnocellular system in the human......The morphology and neurophysin expression of the magnocellular accessory neuroendocrine system located in the rostral human hypothalamus is investigated in a series of brains obtained at autopsy. The hypothalami were fixed in formalin and embedded in paraffin, or after cryoprotection, frozen...

  4. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke

    DEFF Research Database (Denmark)

    Søndergaard, Lars; Kasner, Scott E; Rhodes, John F

    2017-01-01

    BACKGROUND: The efficacy of closure of a patent foramen ovale (PFO) in the prevention of recurrent stroke after cryptogenic stroke is uncertain. We investigated the effect of PFO closure combined with antiplatelet therapy versus antiplatelet therapy alone on the risks of recurrent stroke and new...... brain infarctions. METHODS: In this multinational trial involving patients with a PFO who had had a cryptogenic stroke, we randomly assigned patients, in a 2:1 ratio, to undergo PFO closure plus antiplatelet therapy (PFO closure group) or to receive antiplatelet therapy alone (antiplatelet-only group......). Imaging of the brain was performed at the baseline screening and at 24 months. The coprimary end points were freedom from clinical evidence of ischemic stroke (reported here as the percentage of patients who had a recurrence of stroke) through at least 24 months after randomization and the 24-month...

  5. Jugular foramen meningiomas. Review of the major surgical series

    International Nuclear Information System (INIS)

    Bakar, B.

    2010-01-01

    Primary jugular foramen meningiomas are uncommon, with 96 previous cases published between 1992 and 2007. Exact location and extent of tumor were determined on the basis of radiologic and operative findings and used to develop a staging system. The mean age of patients was 39.4 years. The lesion was located on the right in 14 patients and on the left in 11 patients. The series identified 23 males and 58 females. The most common presenting clinical symptoms were hearing loss and tinnitus. Most clinical findings were middle ear mass and neck mass. Most meningiomas were World Health Organization grade I. The most common postoperative complications were lower cranial nerve paresis and facial nerve paresis. Surgical planning should consider that meningiomas usually invade the dura mater, cranial nerves, and surrounding bone. The surgeon should carefully collect detailed data about the tumor, and consult an otolaryngologist preoperatively for lower cranial nerve functions and hearing levels.(author)

  6. Jugular foramen meningiomas. Review of the major surgical series

    Energy Technology Data Exchange (ETDEWEB)

    Bakar, B [Faculty of Medicine, Kirikkale Univ., Kirikkale (Turkey)

    2010-02-15

    Primary jugular foramen meningiomas are uncommon, with 96 previous cases published between 1992 and 2007. Exact location and extent of tumor were determined on the basis of radiologic and operative findings and used to develop a staging system. The mean age of patients was 39.4 years. The lesion was located on the right in 14 patients and on the left in 11 patients. The series identified 23 males and 58 females. The most common presenting clinical symptoms were hearing loss and tinnitus. Most clinical findings were middle ear mass and neck mass. Most meningiomas were World Health Organization grade I. The most common postoperative complications were lower cranial nerve paresis and facial nerve paresis. Surgical planning should consider that meningiomas usually invade the dura mater, cranial nerves, and surrounding bone. The surgeon should carefully collect detailed data about the tumor, and consult an otolaryngologist preoperatively for lower cranial nerve functions and hearing levels.(author)

  7. Sex differences in cryptogenic stroke with patent foramen ovale.

    Science.gov (United States)

    Nedeltchev, Krassen; Wiedmer, Sebastian; Schwerzmann, Markus; Windecker, Stephan; Haefeli, Tobias; Meier, Bernhard; Mattle, Heinrich P; Arnold, Marcel

    2008-09-01

    Sex differences in patients with patent foramen ovale (PFO) and cryptogenic stroke have not been systematically analyzed. We aimed to determine sex influences on demographics, vascular risk factors, clinical manifestations, stroke location, and clinical outcome. One thousand two hundred eighty-eight consecutive patients with ischemic stroke or transient ischemic attack (TIA) were admitted to a single stroke center. All patients underwent a complete stroke workup including clinical examination, standard blood tests, cerebral and vascular imaging, transesophageal echocardiography, and 24-hour electrocardiography. In 500 patients, no definite etiology could be established (cryptogenic stroke/TIA). Of them, 167 patients (107 men and 60 women, mean age 52 +/- 13 years) had an PFO. The prevalence of PFO in patients with cryptogenic stroke or TIA was higher in men than in women (38% vs 28%, P = .014). Stroke severity and the prevalence of risk factors did not differ between the 2 sexes. There was an independent association between male sex and stroke location in the posterior cerebral circulation (OR 3.0, 95% CI 1.4-6.5, P = .006). Men and women did not differ in respect to PFO grade, prevalence of right-to-left shunt at rest, or coexistence of atrial septal aneurysm. Clinical outcome at 3 months was similar in both sexes. Patent foramen ovale was more prevalent in men than in women with cryptogenic stroke. There were no sex influences on age, risk factors, echocardiographic characteristics of PFO, or clinical outcome. Male sex was independently associated with stroke in the posterior cerebral circulation.

  8. Study of DSA-guided percutaneous puncture location of foramen oval

    International Nuclear Information System (INIS)

    Zhao Xiaojun; He Jiawei; Bai Guanghui; Shi Jianjing; Xu Chongyong; Zhan Gonghao

    2008-01-01

    Objective: To study the technique of digital substraction angiography (DSA)-guided percutaneous puncture location of foramen oval. Methods: 39 cases of trigeminal neuralgia were included in the study from Feb. 2004 to Oct. 2006. The patients were punctured by the amending anterior position. The f0ramen oval was displayed by moving the tube tilted 20-28 degree to the caudal and 16-23 degree to the healthy side. The direction and depth of the needles was determined on the lateral view. Then, radio-frequency thermocoagulation therapy was performed. Results: The needles were located in oval foramen in all the patients. Pain disappeared in 36 cases, alleviated in other cases, and no serious complication occurred during therapy. Conclusions: Oval foramen locations by DSA can improve the successful rate of operation. The foramen oval can be clearly displayed by DSA-guided in amending position, with comfortable position for patients. (authors)

  9. Neuroendoscopic treatment of idiopathic occlusion of unilateral foramen of Monro presenting as chronic headache

    Directory of Open Access Journals (Sweden)

    Dhaval Shukla

    2016-01-01

    Full Text Available Asymmetric ventriculomegly due to idiopathic occlusion of the foramen of Monro is rare. Such patients present with clinical features of raised intracranial pressure (ICP. Presentation as chronic headache has not been previously described. In the absence of raised ICP, pursuing surgical treatment raises a clinical dilemma as the headache may be a primary headache with no improvement after surgery. A 21-year-old woman presented with chronic headache. She was found to have asymmetric ventriculomegaly due to the occlusion of the foramen of Monro. She underwent endoscopic septostomy and widening of the foramen of Monro. Her headache subsided after surgery. At 15 months of follow-up, she was free from headache without medications. Unilateral occlusion of the foramen of Monro can present with asymmetric ventriculomegaly resulting in chronic headache. Though the symptoms of raised ICP may not be present, still endoscopic relief of ventriculomegaly leads to cure of headache.

  10. ACCESSORIES OF FISCAL OBLIGATION. LEGAL REGIME

    Directory of Open Access Journals (Sweden)

    RADA POSTOLACHE

    2012-05-01

    Full Text Available The interest – which is an institution typical to private law, has been taken over by the fiscal field and adapted to the specific features of fiscal obligation – being defined by its imperative legal regime, which has at the least the following characteristic elements: unitary character, imposed legal percentage, compulsory demand of interest, automatic application. In order to render responsible fiscal debtors, the lawmaker has reintroduced, as an accessory of fiscal obligation, delayed payment penalties, which have a distinct nature and legal regime, but without the principle non bis in idem being transgressed. Our study aims to establish the legal regime ofaccessories typical to fiscal obligation, from the perspective of special normative acts, but also of the common law within the field – Civil Code and Government Ordinance No. 13/2011 – by pointing out at the same time both the particular circumstances and procedural ones regulated by the Fiscal Procedure Code, shedding light upon the controversial legal nature of accessories.

  11. Landmarks for Identifying the Suprascapular Foramen Anteriorly: Application to Anterior Neurotization and Decompressive Procedures.

    Science.gov (United States)

    Manouvakhova, Olga V; Macchi, Veronica; Fries, Fabian N; Loukas, Marios; De Caro, Raffaele; Oskouian, Rod J; Spinner, Robert J; Tubbs, R Shane

    2018-02-01

    Additional landmarks for identifying the suprascapular nerve at its entrance into the suprascapular foramen from an anterior approach would be useful to the surgeon. To identify landmarks for the identification of this hidden site within an anterior approach. In 8 adult cadavers (16 sides), lines were used to connect the superior angle of the scapula, the acromion, and the coracoid process tip thus creating an anatomic triangle. The suprascapular nerve's entrance into the suprascapular foramen was documented regarding its position within this anatomical triangle. Depths from the skin surface and specifically from the medial-most point of the clavicular attachment of the trapezius to the suprascapular nerve's entrance into the suprascapular foramen were measured using calipers and a ruler. The clavicle was then fractured and retracted superiorly to verify the position of the nerve's entrance into the suprascapular foramen. From the trapezius, the nerve's entrance into the foramen was 3 to 4.2 cm deep (mean, 3.5 cm). The mean distance from the tip of the corocoid process to the suprascapular foramen was 3.8 cm. The angle best used to approach the suprascapular foramen from the surface was 15° to 20°. Based on our study, an anterior suprascapular approach to the suprascapular nerve as it enters the suprascapular foramen can identify the most medial fibers of the trapezius attachment onto the clavicle and insert a finger at an angle of 15° to 20° laterally and advanced to an average depth of 3.5 cm. Copyright © 2017 by the Congress of Neurological Surgeons

  12. Incidencia del foramen retromolar en mandibulas humanas: aspectos étnicos y clínicos

    OpenAIRE

    Rossi, Ana Claudia; Freire, Alexandre Rodrigues; Prado, Guilherme Bevilacqua; Prado, Felippe Bevilacqua; Botacin, Paulo Roberto [UNESP; Ferreira Caria, Paulo Henrique

    2012-01-01

    The retromolar foramen allows the passage of the neurovascular bundles that contribute to nutrition and innervation of the pulp and periodontium of the lower teeth. Knowledge of this anatomical variation may prevent complications in the anesthesia and surgical procedures in this area and serve as an anatomical landmark for ethnic identification. The aim of this study was to evaluate the impact of the retromolar foramen in human mandibles of adult Brazilians and discuss the clinical and ethnic...

  13. SURGICAL OUTCOME OF CERVICAL AND FORAMEN MAGNUM INTRA DURAL AND INTRA MEDULLARY TUMOURS

    OpenAIRE

    Kumar Babu; Deekshanti Narayan; Biju; Manas; Vijaya Saradhi; Pathapati Rama; Madhavalu

    2014-01-01

    : INTRODUCTION: Spinal tumors account for only approximately 5-15% of the nervous system neoplasms. Technical advances in imaging and surgical procedures have brought about significant better clinical results in the last 2 decades. We also evaluated surgical and functional outcomes in patients having cervical intradural tumors including tumors at foramen magnum. METHODS: All patients who underwent surgical treatment for cervical intradural tumors from foramen magnum to C7,...

  14. SAGITTAL DIAMETER OF FORAMEN MAGNUM IN NORMAL POPULATION: AN MRI STUDY

    OpenAIRE

    Lakshmi

    2015-01-01

    Lower position of cerebellar tonsils was frequently noticed in Western studies. In some of the studies, sagittal diameter of foramen magnum was found to be larger in cases of Chiari malformation. However, there are no Indian studies for comparison. Our study was proposed to determine the standard values for sagittal diameter of foramen magnum in various age groups and both sexes. This gives a guideline for further studies in pathological conditions like Craniovertebral Junctional ...

  15. CORRELATION BETWEEN ENDOCRANIAL CAPACITY AND SIZE OF FORAMEN MAGNUM WITH SPECIAL REFERENCE TO SEX

    OpenAIRE

    Muralidhar P Shepur; Magi M; Nanjundappa B; Pavan P Havaldar; Premalatha Gogi; Shaik Hussain Saheb

    2014-01-01

    Background: Endocranial capacity is an important parameter in the study of human evolution, race and sex determination of skull. Diameters of foramen magnum are important because vital structures passing through it may endues compression and for sex determination of skulls. Correlation between endocranial capacity and area of foramen magnum was reported in mammals. This relation in human can be used to determine sex of damaged skulls. Methods: 150 dry skulls and 30 CT scan imag...

  16. Morphology of the Physiological Apical Foramen in Maxillary and Mandibular First Molars

    OpenAIRE

    Abarca, J.; Zaror, C.; Monardes, H.; Hermosilla, V.; Muñoz, C.; Cantin, M.

    2014-01-01

    Information regarding the anatomy of the physiological apical foramen is limited. Knowing its diameter and shapes contributes to clinical work, specifically to the cleaning and shaping of the apical third. The aim of this ex vivo study was to determine the minimum and maximum diameters and shape of the physiological apical foramen in the roots of maxillary and mandibular first molars. A descriptive study was conducted on 89 recently extracted first molars. Roots 3–5 mm from the apex were sect...

  17. Endoscope-assisted resection of cavernous angioma at the foramen of Monro: a case report

    OpenAIRE

    Matsumoto, Yuji; Kurozumi, Kazuhiko; Shimazu, Yousuke; Ichikawa, Tomotsugu; Date, Isao

    2016-01-01

    Introduction Intraventricular cavernous angiomas are rare pathological entities, and those located at the foramen of Monro are even rarer. We herein present a case of cavernous angioma at the foramen of Monro that was successfully treated by neuroendoscope-assisted surgical removal, and review the relevant literature. Case presentation A 65-year-old woman had experienced headache and vomiting for 10?days before admission to another hospital. Magnetic resonance imaging (MRI) showed a mass at t...

  18. Normal and pathological growth of the foramen occipitale magnum shown in the plain radiograph

    Energy Technology Data Exchange (ETDEWEB)

    Bliesener, J.A.; Schmidt, L.R.

    1980-01-01

    The transverse diameter of the foramen occipitale magnum (f.o.m.) in the semiaxial skull X-ray was measured and evaluated statistically in 174 cerebrally healthy children of different ages. These normal values are contrasted with the foramen diameters of 35 children with verified Arnold-Chiari malformation as well as children with macrocephaly and microcephaly. The values in children with Arnold-Chiari malformation are all above the norm, irrespective of whether or not there is a concomitant hydrocephalus.

  19. MR imaging of spondylolytic spondylolisthesis: changes of intervertebral foramen and nerve root compression

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hyung [Ajou Univ. College of Medicine, Seoul (Korea, Republic of); Chung, Tae Sub; Kim, Young Soo [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-08-01

    To evaluate the factors affecting intervertebral foramen stenosis and nerve root compression in spondylolytic spondylolisthesis. We investigated 120 intervertebral foramina of 60 patients with spondylolytic spondylolisthesis who had undergone lumbar MRI. A retrospective review of their MR images revealed the degree of intervertebral foramen stenosis and causes of nerve root compression. The relationship between disk height diminution following spondylolysis and degree of intervertebral foramen stenosis was also evaluated. Forty eight of 60 patients showed a similar degree of intervertebral foramen stenosis, and in 12 patients the degree of stenosis was different. In 110 intervertebral foramina, stenosis of both the superior and inferior compartments of intervertebral foramina was demonstrated. In 37 of 120 cases (30.8%), stenosis was mild ; in 44 of 120 (36.7%) it was modcrate, and in 29 of 120 (24.2%) it was severe. Stenosis of the inferior compartment was demonstrated in ten of 120 intervertebral foramina (8.3%). Nerve root compression was caused by posterior bulging of the intervertebral disk (65/120), descent of the pedicle (51/120), an isthmic bony segment above the site of spondylolytic (44/120), a bony spur formed at a spondylolytic site (11/120), and fibrocartilaginous callus at a spondylolytic site (5/48). In all cases there was degenerative change of the intervertebral disk at the affected level. There was no relationship between degree of disk height diminution and degree of intervertebral foramen stenosis (p > 0.05). The degree of intervertebral foramen stenosis and causes of nerve root compression in spondylolytic spondylolisthesis are variable, and MRI demonstrates them precisely. There was no positive relationship between degree of nerve root compression at an intervertebral foramen and degree of spondylolysis and degeneration of an intervertebral foramen. The degree of nerve root compression is believed to be another criterion for describing

  20. Paradoxical embolization via a patent foramen ovale following acute pulmonary embolism

    International Nuclear Information System (INIS)

    Thomas, D.V.; Bynevelt, V.; Price, R.

    2005-01-01

    The foramen ovale is usually obliterated following establishment of the adult circulation but remains patent in 25% of individuals. This potential communication between the venous and arterial circulations can allow thromboembolic material to bypass the lungs and enter the systemic circulation. We report two cases of paradoxical embolization through a patent foramen ovale following acute large pulmonary embolism (PE) and discuss the factors that predispose to paradoxical embolization following PE Copyright (2005) Blackwell Publishing Asia Pty Ltd

  1. MR imaging of spondylolytic spondylolisthesis: changes of intervertebral foramen and nerve root compression

    International Nuclear Information System (INIS)

    Kim, Ji Hyung; Chung, Tae Sub; Kim, Young Soo

    1999-01-01

    To evaluate the factors affecting intervertebral foramen stenosis and nerve root compression in spondylolytic spondylolisthesis. We investigated 120 intervertebral foramina of 60 patients with spondylolytic spondylolisthesis who had undergone lumbar MRI. A retrospective review of their MR images revealed the degree of intervertebral foramen stenosis and causes of nerve root compression. The relationship between disk height diminution following spondylolysis and degree of intervertebral foramen stenosis was also evaluated. Forty eight of 60 patients showed a similar degree of intervertebral foramen stenosis, and in 12 patients the degree of stenosis was different. In 110 intervertebral foramina, stenosis of both the superior and inferior compartments of intervertebral foramina was demonstrated. In 37 of 120 cases (30.8%), stenosis was mild ; in 44 of 120 (36.7%) it was modcrate, and in 29 of 120 (24.2%) it was severe. Stenosis of the inferior compartment was demonstrated in ten of 120 intervertebral foramina (8.3%). Nerve root compression was caused by posterior bulging of the intervertebral disk (65/120), descent of the pedicle (51/120), an isthmic bony segment above the site of spondylolytic (44/120), a bony spur formed at a spondylolytic site (11/120), and fibrocartilaginous callus at a spondylolytic site (5/48). In all cases there was degenerative change of the intervertebral disk at the affected level. There was no relationship between degree of disk height diminution and degree of intervertebral foramen stenosis (p > 0.05). The degree of intervertebral foramen stenosis and causes of nerve root compression in spondylolytic spondylolisthesis are variable, and MRI demonstrates them precisely. There was no positive relationship between degree of nerve root compression at an intervertebral foramen and degree of spondylolysis and degeneration of an intervertebral foramen. The degree of nerve root compression is believed to be another criterion for describing

  2. A morphological and morphometric study of jugular foramen in dry skulls with its clinical implications

    Directory of Open Access Journals (Sweden)

    Chandni Gupta

    2014-01-01

    Full Text Available Objective: Jugular foramen of human skull is one of the most interesting foramina. It is a complex bony canal, numerous vital structures, including nerves and vessels are transmitted through it. Most of the intracranial and extra cranial lesions of posterior cranial fossa might affect the structures in jugular foramen in addition to intrinsic abnormalities. As the neurosurgeons have become courageous in approaching this area, so there is a need to become familiar with this area. Hence, the present study was done to examine the anatomy of jugular foramen, including its morphological features and dimensions. Materials and Methods: The study was carried out on 50 dried skulls. 100 jugular foramina were studied on both right and left side of skulls. The length, width of jugular foramen and width and depth of jugular fossa were measured using vernier calipers. Presence of dome, complete and incomplete septation was also looked for. Results: The mean right and left anteroposterior diameter, latero-medial diameter, area, jugular fossa width, depth in our study was 11.22, 16.52, 187.34, 6.83, 11.58 mm and 9.52, 16.02, 153.2, 5.69, 11.13 mm. Dome was present in jugular foramen in 74% on the right side and 58% on the left side. Complete septation in jugular foramen is seen in 44% on the right side and 42% on the left side. Conclusion: This study will help the neurosurgeons while doing surgery in this region.

  3. Comparative morphology of premolar foramen in lagomorphs (Mammalia: Glires and its functional and phylogenetic implications.

    Directory of Open Access Journals (Sweden)

    Łucja Fostowicz-Frelik

    Full Text Available Lagomorphs (a group that consists of pikas, hares, rabbits and allies are notable for their conservative morphology retained for most of their over 50 million years evolutionary history. On the other hand, their remarkable morphological uniformity partly stems from a considerable number of homoplasies in cranial and dental structures that hamper phylogenetic analyses. The premolar foramen, an opening in the palate of lagomorphs, has been characterized as an important synapomorphy of one clade, Ochotonidae (pikas. Within Lagomorpha, however, its phylogenetic distribution is much wider, the foramen being present not only in all ochotonids but also in leporids and stem taxa; its morphology and incidence also varies considerably across the order, even intraspecifically. In this study, we provide a broad survey of the taxonomic distribution of the premolar foramen in extant and fossil Lagomorpha and describe in detail the morphological variation of this character within the group. Micro-computed tomography was used to examine the hard palate and infraorbital groove morphology in Poelagus (Leporidae and Ochotona. Scans revealed the course and contacts of the canal behind the premolar foramen and structural differences between the two crown clades. We propose that the premolar foramen has evolved independently in several lineages of Lagomorpha, and we discuss development and function of this foramen in the lagomorph skull. This study shows the importance of comprehensive studies on phylogenetically informative non-dental characters in Lagomorpha.

  4. 21 CFR 870.4200 - Cardiopulmonary bypass accessory equipment.

    Science.gov (United States)

    2010-04-01

    ... Cardiopulmonary bypass accessory equipment. (a) Identification. Cardiopulmonary bypass accessory equipment is a... mounting bracket or system-priming equipment. (b) Classification. (1) Class I. The device is classified as class I if it does not involve an electrical connection to the patient. The device is exempt from the...

  5. 26 CFR 48.4161(a)-3 - Parts and accessories.

    Science.gov (United States)

    2010-04-01

    ....4161(a)-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) MISCELLANEOUS EXCISE TAXES MANUFACTURERS AND RETAILERS EXCISE TAXES Sporting Goods § 48.4161(a)-3 Parts and accessories. (a) In general. The tax attaches with respect to parts and accessories for articles specified in...

  6. Evolution of the CT imaging findings of accessory spleen infarction

    International Nuclear Information System (INIS)

    Mendi, Resham; Abramson, Lisa P.; Pillai, Srikumar B.; Rigsby, Cynthia K.

    2006-01-01

    We report the case of a 12-year-old girl presenting with multiple episodes of left upper-quadrant pain caused by torsion of an accessory spleen. We present the CT findings of progression of accessory spleen infarction over the course of 7 days. (orig.)

  7. 21 CFR 884.4100 - Endoscopic electrocautery and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Endoscopic electrocautery and accessories. 884... Surgical Devices § 884.4100 Endoscopic electrocautery and accessories. (a) Identification. An endoscopic electrocautery is a device used to perform female sterilization under endoscopic observation. It is designed to...

  8. 21 CFR 884.4120 - Gynecologic electrocautery and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gynecologic electrocautery and accessories. 884... Surgical Devices § 884.4120 Gynecologic electrocautery and accessories. (a) Identification. A gynecologic electrocautery is a device designed to destroy tissue with high temperatures by tissue contact with an...

  9. 19 CFR 10.600 - Accessories, spare parts, or tools.

    Science.gov (United States)

    2010-04-01

    ...-Central America-United States Free Trade Agreement Rules of Origin § 10.600 Accessories, spare parts, or... parts, or tools are customary for the good. (a) Regional value content. If the good is subject to a regional value content requirement, the value of the accessories, spare parts, or tools is taken into...

  10. Incidence and characteristics of mandibular accessory canals: A radiographic investigation.

    Science.gov (United States)

    Borgonovo, Andrea Enrico; Taschieri, Silvio; Vavassori, Virna; Re, Dino; Francetti, Luca; Corbella, Stefano

    2017-11-01

    The aim of the present study was to explore, through tridimensional reconstructions of cone-beam computed tomography (CBCT) scans, the presence and the characteristics of mandibular accessory canals. For each included participant, the presence of accessory canals was recorded. The diameter of the canal, as well as the distance between the canal walls and the walls of the mandibular bone (lingual, buccal, cranial and caudal), were measured and recorded. Mandibular accessory canals could be found in 8.8% of participants. Retromolar canals were the most frequently found accessory mandibular canals. Accessory mandibular canals were found in a relatively high number of participants through the examination of CBCT scans and tridimensional reconstruction. The presence of such structures should be considered cautiously when planning and performing surgical interventions in mandibular area. © 2017 John Wiley & Sons Australia, Ltd.

  11. Case report 376: Accessory (anomalous) soleus muscle

    International Nuclear Information System (INIS)

    Apple, J.S.; Khoury, M.B.; Martinez, S.; Nunley, J.A.

    1986-01-01

    In summary, a case has been presented of a 24-year-old woman who developed pain in the left lower extremity while jogging. Physical examination showed a soft, palpable mass medial and anterior to the Achilles tendon in the left lower extremity. Although a lipoma was suspected, plain films and CT studies indicated clearly that the mass was not of fatty density. In fact, the density of the mass was equivalent to adjacent muscles. The mass itself was lying in the soft tissues of the left ankle tissue. An open biopsy showed a normal muscle which represented an accessory soleus muscle - a muscle known to be anomalous on accoasion and reported as being symptomatic or asymptomatic in different individuals. (orig./SHA)

  12. Anatomy of the patent foramen ovale for the interventionalist.

    Science.gov (United States)

    McKenzie, Jeff A; Edwards, William D; Hagler, Donald J

    2009-05-01

    Patent foramen ovale (PFO) is an interatrial communication whose management is controversial. Several manufacturers have submitted protocols for Food and Drug Administration (FDA) approval of their PFO closure device. The purpose of this study was to define anatomy relevant to percutaneous PFO closure, validate the clinical observation that most PFOs contain little tissue rim at the aorta, comment on proposed closure guidelines, and to discuss approaches to PFO closure. From the Mayo Clinic Tissue Registry, five normal hearts with PFO were selected from each sex from the first 10 decades of life (n = 100). Measurements (mm) included PFO length, diameter, and distance from FO-superior vena cava (SVC) and FO-aortic annulus (AoAn). Patient age, weight, and height were obtained from autopsy reports, and body surface area (BSA) was calculated. PFO length and diameter increased with age (P = 0.029 and 0.001, respectively), and FO-SVC and FO-AoAn increased with BSA (P women than men (P = 0.028). Using current sizing guidelines, 66% (CI = 56-75%) of the 100 patients would have been excluded from device closure, and only 31% could have received the smallest (18 mm) device. Our results suggest that the proposed device closure guidelines may result in inappropriate device sizing. In addition to excluding suitable candidates, strict application of the guidelines could also result in incomplete closure or device embolization. Suggestions for modification of the guidelines and options for device closure are discussed.

  13. [Patent foramen ovele, good reasons to close it].

    Science.gov (United States)

    Meier, Bernhard

    2018-03-01

    A patent foramen ovale (PFO) is not to be considered a disease as it is present in about 25 % of people. Yet, it is the prime reason for paradoxical embolism that can cause serious problems, such as death, stroke, myocardial infarction, and peripheral ischemia. The frequency of such events is probably underestimated as other causes tend to be blamed for them. Device PFO closure can be easily accomplished as outpatient procedure with minimal discomfort and risk and it has been referred to as mechanical vaccination. Randomized trials have proved its value for reduction of recurrent stroke. There is also good evidence that PFO closure solves problems like platypnoea orthodeoxia and exercise desaturation, improves migraine, and is helpful in sleep apnoea. In addition, it renders diving and high altitude climbing safer. The absolute risk of a PFO is dependent on its size and its association with an atrial septal aneurysm, a Eustachian valve, or a Chiari network. The number needed to treat to prevent one stroke by PFO closure may be as low as 2 over lifetime in selected patients. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Effectiveness of percutaneous closure of patent foramen ovale for hypoxemia.

    Science.gov (United States)

    Fenster, Brett E; Nguyen, Bryant H; Buckner, J Kern; Freeman, Andrew M; Carroll, John D

    2013-10-15

    The aim of this study was to evaluate the ability of percutaneous patent foramen ovale (PFO) closure to improve systemic hypoxemia. Although PFO-mediated right-to-left shunt (RTLS) is associated with hypoxemia, the ability of percutaneous closure to ameliorate hypoxemia is unknown. Between 2004 and 2009, 97 patients who underwent PFO closure for systemic hypoxemia and dyspnea that was disproportionate to underlying lung disease were included for evaluation. All patients exhibited PFO-mediated RTLS as determined by agitated saline echocardiography. Procedural success was defined as implantation of a device without major complications and mild or no residual shunt at 6 months. Clinical success was defined as a composite of an improvement in New York Heart Association (NYHA) functional class, reduction of dyspnea symptoms, or decreased oxygen requirement. Procedural success was achieved in 96 of 97 (99%), and clinical success was achieved in 68 of 97 (70%). The presence of any moderate or severe interatrial shunt by agitated saline study (odds ratio [OR] = 4.7; p gender (OR = 0.30; p <0.017) decreased the likelihood of success. In conclusion, based on the largest single-center experience of patients referred for PFO closure for systemic hypoxemia, PFO closure was a mechanically effective procedure with an associated improvement in echocardiographic evidence of RTLS, NYHA functional class, and oxygen requirement. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Accessory neurovascular foramina on the lingual surface of mandible: Incidence, topography, and clinical implications

    Directory of Open Access Journals (Sweden)

    B V Murlimanju

    2012-01-01

    Full Text Available Context: It was suggested that the accessory neurovascular foramina of the mandible might be of significance in relation to the effectiveness of local anesthesia following the routine inferior alveolar nerve block. Aims: To investigate the incidence of neurovascular foramina over the lingual surface of the mandible in South Indian population. Settings and Design: The study was conducted at the department of anatomy. Materials and Methods: The study included 67 human adult dry mandibles, the exact ages and sexes of which were not known. The location and number of neurovascular foramina were topographically analyzed. Statistical Analysis Used: Descriptive statistics. Results: The foramina were observed in 64 mandibles (95.5% and were often multiple in most of the cases. They were located between the two medial incisors in 8 mandibles (1.9%, between the medial and lateral incisor in 34 mandibles (50.7%; 25-bilateral; 7-right; 2-left, between the lateral incisor and canine in 7 mandibles (10.4%; 2-bilateral; 3-right; 2-left, between the canine and first premolar in 6 cases (8.9%; 3 on each side. Foramina were also present around the genial tubercle in 56 mandibles (83.6%. Among them, 52 mandibles showed a single foramen just above the genial tubercle, 34 mandibles had foramina below the tubercles, 13 mandibles had foramina on the right side of genial tubercle and 17 were having on the left side. Conclusion: Since the anatomical details of these foramina are important to various fields of dentistry and oncology, the present investigation was undertaken. The clinical significance and implications are emphasized.

  16. Accessory spleen compromising response to splenectomy for idiopathic thrombocytopenic purpura

    International Nuclear Information System (INIS)

    Ambriz, P.; Munoz, R.; Quintanar, E.; Sigler, L.; Aviles, A.; Pizzuto, J.

    1985-01-01

    Accessory spleens were sought in 28 patients who had undergone splenectomy for chronic idiopathic thrombocytopenic purpura (ITP), using a variety of techniques. Abdominal scintigraphy with autologous erythrocytes labeled with Tc-99m and opsonized with anit-D IgG (radioimmune method) proved to be most useful, clearly demonstrating one or more accessory spleens in 12 cases (43%). Computed tomography (CT) was also helpful. Four out of five patients demonstrated an increased platelet count following surgery, the effectiveness of which was illustrated by the radioimmune scan. Patients who have had splenectomy for chronic ITP should be scanned using radioimmune techniques and CT to determine whether an accessory spleen is present

  17. Morphometric aspects of the foramen magnum and the orbit in Brazilian dry skulls

    Directory of Open Access Journals (Sweden)

    Lucas A. S. Pires

    2016-04-01

    Full Text Available Morphometric analysis of crania structures are of great significance to anatomists, forensic doctors, anthropologists, and surgeons. We performed a morphometric study regarding the foramen magnum and the bony orbit on the right side of the cranium in 77 skulls with the purpose of identifying a correlation between these measures, as they are often employed alone to identify the genre and race of a skeleton with no other remains, since the cranium is a structure that can resist fire, explosions, and mutilations. The foramen magnum receives special attention, as it is located in a region together with many strong muscles and ligaments. The measures were taken with a sliding digital caliper. Our results showed that the foramen magnum had a mean anteroposterior diameter of 34.23±2.54 mm, and the mean transverse diameter was 28.62±2.83 mm. The most common shape for the foramen magnum was oval. The mean right orbital height was 32.89±2.45 mm, and the mean right orbital breadth was 37.15±2.68 mm. There was a weak to moderate correlation between these measures. Furthermore, the foramen magnum and the orbit are regions of surgical and clinical significance, thus requiring knowledge regarding the morphometric aspects of such areas, since they can often suffer morphological changes due to a number of diseases and they undergo surgical procedures in order to treat these conditions.

  18. Radiologic study of mandibular foramen of mandibular prognathism by three-dimensional computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Hun; Moon, Cheol Hyun; Im, Jeong Soo; Seo, Hwa Jeong [Graduate School of Public Health and Social Welfare, Gachon University of Medicine and Science, Incheon (Korea, Republic of)

    2010-06-15

    This study is aimed to evaluate the position of mandibular foramen of mandibular prognathism patients using 3-dimensional CT images in order to reduce the chance of an anesthetic failure of the mandibular nerve and to prevent the damage to the inferior alveolar nerve during the orthognathic surgery. The control group consist of 30 patients with class I occlusion. The experimental group consist of 44 patients with class III malocclusion. Three-dimensional computed tomography was used to evaluate the position of the mandibular foramina. The distance between mandibular plane and mandibular foramen, class I was 25.385 mm, class III was 23.628 mm. About the distance between occlusal plane and mandibular foramen, class I was 1.478 mm, class III was 5.144 mm. The distance between posterior border plan of mandibular ramus and mandibular foramen had not statistically significant. About the distance between sagittal plane of mandible and mandibular foramen did not also showed statistically significant. The result of this study could help the clinicians to apprehend more accurate anatomical locations of the foramina on the mandible with various facial skeletal types. Thereby to perform more accurate block anesthesia of the mandibular nerve and osteotomy with minimal nerve damage. In addition, this study could provide fundamental data for any related researches about the location of the mandibular foramina for other purposes.

  19. Radiologic study of mandibular foramen of mandibular prognathism by three-dimensional computed tomography

    International Nuclear Information System (INIS)

    Lee, Seung Hun; Moon, Cheol Hyun; Im, Jeong Soo; Seo, Hwa Jeong

    2010-01-01

    This study is aimed to evaluate the position of mandibular foramen of mandibular prognathism patients using 3-dimensional CT images in order to reduce the chance of an anesthetic failure of the mandibular nerve and to prevent the damage to the inferior alveolar nerve during the orthognathic surgery. The control group consist of 30 patients with class I occlusion. The experimental group consist of 44 patients with class III malocclusion. Three-dimensional computed tomography was used to evaluate the position of the mandibular foramina. The distance between mandibular plane and mandibular foramen, class I was 25.385 mm, class III was 23.628 mm. About the distance between occlusal plane and mandibular foramen, class I was 1.478 mm, class III was 5.144 mm. The distance between posterior border plan of mandibular ramus and mandibular foramen had not statistically significant. About the distance between sagittal plane of mandible and mandibular foramen did not also showed statistically significant. The result of this study could help the clinicians to apprehend more accurate anatomical locations of the foramina on the mandible with various facial skeletal types. Thereby to perform more accurate block anesthesia of the mandibular nerve and osteotomy with minimal nerve damage. In addition, this study could provide fundamental data for any related researches about the location of the mandibular foramina for other purposes.

  20. Wolff-Parkinson-White Syndrome and Accessory Pathways

    Science.gov (United States)

    ... the American Heart Association Cardiology Patient Page Wolff-Parkinson-White Syndrome and Accessory Pathways James Kulig , Bruce ... rate, which can be dangerous. What is Wolff-Parkinson-White Syndrome? Wolff-Parkinson-White syndrome (WPW) is ...

  1. Giant Accessory Right-Sided Suprarenal Spleen in Thalassaemia

    Directory of Open Access Journals (Sweden)

    A. Arra

    2013-01-01

    Full Text Available An accessory spleen is defined as ectopic splenic tissue that develops due to failure of fusion of cells during embryonic development as they migrate from the midline to the left upper quadrant. While benign, complications may arise which include trauma, torsion, or infarction of the ectopic tissue. Additionally, patients who have had a splenectomy secondary to treatment for previous pathology such as a haematological malignancy or idiopathic thrombocytopenia purpura may experience persistent symptoms due to the accessory splenic tissue. The presence of an accessory spleen is therefore of significant diagnostic and therapeutic importance. To the best of the authors' knowledge, this case is the second and largest reported case of a giant right suprarenal accessory spleen and highlights the difficulty in differentiation of these masses from malignant adrenal tumours.

  2. Male accessory gland secretory protein polymorphism in natural ...

    Indian Academy of Sciences (India)

    [Ravi Ram K. and Ramesh S. R. 2007 Male accessory gland secretory protein polymorphism in natural ..... quence of species-specific genetic responses to variations in .... Eberhard W. G. 1996 Female control: sexual selection by cryptic.

  3. 21 CFR 876.4300 - Endoscopic electrosurgical unit and accessories.

    Science.gov (United States)

    2010-04-01

    ... Endoscopic electrosurgical unit and accessories. (a) Identification. An endoscopic electrosurgical unit and... device includes the electrosurgical generator, patient plate, electric biopsy forceps, electrode, flexible snare, electrosurgical alarm system, electrosurgical power supply unit, electrical clamp, self...

  4. 49 CFR 390.17 - Additional equipment and accessories.

    Science.gov (United States)

    2010-10-01

    ... equipment and accessories, not inconsistent with or prohibited by this subchapter, provided such equipment... are used. [53 FR 18052, May 19, 1988, as amended at 60 FR 38744, July 28, 1995. Redesignated at 65 FR...

  5. Electric accessory drives in automobiles. Elektrische Hilfsantriebe in Kraftfahrzeugen

    Energy Technology Data Exchange (ETDEWEB)

    1981-01-01

    Ten lectures were presented on the conference ''Electric accessory drives in automobiles'' subjects: - Survey on electric accessory drives in automobiles; cooperation of generator, battery and starter; technical solution of accessory drives, considerations on a system; comparison of various solutions for drives by viewing the example of a headlight vertical aim control; wiper motors and their control; blowers for heating, ventilation and air conditioning in automobiles; criteria for dimensioning of blower motors; drives in heating and air-conditioning applicances; permanent magnets for engine excitation; systematic quality assurance of electric accessory drives from car-development to serial production. Numerous illustrations and formulas are supplied which illustrate and explain the lectures. Each lecture is abstracted individually.

  6. Design of a marine sediment trap and accessories

    Digital Repository Service at National Institute of Oceanography (India)

    Janakiraman, G.; Fernando, V.; Venkatesan, R.; Rajaraman, V.S.

    The marine sediment trap and the mooring accessories were developed indigenously and were used successfully for the collection of settling sediments in the Arabian Sea The experience gained in using sediment trap and further improvements...

  7. ISO and EIGA standards for cryogenic vessels and accessories

    CERN Multimedia

    CERN. Geneva

    2016-01-01

    The EIGA/WG 6’s scope is cryogenic vessels and accessories, including their design, material compatibility, operational requirements and periodical inspection. The specific responsibilities include monitoring international standardization (ISO, CEN) and regulations (UN, TPED, PED...

  8. Clinical impact of patent foramen ovale diagnosis with transcranial Doppler.

    Science.gov (United States)

    Anzola, Gian Paolo

    2002-11-01

    The role of patent foramen ovale (PFO) in cryptogenic stroke is still debated, but from recent follow-up studies it seems that the amount of right-to-left shunt (RLS) and the association with atrial septal aneurysm (ASA) are major determinants of stroke recurrence. PFO and RLS through the atrial chambers have been recently studied in a number of conditions not or marginally related to cerebrovascular disease. Historically the first studies addressed the presence of RLS in scuba divers as a possible abnormality related to decompression sickness (DS) of unknown aetiology. Despite initial debate there is now robust evidence to claim that patency of foramen ovale increases the risk of developing DS by two and half to four times. Patients with PFO-related DS tend to have early occurrence of symptoms after surfacing and a clinical presentation that indicates brain or upper cervical spinal cord involvement. Recent reports suggest that divers with hemodynamically significant RLS may have an increased risk of developing clinically asymptomatic multiple brain lesions. PFO has been found in patients suffering from migraine with aura with approximately the same frequency as that encountered in cryptogenic stroke patients. This finding has prompted speculations on the possible role of RLS in increasing the stroke risk in migraineurs and in the pathophysiology of the aura. Recent reports showing that migraine with aura is dramatically improved after transcatheter closure of PFO suggest that migraine with aura may indeed be triggered by humoral factors that reach the brain by escaping the pulmonary filter. A RLS is involved in a rare condition known as platypnea-orthodeoxia and perhaps underlies an increased risk of cerebral complications after major orthopedic surgery. Valsalva-like activities often precede the occurrence of attacks of transient global amnesia (TGA) and abnormalities consistent with hypoperfusion of deep limbic structures have been reported during a typical TGA

  9. Patent foramen ovale: detection with nongated multidetector CT.

    Science.gov (United States)

    Revel, Marie-Pierre; Faivre, Jean-Baptiste; Letourneau, Thierry; Henon, Hilde; Leys, Didier; Delannoy-Deken, Valérie; Remy-Jardin, Martine; Remy, Jacques

    2008-10-01

    To evaluate nongated multidetector computed tomography (CT) in the detection of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) in comparison with transesophageal echocardiography (TEE). The study was approved by the institutional review board, and informed consent was obtained from all patients. One hundred five patients (57 men, 48 women; mean age, 53 years) with a recent stroke underwent TEE and multidetector CT on the same day. After injection of a diluted iodinated contrast material, a series of 2.4-mm-thick transverse images centered on the fossa ovalis were acquired in conjunction with release of the Valsalva maneuver. Two independent radiologists considered PFO present if left atrial enhancement was detected visually before enhancement of the pulmonary veins or if an early peak of left atrial enhancement was found at time-attenuation curve analysis. PFO was detected with 98% specificity (95% confidence interval [CI]: 0.91, 0.99). Overall sensitivity was 55% (95% CI: 0.38, 0.70), ranging from 28% for shunts classified as grade 1 at TEE to 91% for those classified as grade 4 at TEE. Interreader agreement was good (kappa = 0.81). Visual assessment was better than time-attenuation curve analysis, which enabled detection of only 15 of the 40 cases of PFO. Multidetector CT depicted only 22% of cases of ASA. The mean effective radiation dose was 2.3 mSv. Nongated multidetector CT can be used to diagnose high-grade shunts through a PFO, with 91% sensitivity and 98% specificity. Thus, PFO detection, in addition to routine CT evaluation of the lungs, could be indicated in patients with unexplained hypoxemia. (c) RSNA, 2008.

  10. Longitudinal stress fracture: patterns of edema and the importance of the nutrient foramen

    Energy Technology Data Exchange (ETDEWEB)

    Craig, Joseph G.; Widman, David; Holsbeeck, Marnix van [Department of Radiology, Henry Ford Hospital, Detroit, MI 48202 (United States)

    2003-01-01

    We reviewed the MR appearances of six cases of longitudinal stress fracture of the lower extremity.Results. One fracture was in the femur and five were in the tibia. Four of the tibial fractures showed edema starting in the mid-tibia at the level of the nutrient foramen with the fracture on the anteromedial cortex. The other tibial fracture started at the nutrient foramen. Three fractures (two tibial and the femur fracture) showed eccentric marrow edema; all fractures showed either eccentric periosteal reaction or soft tissue edema.Conclusion. Primary diagnosis of longitudinal stress fracture is made by finding a vertical cleft on one or more axial images. Secondary signs of position of the nutrient foramen and patterns of edema may be useful. (orig.)

  11. Persistent foramen of Huschke: a tomographic study; Persistencia do forame de Huschke: um estudo tomografico

    Energy Technology Data Exchange (ETDEWEB)

    Reis, Henrique Nogueira; Carvalho, Antonio Carlos Pires; Mello, Rossana Corbo Ramalho de [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia]. E-mail: hsodonto@gmail.com; Leite, Horacio Faig [UNESP, Sao Jose dos Campos, SP (Brazil). Faculdade de Odontologia; Xavier, Sergio Salles [Universidade Federal do Rio de Janeiro, RJ (Brazil). Hospital Universitario Clementino Fraga Filho. Servico de Cardiologia

    2006-07-15

    Objective: to evaluate the persistency of foramen of Huschke by means of computed tomography study of the ear region and approaching important clinical aspects related to the presence of this anatomical anomaly. Materials and methods: two examiners have analyzed the whole tympanic portion of temporal bone in 150 bilateral computed tomography studies of the ear region, searching for foramen of Huschke presence or absence. Results: the mentioned anatomical anomaly was found in 17 cases (11.3%), 13 patients (76.5%) being female and four (23.5%) male. This higher female incidence is statistically confirmed. Conclusion: ear and/or temporomandibular joint specialists should turn their attention to the persistency of foramen of Huschke. (author)

  12. Adult brain abscess associated with patent foramen ovale: a case report

    Directory of Open Access Journals (Sweden)

    Stathopoulos Georgios T

    2007-08-01

    Full Text Available Abstract Brain abscess results from local or metastatic septic spread to the brain. The primary infectious site is often undetected, more commonly so when it is distant. Unlike pediatric congenital heart disease, minor intracardiac right-to-left shunting due to patent foramen ovale has not been appreciated as a cause of brain abscess in adults. Here we present a case of brain abscess associated with a patent foramen ovale in a 53-year old man with dental-gingival sepsis treated in the intensive care unit. Based on this case and the relevant literature we suggest a link between a silent patent foramen ovale, paradoxic pathogen dissemination to the brain, and development of brain abscess.

  13. Accessory stimulus modulates executive function during stepping task.

    Science.gov (United States)

    Watanabe, Tatsunori; Koyama, Soichiro; Tanabe, Shigeo; Nojima, Ippei

    2015-07-01

    When multiple sensory modalities are simultaneously presented, reaction time can be reduced while interference enlarges. The purpose of this research was to examine the effects of task-irrelevant acoustic accessory stimuli simultaneously presented with visual imperative stimuli on executive function during stepping. Executive functions were assessed by analyzing temporal events and errors in the initial weight transfer of the postural responses prior to a step (anticipatory postural adjustment errors). Eleven healthy young adults stepped forward in response to a visual stimulus. We applied a choice reaction time task and the Simon task, which consisted of congruent and incongruent conditions. Accessory stimuli were randomly presented with the visual stimuli. Compared with trials without accessory stimuli, the anticipatory postural adjustment error rates were higher in trials with accessory stimuli in the incongruent condition and the reaction times were shorter in trials with accessory stimuli in all the task conditions. Analyses after division of trials according to whether anticipatory postural adjustment error occurred or not revealed that the reaction times of trials with anticipatory postural adjustment errors were reduced more than those of trials without anticipatory postural adjustment errors in the incongruent condition. These results suggest that accessory stimuli modulate the initial motor programming of stepping by lowering decision threshold and exclusively under spatial incompatibility facilitate automatic response activation. The present findings advance the knowledge of intersensory judgment processes during stepping and may aid in the development of intervention and evaluation tools for individuals at risk of falls. Copyright © 2015 the American Physiological Society.

  14. Relationship between foramen magnum position and locomotion in extant and extinct hominoids.

    Science.gov (United States)

    Neaux, Dimitri; Bienvenu, Thibaut; Guy, Franck; Daver, Guillaume; Sansalone, Gabriele; Ledogar, Justin A; Rae, Todd C; Wroe, Stephen; Brunet, Michel

    2017-12-01

    From the Miocene Sahelanthropus tchadensis to Pleistocene Homo sapiens, hominins are characterized by a derived anterior position of the foramen magnum relative to basicranial structures. It has been previously suggested that the anterior position of the foramen magnum in hominins is related to bipedal locomotor behavior. Yet, the functional relationship between foramen magnum position and bipedal locomotion remains unclear. Recent studies, using ratios based on cranial linear measurements, have found a link between the anterior position of the foramen magnum and bipedalism in several mammalian clades: marsupials, rodents, and primates. In the present study, we compute these ratios in a sample including a more comprehensive dataset of extant hominoids and fossil hominins. First, we verify if the values of ratios can distinguish extant humans from apes. Then, we test whether extinct hominins can be distinguished from non-bipedal extant hominoids. Finally, we assess if the studied ratios are effective predictors of bipedal behavior by testing if they mainly relate to variation in foramen magnum position rather than changes in other cranial structures. Our results confirm that the ratios discriminate between extant bipeds and non-bipeds. However, the only ratio clearly discriminating between fossil hominins and other extant apes is that which only includes basicranial structures. We show that a large proportion of the interspecific variation in the other ratios relates to changes in facial, rather than basicranial, structures. In this context, we advocate the use of measurements based only on basicranial structures when assessing the relationship between foramen magnum position and bipedalism in future studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. A case of huge neurofibroma expanding extra- and intracranially through the enlarged jugular foramen

    International Nuclear Information System (INIS)

    Hanakita, Junya; Imataka, Kiyoharu; Handa, Hajime

    1984-01-01

    The surgical approach to the jugular foramen has been considered to be very difficult and troublesome, because of the location in which important structures, such as the internal jugular vein, internal carotid artery and lower cranial nerves, converge in the narrow deep space. A case of huge neurofibroma, which extended from the tentorium cerebelli through the dilated jugular foramen to the level of the vertebral body of C 3 was presented. A 12-year-old girl was admitted with complaints of visual disturbance and palsy of the V-XII cranial nerves of the left side. Plain skull film showed prominent widening of the cranial sutures and enlargement of the sella turcica. Horizontal CT scan with contrast showed symmetrical ventricular dilatation and a heterogeneously enhanced mass, which was situated mainly in the left CP angle. Coronal CT scan with contrast revealed a huge mass and enlarged jugular foramen, through which the tumor extended to the level of the vertebral body of C 3 . Occlusion of the sigmoid sinus and the internal jugular vein of the left side was noticed in the vertebral angiography. Two-stage approach, the first one for removal of the intracranial tumor and the second one for extracranial tumor, was performed for its huge tumor. Several authors have reported excellent surgical approaches for the tumors situated in the jugular foramen. By our approach, modifying Gardner's original one, a wide operative field was obtained to remove the tumor around the jugular foramen with success. Our approach for the jugular foramen was described with illustrations. (author)

  16. Locating Mandibular Foramen in Children with Mandibular Retrognathism in Mixed Dentition

    Directory of Open Access Journals (Sweden)

    Mehrsa Paryab

    2015-06-01

    Full Text Available Background and aims. One of the most common reasons forthe inferior alveolar nerve block anesthesia failure is the variation in mandibular foramen location. The aim of this study was to assess the location of mandibular foramen in chil-dren with mandibular retrognathism in comparison to children with normal skeletal occlusion in the mixed dentition. Materials and methods. One hundred and twenty panoramic radiographs of patients in mixed dentition period, undergo-ing orthodontic treatment, were selected based on inclusion criteria, skeletal occlusion and stage of dental development. The radiographs were divided into two groups: I: 60 panoramic radiographs of patients with normal skeletal occlusion (15 in each of the Hellman dental age stages; II: 60 panoramic radiographs of patients with mandibular retrognathism (15 in each of the Hellman dental age stages. The radiographs were traced and the linear distance from the mandibular foramen to the borders of the mandibular ramus and its angular position were identified. The measurements were compared between the two groups and among the four dental age groups by t-test, ANOVA and post hoc tests. Results. No statistically significant differences werefound between the patients with normal skeletal occlusion and patients with mandibular retrognathism (P>0.05. Statistical tests showed significant differences in the vertical location of mandibu-lar foramen and gonial angle between the four dental age groups (P<0.05. Conclusion. Mandibular retrognathism does not have a significant impact on the location of the mandibular foramen in the mixed dentition period. The child’s dental age would be considered in the localization of the mandibular foramen.

  17. A primary leiomyoma in the neural foramen of the lumbar spine: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Jong Chang; Kang, Byeong Seong; Kim, Young Min; Park, Moon Soo; Jeong, Ae Kyung; Yang, Myeon Jun; Hwang, Jae Cheol [University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan (Korea, Republic of)

    2007-12-15

    A primary leiomyoma in the neural foramen of the lumbar spine is a very rare condition. We examined a 23-year-old female presented with back and right flank pain. A plain radiography showed a well-defined, osteolytic lesion in the L3 body. In addition, MR images showed a mass lesion with intense enhancement, after intravenous injection with contrast material, in the right neural foramen at the L2/3 level. A histopathologic examination of the resected specimen revealed a benign leiomyoma.

  18. Normal and pathological growth of the foramen occipitale magnum shown in the plain radiograph

    International Nuclear Information System (INIS)

    Bliesener, J.A.; Schmidt, L.R.

    1980-01-01

    The transverse diameter of the foramen occipitale magnum (f.o.m.) in the semiaxial skull X-ray was measured and evaluated statistically in 174 cerebrally healthy children of different ages. These normal values are contrasted with the foramen diameters of 35 children with verified Arnold-Chiari malformation as well as children with macrocephaly and microcephaly. The values in children with Arnold-Chiari malformation are all above the norm, irrespective of whether or not there is a concomitant hydrocephalus. (orig.) [de

  19. Imaging of patent foramen ovale with 64-section multidetector CT.

    Science.gov (United States)

    Saremi, Farhood; Channual, Stephanie; Raney, Aidan; Gurudevan, Swaminatha V; Narula, Jagat; Fowler, Steven; Abolhoda, Amir; Milliken, Jeffrey C

    2008-11-01

    To investigate the feasibility of 64-section multidetector computed tomography (CT) by using CT angiography (a) to demonstrate anatomic detail of the interatrial septum pertinent to the patent foramen ovale (PFO), and (b) to visually detect left-to-right PFO shunts and compare these findings in patients who also underwent transesophageal echocardiography (TEE). In this institutional review board-approved HIPAA-compliant study, electrocardiographically gated coronary CT angiograms in 264 patients (159 men, 105 women; mean age, 60 years) were reviewed for PFO morphologic features. The length and diameter of the opening of the PFO tunnel, presence of atrial septal aneurysm (ASA), and PFO shunts were evaluated. A left-to-right shunt was assigned a grade according to length of contrast agent jet (grade 1, 1 cm to 2 cm; grade 3, >2 cm). In addition, 23 patients who underwent both modalities were compared (Student t test and linear regression analysis). A difference with P patent at the entry into the right atrium (PFO) in 62 patients (61.4% of patients with flap valve, 23.5% of total patients). A left-to-right shunt was detected in 44 (16.7% of total) patients (grade 1, 61.4%; grade 2, 34.1%; grade 3, 4.5%). No shunt was seen in patients without a flap valve. Mean length of PFO tunnel was 7.1 mm in 44 patients with a shunt and 12.1 mm in 57 patients with a flap valve without a shunt (P < .0001). In patients with a tunnel length of 6 mm or shorter, 92.6% of the shunts were seen. ASA was seen in 11 (4.2%) patients; of these patients, a shunt was seen in seven (63.6%). In 23 patients who underwent CT angiography and TEE, both modalities showed a PFO shunt in seven. Multidetector CT provides detailed anatomic information about size, morphologic features, and shunt grade of the PFO. Shorter tunnel length and septal aneurysms are frequently associated with left-to-right shunts in patients with PFO. (c) RSNA, 2008.

  20. Accessory bones of the feet: Radiological analysis of frequency

    Directory of Open Access Journals (Sweden)

    Vasiljević Vladica

    2010-01-01

    Full Text Available Background/Aim. Accessory bones are most commonly found on the feet and they represent an anatomic variant. They occur when there is a failure in the formation of a unique bone from separated centre of ossification. The aim of this study was to establish their frequency and medical significance. Methods. Anteroposterior and lateral foot radiography was performed in 270 patients aged of 20-80 years with a history of trauma (180 and rheumatology disease (90. The presence and distribution of accessory bones was analysed in relation to the total number of patients and their gender. The results are expressed in numeric values and in terms of percentage. Results. Accessory bones were identified in 62 (22.96% patients: 29 (10.74% of them were found in female patients and 33 (12.22% in males. The most common accessory bones were as follows: os tibiale externum 50%, os peroneum 29.03%, ostrigonum 11.29%, os vaselianum 9.68%. Conclusion. Accessory bones found in 23% of patients with trauma and some of rheumatological diseases. Their significance is demonstrated in the differential diagnosis among degenerative diseases, avulsion fractures, muscle and tendon trauma and other types of injuries which can cause painful affection of the foot, as well as in forensic practice.

  1. [Evaluation of iatrogenic accessory nerve injury in forensic medical practice].

    Science.gov (United States)

    Somogyi, E; Irányi, J

    1996-04-14

    The authors give a survey of the clinical and medical-legal characteristics of the accessory nerve injury. In the past two decades the conception of the successfulness of the surgical treatment of the accessory nerve injury became prevailing. About the medical-legal aspects of the iatrogenic injury of the nerve reported in connection of the reconstructive surgery chiefly also departments of neurosurgery, orthopedics and traumatology. In the case of the authors a 70 year old patient suffered 10 years ago a iatrogenic accessory nerve injury. The mild trapezius palsy recovered spontaneously practically with cosmetic disadvantage. In connection with the development of extreme dorso-lumbal scoliosis associated with torsion the trapezius atrophy worsened. Physical therapy was partly successful. But the patient became unfit for manual work. Their observations sustain the data of authors who established that in the case of accessory nerve injury not only the surgical but also conservative treatment is usually successful. In opposite to certain data of the literature the authors establish that the iatrogenic injuries of the accessory nerve may lead to significant lifelong disability. The diagnosis is not always made in time with consequent delay in repair. This may be regarded as an unfavorable issue during medical-legal discussions. The authors recommend in interest to prevent nerve injury in the posterior triangle of the neck to perform operation in special department.

  2. Morphometrics of foramen magnum in African four-toed hedgehog (Atelerix albiventris).

    Science.gov (United States)

    Girgiri, I; Olopade, J O; Yahaya, A

    The purpose of this study was to examine the morphometry of the foramen magnum of African four-toed hedgehog (Atelerix albiventris) in Maiduguri. Fourteen hedgehog skulls (7 male and 7 female each) were used for this study. The overall mean value of foramen magnum height and width were 0.51 ± 0.05 cm and 0.64 ± 0.04 cm while occipital condylar and interparacondylar widths were 1.00 ± 0.12 cm and 1.62 ± 0.07 cm, respectively. There was no significant difference between the two sexes. The foramen magnum index was 83.4 ± 5.51 cm in males and was significantly higher than 76.3 ± 6.37 cm observed in females. The presences of dorsal notches (occipital dysplasia) were observed, that were of three distinct types. It is envisaged, that the study will provide a valuable database on the anatomy of foramen magnum of hedgehogs in Nigeria for morphological, neurological, zooarchaeological, and comparative anatomical studies.

  3. Is there a correlation between sleep disordered breathing and foramen magnum stenosis in children with achondroplasia?

    Science.gov (United States)

    White, Klane K; Parnell, Shawn E; Kifle, Yemiserach; Blackledge, Marcella; Bompadre, Viviana

    2016-01-01

    Children with achondroplasia have midface hypoplasia, frontal bossing, spinal stenosis, rhizomelia, and a small foramen magnum. Central sleep apnea, with potential resultant sudden death, is thought to be related to compression of the spinal cord at the cervicomedullary junction in these patients. Screening polysomnography and/or cervical spine MRI are often performed for infants with achondroplasia. Decompressive suboccipital craniectomy has been performed in selected cases. We aim to better delineate the relationship between polysomnography, cervical spine MRI, and indications for surgical decompression in achondroplasia.We retrospectively review electronic medical records of all children with achondroplasia in our IRB-approved skeletal dysplasia registry who had received screening polysomnography and cervical spine MRI examination was performed. We explored correlations of polysomnography, MRI parameters, and need for decompressive surgery. Seventeen patients with both polysomnography and MRI of the cervical spine met inclusion criteria. The average age at time of the sleep study was 2.4 ± 3.6 years. An abnormal apnea-hypopnea index was found in all patients, with central sleep apnea found in 6/17. Five patients (29%) required foramen magnum decompression. We found no statistically significant correlation between central sleep apnea and abnormal MRI findings suggestive of foramen magnum stenosis. Screening polysomnography is an important tool but does not appear to correlate with MRI findings of foramen magnum stenosis. Cord compression, with either associated T2 cord signal abnormality or clinical findings of clonus, was most predictive of subsequent surgical decompression. © 2015 Wiley Periodicals, Inc.

  4. Morphology of the Physiological Apical Foramen in Maxillary and Mandibular First Molars

    Science.gov (United States)

    Abarca, J.; Zaror, C.; Monardes, H.; Hermosilla, V.; Muñoz, C.; Cantin, M.

    2015-01-01

    SUMMARY Information regarding the anatomy of the physiological apical foramen is limited. Knowing its diameter and shapes contributes to clinical work, specifically to the cleaning and shaping of the apical third. The aim of this ex vivo study was to determine the minimum and maximum diameters and shape of the physiological apical foramen in the roots of maxillary and mandibular first molars. A descriptive study was conducted on 89 recently extracted first molars. Roots 3–5 mm from the apex were sectioned and prepared for analysis at 40× magnification. The minimum and maximum diameters of each physiological foramen were measured using the program Motic Images plus 2.0 ML. The shape of the foramina, classified as round, oval or irregular, was determined by the difference between the maximum and minimum diameters. A total of 174 physiological foramina were analyzed. The average of the minimum and maximum diameters was between 0.24–0.33 mm in maxillary first molars and between 0.25–0.33 mm in mandibular first molars. In maxillary molars, the most common shape of the foramen was oval (50%), then irregular (32%), then round (18%). In mandibular molars, the oval shape was also the most frequent (59%), followed by irregular (23%) and round (18%). The findings of this study regarding the morphology of physiological apical foramina in first molars make it easier for the operator to choose the appropriately-sized instruments to perform endodontic therapy successfully. PMID:25937698

  5. Endoscopic resection of cavernoma of foramen of Monro in a patient with familial multiple cavernomatosis.

    Science.gov (United States)

    Prat, Ricardo; Galeano, Inmaculada

    2008-09-01

    Intraventricular cavernomas are extremely infrequent and only 11 cases of cavernous hemangioma to occur at the foramen of Monro have been reported in the literature. This 56 years old patient was admitted with progressive and intractable headache of 10 days of evolution. He was known to suffer familial multiple cavernomatosis. Magnetic resonance imaging (MRI), revealed obstructive hydrocephalus due to a cavernoma located in the area of the left foramen of Monro. Under neuronavigation guidance, complete endoscopic resection of the cavernoma was performed and normal ventricular size achieved. The patient experienced transient recent memory loss that resolved within a month after surgery. In the literature attempted endoscopic resection is reported to be abandoned due to bleeding and ineffectiveness of piecemeal endoscopic resection. In this case, the multiplicity of the lesions made it advisable to resect the lesion endoscopically, to avoid an open procedure in a patient with multiple potentially surgical lesions. Endoscopic resection was uneventful with easy control of bleeding with irrigation, suction, and bipolar coagulation despite dense vascular appearance of the lesion. During the procedure, precise visualization of the vascular structures around the foramen of Monro allowed complete resection with satisfactory control of the instruments. To the best of the authors' knowledge, this is the first published cavernoma of foramen of Monro successfully resected using an endoscopic approach.

  6. Morphology of the Physiological Apical Foramen in Maxillary and Mandibular First Molars.

    Science.gov (United States)

    Abarca, J; Zaror, C; Monardes, H; Hermosilla, V; Muñoz, C; Cantin, M

    2014-06-01

    Information regarding the anatomy of the physiological apical foramen is limited. Knowing its diameter and shapes contributes to clinical work, specifically to the cleaning and shaping of the apical third. The aim of this ex vivo study was to determine the minimum and maximum diameters and shape of the physiological apical foramen in the roots of maxillary and mandibular first molars. A descriptive study was conducted on 89 recently extracted first molars. Roots 3-5 mm from the apex were sectioned and prepared for analysis at 40× magnification. The minimum and maximum diameters of each physiological foramen were measured using the program Motic Images plus 2.0 ML. The shape of the foramina, classified as round, oval or irregular, was determined by the difference between the maximum and minimum diameters. A total of 174 physiological foramina were analyzed. The average of the minimum and maximum diameters was between 0.24-0.33 mm in maxillary first molars and between 0.25-0.33 mm in mandibular first molars. In maxillary molars, the most common shape of the foramen was oval (50%), then irregular (32%), then round (18%). In mandibular molars, the oval shape was also the most frequent (59%), followed by irregular (23%) and round (18%). The findings of this study regarding the morphology of physiological apical foramina in first molars make it easier for the operator to choose the appropriately-sized instruments to perform endodontic therapy successfully.

  7. Rapid pre-operative diagnosis of ileal hernia through the foramen of ...

    African Journals Online (AJOL)

    Department of Radiology, China Medical University Hospital, Taichung, Taiwan. Y-P Lo, MD. Corresponding author: Y-H Liao (D14887@mail.cmuh.org.tw). Internal hernias through the foramen of Winslow are extremely rare. Prompt diagnosis and early surgical reduction are vital to prevent bowel gangrene and avoid ...

  8. Accessory left gastric artery: angiographic anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Soo; Lim, Hyung Guhn; Kim, Hong Soo; Jeon, Doo Sung [Presbyterian Medical Center, Chunju (Korea, Republic of); Chung, Jin Wook; Park, Jae Hyung [College of Medicine and the Institute of Radiation Medicine, Seoul National University, Seoul (Korea, Republic of); Song, Soon Young [Myongji Hospital, College of Medicine, Kwandong University, Seoul (Korea, Republic of)

    2000-09-01

    To evaluate the angiographic anatomy of the accessory left gastric artery (accLGA). We evaluated the angiographic findings of the accLGA in 50 patients (Angiostar; Siemens, Erlangen, Germany). Performing celiac and selective angiography in 50 and 34 patients, respectively. By means of celiac angiography, (1) site of origin, (2) anatomical course, (3) diameter, (4) degree of tortuosity, and (5) distal tapering were evaluated, while selective angiography was used to determine (1) arterial branching, (2) area of blood supply, and (3) patterns of gastric wall stain. Celiac angiography showed that the accLGA arose from the left hepatic artery (LHA) in 45 cases (90%) and from the proper hepatic artery in five (10%). If the accLGA arose from the LHA, its origin entirely depended on the branching pattern of the latter. It always arose from the lateral branch of the LHA furthest to the left and uppermost, and proximal to its umbilical point. The most common anatomical course of the accLGA, seen in 27 cases (54%), was between the S2 and S3 segmental branch. The diameter and degree of tortuosity of the accLGA were similar to those of adjacent intrahepatic branches in 21 (42%) and 33 cases (66%), respectively. The degree of tapering was less than that of adjacent intrahepatic vessel in 28 (56%). Selective angiography demonstrated esophageal branching of the acc LGA in 27 cases (79%), inferior phrenic arterial branching in three (9%), a mediastinal branch in one (3%), and hypervascularity of the lung in one (3%). In 15 cases (44%), bifurcation of the accLGA was recognized. The vascular territory of the accLGA was the gastric fundus together with the distal esophagus in 21 cases (62%), mainly the gastric fundus in six (18%), and mainly the distal esophagus in four (12%). The pattern of gastric mucosal stain was curvilinear wall in 31 cases (91%) and nodular in three (9%). A knowledge of the angiographic anatomy of the accLGA facilitates accurate recognition of this artery on

  9. Evaluation of mental foramen location in the 10–70 years age range ...

    African Journals Online (AJOL)

    2015-08-18

    Aug 18, 2015 ... is useful in cases of surgery, root canal treatment, apical ... by radiologists even in a panoramic radiograph. Even if identified ... or skeletal anomalies and between 10 and 70 years old were included in this study. Subjects with missing or incorrect images and individuals with cystic tumors in the MF region.

  10. Case report: accessory head of the deep forearm flexors

    Science.gov (United States)

    JONES, M.; ABRAHAMS, P. H.; SAÑUDO, J. R.

    1997-01-01

    In 1813 Gantzer described 2 accessory muscles in the human forearm which bear his name (Wood, 1868; Macalister, 1875) and these have subsequently been reported with variable attachments (Wood, 1868; Macalister, 1875; Turner, 1879; Schäfer & Thane, 1894; Le Double, 1897; Dykes & Anson, 1944; Mangini, 1960; Malhotra et al. 1982; Kida, 1988; Tountas & Bergman, 1993). The accessory heads of the deep flexors of the forearm (Gantzer's muscles) have been described as 2 different small bellies which insert either into FPL or FDP. There are no previous reports which have mentioned the existence of an accessory muscle which inserts into both of the 2 deep flexors of the forearm as in the case presented here. PMID:9306208

  11. Electrophysiology of Cranial Nerve Testing: Spinal Accessory and Hypoglossal Nerves.

    Science.gov (United States)

    Stino, Amro M; Smith, Benn E

    2018-01-01

    Multiple techniques have been developed for the electrodiagnostic evaluation of cranial nerves XI and XII. Each of these carries both benefits and limitations, with more techniques and data being available in the literature for spinal accessory than hypoglossal nerve evaluation. Spinal accessory and hypoglossal neuropathy are relatively uncommon cranial mononeuropathies that may be evaluated in the outpatient electrodiagnostic laboratory setting. A review of available literature using PubMed was conducted regarding electrodiagnostic technique in the evaluation of spinal accessory and hypoglossal nerves searching for both routine nerve conduction studies and repetitive nerve conduction studies. The review provided herein provides a resource by which clinical neurophysiologists may develop and implement clinical and research protocols for the evaluation of both of these lower cranial nerves in the outpatient setting.

  12. An Accessory Muscle of Pectoral Region: A Case Report

    Science.gov (United States)

    Bannur, B.M.; Mallashetty, Nagaraj; Endigeri, Preetish

    2013-01-01

    Among the variations of pectoral muscles, this case appears to be unique in the literature. This was a case of an accessory pectoral muscle which was located between pectoralis major and pectoralis minor muscles, which was discovered during a routine anatomy dissection. The accessory muscle originated from 6th and 7th ribs at costo-chondral junction, which travelled supero-laterally and inserted by fusing with fibres of pectoralis minor. This unusual muscle holds importance for surgeons while they perform dissectomies, in avoiding complications. PMID:24179919

  13. 21 CFR 864.3600 - Microscopes and accessories.

    Science.gov (United States)

    2010-04-01

    ... enlarge images of specimens, preparations, and cultures for medical purposes. Variations of microscopes... light. (3) Inverted stage microscopes, which permit examination of tissue cultures or other biological... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Microscopes and accessories. 864.3600 Section 864...

  14. 21 CFR 884.6120 - Assisted reproduction accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction accessories. 884.6120 Section 884.6120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES..., and maintain gametes and/or embryos at an appropriate freezing temperature. (b) Classification. Class...

  15. Accessory enzymes from Aspergillus involved in xylan and pectin degradation

    NARCIS (Netherlands)

    Vries, de R.P.

    1999-01-01

    The xylanolytic and pectinolytic enzyme systems from Aspergillus have been the subject of study for many years. Although the main chain cleaving enzymes and their encoding genes have been studied in detail, little information is available about most of the accessory

  16. Validated Competency Task Lists for Apparel and Accessories Marketing.

    Science.gov (United States)

    Selke-Kern, Barbara E.

    Developed by a project that validated task lists by a variety of teachers and apparel marketing business persons, this guide contains task lists for occupations in the field of apparel and accessories marketing. The guide is organized in three sections. Section 1 includes the following: (1) notes on using the information in the guide; (2) a…

  17. 21 CFR 890.3025 - Prosthetic and orthotic accessory.

    Science.gov (United States)

    2010-04-01

    ... (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3025... intended for medical purposes to support, protect, or aid in the use of a cast, orthosis (brace), or prosthesis. Examples of prosthetic and orthotic accessories include the following: A pelvic support band and...

  18. Cancer of the accessory breast - a case report

    International Nuclear Information System (INIS)

    Madej, B.; Balak, B.; Winkler, I.; Burdan, F.

    2009-01-01

    Breast neoplasm may develop in ectopically located glandular tissue. This paper presents an interesting and rare case of a 50-year-old female who despite regular mammography screening examination developed an invasive accessory breast cancer. Clinical examination revealed a 2 cm - tumour localized 4 cm below the left infra mammary fold. The lesion was immobile, the skin and the atrophic nipple were retracted, the tumour infiltrated the thoracic wall. Oligo biopsy and additional examinations showed an invasive stage IIIB ductal breast cancer (Bloom II, G-2). The receptor status was: ER(+), PGR(+), HER2(-). The increased level of cancer antigen 15.3 was found. The patient was submitted to pre-operative chemotherapy. She also underwent surgery and subsequently post-operative chemotherapy and radiotherapy. On the basis of the presented case, it could be concluded that the accessory mammary glands are out of the image of screening breast examinations. Accessory breast cancer is usually diagnosed by clinical examination and ultrasonography. Preventive resection of accessory breast in women at high risk of developing breast cancer can be considered as the treatment of choice in most patients. (authors)

  19. Complete Spinal Accessory Nerve Palsy From Carrying Climbing Gear.

    Science.gov (United States)

    Coulter, Jess M; Warme, Winston J

    2015-09-01

    We report an unusual case of spinal accessory nerve palsy sustained while transporting climbing gear. Spinal accessory nerve injury is commonly a result of iatrogenic surgical trauma during lymph node excision. This particular nerve is less frequently injured by blunt trauma. The case reported here results from compression of the spinal accessory nerve for a sustained period-that is, carrying a load over the shoulder using a single nylon rope for 2.5 hours. This highlights the importance of using proper load-carrying equipment to distribute weight over a greater surface area to avoid nerve compression in the posterior triangle of the neck. The signs and symptoms of spinal accessory nerve palsy and its etiology are discussed. This report is particularly relevant to individuals involved in mountaineering and rock climbing but can be extended to anyone carrying a load with a strap over one shoulder and across the body. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  20. 21 CFR 886.1930 - Tonometer and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tonometer and accessories. 886.1930 Section 886.1930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... type) or to measure intraocular tension by applanation (applying a small flat disk to the cornea...

  1. Modeling and Simulation of Two Wheelchair Accessories for Pushing Doors.

    Science.gov (United States)

    Abdullah, Soran Jalal; Shaikh Mohammed, Javeed

    2017-03-27

    Independent mobility is vital to individuals of all ages, and wheelchairs have proven to be great personal mobility devices. The tasks of opening and navigating through a door are trivial for healthy people, while the same tasks could be difficult for some wheelchair users. A wide range of intelligent wheelchair controllers and systems, robotic arms, or manipulator attachments integrated with wheelchairs have been developed for various applications, including manipulating door knobs. Unfortunately, the intelligent wheelchairs and robotic attachments are not widely available as commercial products. Therefore, the current manuscript presents the modeling and simulation of a novel but simple technology in the form of a passive wheelchair accessory (straight, arm-like with a single wheel, and arc-shaped with multiple wheels) for pushing doors open from a wheelchair. From the simulations using different wheel shapes and sizes, it was found that the arc-shaped accessory could push open the doors faster and with almost half the required force as compared to the arm-like accessory. Also, smaller spherical wheels were found to be best in terms of reaction forces on the wheels. Prototypes based on the arc-shaped accessory design will be manufactured and evaluated for pushing doors open and dodging or gliding other obstacles.

  2. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Science.gov (United States)

    2010-04-01

    ... appliances and accessories. 888.3030 Section 888.3030 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT....3030 Single/multiple component metallic bone fixation appliances and accessories. (a) Identification. Single/multiple component metallic bone fixation appliances and accessories are devices intended to be...

  3. Large Dumbbell-Shaped C1 Schwannoma Presenting as a Foramen Magnum Mass

    Science.gov (United States)

    Helms, Jody; Michael, Lattimore Madison

    2012-01-01

    Schwannomas involving the foramen magnum commonly originate from the lower cranial nerves, but they are rarely found arising from the first cervical root. To date, very few cases have been described in the literature. The majority involve either the intradural or extradural compartment but not both. We report the second case of a dumbbell-shaped schwannoma arising from the first cervical root. Our patient presented with hemisensory deficits secondary to brainstem compression at the level of the foramen magnum. The patient underwent a far lateral approach, and a gross total resection was achieved. Preoperative suspicion of the diagnosis is helpful in anticipating displacement and avoiding damage to the surrounding neurovascular structures. PMID:23946923

  4. Trepanation and enlarged parietal foramen on skulls from the Loyalty Islands (Melanesia).

    Science.gov (United States)

    Vasilyev, Sergey V; Sviridov, Alexey A

    2017-06-01

    The goal of this study is a comprehensive examination of openings discovered on two skulls in the collection of skeletal remains from the Loyalty Islands (Melanesia). The skull No. 1524 displayed an evidence of successful trepanation, and the skull No. 7985 revealed openings that were reminiscent of a trepanation, however, we are inclined to believe that in the latter case we are dealing with a rare genetic anomaly - enlarged parietal foramen.

  5. Patent Foramen Ovale as a Risk Factor for Altitude Decompression Illness

    Science.gov (United States)

    2001-06-01

    Medical Issues in Hypo-and Hyperbaric Conditions [les Questions medicales a caractere oprationel liees aux conditions hypobares ou hyperbares ] To order the...on "Operational Medical Issues in Hypo- and Hyperbaric Conditions ", held in Toronto, Canada, 16-19 October 2000, and published in RTO MP-062. 3-2...Space Environ Med 1996; 67: 1092-6. Powell MR, Norfleet WT, Kumar KV, Butler BD. Patent foramen ovale and hypobaric decompression. Aviat Space Environ

  6. Dumb-bell sarcoma of the foramen jugulare with syringomyelia. A radio-induced tumour

    Energy Technology Data Exchange (ETDEWEB)

    Sieben, G; Sieben-Praet, M; de Reuck, J; de Coster, W; Remouchamps, A; Roels, H; van der Eecken, H [Ghent Rijksuniversiteit (Belgium). Dept. of. Neurology and Pathology

    1980-01-01

    The clinicopathological findings of a 58-year-old man, who developed cervicothoracic syringomyelia at the age of 25 are presented. He was given radiation therapy at the age of 33. At the age of 57 he developed a foramen jugulare syndrome on the left, caused by a low grade leiomyosarcoma. Etiologically, the most attractive hypothesis appears to be that the tumour was induced by radiation therapy administered 24 years previously.

  7. MORPHOMETRIC EVALUATION OF FORAMEN MAGNUM FOR SEX DETERMINATION IN A DOCUMENTED NORTH INDIAN SAMPLE

    OpenAIRE

    Jain; Alok Kumar; Pankaj

    2013-01-01

    ABSTRACT: Sex determination is used in anthropology, forensic medicine and medic o - legal cases. It is (1) remarked that “next to the pelvis, the skull is the most easily sexed portion of the skeleton”. It has been suggested (2 - 5) that the measurements of the foramen magnum are useful for determining the sex. There are two osteological techniques used to determine the sex of an individual; the first is visual assessment to evaluate the morphological sex tra...

  8. Foramen of Monro meningioma with atypical appearance: CT and conventional MR findings

    International Nuclear Information System (INIS)

    Hakyemez, B.; Erdogan, C.; Oruc, E.; Parlak, M.; Aker, S.; Aksoy, K.

    2007-01-01

    Full text: Intraventricular meningiomas have often been reported; however, literature reveals very few cases localized within foramen of Monro. Herein we report a 57-year-old woman admitted with obstructive hydrocephalus-related symptoms. Strikingly, the lesion was completely calcified in (T and had no marked solid component on MRI. The lesion was completely removed by surgical resection with a transfrontal intraventricular approach. The resected mass was histopathologically diagnosed as meningioma. The patient's symptoms resolved immediately after the operation

  9. Large Dumbbell-Shaped C1 Schwannoma Presenting as a Foramen Magnum Mass

    OpenAIRE

    Helms, Jody; Michael, Lattimore Madison

    2012-01-01

    Schwannomas involving the foramen magnum commonly originate from the lower cranial nerves, but they are rarely found arising from the first cervical root. To date, very few cases have been described in the literature. The majority involve either the intradural or extradural compartment but not both. We report the second case of a dumbbell-shaped schwannoma arising from the first cervical root. Our patient presented with hemisensory deficits secondary to brainstem compression at the level of t...

  10. Retrieval of Embolized Amplatzer Patent Foramen Ovale Occlusion Device: Issues Related to Late Recognition

    Directory of Open Access Journals (Sweden)

    Allan J. Davies

    2017-01-01

    Full Text Available Embolization of a percutaneous patent foramen ovale (PFO closure device is a rare but serious complication. While early, periprocedural device embolization can normally be managed with snare and percutaneous retrieval, late embolization requires a different management strategy due to inability of the device to deform to allow passage into a large caliber sheath. We present a case of asymptomatic device embolization recognized six months following implantation and discuss the challenges encountered in successfully retrieving the device.

  11. Patent foramen ovale influences the presentation of decompression illness in SCUBA divers.

    Science.gov (United States)

    Liou, Kevin; Wolfers, Darren; Turner, Robert; Bennett, Michael; Allan, Roger; Jepson, Nigel; Cranney, Greg

    2015-01-01

    Few have examined the influence of patent foramen ovale (PFO) on the phenotype of decompression illness (DCI) in affected divers. A retrospective review of our database was performed for 75 SCUBA divers over a 10-year period. Overall 4,945 bubble studies were performed at our institution during the study period. Divers with DCI were more likely to have positive bubble studies than other indications (pAustralia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  12. Can patent foramen ovale affect rehabilitation? The uncommon association of platypnea-orthodeoxia syndrome and stroke.

    Science.gov (United States)

    Gallerini, S; Calchetti, B; Cianchi, C; Di Troia, A M; Madonna, R; Cresti, A; Mancuso, M

    2011-06-01

    Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea and deoxygenation induced by a change to a sitting or standing from a recumbent position. It is the result of posturally accentuated intracardiac or pulmonary right-to-left shunt leading to arterial oxygen desaturation. Only few cases of platypnea-orthodeoxia syndrome are reported in the literature and the association between stroke and platypnea-orthodeoxia syndrome with evidence of patent foramen ovale is extremely rare. We describe the case of a 67-year-old female admitted to our Rehabilitation Unit for disabling basilar stroke due to paradoxical embolism from patent foramen ovale that during the first days of rehabilitation showed signs and symptoms of platypnea-orthodeoxia syndrome. To remove a life-threatening condition for the patient and in order to develop the normal rehabilitation project, that was stopped by the platypnea-orthodeoxia syndrome, the patient fastly underwent to percutaneous closure of patent foramen ovale. The stabilization of oxygen arterial saturation with postural changes and the disappearance of symptoms of POS allowed to develop the rehabilitation project with progressive neurological improvement.

  13. Best practices in the evaluation and treatment of foramen magnum stenosis in achondroplasia during infancy.

    Science.gov (United States)

    White, Klane K; Bompadre, Viviana; Goldberg, Michael J; Bober, Michael B; Campbell, Jeffrey W; Cho, Tae-Joon; Hoover-Fong, Julie; Mackenzie, William; Parnell, Shawn E; Raggio, Cathleen; Rapoport, David M; Spencer, Samantha A; Savarirayan, Ravi

    2016-01-01

    Achondroplasia is the most common inherited disorder of bone growth (skeletal dysplasia). Despite this fact, consistent and evidence-based management approaches to recognized, life-threatening complications, such as foramen magnum stenosis, are lacking. This study aims to outline best practice, based on evidence and expert consensus, regarding the diagnosis, assessment, and management of foramen magnum stenosis in achondroplasia during infancy. A panel of 11 multidisciplinary international experts on skeletal dysplasia was invited to participate in a Delphi process. They were: 1) presented with a list of 26 indications and a thorough literature review, 2) given the opportunity to anonymously rate the indications and discuss in face to face discussion; 3) edit the list and rate it in a second round. Those indications with more than 80% agreement were considered as consensual. After two rounds of rating and a face-to-face meeting, consensus was reached to support 22 recommendations for the evaluation and treatment of foramen magnum stenosis in infants with achondroplasia. These recommendations include indications for surgical decompression, ventriculomegaly, and hydrocephalus, sleep-disordered breathing, physical exams and the use of polysomnography and imaging in this condition. We present a consensus-based best practice guidelines consisting of 22 recommendations. It is hoped that these guidelines will lead to more uniform and structured evaluation, standardizing care pathways, and improving mortality and morbidity outcomes for this cohort. © 2015 Wiley Periodicals, Inc.

  14. A 2-D simulation of hydrocephalus in the Foramens of Monro of the human ventricular system

    Energy Technology Data Exchange (ETDEWEB)

    Ammourah, S.; Aroussi, A. [Univ. of Nottingham, School of Mechanical, Materials, Manufacturing and Management, University Park, Nottingham (United Kingdom)]. E-mail: eaxsaka@nottingham.ac.uk; Vloeberghs, M. [Queen' s Medical Centre, Dept. of Child Health, Nottingham (United Kingdom)

    2004-07-01

    This study investigates the Cerebrospinal fluid (CSF) flow behavior in a two-dimensional plane (2-D) of the human ventricular system when the hydrocephalus in the Foramens of Monro (F.O.M) occurs. In order to understand the CSF behaviour when the hydrocephalus occurs, it is essential to comprehend its normal flow dynamics i.e. the healthy case with no hydrocephalus. This had been done numerically by reconstructing the ventricular system geometry from the MRI scans and then made a 15{sup o} degree cut in the surgical line to obtain the outlines of the 2-D plane. The healthy cases were solved for the CSF actual flow rate, which is between 100-500 ml/day in 100 incremental steps. The unhealthy cases were studied for the average flow rate, which is 300 ml/day but for blockage ratios of the Foramen diameter of 20%, 50% and 75%. These obstructions are designed to simulate the hydrocephalus. The results show that as the flow rate increases the pressure and the velocity values increases, but no changes in the flow pattern occurs. The maximum pressure on the normal cases occurred in the lateral ventricles and the maximum velocity occurred in the aqueduct neck. The results of the hydrocephalus cases show that as the obstruction degree increases the pressure in the lateral ventricle increases accompanied with a velocity increase in the obstructed Foramen, which may cause unwanted stress on the neighboring tissues. (author)

  15. Differentiating human versus non-human bone by exploring the nutrient foramen: implications for forensic anthropology.

    Science.gov (United States)

    Johnson, Vail; Beckett, Sophie; Márquez-Grant, Nicholas

    2017-11-01

    One of the roles of a forensic anthropologist is to assist medico-legal investigations in the identification of human skeletal remains. In some instances, only small fragments of bone may be present. In this study, a non-destructive novel technique is presented to distinguish between human and non-human long bones. This technique is based on the macroscopic and computed tomography (CT) analysis of nutrient foramina. The nutrient foramen of long bone diaphyses transmits the nutrient artery which provides much of the oxygen and nutrients to the bone. The nutrient foramen and its canal were analysed in six femora and humeri of human, sheep (Ovies aries) and pig (Sus scrofa) species. The location, position and direction of the nutrient foramina were measured macroscopically. The length of the canal, angle of the canal, circumference and area of the entrance of the foramen were measured from CT images. Macroscopic analysis revealed the femora nutrient foramina are more proximal, whereas humeri foramina are more distal. The human bones and sheep humerus conform to the perceived directionality, but the pig bones and sheep femur do not. Amongst the parameters measured in the CT analysis, the angle of the canal had a discriminatory power. This study shows the potential of this technique to be used independently or complementary to other methods in distinguishing between human and non-human bone in forensic anthropology.

  16. Patent foramen ovale and cryptogenic stroke. Echocardiography role and state of the art

    International Nuclear Information System (INIS)

    Jaramillo U, Mario H

    2008-01-01

    The causes of ischemic stroke in young patients are difficult to find, in spite of systematic investigations directed to rule out heart etiology, alterations in coagulation or any other type of vascular disease; hence the cryptogenic definition. There have been speculations regarding the potential role of right-to-left intracardiac shunts as a path for paradoxical embolisms that result in ischemic cerebral disease. Transesophagic echocardiography with peripheral venous injection of saline contrast has shown to be the preferred method for the diagnosis of patent foramen ovale and right-to-left shunt. Prospective studies using acetylsalicylic acid or warfarin have not shown significant reduction of recurrent strokes. Even though both surgical and percutaneous closure of the patent foramen ovale have shown to decrease the rate of subsequent embolic episodes, their indication remains under discussion, at least until the appearance of randomized clinical trials, now under development. However, the cases of recurrent paradoxical embolism and those in professional scuba divers, both with intra-atrial septum aneurysm and an associated patent foramen ovale, are the only unequivocal indications for percutaneous closure. Successful closure, defined by transesophagic echocardiography, seems to predict lack of recurrent embolic events. As the complication rate of device implantation may decrease and these devices become technologically simple, percutaneous closure will prevail over surgical closure

  17. A 2-D simulation of hydrocephalus in the Foramens of Monro of the human ventricular system

    International Nuclear Information System (INIS)

    Ammourah, S.; Aroussi, A.; Vloeberghs, M.

    2004-01-01

    This study investigates the Cerebrospinal fluid (CSF) flow behavior in a two-dimensional plane (2-D) of the human ventricular system when the hydrocephalus in the Foramens of Monro (F.O.M) occurs. In order to understand the CSF behaviour when the hydrocephalus occurs, it is essential to comprehend its normal flow dynamics i.e. the healthy case with no hydrocephalus. This had been done numerically by reconstructing the ventricular system geometry from the MRI scans and then made a 15 o degree cut in the surgical line to obtain the outlines of the 2-D plane. The healthy cases were solved for the CSF actual flow rate, which is between 100-500 ml/day in 100 incremental steps. The unhealthy cases were studied for the average flow rate, which is 300 ml/day but for blockage ratios of the Foramen diameter of 20%, 50% and 75%. These obstructions are designed to simulate the hydrocephalus. The results show that as the flow rate increases the pressure and the velocity values increases, but no changes in the flow pattern occurs. The maximum pressure on the normal cases occurred in the lateral ventricles and the maximum velocity occurred in the aqueduct neck. The results of the hydrocephalus cases show that as the obstruction degree increases the pressure in the lateral ventricle increases accompanied with a velocity increase in the obstructed Foramen, which may cause unwanted stress on the neighboring tissues. (author)

  18. Tromboembolismo pulmonar masivo de alto riesgo asociado a foramen oval permeable High-risk massive pulmonary thromboembolism associated with patent foramen ovale

    Directory of Open Access Journals (Sweden)

    Antonio Miranda

    2012-04-01

    Full Text Available La alta mortalidad de los pacientes con tromboembolismo pulmonar masivo de alto riesgo amerita un enfoque terapéutico enérgico e invasivo que incluya la embolectomía pulmonar quirúrgica en aquellos pacientes con contraindicación para trombolisis o trombolisis fallida. Describimos un caso de tromboembolismo pulmonar masivo de alto riesgo que recibió tratamiento quirúrgico en vez de trombolisis debido a que al momento del diagnóstico presentaba un trombo móvil a través de un foramen oval permeable con altísima posibilidad de embolismo paradójico arterial.High mortality rate associated with massive pulmonary embolism requires an aggressive invasive approach including surgical pulmonary embolectomy when thrombolytic therapy has failed or is contraindicated. We describe a case of high-risk massive pulmonary embolism who underwent surgical treatment due to the presence of a mobile intracardiac clot in a patent foramen ovale, and the possible risk of paradoxical arterial embolism.

  19. Quality of life after percutaneous closure of patent foramen ovale in patients after cryptogenic stroke compared to a normative sample.

    Science.gov (United States)

    Mirzada, Naqibullah; Ladenvall, Per; Hansson, Per-Olof; Eriksson, Peter; Taft, Charles; Dellborg, Mikael

    2018-04-15

    Despite the widespread use of percutaneous closure of patent foramen ovale (PFO) in patients after a cryptogenic stroke, little is known about its impact on health-related quality of life (HRQoL). The aim of this study was to assess HRQoL in these patients compared to PFO patients not considered candidates for percutaneous closure, and to a normal population. A total of 402 patients with cryptogenic stroke or transient ischaemic attack (TIA) who had been referred to our center for PFO closure were invited to a long-term clinical follow-up (mean follow-up 5.5 years; range 3-13 years). HRQoL was assessed using the SF-36 Health Survey and data were compared with an age- and gender-matched reference group from the Swedish SF-36 normative database. Fifteen patients had died and 43 did not answer the SF-36. Of the remaining 344 patients, 208 had undergone PFO closure, and 136 had not. The closure group and reference group reported similar HRQoL levels. However, the non-closure group showed significantly lower HRQoL in role limitation - physical, vitality, general health, mental health (p < 0.05) and social functioning (p = 0.05) than the reference group and also had significantly lower scores than the closure group, correcting for age differences, on physical functioning, role limitation - physical, vitality and general health (p < 0.05). Non-closure patients had lower HRQoL than their counterparts in the normal population and the closure group. Percutaneous PFO closure is associated with a favorable quality of life. Copyright © 2018 Elsevier B.V. All rights reserved.

  20. KNOW-BLADE Task-2 report: Aerodynamic accessories

    DEFF Research Database (Denmark)

    Johansen, J.; Sørensen, Niels N.; Zahle, Frederik

    2004-01-01

    In the EC project KNOW-BLADE a work package has been defined to investigate the possibility to numerically model aerodynamic accessories in existing Navier-Stokes solvers. Four different aerodynamic accessories have been investigated. Firstly, thepotential of applying active flow control by means...... of the stall strip. Finally, the effect of surface roughness was modelled by either modifying the boundary condition of the turbulence model or by modifying the airfoil geometry. Using the roughness model gave relatively good agreement withmeasurements and it must be concluded that the effect of using...... to increase the oscillation amplitude, which is not very attractive for load control on wind turbines. Secondly, the effect of vortex generators hasbeen modelled using two phenomenological vortex generator models. The models have been applied to three airfoil configurations. For all cases investigated...

  1. Spinal accessory nerve schwannomas masquerading as a fourth ventricular lesion

    Directory of Open Access Journals (Sweden)

    Shyam Sundar Krishnan

    2015-01-01

    Full Text Available Schwannomas are benign lesions that arise from the nerve sheath of cranial nerves. The most common schwannomas arise from the 8 th cranial nerve (the vestibulo-cochlear nerve followed by trigeminal and facial nerves and then from glossopharyngeal, vagus, and spinal accessory nerves. Schwannomas involving the oculomotor, trochlear, abducens and hypoglossal nerves are very rare. We report a very unusual spinal accessory nerve schwannoma which occupied the fourth ventricle and extended inferiorly to the upper cervical canal. The radiological features have been detailed. The diagnostic dilemma was due to its midline posterior location mimicking a fourth ventricular lesion like medulloblastoma and ependymoma. Total excision is the ideal treatment for these tumors. A brief review of literature with tabulations of the variants has been listed.

  2. Accessory hepatic lobe simulating a left hemidiaphragmatic tumor

    International Nuclear Information System (INIS)

    Kuroiwa, Toshiro; Hirata, Hitoshi; Iwashita, Akinori; Yasumori, Kotaro; Mogami, Hiroshi; Teraoka, Hiroaki

    1984-01-01

    A 72-year-old woman with a 20-year history of neuralgia was confirmed at surgery to have a tumor in the left hemidiaphragmatic region which was connected with the left lobe of the liver. Reassessment of radiological diagnosis after surgery revealed that hepatobiliary scintigraphy and computed tomography using left anterior oblique scanning are useful in differentiating the accessory hepatic lobe of the liver from a tumor and in confirming the diagnosis, respectively. (Namekawa, K.)

  3. Headgear Accessories Classification Using an Overhead Depth Sensor

    Directory of Open Access Journals (Sweden)

    Carlos A. Luna

    2017-08-01

    Full Text Available In this paper, we address the generation of semantic labels describing the headgear accessories carried out by people in a scene under surveillance, only using depth information obtained from a Time-of-Flight (ToF camera placed in an overhead position. We propose a new method for headgear accessories classification based on the design of a robust processing strategy that includes the estimation of a meaningful feature vector that provides the relevant information about the people’s head and shoulder areas. This paper includes a detailed description of the proposed algorithmic approach, and the results obtained in tests with persons with and without headgear accessories, and with different types of hats and caps. In order to evaluate the proposal, a wide experimental validation has been carried out on a fully labeled database (that has been made available to the scientific community, including a broad variety of people and headgear accessories. For the validation, three different levels of detail have been defined, considering a different number of classes: the first level only includes two classes (hat/cap, and no hat/cap, the second one considers three classes (hat, cap and no hat/cap, and the last one includes the full class set with the five classes (no hat/cap, cap, small size hat, medium size hat, and large size hat. The achieved performance is satisfactory in every case: the average classification rates for the first level reaches 95.25%, for the second one is 92.34%, and for the full class set equals 84.60%. In addition, the online stage processing time is 5.75 ms per frame in a standard PC, thus allowing for real-time operation.

  4. Improving the supply chain agility of a fashion accessories company

    OpenAIRE

    Rosenlund, Kristian

    2015-01-01

    This thesis aims to improve the supply chain agility of a case company that is engaged in the design, development and worldwide marketing and selling of fashion accessories and design services. This thesis explores agility in context of supply chain management and in fashion industry where the typical challenges are that demand is highly volatile and hard to predict, the number of products per sales season is large and products have a fairly short life-cycles. In this study, the research ...

  5. Clinical Experiences in the Surgical Treatment of Accessory Tragus

    Directory of Open Access Journals (Sweden)

    Uğur Horoz

    2016-09-01

    Full Text Available Objective: Tragus is a part of the external ear that develops from the first branchial arch. Accessory ear is a congenital external ear anomaly and has skin elevation containing remnant cartilage. The auricle develops between the 4th and 12th week of the embryonic stage, which groove the tissue from the 1st and 2nd branchial arches. Histologically, the lesions include a rugated epidermis with a thin layer stratum corneum, tiny mature hair follicles, fat lobules, and connective tissue framework that may include a central cartilage core. The aim of this study was to evaluate the accessory tragus lesions with our clinical surgical treatment results. Material and Methods: Lesions usually located anterior to the tragus and along an imaginary line drawn from the tragus to the angle of the mouth. Twelve patients admitted to our clinic between October 2011 and November 2014 were included in this study. Results: Seven boys and five girls between two–13 years old underwent operation. In total, 28 accessory ears were excised. No complications were observed during the procedure, and no complaints were noted in the postoperative period. Conclusion: Generally, limited anomaly is associated with the first and second branchial arch anomalies. Surgical excision is the standard treatment for the lesions which usually due to the esthetic concerns.

  6. Correction of accessory axillary breast tissue without visible scar.

    Science.gov (United States)

    Kim, Young Soo

    2004-01-01

    Various methods for correction of accessory axillary breast tissue have been proposed, including simple excision, diamond-shaped excision, a Y-V technique, and lipoplasty. We present an effective method for correction of a prominent axillary mound that combines lipoplasty with excision of accessory breast tissue along the axillary transverse line. Preoperative markings included an incision within the natural wrinkle line in the axillary fold, and demarcation of areas in which lipoplasty and excision were to be performed. After lipoplasty, deep dissection was performed to isolate and remove accessory breast tissue and excess fat tissue. A compression dressing was applied for 1 to 2 weeks postoperatively, and the patient was instructed to wear a sports bra for 1 to 2 months after removal of the dressing. We treated 7 patients using this procedure between October 1999 and March 2003. No major postoperative complications were detected and recurrence was not noted during the follow-up periods. Aesthetic results were satisfactory. We believe that a procedure that combines lipoplasty and excision provides numerous advantages as a surgical option in treating a prominent axillary mound. The main advantage is that the final scar is laid in the natural axillary fold, rendering scars less conspicuous and eliminating the need to remove excess skin. The one disadvantage was that elevation of the skin flap via small, remote incisions initially produced surgical difficulties, but these were overcome with experience.

  7. Partial discharge testing of in-situ power cable accessories

    Energy Technology Data Exchange (ETDEWEB)

    Orban, H. E.

    2002-07-01

    An overview of commercially available diagnostic methods for in-situ power cable accessories is given and relevant field experiences with these diagnostics are described. The discussion includes both PILC and polymeric insulated cables. Two major types of degradation are most frequently involved in cable systems. One is an overall condition caused by chemical aging and /or water treeing. Diagnostics for this type of aging include dissipation factor (loss angle), harmonic analysis, return voltage, isothermal relaxation current, dielectric response, or dc leakage current. The second type of degradation is discrete or incremental; condition assessment utilizes dissipation factor measurements or partial discharge (PD) level measurements. The focus in this paper is on PD diagnostics, especially off-line methods such as the 60 Hz test, the combined AC and VLF diagnostic, and the oscillating wave test system test. Among on-line diagnostics, ultrasonic detection of partial discharge and measurement of partial discharge by installing direct, capacitive or inductive couplers near cable accessories, are described. Overall, partial discharge detection and location in cable accessories is considered inadequate, since interpretation of results is difficult due to the number of variables involved. 28 refs., 1 tab.

  8. Achondroplasia in children: correlation of ventriculomegaly, size of foramen magnum and jugular foramina, and emissary vein enlargement.

    Science.gov (United States)

    Bosemani, Thangamadhan; Orman, Gunes; Hergan, Benedikt; Carson, Kathryn A; Huisman, Thierry A G M; Poretti, Andrea

    2015-01-01

    Achondroplasia is a skeletal dysplasia with diminished growth of the skull base secondary to defective enchondral bone formation. This leads to narrowing of the foramen magnum and jugular foramina, which further leads to ventricular dilatation and prominence of the emissary veins. The primary goal of our study was to determine a correlation between the degree of ventricular dilatation, jugular foramina and foramen magnum narrowing, as well as emissary vein enlargement. Conventional T2-weighted MR images were evaluated for surface area of the foramen magnum and jugular foramina, ventricular dilatation, and emissary veins enlargement in 16 achondroplasia patients and 16 age-matched controls. Ratios were calculated for the individual parameters using median values from age-matched control groups to avoid age as a confounder. Compared to age-matched controls, in children with achondroplasia, the surface area of the foramen magnum (median 0.50 cm(2), range 0.23-1.37 cm(2) vs. 3.14 cm(2), 1.83-6.68 cm(2), p achondroplasia, (1) the variation in ventricular dilatation may be related to an unquantifiable interdependent relationship of emissary vein enlargement, venous channel narrowing, and foramen magnum compression and (2) stable ventricular size facilitated by interdependent factors likely obviates the need for ventricular shunt placement.

  9. Endoscopic biopsy of foramen of Monro and third ventricle lesions guided by frameless neuronavigation: usefulness and limitations.

    Science.gov (United States)

    Prat, Ricardo; Galeano, Inmaculada

    2009-09-01

    To describe our institution experience regarding the usefulness and limitations of frameless neuronavigation in the endoscopic biopsy of foramen of Monro and third ventricle lesions. We report our experience with 22 patients harbouring intraventricular lesions located in the region of the foramen of Monro or the third ventricle who underwent endoscopic biopsy guided by the neuronavigation system. Nine lesions were located on the posterior aspect of the third ventricle or at the pineal region, and thirteen lesions were located at the foramen of Monro or anterior third ventricle region. The endoscopes were introduced via an operating sheath, which had previously been inserted with a trocar under neuronavigational control. After approaching the foramen of Monro from the planned angle, surgery was continued under direct visualisation until the lesion was reached, if it was located on the third ventricle. In cases where the lesion was located at the foramen of Monro, an excellent view of the lesion was obtained and neuronavigation was used to determine the location of critical areas. Histological examination of biopsy specimens obtained endoscopically was diagnostic in all cases. Open surgery following endoscopic biopsy was only needed in 1 patient out of 22. In our experience, image-guided neuroendoscopy can improve the accuracy of the endoscopic approach, minimising brain trauma. It can be particularly helpful when performing a brain biopsy in the absence of clear intraventricular landmarks or in the event of adverse visual conditions such as intraventricular bleeding.

  10. Radiographic and computed tomographic features of caval foramen hernias of the liver in 7 dogs: mimicking lung nodules.

    Science.gov (United States)

    Kim, Jaehwan; Kim, Soyoung; Jo, Jieun; Lee, Seungjun; Eom, Kidong

    2016-12-01

    This study describes the imaging features and characteristics of caval foramen hernias in 7 dogs diagnosed by computed tomography (CT). On lateral radiographs, 6 of 7 dogs showed dome-shaped, broad-based, caudal mediastinal lesions. CT findings included caudal vena cava (CVC) compression (n=7), right lateral (n=6) or medial (n=1) liver lobe involvement, hepatic vein dilation (n=5) and biliary tract involvement (n=1) with partial (n=6) or entire (n=1) liver lobe hernias. A caval foramen hernia should be part of the differential diagnosis when the aforementioned imaging features are detected. CT is considered as a useful tool for diagnosis and evaluation in dogs with a caval foramen hernia.

  11. Computed tomography in the foramen magnum and high cervical cord lesion

    Energy Technology Data Exchange (ETDEWEB)

    Isu, T.; Ito, T.; Iwasaki, Y.; Tsuru, M. (Hokkaido Univ., Sapporo (Japan). School of Medicine); Kitaoka, K.

    1981-10-01

    The value of computed tomography in the spine and spinal cord disease recently has been well documented. However, little attention is made to the role of computed tomography in foramen magnum and high cervical cord lesion. We report 16 cases of the foramen magnum and high cervical cord lesion. Method: Either EMI Head Scanner, CT 1010 (slice thickness 10 mm) or EMI Whole Body Scanner, CT 5005 (slice thickness 13 mm) was used. In 9 cases enhanced CT with intravenous injection of contrast medium was performed. Eleven cases received intrathecal injection of metrizamide. Materials: 1) control group without cervical pathology 70 cases, 2) spinal cord tumor 6 cases, 3) atlanto-axial dislocation 6 cases, 4) Chiari malformation (type 1) 3 cases, 5) spinal foreign body (acupuncture needle) 1 case. Results: 1. plain CT. 1) In control group without cervical pathology the cervical cord at C/sub 1/ level was seen as area surrounded by ring of subarachnoid space. 2) In 14 cases except for 1 case of atlanto-axial dislocation and 1 case of spinal foreign body identification of the cervical cord at C/sub 1/ level was impossible. 3) CT was of diagnostic value in detecting altanto-axial dislocation and spinal foreign body. 2. enhanded CT. Meningioma and neurinoma showed positive contrast enhancement. However, astrocytoma and herniated cerebellar tonsils were not detectable. 3. CT metrizamide myelography visualized the subarachnoid space and made it possible to localize the lesion in the spinal canal in relation to the spinal cord. Conclusion: Attention should be given to plain CT finding at C/sub 1/ level in diagnosis of foramen magnum and high cervical cord lesion. If identification of cervical cord at C/sub 1/ level is impossible, it is suspected that subarachnoid space is blocked by the lesion, and enhanced CT and CT metrizamide myelography must be performed.

  12. ILEAL HERNIATION THROUGH THE FORAMEN OF WINSLOW: OVEREATING AS A RISK FACTOR FOR INTERNAL HERNIATION.

    Science.gov (United States)

    Kirigin, Lora Stanka; Nikolić, Marko; Kruljac, Ivan; Marjan, Domagoj; Penavić, Ivan; Ljubicić, Neven; Budimir, Ivan; Vrkljan, Milan

    2016-03-01

    Internal hernias have an overall incidence of less than 1% and are difficult to diagnose clinically due to their nonspecific presentation. Most internal hernias present as strangulating closed-loop obstruction and delay in surgical intervention is responsible for a high mortality rate (49%). We present a case of ileal herniation through the foramen of Winslow. A 29-year-old previously healthy female presented with acute onset right upper quadrant pain, abdominal fullness, and nausea. The pain was sudden in onset and began shortly after a dinner party where she consumed larger portions of food. Laboratory investigations revealed mild leukocytosis with left shift. Dual-phase multi-detector computed tomography disclosed herniation of the small bowel into the lesser sac. The patient underwent an emergency median laparotomy that revealed ileal herniation through the foramen of Winslow. Adhesiolysis and manual reduction of the bowel was performed, and the reduced bowel showed only congestive changes. The postoperative recovery was uneventful and the patient was discharged on the third postoperative day. Risk factors for internal herniation still remain unclear, although excessively mobile bowel loops and an enlarged foramen of Winslow have been described. Our case demonstrated that overeating could be an additional risk factor for internal herniation. We describe our clinical and radiology findings, as well as surgical management. Due to the high rates of morbidity and mortality, it is imperative that clinicians be aware of the possible risks factors for internal herniation. Internal hernias should be included in the differential diagnosis of small bowel obstruction so that appropriate steps can be made in the work-up of these patients, followed by timely surgical intervention.

  13. Development of a new laparoscopic Foramen Epiploicum Mesh Closure (FEMC) technique in 6 horses.

    Science.gov (United States)

    van Bergen, T; Wiemer, P; Bosseler, L; Ugahary, F; Martens, A

    2016-05-01

    Epiploic foramen entrapment (EFE) is, based on the number of reports in the literature, a relatively important life-threatening cause of colic in horses that could be prevented by closing the epiploic foramen (EF) in horses at risk of developing EFE. To describe the laparoscopic foramen epiploicum mesh closure (FEMC) technique and its outcome. Descriptive experimental study. The EF of 6 horses was closed with the FEMC technique. A diabolo-shaped constructed mesh was introduced into the omental vestibule through the EF under laparoscopic visualisation in the standing sedated horse. Clinical and laboratory parameters were recorded during the post operative period. Four weeks after the intervention, repeat laparoscopy was performed in all horses. Three horses were subjected to euthanasia one, 2 and 3 months after the intervention, and were examined on necropsy and histopathology. The remaining 3 horses were followed clinically for 6 months. The 6 FEMC procedures were performed successfully in a median surgery time of 22 min (range 18-27 min). One horse was treated for large colon impaction in the immediate post operative period. On repeat laparoscopy at 4 weeks all 6 EFs were closed and no undesired adhesions were identified. This was confirmed on gross and histopathological examination of the 3 horses that were subjected to euthanasia. The 3 remaining horses were clinically normal in the 6-month post operative observation period. This FEMC technique provides a fast, simple, reliable and safe procedure to obliterate the EF and may be useful in horses at risk for EFE. © 2015 EVJ Ltd.

  14. Patent foramen ovale and the risk of ischemic stroke in a multiethnic population.

    Science.gov (United States)

    Di Tullio, Marco R; Sacco, Ralph L; Sciacca, Robert R; Jin, Zhezhen; Homma, Shunichi

    2007-02-20

    We sought to assess the risk of ischemic stroke from a patent foramen ovale (PFO) in the multiethnic prospective cohort of northern Manhattan. Patent foramen ovale has been associated with increased risk of ischemic stroke, mainly in case-control studies. The actual PFO-related stroke risk in the general population is unclear. The presence of PFO was assessed at baseline by using transthoracic 2-dimensional echocardiography with contrast injection in 1,100 stroke-free subjects older than 39 years of age (mean age 68.7 +/- 10.0 years) from the Northern Manhattan Study (NOMAS). The presence of atrial septal aneurysm (ASA) also was recorded. Subjects were followed annually for outcomes. We assessed PFO/ASA-related stroke risk after adjusting for established stroke risk factors. We detected PFO in 164 subjects (14.9%); ASA was present in 27 subjects (2.5%) and associated with PFO in 19 subjects. During a mean follow-up of 79.7 +/- 28.0 months, an ischemic stroke occurred in 68 subjects (6.2%). After adjustment for demographics and risk factors, PFO was not found to be significantly associated with stroke (hazard ratio 1.64, 95% confidence interval [CI] 0.87 to 3.09). The same trend was observed in all age, gender, and race-ethnic subgroups. The coexistence of PFO and ASA did not increase the stroke risk (adjusted hazard ratio 1.25, 95% CI 0.17 to 9.24). Isolated ASA was associated with elevated stroke incidence (2 of 8, or 25%; adjusted hazard ratio 3.66, 95% CI 0.88 to 15.30). Patent foramen ovale, alone or together with ASA, was not associated with an increased stroke risk in this multiethnic cohort. The independent role of ASA needs further assessment in appositely designed and powered studies.

  15. Computed tomography in the foramen magnum and high cervical cord lesion

    International Nuclear Information System (INIS)

    Isu, Toyohiko; Ito, Terufumi; Iwasaki, Yoshnobu; Tsuru, Mitsuo; Kitaoka, Kenichi.

    1981-01-01

    The value of computed tomography in the spine and spinal cord disease recently has been well documented. However, little attention is made to the role of computed tomography in foramen magnum and high cervical cord lesion. We report 16 cases of the foramen magnum and high cervical cord lesion. Method: Either EMI Head Scanner, CT 1010 (slice thickness 10 mm) or EMI Whole Body Scanner, CT 5005 (slice thickness 13 mm) was used. In 9 cases enhanced CT with intravenous injection of contrast medium was performed. Eleven cases received intrathecal injection of metrizamide. Materials: 1) control group without cervical pathology 70 cases, 2) spinal cord tumor 6 cases, 3) atlanto-axial dislocation 6 cases, 4) Chiari malformation (type 1) 3 cases, 5) spinal foreign body (acupuncture needle) 1 case. Results: 1. plain CT. 1) In control group without cervical pathology the cervical cord at C 1 level was seen as area surrounded by ring of subarachnoid space. 2) In 14 cases except for 1 case of atlanto-axial dislocation and 1 case of spinal foreign body identification of the cervical cord at C 1 level was impossible. 3) CT was of diagnostic value in detecting altanto-axial dislocation and spinal foreign body. 2. enhanded CT. Meningioma and neurinoma showed positive contrast enhancement. However, astrocytoma and herniated cerebellar tonsils were not detectable. 3. CT metrizamide myelography visualized the subarachnoid space and made it possible to localize the lesion in the spinal canal in relation to the spinal cord. Conclusion: Attention should be given to plain CT finding at C 1 level in diagnosis of foramen magnum and high cervical cord lesion. If identification of cervical cord at C 1 level is impossible, it is suspected that subarachnoid space is blocked by the lesion, and enhanced CT and CT metrizamide myelography must be performed. (author)

  16. Accessory spleen presenting as acute abdomen: A case report and operative management

    Directory of Open Access Journals (Sweden)

    A. Landmann

    2016-09-01

    Full Text Available Accessory spleens are found in 10–30% of patients and are asymptomatic. Rarely, torsion of an accessory spleen can cause abdominal pain and acute abdomen. We present the case of an 8-year-old girl who arrives to the emergency room with left upper quadrant abdominal pain. CT scan revealed a non-enhancing soft tissue mass and multiple small splenules. Laparoscopy revealed a torsed accessory spleen and malrotation. Accessory spleen is a common congenital anomaly that is frequently asymptomatic. Rarely, an accessory spleen may become torsed around its vascular pedicle resulting in severe abdominal pain. Treatment is surgical resection. Torsion of accessory splenic tissue is a rare cause of acute abdomen in pediatric patients.

  17. Threading the Needle: Intrapelvic Displacement of a Femoral Neck Fracture through the Obturator Foramen

    Directory of Open Access Journals (Sweden)

    Gautham Prabhakar

    2018-01-01

    Full Text Available Despite timely and appropriate management, displaced femoral neck fractures are often devastating injuries for the young patient. The risk of negative sequelae is further amplified with increasing displacement and vertical fracture patterns. Open anatomic reduction with rigid internal fixation is essential to maximize the healing potential in displaced fractures of the femoral neck. Successful primary osteosynthesis of significantly displaced femoral neck fractures in the young patient has been reported in the literature. We present a unique case of open reduction and internal fixation of a high-energy femoral neck fracture with extrusion of the head through the obturator foramen into the pelvis without associated acetabular or pelvic injury.

  18. Correlation or causation: untangling the relationship between patent foramen ovale and migraine.

    Science.gov (United States)

    Adler, Eric; Love, Barry; Giovannone, Steve; Volpicelli, Frank; Goldman, Martin E

    2007-03-01

    Observational evidence from the literature has shown an association between migraine headaches and patent foramen ovale (PFO). This observation has led to hypotheses that could explain the etiology of migraines in those with a PFO, including right-to-left shunting of venous agents such as serotonin that are normally broken down in the pulmonary circulation. Further evidence suggests that closure of a PFO may improve migraine symptoms and serve as an effective treatment modality for migraines. Several randomized controlled double-blinded studies are underway that will more definitively establish the role of specific devices in PFO closure in those suffering from migraines.

  19. Spectral Doppler interrogation of the patent foramen ovale-a window to left heart hemodynamics.

    Science.gov (United States)

    Fadel, Bahaa M; Husain, Aysha; Bakarman, Hatem; Dahdouh, Ziad; Salvo, Giovanni Di; Mohty, Dania

    2015-02-01

    Spectral Doppler interrogation of flow across a patent foramen ovale (PFO) allows recording of the instantaneous pressure gradient between left and right atrium (RA). The assessment of RA pressure using the size and collapsibility of the inferior vena cava would thus allow estimation of left atrial (LA) pressure. In this article, we illustrate the value of spectral Doppler interrogation of flow across the PFO by transthoracic echocardiography as a novel and simple tool for the assessment of LA pressure and left cardiac hemodynamics in addition to the conventional noninvasive parameters. © 2014, Wiley Periodicals, Inc.

  20. Non-obstructive carotid atherosclerosis and patent foramen ovale in young adults with cryptogenic stroke.

    Science.gov (United States)

    Jaffre, A; Guidolin, B; Ruidavets, J-B; Nasr, N; Larrue, V

    2017-05-01

    Up to 50% of ischaemic strokes in young adults are classified as cryptogenic despite extensive work-up. We sought to evaluate the prevalence of non-obstructive carotid atherosclerosis (NOCA) and its association with patent foramen ovale (PFO) in young adults with cryptogenic stroke (CS). Patients aged 18-54 years, consecutively treated for first-ever CS in an academic stroke service, were included. NOCA was assessed using carotid ultrasound examination and was defined as carotid plaque with young adults with CS. NOCA is negatively associated with PFO. Detecting NOCA is an important component of stroke investigation in young adults. © 2017 EAN.

  1. A 51-year-old man with intramedullary spinal cord abscess having a patent foramen ovale

    Science.gov (United States)

    Higuchi, Kanako; Ishihara, Hiroyuki; Okuda, Shiho; Kanda, Fumio

    2011-01-01

    The authors report a case of a 51-year-old man with intramedullary spinal cord abscess (ISCA) having a patent foramen ovale (PFO). He developed fever and tetraplegia after a recent dental treatment. MRI showed ISCA with longitudinal swelling from the upper cervical to the lumbar spinal cord. Cerebrospinal fluid (CSF) analysis indicated bacterial meningitis, and the culture of CSF revealed Streptococcus viridans. Transoesophageal echocardiography revealed the existence of a PFO. We suspected another possibility other than systemic bacteraemia, that paradoxical bacteric embolisation through PFO after the dental treatment caused ISCA. While several reports of brain abscess with PFO are available, this is the first report of ISCA with PFO. PMID:22696715

  2. Accuracy of five electronic foramen locators with different operating systems: an ex vivo study.

    Science.gov (United States)

    Vasconcelos, Bruno Carvalho de; Bueno, Michelli de Medeiros; Luna-Cruz, Suyane Maria; Duarte, Marco Antonio Hungaro; Fernandes, Carlos Augusto de Oliveira

    2013-01-01

    The aim of this study was to evaluate, ex vivo, the precision of five electronic root canal length measurement devices (ERCLMDs) with different operating systems: the Root ZX, Mini Apex Locator, Propex II, iPex, and RomiApex A-15, and the possible influence of the positioning of the instrument tips short of the apical foramen. Forty-two mandibular bicuspids had their real canal lengths (RL) previously determined. Electronic measurements were performed 1.0 mm short of the apical foramen (-1.0), followed by measurements at the apical foramen (0.0). The data resulting from the comparison of the ERCLMD measurements and the RL were evaluated by the Wilcoxon and Friedman tests at a significance level of 5%. Considering the measurements performed at 0.0 and -1.0, the precision rates for the ERCLMDs were: 73.5% and 47.1% (Root ZX), 73.5% and 55.9% (Mini Apex Locator), 67.6% and 41.1% (Propex II), 61.7% and 44.1% (iPex), and 79.4% and 44.1% (RomiApex A-15), respectively, considering ±0.5 mm of tolerance. Regarding the mean discrepancies, no differences were observed at 0.0; however, in the measurements at -1.0, the iPex, a multi-frequency ERCLMD, had significantly more discrepant readings short of the apical foramen than the other devices, except for the Propex II, which had intermediate results. When the ERCLMDs measurements at -1.0 were compared with those at 0.0, the Propex II, iPex and RomiApex A-15 presented significantly higher discrepancies in their readings. Under the conditions of the present study, all the ERCLMDs provided acceptable measurements at the 0.0 position. However, at the -1.0 position, the ERCLMDs had a lower precision, with statistically significant differences for the Propex II, iPex, and RomiApex A-15.

  3. Foramen ovale electrodes in the evaluation of epilepsy surgery: conventional and unconventional uses.

    Science.gov (United States)

    Karakis, Ioannis; Velez-Ruiz, Naymee; Pathmanathan, Jay S; Sheth, Sameer A; Eskandar, Emad N; Cole, Andrew J

    2011-10-01

    Foramen ovale (FO) electrodes have been used in the evaluation of epilepsy surgery for more than 25 years. Their traditional application was in patients with mesial temporal lobe epilepsy. Due in part to advances in neuroimaging, their use has declined. We describe our cumulative experience with FO electrodes and use examples to illustrate a range of indications for FO recordings that extend beyond their conventional utility for mesial temporal lobe cases. We also summarize the pros and cons of FO electrodes implantation and attempt to reestablish their utility in presurgical evaluation. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Morphologic and Morphometric Analysis of Lingula in Localizing Mandibular Foramen with its Surgical Importance

    Directory of Open Access Journals (Sweden)

    Phalguni Srimani

    2017-10-01

    Full Text Available Introduction: Morphologic and morphometric evaluation of mandible is clinically important. Considering the close relationship of lingula with neurovascular structures entering through mandibular foramen, lingula is often used as an important bony landmark during oral and maxillofacial surgical approach and inferior alveolar nerve block anaesthesia. Inadequate anatomical knowledge may result various intra operative complications like haemorrhge, fractures and nerve injury. Also, structural variations of lingula followed by inaccurate localization of mandibular foramen have been implicated as causative factor for unsuccessful inferior alveolar nerve block anaesthesia. Aim: To determine morphological and morphometric variations related to lingula of mandible in localizing mandibular foramen and to compare the results with similar type of osteological studies performed earlier on different population group. Materials and Methods: The study was performed on 36 adult dry human mandibles on both sides to categorize lingula according to its various shapes and determine the location of lingula based on surrounding mandibular landmarks by using Vernier caliper as 5 distances from tip of lingula as follows: i to anterior border of ramus of mandible; ii to posterior border of ramus of mandible; iii to centre of mandibular notch; iv to the alveolar socket of second molar tooth; and v to the base of mandible. The present study also indicated bilingual distance between tips of lingula of both sides. Data collected were analyzed statistically. Results: The most common shape of lingula was observed as triangular (51.39% followed by truncated (23.61%, then nodular (20.83% and assimilated (4.17% as least prevalent type. The average distances of tip of lingula from anterior and posterior borders of ramus of mandible were 18.21±1.50 mm and 16.33±1.21 mm respectively. On average, the tip of lingula was situated at 18.17±1.51 mm, 33.40±2.11 mm and 32.07±2.68 mm

  5. Isolated brain metastases of osteosarcoma in a patient presenting with a patent foramen ovale

    International Nuclear Information System (INIS)

    Menassa, L.; Haddad, S.; Aoun, N.; Slaba, S.; Atallah, N.

    1997-01-01

    We report the case of a patient in whom brain MR imaging was requested for initial symptoms of intracranial hypertension. The presence of multiple intracranial hemorrhagic lesions suggested brain metastases. Body screening showed periosteal osteosarcoma of the left fibula with no lung metastases, but with a patent foramen ovale which probably allowed neoplastic cells to reach the brain without being filtered through the lungs. The conclusion of this study was that a left-right cardiac communication is to be considered in cases of isolated brain metastases from osteosarcoma. (orig.). With 3 figs

  6. Multidetector computed tomography diagnosis of gastric volvulus through the foramen of Morgagni.

    Science.gov (United States)

    Lecouvet, S; Coulier, B; Pierard, F; Gogoase, M; Coppens, J P; Van Hoof, M

    2014-01-01

    Morgagni hernia is considered to be the rarest form of all diaphragmatic hernias. It develops through a congenital defect in the retrosternal area. Usually asymptomatic, this entity can lead to life-threatening complications such as incarceration, strangulation or volvulus of the herniated viscus. We hereby report a rare case of organoaxial gastric volvulus producing through the foramen of Morgagni in a 78-year-old woman. The full diagnosis was made by upper gastro-intestinal series and multidetector computed tomography (MDCT). The basic anatomy, physiopathology, diagnostic methods, complications and surgical treatment of Morgagni hernia are briefly reviewed.

  7. A rare nasal cavity mass in a child: Accessory middle turbinate

    OpenAIRE

    Chang, Andrew; Ulualp, Seckin O; Koral, Korgun; Veling, Maria

    2016-01-01

    Objectives: The accessory middle turbinate, a rare anatomical variation of the nasal cavity, have been systematically studied in adults. Presence of accessory middle turbinate and its clinical significance in a child has not been reported. We describe clinical appearance and radiologic features of accessory middle turbinate in a child. Methods: Retrospective chart review. Results: A 3-year-old boy presented to the otolaryngology clinic for evaluation of recurrent epistaxis. Anterior rhinoscop...

  8. Snapping wrist due to multiple accessory tendon of first extensor compartment

    Directory of Open Access Journals (Sweden)

    S. Dhiyaneswaran Subramaniyam

    2018-01-01

    Conclusion: There are various causes for snapping wrist syndrome. Multiple accessory tendon can also cause snapping as shown in this case report. Moreover am presenting this case to highlight the diagnostic failure with non dynamic radiological investigation and to consider multiple accessory tendon as differential diagnosis for snapping wrist syndrome. Also suggest dynamic study could be a better choice of investigation to diagnosis snapping syndrome. First compartment tunnel release with few accessory tendon slip tenotomy gives good result.

  9. Torsion of the accessory spleen with infarction : CT features in a case report

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Jung Kyung; Lee, Jun Sik; Kim, Mee Eun; Pyun, Hae Wook; Lee, Il Gi; Lee, Jong Gil; Kim, Hee Jin; Kim, Ik Su [Fatima Hospital, Taegu (Korea, Republic of)

    2000-05-01

    Torsion of the accessory spleen is a rare entity that can have variable clinical presentations. We report case involving an 11-year-old boy with severe abdominal pain and a mass that was found to be due to infarction of the accessory spleen, which was twisted on its pedicle. CT revealed a low-attenuating mass with peripheral inflammatory changes in the left upper abdomen. The mass was pathologically confirmed as torsion of the accessory spleen with infarction. (author)

  10. Radiographic and computed tomographic features of caval foramen hernias of the liver in 7 dogs: mimicking lung nodules

    OpenAIRE

    KIM, Jaehwan; KIM, Soyoung; JO, Jieun; LEE, Seungjun; EOM, Kidong

    2016-01-01

    This study describes the imaging features and characteristics of caval foramen hernias in 7 dogs diagnosed by computed tomography (CT). On lateral radiographs, 6 of 7 dogs showed dome-shaped, broad-based, caudal mediastinal lesions. CT findings included caudal vena cava (CVC) compression (n=7), right lateral (n=6) or medial (n=1) liver lobe involvement, hepatic vein dilation (n=5) and biliary tract involvement (n=1) with partial (n=6) or entire (n=1) liver lobe hernias. A caval foramen hernia...

  11. Role of the Accessory Parotid Gland in the Etiology of Parotitis: Statistical Analysis of Sialographic Features.

    Science.gov (United States)

    Zhu, Wangyong; Hu, Fengchun; Liu, Xingguang; Guo, Songcan; Tao, Qian

    2016-01-01

    This retrospective study aimed to identify if the existence of the accessory parotid gland correlated with the etiology of parotitis. This may aid the development of better treatment strategies in the future. Sialographic features of cases with parotitis and healthy subjects were reviewed. The chi-square test was used to compare the incidence of accessory parotid gland between the groups. The Student's t test was used to compare the length of Stensen's duct, the length from the orifice to the confluence of the accessory duct, and the angle between the accessory duct and Stensen's duct between the groups. The incidence of accessory parotid gland in patients with parotitis was 71.8% (28/39), which was significantly higher than that in healthy subjects (P = 0.005). Patients with parotitis had a longer Stensen's duct than healthy subjects (P = 0.003). There was no significant difference in the length from the orifice to the confluence of the accessory duct or the angle between the accessory duct and Stensen's duct (P = 0.136 and 0.511, respectively) between the groups. The accessory parotid gland might play a role in the pathogenesis of parotitis. The existence of an accessory parotid gland is likely to interfere with salivary flow. Computational fluid dynamics analysis of salivary flow in the ductal system would be useful in future etiologic studies on parotitis.

  12. B-mode and contrast-enhanced sonographic assessment of accessory spleen in the dog.

    Science.gov (United States)

    Rossi, Federica; Rabba, Silvia; Vignoli, Massimo; Haers, Hendrik; Terragni, Rossella; Saunders, Jimmy H

    2010-01-01

    Four dogs with an accessory spleen are described. The accessory spleens appeared as a round-to-triangular structure located in the perisplenic area. They were homogeneous and isoechoic with the adjacent spleen. Contrast-enhanced ultrasound was performed using a second generation microbubble contrast medium (sulfur hexafluoride). The type and timing of enhancement of the accessory spleen was similar to that of the parent spleen. Contrast-enhanced ultrasound is a noninvasive modality useful in distinguishing an accessory spleen from a mass of another origin.

  13. Bilateral Tensor Fasciae Suralis Muscles in a Cadaver with Unilateral Accessory Flexor Digitorum Longus Muscle

    Directory of Open Access Journals (Sweden)

    Logan S. W. Bale

    2017-01-01

    Full Text Available Muscle variants are routinely encountered in the dissection laboratory and in clinical practice and therefore anatomists and clinicians need to be aware of their existence. Here we describe two different accessory muscles identified while performing educational dissection of a 51-year-old male cadaver. Tensor fasciae suralis, a rare muscle variant, was identified bilaterally and accessory flexor digitorum longus, a more common muscle variant, was present unilaterally. Tensor fasciae suralis and accessory flexor digitorum longus are clinically relevant muscle variants. To our knowledge, the coexistence of tensor fasciae suralis and accessory flexor digitorum longus in the same individual has not been reported in either cadaveric or imaging studies.

  14. GSM accessories now available from the CERN Stores

    CERN Multimedia

    Labo Telecom

    2001-01-01

    As of 1st October you can order and receive GSM accessories from the CERN stores like any other article. The CERN stores also manage GSM telephones but, for technical reasons, only the Labo Telecom shop (Building 31, Room S026) is able to make the standard sales, repairs and exchanges for authorised persons with a CERN subscription. Labo Telecom will thus become a specialist shop, open from 11 a.m. to 12 a.m., and will apply the usual rules and authorisation procedures of the stores. The paper form for requests for GSM subscriptions is being computerized and will be available on EDH in the near future.

  15. Frequency of Syncope in Patients with Accessory Atrioventricular Connection

    Directory of Open Access Journals (Sweden)

    A Aslani

    2010-03-01

    Full Text Available Background: Syncope in patients with Wolff-Parkinson-White (WPW syndrome is related to rapid reciprocating tachycardia or rapid ventricular response over the accessory pathway during atrial fibrillation (AF. The aim of this retrospective study is to evaluate the frequency of syncope in patients with WPW syndrome. Methods: We reviewed the records of 150 consecutive patients with WPW syndrome.Results: There were 20 patients (13.3% who reported at least one episode of syncope and 130 patients (86.7% without such a history.Conclusion: Syncope is relatively frequent in patients with WPW. Patient with WPW syndrome who has experienced this symptom should be thoroughly evaluated.

  16. Locomotor pattern fails to predict foramen magnum angle in rodents, strepsirrhine primates, and marsupials.

    Science.gov (United States)

    Ruth, Aidan A; Raghanti, Mary Ann; Meindl, Richard S; Lovejoy, C Owen

    2016-05-01

    Foramen magnum position has traditionally been used as an indicator of bipedality because it has been thought to favor a more "balanced" skull position. Here, we analyzed foramen magnum angle (FMA) in relation to locomotion in three mammalian orders that include bipedal or orthograde species in addition to quadrupedal or pronograde species. In marsupials and strepsirrhine primates, we found that there is no relationship between locomotor pattern and FMA. In rodents, we found that there is a significant difference in FMA between bipedal and quadrupedal rodents. However, when these species are analyzed in the context of enlarged auditory bullae, this relationship is no longer significant. Additionally, we find a significant relationship between relative brain size and FMA in strepsirrhine primates. Taken together, these data indicate that several developmental modules of the cranium influence FMA, but that locomotion does not. We caution that basicranial evolution is a complex phenomenon that must be explored in the context of each taxon's unique evolutionary and developmental history. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Effect of a patent foramen ovale in humans on thermal responses to passive cooling and heating.

    Science.gov (United States)

    Davis, James T; Hay, Madeline W; Hardin, Alyssa M; White, Matthew D; Lovering, Andrew T

    2017-12-01

    Humans with a patent foramen ovale (PFO) have a higher esophageal temperature (T esoph ) than humans without a PFO (PFO-). Thus the presence of a PFO might also be associated with differences in thermal responsiveness to passive cooling and heating such as shivering and hyperpnea, respectively. The purpose of this study was to determine whether thermal responses to passive cooling and heating are different between PFO- subjects and subjects with a PFO (PFO+). We hypothesized that compared with PFO- subjects PFO+ subjects would cool down more rapidly and heat up slower and that PFO+ subjects who experienced thermal hyperpnea would have a blunted increase in ventilation. Twenty-seven men (13 PFO+) completed two trials separated by >48 h: 1 ) 60 min of cold water immersion (19.5 ± 0.9°C) and 2 ) 30 min of hot water immersion (40.5 ± 0.2°C). PFO+ subjects had a higher T esoph before and during cold water and hot water immersion ( P heating. NEW & NOTEWORTHY Patent foramen ovale (PFO) is found in ~25-40% of the population. The presence of a PFO appears to be associated with a greater core body temperature and blunted ventilatory responses during passive heating. The reason for this blunted ventilatory response to passive heating is unknown but may suggest differences in thermal sensitivity in PFO+ subjects compared with PFO- subjects. Copyright © 2017 the American Physiological Society.

  18. Prevalence of patent foramen ovale with right-to-left shunting in dogs with pulmonic stenosis.

    Science.gov (United States)

    Fujii, Y; Nishimoto, Y; Sunahara, H; Takano, H; Aoki, T

    2012-01-01

    Right-to-left (R-L) shunt caused by patent foramen ovale (PFO) concurrent with pulmonic stenosis (PS) is considered common, although there is a lack of published evidence. To investigate the prevalence of R-L shunt caused by a PFO in dogs with PS. Thirty-one client-owned dogs with PS, without obvious extracardiac disease detected on the clinical examinations. Case control study: R-L shunt probably caused by PFO was diagnosed when IV injected microbubbles appeared at the left atrial level with an intact atrial septum on echocardiography (bubble-positive dogs). The severity of PS concurrent tricuspid regurgitation (TR), relative thickness of the right ventricle, and relative right atrial area were compared between bubble-positive and bubble-negative dogs. The prevalence of R-L shunts caused by PFO was 39% (12 of 31 cases). The instantaneous pressure gradient (PG) across the pulmonic valve and relative thickness of the right ventricle were significantly increased in bubble-positive compared with those in bubble-negative dogs. None of the dogs with mild or moderate PS (pressure gradient dogs was significantly higher than that in bubble-negative dogs. DISCUSSION AND CLINICAL RELEVANCE: Patent foramen ovale PFO with R-L shunt was more common in dogs with very severe PS and absent in dogs with mild PS. Copyright © 2011 by the American College of Veterinary Internal Medicine.

  19. Features of the brainstem and tentorial foramen relationship and their practical value

    Directory of Open Access Journals (Sweden)

    O. V. Redyakina

    2016-11-01

    Full Text Available Objective. Establish the morphological features and practical significance of the tentorial-stem relationship from the position of individual anatomical variability. Methods: head morphometry, macro and microscopic examination of the brainstem, morphometry of the brainstem and its departments, tentorial aperture morphometry, foramen magnum craniometry, manufacture of corrosion molds of the posterior cranial fossa, statistical processing of the results, computer-graphic modeling of the brainstem and surrounding formations. Results.  In the course of the study, the features of the individual variability of the tentorial foramen form were established, namely: shortened-expanded and oval-convex forms were defined in brachycephalic; in dolichocephalic - oblong-narrowed and elongated-conical. At the same time, a number of existing sizes and forms of the tentorial-stem spaces were noted. Among them, four main ones are described: front, side (right and left and rear. They have individual characteristics. Thus, in the brachycephalic we define lateral holes, due to the convexity of the tentorial margins. In dolichocephalic - front and back gaps, depending on the characteristics of their elongations. The obtained data are of great importance for the craniotopographic justification of the tentorial-stem wedges, which are formed with tumors which located here. In our opinion, tumors have the greatest possibility of passage through the left or right lateral intervals in people with a brachymorph form of the head, and through the anterior and posterior intervals - in people with meso- and dolichomorph forms of the head.

  20. Atypical Teratoid Rhabdoid Tumor in a Teenager with Unusual Infiltration Into the Jugular Foramen.

    Science.gov (United States)

    Udaka, Yoko T; Yoon, Janet M; Malicki, Denise M; Khanna, Paritosh C; Levy, Michael L; Crawford, John R

    2015-12-01

    Atypical teratoid rhabdoid tumor is a rare malignant neoplasm that represents 1%-2% of all pediatric central nervous system tumors. Immunohistochemistry plays an important role in establishing the diagnosis with a loss of INI-1 staining in tumor cells. In this case report, we describe a teenager with an unusual presentation and pattern of infiltration of the tumor. A 13-year-old boy presented with a history over several months of progressive nausea, weight loss, and hoarseness of voice associated with multiple lower cranial nerve palsies on neurologic examination. Magnetic resonance imaging revealed a large heterogeneously enhancing extra-axial neoplasm with extension and bony expansion of the jugular foramen. After near total resection, neuropathology demonstrated the absence of INI-1 expression consistent with a diagnosis of atypical teratoid rhabdoid tumor. This case highlights the diverse clinical presentation and infiltrative potential of atypical teratoid rhabdoid tumors, thus expanding the differential diagnosis of extra-axial tumors invading the jugular foramen. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Neuroradiological evaluation of benign extramedullary tumors in the high cervical region and at the foramen magnum

    Energy Technology Data Exchange (ETDEWEB)

    Nishiura, Iwao; Koyama, Tsunemaro; Tanaka, Kimito; Aii, Heihachirou

    1986-06-01

    Twelve cases of benign extramedullary tumors in the high cervical region and at the foramen magnum were experienced during past five years among eighty all spinal and paraspinal tumors. The diagnosis of masses in this region is very difficult because of the variety of clinical course, symptoms and neurological findings as pointed out by many reporters. Also in our cases, 70 % of the patients complained of the deteriorated motor weakness of the upper or lower extremities on admission, though they had noticed the onset of slight neck or occipital pain a few years ago. Neurological examination on admission clearly showed the symptom of myelopathy except in two cases with a tumor at the foramen magnum and C/sub 1/ level. The percentage of positive findings of plain X-rays was 50 %, that of metrizamide myelography was 92 % and that of IV. e. CT and met. e. CT was 100 %. NMR-CT was performed in 2 cases, and in one of them it was useful in confirming the tumor configuration and extension. Five interesting cases were described mainly from the neuroradiological aspects. Finally the differentiation between meningioma and neurinoma was discussed from the aspects of myelogram, CT and NMR-CT. As already pointed out, it is most important not to forget the existence of tumors in this region when one comes across the confused symptoms, afterwards not to overlook the slight positive neurological and neuroradiological findings.

  2. Antagonism of Innate Immunity by Paramyxovirus Accessory Proteins

    Directory of Open Access Journals (Sweden)

    Raychel Chambers

    2009-10-01

    Full Text Available Paramyxovirinae, a subfamily of Paramyxoviridae, are negative strand RNA viruses comprised of many important human and animal pathogens, which share a high degree of genetic and structural homology. The accessory proteins expressed from the P/V/C gene are major factors in the pathogenicity of the viruses, because of their ability to abrogate various facets of type I interferon (IFN induction and signaling. Most of the paramyxoviruses exhibit a commonality in their ability to antagonize innate immunity by blocking IFN induction and the Jak/STAT pathway. However, the manner in which the accessory proteins inhibit the pathway differs among viruses. Similarly, there are variations in the capability of the viruses to counteract intracellular detectors (RNA helicases, mda-5 and RIG-I. Furthermore, a functional specificity in the antagonism of the IFN response has been reported, suggesting that specificity in the circumvention of innate immunity restricts viral host range. Available evidence indicates that paramyxoviruses employ specific strategies to antagonize the IFN response of their specific hosts, which is one of the major factors that determine viral pathogenicity and host range.

  3. Behaviour of bentonite accessory minerals during the thermal stage

    International Nuclear Information System (INIS)

    Arcos, David; Bruno, Jordi; Benbow, Steven; Takase, Hiro

    2000-03-01

    This report discusses in a quantitative manner the evolution of the accessory minerals in the bentonite as a result of the thermal event exerted by the spent fuel in the near field. Three different modelling approaches have been used and the results compared between them. The three different approaches have been calculated using two Differential Algebraic Equation (DAE) solver: DYLAN (Model-1) and the Nag DAE solver, d02ngf (Model-2) and the third approach (Model-3) using the last version of PHREEQC. The results from these calculations indicate the feasibility of the modelling approach to model the migration of bentonite accessory minerals and relevant aqueous species throughout the thermal gradient. These calculations indicate that the migration of quartz and quartz polymorphs is a lesser problem. The aqueous speciation of Ca in the bentonite pore water is fundamental in order to define the potential migration of anhydrite during the thermal stage. If CaSO 4 (aq) is the predominant aqueous species, then anhydrite dissolves at the initial groundwater migration times through bentonite. However, if Ca 2+ is considered to be the dominant Ca species at the bentonite pore water, then anhydrite migrates towards the clay/granite interface. This is the main difference in the chemical systems considered in the three model approaches used in this work. The main process affecting the trace mineral behaviour in bentonite is cation exchange. This process controls the concentration of calcium, which results in a direct control of the calcite precipitation-dissolution

  4. Nipple adenoma arising from axillary accessory breast: a case report

    Directory of Open Access Journals (Sweden)

    Shioi Yoshihiro

    2012-11-01

    Full Text Available Abstract Nipple adenoma is a relatively rare benign breast neoplasm, and cases of the disease arising from the axillary accessory breast have very seldom been reported in the English literature. We report a case of nipple adenoma arising from axillary accessory breast including clinical and pathological findings. An 82-year-old woman presented with the complaint of a small painful mass in the right axilla. Physical examination confirmed a well-defined eczematous crusted mass that was 8 mm in size. The diagnosis of nipple adenoma was made from an excisional specimen on the basis of characteristic histological findings. Microscopic structural features included a compact proliferation of small tubules lined by epithelial and myoepithelial cells, and the merging of glandular epithelial cells of the adenoma into squamous epithelial cells in the superficial epidermal layer. Because clinically nipple adenoma may resemble Paget’s disease and pathologically can be misinterpreted as tubular carcinoma, the correct identification of nipple adenoma is an important factor in the differential diagnosis for axillary tumor neoplasms. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1186821489769063

  5. Digital dermatitis of the accessory digits of dairy cows

    Directory of Open Access Journals (Sweden)

    Celso A. Rodrigues

    2010-03-01

    Full Text Available This report characterizes the digital dermatitis (DD lesions in the accessory digits of dairy cows and presents data on the applied therapy. Fifteen Holstein cattle with DD affecting the accessory digits of the hindlimbs from four dairy farms with previous history of DD were evaluated. Lesions were excised, the wounds were sutured, and a topical application of oxytetracycline powder covered by bandaging was associated with a single parenteral administration of long acting oxytetracycline IM (20mg/kg. Tissue samples were obtained for histopathology and transmission electronic microscopy (TEM. Lesions from all the animals were recuperated 15 days after surgical procedure. Overal, most DD lesions were papillomatous epidermal projections or wartlike verrucous lesions. Histopathologically, samples revealed hyperplasia of epidermis with hyperkeratosis, several mitoses in the stratum basale and elongated rete ridges in the superficial and middle dermis. TEM revealed long, thin spirochete-like bacteria. Morphologic features of lesions and its response to therapy were comparable to those described for DD.

  6. The accessory coracobrachialis muscle: ultrasound and MR features

    Energy Technology Data Exchange (ETDEWEB)

    Bauones, Salem [Centre hospitalier de l' Universite de Montreal (CHUM), Department of Radiology, Hopital Saint-Luc, Montreal, Quebec (Canada); Moraux, Antoine [Imagerie Medicale Jacquemars Gielee, Lille (France)

    2015-09-15

    To present the prevalence, clinical relevance, and ultrasound (US) and magnetic resonance imaging (MRI) appearances of the accessory coracobrachialis (ACB) muscle. We present an US prospective study of the ACB muscle over a 2-year period. Five of the eight patients with suspected ACB on US were subsequently examined by MRI. An ACB muscle was demonstrated by US in eight patients (eight shoulders), including seven females, one male, with mean age 39 years, over 770 (664 patients) consecutive shoulder US examinations referred to our institution yielding a prevalence of 1.04 %. In dynamic US assessment, one case of subcoracoid impingement secondary to a bulky ACB was diagnosed. No thoracic outlet syndrome was encountered in the remaining cases. MRI confirmed the presence of the accessory muscle in five cases. ACB muscle is a rarely reported yet not uncommon anatomic variation of the shoulder musculature encountered only in eight of 664 patients referred for shoulder US study. Its US and MRI appearance is described. One of our patients presented with subcoracoid impingement related to the presence of an ACB. (orig.)

  7. Decontamination of minimally invasive surgical endoscopes and accessories.

    Science.gov (United States)

    Ayliffe, G

    2000-08-01

    (1) Infections following invasive endoscopy are rare and are usually of endogenous origin. Nevertheless, infections do occur due to inadequate cleaning and disinfection and the use of contaminated rinse water and processing equipment. (2) Rigid and flexible operative endoscopes and accessories should be thoroughly cleaned and preferably sterilized using properly validated processes. (3) Heat tolerant operative endoscopes and accessories should be sterilized using a vacuum assisted steam sterilizer. Use autoclavable instrument trays or containers to protect equipment during transit and processing. Small bench top sterilizers without vacuum assisted air removal are unsuitable for packaged and lumened devices. (4) Heat sensitive rigid and flexible endoscopes and accessories should preferably be sterilized using ethylene oxide, low temperature steam and formaldehyde (rigid only) or gas plasma (if appropriate). (5) If there are insufficient instruments or time to sterilize invasive endoscopes, or if no suitable method is available locally, they may be disinfected by immersion in 2% glutaraldehyde or a suitable alternative. An immersion time of at least 10 min should be adopted for glutaraldehyde. This is sufficient to inactivate most vegetative bacteria and viruses including HIV and hepatitis B virus (HBV). Longer contact times of 20 min or more may be necessary if a mycobacterial infection is known or suspected. At least 3 h immersion in glutaraldehyde is required to kill spores. (6) Glutaraldehyde is irritant and sensitizing to the skin, eyes and respiratory tract. Measures must be taken to ensure glutaraldehyde is used in a safe manner, i.e., total containment and/or extraction of harmful vapour and the provision of suitable personal protective equipment, i.e., gloves, apron and eye protection if splashing could occur. Health surveillance of staff is recommended and should include a pre-employment enquiry regarding asthma, skin and mucosal sensitivity problems and

  8. Long-term follow up after transcatheter closure of atrial septal defect and patent foramen ovale in adults

    Directory of Open Access Journals (Sweden)

    Jure Dolenc

    2014-01-01

    Full Text Available Background: The aim of our study was to define long-term electrocardiographic and echocardiographic changes and complications after transcatheter closure of atrial septal defect and patent foramen ovale in adults.Methods: The clinical, electrocardiographic and echocardiographic follow-up of 137 consecutive patients that underwent transcatheter closure of atrial septal defect (51 patients or patent foramen ovale (86 patients in a 10-year period was analyzed retrospectively.Results: In the patent foramen ovale group, we observed no significant postprocedural changes. There were no changes in heart rate, heart rhythm and PR or QRS duration in both groups. In the atrial septal defect group, we observed a leftward shift in the heart axis (p = 0.017, a decrease in the estimated systolic pulmonary artery pressure (p = 0.024, decreased tricuspid early diastolic flow velocity (p = 0.002, a decrease in the right chamber dimensions (p = 0.0004 and interventricular septal movement normalization (p < 0.0001. Most of the complications were mild and occurred early after the procedure. Three early serious complications were documented.Conclusions: No electrocardiographic or echocardiographic changes occurred after patent foramen ovale closure. Atrial septal defect closure is related to significant early morphological and hemodynamic improvement. Postprocedural complications are usually early and mild but serious late complications can occur. For that reason, long-term follow up is recommended in these patients.

  9. Determination of apical constriction and apical foramen using electronic apex locator in vivo: Comparison between vital and nonvital teeth

    Directory of Open Access Journals (Sweden)

    Gaurav Aggarwal

    2018-01-01

    Conclusion: The study supports that EAL measures the location of AC and apical foramen with similar accuracy in vital and nonvital teeth. Furthermore, the distance between the two is reliable when compared with the actual distance observed under stereomicroscope supporting its widespread usage in clinical endodontics.

  10. Measurements of the vertebral foramen and the spinal cord by means of x-ray computed tomography (corpse)

    International Nuclear Information System (INIS)

    Kimura, Kazue; Katakura, Toshihiko; Suzuki, Kenji; Sato, Takanori; Azuma, Koji; Okuaki, Koju; Mizukoshi, Hitoshi; Kageyama, Kazuhiro; Suzuki, Sigeki

    1985-01-01

    It is important for orthopedics to measure the sizes of the vertebral canal and the spinal cord. Owing to the development of X-ray computed tomography (XCT), clear cross section images of the vertebral foramen and the spinal cord are now available, facilitating the measurement of these sizes, so that many literatures on this subject have been reported. The authors studied the errors of measurements of the anteroposterior diameterers of the vertebral foramen and the spinal cord by means of XCT (EMI CT 5005 type, slice thickness: 14mm). Method: Cross section images by XCT at the mid-plane of each vertebral body of cadaver were taken, and then, sawed cross sections were prepared for actual survey of the antero-posterior diameters of the vertebral foramen and the spinal cord. Measurements by XCT were made with the CT-number profile method and the multi-format film method. Results: The errors at the measurement of the antero-posterior diameters of the vertebral foramen and the spinal cord were about +- 2.0 - +- 4.5 %. The slice thickness of XCT pictures at present is thinner than 14mm and if we can make the tomographic plane at a right angle to the long axis of the vertebral column, the errors may be more minimized. (author)

  11. Multidetector Row CT Detection of a Patent Foramen Ovale Causing Neurologic Deficits in an Adolescent: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Bin [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Kim, Dong Hun; Oh, Jae Hee [Dept. of Radiology, Chosun University College of Medicine, Gwangju (Korea, Republic of); Seo, Hye Sun [Dept. of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Suk, Eun Ha [Dept. of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2012-02-15

    A patent foramen ovale (PFO) is a persisting fetal circulation structural abnormality that can cause neurologic deficits such as migraine and cryptogenic stroke. Here we report a case of PFO diagnosed by cardiac multidetector row CT in an adolescent male with chronic migraine and stroke.

  12. Multidetector Row CT Detection of a Patent Foramen Ovale Causing Neurologic Deficits in an Adolescent: A Case Report

    International Nuclear Information System (INIS)

    Lee, Jung Bin; Kim, Dong Hun; Oh, Jae Hee; Seo, Hye Sun; Suk, Eun Ha

    2012-01-01

    A patent foramen ovale (PFO) is a persisting fetal circulation structural abnormality that can cause neurologic deficits such as migraine and cryptogenic stroke. Here we report a case of PFO diagnosed by cardiac multidetector row CT in an adolescent male with chronic migraine and stroke.

  13. [Excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for treatment of flatfoot related with accessory navicular].

    Science.gov (United States)

    Cao, Honghui; Tang, Kanglai; Deng, Yinshuan; Tan, Xiaokang; Zhou, Binghua; Tao, Xu; Chen, Lei; Chen, Qianbo

    2012-06-01

    To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its effectiveness. Between May 2006 and June 2011, 33 patients (40 feet) with flatfoot related with accessory navicular were treated. There were 14 males (17 feet) and 19 females (23 feet) with an average age of 30.1 years (range, 16-56 years). All patients had bilateral accessory navicular; 26 had unilateral flatfoot and 7 had bilateral flatfeet. The disease duration ranged from 7 months to 9 years (median, 24 months). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-midfoot score was 47.9 +/- 7.3. The X-ray films showed type II accessory navicular, the arch height loss, and heel valgus in all patients. All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor. All patients got primary wound healing without any complication. Thirty patients (36 feet) were followed up 6-54 months with an average of 23 months. All patients achieved complete pain relief at 6 months after surgery and had good appearance of the feet. The AOFAS ankle-midfoot score was 90.4 +/- 2.0 at last follow-up, showing significant difference when compared with preoperative score (t=29.73, P=0.00). X-ray films showed that no screw loosening or breakage was observed. There were significant differences in the arch height, calcaneus inclination angle, talocalcaneal angle, and talar-first metatarsal angle between pre-operation and last follow-up (P < 0.01). The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular, with correction of deformity, excellent effectiveness, and less complications.

  14. 26 CFR 48.4061(b)-2 - Definition of parts or accessories.

    Science.gov (United States)

    2010-04-01

    .... Examples of articles which are taxable as parts or accessories are: Automobile air conditioners; baby seats...) MISCELLANEOUS EXCISE TAXES MANUFACTURERS AND RETAILERS EXCISE TAXES Motor Vehicles, Tires, Tubes, Tread Rubber... motors, and other automobile parts or accessories. (c) Materials of a general use—(1) General rule. The...

  15. 29 CFR 1919.28 - Unit proof tests-cranes and gear accessory thereto.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 7 2010-07-01 2010-07-01 false Unit proof tests-cranes and gear accessory thereto. 1919.28... Loads; Heat Treatment; Competent Persons § 1919.28 Unit proof tests—cranes and gear accessory thereto. (a) Except as noted in paragraph (e) of this section, cranes and other hoisting machines, together...

  16. An epidermoid cyst of accessory spleen simulating tumors of the tail of pancreas

    Directory of Open Access Journals (Sweden)

    Amit Kumar Sinha

    2015-07-01

    Full Text Available An epidermoid cyst of accessory spleen, a rare condition may present as pseudocyst of pancreas and other cystic tumors of the pancreas. This case report along with the review of literature attributes some clinical features and investigative pattern to differentiate between epidermoid cyst of accessory spleen and other cystic tumor of pancreas.

  17. 21 CFR 884.6190 - Assisted reproductive microscopes and microscope accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproductive microscopes and microscope... Devices § 884.6190 Assisted reproductive microscopes and microscope accessories. (a) Identification. Assisted reproduction microscopes and microscope accessories (excluding microscope stage warmers, which are...

  18. Chloroquine inhibits accessory cell presentation of soluble natural and synthetic protein antigens

    DEFF Research Database (Denmark)

    Buus, S; Werdelin, O

    1984-01-01

    We have studied the in vitro effect of the lysosomotrophic agent, chloroquine, on the presentation of soluble protein antigens by guinea pig accessory cells. Chloroquine inhibited the capacity of antigen-pulsed accessory cells to stimulate proliferation in appropriately primed T cells. The effect...... was time- and dose-dependent. A brief treatment solely of the accessory cells with the drug compromised their ability to stimulate primed T cells in a subsequent culture provided the accessory cells were treated with chloroquine before their exposure to the antigen. These results suggest that chloroquine...... acts on an early event in the antigen handling by accessory cells. Chloroquine is a well known inhibitor of lysosomal proteolysis, and it is likely that its effect on antigen presentation is caused by an inhibition of antigen degradation....

  19. Role of nuclear medicine imaging in differential diagnosis of accessory spleens in patients after splenectomy

    International Nuclear Information System (INIS)

    D’Amico, Andrea; Cofalik, Anna; Przeorek, Cesary; Gawlik, Tomasz; Olczyk, Tomasz; Kalemba, Michał; Modorowska, Alicja; Turska-d’Amico, Maria; Bobek-Billewicz, Barbara; Jarzab, Barbara

    2012-01-01

    More than 10% of healthy population has one or more accessory spleens. The most common location is the hilum of the spleen or area near the tail of the pancreas. The radiological appearance of accessory spleens in oncologic patients who underwent splenectomy can be misinterpreted as a recurrence, especially in the case of compensatory growth of an accessory spleen in successive radiological examinations. We present the cases of three patients who underwent splenectomy for gastric carcinoid, gastric adenocarcinoma and cancer of the left adrenal gland, respectively. CT examination and/or PET-CT scan revealed suspicious findings in the left upper abdomen. In one patient, the dimensional increase of this finding in successive examinations was initially considered suggestive for cancer recurrence. Scintigraphy with 99m Tc-nanocolloid was able to confirm the presence of an accessory spleen in all these patients. Splenic scintigraphy is an economical, accessible and accurate tool in differential diagnosis of accessory spleens in patients after splenectomy

  20. Oligopeptide antigens of the angiotensin lineage compete for presentation by paraformaldehyde-treated accessory cells to T cells

    DEFF Research Database (Denmark)

    Buus, S; Werdelin, O

    1986-01-01

    series are highly susceptible to proteolytic destruction in cultures containing prefixed accessory cells. The proteases responsible for the destruction of these peptides are apparently located in the plasma membrane of accessory cells. These enzymes represent a methodologic problem in studies...

  1. Maternal administration of meclozine for the treatment of foramen magnum stenosis in transgenic mice with achondroplasia.

    Science.gov (United States)

    Matsushita, Masaki; Mishima, Kenichi; Esaki, Ryusaku; Ishiguro, Naoki; Ohno, Kinji; Kitoh, Hiroshi

    2017-01-01

    OBJECTIVE Achondroplasia (ACH) is the most common short-limbed skeletal dysplasia caused by gain-of-function mutations in the fibroblast growth factor receptor 3 (FGFR3) gene. Foramen magnum stenosis (FMS) is one of the serious neurological complications in ACH. Through comprehensive drug screening, the authors identified that meclozine, an over-the-counter drug for motion sickness, inhibited activation of FGFR3 signaling. Oral administration of meclozine to the growing ACH mice promoted longitudinal bone growth, but it did not prevent FMS. In the current study, the authors evaluated the effects of maternal administration of meclozine on FMS in ACH mice. METHODS The area of the foramen magnum was measured in 17-day-old Fgfr3 ach mice and wild-type mice using micro-CT scanning. Meclozine was administered to the pregnant mice carrying Fgfr3 ach offspring from embryonic Day (ED) 14.5 to postnatal Day (PD) 4.5. Spheno-occipital and anterior intraoccipital synchondroses were histologically examined, and the bony bridges were scored on PD 4.5. In wild-type mice, tissue concentrations of meclozine in ED 17.5 fetuses and PD 6.5 pups were investigated. RESULTS The area of the foramen magnum was significantly smaller in 17-day-old Fgfr3 ach mice than in wild-type mice (p < 0.005). There were no bony bridges in the spheno-occipital and anterior intraoccipital synchondroses in wild-type mice, while some of the synchondroses prematurely closed in untreated Fgfr3 ach mice at PD 4.5. The average bony bridge score in the cranial base was 7.053 ± 1.393 in untreated Fgfr3 ach mice and 6.125 ± 2.029 in meclozine-treated Fgfr3 ach mice. The scores were not statistically significant between mice with and those without meclozine treatment (p = 0.12). The average tissue concentration of meclozine was significantly higher (508.88 ± 205.16 ng/g) in PD 6.5 mice than in ED 17.5 mice (56.91 ± 20.05 ng/g) (p < 0.005). CONCLUSIONS Maternal administration of meclozine postponed premature

  2. [Migraine with aura and patent foramen ovale. A different clinical entity].

    Science.gov (United States)

    Ramírez-Moreno, J M; Casado-Naranjo, I; Gómez, M; Portilla, Jc; Caballero, M; Serrano, A; Ojalvo, M J; Falcón, A; Tena-Mora, D; Calle, M

    2008-10-01

    This work has aimed to evaluate the prevalence of patent foramen ovale in subjects with migraine with aura by transcranial contrast doppler and to describe the clinical and risk profile of these patients. We performed a transcranial contrast doppler in 94 consecutive out-patients with migraine with aura (MWA) in a neurology outpatient clinic. They were divided into two groups according to the presence of patent foramen ovale: MWA_RLsh (with right-to-left shunt) and MWA_RLNsh (without right-to-left shunt). Differences between the groups were analyzed according to endpoints of age, gender, clinical severity, aura type and attacks frequency, comorbility, cardiovascular risk factors (CVRFs), neuroimaging findings, severity of shunt and treatment. n=94; MWA_RLsh: 47 (54%). MWA_RLNsh: 40 (46%). Age: 33.13; standard desviation (SD): 10.8 vs 33.496; SD: 11.2; p=0.728. Female: 66 vs 72.5%; p=0.511. Visual aura: 73.9% vs 78.9%; p=0.921. There were no significant differences in regards to the risk factors studied or to the comorbid diseases that are associated to migraine. The patients with patent foramen ovale have an odds ratio (OR) of ischemic stroke: 1.189 (95% confidence interval [CI]: 0.226 to 6.248; p=0.840), OR for subclinical brain lesions in cranial magnetic resonance imaging (MRI): 0.589 (95% CI: 0.193 to 1.799; p=0.35) and OR for combined previous ischemic stroke and subclinical brain lesions: 0.745 (95% CI: 0.261 to 2.129; p=0.58). Migraine attack frequency >1 per month: 27.9 vs 36.4; p=0.464. Need for prophylaxis therapy: 44.7 vs 57.7%; p=0.284. Both groups are similar regarding their clinical profile. We did not find a greater prevalence of stroke or silent brain lesions in the group with positive shunt..

  3. Multidisciplinary Assessment in Optimising Results of Percutaneous Patent Foramen Ovale Closure.

    Science.gov (United States)

    Davies, Allan; Ekmejian, Avedis; Collins, Nicholas; Bhagwandeen, Rohan

    2017-03-01

    Percutaneous patent foramen ovale (PFO) closure is a therapeutic option to prevent recurrent cerebral ischaemia in patients with cryptogenic stroke and transient cerebral ischaemia (TIA). The apparent lack of benefit seen in previous randomised trials has, in part, reflected inclusion of patients with alternate mechanisms of stroke. The role of formal neurology involvement in accurately delineating the likely aetiology of stroke or TIA is crucial in appropriate identification of patients for device closure. Furthermore, as the benefits of device closure may accrue over time, long-term follow-up is essential to define the role of device closure in management of presumed cryptogenic stroke. We retrospectively reviewed our experience with percutaneous PFO device closure since 2005. All subjects who underwent PFO closure at John Hunter and Lake Macquarie Private Hospitals were included in the study. All patients referred for device closure following cryptogenic stroke or TIA had first undergone formal neurology review with appropriate imaging and exclusion of paroxysmal atrial arrhythmia. Patients with a history of transient ischaemic attack (TIA) are frequently referred to a specialised clinic, aimed to identify patients with conditions not referable to cerebral ischaemia, with investigations initiated by the specialist clinic to elucidate an underlying aetiology. Outcome data was derived from the Hunter New England Area Local Health District Cardiac and Stroke Outcomes Unit, in addition to review of the medical record. The Cardiac and Stroke Outcomes Unit prospectively identified all patients presenting with stroke, TIA and atrial fibrillation. One hundred and twelve consecutive patients undergoing percutaneous patent foramen ovale closure between 2005 and 2015 were identified. The average age was 42.7 years and 57 (50.9%) patients were male. Cryptogenic stroke (68.8%) and transient cerebral ischaemia (23.2%) were the most common indications for PFO closure, with the

  4. Successful catheter ablation of a left anterior accessory pathway from the non-coronary cusp of the aortic valve.

    Science.gov (United States)

    Laranjo, Sérgio; Oliveira, Mário; Trigo, Conceição

    2015-08-01

    Left anterior accessory pathways are considered to be rare findings. Catheter ablation of accessory pathways in this location remains a challenging target, and few reports about successful ablation of these accessory pathways are available. We describe our experience regarding a case of a manifest left anterior accessory pathway ablation using radiofrequency energy at the junction of the left coronary cusp with the non-coronary cusp.

  5. Antegrade or Retrograde Accessory Pathway Conduction: Who Dies First?

    Directory of Open Access Journals (Sweden)

    Claudio Hadid, MD

    2012-05-01

    Full Text Available A 36 year-old man with Wolff Parkinson White syndrome due to a left-sided accessory pathway (AP was referred for catheter ablation. Whether abolition of antegrade and retrograde AP conduction during ablation therapy occurs simultaneously, is unclear. At the ablation procedure, radiofrequency delivery resulted in loss of preexcitation followed by a short run of orthodromic tachycardia with eccentric atrial activation, demonstrating persistence of retrograde conduction over the AP after abolition of its antegrade conduction. During continued radiofrequency delivery at the same position, the fifth non-preexcitated beat failed to conduct retrogradely and the tachycardia ended. In this case, antegrade AP conduction was abolished earlier than retrograde conduction.

  6. Accessory mammary tissue associated with congenital and hereditary nephrourinary malformations.

    Science.gov (United States)

    Urbani, C E; Betti, R

    1996-05-01

    The association between polythelia (supernumerary nipple) and kidney and urinary tract malformations (KUTM) is controversial. Some authors reported this association in newborns and infants. Case-control studies dealing with adult subjects are not found in the literature. The purpose of this study is to determine the frequency of the association between accessory mammary tissue (AMT) and congenital and hereditary nephrourinary defects in an adult population compared to a control group. The study was performed in 146 white patients (123 men, 23 women) with AMT out of 2645 subjects consecutively referred to us for physical examination. The following investigations were undertaken: ultrasonographic examination of the abdomen and the kidneys, ECG, echocardiogram, roentgenogram of the vertebral column, urinalysis, and other laboratory tests. A sex- and age-matched control group without any evidence of AMT or lateral displacement of the nipples underwent the same examinations. Kidney and urinary tract malformations were detected in 11 patients with AMT (nine men, two women) and in one control. These data indicate a significantly higher frequency of KUTM in the AMT-affected patients compared to controls (7.53% vs. 0.68%, P < 0.001). A broad spectrum of KUTM was discovered in association with AMT: adult dominant polycystic kidney disease, unilateral renal agenesis, cystic renal dysplasia, familial renal cysts, and congenital stenosis of the pyeloureteral joint. Accessory mammary tissue offers an important clue for congenital and hereditary anomalies of the kidneys and urinary collecting systems. Patients with AMT should, therefore, be extensively examined for the presence of occult nephrouropathies.

  7. Melanocortin receptor accessory proteins in adrenal gland physiology and beyond.

    Science.gov (United States)

    Novoselova, T V; Jackson, D; Campbell, D C; Clark, A J L; Chan, L F

    2013-04-01

    The melanocortin receptor (MCR) family consists of five G-protein-coupled receptors (MC1R-MC5R) with diverse physiological roles. MC1R controls pigmentation, MC2R is a critical component of the hypothalamic-pituitary-adrenal axis, MC3R and MC4R have a vital role in energy homeostasis and MC5R is involved in exocrine function. The melanocortin receptor accessory protein (MRAP) and its paralogue MRAP2 are small single-pass transmembrane proteins that have been shown to regulate MCR expression and function. In the adrenal gland, MRAP is an essential accessory factor for the functional expression of the MC2R/ACTH receptor. The importance of MRAP in adrenal gland physiology is demonstrated by the clinical condition familial glucocorticoid deficiency, where inactivating MRAP mutations account for ∼20% of cases. MRAP is highly expressed in both the zona fasciculata and the undifferentiated zone. Expression in the undifferentiated zone suggests that MRAP could also be important in adrenal cell differentiation and/or maintenance. In contrast, the role of adrenal MRAP2, which is highly expressed in the foetal gland, is unclear. The expression of MRAPs outside the adrenal gland is suggestive of a wider physiological purpose, beyond MC2R-mediated adrenal steroidogenesis. In vitro, MRAPs have been shown to reduce surface expression and signalling of all the other MCRs (MC1,3,4,5R). MRAP2 is predominantly expressed in the hypothalamus, a site that also expresses a high level of MC3R and MC4R. This raises the intriguing possibility of a CNS role for the MRAPs.

  8. Tromboembolismo pulmonar masivo de alto riesgo asociado a foramen oval permeable

    Directory of Open Access Journals (Sweden)

    Antonio Miranda

    2012-04-01

    Full Text Available La alta mortalidad de los pacientes con tromboembolismo pulmonar masivo de alto riesgo amerita un enfoque terapéutico enérgico e invasivo que incluya la embolectomía pulmonar quirúrgica en aquellos pacientes con contraindicación para trombolisis o trombolisis fallida. Describimos un caso de tromboembolismo pulmonar masivo de alto riesgo que recibió tratamiento quirúrgico en vez de trombolisis debido a que al momento del diagnóstico presentaba un trombo móvil a través de un foramen oval permeable con altísima posibilidad de embolismo paradójico arterial.

  9. Association of a patent foramen ovale with myocardial infarction and pulmonary emboli in a peripartum woman.

    Science.gov (United States)

    Ramineni, Rajesh; Daniel, George K

    2010-10-01

    Peripartum myocardial infarction is uncommon but devastating in young women. Although it is generally associated with arterial dissection, pregnancy-induced hypercoagulable state can also be a major contributor. Association of patent foramen ovale (PFO) adds to this potential risk. A 29-year-old postpartum female presented with worsening chest pressure, shortness of breath and syncope. She was hypotensive and tachycardic. A ventilation perfusion imaging displayed high probability for pulmonary emboli. With elevated cardiac enzymes and echocardiogram showing wall motion abnormalities, patient underwent percutaneous coronary angioplasty for a midvessel thrombus in the left anterior descending artery. Further workup showed a thrombus straddling into the left atrium via a PFO and a deep venous thrombus in the right iliac vein. Hormonal changes in pregnancy are noted to place young women in a hypercoagulable state. Screening for PFO in this group of patients with timely intervention might prevent a major systemic event caused by paradoxical embolus.

  10. [Cryptogenic stroke - patent foramen ovale - migraine with aura: incidental triad or significant relationship? Part II].

    Science.gov (United States)

    Łukasik, Maria; Kozubski, Wojciech

    2012-01-01

    In the second part of the paper, we discuss the relationship between migraine with aura and either patent foramen ovale (PFO) or stroke. The results of the studies suggest that PFO with right-to-left shunt is more prevalent among patients suffering from migraine with aura. Moreover, migraine with aura is a risk factor for ischaemic stroke in women and the risk increases when they have additional vascular risk factors such as taking oral contraception and smoking. However, the pathophysiology of these phenomena remains hypothetical. The most frequently reported theory suggests paradoxical embolism as a mechanism of the above-mentioned pathologies. In this paper we compare the pros and cons of the general theories. We discuss the percutaneous closure of PFO in patients with migraine, regarding the benefit/risk ratio.

  11. Intraoperative computed tomography for cervicomedullary decompression of foramen magnum stenosis in achondroplasia: two case reports.

    Science.gov (United States)

    Arishima, Hidetaka; Tsunetoshi, Kenzo; Kodera, Toshiaki; Kitai, Ryuhei; Takeuchi, Hiroaki; Kikuta, Ken-Ichiro

    2013-01-01

    The authors report two cases of cervicomedullary decompression of foramen magnum (FM) stenosis in children with achondroplasia using intraoperative computed tomography (iCT). A 14-month-old girl with myelopathy and retarded motor development, and a 10-year-old girl who had already undergone incomplete FM decompression was presented with myelopathy. Both patients underwent decompressive sub-occipitalcraniectomy and C1 laminectomy without duraplasty using iCT. It clearly showed the extent of FM decompression during surgery, which finally enabled sufficient decompression. After the operation, their myelopathy improved. We think that iCT can provide useful information and guidance for sufficient decompression for FM stenosis in children with achondroplasia.

  12. Foramen magnum decompression versus terminal ventriculostomy for the treatment of syringomyelia.

    Science.gov (United States)

    Filizzolo, F; Versari, P; D'Aliberti, G; Arena, O; Scotti, G; Mariani, C

    1988-01-01

    The A.A review 30 consecutive cases of syringomyelia operated on during the last seven years. Six terminal ventriculostomies (TV) and twenty-seven procedures for foramen magnum decompression (FMD) were performed. All patients of TV group had CT-myelography (CTM) and/or NMR controls at different times after surgery. Clinical results are as follows: 1) of the 6 patients who had TV, only one showed an improvement while five continued to deteriorate and three of them needed a FMD, one a cysto-peritoneal shunt and the last one died from lung cancer. 2) of the 27 patients who had FMD, twenty improved, four were unchanged and three worsened. 3) no surgical deaths occurred in this series. Postoperative NMR monitoring represents an effective non-invasive neuroradiological procedure that allows follow-up of syrinx evolution over the years.

  13. Hemodynamic and respiratory factors that influence the opening of patent foramen ovale in mechanically ventilated patients.

    Science.gov (United States)

    Vavlitou, A; Minas, G; Zannetos, S; Kyprianou, T; Tsagourias, M; Matamis, D

    2016-01-01

    Patent foramen ovale (PFO) is an anatomic variant that may lead to several pathological conditions, notably right to left shunt, paradoxical embolism, hypoxemia, and cerebral fat embolism. Mechanical positive pressure ventilation may increase the prevalence of PFO opening in Intensive Care Unit (ICU) patients; however, the respiratory and hemodynamic determinants of PFO opening have been poorly investigated. Contrast-enhanced transesophageal echocardiogram (ce-TEE) is considered the gold standard for PFO detection. We prospectively performed a multicenter study using ce-TEE in order to determine the respiratory and hemodynamic factors that may lead to PFO opening. One hundred and eight consecutive ICU adult patients under mechanical ventilation from three tertiary care hospitals, were included in the study. A standard multiplane ce-TEE was performed, and the dimensions and function of the right and left ventricle were studied. In each patient, the right ventricle (RV) end-diastolic area, RV end-systolic area, left ventricle (LV) end-diastolic area, and LV ejection fraction were measured using the modified Simpson's rule and the four-chamber view. At least three bubble tests were performed to detect PFO opening. Ventilatory parameters such as tidal volume, plateau pressure, static lung compliance, and positive end-expiratory pressure were recorded during the bubble test. Data for 81 men and 27 women were analyzed. PFO was detected in 27 % of the study population. Statistical significance was found between the presence of PFO and plateau pressure (odds ratio 3.421, 95 % CI: 1.2-9.4, p =0.017). Additionally, the presence of right ventricular dilatation (RV>LV) was strongly associated with PFO opening (odds ratio 3.163, 95 % CI: 1.2-8.075, p =0.018). In this group of mechanically ventilated, critically ill adult patients, right ventricular dilatation and plateau pressure above 26 mmHg were significantly associated with foramen ovale opening. Hippokratia 2016, 20

  14. Morphometrical and Topographical Anatomy of Position of Nutrient Foramen on Fully Ossified Left Femur

    Directory of Open Access Journals (Sweden)

    Tanvir Hossain Parash

    2013-05-01

    Full Text Available Background: The femur is the typical long bone of lower limb which extends from the pelvis to the knee. It forms the skeleton of the thigh, bears body weight, supports movement of legs; provide attachment to muscles, form blood cells and acts as a store house for calcium and phosphate. The nutrient foramina are cavities that conduct the nutrient arteries and the peripheral nerves. The majority blood supply for femur originates from the nutrient arteries, mainly during the growing period and during the early phase of ossification. In bone grafts the nutrient blood supply is crucial and it should be preserved in order to promote the fracture healing.Objective: The anatomy of nutrient foramen of femur is very essential for orthopedic & vascular surgeons as well as to radiologists for planning of treatment.Materials and method: This cross sectional study was carried out in the department of Anatomy, Sir Salimullah Medical College, Dhaka, Bangladesh from July 2011 to June 2012. The study comprised 199 fully ossified left sided dry femur of both sex (n=89 male, n=110 female. Sampling technique was purposive. Morphometric and topographic study was carried out on all samples by direct physical and photographic methods.Results: The most common position of nutrient foramen on the shaft of femur was found on the middle 1/5th in both male and female femur (50.78% in male and 56.86% in female respectively.Conclusion: The anatomical knowledge about this study might be useful in certain surgical procedures as well as micro vascular bone transfer to preserve the circulation.

  15. PREVALENCE OF PATENT FORAMEN OVALE IN YOUNG PATIENTS WITH CRYPTOGENIC ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    Masoumeh Sadeghi

    2010-11-01

    Full Text Available Abstract    BACKGROUND: Patent foramen ovale (PFO is the most commonly persistent abnormality of fetal origin. PFO has long been recognized as a potential risk factor for ischemic stroke. This study has shown the prevalence of PFO among young patients with cryptogenic stroke.    METHODS: In our case-control study we had 32 patients, 18 to 55 years old with cryptogenic stroke and 64 participants among normal population with matched age and sex in control group. We studied them for stroke risk factors like hypertension, diabetes mellitus, ischemic heart disease, dyslipidemia and then election of PFO by contrast trans-thoracic echocardiography. Data entered in SPSS11 and analyzed by Chi-Square and logistic regression. P value less than 0.05 was considered statistically significant.    RESULTS: We found that 37.5 % of patients in case group and 7.7 % of patients in controls had PFO and this difference was statistically significant (P = 0.001. They had no significant difference in other atherosclerosis risk factors. In control group we saw small shunt but in stroke group large shunt was more prevalence (P < 0.05.     CONCLUSION: Our findings supported this idea that PFO is a predisposing factor for stroke and it had a higher prevalence among patients with cryptogenic stroke. Besides, large shunt was more concomitant with ischemic attack. Then we suggest any patient with undefined cause of stroke must be evaluated for PFO.      Keywords: Patent foramen ovale, Stroke, Young.  

  16. The morphometric analysis of the intervertebral foramen and the spinal nerve root in the cervical spine

    International Nuclear Information System (INIS)

    Yoshida, Yasuo

    2008-01-01

    The purpose of this study was to clarify the onset of cervical myelopathy and cervical spondylotic radiculopathy as well as what influence the anatomy of the cervical spine and cervical nerves have on their onset and occurrence of various types of disease state. We conducted imaging and morphological measurements on specimens of cervical spine of Japanese people, focusing attention on the running of intervertebral foramen and dorsal nerve rootlets of the cervical spine. The subjects were cervical spine specimens from 12 cadavers (7 males and 5 females, age at the time of death ranged from 48 to 93 years with a mean of 71 years) obtained at Showa University School of Dentistry in 2005 and 2006. Specimens were prepared by removing the atlas through the 1st thoracic vertebra from the cadavers, then resecting the soft tissue such as muscles to expose the cervical spine in whole circumference. The removed cervical spine specimens, from 1st to 7th cervical spines, were imaged by volume scan of radiographic helical CT at 0.6 mm spatial resolution, and their images were stored as Digital Imaging and Communications in Medicine (DICOM) data. Image measurement on the vertebral body, vertebral foramen, and intervertebral foramen was conducted based on DICOM data. Furthermore, macroscopic observation and measurement were conducted on the dorsal nerve rootlets of cervical spine specimens. The image measurement of cervical spine specimens showed that the intervertebral foramen at C5/6 was the narrowest, followed by C3/4, C4/5, C6/7, and C2/3, respecting. With regard to angles in the frontal section and horizontal section of the groove for the spinal nerve, there was no significant difference in the angle between the right and the left. In the frontal section, the angle was about 63deg at C3, about 57deg at C4, about 52deg at C5, and about 55deg at C6, showing a significantly acute angle at C5, while in the horizontal section, it was about 54deg at C3, about 59deg at C4, about 63

  17. Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials.

    Science.gov (United States)

    Vaduganathan, Muthiah; Qamar, Arman; Gupta, Ankur; Bajaj, Navkaranbir; Golwala, Harsh B; Pandey, Ambarish; Bhatt, Deepak L

    2018-05-01

    Patent foramen ovale closure represents a potential secondary prevention strategy for cryptogenic stroke, but available trials have varied by size, device studied, and follow-up. We conducted a systematic search of published randomized clinical trials evaluating patent foramen ovale closure versus medical therapy in patients with recent stroke or transient ischemic attack using PubMED, EMBASE, and Cochrane through September 2017. Weighting was by random effects models. Of 480 studies screened, we included 5 randomized clinical trials in the meta-analysis in which 3440 patients were randomized to patent foramen ovale closure (n = 1829) or medical therapy (n = 1611) and followed for an average of 2.0 to 5.9 years. Index stroke/transient ischemic attack occurred within 6 to 9 months of randomization. The primary end point was composite stroke/transient ischemic attack and death (in 3 trials) or stroke alone (in 2 trials). Patent foramen ovale closure reduced the primary end point (0.70 vs 1.48 events per 100 patient-years; risk ratio [RR], 0.52 [0.29-0.91]; I 2  = 55.0%) and stroke/transient ischemic attack (1.04 vs 2.00 events per 100 patient-years; RR, 0.55 [0.37-0.82]; I 2  = 42.2%) with modest heterogeneity compared with medical therapy. Procedural bleeding was not different between study arms (1.8% vs 1.8%; RR, 0.94 [0.49-1.83]; I 2  = 29.2%), but new-onset atrial fibrillation/flutter was increased with patent foramen ovale closure (6.6% vs 0.7%; RR, 4.69 [2.17-10.12]; I 2  = 29.3%). In patients with recent cryptogenic stroke, patent foramen ovale closure reduces recurrent stroke/transient ischemic attack compared with medical therapy, but is associated with a higher risk of new-onset atrial fibrillation/flutter. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Deleterious effect of ultraviolet-B radiation on accessory function of human blood adherent mononuclear cells

    International Nuclear Information System (INIS)

    Rich, E.A.; Elmets, C.A.; Fujiwara, H.; Wallis, R.S.; Ellner, J.J.

    1987-01-01

    The effects of ultraviolet-B radiation (UV-B) on accessory function of human blood adherent mononuclear cells (ADH) for antigen and mitogen-induced responses, and production by ADH of the amplifying cytokine interleukin 1 (IL-1) were examined. Responder lymphocytes were rendered accessory cell dependent by treatment of nonadherent cells with OKIal + complement. UV-B depressed accessory function of ADH in a dose-dependent manner. UV-B decreased accessory function of ADH for tetanus toxoid-induced responses and phytohaemagglutinin-induced responses. UV-B also decreased accessory activity of peripheral blood mononuclear cells but not Epstein-Barr virus-transformed B cells for a PPD-reactive T cell line. Interleukin 1 (IL-1) activity of supernatants of ADH was assayed on C3H/HeJ mouse thymocytes. Pretreatment of ADH with UV-B decreased lipopolysaccharide-stimulated IL-1 activity. Lysates of UV-B irradiated, LPS-stimulated ADH had no discernible IL-1 activity. Addition of IL-1 partially restored accessory activity of UV-B irradiated ADH for lymphocyte responses to TT. Exposure of ADH to TT or PHA for 30 min before irradiation blocked the inhibitory effect of UV-B on accessory activity. Thus, low doses of UV-B are deleterious to accessory function and to production of IL-1 by ADH. Interference with production of cytokines and with initial interactions of accessory cells with antigen and mitogen may be critical to the effects of UV-B on immunoregulatory function of ADH. (author)

  19. The sixth sense in mammalian forerunners: Variability of the parietal foramen and the evolution of the pineal eye in South African Permo-Triassic eutheriodont therapsids

    Directory of Open Access Journals (Sweden)

    Julien Benoit

    2016-12-01

    Full Text Available In some extant ectotherms, the third eye (or pineal eye is a photosensitive organ located in the parietal foramen on the midline of the skull roof. The pineal eye sends information regarding exposure to sunlight to the pineal complex, a region of the brain devoted to the regulation of body temperature, reproductive synchrony, and biological rhythms. The parietal foramen is absent in mammals but present in most of the closest extinct relatives of mammals, the Therapsida. A broad ranging survey of the occurrence and size of the parietal foramen in different South African therapsid taxa demonstrates that through time the parietal foramen tends, in a convergent manner, to become smaller and is absent more frequently in eutherocephalians (Akidnognathiidae, Whaitsiidae, and Baurioidea and non-mammaliaform eucynodonts. Among the latter, the Probainognathia, the lineage leading to mammaliaforms, are the only one to achieve the complete loss of the parietal foramen. These results suggest a gradual and convergent loss of the photoreceptive function of the pineal organ and degeneration of the third eye. Given the role of the pineal organ to achieve fine-tuned thermoregulation in ectotherms (i.e., “cold-blooded” vertebrates, the gradual loss of the parietal foramen through time in the Karoo stratigraphic succession may be correlated with the transition from a mesothermic metabolism to a high metabolic rate (endothermy in mammalian ancestry. The appearance in the eye of melanopsin-containing retinal ganglion cells replacing the photoreceptive role of the pineal eye could also have accompanied its loss.

  20. Retardo mental Mental retardation

    Directory of Open Access Journals (Sweden)

    Marcio M. Vasconcelos

    2004-04-01

    Full Text Available OBJETIVO: Esta revisão aborda as recentes descobertas da neurobiologia do retardo mental, enfatizando os novos recursos da citogenética, das técnicas moleculares e da neurorradiologia para esclarecer o diagnóstico. FONTES DE DADOS: O autor pesquisou o banco de dados MEDLINE da National Library of Medicine utilizando as palavras-chave "mental retardation", "developmental disability", "child" e "adolescent" em diferentes combinações, abrangendo o período de janeiro de 2000 a outubro de 2003. Também foram utilizados os bancos de dados das revistas científicas Pediatrics e New England Journal of Medicine através da palavra-chave "mental retardation". No total, o autor consultou cerca de 1.500 títulos de artigos e 500 resumos, e teve acesso direto a 150 artigos completos pertinentes. Quando oportuno, algumas referências dos artigos consultados também foram consideradas. O site Online Mendelian Inheritance in Man foi utilizado como fonte de informações em genética clínica. SÍNTESE DOS DADOS: Em outubro de 2003, o total de síndromes genéticas associadas a retardo mental chegou a 1.149. Considerando-se o conjunto das causas genéticas ou ambientais e congênitas ou adquiridas de retardo mental, a avaliação diagnóstica atual é capaz de esclarecer a etiologia em 50 a 70% dos casos. CONCLUSÕES: O autor sugere uma avaliação diagnóstica do retardo mental em etapas lógicas, visando ao uso racional dos dispendiosos recursos da citogenética, biologia molecular e neuroimagem.OBJECTIVE: This paper describes recent advances in the neurobiology of mental retardation, emphasizing new diagnostic resources provided by cytogenetics, molecular testing, and neuroimaging. SOURCES OF DATA: MEDLINE (January 2000 through October 2003, using the following key words: mental retardation, developmental disability, child, and adolescent. Search of the Pediatrics and New England Journal of Medicine websites using the key word mental retardation. The

  1. CT and MR imaging findings of subdural dermoid cyst extending into right foramen ovale: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, You Cheol; Park, Cheol Min; Lee, Si Kyeong [Seoul Medical Center, Seoul (Korea, Republic of)

    2006-12-15

    Intracranial dermoid cyst is a rare congenital benign disease, representing less than 0.5% of primary brain tumors. Nevertheless, if ruptured spontaneously or during surgery, it has a poor prognosis due to chemical meningitis. Therefore, it is essential to perform accurate diagnosis and proper treatment. We report an intracranial subdural dermoid cyst that may be misdiagnosed as extracranial or epidural lesion because of extension into the right foramen ovale, and describe the CT and MR imaging findings.

  2. Closure of patent foramen ovale for cryptogenic stroke patients: an updated systematic review and meta-analysis of randomized trials.

    Science.gov (United States)

    Niu, Xuan; Ou-Yang, Guang; Yan, Peng-Fei; Huang, Shu-Lan; Zhang, Zhen-Tao; Zhang, Zhao-Hui

    2018-06-01

    This systematic review and meta-analysis was performed to investigate the efficacy and safety of transcatheter device closure (TDC) plus anti-thrombotic drugs over medical management alone for patients with cryptogenic stroke and patent foramen oval. PubMed, Embase and Cochrane Library database were searched for randomized controlled clinical trials (RCTs). The primary endpoint is the composite of stroke and transient ischemic attack. The secondary endpoints are all-cause mortality, total serious adverse events, atrial fibrillation and bleeding. Five RCTs with a total of 3440 participants were included. TDC significantly decreased the risk of primary endpoint when compared to medical therapy alone (RR 0.54, 95% CI 0.43-0.69). Further subgroup analyses showed that patients with male gender and with substantial shunt size of foramen ovale significantly benefited from TDC as compared to those with female gender and with no substantial shunt size of foramen oval separately. Moreover, TDC was superior to medical therapy with anti-platelet drug alone (not with anti-coagulation). On the other hand, the incidence of atrial fibrillation was higher in TDC group (RR 4.49, 95% CI 2.02-9.97), with the risk of other adverse events equivalent between the two groups. TDC plus anti-thrombotic drugs is superior than medical therapy alone for secondary prevention of stroke, especially for those with male gender and with substantial shunt size of foramen ovale. Though it may increase the risk of postoperative atrial fibrillation, it would not bring higher risk of all-cause mortality, total adverse events and bleeding.

  3. Implementation of immobilization accessories for positioning of small animals for radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Vettorato, M.C.; Girotto, C.H.; Fogaça, J.L.; Vulcano, L.C.; Fernandes, M.A.R., E-mail: m_vettorato@hotmail.com [Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP (Brazil)

    2017-11-15

    Radiation therapy is a modality that is presenting great advances in veterinary medicine worldwide. In Brazil, this therapeutic option is underachieved. The success of this method depends on several factors, including the use of appropriate accessories for protection and immobilization of patients. For the immobilization of small animals during treatment, in addition to sedation and anesthesia, immobilizing accessories, similar to those used in human radiotherapy, are used. This study aimed to present proposals for immobilizing accessories adapted to the positioning of small animals in order to be used in radiotherapy planning. In order to achieve results, accessories were made and tested in a living animal simulating a radiotherapy planning, which proved to be favorable to use in positioning small animals undergoing radiotherapy and for implementation processes. (author)

  4. Implementation of immobilization accessories for positioning of small animals for radiation therapy

    International Nuclear Information System (INIS)

    Vettorato, M.C.; Girotto, C.H.; Fogaça, J.L.; Vulcano, L.C.; Fernandes, M.A.R.

    2017-01-01

    Radiation therapy is a modality that is presenting great advances in veterinary medicine worldwide. In Brazil, this therapeutic option is underachieved. The success of this method depends on several factors, including the use of appropriate accessories for protection and immobilization of patients. For the immobilization of small animals during treatment, in addition to sedation and anesthesia, immobilizing accessories, similar to those used in human radiotherapy, are used. This study aimed to present proposals for immobilizing accessories adapted to the positioning of small animals in order to be used in radiotherapy planning. In order to achieve results, accessories were made and tested in a living animal simulating a radiotherapy planning, which proved to be favorable to use in positioning small animals undergoing radiotherapy and for implementation processes. (author)

  5. The Online Marketing Research on the Factors of Competitiveness of Enterprises in the Computer Accessory Market

    Directory of Open Access Journals (Sweden)

    Yashkina Oksana I.

    2017-04-01

    Full Text Available The article is aimed at identifyng the factors of competitiveness of enterprises in the market for computer accessories (on the example of the «ZONA51» store and suggesting certain actions as to creating and strengthening competitive advantages. The main competitors of the enterprise, which offer computer accessories, as well as the basic preferences of consumers in choosing the game-oriented computer accessories, have been explored. The study has found that price and active Internet communications are the main factors in the competitiveness of enterprises in the market for computer accessories. It is also important to use communicative channels such as «word-of-mouth marketing» for specific types of goods. The target audience of the products analyzed is young people, so it is also important to advertise resources near the places of youth gatherings to provide active communications. Further studies should consider the factors of competitiveness of Internet shops with different orientation.

  6. A rare nasal cavity mass in a child: Accessory middle turbinate

    Directory of Open Access Journals (Sweden)

    Andrew Chang

    2016-09-01

    Full Text Available Objectives: The accessory middle turbinate, a rare anatomical variation of the nasal cavity, have been systematically studied in adults. Presence of accessory middle turbinate and its clinical significance in a child has not been reported. We describe clinical appearance and radiologic features of accessory middle turbinate in a child. Methods: Retrospective chart review. Results: A 3-year-old boy presented to the otolaryngology clinic for evaluation of recurrent epistaxis. Anterior rhinoscopy revealed moist nasal mucosa without inflammation and bilateral prominent blood vessels on the anterior nasal septum. Nasal endoscopy showed turbinate like protuberances in bilateral middle meatus. CT images documented accessory middle turbinate in the bilateral nasal cavity. Conclusion: Otolaryngologists should be cognizant of anatomical variations of middle turbinate to achieve correct diagnosis and avoid potential complications during surgical management.

  7. Design of Fashion Accessories Using Akwa-Ocha Motifs and Symbols

    African Journals Online (AJOL)

    Nneka Umera-Okeke

    Nkpopu: holes. 16. Osikapa na ... accessories anchors in both social semiotics and archetypal theories. Social semiotics theory as ... the two earrings incorporate the Onwa (moon) motif in spherical shape and in black colour. They are held ...

  8. Scintigraphic diagnosis and computed tomographic localization of an accessory spleen following relapse of chronic immune thrombocytopaenia

    International Nuclear Information System (INIS)

    Cardaci, G.T.; Blake, M.P.

    1992-01-01

    Chronic immune thrombocytopaenia is an immunologically mediated disorder resulting in disordered platelet kinetics and potentially life-threatening disease. Failure of medical therapy is an indication for splenectomy, and responses are seen in 80% of patients following this procedure. An important cause of relapse following splenectomy is the presence of an accessory spleen. A patient with Hodgkin's Disease developed chronic immune thrombocytopaenia despite previous splenectomy. A remission was induced with immunosuppressive therapy, but he later relapsed. An accessory spleen was detected using 99 m Tc denatured red blood cells and localized using computed tomography. Resection of the accessory spleen resulted in clinical remission. As accessory spleens are often small in size, combined modality imaging is recommended in the evaluation of this disorder. 15 refs., 2 figs

  9. A giant cholesteatoma of the mastoid extending into the foramen magnum: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Seidu A Richard

    2018-04-01

    Full Text Available Cholesteatomas are very rare benign, progressive lesions that have embryologic derivation and usually result in progressive exfoliation and confinement of squamous epithelium behind an intact or preciously infected tympanic membrane. To the best of our understanding no reports demonstrates the extension of cholesteatoma from the temporal bone into the foramen magnum. We therefore present a case of cholesteatoma extending down into the foramen magnum. We report a case of 67- year-old man with a giant cholesteatoma extending into the foramen magnum without substantial destruction of the mastoid and petrous temporal bones. The patient’s major symptoms were recurrent tinnitus in the left ear and dizziness with unilateral conductive hearing loss. A working diagnosis of cholesteatomas was made combining the symptoms and magnetic resonance imaging findings. He was then successfully operated on with very minimal postoperative complications. Cholesteatomas originating from the mastoid bone often linger with the patients for many years in a subclinical state and progress into a massive size before causing symptoms. Patients with unilateral conductive hearing loss who are otherwise asymptomatic and have a normal tympanic membrane should be suspected with a progressive cholesteatoma. Cholesteatoma should be one of the working diagnosis when an elderly patient present with unilateral conductive hearing loss that is associated with tinnitus and dizziness.

  10. Incidental occurrence of an unusually large mastoid foramen on cone beam computed tomography and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Syed, Ali Z.; Sin, Cleo; Rios, Raquel [Dept. of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland (United States); Mupparapu, Mel [Div. of Radiology, University of Pennsylvania School of Dental Medicine, Philadelphia(United States)

    2016-03-15

    The incidental finding of an enlarged mastoid foramen on the right posterior mastoid region of temporal bone is reported, together with a discussion of its clinical significance. A 67-year-old female underwent the pre-implant assessment of a maxillary left edentulous region. A cone-beam computed tomographic (CBCT) image was acquired and referred for consultation. Axial CBCT slices revealed a unilateral, well-defined, noncorticated, low-attenuation, transosseous defect posterior to the mastoid air cells in the right temporal bone. The borders of the osseous defect were smooth and continuous. No other radiographic signs suggestive of erosion or sclerosis were noted in the vicinity. The density within the defect was homogenous and consistent with a foramen and/or soft tissue. The patient's history and physical examination revealed no significant medical issues, and she was referred to a neuroradiologist for a second opinion. The diagnosis of an enlarged mastoid foramen was made and the patient was reassured.

  11. An enlarged parietal foramen in the late archaic Xujiayao 11 neurocranium from Northern China, and rare anomalies among Pleistocene Homo.

    Science.gov (United States)

    Wu, Xiu-Jie; Xing, Song; Trinkaus, Erik

    2013-01-01

    We report here a neurocranial abnormality previously undescribed in Pleistocene human fossils, an enlarged parietal foramen (EPF) in the early Late Pleistocene Xujiayao 11 parietal bones from the Xujiayao (Houjiayao) site, northern China. Xujiayao 11 is a pair of partial posteromedial parietal bones from an adult. It exhibits thick cranial vault bones, arachnoid granulations, a deviated posterior sagittal suture, and a unilateral (right) parietal lacuna with a posteriorly-directed and enlarged endocranial vascular sulcus. Differential diagnosis indicates that the perforation is a congenital defect, an enlarged parietal foramen, commonly associated with cerebral venous and cranial vault anomalies. It was not lethal given the individual's age-at-death, but it may have been associated with secondary neurological deficiencies. The fossil constitutes the oldest evidence in human evolution of this very rare condition (a single enlarged parietal foramen). In combination with developmental and degenerative abnormalities in other Pleistocene human remains, it suggests demographic and survival patterns among Pleistocene Homo that led to an elevated frequency of conditions unknown or rare among recent humans.

  12. An enlarged parietal foramen in the late archaic Xujiayao 11 neurocranium from Northern China, and rare anomalies among Pleistocene Homo.

    Directory of Open Access Journals (Sweden)

    Xiu-Jie Wu

    Full Text Available We report here a neurocranial abnormality previously undescribed in Pleistocene human fossils, an enlarged parietal foramen (EPF in the early Late Pleistocene Xujiayao 11 parietal bones from the Xujiayao (Houjiayao site, northern China. Xujiayao 11 is a pair of partial posteromedial parietal bones from an adult. It exhibits thick cranial vault bones, arachnoid granulations, a deviated posterior sagittal suture, and a unilateral (right parietal lacuna with a posteriorly-directed and enlarged endocranial vascular sulcus. Differential diagnosis indicates that the perforation is a congenital defect, an enlarged parietal foramen, commonly associated with cerebral venous and cranial vault anomalies. It was not lethal given the individual's age-at-death, but it may have been associated with secondary neurological deficiencies. The fossil constitutes the oldest evidence in human evolution of this very rare condition (a single enlarged parietal foramen. In combination with developmental and degenerative abnormalities in other Pleistocene human remains, it suggests demographic and survival patterns among Pleistocene Homo that led to an elevated frequency of conditions unknown or rare among recent humans.

  13. Subdural Fluid Collection and Hydrocephalus After Foramen Magnum Decompression for Chiari Malformation Type I: Management Algorithm of a Rare Complication.

    Science.gov (United States)

    Rossini, Zefferino; Milani, Davide; Costa, Francesco; Castellani, Carlotta; Lasio, Giovanni; Fornari, Maurizio

    2017-10-01

    Chiari malformation type I is a hindbrain abnormality characterized by descent of the cerebellar tonsils beneath the foramen magnum, frequently associated with symptoms or brainstem compression, impaired cerebrospinal fluid circulation, and syringomyelia. Foramen magnum decompression represents the most common way of treatment. Rarely, subdural fluid collection and hydrocephalus represent postoperative adverse events. The treatment of this complication is still debated, and physicians are sometimes uncertain when to perform diversion surgery and when to perform more conservative management. We report an unusual occurrence of subdural fluid collection and hydrocephalus that developed in a 23-year-old patient after foramen magnum decompression for Chiari malformation type I. Following a management protocol, based on a step-by-step approach, from conservative therapy to diversion surgery, the patient was managed with urgent external ventricular drainage, and then with conservative management and wound revision. Because of the rarity of this adverse event, previous case reports differ about the form of treatment. In future cases, finding clinical and radiologic features to identify risk factors that are useful in predicting if the patient will benefit from conservative management or will need to undergo diversion surgery is only possible if a uniform form of treatment is used. Therefore, we believe that a management algorithm based on a step-by-step approach will reduce the use of invasive therapies and help to create a standard of care. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Clinical anatomy and significance of the thoracic intervertebral foramen: A cadaveric study and review of the literature.

    Science.gov (United States)

    Gkasdaris, Grigorios; Tripsianis, Grigorios; Kotopoulos, Konstantinos; Kapetanakis, Stylianos

    2016-01-01

    The literature is lacking information on the anatomy and the osseous dimensions of the thoracic intervertebral foramen (IVF). We describe the anatomy of the broader area, and we proceed with morphometric data of the vertebrae and the foramina. Depiction of these features is provided with imaging and illustrations. The purpose of this paper is to survey and present the anatomy of the foramen as a whole and provide baseline statistical data. We review relevant literature, and we present data obtained from skeletal samples of known population and sex. One hundred and nineteen thoracic vertebrae of ten cadaveric spines from the prefecture of Eastern Macedonia and Thrace, Greece, were selected. Statistical analysis measuring the vertical height and the foraminal width of each vertebra was made in accordance with sex. No statistically important differences referring to the descriptive data of both sexes were found. However, statistically, important positive correlation between the vertebral height and the foraminal width was observed, especially for men. The components of the foramen including arteries and veins passing through or neighboring it, and the spinal nerves and roots are described and depicted. The osseous thoracic IVF reveals a glimpse of the in vivo structure and alterations of its width may be present in back pain and other degenerative diseases. Although it is crucial for surgeries and other interventional procedures of the thoracic spine, little is known about the precise anatomy and dimensions of this anatomical landmark.

  15. Clinical anatomy and significance of the thoracic intervertebral foramen: A cadaveric study and review of the literature

    Directory of Open Access Journals (Sweden)

    Grigorios Gkasdaris

    2016-01-01

    Full Text Available Introduction: The literature is lacking information on the anatomy and the osseous dimensions of the thoracic intervertebral foramen (IVF. We describe the anatomy of the broader area, and we proceed with morphometric data of the vertebrae and the foramina. Depiction of these features is provided with imaging and illustrations. The purpose of this paper is to survey and present the anatomy of the foramen as a whole and provide baseline statistical data. Materials and Methods: We review relevant literature, and we present data obtained from skeletal samples of known population and sex. One hundred and nineteen thoracic vertebrae of ten cadaveric spines from the prefecture of Eastern Macedonia and Thrace, Greece, were selected. Statistical analysis measuring the vertical height and the foraminal width of each vertebra was made in accordance with sex. Results: No statistically important differences referring to the descriptive data of both sexes were found. However, statistically, important positive correlation between the vertebral height and the foraminal width was observed, especially for men. The components of the foramen including arteries and veins passing through or neighboring it, and the spinal nerves and roots are described and depicted. Conclusions: The osseous thoracic IVF reveals a glimpse of the in vivo structure and alterations of its width may be present in back pain and other degenerative diseases. Although it is crucial for surgeries and other interventional procedures of the thoracic spine, little is known about the precise anatomy and dimensions of this anatomical landmark.

  16. The risk of translaminar screw fixation to the transverse foramen of the lower cervical spine: a computed tomography study.

    Science.gov (United States)

    Kong, Ganggang; Ji, Wei; Huang, Zucheng; Liu, Junhao; Chen, Jianting; Zhu, Qingan

    2017-04-21

    Translaminar screw fixation (TSF) of the axis is considered as an efficient, safe and simple surgical procedure, however the study of the potential risk of TSF to the transverse foramen in lower cervical spine is lacked. Head-neck CT images of 60 patients were included in this study. Maximum screw length, laminar thickness, the screw angle and the laminar height were measured. The feasibility of 3.5-mm diameter screw fixation and the potential risk of transverse foramen injury was analyzed. The TSF was safe at C3 and C4, but risky to the transverse foraman at a rate of 8.7% at C5 (0% on the left side and 20% on the right side), 33.3% at C6 (24.4% on the left side and 42.9% on the right side). C7 had the highest 77.8% rate (65.5% on the left side and 89.8% on the right side). The safe screw length was 27.7 mm at C3, 27.4 mm at C4, 28.0 mm at C5, 25.6 mm at C6 and 25.5 mm at C7, respectively. The present study showed that translaminar screw could place the transverse foramen of C5-C7 at risk. Preoperative CT scanning was necessary for safe screw placement.

  17. Incidental occurrence of an unusually large mastoid foramen on cone beam computed tomography and review of the literature

    International Nuclear Information System (INIS)

    Syed, Ali Z.; Sin, Cleo; Rios, Raquel; Mupparapu, Mel

    2016-01-01

    The incidental finding of an enlarged mastoid foramen on the right posterior mastoid region of temporal bone is reported, together with a discussion of its clinical significance. A 67-year-old female underwent the pre-implant assessment of a maxillary left edentulous region. A cone-beam computed tomographic (CBCT) image was acquired and referred for consultation. Axial CBCT slices revealed a unilateral, well-defined, noncorticated, low-attenuation, transosseous defect posterior to the mastoid air cells in the right temporal bone. The borders of the osseous defect were smooth and continuous. No other radiographic signs suggestive of erosion or sclerosis were noted in the vicinity. The density within the defect was homogenous and consistent with a foramen and/or soft tissue. The patient's history and physical examination revealed no significant medical issues, and she was referred to a neuroradiologist for a second opinion. The diagnosis of an enlarged mastoid foramen was made and the patient was reassured

  18. Accessory cardiac bronchus: Proposed imaging classification on multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kang Min; Kim, Young Tong; Han, Jong Kyu; Jou, Sung Shick [Dept. of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan (Korea, Republic of)

    2016-02-15

    To propose the classification of accessory cardiac bronchus (ACB) based on imaging using multidetector computed tomography (MDCT), and evaluate follow-up changes of ACB. This study included 58 patients diagnosed as ACB since 9 years, using MDCT. We analyzed the types, division locations and division directions of ACB, and also evaluated changes on follow-up. We identified two main types of ACB: blind-end (51.7%) and lobule (48.3%). The blind-end ACB was further classified into three subtypes: blunt (70%), pointy (23.3%) and saccular (6.7%). The lobule ACB was also further classified into three subtypes: complete (46.4%), incomplete (28.6%) and rudimentary (25%). Division location to the upper half bronchus intermedius (79.3%) and medial direction (60.3%) were the most common in all patients. The difference in division direction was statistically significant between the blind-end and lobule types (p = 0.019). Peribronchial soft tissue was found in five cases. One calcification case was identified in the lobule type. During follow-up, ACB had disappeared in two cases of the blind-end type and in one case of the rudimentary subtype. The proposed classification of ACB based on imaging, and the follow-up CT, helped us to understand the various imaging features of ACB.

  19. Protein Tunnels: The Case of Urease Accessory Proteins.

    Science.gov (United States)

    Musiani, Francesco; Gioia, Dario; Masetti, Matteo; Falchi, Federico; Cavalli, Andrea; Recanatini, Maurizio; Ciurli, Stefano

    2017-05-09

    Transition metals are both essential micronutrients and limited in environmental availability. The Ni(II)-dependent urease protein, the most efficient enzyme known to date, is a paradigm for studying the strategies that cells use to handle an essential, yet toxic, metal ion. Urease is a virulence factor of several human pathogens, in addition to decreasing the efficiency of soil organic nitrogen fertilization. Ni(II) insertion in the urease active site is performed through the action of three essential accessory proteins: UreD, UreF, and UreG. The crystal structure of the UreD-UreF-UreG complex from the human pathogen Helicobacter pylori (HpUreDFG) revealed the presence of tunnels that cross the entire length of both UreF and UreD, potentially able to deliver Ni(II) ions from UreG to apo-urease. Atomistic molecular dynamics simulations performed on the HpUreDFG complex in explicit solvent and at physiological ionic conditions demonstrate the stability of these protein tunnels in solution and provide insights on the trafficking of water molecules inside the tunnels. The presence of different alternative routes across the identified tunnels for Ni(II) ions, water molecules, and carbonate ions, all involved in urease activation, is highlighted here, and their potential role in the urease activation mechanism is discussed.

  20. Rock sealing - large scale field test and accessory investigations

    International Nuclear Information System (INIS)

    Pusch, R.

    1988-03-01

    The experience from the pilot field test and the basic knowledge extracted from the lab experiments have formed the basis of the planning of a Large Scale Field Test. The intention is to find out how the 'instrument of rock sealing' can be applied to a number of practical cases, where cutting-off and redirection of groundwater flow in repositories are called for. Five field subtests, which are integrated mutually or with other Stripa projects (3D), are proposed. One of them concerns 'near-field' sealing, i.e. sealing of tunnel floors hosting deposition holes, while two involve sealing of 'disturbed' rock around tunnels. The fourth concerns sealing of a natural fracture zone in the 3D area, and this latter test has the expected spin-off effect of obtaining additional information on the general flow pattern around the northeastern wing of the 3D cross. The fifth test is an option of sealing structures in the Validation Drift. The longevity of major grout types is focussed on as the most important part of the 'Accessory Investigations', and detailed plans have been worked out for that purpose. It is foreseen that the continuation of the project, as outlined in this report, will yield suitable methods and grouts for effective and long-lasting sealing of rock for use at stategic points in repositories. (author)

  1. Macaque accessory optic system: II. Connections with the pretectum

    International Nuclear Information System (INIS)

    Baleydier, C.; Magnin, M.; Cooper, H.M.

    1990-01-01

    Connections of the accessory optic system (AOS) with the pretectum are described in the macaque monkey. Injections of tritiated amino acids in the pretectum demonstrate a major contralateral projection to the dorsal (DTN), lateral (LTN), and medial (MTN) terminal nuclei of the AOS and a sparser projection to the ipsilateral LTN. Injections of retrograde tracers, Fast Blue (FB), or wheat germ agglutinin horseradish peroxidase (WGA-HRP) plus nonconjugated horseradish peroxidase (HRP) in the LTN show that the pretectal-LTN projection originates from two nuclei. The main source of pretectal efferents to the LTN is from the pretectal olivary nucleus (OPN) and is entirely contralateral. This projection, which appears unique to primates, originates from the large multipolar cells of the OPN. In addition to this projection, the nucleus of the optic tract (NOT) projects to the ipsilateral LTN, as in nonprimates. Injection of WGA-HRP in the pretectum shows a reciprocal predominantely ipsilateral projection from the LTN to the pretectum. Retinas were observed after injection of FB in the LTN. The retinal ganglion cells projecting to the AOS are mainly distributed near the fovea and in the nasal region of the contralateral eye, suggesting a nasotemporal pattern of decussation. The demonstration of a direct connection between LTN and OPN forces to a reconsideration of the functional role of the AOS. Previous descriptions of luminance responsive cells in the LTN support a possible participation of this nucleus in the control of the pupillary light reflex

  2. Gold in Accessory Zircon (the Kozhim Massif, Subpolar Urals)

    Science.gov (United States)

    Denisova, Yuliya; Pystin, Aleksandr

    2017-12-01

    The crystals of zircon due to their resistance to external impact of various processes can reveal information about the environment of their formation and the inclusions observed of them. Zircon contains different mineral inclusions: biotite, plagioclase, quartz, apatite, etc. However, there is no information about gold inclusions in the zircons from granites of the Sudpolar Urals. The study results of the inclusions of gold in accessory zircon of the Kozhim granitic massif are presented in this paper. The studied mineral is a dark-brown translucent short-prismatic crystal containing the inclusion of gold and the allocations of quartz. According to studies, the inclusion of gold formed during the growth of zircon and it is the gold covered with a thin film of oxide gold. It was confirmed that the crystallization of the studied zircon occurred at a temperature of 800°C and above on the stage of formation of granites of Kozhim massif. The assumption is made about the additional temperature in the course of which was caused by decreasing of temperature up to 700° C and below during postmagmatic stage.

  3. Male Accessory Gland Infection: Relevance of Serum Total Testosterone Levels

    Directory of Open Access Journals (Sweden)

    R. A. Condorelli

    2014-01-01

    Full Text Available Aim of the present study was to evaluate the different ultrasound characterization of fertile symptomatic patients with MAGI (male accessory gland infection according to different serum concentrations of total T (TT. We analyzed the ultrasound and hormonal data of 200 patients aged between 24.0 and 67.0 years. Patients were divided into six groups according to the sextile distribution of TT. Patients with serum concentrations of TT 6.6 ng mL−1 showed a frequency of ultrasound criteria suggestive for bilateral form of prostatitis and prostate-vesiculo-epididymitis and significantly lower compared to the other examined groups. At multivariate logistic regression analysis adjusted for age and BMI, TT was an independent predictive factor of prostatovesiculitis (OR = 0.818 [95% CI: 0.675–0.992]; P<0.01 and prostate-vesiculo-epididymitis (OR = 0.714 [95% CI: 0.578–0.880]; P<0.01, which represent the main forms of complicated MAGI. The results of this study suggest that male hypogonadism could be associated with a different ultrasound characterization of these patients.

  4. Accessory minerals of Permian volcanites of South Gemeric Unit and Borka Nappe

    Energy Technology Data Exchange (ETDEWEB)

    Smelko, M; Vozarova, A [Comenius University in Bratislava, Faculty of Natural Sciences, Department of Mineralogy and Petrology, 84215 Bratislava (Slovakia)

    2010-04-28

    The goal of this study was to summarize and complete the results from the study of metavolcanites and their accessory minerals (Zircon Zr{sub 2}SiO{sub 4}, Monazite CePO{sub 4} and Xenotime YPO{sub 4}) from the Southern Gemericum Unit and from the Borka Nappe. The acid metavolcanites and their accessory minerals were observed of the modern analytical methods.

  5. Innovative usage of accessory auricles as full-thickness skin graft

    Directory of Open Access Journals (Sweden)

    Elankumar Subbarayan

    2017-01-01

    Full Text Available Accessory auricles are relatively rare malformations arising from the first branchial arch which contains skin, fat and cartilage. The treatment is usually surgical removal for the cosmetic purpose. We are sharing our experience of utilising the accessory auricle skin as full thickness graft for post.burn reconstruction of the fingers contracture of a child. Even though this type of association is rare, it is an innovative idea following Sir Harold Gilles’ principle ‘Never throw anything away’.

  6. Meningiomas del foramen magno: Reporte de 12 casos y revisión de la literatura

    Science.gov (United States)

    Campero, Álvaro; Ajler, Pablo; Roman, Guillermo; Rivadeneira, Conrado

    2017-01-01

    Resumen Objetivo: El propósito del presente trabajo es presentar los resultados de 12 pacientes con diagnóstico de meningiomas del foramen magno (MFM), de localización anterior o lateral, operados con técnicas microquirúrgicas. Método: Desde Junio de 2005 a Diciembre de 2016, 12 pacientes con diagnóstico de MFM fueron intervenidos quirúrgicamente. Se evaluó: edad, sexo, localización de la lesión (anterior o lateral), sintomatología, tipo de abordaje utilizado y resultados postoperatorios. Resultados: De los pacientes intervenidos, 8 fueron mujeres y 4 varones. La edad promedio fue de 47 años. La localización fue anterior en 8 casos y lateral en 4 casos. La sintomatología más frecuente fue dolor occipito-cervical (8 casos), seguido de tetraparesia (3 casos). En los pacientes con MFM de localización anterior se realizó un abordaje extremo-lateral transcondilar (ELTC), mientras que en los tumores laterales el abordaje fue extremo-lateral retrocondilar (ELRC). En 10 casos la resección fue completa. En dos pacientes fue necesario dejar una pequeña lámina de meningioma sobre la arteria vertebral y a nivel del foramen yugular. Como complicaciones postoperatorias, 3 pacientes presentaron una paresia del XII nervio craneano y 2 pacientes paresia del XI nervio craneano; además, 1 paciente presentó una fístula de LCR. Conclusión: La cirugía de los MFM de localización anterior y lateral puede ser realizada de forma segura y efectiva. Es necesario: a) buen conocimiento anatómico de la región; b) disecar los músculos de la nuca en 2 planos, exponiendo el triángulo suboccipital y la arteria vertebral (AV); 3) realizar un abordaje ELRC en los tumores laterales, y ELTC en los tumores anteriores; y 4) buena técnica microquirúrgica. PMID:29142778

  7. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke.

    Science.gov (United States)

    Saver, Jeffrey L; Carroll, John D; Thaler, David E; Smalling, Richard W; MacDonald, Lee A; Marks, David S; Tirschwell, David L

    2017-09-14

    Whether closure of a patent foramen ovale reduces the risk of recurrence of ischemic stroke in patients who have had a cryptogenic ischemic stroke is unknown. In a multicenter, randomized, open-label trial, with blinded adjudication of end-point events, we randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group). The primary efficacy end point was a composite of recurrent nonfatal ischemic stroke, fatal ischemic stroke, or early death after randomization. The results of the analysis of the primary outcome from the original trial period have been reported previously; the current analysis of data from the extended follow-up period was considered to be exploratory. We enrolled 980 patients (mean age, 45.9 years) at 69 sites. Patients were followed for a median of 5.9 years. Treatment exposure in the two groups was unequal (3141 patient-years in the PFO closure group vs. 2669 patient-years in the medical-therapy group), owing to a higher dropout rate in the medical-therapy group. In the intention-to-treat population, recurrent ischemic stroke occurred in 18 patients in the PFO closure group and in 28 patients in the medical-therapy group, resulting in rates of 0.58 events per 100 patient-years and 1.07 events per 100 patient-years, respectively (hazard ratio with PFO closure vs. medical therapy, 0.55; 95% confidence interval [CI], 0.31 to 0.999; P=0.046 by the log-rank test). Recurrent ischemic stroke of undetermined cause occurred in 10 patients in the PFO closure group and in 23 patients in the medical-therapy group (hazard ratio, 0.38; 95% CI, 0.18 to 0.79; P=0.007). Venous thromboembolism (which comprised events of pulmonary embolism and deep-vein thrombosis) was more common in the PFO closure group

  8. Incidence and morphology of accessory heads of flexor pollicis longus and flexor digitorum profundus (Gantzer's muscles)

    Science.gov (United States)

    JONES, M.; ABRAHAMS, P. H.; SAÑUDO, J. R.; CAMPILLO, M.

    1997-01-01

    In 1813 Gantzer described 2 accessory muscles in the human forearm which bear his name (Wood, 1868; Macalister, 1875; Testut, 1884; Le Double, 1897). The more frequent of the 2 accessory muscles or ‘accessorius ad pollicem’ was found to arise from the coronoid process of the ulna, coursing distally to attach into the flexor pollicis longus muscle (flexor pollicis longus accessory head, FPLah). The less frequently observed or ‘accessorius ad flexorem profundum digitorum’ was again found to arise from the coronoid process and course to join into the flexor digitorum profundus (flexor digitorum profundus accessory head, FDPah). Since their initial description, they have been examined in further detail by a number of authors (Wood, 1868; Macalister, 1875; Le Double, 1897; Dykes & Anson, 1944; Mangini, 1960; Malhotra et al. 1982; Dellon & McKinnon, 1987; Kida, 1988). These studies, most of them focusing on the FPLah, all show different results of prevalence, origin, insertion, relations and nerve supply. We undertook this study with the aim of providing a more accurate account of the detailed morphology of both accessory muscles because of the above-mentioned inconsistent anatomical descriptions and the lack of information as to important aspects such as vascular supply, morphology (shape and length) and the coexistence of both accessory heads. PMID:9419002

  9. MR imaging findings of painful type II accessory navicular bone: correlation with surgical and pathologic studies

    International Nuclear Information System (INIS)

    Choi, Yun Sun; Lee, Kyung Tai; Kim, Eun Kyung; Kang, Heung Sik

    2004-01-01

    To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients

  10. Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen.

    Science.gov (United States)

    Leo, C A; Pravisani, R; Bidinost, S; Baccarani, U; Bresadola, V; Risaliti, A; Terrosu, G

    2015-01-01

    Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice. At our Department, between July and November 2011 two patients underwent laparoscopic accessory splenectomy for recurrence of ITP. Both patients had a previously laparoscopic splenectomy. Preoperative Magnetic Resonance (MR) was performed in both the cases revealing the presence of an accessory spleen. The operative time was 105 and 100 minutes respectively. No perioperative complications occured. Hospital stay was four days in both cases. The first patient had a disease free period of two months; the second one of one month. Both patients restarted immunosuppressive therapy. The relapse of thrombocytopenia post-splenectomy can be associated with the presence of an accessory spleen. The laparoscopic accessory splenectomy should be considered the first choice approach. Surgical accessory splenectomy allows a transitory remission of the disease.

  11. Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation.

    Science.gov (United States)

    VonAchen, Paige; Hamann, Jason; Houghland, Thomas; Lesser, John R; Wang, Yale; Caye, David; Rosenthal, Kristi; Garberich, Ross F; Daniels, Mary; Schwartz, Robert S

    The aim of this study was to understand the role of accessory renal arteries in resistant hypertension, and to establish their role in nonresponse to radiofrequency renal denervation (RDN) procedures. Prior studies suggest a role for accessory renal arteries in hypertensive syndromes, and recent clinical trials of renal denervation report that these anomalies are highly prevalent in resistant hypertension. This study evaluated the relationships among resistant hypertension, accessory renal arteries, and the response to radiofrequency (RF) renal denervation. Computed Tomography Angiography (CTA) and magnetic resonance imaging (MRI) scans from 58 patients with resistant hypertension undergoing RF renal denervation (RDN) were evaluated. Results were compared with CT scans in 57 healthy, normotensive subjects undergoing screening as possible renal transplant donors. All scans were carefully studied for accessory renal arteries, and were correlated with long term blood pressure reduction. Accessory renal arteries were markedly more prevalent in the hypertensive patients than normotensive renal donors (59% vs 32% respectively, p=0.004). RDN had an overall nonresponse rate of 29% (response rate 71%). Patients without accessory vessels had a borderline higher response rate to RDN than those with at least one accessory vessel (83% vs 62% respectively, p=0.076) and a higher RDN response than patients with untreated accessory arteries (83% vs 55%; p=0.040). For accessory renal arteries and nonresponse, the sensitivity was 76%, specificity 49%, with positive and negative predictive values 38% and 83% respectively. Accessory renal arteries were markedly over-represented in resistant hypertensives compared with healthy controls. While not all patients with accessory arteries were nonresponders, nonresponse was related to both the presence and non-treatment of accessory arteries. Addressing accessory renal arteries in future clinical trials may improve RDN therapeutic efficacy

  12. Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

    Science.gov (United States)

    Sanz-García, Ancor; Vega-Zelaya, Lorena; Pastor, Jesús; Torres, Cristina V.; Sola, Rafael G.; Ortega, Guillermo J.

    2016-01-01

    Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area. PMID:28060326

  13. Patent foramen ovale and atrial septal aneurysm can cause ischemic stroke in patients with antiphospholipid syndrome.

    Science.gov (United States)

    Tanaka, Yasutaka; Ueno, Yuji; Miyamoto, Nobukazu; Shimada, Yoshiaki; Tanaka, Ryota; Hattori, Nobutaka; Urabe, Takao

    2013-01-01

    The purpose of the present study was to evaluate the contributions of embolic etiologies, patent foramen ovale (PFO) and atrial septal aneurysm (ASA) to the pathogenesis of ischemic stroke in patients with antiphospholipid syndrome (APS). We performed transesophageal echocardiography (TEE) examination for consecutive stroke patients who had been diagnosed with APS (APS group) to detect potential embolic sources. APS was diagnosed based on the modified Sapporo criteria. The control stroke group comprised age- and sex-matched cryptogenic stroke patients undergoing TEE. We assessed and compared the clinical characteristics and TEE findings between stroke patients with APS and control stroke groups. Among 582 patients, nine patients (nine women; mean age, 50 ± 18 years) were classified into the APS group. In 137 patients undergoing TEE, 41 age-matched female stroke patients were recruited to the control stroke group. Prevalences of PFO and ASA were significantly higher in the APS group than in the control stroke group (89 vs. 41 %, p = 0.027; 67 vs. 20 %, p = 0.015, respectively). Multiple logistic regression analysis showed that PFO (odds ratio (OR), 13.71; 95 % confidence interval (CI), 1.01-185.62; p = 0.049) and ASA (OR, 8.06; 95 % CI, 1.17-55.59; p = 0.034) were independently associated with the APS group. PFO and ASA were strongly associated with the APS group, and could thus represent potential embolic sources in ischemic stroke patients with APS.

  14. [Periprocedural and late complications after percutaneous closure of patent foramen ovale: a single centre experience].

    Science.gov (United States)

    Węglarz, Przemysław; Konarska Kuszewska, Ewa; Spisak Borowska, Katarzyna; Machowski, Jerzy; Drzewiecka-Gerber, Agnieszka; Kuszewski, Piotr; Jackson, Christopher L; Opala, Grzegorz; Trusz Gluza, Maria

    2012-01-01

    Patent foramen ovale (PFO) is a potential risk factor for ischaemic stroke in young individuals. An interventional method of secondary stroke prevention in PFO patients is its percutaneous closure. To assess safety and effectiveness (i.e. lack of residual shunt) of percutaneous PFO closure in patients with history of cryptogenic cerebrovascular event. 149 patients (56 men/93 women), aged 39 ± 12 years, underwent percutaneous PFO closure. The implantation was performed under local anaesthesia, guided by trans-oesophageal echocardiography (TEE) and fluoroscopy. Follow-up trans-thoracic echocardiography (TTE) was performed at 1 month and follow-up TEE at 6-months. In cases of residual shunt, additional TEE was performed after ensuing 6 months. Effective PFO closure (no residual shunt) was achieved in 91.3% patients at 6 months and 95.3% patients at 12 months. In 2 patients transient atrial fibrillation was observed during the procedure. In 2 patients, a puncture site haematoma developed and in 1 patient superficial thrombophlebitis was noted. In 1 patient a small pericardial effusion was observed, which resolved at day 3 post-procedurally, after administration of non-steroidal anti-inflammatory drugs. Percutaneous PFO closure seems to be a safe procedure when performed in a centre with adequate expertise with regard to these procedures.

  15. Mean platelet volume is elevated in patients with patent foramen ovale.

    Science.gov (United States)

    Demir, Bulent; Caglar, Ilker Murat; Ungan, Ismail; Ugurlucan, Murat; Tureli, Hande Oktay; Karakaya, Osman

    2013-12-30

    Platelets play a major role in thromboembolic events. Increased mean platelet volume (MPV) indicates higher platelet reactivity and also a tendency to thrombosis. Patent foramen ovale (PFO), persistence of the fetal anatomic shunt between right and left atria, is strongly associated with cryptogenic stroke. The aim of this study is to determine the relationship between MPV and PFO and if such an association exists, whether higher MPV levels may require antiplatelet therapy before a thromboembolic event happens, together with a literature review. Thirty patients (15 women, 15 men), free of any cerebrovascular events, were diagnosed with PFO by transesophageal echocardiography (TEE), enrolled as the study group. Thirty consecutive patients (16 women and 14 men), who were diagnosed as normal in TEE, were enrolled as the control group. These two groups were compared according to MPV and anatomical features of the right atrium. There was no significant difference between study and control groups in clinical features and also no difference was observed in platelet counts; however, MPV in the PFO group was significantly higher than the control group (8.38 ±0.93 fl and 7.45 ±0.68 fl respectively). Our results indicate that elevated MPV may be detected in patients with PFO. This might be one of the explanations for the relationship between PFO and cryptogenic stroke; however, larger cohorts are warranted in order to define further mechanisms.

  16. Foramen magnum meningiomas: surgical treatment in a single public institution in a developing country

    Directory of Open Access Journals (Sweden)

    Benedicto Oscar Colli

    2014-07-01

    Full Text Available Objective: To analyze the clinical outcome of patients with foramen magnum (FM meningiomas. Method: Thirteen patients (11 Feminine / 2 Masculine with FM meningiomas operated on through lateral suboccipital approach were studied. Clinical outcome were analyzed using survival (SC and recurrence-free survival curves (RFSC. Results: All tumors were World Health Organization grade I. Total, subtotal and partial resections were acchieved in 69.2%, 23.1% and 7.7%, respectively, and SC was better for males and RFSC for females. Tumor location, extent of resection and involvement of vertebral artery/lower cranial nerves did not influence SC and RFSC. Recurrence rate was 7.7%. Operative mortality was 0. Main complications were transient (38.5% and permanent (7.7% lower cranial nerve deficits, cerebrospinal fluid fistula (30.8%, and transient and permanent respiratory difficulties in 7.7% each. Conclusions: FM meningiomas can be adequately treated in public hospitals in developing countries if a multidisciplinary team is available for managing postoperative lower cranial nerve deficits.

  17. Neonatal neurological disorders involving the brainstem: neurosonographic approaches through the squamous suture and the foramen magnum

    International Nuclear Information System (INIS)

    Tu, Yi-Fang; Chen, Cheng-Yu; Lin, Yuh-Jey; Chang, Ying-Chao; Huang, Chao-Ching

    2005-01-01

    Brainstem damage which often indicates a critical condition is usually underestimated by trans-anterior-fontanel neurosonography (NS) owing to the far-field limitations. Instead, NS alternately scanning through the squamous suture of the temporal bones and the foramen magnum could provide a better visualization of the brainstem structures. The NS characteristics of brainstem lesions caused by various neonatal neurological disorders, such as hypoxic-ischemic encephalopathy (HIE), metabolic encephalopathy, birth trauma and bacterial meningoencephalitis, can be depicted at the acute stage. An echogenic change in the midbrain was found in patients with HIE or metabolic encephalopathy. In addition to the echogenic change, bilateral transtentorial temporal lobe herniation distorting the contour of the midbrain was observed in a patient with group B streptococcus meningoencephalitis, whereas echogenic changes at the level of the pons and/or the medulla oblongata, mainly localized in the dorsal part, could be observed in newborns with severe HIE, maple syrup urine disease or birth trauma. In this pictorial assay, we demonstrate the feasibility of NS imaging in evaluating the entire brainstem structure of critically ill neonates in the near field and illustrate the characteristic features of brainstem involvement in various neonatal neurological disorders along with computed tomography or magnetic resonance imaging correlation. (orig.)

  18. Relative position of the mandibular foramen in different age groups of children: A radiographic study

    Directory of Open Access Journals (Sweden)

    Poonacha K

    2010-09-01

    Full Text Available Objectives: To assess the relative position of the mandibular foramen (MF and to evaluate the measurement of gonial angle (GoA and its relationship with distances between different mandibular borders in growing children between 3 and 13years of dental age. Materials and methods: The radiographs were traced to arrive at six linear and two angular measurements from which the relative position of the MF was assessed and compared in different age groups to determine the growth pattern of the mandible and changes in the location of the MF. Results: The distances between the MF and the anterior plane of the ramus were greater than that between MF and posterior plane of the ramus through all stages. There was a maximum increase in the vertical dimensions of the mandible compared with the horizontal dimensions, particularly in the late mixed dentition period. Conclusion: The mandible and its growth did not alter the position of the MF, both vertically and horizontally, in relation to different landmarks, and more obtuse GoA indicated an increased growth potential of the mandible. This has major implications in the inferior alveolar nerve block technique when used in children.

  19. Concomitant coronary and pulmonary embolism associated with patent foramen ovale: A case report.

    Science.gov (United States)

    Chen, Zhongxiu; Li, Chen; Li, Yajiao; Tang, Hong; Rao, Li; Wang, Mian

    2017-12-01

    The differential diagnosis of acute chest pain is very important, and can sometimes be challenging. Related diseases share a number of risk factors, and occasionally, 1 condition causes another disease to develop. We described a 59-year-old man who presented to emergency department complaining of chest pain. He was suffered acute myocardial infarction (MI) and pulmonary embolism (PE) simultaneously. Dual antiplatelet therapy, statin, and low molecular weight heparin were administrated during his stay. The searches for cancers, autoimmune diseases, and hematologic diseases were unremarkable, ruling out a hypercoagulable state. Subsequent ultrasound scan revealed a thrombus in a vein of the lower left extremity. Thus, paradoxical embolism was highly suspected. Paradoxical embolism is a rare cause of acute MI, which may have occurred in our patient. This was evidenced by a previously unrecognized patent foramen ovale (PFO) with a right-to-left atrial shunt detected using contrast transesophageal echocardiography. Acute MI complicated with PE is not common in the clinical setting. The fatal condition is difficult to diagnose because of the similar symptoms and confusing causes. Paradoxical embolism can cause this phenomenon, and physicians should be highly vigilant in the search for a PFO in cases of paradoxical embolism. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  20. A Case of Shunting Postoperative Patent Foramen Ovale Under Mechanical Ventilation Controlled by Different Ventilator Settings.

    Science.gov (United States)

    Pragliola, Claudio; Di Michele, Sara; Galzerano, Domenico

    2017-06-07

    A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE) performed while the patient was being ventilated at a positive end expiratory pressure (PEEP) of 8 cm H 2 O demonstrated a right to left interatrial shunt across a patent foramen ovale (PFO). Whereas oxygen saturation was normal, a reduction of the PEEP to 3 cm H 2 O led to the complete resolution of the shunt with no change in arterial blood gases. Attempts to increase the PEEP level above 3 mmHg resulted in recurrence of the interatrial shunt. The remaining of the TEE was unremarkable. Mechanical ventilation, particularly with PEEP, causes an increase in intrathoracic pressure. The resulting rise in right atrial pressure, mostly during inspiration, may unveil and pop open an unrecognized PFO, thus provoking a right to left shunt across a seemingly intact interatrial septum. This phenomenon increases the risk of paradoxical embolism and can lead to hypoxemia. The immediate management would be to adjust the ventilatory settings to a lower PEEP level. A routine search for a PFO should be performed in ventilated patients who undergo a TEE.

  1. Systematic Review of Treatment for Trapped Thrombus in Patent Foramen Ovale.

    Science.gov (United States)

    Seo, Won-Woo; Kim, Sung Eun; Park, Myung-Soo; Lee, Jun-Hee; Park, Dae-Gyun; Han, Kyoo-Rok; Oh, Dong-Jin

    2017-09-01

    Trapped thrombus in patent foramen ovale (PFO) is a rare complication of pulmonary embolism that may lead to tragic clinical events. The aim of this study was to identify the optimal treatment for different clinical situations in patients with trapped thrombus in a PFO by conducting a literature review. A PubMed database search was conducted from 1991 through 2015, and 194 patients (185 articles) with trapped thrombus in a PFO were identified. Patient characteristics, paradoxical embolic events, and factors affecting 60-day mortality were analyzed retrospectively. Among all patients, 112 (57.7%) were treated with surgery, 28 with thrombolysis, and 54 with anticoagulation alone. Dyspnea (79.4%), chest pain (33.0%), and syncope (17.5%) were the most common presenting symptoms. Pretreatment embolism was found in 37.6% of cases, and stroke (24.7%) was the most common event. Surgery was associated with fewer post-treatment embolic events than were other treatment options (p=0.044). In the multivariate analysis, initial shock or arrest, and thrombolysis were independent predictors of 60-day mortality. Thrombolysis was related with higher 60-day mortality compared with surgery in patients who had no initial shock or arrest. This systematic review showed that surgery was associated with a lower overall incidence of post-treatment embolic events and a lower 60-day mortality in patients with trapped thrombus in a PFO. In patients without initial shock or arrest, thrombolysis was related with a higher 60-day mortality compared with surgery.

  2. A case of shunting postoperative patent foramen ovale under mechanical ventilation controlled by different ventilator settings

    Directory of Open Access Journals (Sweden)

    Claudio Pragliola

    2017-08-01

    Full Text Available A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE performed while the patient was being ventilated at a positive end expiratory pressure (PEEP of 8 cm H2O demonstrated a right to left interatrial shunt across a patent foramen ovale (PFO. Whereas oxygen saturation was normal, a reduction of the PEEP to 3 cm H2O led to the complete resolution of the shunt with no change in arterial blood gases. Attempts to increase the PEEP level above 3 mmHg resulted in recurrence of the interatrial shunt. The remaining of the TEE was unremarkable. Mechanical ventilation, particularly with PEEP, causes an increase in intrathoracic pressure. The resulting rise in right atrial pressure, mostly during inspiration, may unveil and pop open an unrecognized PFO, thus provoking a right to left shunt across a seemingly intact interatrial septum. This phenomenon increases the risk of paradoxical embolism and can lead to hypoxemia. The immediate management would be to adjust the ventilatory settings to a lower PEEP level. A routine search for a PFO should be performed in ventilated patients who undergo a TEE.

  3. Catheter closure of patent foramen ovale in patients with cryptogenic cerebrovascular accidents: initial experiences in Japan.

    Science.gov (United States)

    Kijima, Yasufumi; Akagi, Teiji; Nakagawa, Koji; Taniguchi, Manabu; Ueoka, Akira; Deguchi, Kentaro; Toh, Norihisa; Oe, Hiroki; Kusano, Kengo; Sano, Shunji; Ito, Hiroshi

    2014-01-01

    Although numerous studies have shown an association between a patent foramen ovale (PFO) and cryptogenic cerebrovascular accidents (CVA), there has been no definitive control study that demonstrated the benefit of percutaneous device closure of a PFO compared to medical therapy in patients with CVA. Additionally, few clinical data exist for Japanese patients in this field. We demonstrate the initial experiences in catheter closure of a PFO as secondary prevention of CVA in Japan. Catheter closure of a PFO was attempted in 7 patients who were diagnosed with cryptogenic CVA. Mean age at the procedure was 54 ± 19 years. The presence of spontaneous interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography without Valsalva maneuver in all of the patients. Amplatzer Cribriform device (n = 4) or Amplatzer PFO Occluder (n = 3) was used for the procedure and was successfully deployed. Device-related complications were not observed at the time of the procedure or during the follow-up period (mean period of 16 ± 9 months). Catheter closure of a PFO could be safely performed with Amplatzer Cribriform or Amplatzer PFO Occluder. This procedure may contribute to prevention of recurrent cryptogenic CVA in Japanese patients.

  4. Increased Incidence of Interatrial Block in Younger Adults with Cryptogenic Stroke and Patent Foramen Ovale

    Directory of Open Access Journals (Sweden)

    P.E. Cotter

    2011-04-01

    Full Text Available Background: Stroke is often unexplained in younger adults, although it is often associated with a patent foramen ovale (PFO. The reason for the association is not fully explained, and mechanisms other than paradoxical embolism may be involved. Young stroke patients with PFO have more atrial vulnerability than those without PFO. It is plausible that stretching of the interatrial septum may disrupt the interatrial conduction pathways causing interatrial block (IAB. IAB is associated with atrial fibrillation, dysfunctional left atria and stroke. Methods: Electrocardiogram (ECG characteristics of prospectively recruited young patients (≤55 years of age with unexplained stroke (TOAST and A-S-C-O were compared with control data. All stroke cases underwent bubble contrast transthoracic and transoesophageal echography. IAB was defined as a P-wave duration of ≧110 ms. ECG data were converted to electronic format and analysed in a blind manner. Results: Fifty-five patients and 23 datasets were analysed. Patients with unexplained stroke had longer P-wave duration (p = 0.013 and a greater prevalence of IAB (p = 0.02 than healthy controls. Case status was an independent predictor of P-wave duration in a significant multivariate model. There was a significant increase in the proportion of cases with a PFO with IAB compared with cases without PFO and with controls (p = 0.005. Conclusions: Young patients with unexplained stroke, particularly those with PFO, exhibit abnormal atrial electrical characteristics suggesting atrial arrhythmia or atrial dysfunction as a possible mechanism of stroke.

  5. Patent Foramen Ovale and Cryptogenic Strokes in the Stroke in Young Fabry Patients Study.

    Science.gov (United States)

    Huber, Roman; Grittner, Ulrike; Weidemann, Frank; Thijs, Vincent; Tanislav, Christian; Enzinger, Christian; Fazekas, Franz; Wolf, Markus; Hennerici, Michael G; McCabe, Dominick J H; Putaala, Jukaa; Tatlisumak, Turgut; Kessler, Christoph; von Sarnowski, Bettina; Martus, Peter; Kolodny, Edwin; Norrving, Bo; Rolfs, Arndt

    2017-01-01

    A patent foramen ovale (PFO) is disproportionately prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. A detailed stratification of these patients may improve the identification of incidental PFO. We investigated the PFO prevalence in 3497 transient ischemic attack and ischemic stroke patients aged 18 to 55 years in the prospective multicenter SIFAP1 study (Stroke in Young Fabry Patients 1) using the ASCO classification. Patients without an obvious cause for transient ischemic attack/stroke (ASCO 0) were divided into subgroups with and without vascular risk factors (ASCO 0+ and 0-). In addition, we looked for PFO-related magnetic resonance imaging lesion patterns. PFO was identified in 25% of patients. Twenty percent of patients with a definite or probable cause of transient ischemic attack/stroke (≥1 grade 1 or 2 ASCO criterion; n=1769) had a PFO compared with 29% of cryptogenic stroke patients (ASCO 0 and 3; n=1728; Pstrokes revealed a PFO in 24% of 978 ASCO 3 patients (n.s. versus ASCO 1 and 2) and a higher prevalence of 36% in 750 ASCO 0 cases (Pstroke patients demonstrate a heterogeneous PFO prevalence. Even in case of less conclusive diseases like nonstenotic arteriosclerosis, patients should preferentially be considered to have a non-PFO-mediated stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2016 American Heart Association, Inc.

  6. Evidence that Patent Foramen Ovale is not a Risk Factor for Cerebral Ischemia in the Elderly

    Science.gov (United States)

    Jones, Elizabeth F.; Calafiore, Paul; Donnan, Geoffrey A.; Tonkin, Andrew M.

    1994-01-01

    Patent foramen ovale (PFO) may be a risk factor for ischemic stroke in young patients. The aim of this study was to assess the importance of PFO in subjects with a wider age range using patient-control methodology. Transesophageal contrast echocardiography and carotid imaging were performed in 220 consecutive patients with cerebral ischemia (mean age 66 +/- 13 years) and in 202 community-based control subjects (mean age 64 +/- 11 years). Of patients with stroke, 35 (16%) had PFO compared with 31 control subjects (15%) (p = 0.98). Analysis of PFO prevalence by age did not show a significant difference between patients and control subjects in the age groups or equal to 70 years (12% vs 17%; p = 0.43). However, the group aged 450 years was relatively small (26 cases, 19 controls). No significant difference in PFO prevalence was detected between patients with cryptogenic stroke (20%), noncryptogenic stroke (14%), and control subjects (15%). These results suggest that PFO is not a risk factor for cerebral ischemia in subjects aged >50 years, which would have major implications for the investigation and management of stroke patients in this age group. Longitudinal studies are now required to assess the incidence of stroke in symptom free patients with PFO.

  7. Ischemic stroke and patent foramen ovale: risk factors and genetic profile.

    Science.gov (United States)

    Lantz, Maria; Sjöstrand, Christina; Kostulas, Konstantinos

    2013-08-01

    Patent foramen ovale (PFO) is considered to be a risk factor for ischemic cerebrovascular disease (ICVD), especially in young people. However, the potential pathophysiological relevance in ischemic stroke is controversial and in need of further investigation. In this study, we examined the conventional risk factors and the distribution of 100 polymorphisms in 47 suspected susceptibility genes for ICVD in stroke patients with or without a PFO. In the South Stockholm Ischemic Stroke Study, 928 ICVD patients and 602 controls were genotyped for 100 different gene polymorphisms. The stroke patients also underwent relevant investigation and standardized blood tests. Patients who underwent transeosophageal echocardiography as part of their investigation were divided into groups that either had or did not have a PFO. There were no significant differences in the 2 groups with regard to conventional risk factors or blood analyses. Three different polymorphisms located in the prothrombin, F2 (20210G/A), and apolipoprotein-C3 (-641A/C and -455T/A) genes were significantly associated with ICVD and PFO. The strongest association was found for F2 (P = .0049; odds ratio 26.4). We found that F2, which previously has been described as being a possible link between PFO and ICVD, was significantly associated with ICVD and PFO. There was also a trend toward an association between 2 other polymorphisms in the APO-CIII gene and PFO and ICVD. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. Infraorbital Foramen and Pterygopalatine Fossa Location in Dry Skulls: Anatomical Guidelines for Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Omar Masabni

    2017-01-01

    Full Text Available Purpose. The aim of the study was to locate the infraorbital foramen (IOF in relation to the infraorbital margin (IOM for proper injections of local anesthetics in skull specimens. Another aim was to determine the depth of needle penetration into pterygopalatine fossa through the greater palatine canal (GPC. Materials and Methods. 102 skull halves were used to measure the distances between (1 IOF and IOM and (2 IOF and alveolar ridge of maxilla at second premolar. Needles were inserted and bent at a 45° angle, passing through the GPC at the level of hard palate. The depth of the tip of needle emerging out of GPC into pterygopalatine fossa was measured. Results. The mean distance between IOF and IOM was 6.46±1.57 mm on the right side and 6.74±1.72 mm on the left. The mean distance between IOF and alveolar bone process of the maxilla at second premolar was 29.07±3.58 mm on the right side and 29.39±3.78 mm on the left. The mean depth of penetration of the needle into the pterygopalatine fossa was similar on both sides. Conclusions. Proper identification of IOF and pterygopalatine fossa is of great significance during local anesthesia injections, due to their close proximity to vital anatomic structures.

  9. Clinical results of sacral neuromodulation for chronic voiding dysfunction using unilateral sacral foramen electrodes.

    Science.gov (United States)

    Weil, E H; Ruiz-Cerdá, J L; Eerdmans, P H; Janknegt, R A; Van Kerrebroeck, P E

    1998-01-01

    The aim of this study was to determine the long-term clinical efficacy and complications of neuromodulation with a unilateral sacral foramen electrode in 36 patients with chronic voiding dysfunction. Following a positive effect of a percutaneous nerve evaluation test, patients underwent open surgery. A permanent electrode was implanted in 24 patients with urge incontinence, in 6 with urgency-frequency syndrome, and in 6 with nonobstructive urinary retention. After an average follow-up period of 37.8 months, 19 patients (52.8%) continue to benefit from the neuromodulation with a significant improvement of symptoms and urodynamic parameters. The median duration of the therapeutic effect for the total study population was longer than 60 months. No significant difference in the median duration of therapeutic effect with regard to sex, the type of voiding disorder, or the implant pulse generator was found. However, in patients with previous psychological disorders the median duration of therapeutic effect was only 12 months (P = 0.008). Complications were mild. In the group of patients in whom the therapeutic effect remains, 37 reoperations have had to be performed. We conclude that although reoperations were needed to overcome technical problems, patients can achieve lasting symptomatic improvement. Since technical changes in the equipment have reduced the number of complications, even better results can be expected in terms of the reoperation rate.

  10. Brain magnetic resonance imaging findings in cryptogenic stroke patients under 60 years with patent foramen ovale

    Energy Technology Data Exchange (ETDEWEB)

    Boutet, Claire, E-mail: claire.boutet@chu-st-etienne.fr [Department of Radiology, University Hospital of Saint-Etienne (France); Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Rouffiange-Leclair, Laure, E-mail: laurerouffiange@hotmail.com [Department of Radiology, University Hospital of Saint-Etienne (France); Garnier, Pierre, E-mail: pierre.garnier@chu-st-etienne.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Neurology, University Hospital of Saint-Etienne (France); Quenet, Sara, E-mail: sara.quenet@chu-st-etienne.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Delsart, Daphné, E-mail: daphne.delsart@hotmail.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne (France); Inserm, CIE3, F-42055 Saint-Etienne (France); Varvat, Jérôme, E-mail: jvarvat@9online.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Neurology, University Hospital of Saint-Etienne (France); Epinat, Magali, E-mail: magali.epinat@chu-st-etienne.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Neurology, University Hospital of Saint-Etienne (France); Schneider, Fabien, E-mail: fabien.schneider@univ-st-etienne.fr [Department of Radiology, University Hospital of Saint-Etienne (France); Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Antoine, Jean-Christophe, E-mail: j.christophe.antoine@chu-st-etienne.fr [Department of Neurology, University Hospital of Saint-Etienne (France); Lyon Neuroscience Research Center, INSERM U1028 – CNRS UMR5292 (France); EA 4338, Jean Monnet University, Saint-Etienne (France); and others

    2014-05-15

    Purpose: To compare magnetic resonance imaging (MRI) brain feature in cryptogenic stroke patients with patent foramen ovale (PFO), cryptogenic stroke patients without PFO and patients with cardioembolic stroke. Materials and methods: The ethics committee required neither institutional review board approval nor informed patient consent for retrospective analyses of the patients’ medical records and imaging data. The patients’ medical files were retrospectively reviewed in accordance with human subject research protocols. Ninety-two patients under 60 years of age were included: 15 with cardioembolic stroke, 32 with cryptogenic stroke with PFO and 45 with cryptogenic stroke without PFO. Diffusion-weighted imaging of brain MRI was performed by a radiologist blinded to clinical data. Univariate, Fischer's exact test for qualitative data and non-parametric Wilcoxon test for quantitative data were used. Results: There was no statistically significant difference found between MRI features of patients with PFO and those with cardioembolic stroke (p < .05). Patients without PFO present more corticosubcortical single lesions (p < .05) than patients with PFO. Patients with PFO have more often subcortical single lesions larger than 15 mm, involvement of posterior cerebral arterial territory and intracranial occlusion (p < .05) than patients with cryptogenic stroke without PFO. Conclusion: Our study suggests a cardioembolic mechanism in ischemic stroke with PFO.

  11. Prevalence of patent foramen ovale and usefulness of percutaneous closure device in carcinoid heart disease.

    Science.gov (United States)

    Mansencal, Nicolas; Mitry, Emmanuel; Pillière, Rémy; Lepère, Céline; Gérardin, Benoît; Petit, Jérôme; Gandjbakhch, Iradj; Rougier, Philippe; Dubourg, Olivier

    2008-04-01

    The aim of this study was to assess (1) the incidence of patent foramen ovale (PFO) in carcinoid syndrome (CS) and (2) the feasibility of percutaneous closure procedure in selected patients with CS. One hundred eight patients were prospectively studied: 54 with CS and an age- and gender-matched control group. All patients underwent conventional and contrast echocardiography. Patients with clinical signs of dyspnea (New York Heart Association class > or =III), cyanosis, carcinoid heart disease (CHD), and severe PFO were referred for the percutaneous closure of PFO. The prevalence of PFO was 41% in patients with CS and 22% in the control group (p = 0.03) and was significantly higher in patients with CHD (59%, p = 0.009). Four patients (14% of those with CHD) were referred for the percutaneous closure of PFO, and 3 patients ultimately underwent PFO closure (using Amplatzer septal occluders). At 6-month follow-up, New York Heart Association class was improved in all patients, as well as arterial blood gas results (p = 0.04) and 6-minute walking distance (p = 0.03), but all patients presented residual right-to-left shunts. In conclusion, this prospective study demonstrates that in patients with CHD, the prevalence of PFO is high and that percutaneous closure of PFO is feasible, with a reduction in symptoms but with residual shunting.

  12. Impact of social characteristics on the treatment of patients with ischaemic events and patent foramen ovale.

    Science.gov (United States)

    Schurter, David; Braun, Julia; Jenni, Rolf; Van Der Loo, Bernd

    2012-02-01

    Percutaneous closure of a patent foramen ovale (PFO) is a technically simple and safe procedure. PFO is a common finding present in up to one third of the population. Although several conditions such as stroke, migraine, and sleep apnoea have been associated with a PFO, as underlined by observational studies, no causal relationship has been documented so far. As this setting may potentially leave more space for the involved physicians for the choice of treatment, we hypothesized that social characteristics of the patient with a PFO might play a role. We retrospectively analysed the data of 153 patients with a cerebrovascular and/or peripheral ischaemic event with the diagnosis of a PFO as documented in echocardiography from 2000 until 2005 at the University Hospital in Zurich, Switzerland. Forty-four patients (= 23%) underwent catheter-based PFO closure. There was no significant difference with respect to age ( or =60 years: P= 0.234, ns), gender (P = 0.356, ns) and insurance status (<40 years: P= 0.15, ns; 40-59 years: P= 0.37, ns; 60 years: P = 0.26, ns) between those who underwent percutaneous PFO closure and those who did not. We conclude from this single-centre experience that social characteristics of patients only have a marginal impact on the indication of percutaneous closure of a PFO, if at all.

  13. Foramen magnum schwannoma: review of the literature and report of a case

    International Nuclear Information System (INIS)

    Nacif, Marcelo Souto; Caiado, Stella; Oliveira, Nidia di Paula Silva; Paula Neto, Walter Teixeira de; Campos, Flavio do Amaral; Santos, Alair Augusto Sarmet Moreira Damas dos

    2001-01-01

    The authors report an unusual presentation of a voluminous neck schwannoma in a 53-year-old female that presented with a three-year history of progressive weakness associated with impaired movement of the limbs. Neurological examination revealed postural instability, unstable and paraparetic gait, tetraparesis and dyspnea. A preoperative magnetic resonance imaging of the neck revealed an expansive, extradural, well-circumscribed lesion, with soft-tissue attenuation, at the level of C1-C2 vertebral bodies. During surgery, the tumor was found to be extradural, lateral to the cervical spinal cord, attached to the C1 left nerve root and extending upwards through the foramen magnum. Histopathological analysis of the resected specimen confirmed the diagnosis of schwannoma. The patient showed a favorable outcome with progressive improvement of the symptoms. Magnetic resonance imaging proved to be valuable in the detection and evaluation of the lesion, although the definite diagnosis was achieved only after histopathological studies. We concluded that magnetic resonance imaging for early diagnosis and prompt surgical resection seems to be the best approach to achieve good prognosis. (author)

  14. Neonatal neurological disorders involving the brainstem: neurosonographic approaches through the squamous suture and the foramen magnum

    Energy Technology Data Exchange (ETDEWEB)

    Tu, Yi-Fang [National Cheng Kung University Hospital, Department of Emergency Medicine, Tainan (Taiwan); Chen, Cheng-Yu [National Defense Medical Center, Department of Radiology, Taipei (Taiwan); Lin, Yuh-Jey [National Cheng Kung University Hospital, Department of Pediatrics, Tainan (Taiwan); Chang, Ying-Chao [Kaohsiung Chang Gung Children Hospital, Department of Pediatrics, Kaohsiung (Taiwan); Huang, Chao-Ching [National Cheng Kung University Hospital, Department of Pediatrics, Tainan (Taiwan); National Cheng Kung University Hospital, Department of Institute of Molecular Medicine, Tainan (Taiwan)

    2005-09-01

    Brainstem damage which often indicates a critical condition is usually underestimated by trans-anterior-fontanel neurosonography (NS) owing to the far-field limitations. Instead, NS alternately scanning through the squamous suture of the temporal bones and the foramen magnum could provide a better visualization of the brainstem structures. The NS characteristics of brainstem lesions caused by various neonatal neurological disorders, such as hypoxic-ischemic encephalopathy (HIE), metabolic encephalopathy, birth trauma and bacterial meningoencephalitis, can be depicted at the acute stage. An echogenic change in the midbrain was found in patients with HIE or metabolic encephalopathy. In addition to the echogenic change, bilateral transtentorial temporal lobe herniation distorting the contour of the midbrain was observed in a patient with group B streptococcus meningoencephalitis, whereas echogenic changes at the level of the pons and/or the medulla oblongata, mainly localized in the dorsal part, could be observed in newborns with severe HIE, maple syrup urine disease or birth trauma. In this pictorial assay, we demonstrate the feasibility of NS imaging in evaluating the entire brainstem structure of critically ill neonates in the near field and illustrate the characteristic features of brainstem involvement in various neonatal neurological disorders along with computed tomography or magnetic resonance imaging correlation. (orig.)

  15. Significance of localization of mandibular foramen in an inferior alveolar nerve block.

    Science.gov (United States)

    Thangavelu, K; Kannan, R; Kumar, N Senthil; Rethish, E; Sabitha, S; Sayeeganesh, N

    2012-07-01

    The mandibular foramen (MF) is an opening on the internal surface of the ramus for divisions of the mandibular vessels and nerve to pass. The aim of this study is to determine the position of the MF from various anatomical landmarks in several dry adult mandibles. A total of 102 human dry mandibles were examined, of which 93 were of dentulous and 9 were of edentulous. The measurements were taken from the anterior border of the ramus (coronoid notch) to the midportion of the MF and then from the midportion of the MF to the other landmarks such as internal oblique ridge, inferior border, sigmoid notch, and condyle were measured and recorded. The data were compared using Student's t-test. The MF is positioned at a mean distance of 19 mm (with SD 2.34) from coronoid notch of the anterior border of the ramus. Superio-inferiorly from the condyle to the inferior border MF is situated 5 mm inferior to the midpoint of condyle to the inferior border distance (ramus height). We conclude that failures in the anesthesia of the inferior alveolar nerve are due to the operator error and not due to the anatomical variation.

  16. Patent foramen ovale and asymptomatic brain lesions in military fighter pilots.

    Science.gov (United States)

    Kang, Kyung Wook; Kim, Joon-Tae; Choi, Won-Ho; Park, Won-Ju; Shin, Young Ho; Choi, Kang-Ho

    2014-10-01

    Previous studies have reported higher incidence of white matter lesions (WMLs) in military pilots. The anti-gravity straining maneuver, which fighter military pilots perform numerously during a flight is identical to the valsalva maneuver. We sought to investigate the prevalence of right-to-left shunt (RLS) associated with WMLs in military pilots. A prospective study was performed involving military pilots who visited the Airomedical Center. The pilots underwent brain magnetic resonance imaging (MRI) scan and transcranial Doppler (TCD) with intravenous injection of agitated saline solution for the detection of RLS. Periventricular WMLs (PVWMLs) on MRI were graded using Fazeka's scale, and deep WMLs (DWMLs) were graded using Scheltens's scale. This study included 81 military pilots. RLS on TCD was observed less frequently in non-fighter pilots than in fighter pilots (35.5% vs. 64.5%, p=0.011). Fighter pilot was an independently associated factor with RLS on the TCD. DWMLs were independently associated with RLSs through a patent foramen ovale (PFO) (OR 3.507, 95% CI 1.223-10.055, p=0.02). The results suggest that DWMLs in military pilots may significantly be associated with RLS via PFO. Additional investigations are warranted. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Stent placement for palliation of cor triatriatum dexter in a dog with suspected patent foramen ovale.

    Science.gov (United States)

    Barncord, Kristin; Stauthammer, Christopher; Moen, Sean L; Hanson, Melissa; Gruenstein, Daniel H

    2016-03-01

    An 11 month old spayed, female dog presented with exercise intolerance and cyanosis upon exertion. Echocardiography revealed an imperforate cor triatriatum dexter with mild tricuspid valve dysplasia, an underfilled right ventricle and significant right to left shunting across a presumptive patent foramen ovale. Balloon dilation of the abnormal atrial membrane was initially successful in creating a communication between the right atrial chambers, but stenosis of the original perforation and persistent clinical signs prompted a second intervention. A balloon expandable biliary stent was placed across the abnormal partition, improving caudal venous return to the right ventricle and reducing the right to left shunt. Three months after stent placement, resting oxygen saturation had normalized. Six months after stent placement, exercise tolerance had improved and exertional cyanosis had resolved. Long term follow up will be necessary to assess for remodeling of the right ventricle with improved venous return. Stent placement can be considered as a palliative treatment option for cor triatriatum dexter, especially for stenosis post-balloon dilation. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. VPAC receptors: structure, molecular pharmacology and interaction with accessory proteins.

    Science.gov (United States)

    Couvineau, Alain; Laburthe, Marc

    2012-05-01

    The vasoactive intestinal peptide (VIP) is a neuropeptide with wide distribution in both central and peripheral nervous systems, where it plays important regulatory role in many physiological processes. VIP displays a large biological functions including regulation of exocrine secretions, hormone release, fetal development, immune responses, etc. VIP appears to exert beneficial effect in neuro-degenerative and inflammatory diseases. The mechanism of action of VIP implicates two subtypes of receptors (VPAC1 and VPAC2), which are members of class B receptors belonging to the super-family of GPCR. This article reviews the current knowledge regarding the structure and molecular pharmacology of VPAC receptors. The structure-function relationship of VPAC1 receptor has been extensively studied, allowing to understand the molecular basis for receptor affinity, specificity, desensitization and coupling to adenylyl cyclase. Those studies have clearly demonstrated the crucial role of the N-terminal ectodomain (N-ted) of VPAC1 receptor in VIP recognition. By using different approaches including directed mutagenesis, photoaffinity labelling, NMR, molecular modelling and molecular dynamic simulation, it has been shown that the VIP molecule interacts with the N-ted of VPAC1 receptor, which is itself structured as a 'Sushi' domain. VPAC1 receptor also interacts with a few accessory proteins that play a role in cell signalling of receptors. Recent advances in the structural characterization of VPAC receptor and more generally of class B GPCRs will lead to the design of new molecules, which could have considerable interest for the treatment of inflammatory and neuro-degenerative diseases. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  19. Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation

    Energy Technology Data Exchange (ETDEWEB)

    VonAchen, Paige [Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN (United States); Hamann, Jason [Boston Scientific Corporation, Maple Grove, MN (United States); Houghland, Thomas; Lesser, John R.; Wang, Yale; Caye, David; Rosenthal, Kristi; Garberich, Ross F. [Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN (United States); Daniels, Mary [Vital Images/Toshiba, Minnetonka, MN (United States); Schwartz, Robert S., E-mail: rss@rsschwartz.com [Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN (United States)

    2016-10-15

    Objective: The aim of this study was to understand the role of accessory renal arteries in resistant hypertension, and to establish their role in nonresponse to radiofrequency renal denervation (RDN) procedures. Background: Prior studies suggest a role for accessory renal arteries in hypertensive syndromes, and recent clinical trials of renal denervation report that these anomalies are highly prevalent in resistant hypertension. This study evaluated the relationships among resistant hypertension, accessory renal arteries, and the response to radiofrequency (RF) renal denervation. Methods: Computed Tomography Angiography (CTA) and magnetic resonance imaging (MRI) scans from 58 patients with resistant hypertension undergoing RF renal denervation (RDN) were evaluated. Results were compared with CT scans in 57 healthy, normotensive subjects undergoing screening as possible renal transplant donors. All scans were carefully studied for accessory renal arteries, and were correlated with long term blood pressure reduction. Results: Accessory renal arteries were markedly more prevalent in the hypertensive patients than normotensive renal donors (59% vs 32% respectively, p = 0.004). RDN had an overall nonresponse rate of 29% (response rate 71%). Patients without accessory vessels had a borderline higher response rate to RDN than those with at least one accessory vessel (83% vs 62% respectively, p = 0.076) and a higher RDN response than patients with untreated accessory arteries (83% vs 55%; p = 0.040). For accessory renal arteries and nonresponse, the sensitivity was 76%, specificity 49%, with positive and negative predictive values 38% and 83% respectively. Conclusions: Accessory renal arteries were markedly over-represented in resistant hypertensives compared with healthy controls. While not all patients with accessory arteries were nonresponders, nonresponse was related to both the presence and non-treatment of accessory arteries. Addressing accessory renal arteries in

  20. Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation

    International Nuclear Information System (INIS)

    VonAchen, Paige; Hamann, Jason; Houghland, Thomas; Lesser, John R.; Wang, Yale; Caye, David; Rosenthal, Kristi; Garberich, Ross F.; Daniels, Mary; Schwartz, Robert S.

    2016-01-01

    Objective: The aim of this study was to understand the role of accessory renal arteries in resistant hypertension, and to establish their role in nonresponse to radiofrequency renal denervation (RDN) procedures. Background: Prior studies suggest a role for accessory renal arteries in hypertensive syndromes, and recent clinical trials of renal denervation report that these anomalies are highly prevalent in resistant hypertension. This study evaluated the relationships among resistant hypertension, accessory renal arteries, and the response to radiofrequency (RF) renal denervation. Methods: Computed Tomography Angiography (CTA) and magnetic resonance imaging (MRI) scans from 58 patients with resistant hypertension undergoing RF renal denervation (RDN) were evaluated. Results were compared with CT scans in 57 healthy, normotensive subjects undergoing screening as possible renal transplant donors. All scans were carefully studied for accessory renal arteries, and were correlated with long term blood pressure reduction. Results: Accessory renal arteries were markedly more prevalent in the hypertensive patients than normotensive renal donors (59% vs 32% respectively, p = 0.004). RDN had an overall nonresponse rate of 29% (response rate 71%). Patients without accessory vessels had a borderline higher response rate to RDN than those with at least one accessory vessel (83% vs 62% respectively, p = 0.076) and a higher RDN response than patients with untreated accessory arteries (83% vs 55%; p = 0.040). For accessory renal arteries and nonresponse, the sensitivity was 76%, specificity 49%, with positive and negative predictive values 38% and 83% respectively. Conclusions: Accessory renal arteries were markedly over-represented in resistant hypertensives compared with healthy controls. While not all patients with accessory arteries were nonresponders, nonresponse was related to both the presence and non-treatment of accessory arteries. Addressing accessory renal arteries in

  1. MERS-CoV Accessory ORFs Play Key Role for Infection and Pathogenesis

    Energy Technology Data Exchange (ETDEWEB)

    Menachery, Vineet D.; Mitchell, Hugh D.; Cockrell, Adam S.; Gralinski, Lisa E.; Yount, Boyd L.; Graham, Rachel L.; McAnarney, Eileen T.; Douglas, Madeline G.; Scobey, Trevor; Beall, Anne; Dinnon, Kenneth; Kocher, Jacob F.; Hale, Andrew E.; Stratton, Kelly G.; Waters, Katrina M.; Baric, Ralph S.; Racaniello, Vincent R.

    2017-08-22

    ABSTRACT

    While dispensable for viral replication, coronavirus (CoV) accessory open reading frame (ORF) proteins often play critical roles during infection and pathogenesis. Utilizing a previously generated mutant, we demonstrate that the absence of all four Middle East respiratory syndrome CoV (MERS-CoV) accessory ORFs (deletion of ORF3, -4a, -4b, and -5 [dORF3-5]) has major implications for viral replication and pathogenesis. Importantly, attenuation of the dORF3-5 mutant is primarily driven by dysregulated host responses, including disrupted cell processes, augmented interferon (IFN) pathway activation, and robust inflammation.In vitroreplication attenuation also extends toin vivomodels, allowing use of dORF3-5 as a live attenuated vaccine platform. Finally, examination of ORF5 implicates a partial role in modulation of NF-κB-mediated inflammation. Together, the results demonstrate the importance of MERS-CoV accessory ORFs for pathogenesis and highlight them as potential targets for surveillance and therapeutic treatments moving forward.

    IMPORTANCEThe initial emergence and periodic outbreaks of MERS-CoV highlight a continuing threat posed by zoonotic pathogens to global public health. In these studies, mutant virus generation demonstrates the necessity of accessory ORFs in regard to MERS-CoV infection and pathogenesis. With this in mind, accessory ORF functions can be targeted for both therapeutic and vaccine treatments in response to MERS-CoV and related group 2C coronaviruses. In addition, disruption of accessory ORFs in parallel may offer a rapid response platform to attenuation of future emergent strains based on both SARS- and MERS-CoV accessory ORF mutants.

  2. Mental Disorders

    Science.gov (United States)

    Mental disorders include a wide range of problems, including Anxiety disorders, including panic disorder, obsessive-compulsive disorder, ... disorders, including schizophrenia There are many causes of mental disorders. Your genes and family history may play ...

  3. Mental Health

    Science.gov (United States)

    Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel and act as ... stress, relate to others, and make choices. Mental health is important at every stage of life, from ...

  4. Elliptical Fourier descriptors of outline and morphological analysis in caudal view of foramen magnum of the tropical raccoon (Procyon cancrivorus) (Linnaeus, 1758).

    Science.gov (United States)

    Samuel, O M; Casanova, P M; Olopade, J O

    2018-03-01

    To evaluate sexual-size dimorphism and attempt at categorization of inter-individual shapes of foramen magnum outlines using Fourier descriptors which allow for shape outline evaluations with a resultant specimen character definition. Individual characterization and quantification of foramen magnum shapes in direct caudal view based on elliptical Fourier technique was applied to 46 tropical raccoon skulls (26 females, 20 males). Incremental number of harmonics demonstrates morphological contributions of such descriptors with their relations to specific anatomical constructions established. The initial harmonics (1st to 3rd) described the general foramen shapes while the second (4th to 12th) demonstrated fine morphological details. Sexual-size dimorphism was observed in females (87.1%) and 91.7% in males, normalization of size produces 75% in females and 83% in males. With respect to foramen magnum dimorphism analysis, the result obtained through elliptic Fourier analysis was comparatively better in detail information of outline contours than earlier classical methods. The first four effective principal components defined 70.63% of its shape properties while the rest (22.51%) constituted fine details of morphology. Both size and shape seems important in sexual dimorphisms in this species, this investigation suggest clinical implications, taxonomic and anthropologic perspectives in foramen characterization magnum characterization and further postulates an increased possibility of volume reduction cerebellar protrusion, ontogenic magnum shape irregularities in the sample population with neurologic consequences especially among females. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Mental Illness

    Science.gov (United States)

    ... the same time. For example, you may have depression and a substance use disorder. Complications Mental illness is a leading cause of disability. Untreated mental illness can cause severe emotional, behavioral and physical health problems. Complications sometimes linked to mental illness include: ...

  6. Foramen ovale permeable y ataque criptogénico: Papel de la ecocardiografía y estado del arte Patent foramen ovale and cryptogenic stroke: Echocardiography role and state of the art

    Directory of Open Access Journals (Sweden)

    Mario H Jaramillo U

    2008-08-01

    Full Text Available Las causas de ataque isquémico en pacientes jóvenes, son difíciles de encontrar pese a las investigaciones sistemáticas dirigidas a descartar origen cardiaco, alteraciones de la coagulación o cualquier otro tipo de enfermedades vasculares; de ahí la definición de «criptogénico». Se especula acerca del papel potencial de los cortocircuitos intracardiacos de derecha a izquierda como vía de embolismos paradójicos que culminan en enfermedad cerebral isquémica. Se demostró que la ecocardiografía transesofágica con inyección venosa periférica de solución salina agitada, es el método de elección para diagnosticar foramen ovale permeable y cortocircuito de derecha a izquierda. Estudios prospectivos que utilizan tratamiento con ácido acetil salicílico o warfarina, no demuestran una reducción significativa de los ataques recurrentes. Aunque, tanto el cierre quirúrgico del foramen ovale permeable como el percutáneo, muestran una disminución de la tasa de eventos embólicos subsecuentes, aún se discute su indicación, al menos hasta que aparezcan resultados de trabajos con escogencia al azar, que están en proceso en la actualidad. Sin embargo, los casos de embolismo paradójico recurrente y en los buzos profesionales, ambos casos con aneurisma del septum auricular y foramen ovale permeable asociados, son las únicas indicaciones inequívocas de cierre percutáneo. El cierre exitoso, definido por ecocardiografía transesofágica, parece predecir la ausencia de eventos embólicos recurrentes. En la medida en que la tasa de complicaciones de la implantación de dispositivos disminuya y que éstos sean técnicamente más sencillos, el cierre percutáneo se impondrá al quirúrgico.The causes of ischemic stroke in young patients are difficult to find, in spite of systematic investigations directed to rule out heart etiology, alterations in coagulation or any other type of vascular disease; hence the «cryptogenic» definition. There

  7. Accessories modifying based on plastic waste of shampoo bottle as home economic product

    Science.gov (United States)

    Setyowati, Erna; Sukesi, Siti

    2018-03-01

    Plastic is a waste that can not decompose by the soil and if its left without a good handling can pollute the environment. Plastic waste needs processing by the recycle bottles principle. Shampoo bottle is one of plastic waste with high density polyethylene type (HDPE). One of the innovation to recycling shampoo bottles waste into the new products whichbeneficially and aestheticallyform by engineered the buns accesories. Accessories are one of the tools used by most women, in the form of trinkets or ornaments which ajusted to the trend to beautify the look. Accessories from shampoo bottle waste can be obtained from household waste, beauty salon and the beauty program study by inculcating human beings' behavior by transforming waste into blessing while also increasing family income. Technique of making its by compiling through improvement of panelist team. The goal of this research is to engineering theaccessories based on shampoo bottle waste as home economics. The method are using experiment, observation and documentation, analysis using descriptive. The results obtained from the overall sensory test averaged at 93%, while the favored test averaged at 85.5%. The product can be ordered according to the desired design, but it takes a long time. Therefore accessories engineering from shampoo bottles waste-based can be used as home economics. The production of shampoo bottles waste-based accessories should improved its quality and quantity, to be marketed through the community, by the cooperation with accessories and bun craftsmen.

  8. Does the presence of accessory renal arteries affect the efficacy of renal denervation?

    Science.gov (United States)

    Id, Dani; Kaltenbach, Benjamin; Bertog, Stefan C; Hornung, Marius; Hofmann, Ilona; Vaskelyte, Laura; Sievert, Horst

    2013-10-01

    This study sought to assess the efficacy of catheter-based renal sympathetic denervation in patients with accessory renal arteries and to compare the blood pressure (BP)-lowering effect with that observed in patients with bilateral single renal arteries after renal denervation. Catheter-based renal sympathetic denervation causes significant BP reductions in patients with resistant hypertension. Seventy-four patients were included in this study. Patients were assigned to 2 main groups: a bilateral single renal arteries group I (n = 54) and an accessory renal arteries group II (n = 20). Group II consisted of 9 patients whose accessory renal arteries were all denervated (group IIa), and 11 patients whose accessory renal arteries were not, or only incompletely, denervated (group IIb). The primary endpoint was the change in office systolic BP after 6 months. The procedure was successful in all patients. Group I: mean BP at baseline was 166.2/89.4 ± 20.5/14.6 mm Hg and decreased by -16.6 (p renal denervation in patients with accessory renal arteries is less pronounced than in patients with bilateral single renal arteries. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. Factors associated with survival of epiploic foramen entrapment colic: a multicentre, international study.

    Science.gov (United States)

    Archer, D C; Pinchbeck, G L; Proudman, C J

    2011-08-01

    Epiploic foramen entrapment (EFE) has been associated with reduced post operative survival compared to other types of colic but specific factors associated with reduced long-term survival of these cases have not been evaluated in a large number of horses using survival analysis. To describe post operative survival of EFE cases and to identify factors associated with long-term survival. A prospective, multicentre, international study was conducted using clinical data and long-term follow-up information for 126 horses diagnosed with EFE during exploratory laparotomy at 15 clinics in the UK, Ireland and USA. Descriptive data were generated and survival analysis performed to identify factors associated with reduced post operative survival. For the EFE cohort that recovered following anaesthesia, survival to hospital discharge was 78.5%. Survival to 1 and 2 years post operatively was 50.6 and 34.3%, respectively. The median survival time of EFE cases undergoing surgery was 397 days. Increased packed cell volume (PCV) and increased length of small intestine (SI) resected were significantly associated with increased likelihood of mortality when multivariable analysis of pre- and intraoperative variables were analysed. When all pre-, intra- and post operative variables were analysed separately, only horses that developed post operative ileus (POI) were shown to be at increased likelihood of mortality. Increased PCV, increased length of SI resected and POI are all associated with increased likelihood of mortality of EFE cases. This emphasises the importance of early diagnosis and treatment and the need for improved strategies in the management of POI in order to reduce post operative mortality in these cases. The present study provides evidence-based information to clinicians and owners of horses undergoing surgery for EFE about long-term survival. These results are applicable to university and large private clinics over a wide geographical area. © 2011 EVJ Ltd.

  10. Seven-year follow-up of percutaneous closure of patent foramen ovale.

    Science.gov (United States)

    Mirzada, Naqibullah; Ladenvall, Per; Hansson, Per-Olof; Johansson, Magnus Carl; Furenäs, Eva; Eriksson, Peter; Dellborg, Mikael

    2013-12-01

    Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical treatment to reduce recurrent stroke while randomized trials fail to demonstrate significant superiority of percutaneous PFO closure. Few long-term studies are available post PFO closure. This study reports long-term clinical outcomes after percutaneous PFO closure. Between 1997 and 2006, 86 consecutive eligible patients with cerebrovascular events, presumably related to PFO, underwent percutaneous PFO closure. All 86 patients were invited to a long-term follow-up, which was carried out during 2011 and 2012. Percutaneous PFO closure was successfully performed in 85 of 86 patients. The follow-up rate was 100%. No cardiovascular or cerebrovascular deaths occurred. Two patients (both women) died from lung cancer during follow-up. Follow-up visits were conducted for 64 patients and the remaining 20 patients were followed up by phone. The mean follow-up time was 7.3 years (5 to 12.4 years). Mean age at PFO closure was 49 years. One patient had a minor stroke one month after PFO closure and a transient ischemic attack (TIA) two years afterwards. One other patient suffered from a TIA six years after closure. No long-term device-related complications were observed. Percutaneous PFO closure was associated with very low risk of recurrent stroke and is suitable in most patients. We observed no mortality and no long-term device-related complications related to PFO closure, indicating that percutaneous PFO closure is a safe and efficient treatment even in the long term.

  11. [Irritable bowel syndrome and cardiac right-to-left shunt through a patent foramen ovale].

    Science.gov (United States)

    Alarcón-Fernández, Onofre; Alvarez-Fernández, Jesús-Andrés; Baudet, Juan-Salvador; Pérez-Quintero, Raquel; Sánchez-Del Río, Antonio; Borja-Gutiérrez, Elisa; Borque-Barrera, Pilar

    2008-05-31

    Both irritable bowel syndrome (IBS) and patent foramen ovale (PFO) have a similar prevalence in the general population, affect more commonly women and are related to comorbidities such as migraine. In IBS there are alterations in the metabolism of certain substances like serotonin. In the presence of PFO with a right- to left-shunt (RLS), a percentage of venous blood bypasses the lung filter and may increase these substances in blood. A phone interview was done to determine the presence of IBS in patients previously attended for detection of RLS with transcranial Doppler ultrasound. The presence and grade of RLS was analyzed and compared with subjects without gastrointestinal symptoms (NoGI). Rome II criteria were used to diagnose IBS or other functional gastrointestinal disorder (FGD) and Venice 1999 consensus were used for the diagnosis of RLS. Thirthy-three (18.3%) of 180 interviewed patients had IBS and 62 (34.4%) other FGD. RLS was found in 41% of NoGI patients, 64% of patients with IBS and 68% of patients with other FGD (odds ratio [OR] = 2.56; p < 0.05 for SII, and OR = 3.06; p < 0.01 for other FGD). RLS with a massive pattern was registered in en 27% of NoGI patients, 39% of patients with IBS and 45% of patients with other FGD (OR = 1.73; p = 1 for IBS, and OR = 2.21; p < 0.05 for other FGD). We found a higher prevalence of cardiac RLS through a PFO in patients with IBS and other FGD. A possible etiopathogenic relationship must be considered in future studies.

  12. Sustained long-term benefit of patent foramen ovale closure on migraine.

    Science.gov (United States)

    Trabattoni, Daniela; Fabbiocchi, Franco; Montorsi, Piero; Galli, Stefano; Teruzzi, Giovanni; Grancini, Luca; Gatto, Pamela; Bartorelli, Antonio L

    2011-03-01

    This single-center, observational, prospective study evaluated the impact of patent foramen ovale (PFO) closure on migraine attacks over time. PFO closure may reduce the frequency and severity of migraine headaches in patients with significant right-to-left shunts. Between May 2000 and September 2009, 305 consecutive patients (mean age, 43 ± 12 years; 54.5% women) with a prior embolic cerebrovascular event underwent PFO closure with the Amplatzer PFO occluder for recurrence prevention. All patients had right-to-left shunts; the shunts were associated with migraine symptoms in 77 (25%), either alone (n = 64, 83%) or with aura (n = 13, 17%). Septal aneurysm was present in 15 (19.5%) migraine patients, and 43 (56%) had a previous transient brain ischemic attack. All migraine patients had a computed tomography scan or magnetic resonance imaging, indicating a previous brain ischemic lesion. All 305 patients underwent transthoracic echocardiography with clinical follow-up at 24 hr, at 3, 6, and 12 months, and then yearly. An acute migraine attack occurred 24-48 hr after PFO closure in 28 (36.4%) of 77 patients. There was a significant reduction (>50%) in the number and intensity of attacks in 46 (60.5%) of 77 patients at the 3-month follow-up. At the 12-month follow-up, migraine had ceased in 23 (46%) patients, and 20 (40%) had a reduction in the migraine recurrence rate and disabling symptoms. These results were maintained at follow-up (mean, 28 ± 27 months). There was overall improvement in migraine in 89% of the treated patients. Percutaneous PFO closure in migraineurs may provide beneficial mid-term and long-term results, with significant reduction in the intensity and frequency of headache symptoms. Copyright © 2010 Wiley-Liss, Inc.

  13. Permanent right-to-left shunt is the key factor in managing patent foramen ovale.

    Science.gov (United States)

    Rigatelli, Gianluca; Dell'Avvocata, Fabio; Cardaioli, Paolo; Giordan, Massimo; Braggion, Gabriele; Aggio, Silvio; Chinaglia, Mauro; Mandapaka, Sangeeta; Kuruvilla, John; Chen, Jack P; Nanjundappa, Aravinda

    2011-11-15

    We sought to prospectively evaluate risk of stroke and impact of transcatheter patent foramen ovale (PFO) closure in patients with permanent right-to left shunt compared with those with Valsalva maneuver-induced right-to-left shunt. Pathophysiology and properly management of PFO still remain far from being fully clarified: in particular, the contribution of permanent right-to-left shunt remains unknown. Between March 2006 and October 2010, we enrolled 180 (mean age 44 ± 10.9 years, 98 women) of 320 consecutive patients referred to our center for transcatheter PFO closure, who had spontaneous permanent right-to-left shunt on transcranial Doppler and transthoracic/transesophageal echocardiography. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative transesophageal echocardiography and brain magnetic resonance imaging, with subsequent intracardiac echocardiographic-guided transcatheter PFO closure. We compared the clinical echocardiographic characteristics of these patients (Permanent Group) with the rest of 140 patients with right-to-left shunt only during Valsalva maneuver (Valsalva Group). Compared with the Valsalva Group patients, patients of the Permanent Group had increased frequency of multiple ischemic brain lesions on magnetic resonance imaging, previous recurrent stroke, previous peripheral arteries embolism, migraine with aura, and-more frequently-atrial septal aneurysm and prominent Eustachian valve. The presence of permanent shunt confers the highest risk of recurrent stroke (odds ratio: 5.9, 95% confidence interval: 2.0 to 12, p < 0.001). No differences were recorded between the 2 groups with regard to recurrence of ischemic events after the closure procedure. Despite its small-sample nature, our study suggests that patients with permanent right-to-left shunt have potentially a higher risk of paradoxical embolism compared with those without. Copyright © 2011 American College of Cardiology

  14. Patent foramen ovale: diagnosis with multidetector CT--comparison with transesophageal echocardiography.

    Science.gov (United States)

    Kim, Young Jin; Hur, Jin; Shim, Chi-Young; Lee, Hye-Jeong; Ha, Jong-Won; Choe, Kyu Ok; Heo, Ji Hoe; Choi, Eui-Young; Choi, Byoung Wook

    2009-01-01

    To evaluate the clinical feasibility and accuracy of 64-section multidetector computed tomography (CT) compared with transesophageal echocardiography (TEE) for diagnosis of a patent foramen ovale (PFO). Institutional review board approval was obtained for this retrospective study. The study included 152 consecutive stroke patients (mean age, 61.7 years; 98 men, 54 women) who underwent both cardiac multidetector CT and TEE. Electrocardiographically gated cardiac CT was performed with a 64-section CT scanner by using a saline-chaser contrast agent injection technique. A contrast agent jet from the contrast agent-filled left atrium (LA) to the saline-filled right atrium (RA) and channel-like appearance of the interatrial septum (IAS) were evaluated on axial and oblique sagittal CT images. Two-dimensional and Doppler TEE were performed to detect PFO. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT were obtained with TEE as the reference standard. A PFO was present in 26 patients at TEE. On CT images, a left-to-right contrast agent jet toward the inferior vena cava was noted in 21 patients (sensitivity, 73.1%; specificity, 98.4%; PPV, 90.5%; NPV, 94.7%). Channel-like appearance of the IAS was detected in 38 patients (sensitivity, 76.9%; specificity, 85.7%; PPV, 52.6%; NPV, 94.7%). Channel-like appearance of the IAS was noted in all patients who had a contrast agent jet. A contrast agent jet from LA to RA toward the inferior vena cava with channel-like appearance of the IAS on CT images confirms the presence of a PFO. (c) RSNA, 2008.

  15. Patent foramen ovale is not associated with an increased risk of stroke recurrence.

    Science.gov (United States)

    Feurer, R; Sadikovic, S; Sepp, D; Esposito, L; Schleef, M; Bockelbrink, A; Schwarze, J; Hemmer, B; Sander, D; Poppert, H

    2010-11-01

    Despite numerous studies suggesting a relationship between paradoxical embolism from a patent foramen ovale (PFO) and stroke, the role of PFO as a risk factor for cerebral ischaemia remains controversial. We therefore sought to determine the association between a RLS detected by contrast-enhanced transcranial Doppler ultrasonography (c-TCD) and recurrent stroke in an unselected population sample. We analyzed the records of 763 patients with diagnosis of cerebral ischaemia at our institution. All patients had undergone TCD-based detection of RLS. Embolic signals have been measured both under resting conditions and after performing a Valsalva maneuver. For follow-up, all patients were contacted by mail, which included a standardized questionnaire. Endpoints of follow-up were defined as recurrence of cerebral ischaemia, occurrence of myocardial infarction or death from any cause. Follow-up data were available in 639 patients (83.7%). At baseline, a RLS was detected in 140 (28%) men and in 114 (42%) women. Ten shunt-carriers (1.6%) and 32 patients (5.0%) without RLS had suffered a recurrent stroke. After adjustment for age, sex, and atrial fibrillation, the hazard ratio of RLS for stroke recurrence was 0.86 (95% CI 0.41-1.79). The condition of RLS at rest adjusted for age, sex, stroke subtype, and cardiovascular risk factors was not found to increase the risk of stroke substantially (HR 1.16 [95% CI 0.41-3.29]) Our data suggest that the risk of recurrent stroke in subjects with PFO is not significantly increased in comparison with subject without it. © 2010 The Author(s). Journal compilation © 2010 EFNS.

  16. Meningiomas anteriores e antero-laterais do forame magno Anterior and lateral foramen magnum meningiomas

    Directory of Open Access Journals (Sweden)

    Osvaldo Inácio de Tella Jr

    2006-06-01

    Full Text Available Relatamos nossa experiência com 11 pacientes portadores de meningiomas do forame magno, oito cranioespinhais e três espinocraniais. A média de idade foi 50,8 anos, o sintoma mais comum foi cefaléia occipital com duração média de 18,6 meses. Os principais achados neurológicos foram tetraparesia e comprometimento dos nervos cranianos baixos. O tratamento foi cirúrgico, sempre com exposição da artéria vertebral em sua entrada na dura-máter da fossa posterior e ressecção de parte do côndilo occipital apenas em três casos. Ressecção total foi possível em sete pacientes e parcial nos demais, devido às aderências a vasos e nervos. O prognóstico esteve relacionado com as condições neurológicas pré-operatórias.We report our experience with 11 cases of foramen magnum meningiomas, eight originating inside the posterior fossa and three in the caudal region. The mean age of the patients was 50.8 years and the main complaint was cervical headache for at least 18.6 months and at the neurological examination, tetraparesis and deficit of the lower cranial nerves were very often observed. All patients were submitted to surgical treatment, always with exposition of the vertebral artery at the entry zone in the duramater of the posterior fossa, with partial removal of the occipital condyle in only three cases. Total resection was obtained in seven patients and partial removal in the other four due to adherences to vessels and nerves. The prognostic was related to the neurological condition before surgery.

  17. Diagnostic accuracy of transesophageal echocardiogram for the detection of patent foramen ovale: a meta-analysis.

    Science.gov (United States)

    Mojadidi, Mohammad Khalid; Bogush, Nikolay; Caceres, Jose Diego; Msaouel, Pavlos; Tobis, Jonathan M

    2014-07-01

    Patent foramen ovale (PFO) is a remnant of the fetal circulation present in 20% of the population. Right-to-left shunting (RLS) through a PFO has been linked to the pathophysiology of stroke, migraine with aura, and hypoxemia. While different imaging modalities including transcranial Doppler, intra-cardiac echo, and transthoracic echo (TTE) have often been used to detect RLS, transesophageal echo (TEE) bubble study remains the gold standard for diagnosing PFO. The aim of this study was to determine the relative accuracy of TEE in the detection of PFO. A systematic review of Medline, using a standard approach for meta-analysis, was performed for all prospective studies assessing accuracy of TEE in the detection of PFO using confirmation by autopsy, cardiac surgery, and/or catheterization as the reference. Search results revealed 3105 studies; 4 met inclusion criteria. A total of 164 patients were included. TEE had a weighted sensitivity of 89.2% (95% CI: 81.1-94.7%) and specificity of 91.4% (95% CI: 82.3-96.8%) to detect PFO. The overall positive likelihood ratio (LR+) was 5.93 (95% CI: 1.30-27.09) and the overall negative likelihood ratio (LR-) was 0.22 (95% CI: 0.08-0.56). While TEE bubble study is considered to be the gold standard modality for diagnosing PFO, some PFOs may still be missed or misdiagnosed. It is important to understand the limitations of TEE and perhaps use other highly sensitive screening tests, such as transcranial doppler (TCD), in conjunction with TEE before scheduling a patient for transcatheter PFO closure. © 2013, Wiley Periodicals, Inc.

  18. Percutaneous patent foramen ovale closure: the Paradoxical Cerebral Embolism Prevention Registry.

    Science.gov (United States)

    Paiva, Luís; Dinis, Paulo; Providência, Rui; Costa, Marco; Margalho, Susana; Goncalves, Lino

    2015-03-01

    The natural history and therapeutic interventions for secondary prevention after a cerebrovascular event in patients with patent foramen ovale (PFO) are not yet established. This study aims to assess the safety and efficacy of percutaneous PFO closure in a population of patients with ischemic cerebrovascular disease of unknown etiology. This prospective observational study included patients with a history of cryptogenic transient ischemic attack (TIA) or stroke who underwent percutaneous PFO closure. The effectiveness of the device for the secondary prevention of TIA or stroke was assessed by comparing observed events in the sample with expected events for this clinical setting. The sample included 193 cases of percutaneous PFO closure (age 46.4 ± 13.1 years, 62.2% female) with a mean follow-up of 4.3 ± 2.2 years, corresponding to a total exposure to ischemic events of 542 patient-years. The high-risk characteristics of the PFO were assessed prior to device implantation. There were seven primary endpoint events during follow-up (1.3 per 100 patient-years), corresponding to a relative risk reduction of 68.2% in recurrent TIA or stroke compared to medical therapy alone. The procedure was associated with a low rate of device- or intervention-related complications (1.5%). In this long-term registry, percutaneous PFO closure was shown to be a safe and effective therapy for the secondary prevention of cryptogenic stroke or TIA. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  19. Reconstruction of the cranial base in surgery for jugular foramen tumors.

    Science.gov (United States)

    Ramina, Ricardo; Maniglia, Joao J; Paschoal, Jorge R; Fernandes, Yvens B; Neto, Mauricio Coelho; Honorato, Donizeti C

    2005-04-01

    The surgical removal of a jugular foramen (JF) tumor presents the neurosurgeon with a complex management problem that requires an understanding of the natural history, diagnosis, surgical approaches, and postoperative complications. Cerebrospinal fluid (CSF) leakage is one of the most common complications of this surgery. Different surgical approaches and management concepts to avoid this complication have been described, mainly in the ear, nose, and throat literature. The purpose of this study was to review the results of CSF leakage prevention in a series of 66 patients with JF tumors operated on by a multidisciplinary cranial base team using a new technique for cranial base reconstruction. We retrospectively studied 66 patients who had JF tumors with intracranial extension and who underwent surgical treatment in our institutions from January 1987 to December 2001. Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. All patients were operated on using the same multidisciplinary surgical approach (neurosurgeons and ear, nose, and throat surgeons). A surgical strategy for reconstruction of the cranial base using vascularized flaps was carried out. The closure of the surgical wound was performed in three layers. A specially developed myofascial flap (temporalis fascia, cervical fascia, and sternocleidomastoid muscle) associated to the inferior rotation of the posterior portion of the temporalis muscle was used to reconstruct the cranial base with vascularized flaps. In this series of 66 patients, postoperative CSF leakage developed in three cases. These patients presented with very large or recurrent tumors, and the postoperative CSF fistulae were surgically closed. The cosmetic result obtained with this reconstruction was classified as excellent or good in all patients. Our results compare favorably with those reported in the literature. The surgical strategy used for cranial base reconstruction presented in this article has

  20. The interpretive power of infraorbital foramen area in making dietary inferences in extant apes.

    Science.gov (United States)

    Muchlinski, Magdalena N; Deane, Andrew S

    2014-08-01

    The infraorbital foramen (IOF) is located below the orbit and transmits the sensory infraorbital nerve (ION) to mechanoreceptors located throughout the maxillary region. The size of the IOF correlates with the size of the ION; thus, the IOF appears to indicate relative touch sensitivity of maxillary region. In primates, IOF size correlates well with diet. Frugivores have relatively larger IOFs than folivores or insectivores because fruit handling/processing requires increased touch sensitivity. However, it is unknown if the IOF can be used to detect subtle dietary differences among closely related hominoid species. Hominoids are traditionally grouped into broad dietary categories, despite the fact that hominoid diets are remarkably diverse. This study examines whether relative IOF size is capable of differentiating among the dietary preferences of closely related species with overlapping, yet divergent diets. We measured IOF area in Hylobates lar, Symphalangus syndactulus, Pongo pygmaeus spp., Pan troglodytes, Gorilla gorilla, Gorilla beringei graueri, and Gorilla beringei beringei. We classified each species as a dedicated folivore, mixed folivore/frugivore, soft object frugivore, or hard object frugivore. The IOF is documented to be larger in more frugivorous species and smaller in more folivorous taxa. Interestingly, G.b. beringei, had the largest relative IOF of any gorilla, despite being a dedicated folivore. G.b. beringei does have unique food processing behavior that relies heavily on maxillary mechanoreception, thus this finding is not entirely unsupported behaviorally. The results of this study provide evidence that the IOF is an informative feature in interpretations of fossil apes. Copyright © 2014 Wiley Periodicals, Inc.

  1. Hydrocephalus caused by unilateral foramen of Monro obstruction: A review on terminology

    Science.gov (United States)

    Nigri, Flavio; Gobbi, Gabriel Neffa; da Costa Ferreira Pinto, Pedro Henrique; Simões, Elington Lannes; Caparelli-Daquer, Egas Moniz

    2016-01-01

    Background: Hydrocephalus caused by unilateral foramen of Monro (FM) obstruction has been referred to in literature by many different terminologies. Precise terminology describing hydrocephalus confined to just one lateral ventricle has a very important prognostic value and determines whether or not the patient can be shunt free after an endoscopic procedure. Methods: Aiming to define the best term for unilateral FM obstruction, 19 terms were employed on PubMed database (http://www.ncbi.nlm.nih.gov/pubmed) as quoted phrases. Results: A total of 194 articles were found. Four patterns of hydrocephalus were discriminated as a result of our research term query and were divided by types for didactic purpose. Type A - partial dilation of the lateral ventricle; Type B - pure unilateral obstruction of the FM; Type C - previously shunted patients with secondary obstruction of the FM; and Type D - asymmetric lateral ventricles with patent FM. Conclusion: In unilateral FM obstruction hydrocephalus, an in-depth review on terminology application is critical to avoid mistakes that may compromise comparisons among different series. This terminology review suggests that Type B hydrocephalus, i.e., the hydrocephalus confined to just one lateral ventricle with no other sites of cerebrospinal fluid circulation blockage, are best described by the terms unilateral hydrocephalus (UH) and monoventricular hydrocephalus, the first being by far the most popular. Type A hydrocephalus is best represented in the literature by the terms uniloculated hydrocephalus and loculated ventricle; Type C hydrocephalus by the terms isolated lateral ventricle and isolated UH; and Type D hydrocephalus by the term asymmetric hydrocephalus. PMID:27274402

  2. Patent foramen ovale: comparison among diagnostic strategies in cryptogenic stroke and migraine.

    Science.gov (United States)

    Zito, Concetta; Dattilo, Giuseppe; Oreto, Giuseppe; Di Bella, Gianluca; Lamari, Annalisa; Iudicello, Raffaella; Trio, Olimpia; Caracciolo, Giuseppe; Coglitore, Sebastiano; Arrigo, Francesco; Carerj, Scipione

    2009-05-01

    The aim of this study was to compare transthoracic echocardiography (TTE) and transcranial Doppler ultrasonography (TCD) with transesophageal echocardiography (TEE) in order to define the best clinical approach to patent foramen ovale (PFO) detection. In total, 72 consecutive patients (33 men) with a mean age of 49 +/- 13 years were prospectively enrolled. The TEE indication was cryptogenic stroke (36 patients) or migraine (36 patients, 22 with aura). All patients underwent standard TTE, TCD, and TEE examination. For any study, a contrast test was carried on using an agitated saline solution mixed with urea-linked gelatine (Haemaccel), injected as a rapid bolus via a right antecubital vein. A prolonged Valsalva maneuver was performed to improve test sensitivity. TEE identified a PFO in 65% of the whole population: 56.5% in the migraine cohort and 43.5% in the cryptogenic stroke cohort. TTE was able to detect a PFO in 55% of patients positive at TEE (54% negative predictive value, 100% positive predictive value, 55% sensitivity, and 100% specificity). TCD was able to identify a PFO in 97% of patients positive at TEE (89% negative predictive value, 98% positive predictive value, 94% sensitivity, and 96% specificity). In patients with cryptogenic stroke and migraine, there is a fair concordance (k = 0.89) between TCD and TEE in PFO recognition. Accordingly, TCD should be recommended as a simple, noninvasive, and reliable technique, whereas TEE indication should be restricted to selected patients. TTE is a very specific technique, whose major advantage is the ability to detect a large right-to-left shunt, particularly if associated with an atrial septal aneurysm.

  3. Morphological approach of the sternal foramen: an anatomic study and a short review of the literature.

    Science.gov (United States)

    Gkantsinikoudis, N; Chaniotakis, C; Gkasdaris, G; Georgiou, N; Kapetanakis, S

    2017-01-01

    The sternal foramen (SF) constitutes a specific anatomic defect in sternum, indicating an impaired fusion of ossificated segments, which occurs either in an anatomical part of the sternum or in sternal joints. The aim of this article is to provide baseline statistical data about the variations of the SF, to present a short review of the relevant literature and to compare results with other studies and populations. We review relevant literature, and we present data obtai-ned from skeletal samples of known population and sex. A total of 35 well-preserved dried sterna from the prefecture of Eastern Macedonia and Thrace, Greece, were selected: 20 men and 15 women with a mean age of 55 ± 6 years old. Measurements were made with a sliding calliper and photographic documentation. The incidence of the SF in the 35 dried specimens was 14.2%, 4 men (20% of male sample) and 1 woman (6.6% of female sample) and 80% of sternal foramina were observed in male individuals. The SF was found in the sternum body (2 cases, 40% of foramina), in xiphoid process (2 cases, 40% of foramina) and in sternoxiphoidal junction (1 case, 20% of foramina). All of the sterna presented 1 single visible SF. Two anatomically unique cases were identified throughout these 5 sterna, both belonging in male subjects. The SF constitutes a relatively common variation with great radiological, clinical, and forensic significance. Presence of a SF with irregular bony margins complicates considerably radiological differential diagnosis. Awareness of this important anatomic variation is fundamental for clinicians and autopsy pathologists, in order to avoid severe fatal complications and elucidate the exact cause of death, respectively.

  4. To Be or Not to Be Patent: The Relationship Between Migraine and Patent Foramen Ovale.

    Science.gov (United States)

    Kahya Eren, Nihan; Bülbül, Nazlı G; Yakar Tülüce, Selcen; Nazlı, Cem; Beckmann, Yeşim

    2015-01-01

    Migraine is a common neurological disorder with an uncertain pathogenesis. A pathophysiological link has been proposed between the migraine headache and patent foramen ovale (PFO). However, the data about the association of migraine with the presence of PFO are conflicting. The study aims to prospectively investigate the prevalence of PFO in patients with migraine compared with that of control subjects. A total of 203 migraineous patients and 212 control subjects with similar demographic characteristics to that of case subjects regarding age and gender were included in the study. Transthoracic echocardiography with agitated saline injection was used to evaluate the presence of PFO. PFO was judged to be present if any microbubble was seen in the left cardiac chambers within the first 5 cardiac cycles from the maximum right atrial opacification at rest or after provocative maneuvers. Mean age of the patients was 37.2 ± 9.8 years and 93% were female. Migraine with aura was present in 32% (n = 65) of the patients. The prevalence of PFO was similar in patients with migraine and the control subjects (42% vs 44%; odds ratio 0.90, 95% confidence interval 0.61-1.33, P = .61). Likewise, the prevalence of PFO was similar in migraineurs patients with or without aura (41% vs 42%; odds ratio 0.95, 95% confidence interval 0.51-1.76, P = .87). This study suggest that PFO is not more common in patients with migraine compared with healthy subjects. Therefore, our findings suggest that the relationship between migraine headache and the presence of PFO is questionable. © 2015 American Headache Society.

  5. Migraine with aura and silent brain infarcts lack of mediation of patent foramen ovale.

    Science.gov (United States)

    Calviere, L; Tall, P; Massabuau, P; Bonneville, F; Larrue, V

    2013-12-01

    Population-based studies have shown a heightened prevalence of clinically silent brain infarcts in subjects who have migraine with aura (MA). We sought to determine whether this association could be confirmed in young patients with cryptogenic ischemic stroke, and explored the role of patent foramen ovale (PFO) as a potential underlying mechanism. Patients were selected from a registry of young patients consecutively treated for ischemic stroke in a tertiary university hospital among those without definite cause of stroke. Patients with PFO were matched for age and gender with patients with normal atrial septum. Migraine and MA were evaluated after patient selection and matching. Silent brain infarcts were independently evaluated on MRI. We included 100 patients [60 men; mean age (SD), 44.8 years (8.3)], 50 patients with PFO. We found silent brain infarcts in 36 patients and MA in 13 patients. MA was more frequent in patients with silent brain infarcts than in patients without silent brain infarcts (25.0% vs. 6.3%; OR, 5; 95% CI, 1.4-17.6; P = 0.01). Traditional cardiovascular risk factors were not associated with silent brain infarcts. PFO was neither associated with MA (OR, 1.7; 95% CI, 0.5-5.3) nor silent brain infarcts (OR, 0.7; 95% CI, 0.3-1.5). The association of MA with silent brain infarcts was not altered after adjustment for PFO. Findings suggest that silent brain infarcts in young patients with cryptogenic stroke is associated with MA. We found no evidence for a mediating effect of PFO on this association. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

  6. Mutations in the NKX2-5 gene in patients with stroke and patent foramen ovale.

    Science.gov (United States)

    Belvís, Robert; Tizzano, Eduardo F; Martí-Fàbregas, Joan; Leta, Rubén G; Baena, Manel; Carreras, Francesc; Pons-Lladó, Guillem; Baiget, Montserrat; Martí-Vilalta, Josep Lluis

    2009-09-01

    Patent foramen ovale (PFO) has been related to stroke but its existence has not been explained to date. NKX2-5 is the most implicated gene in fetal atrial septation. We studied NKX2-5 with respect to the presence or absence of PFO in stroke patients. A prospective analysis of NKX2-5 regarding age, gender, PFO, right-to-left shunt (RLS) size and atrial septal aneurysm (ASA) was performed in consecutive stroke patients and in 50 controls. The entire coding region and intron-exon boundaries of NKX2-5 gene were analyzed by PCR and sequencing of DNA from peripheral lymphocytes. One hundred patients participated in the study (mean age 56.5+/-12.4 years, 58% males) and PFO was diagnosed in 34% of them by transesophageal echocardiography. RLS was small (12%), moderate (2%) and large (20%). ASA was present in four patients. DNA revealed a novel c.2357G>A change in one PFO patient with cryptogenic stroke. Furthermore, c.182C>T, a mutation previously described in patients with cardiac defects, was detected in two non-PFO women with cryptogenic stroke. None of these changes were detected in our controls. The c.172A>G polymorphism was found in 21% of controls. It appeared more frequently in ASA patients (p=0.084), in cryptogenic PFO stroke patients (p=0.097) and in patients with known causes of stroke (p=0.037). The c.2850C>A polymorphism was also detected in our series with no differences in PFO, RLS size or ASA. Despite the fact that the NKX2-5 could account for the persistence of PFO, mutations of this gene in peripheral blood DNA were barely detected in our study.

  7. Variability of the vertebral artery origin and transverse foramen entrance level - CT angiographic study.

    Science.gov (United States)

    Vujmilović, Siniša; Spasojević, Goran; Vujnović, Saša; Malobabić, Slobodan; Vujković, Zoran

    2018-04-13

    Vertebral artery (VA), the main element of the posterior brain circulation, has many anatomical variations which generally were widely investigated. However, available data vary in wide ranges, reflecting very different sample sizes, lack of data about left-right or sex differences, and about possible ethnic, regionally specific or genetic differences. Certain new findings suggest possible involvement of some environmental factors in VA variations. Accurate anatomical data about VA variations in different regions of the world, including Balkans countries, are still lacking. Therefore we investigated morphological variability of VA origin and its entrance level into cervical transverse foramina in population of Republika Srpska (Bosnia and Herzegovina), including data about the sex and side. Anatomy of VA was investigated in 112 persons (224 arteries) of both sexes (58 males, 54 females; age 19 - 83 years), using 64-slice CT scanner. Origin of VA from subclavian artery (SCA) we found in 95.08% of arteries (52 males, 49 females). Only in one male (0.45 %) left VA and left SCA had an specific origin from aortic arch (AA), which we named as an "common area of origin". All other observed variations in origin were only of left VA, originating from AA in 4.47 % (5 males, 5 females). Left VA Most often (usual) entrance level into transverse foramen we found at C6 (87.5%), followed by C5 (8.93 %), C4 (3.12 %), and in one case at level C7 (0.45 %). Entry levels at C5 both, on right and on the left side, were 3 times more frequent in males than in females. Wide ranges of differences between the data we obtained on a sample in Republika Srpska (Bosnia and Herzegovina) and the data from many other studies require further and wider investigations.

  8. Effect of body position and oxygen tension on foramen ovale recruitment.

    Science.gov (United States)

    Moses, Kayla L; Beshish, Arij G; Heinowski, Nicole; Baker, Kim R; Pegelow, David F; Eldridge, Marlowe W; Bates, Melissa L

    2015-01-01

    While there is an increased prevalence of stroke at altitude in individuals who are considered to be low risk for thrombotic events, it is uncertain how venous thrombi reach the brain. The patent foramen ovale (PFO) is a recruitable intracardiac shunt between the right and left atrium. We aimed to determine whether body position and oxygen tension affect blood flow through the PFO in healthy adults. We hypothesized that hypoxia and body positions that promote right atrial filling would independently recruit the PFO. Subjects with a PFO (n = 11) performed 11 trials, combining four different fractions of inhaled oxygen (FiO₂) (1.0, 0.21, 0.15, and 0.10) and three positions (upright, supine, and 45° head down), with the exception of FiO₂ = 0.10, while 45° head down. After 5 min in each position, breathing the prescribed oxygen tension, saline bubbles were injected into an antecubital vein and a four-chamber echocardiogram was obtained to evaluate PFO recruitment. We observed a high incidence of PFO recruitment in all conditions, with increased recruitment in response to severe hypoxia and some contribution of body position at moderate levels of hypoxia. We suspect that increased pulmonary vascular pressure, secondary to hypoxia-induced pulmonary vasoconstriction, increased right atrial pressure enough to recruit the PFO. Additionally, we hypothesize that the minor increase in breathing resistance that was added by the mouthpiece, used during experimental trials, affected intrathoracic pressure and venous return sufficiently to recruit the PFO. Copyright © 2015 the American Physiological Society.

  9. Uterine-sparing Laparoscopic Resection of Accessory Cavitated Uterine Masses.

    Science.gov (United States)

    Peters, Ann; Rindos, Noah B; Guido, Richard S; Donnellan, Nicole M

    2018-01-01

    To demonstrate surgical techniques utilized during uterine-sparing laparoscopic resections of accessory cavitated uterine masses (ACUMs). ACUMs represent a rare uterine entity observed in premenopausal women suffering from dysmenorrhea and recurrent pelvic pain. The diagnosis is made when an isolated extra-cavitated uterine mass is resected from an otherwise normal appearing uterus with unremarkable endometrial lumen and adnexal structures. Pathologic confirmation requires an accessory cavity lined with endometrial epithelium (and corresponding glands and stroma) filled with chocolate-brown fluid. Adenomyosis must be absent. Although the origin of ACUMs is currently unknown, the most common presentation is a 2-4 cm lateral uterine wall mass at the level of the insertion of the round ligament. Hence it has been hypothesized that gubernaculum dysfunction may be responsible for duplication or persistence of paramesonephric tissue leading to ACUM formation as a new Müllerian anomaly. A stepwise surgical tutorial describing 2 laparoscopic ACUM resections using a narrated video (Canadian Task Force classification III). An academic tertiary care hospital. In this video, we present 2 patients who underwent uterine-sparing laparoscopic resections of their ACUM in order to preserve fertility (Case 1) or avoid the complications and surgical recovery time of a total laparoscopic hysterectomy (Case 2). Case 1 is a 19-year-old, gravida 0, para 0 woman with dysmenorrhea and recurrent pelvic pain who presented for multiple emergency room and outpatient evaluations. Transvaginal ultrasonography was unremarkable except for a 28×30×26mm left lateral uterine mass with peripheral vascular flow that was initially felt to be a leiomyoma or rudimentary uterine horn. MRI imaging, however, demonstrated this mass to be more consistent with an ACUM. This was based on the lack of communication between the lesion and the main uterine cavity exhibited by high T2 signal (compatible with

  10. Evaluation of Relative Position of Mandibular Foramen in Children as a Reference for Inferior Alveolar Nerve Block using Orthopantamograph.

    Science.gov (United States)

    Krishnamurthy, Navin Hadadi; Unnikrishnan, Surej; Ramachandra, Jaya Agali; Arali, Veena

    2017-03-01

    The Mandibular Foramen (MF) is a landmark for administering local anaesthetic solution for Inferior Alveolar Nerve Block (IANB). The position of MF shows considerable variation among different ethnicity, ages and on either sides even within the same individual. Failure to achieve IANB leading to repeated injection of the local anaesthetic solution will not only pose a behaviour problem in children but can also lead to systemic toxic level of anaesthetic solution being administered. To determine the relative position of the mandibular foramen in 7 to 12-year-old children in relation to the mandibular occlusal plane and the deepest point on coronoid notch. Ninety orthopantamograph of 7 to 12-year-old children were selected from the database and were divided into three groups: Group 1 (G1): seven to eight-year-old, Group 2 (G2): 9 to 10-year-old and Group 3 (G3): 11 to 12-year-old. The radiographs were traced on acetate paper, anatomical landmarks were marked and linear measurements were noted from the Mandibular Lingula (ML) to the occlusal plane, and to the deepest point on coronoid notch. The data obtained was tabulated and subjected to statistical analysis. One way ANOVA test followed by Bonferroni post hoc analysis and Student's paired t-test were used. Mandibular foramen is approximately, 2-3 mm above the occlusal plane and 11.6-13.0 mm from deepest point of coronoid notch for seven to eight-year-old children, 3-4 mm above the occlusal plane and 13.0-13.9 mm from deepest point of coronoid notch for 9-10 year age group and 5.5-6.5 mm above the occlusal plane and 11.9-12.2 mm from deepest point of coronoid notch for children of the ages 11-12 years. The linear distance from the deepest point of coronoid notch to the mandibular lingula showed statistical significance in G2 vs G3 on right side G1 vs G2 and G2 vs G3 on the left side. The variance of this distance for either side showed statistical significance for G1 and G2. The distance from the mandibular lingula

  11. Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study using Transesophageal Echocardiography

    Science.gov (United States)

    Cabanes, L.; Mas, J. L.; Cohen, A.; Amarenco, P.; Cabanes, P. A.; Oubary, P.; Chedru, F.; Guerin, F.; Bousser, M. G.; deRecondo, J.

    1993-01-01

    Background and Purpose: An association between atrial septal aneurysm and embolic events has been suggested. Atrial septal aneurysm has been shown to be associated with patent foramen ovale and,.in some reports, with mitral valve prolapse. These two latter cardiac disorder; have been identified as potential risk factors for ischemic stroke. The aim of this prospective study was to assess the role of atrial septal aneurysm as an independent risk factor for stroke, especially for cryptogenic stroke. Methods: We studied the prevalence of atrial septal aneurysm, patent foramen ovale, and mitral valve prolapse in 100 consecutive patients ischemic stroke who underwent extensive etiological investigations. We compared these results with those in a control group of 50 consecutive patients. The diagnosis of atrial septal aneurysm and patent foramen ovale relied on transesophageal echocardiography with a contrast study and that of mitral valve prolapse, on two-dimensional transthoracic echocardiography. Results: Stepwise logistic regression analysis showed that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3 to 14.6; P=.01) and patent foramen ovale (odds ratio, 3.9; 95% confidence interval, 1.5 to 10; P=.003) but not mitral valve prolapse were significantly associated with the diagnosis of cryptogenic stroke. The stroke odds of a patient with both atrial septal aneurysm and patent foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the stroke odds of a patient with neither of these cardiac disorders. For a patient with atrial septal aneurysm of >lo-mm excursion, the stroke odds were approximately 8 times the stroke odds of a patient with atrial septal aneurysm of stroke and that their association has a marked synergistic effect. Atrial septal aneurysms of >lo-mm excursion are associated with a higher risk of stroke. (Stroke. 1993;24:1865-1873.) KEY WORDS aneurysm echocardiography foramen ovale, patent mitral valve prolapse o young adults

  12. An exploration study to find important factors influencing on brand in car accessory market

    Directory of Open Access Journals (Sweden)

    Naser Azad

    2013-08-01

    Full Text Available Supplying car accessory is one of the most important growing industries in the world. Every year, millions of cars are produced and people need to have the access to necessary car accessory. In this paper, we present an exploration study to detect important factors influencing car accessory market. The proposed study designs a questionnaire in Likert scale consists of 16 questions, distributes it among 200 experts and analyses it using factor analysis. Cronbach alpha and Kaiser-Meyer-Olkin Measure of Sampling Adequacy are calculated as 0.823 and 0.863, which validate the overall questionnaire. The results indicate that there are three influencing factors including brand capability, brand characteristics and consumers’ believe.

  13. Acquired cavo-varus deformity caused by an accessory calcaneus: a case report and literature review

    International Nuclear Information System (INIS)

    Singh Baghla, Davinder Paul; Shariff, Sajid; Bashir, Waseem A.

    2010-01-01

    We describe an unusual cause of an acquired cavo-varus foot deformity produced by progressive enlargement of an accessory calcaneal ossicle. A 13-year-old boy with constitutional plano-valgus flat feet noted a gradual change in foot shape associated with lateral ankle pain on ambulation following an inversion injury 2 years earlier. CT and MRI scans confirmed a large accessory calcaneal ossicle lying within the sinus tarsi, with associated marrow oedema. Following surgical excision of the ossicle, the foot returned to its original shape and the symptoms were alleviated. This is the fifth reported case of an accessory calcaneal ossicle, but the only case that has occurred in a flatfooted individual. We also present the first reported MRI images of the lesion confirming pathological marrow oedema as a response to mechanical stress. (orig.)

  14. Accessories for detention and protection used in small animals radiation therapy

    International Nuclear Information System (INIS)

    Vettorato, Michel Campos; Vulcano, Luiz Carlos; Fernandes, Marco Antonio Rodrigues

    2016-01-01

    Radiation therapy is a medical method well established in the treatment of cancer in veterinary medicine worldwide. The radiotherapy protocols applied in animals vary according to several factors. In most procedures require sedation or anesthesia of the animal and this fact imposes the use of immobilization accessories specially developed for the different species of animals and treated as their specified procedures. Therefore, this study aims to describe the types of accessories used for immobilization and for the protection of small animals undergoing radiotherapy. For its development a literature search was performed by search sites like Google Scholar, Scielo, Bireme, PubMed, and consultations in books campus library Botucatu UNESP. Despite the limitations of each accessory rated this review, it was possible to identify the use of each and how this can be advantageous for the treatment of animals undergoing radiation therapy. (author)

  15. Accessory left atrial diverticulae: contractile properties depicted with 64-slice cine-cardiac CT.

    LENUS (Irish Health Repository)

    Killeen, Ronan P

    2012-02-01

    To assess the contractility of accessory left atrial appendages (LAAs) using multiphasic cardiac CT. We retrospectively analyzed the presence, location, size and contractile properties of accessory LAAs using multiphasic cardiac 64-slice CT in 102 consecutive patients (63 males, 39 females, mean age 57). Multiplanar reformats were used to create image planes in axial oblique, sagittal oblique and coronal oblique planes. For all appendages with an orifice diameter >or= 10 mm, axial and sagittal diameters and appendage volumes were recorded in atrial diastole and systole. Regression analysis was performed to assess which imaging appearances best predicted accessory appendage contractility. Twenty-three (23%) patients demonstrated an accessory LAA, all identified along the anterior LA wall. Dimensions for axial oblique (AOD) and sagittal oblique (SOD) diameters and sagittal oblique length (SOL) were 6.3-19, 3.4-20 and 5-21 mm, respectively. All appendages (>or=10 mm) demonstrated significant contraction during atrial systole (greatest diameter reduction was AOD [3.8 mm, 27%]). Significant correlations were noted between AOD-contraction and AOD (R = 0.57, P < 0.05) and SOD-contraction and AOD, SOD and SOL (R = 0.6, P < 0.05). Mean diverticulum volume in atrial diastole was 468.4 +\\/- 493 mm(3) and in systole was 171.2 +\\/- 122 mm(3), indicating a mean change in volume of 297.2 +\\/- 390 mm(3), P < 0.0001. Stepwise multiple regression analysis revealed SOL to be the strongest independent predictor of appendage contractility (R(2) = 0.86, P < 0.0001) followed by SOD (R(2) = 0.91, P < 0.0001). Accessory LAAs show significant contractile properties on cardiac CT. Those accessory LAAs with a large sagittal height or depth should be evaluated for contractile properties, and if present should be examined for ectopic activity during electrophysiological studies.

  16. Accessory Axillary Breast Excision with Liposuction Using Minimal Incision: A Preliminary Report.

    Science.gov (United States)

    Hwang, Seong Bae; Choi, Byung Seo; Byun, Geon Young; Koo, Bum Hwan; Lee, Sung Ryul

    2017-02-01

    Accessory breasts have received little attention in the surgical fields, although the condition is quite common in the female population, with 2-6% of women suffering from it. Its convexity and cyclic pain make women feel embarrassed and uncomfortable, so patients often desire surgical excision to improve their appearances and to remove the pain. A total of 967 patients who had been treated by an excision of accessory breast tissue with liposuction using minimal incision from September 2013 to Dec 2015 at the Damsoyu Hospital were analyzed for clinical factors retrospectively. All 967 patients were female. There were 514 (53.2%) unmarried patients and 453 (46.8%) married patients. The major clinical manifestation was the problem in the appearance with cyclic pain in both unmarried and married groups (82.7 vs. 87.9%). Three types of accessory breasts were observed: 779 (80.6%) breast tissue only in axillae, 182 (18.8%) breast tissue with accessory nipple, and 6 (0.6%) breast tissue with accessory nipple-areolar complex. The mean operation time was 58 min. All cyclic axillar pain in our cases was resolved after the operation. Postoperative complications developed in 160 patients (16.55%). Among them, seroma after operation was the most common (11.27%). In our study, 95.65% of the patients were satisfied with the cosmetic outcomes. The surgical excision of accessory breasts with liposuction through the minimal incision is a safe and effective method to make women feel comfortable in clinical manifestations and be satisfied with their cosmetic axillar line. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  17. When to use femoral vein injection for diagnosis of patent foramen ovale-Effect of a persistent eustachian valve on right atrial flow patterns during contrast transesophageal echocardiography.

    Science.gov (United States)

    Koh, Tat W

    2017-05-01

    Contrast echocardiography using agitated saline injected into the antecubital vein is the most common method used for the diagnosis of patent foramen ovale. We describe a case whereby the presence of a persistent eustachian valve and a "negative contrast sign" during contrast transesophageal echocardiography raised suspicion of a false-negative result. Femoral vein injection of contrast successfully demonstrated a patent foramen ovale. Femoral vein injection should be considered if this scenario is recognized because the eustachian valve directs blood preferentially from the inferior vena cava toward the interatrial septum and this route may prove to be more reliable. © 2017, Wiley Periodicals, Inc.

  18. Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly

    Directory of Open Access Journals (Sweden)

    Nishchint Jain

    2014-01-01

    Full Text Available Accessory and Cavitated Uterine Mass (ACUM is a rare form of developmental Mullerian anomaly seen in young females, which presents as chronic recurrent pelvic pain and severe dysmenorrhea. It is an accessory cavity lying within an otherwise normal uterus. It is lined by functional endometrium and surrounded by myometrium-like smooth muscle cells; hence, it bears striking macroscopic and microscopic resemblance to the uterus. Hysterosalpingography (HSG, Ultrasonography (USG, and Magnetic Resonance Imaging (MRI form the mainstay of diagnostic imaging. The entity is often under diagnosed; therefore, a high index of suspicion combined with HSG and MRI imaging can help in making an accurate diagnosis.

  19. Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly

    International Nuclear Information System (INIS)

    Jain, Nishchint; Verma, Ritu

    2014-01-01

    Accessory and Cavitated Uterine Mass (ACUM) is a rare form of developmental Mullerian anomaly seen in young females, which presents as chronic recurrent pelvic pain and severe dysmenorrhea. It is an accessory cavity lying within an otherwise normal uterus. It is lined by functional endometrium and surrounded by myometrium-like smooth muscle cells; hence, it bears striking macroscopic and microscopic resemblance to the uterus. Hysterosalpingography (HSG), Ultrasonography (USG), and Magnetic Resonance Imaging (MRI) form the mainstay of diagnostic imaging. The entity is often under diagnosed; therefore, a high index of suspicion combined with HSG and MRI imaging can help in making an accurate diagnosis

  20. Ablation of an atriofascicular accessory pathway with a zero-fluoroscopy procedure

    Directory of Open Access Journals (Sweden)

    Riccardo Proietti, MD, PhD

    2015-10-01

    Full Text Available A 16-year-old patient with recurrent palpitations and documented left bundle branch block superior axis wide complex tachycardia underwent an electrophysiological study and ablation with a zero-fluoroscopy procedure. The electrophysiological study showed a decremental antegrade conducting atriofascicular pathway. Three-dimensional CARTO-guided mapping of the tricuspid annulus in sinus rhythm was performed, and a distinct signal corresponding to the accessory pathway potential of the atriofascicular pathway was found in the posterolateral region. By using an SR0 sheath and a 4-mm-tip catheter, radiofrequency application was delivered at this point on the annulus and successfully eliminated conduction through the accessory pathway.

  1. Reactive Hypertrophy of an Accessory Spleen Mimicking Tumour Recurrence of Metastatic Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Christin Tjaden

    2011-01-01

    Full Text Available De novo occurrence of an accessory spleen after splenectomy is worth noting for two reasons. First, it is known that splenectomy can cause reactive hypertrophy of initially inactive and macroscopically invisible splenic tissue. Second, it can mimic tumour recurrence in situations in which splenectomy has been performed for oncological reasons. This might cause difficulties in differential diagnosis and the clinical decision for reoperation. We report the case of a patient with suspected recurrence of renal cell carcinoma after total pancreatectomy and splenectomy for metastatic renal cell carcinoma, which finally revealed an accessory spleen as the morphological correlate of the newly diagnosed mass in the left retroperitoneum.

  2. Properties of Phase Transition of Traffic Flow on Urban Expressway Systems with Ramps and Accessory Roads

    International Nuclear Information System (INIS)

    Mei Chaoqun; Liu Yejin

    2011-01-01

    In this paper, we develop a cellular automaton model to describe the phase transition of traffic flow on urban expressway systems with on-off-ramps and accessory roads. The lane changing rules are given in detailed, the numerical results show that the main road and the accessory road both produce phase transitions. These phase transitions will often be influenced by the number of lanes, lane changing, the ramp flow, the input flow rate, and the geometry structure. (interdisciplinary physics and related areas of science and technology)

  3. Embolismo paradójico inminente evidenciado por ecocardiografía en pacientes con foramen ovale persistente Imminent paradoxical embolism evidenced by echocardiography in patients with patent foramen ovale

    Directory of Open Access Journals (Sweden)

    Luis E Mayorga

    2008-10-01

    Full Text Available Paciente de género masculino, de 72 años de edad, con antecedente de trombo-embolismo pulmonar, quien ingresó por evento cerebro-vascular isquémico y en quien en el ecocardiograma trans-torácico y luego en el trans-esofágico, se encontró una masa móvil que sugería un trombo que traspasaba el foramen ovale permeable. Ante el diagnóstico de embolismo paradójico inminente, se consideró realizar trombectomía quirúrgica, la cual se difirió por infección y se inició anticoagulación con heparina de bajo peso molecular. Se realizó un ecocardiograma de control y se observó que la masa había desaparecido por completo. Se dio de alta con anticoagulación oral.A 72 years old male patient with previous history of pulmonary thrombosis was admitted with an ischemic stroke. In a transtoraxic echocardiogram, as well as in a posterior transesophagic one, a mobile mass suggesting a thrombus going through a patent foramen ovale, was found. Facing an imminent paradoxical embolism, surgical thrombectomy was considered that could no be realized due to infection. Anticoagulation with low molecular weight heparin was initiated. A control echocardiogram showed complete disappearance of the mass. The patient was discharged with oral anticoagulation.

  4. Mental Health

    Science.gov (United States)

    ... well Feeling guilty, worthless, or helpless Thinking about suicide or hurting yourself Other mental health conditions include anxiety disorders, mood disorders, and personality disorders. For a good description ...

  5. [Anatomic rationale for clinical efficacy of intraosseous mental nerve anesthesia].

    Science.gov (United States)

    Rabinovich, S A; Vasil'ev, Yu L; Kuzin, A N

    2018-01-01

    The aim of the study was to prove the anatomical and clinical effectiveness of the modified anesthesia of mental nerve. The effectiveness of conductive anesthesia near the mental foramen was objectively evaluated using the electric pulp test (EPT) in 100 volunteers of both sexes, aged 35-43 years. Wet anterior mandible preparations obtained from 350 cadavers aged 18-74 years were also studied. EPT value after local mental anesthesia conducted according to Malamed C. using 4% articain solution of local anesthetic with vasoconstrictor concentration of 1:200.000 after 2 minutes was 93±0.82 mA, after 4 minutes - 188±1.26 mA. Yield variability indicators of intraosseous mental nerve anesthesia was slightly higher varying from 94.11 mA to 96.61 mA after 2 minutes and from 197.4 to 199.92 mA after 4 minutes survey. The study showed the efficiency and predictability of intraosseous anesthesia of the mental nerve.

  6. Morphometric analysis of the infraorbital foramen, canal and groove using cone beam CT: considerations for creating artificial organs.

    Science.gov (United States)

    Orhan, Kaan; Misirli, Melis; Aksoy, Secil; Seki, Umut; Hincal, Evren; Ormeci, Tugrul; Arslan, Ahmet

    2016-01-01

    The aim of this study was to examine the anatomy and variations of the infraorbital foramen and its surroundings via morphometric measurements using cone beam computed tomography (CBCT) scans derived from a 3D volumetric rendering program. 354 sides of CBCT scans from 177 patients were examined in this study. DICOM data from these images were exported to Maxilim® software in order to generate 3D surface models. The morphometric measurements were done for infraorbital foramen (IOF), infraorbital groove (IOG) and infraorbital canal (IOC). All images were evaluated by 1 radiologist. To assess intra-observer reliability, the Wilcoxon matched-pairs signed rank test was used. Differences between sex, side, age and measurements were evaluated using chi-square and paired t-test and measurements were evaluated using 1-way ANOVA tests. Differences were considered significant when p0.05). No significant difference was found according to age groups (p>0.05). These results provide detailed knowledge of the anatomical characteristics in this particular area. CBCT imaging with lower radiation dose and thin slices can be a powerful tool for anesthesia procedures like infra orbital nerve blocks, for surgical approaches like osteotomies and neurectomies and also for generating artificial prostheses.

  7. Progress in the clinical imaging research of bone diseases on ankle and foot sesamoid bones and accessory ossicles

    Science.gov (United States)

    Li, Xiaozhong; Shi, Lenian; Liu, Taiyun; Wang, Lin

    2012-01-01

    Summary Sesamoid bones and accessory ossicles are research focuses of foot and ankle surgery. Pains of the foot and ankle are related to sesamoid bones and accessory ossicles. The specific anatomical and functional relationship of sesamoid bones and accessory ossicles can cause such bone diseases as the dislocation of sesamoid bones and accessory bones, infection, inflammation and necrosis of sesamoid bones, cartilage softening, tenosynovitis of sesamoid bones and the sesamoid bone syndrome. However, these bone diseases are often misdiagnosed or mistreated. In patients with trauma history, relevant diseases of sesamoid bones and accessory ossicles as above mentioned are highly probable to be misdiagnosed as avulsion fractures. In such cases, radiographic findings may provide a basis for clinical diagnosis. PMID:25343083

  8. Patent foramen ovale in patients with pulmonary embolism: A prognostic factor on CT pulmonary angiography?

    Science.gov (United States)

    Zhang, Meng; Tan, Stephanie; Patel, Vishal; Zalta, Benjamin A; Shmukler, Anna; Levsky, Jeffrey M; Jain, Vineet R; Shaban, Nada M; Haramati, Linda B

    2017-12-02

    Patent foramen ovale (PFO) in patients with acute pulmonary embolism (PE) represents a risk factor for mortality, but this has not been evaluated for CT pulmonary angiography (CTPA). The purpose of the present study was to assess the relationship between PFO and mortality in patients with acute PE diagnosed on CTPA. This retrospective study included 268 adults [173 women, mean age 61 (range 22-98) years] diagnosed with acute PE on non-ECG-gated 64-slice CTPA in 2012 at our medical center. The images were reviewed for PFO by a panel of cardiothoracic radiologists with an average of 11 years of experience (range 1-25 years). CT signs of right heart strain and PE level were noted. Transthoracic echocardiograms (TTE), when available (n = 207), were reviewed for PFO by a cardiologist with subspecialty training in advanced imaging and with 3 years of experience. The main outcome was 30-day mortality. Fischer's exact test was utilized to compare mortality. PFO prevalence on CTPA was 22% (58/268) and 4% (9/207) on TTE. Overall 30-day mortality was 6% (16/268), 9% (5/58) for patients with PFO and 5% (11/210) for those without (p = 0.35). CT signs of right heart strain trended with higher mortality, but statistically significant only for hepatic vein contrast reflux [14% (6/44) vs 4% (10/224), p = 0.03]; right ventricular (RV) to left ventricular (LV) diameter ratio >1 [8% (13/156) vs RV:LV ≤ 1 3% (3/112), p = 0.07], septal bowing [10% (4/42) vs without 5% (12/226), p = 0.30]. PFO was demonstrated on CTPA in a proportion similar to the known population prevalence, while routine TTE was less sensitive. Mortality was non-significantly higher in patients with acute PE and PFO in this moderate-sized study. A larger study to answer this clinically important question is worthwhile. Copyright © 2017 Society of Cardiovascular Computed Tomography. All rights reserved.

  9. Patent foramen ovale and migraine: a cross-sectional study from the Northern Manhattan Study (NOMAS).

    Science.gov (United States)

    Rundek, Tatjana; Elkind, Mitchell S V; Di Tullio, Marco R; Carrera, Emmanuel; Jin, Zhezhen; Sacco, Ralph L; Homma, Shunichi

    2008-09-30

    A causal relationship between patent foramen ovale (PFO) and migraine has been hypothesized, and improvement of migraine frequency and severity after percutaneous PFO closure has been reported. Population-based data on the relationship between PFO and migraine are sparse, however. The objective of this study was to examine the association between PFO and migraine among stroke-free individuals in an urban, population-based, multiethnic cohort. As a part of the ongoing Northern Manhattan Study (NOMAS), 1101 stroke-free subjects were assessed for self-reported history of migraine. The presence of PFO was assessed by transthoracic echocardiography. The mean age of the group was 69+/-10 years; 58% were women. Forty-eight percent were Caribbean Hispanic, 24% were white, 26% were black, and 2% were another race/ethnicity. The prevalence of self-reported migraine was 16% (13% migraine with aura). The prevalence of PFO was 15%. Migraine was significantly more frequent among younger subjects, women, and Hispanics. The prevalence of PFO was not significantly different between subjects who had migraine (26/178, or 14.6%) and those who did not (138/923, or 15.0%; P=0.9). In an adjusted multivariate logistic regression model, the presence of PFO was not associated with increased prevalence of migraine (odds ratio 1.01, 95% confidence interval 0.63 to 1.61). Increasing age was associated with lower prevalence of migraine in both subjects with a PFO (odds ratio 0.94, 95% confidence interval 0.90 to 0.99 per year) and those without PFO (odds ratio 0.97, 95% confidence interval 0.95 to 0.99 per year). The observed lack of association between PFO and migraine (with or without aura) was not modified by diabetes mellitus, hypertension, cigarette smoking, or dyslipidemia. In this multiethnic, elderly, population-based cohort, PFO detected with transthoracic echocardiography and agitated saline was not associated with self-reported migraine. The causal relationship between PFO and

  10. Percutaneous Closure of Patent Foramen Ovale in Patients With Migraine: The PREMIUM Trial.

    Science.gov (United States)

    Tobis, Jonathan M; Charles, Andrew; Silberstein, Stephen D; Sorensen, Sherman; Maini, Brijeshwar; Horwitz, Phillip A; Gurley, John C

    2017-12-05

    Migraine is a prevalent and disabling disorder. Patent foramen ovale (PFO) has been associated with migraine, but its role in the disorder remains poorly understood. This study examined the efficacy of percutaneous PFO closure as a therapy for migraine with or without aura. The PREMIUM (Prospective, Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects With Migraine and PFO Using the AMPLATZER PFO Occluder to Medical Management) was a double-blind study investigating migraine characteristics over 1 year in subjects randomized to medical therapy with a sham procedure (right heart catheterization) versus medical therapy and PFO closure with the Amplatzer PFO Occluder device (St. Jude Medical, St. Paul, Minnesota). Subjects had 6 to 14 days of migraine per month, had failed at least 3 migraine preventive medications, and had significant right-to-left shunt defined by transcranial Doppler. Primary endpoints were responder rate defined as 50% reduction in migraine attacks and adverse events. Secondary endpoints included reduction in migraine days and efficacy in patients with versus without aura. Of 1,653 subjects consented, 230 were enrolled. There was no difference in responder rate in the PFO closure (45 of 117) versus control (33 of 103) groups. One serious adverse event (transient atrial fibrillation) occurred in 205 subjects who underwent PFO closure. Subjects in the PFO closure group had a significantly greater reduction in headache days (-3.4 vs. -2.0 days/month, p = 0.025). Complete migraine remission for 1 year occurred in 10 patients (8.5%) in the treatment group versus 1 (1%) in the control group (p = 0.01). PFO closure did not meet the primary endpoint of reduction in responder rate in patients with frequent migraine. (Prospective, Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects With Migraine and PFO Using the AMPLATZER PFO Occluder to Medical Management [PREMIUM]; NCT00355056). Copyright

  11. A morphometric anatomical and comparative study of the foramen magnum region in a Greek population.

    Science.gov (United States)

    Natsis, K; Piagkou, M; Skotsimara, G; Piagkos, G; Skandalakis, P

    2013-12-01

    The foramen magnum (FM), a complex area in craniocervical surgery, poses a challenge for neurosurgeons. The knowledge of the detailed anatomy of the FM, occipital condyles (OC) and variations of the region is crucial for the safety of vital structures. This study focuses on the FM and OC morphometry, highlights anatomical variability and investigates correlations between the parameters studied. One hundred and forty-three Greek adult dry skulls were examined using a digital sliding calliper (accuracy, 0.01 mm). Mean FM width and length were found 30.31 ± 2.79 and 35.53 ± 3.06 mm, respectively. The commonest FM shape was two semicircles (25.9 %), whereas the most unusual was irregular (0.7 %). The OC minimum width, maximum width and length were 5.71 ± 1.61, 13.09 ± 1.99 and 25.60 ± 2.91 mm on the right, and 6.25 ± 1.76, 13.01 ± 1.98 and 25.60 ± 2.70 mm on the left side. The commonest OC shape was S-like and the most unusual was ring, bilaterally. The mean anterior and posterior intercondylar distances were 19.30 ± 3.25 and 51.61 ± 5.01 mm, respectively. The OC protruded into the FM in 86.7 % of the skulls. Variations such as a third OC existed in 5.6 % and basilar processes in 2.8 %. Posterior condylar foramina were present in 75.5 %. The gender was correlated with FM width and length, OC length, bilaterally, anterior intercondylar distance (AID) and posterior intercondylar distance (PID). The OC protrusion and existence of posterior condylar foramina were correlated. Bilateral asymmetry for OC shape was statistically significant. Our results provide useful information that will enable effective and reliable surgical intervention in the FM region with the maximum safety and widest possible exposure.

  12. A novel method of lengthening the accessory nerve for direct coaptation during nerve repair and nerve transfer procedures.

    Science.gov (United States)

    Tubbs, R Shane; Maldonado, Andrés A; Stoves, Yolanda; Fries, Fabian N; Li, Rong; Loukas, Marios; Oskouian, Rod J; Spinner, Robert J

    2018-01-01

    OBJECTIVE The accessory nerve is frequently repaired or used for nerve transfer. The length of accessory nerve available is often insufficient or marginal (under tension) for allowing direct coaptation during nerve repair or nerve transfer (neurotization), necessitating an interpositional graft. An attractive maneuver would facilitate lengthening of the accessory nerve for direct coaptation. The aim of the present study was to identify an anatomical method for such lengthening. METHODS In 20 adult cadavers, the C-2 or C-3 connections to the accessory nerve were identified medial to the sternocleidomastoid (SCM) muscle and the anatomy of the accessory nerve/cervical nerve fibers within the SCM was documented. The cervical nerve connections were cut. Lengths of the accessory nerve were measured. Samples of the cut C-2 and C-3 nerves were examined using immunohistochemistry. RESULTS The anatomy and adjacent neural connections within the SCM are complicated. However, after the accessory nerve was "detethered" from within the SCM and following transection, the additional length of the accessory nerve increased from a mean of 6 cm to a mean of 10.5 cm (increase of 4.5 cm) after cutting the C-2 connections, and from a mean of 6 cm to a mean length of 9 cm (increase of 3.5 cm) after cutting the C-3 connections. The additional length of accessory nerve even allowed direct repair of an infraclavicular target (i.e., the proximal musculocutaneous nerve). The cervical nerve connections were shown not to contain motor fibers. CONCLUSIONS An additional length of the accessory nerve made available in the posterior cervical triangle can facilitate direct repair or neurotization procedures, thus eliminating the need for an interpositional nerve graft, decreasing the time/distance for regeneration and potentially improving clinical outcomes.

  13. Accessory atrioventricular myocardial connections in the developing human heart: relevance for perinatal supraventricular tachycardias

    NARCIS (Netherlands)

    Hahurij, Nathan D.; Gittenberger-de Groot, Adriana C.; Kolditz, Denise P.; Bökenkamp, Regina; Schalij, Martin J.; Poelmann, Robert E.; Blom, Nico A.

    2008-01-01

    BACKGROUND: Fetal and neonatal atrioventricular (AV) reentrant tachycardias can be life-threatening but resolve in most cases during the first year of life. The transient presence of accessory AV myocardial connections during annulus fibrosus development may explain this phenomenon. METHODS AND

  14. Assessment of exposure to manganese in welding operations during the assembly of heavy excavation machinery accessories.

    Science.gov (United States)

    Smargiassi, A; Baldwin, M; Savard, S; Kennedy, G; Mergler, D; Zayed, J

    2000-10-01

    Welder exposure to metals in various industrial sectors is poorly characterized. We had the opportunity to carry out an exploratory study to characterize manganese exposure in welding operations in a recently established Quebec factory that assembled accessories for heavy excavation machinery. Ten workers were sampled for total manganese for at least two consecutive days out of three followed by two consecutive days for respirable manganese (with a size selective sampler with a median cut-off of 4 microns), during a typical week in the summer of 1998. Parts being welded were characterized as large or small. Small parts were those being welded on tables during subassembly. Workers were divided into two groups according to the parts they were welding. Seventy-eight percent of the total manganese exposure levels of welding operations during the assembly of large accessories of heavy excavation machinery exceeded the manganese American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) of 0.20 mg/m3 (GM 0.24 mg/m3, n = 14) while none exceeded the TLV during the assembly of small pieces (GM 0.06 mg/m3, n = 8). Welding operations during the assembly of large heavy excavation machinery accessories may pose a significant health hazard. Considering the importance of task-related variables affecting exposure among workers, further studies are needed to better characterize exposure determinants of welding operations during the assembly of heavy excavation machinery accessories.

  15. Does Accessory Ossicle Affect Management Plan in an Athlete After Ankle Sprain? A Case Report

    Directory of Open Access Journals (Sweden)

    Şerife Şeyma TORĞUTALP

    2016-09-01

    Full Text Available Os subfibulare is an accessory ossicle that lies at the distal part of lateral malleolus. It is typically asymptomatic and detected incidentally by the presence of ankle injuries. A case report of sixteen years old male athlete with ankle injury was presented.

  16. 41 CFR 101-39.304 - Modification or installation of accessory equipment.

    Science.gov (United States)

    2010-07-01

    ..., TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.3-Use and Care of GSA Interagency Fleet Management System Vehicles § 101-39.304 Modification or installation of accessory equipment. The modification of a GSA Interagency Fleet Management System (IFMS) vehicle or the permanent installation of...

  17. Tetralogy of Fallot with restrictive ventricular septal defect by accessory tricuspid leaflet tissue

    OpenAIRE

    Mahipat Raj Soni; Deepak A. Bohara; Ajay U. Mahajan; Pratap J. Nathani

    2012-01-01

    In tetralogy of Fallot septal defect is usually large because of malalignment of outlet septum, restrictive defect has been reported rarely. We present a case of tetralogy of Fallot with accessory tricuspid leaflet tissue restricting ventricular septal defect. The report includes echocardiographic and catheter images of this rare presentation of tetralogy of Fallot.

  18. 21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Manual gastroenterology-urology surgical... OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4730 Manual gastroenterology-urology surgical instrument and accessories. (a) Identification...

  19. Pre-excitation pattern associated with accessory pathway related tachycardia: Case report

    Directory of Open Access Journals (Sweden)

    Burazor Mirko

    2010-01-01

    Full Text Available Introduction. Pre-excitation is based on an accessory conduction pathway between the atrium and ventricle. The term Wolff- Parkinson-White (WPW syndrome is used for patients with the pre-excitation/WPW pattern associated with AP-related tachycardia. Case Outline. We present a 52-year-old man with severe palpitation, fatigue, lightheadedness and difficulty breathing. The initial ECG showed tachyarrhythmia with heart rate between 240 and 300/min. He was treated with antiarrhythmics (Digitalis, Verapamil, Lidocaine with no response. Then, the patient was treated with electrical cardioversion and was referred to our Clinic for further evaluation with the diagnosis: “Ventricular tachycardia”. During in-hospital stay, the previously undiagnosed WPW pattern had been seen. Additional diagnostic tests confirmed permanent pre-excitacion pattern (ECG Holter recording, exercises test. The patient was referred to an electrophysiologist for further evaluation. Mapping techniques provided an accurate assessment of the position of the accessory pathway which was left lateral. The elimination of the accessory pathway by radiofrequent catheter ablation is highly effective in termination and elimination of tacchyarrhythmias. Conclusion. Symptomatic, life-threatening arrhythmia, first considered as ventricular tachycardia, reflected atrial fibrillation with ventricular pre-excitation over an accessory pathway in a patient with previously undiagnosed WPW syndrome.

  20. Prophylactic accessory-pathway ablation in asymptomatic patients with a Wolff-Parkinson-White electrocardiographic pattern.

    Science.gov (United States)

    Ozenc, S; Iscen, S; Kibrisli, E; Tok, D; Parlak, A; Altinel, O; Altinel, S

    2014-01-01

    The optimal approach is controversial in asymptomatic patients who are coincidentally found to have evidence of an accessory pathway (AP) on an ECG. The risk of sudden cardiac death (SCD) is low, and the risk of developing symptoms also appears to be low, although a wide range of incidences have been reported. In our trial, we tested the hypothesis that if prophylactic accessory-pathway ablation performed at the time of the initial electrophysiological testing would improve the long-term outcome in asymptomatic patients with a Wolff-Parkinson-White electrocardiographic pattern. Recruitment of patients began on February 1, 2004, and ended on February 5, 2009. All 110 asymptomatic patients were hospitalized and underwent electrophysiological testing the same day to assess the inducibility of atrioventricular reciprocating tachycardia. The anterograde effective refractory period of the accessory pathway was defined as the longest coupling interval at which anterograde block in the bypass tract was observed. For the statistical analysis, the statistical software SPSS version 15.0 for Windows (SPSS Inc., Chicago, IL, USA). Of 110 asymptomatic patients with a Wolff-Parkinson-White electrocardiographic pattern, 80 patients were ablated. Ablation group consisted of these patients. Control group consisted of remaining 30 and were divided into two groups according to the anterograde effective refractory period of the accessory pathway. There was no significant difference between three groups in terms of arrhythmic events (p: 0.58). Asymptomatic patients with the Wolff-Parkinson-White syndrome do not require prophylactic ablation, since they remain asymptomatic for many years.

  1. Accessory enzymes influence cellulase hydrolysis of the model substrate and the realistic lignocellulosic biomass.

    Science.gov (United States)

    Sun, Fubao Fuebiol; Hong, Jiapeng; Hu, Jinguang; Saddler, Jack N; Fang, Xu; Zhang, Zhenyu; Shen, Song

    2015-11-01

    The potential of cellulase enzymes in the developing and ongoing "biorefinery" industry has provided a great motivation to develop an efficient cellulase mixture. Recent work has shown how important the role that the so-called accessory enzymes can play in an effective enzymatic hydrolysis. In this study, three newest Novozymes Cellic CTec cellulase preparations (CTec 1/2/3) were compared to hydrolyze steam pretreated lignocellulosic substrates and model substances at an identical FPA loading. These cellulase preparations were found to display significantly different hydrolytic performances irrelevant with the FPA. And this difference was even observed on the filter paper itself when the FPA based assay was revisited. The analysis of specific enzyme activity in cellulase preparations demonstrated that different accessory enzymes were mainly responsible for the discrepancy of enzymatic hydrolysis between diversified substrates and various cellulases. Such the active role of accessory enzymes present in cellulase preparations was finally verified by supplementation with β-glucosidase, xylanase and lytic polysaccharide monooxygenases AA9. This paper provides new insights into the role of accessory enzymes, which can further provide a useful reference for the rational customization of cellulase cocktails in order to realize an efficient conversion of natural lignocellulosic substrates. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. 49 CFR 398.5 - Parts and accessories necessary for safe operation.

    Science.gov (United States)

    2010-10-01

    ... REGULATIONS TRANSPORTATION OF MIGRANT WORKERS § 398.5 Parts and accessories necessary for safe operation. (a... not be of welded construction. The installation shall be such as not to cause cracking, warping, or... high, by attachment of sideboards to the permanent body construction if necessary. Stake body...

  3. Shoulder complaints after neck dissection; is the spinal accessory nerve involved?

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    The purpose of the current study was to investigate the relation between shoulder morbidity (pain and range of motion), and the function of the spinal accessory nerve after neck dissection. Identifying dysfunction of the nerve gives insight in the mechanisms of post-operative shoulder complaints. In

  4. Electrophysiological mapping of the accessory olfactory bulb of the rabbit (Oryctolagus cuniculus).

    Science.gov (United States)

    van Groen, T; Ruardy, L; da Silva, F H

    1986-07-01

    Field potentials elicited by electrical stimulation of the vomeronasal nerve were measured in the accessory olfactory bulb of the rabbit. Maps were made of the distribution of surface field potentials and of the corresponding depth profiles. The surface maps followed closely the contours of the accessory olfactory bulb: at the frontal border the field potential tended to zero and at the center of the structure the field potential attained a maximum. Depth profiles of the field potentials through the accessory olfactory bulb presented a surface-negative wave and, in depth, a positive wave. The polarity reversal occurred at the deep part of the granule cell layer. The zero equipotential line followed closely the curvature of the granule cell layer. Current source density analysis of the depth profiles revealed a main sink at the external plexiform and granule cell layers. This indicates that the main activity in the accessory olfactory bulb is generated by the synapses between the mitral cells and the granule cells as is found in the main olfactory bulb.

  5. [Blockade of the pheromonal effects in rat by central deafferentation of the accessory olfactory system].

    Science.gov (United States)

    Sánchez-Criado, J E

    1979-06-01

    Female rats reared without sex odours from male rats have a five day stral cycle. With exposure to male odour the estral cycle is shortened from five to four days. This pheromonal effect is blocked on deafferenting the vomeronasal system by electrolytically damaging both accessory olfactory bulbs.

  6. Surgical treatment of a comminuted articular fracture of the accessory carpal bone in a thoroughbred horse

    International Nuclear Information System (INIS)

    Munroe, G.A.; Cauvin, E.

    1997-01-01

    The clinical, radiographic and ultrasonographic findings in a case ofa comminuted articular fracture of the accessory carpal bone of a thoroughbred chaser are described, and its surgical treatment and aftercare are detailed. The horse made an uneventful recovery and successfully returned to racing

  7. The right vertebral artery originating from the right occipital artery and the absence of the transverse foramen: a rare anatomical variation.

    Science.gov (United States)

    Öner, Zülal; Öner, Serkan; Kahraman, Ayşegül Sağır

    2017-12-01

    Variations in the origin of the vertebral artery (VA) is a congenital anomaly that occurs during embryological development. Multiple variations related to VA origin have been reported in the literature. Abnormal VA origin is usually determined as incidental findings during angiographic or postmortem anatomical studies. Although most of the cases are asymptomatic, in patients with VA anomaly symptoms such as dizziness have been described. The anomalous variation in the origin of the right VA is rare and separated into three categories: (1) originating from the aorta, (2) originating from the carotid arteries, (3) duplicated origin. In this case, we aimed to present the right VA originating from the right occipital artery and concomitant anomalies of the transverse foramen that have not been reported previously according to our knowledge in literature. In a 32-year-old female patient referred to our hospital because of dizziness, the right VA was not observed on magnetic resonance imaging and computed tomography angiography (CTA) examination was performed. CTA showed hypoplasia of the right transverse foramen at the levels of the C1, C5 and C6 vertebrae and aplasia of the right transverse foramen at the levels of the C2, C3 and C4 vertebrae. The right VA originating from the right occipital artery continues to its normal course by entering the cranium through the foramen magnum at the level of the atlantooccipital junction.

  8. The anatomical perspective of human occipital condyle in relation to the hypoglossal canal, condylar canal, and jugular foramen and its surgical significance

    Directory of Open Access Journals (Sweden)

    Ranjana Verma

    2016-01-01

    Conclusion: The OC and related structures such as HC, CC, and JF are likely to have variations in respect to morphometry and morphology. This study may prove helpful to neurosurgeons operating in this field, especially during TCA where neurovascular structures emerging from these canals and foramen are more vulnerable to injury.

  9. Divided infraorbital foramen in the lion (Panthera leo): its implications for colonisation history, population bottlenecks, and conservation of the Asian lion (P. l. persica)

    NARCIS (Netherlands)

    Yamaguchi, N.; Kitchener, A.C.; Driscoll, C.A.; Macdonald, D.W.

    2009-01-01

    A divided infraorbital foramen is an important morphological feature in lion taxonomy and has previously been considered to occur only in the Asian lion, Panthera leo persica. Based on an examination of 498 lion skulls from museum collections in Europe and southern Africa, we report for the first

  10. Accessory papillary muscles and papillary muscle hypertrophy are associated with sudden cardiac arrest of unknown cause.

    Science.gov (United States)

    Uhm, Jae-Sun; Youn, Jong-Chan; Lee, Hye-Jeong; Park, Junbeom; Park, Jin-Kyu; Shim, Chi Young; Hong, Geu-Ru; Joung, Boyoung; Pak, Hui-Nam; Lee, Moon-Hyoung

    2015-10-15

    The present study was performed for elucidating the associations between the morphology of the papillary muscles (PMs) and sudden cardiac arrest (SCA). We retrospectively reviewed history, laboratory data, electrocardiography, echocardiography, coronary angiography, and cardiac CT/MRI for 190 patients with SCA. The prevalence of accessory PMs and PM hypertrophy in patients with SCA of unknown cause was compared with that in patients with SCA of known causes and 98 age- and sex-matched patients without SCA. An accessory PM was defined as a PM with origins separated from the anterolateral and posteromedial PMs, or a PM that branched into two or three bellies at the base of the anterolateral or posteromedial PM. PM hypertrophy was defined as at least one of the two PMs having a diameter of ≥1.1cm. In 49 patients (age 49.9±15.9years; 38 men) the cause of SCA was unknown, whereas 141 (age 54.2±16.6years; 121 men) had a known cause. The prevalence of accessory PMs was significantly higher in the unknown-cause group than in the known-cause group (24.5% and 7.8%, respectively; p=0.002) or the no-SCA group (7.1%, p=0.003). The same was true for PM hypertrophy (unknown-cause 12.2%, known-cause 2.1%, p=0.010; no SCA group 1.0%, p=0.006). By logistic regression, accessory PM and PM hypertrophy were independently associated with sudden cardiac arrest of unknown cause. An accessory PM and PM hypertrophy are associated with SCA of unknown cause. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Accessory genes confer a high replication rate to virulent feline immunodeficiency virus.

    Science.gov (United States)

    Troyer, Ryan M; Thompson, Jesse; Elder, John H; VandeWoude, Sue

    2013-07-01

    Feline immunodeficiency virus (FIV) is a lentivirus that causes AIDS in domestic cats, similar to human immunodeficiency virus (HIV)/AIDS in humans. The FIV accessory protein Vif abrogates the inhibition of infection by cat APOBEC3 restriction factors. FIV also encodes a multifunctional OrfA accessory protein that has characteristics similar to HIV Tat, Vpu, Vpr, and Nef. To examine the role of vif and orfA accessory genes in FIV replication and pathogenicity, we generated chimeras between two FIV molecular clones with divergent disease potentials: a highly pathogenic isolate that replicates rapidly in vitro and is associated with significant immunopathology in vivo, FIV-C36 (referred to here as high-virulence FIV [HV-FIV]), and a less-pathogenic strain, FIV-PPR (referred to here as low-virulence FIV [LV-FIV]). Using PCR-driven overlap extension, we produced viruses in which vif, orfA, or both genes from virulent HV-FIV replaced equivalent genes in LV-FIV. The generation of these chimeras is more straightforward in FIV than in primate lentiviruses, since FIV accessory gene open reading frames have very little overlap with other genes. All three chimeric viruses exhibited increased replication kinetics in vitro compared to the replication kinetics of LV-FIV. Chimeras containing HV-Vif or Vif/OrfA had replication rates equivalent to those of the virulent HV-FIV parental virus. Furthermore, small interfering RNA knockdown of feline APOBEC3 genes resulted in equalization of replication rates between LV-FIV and LV-FIV encoding HV-FIV Vif. These findings demonstrate that Vif-APOBEC interactions play a key role in controlling the replication and pathogenicity of this immunodeficiency-inducing virus in its native host species and that accessory genes act as mediators of lentiviral strain-specific virulence.

  12. Forward Genetics Approach Reveals Host Genotype-Dependent Importance of Accessory Chromosomes in the Fungal Wheat Pathogen Zymoseptoria tritici

    Directory of Open Access Journals (Sweden)

    Michael Habig

    2017-11-01

    Full Text Available The fungal wheat pathogen Zymoseptoria tritici possesses a large complement of accessory chromosomes showing presence/absence polymorphism among isolates. These chromosomes encode hundreds of genes; however, their functional role and why the chromosomes have been maintained over long evolutionary times are so far not known. In this study, we addressed the functional relevance of eight accessory chromosomes in reference isolate IPO323. We induced chromosome losses by inhibiting the β-tubulin assembly during mitosis using carbendazim and generated several independent isogenic strains, each lacking one of the accessory chromosomes. We confirmed chromosome losses by electrophoretic karyotyping and whole-genome sequencing. To assess the importance of the individual chromosomes during host infection, we performed in planta assays comparing disease development results in wild-type and chromosome mutant strains. Loss of the accessory chromosomes 14, 16, 18, 19, and 21 resulted in increased virulence on wheat cultivar Runal but not on cultivars Obelisk, Titlis, and Riband. Moreover, some accessory chromosomes affected the switch from biotrophy to necrotrophy as strains lacking accessory chromosomes 14, 18, 19, and 21 showed a significantly earlier onset of necrosis than the wild type on the Runal cultivar. In general, we observed that the timing of the lifestyle switch affects the fitness of Z. tritici. Taking the results together, this study was the first to use a forward-genetics approach to demonstrate a cultivar-dependent functional relevance of the accessory chromosomes of Z. tritici during host infection.

  13. Three-dimensional finite element analysis on canine teeth distalization by different accessories of bracket-free invisible orthodontics technology

    Science.gov (United States)

    Xu, Nuo; Lei, Xue; Yang, Xiaoli; Li, Xinhui; Ge, Zhenlin

    2018-04-01

    Objective: to compare canine tooth stress distribution condition during maxillary canine tooth distalization by different accessories of bracket-free invisible orthodontics technology after removal of maxillary first premolar, and provide basis for clinical design of invisible orthodontics technology. Method: CBCT scanning image of a patient with individual normal occlusion was adopted, Mimics, Geomagic and ProlE software were used for establishing three-dimensional models of maxilla, maxillary dentition, parodontium, invisible orthodontics appliance and accessories, ANSYS WORKBENCH was utilized as finite element analysis tools for analyzing stress distribution and movement pattern of canine tooth and parodontium when canine tooth was equipped with power arm and vertical rectangle accessory. Meanwhile, canine tooth none-accessory design group was regarded as a control. Result: teeth had even bistal surface stress distribution in the power arm group; stress was concentrated on distal tooth neck, and the stress was gradually deviated to mesial-labial side and distal lingual side in vertical rectangle group and none-accessory group. Conclusion: teeth tend to move as a whole in the Power arm group, vertical rectangle group has lower tooth gradient compared with the none-accessory group, teeth are inclined for movement in the none-accessory group, and canine teeth tend to rotate to the distal lingual side.

  14. Clinical differentiation of patent foramen ovale and secundum atrial septal defect: a survey of pediatric cardiologists in Dallas, Texas, USA.

    Science.gov (United States)

    Scheuerle, Angela

    2011-01-01

    Public health birth defect surveillance registries rely on health care provider diagnosis and definition of congenital anomalies. Major anomalies are likely to have consistent diagnoses across providers; however, definition of some more common, often minor, defects can be problematic. Of particular frustration are the transient neonatal heart findings: patent ductus arteriosus, patent foramen ovale, and pulmonary artery branch stenosis. Under certain circumstances these findings may be considered true anomalies-patent foramen ovale (PFO) as a clinical finding overlaps significantly with atrial septal defect (ASD) of secundum type, the latter being considered a true congenital malformation. Some criteria must be established to separate these conditions in case ascertainment. It is therefore helpful to understand the clinical definitions of patent foramen ovale and secundum atrial septal defect. Pediatric cardiologists in the greater Dallas, Texas metropolitan area were surveyed by telephone, fax, and/or email and asked what criteria they use to distinguish a PFO from a secundum ASD. This was an open-ended question. No baseline parameters were suggested or introduced by the interviewer. Pediatric cardiology fellowship training was identified for each physician to examine the hypothesis that graduates of a given program would use the same diagnostic criteria. Responses were obtained from 22 of 23 pediatric cardiologists. Four measurement criteria were identified: size of the opening, presence or absence of a flap of septal tissue, appearance of the defect on echocardiogram and presence/absence/amount of blood shunting across through the opening. Though there was overlap, diagnostic criteria differentiating PFO and secundum ASD varied among pediatric cardiologists. Two fellowship programs were well represented by the respondent population. Eight respondents were trained at Fellowship 1 and 5 at Fellowship 2. Place of fellowship training was not a strong indicator of

  15. Formation of accessory mineral bed layers during erosion of bentonite buffer material

    International Nuclear Information System (INIS)

    Schatz, Timothy; Kanerva, Noora

    2012-01-01

    Document available in extended abstract form only. dilute groundwater at a transmissive fracture interface, accessory phases within bentonite, such as quartz, feldspar, etc., might remain behind and form a filter bed or cake. As more and more montmorillonite is lost, the thickness of the accessory mineral bed increases and the continued transport of montmorillonite slows and possibly stops if the porosity of the filter bed is sufficiently compressed. Alternatively or concurrently, as the accessory mineral filter bed retains montmorillonite colloids, a filter cake composed of montmorillonite itself may be formed. Ultimately, depending on their extent, properties, and durability, such processes may provide the bentonite buffer system with an inherent, self-filtration mechanism which serves to limit the effects of colloidal erosion. A conceptual view of bentonite buffer extrusion and erosion in an intersecting fracture with formation of an accessory mineral filter bed and montmorillonite filter cake is presented in Figure 1. Due to the swelling pressure of the bentonite buffer, the situation described in Figure 1 may be analogous to that of the case of pressure filtration where a filter cake is formed by pressing a suspension through a filter medium and, by a mechanism known as expression, the filter cake is compressed by direct contact with a solid surface resulting in a reduction of its porosity. In order to examine whether the erosion of bentonite material through contact with dilute groundwater at a transmissive fracture interface could intrinsically result in 1) the formation of an accessory mineral filter bed and cake and/or 2) filter caking of montmorillonite itself, a series of laboratory tests were performed in a flow-through, horizontal, 1 mm aperture, artificial fracture system. Bentonite buffer material was simulated by using mixtures (75/25 weight percent ratio) of purified sodium montmorillonite and various additives serving as accessory mineral proxies

  16. What Is Mental Health?

    Science.gov (United States)

    ... Myths and Facts Recovery Is Possible What Is Mental Health? Mental health includes our emotional, psychological, and social ... mental health problems and where to find help . Mental Health and Wellness Positive mental health allows people to: ...

  17. Mentalizing animals

    DEFF Research Database (Denmark)

    Kasperbauer, Tyler Joshua

    2017-01-01

    Ethicists have tended to treat the psychology of attributing mental states to animals as an entirely separate issue from the moral importance of animals’ mental states. In this paper I bring these two issues together. I argue for two theses, one descriptive and one normative. The descriptive thesis...... holds that ordinary human agents use what are generally called phenomenal mental states (e.g., pain and other emotions) to assign moral considerability to animals. I examine recent empirical research on the attribution of phenomenal states and agential states (e.g., memory and intelligence) to argue...... that phenomenal mental states are the primary factor, psychologically, for judging an animal to be morally considerable. I further argue that, given the role of phenomenal states in assigning moral considerability, certain theories in animal ethics will meet significant psychological resistance. The normative...

  18. Para-muscular and trans-muscular approaches to the lumbar inter-vertebral foramen: an anatomical comparison.

    Science.gov (United States)

    Poetscher, Arthur Werner; Ribas, Guilherme Carvalhal; Yasuda, Alexandre; Nishikuni, Koshiro

    2005-03-01

    Foraminal and extra-foraminal disc herniations comprise up to 11.7% of all lumbar disc herniations. Facetectomy, which had been the classic approach, is now recognized as cause of pain and instability after surgery. Otherwise, posterior lateral approaches through a trans-muscular or a para-muscular technique offer no significant damage to key structures for spinal stability. The surgical anatomy of these approaches has already been described, but they were not compared. In order to quantify the angle of vision towards the intervertebral foramen offered by each technique, 12 fresh cadavers were dissected and studied regarding these approaches. The angle presented by trans-muscular approach was wider in all studied lumbar levels. Surgery through the trans-muscular approach is performed with a better working angle, requiring a smaller resection of surrounding tissues. Therefore, minor surgical trauma can be expected. Our measurements support previously published data that point the trans-muscular approach as the best surgical option.

  19. Angiographic frequency of blunt cerebrovascular injury in patients with carotid canal or vertebral foramen fractures on multidetector CT

    International Nuclear Information System (INIS)

    McKinney, Alexander; Ott, Frederick; Short, James; McKinney, Zeke; Truwit, Charles

    2007-01-01

    Purpose: Blunt carotid injuries (BCI's) and blunt vertebral artery injuries (BVI's), known jointly as BCVI's, are common in 'high risk' patients. The purpose is to evaluate the rate of occurrence of BCI/BVI in patients screened purely by the radiologic criteria of fracture through the carotid canal or vertebral transverse foramina, or significant cervical subluxation, noted by multidetector CT. Methods: Seventy-one patients with 108 catheterized vessels were included over a 13-month interval. The angiographic examinations were prompted by current hospital protocol, solely by the presence of fractures involving/adjacent to the carotid canal, cervical fractures involving/adjacent to the foramen transversarium, or cervical fractures with significant subluxation. The incidence of each grade of blunt injury was calculated after review of the CT scans and catheter angiograms by two neuroradiologists. Results: Two thousand and seventy-three total blunt trauma admissions occurred during the time period, with a BCVI rate of 0.92-1.0% (depending on the reviewer), similar to previous studies. Mean time to catheter angiography was 16.6 h. Of the 71 included patients, there were 11-12 BCI's and 10-12 BVI's, an overall rate of 27-30% of BCVI in the patients with foraminal fractures. Interobserver agreement in reviewing the catheter angiograms was excellent (Kappa 0.795). Of note, three internal carotid pseudoaneurysms resolved spontaneously after anticoagulation or aspirin. Conclusion: This study confirms that there is a high rate of BCVI in the presence of carotid canal or vertebral foramen fractures that are noted by multidetector CT. Utilization of purely radiologic criteria of foraminal involvement may be a significant screening tool in the decision of whether to evaluate these patients acutely by catheter or CT angiography, and for early detection of patients at risk for symptomatology, to initiate prompt, prophylactic treatment

  20. Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials.

    Science.gov (United States)

    Kheiri, Babikir; Abdalla, Ahmed; Osman, Mohammed; Ahmed, Sahar; Hassan, Mustafa; Bachuwa, Ghassan

    2018-03-07

    Cryptogenic strokes can be attributed to paradoxical emboli through patent foramen ovale (PFO). However, the effectiveness of PFO closure in preventing recurrent stroke is uncertain and the results of previous randomized clinical trials (RCTs) have been inconclusive. Hence, this study provides an updated meta-analysis of all RCTs comparing PFO closure with medical therapy for secondary prevention of cryptogenic stroke. All RCTs were identified by a comprehensive literature search of PubMed, Embase, the Cochrane Collaboration Central Register of Controlled Trials, Scopus, and Clinicaltrials.gov. The primary outcome was recurrent ischemic stroke and secondary outcomes were transient ischemic attack (TIA), all-cause mortality, new-onset atrial fibrillation (AF), serious adverse events, and major bleeding. 5 RCTs with 3440 participants were included in the present study (1829 patients underwent PFO closure and 1611 were treated medically). Pooled analysis showed a statistically significant reduction in the rate of recurrent stroke with PFO closure in comparison to medical therapy (OR 0.41; 95% CI 0.19-0.90; p = 0.03). However, there were no statistically significant reductions of recurrent TIAs (OR 0.77; 95% CI 0.51-1.14; p = 0.19) or all-cause mortality (OR 0.76; 95% CI 0.35-1.65; p = 0.48). The risk of developing new-onset AF was increased significantly with PFO closure (OR 4.74; 95% CI 2.33-9.61; p Patent foramen ovale closure in adults with recent cryptogenic stroke was associated with a lower rate of recurrent strokes in comparison with medical therapy alone.

  1. Transcatheter Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke: A Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Darmoch, Fahed; Al-Khadra, Yasser; Soud, Mohamad; Fanari, Zaher; Alraies, M Chadi

    2018-01-01

    Patent foramen ovale (PFO) with atrial septal aneurysm is suggested as an important potential source for cryptogenic strokes. Percutaneous PFO closure to reduce the recurrence of stroke compared to medical therapy has been intensely debated. The aim of this study is to assess whether PFO closure in patients with cryptogenic stroke is safe and effective compared with medical therapy. A search of PubMed, Medline, and Cochrane Central Register from January 2000 through September 2017 for randomized controlled trails (RCT), which compared PFO closure to medical therapy in patients with cryptogenic stroke was conducted. We used the items "PFO or patent foramen ovale", "paradoxical embolism", "PFO closure" and "stroke". Data were pooled for the primary outcome measure using the random-effects model as pooled rate ratio (RR). The primary outcome was reduction in recurrent strokes. Among 282 studies, 5 were selected. Our analysis included 3,440 patients (mean age 45 years, 55% men, mean follow-up 2.9 years), 1,829 in the PFO closure group and 1,611 in the medical therapy group. The I2 heterogeneity test was found to be 48%. A random effects model combining the results of the included studies demonstrated a statistically significant risk reduction in risk of recurrent stroke in the PFO closure group when compared with medical therapy (RR 0.42; 95% CI 0.20-0.91, p = 0.03). Pooled data from 5 large RCTs showed that PFO closure in patients with cryptogenic stroke is safe and effective intervention for prevention of stroke recurrence compared with medical therapy. © 2018 S. Karger AG, Basel.

  2. Angiographic frequency of blunt cerebrovascular injury in patients with carotid canal or vertebral foramen fractures on multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    McKinney, Alexander [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States)]. E-mail: mckin022@umn.edu; Ott, Frederick [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States); Short, James [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States); McKinney, Zeke [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States); Truwit, Charles [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States)

    2007-06-15

    Purpose: Blunt carotid injuries (BCI's) and blunt vertebral artery injuries (BVI's), known jointly as BCVI's, are common in 'high risk' patients. The purpose is to evaluate the rate of occurrence of BCI/BVI in patients screened purely by the radiologic criteria of fracture through the carotid canal or vertebral transverse foramina, or significant cervical subluxation, noted by multidetector CT. Methods: Seventy-one patients with 108 catheterized vessels were included over a 13-month interval. The angiographic examinations were prompted by current hospital protocol, solely by the presence of fractures involving/adjacent to the carotid canal, cervical fractures involving/adjacent to the foramen transversarium, or cervical fractures with significant subluxation. The incidence of each grade of blunt injury was calculated after review of the CT scans and catheter angiograms by two neuroradiologists. Results: Two thousand and seventy-three total blunt trauma admissions occurred during the time period, with a BCVI rate of 0.92-1.0% (depending on the reviewer), similar to previous studies. Mean time to catheter angiography was 16.6 h. Of the 71 included patients, there were 11-12 BCI's and 10-12 BVI's, an overall rate of 27-30% of BCVI in the patients with foraminal fractures. Interobserver agreement in reviewing the catheter angiograms was excellent (Kappa 0.795). Of note, three internal carotid pseudoaneurysms resolved spontaneously after anticoagulation or aspirin. Conclusion: This study confirms that there is a high rate of BCVI in the presence of carotid canal or vertebral foramen fractures that are noted by multidetector CT. Utilization of purely radiologic criteria of foraminal involvement may be a significant screening tool in the decision of whether to evaluate these patients acutely by catheter or CT angiography, and for early detection of patients at risk for symptomatology, to initiate prompt, prophylactic treatment.

  3. Cryptogenic transient ischemic attack after nose blowing: association of huge atrial septal aneurysm with patent foramen ovale as potential cause

    Directory of Open Access Journals (Sweden)

    Lotze U

    2013-07-01

    Full Text Available Ulrich Lotze,1 Uwe Kirsch,1 Marc-Alexander Ohlow,2 Thorsten Scholle,3 Jochen Leonhardi,3 Bernward Lauer,2 Gerhard Oltmanns,4 Hendrik Schmidt5,6 1Department of Internal Medicine, DRK Krankenhaus Sondershausen, Sondershausen, Germany; 2Department of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany; 3Institute of Diagnostic and Interventional Radiology, Zentralklinik Bad Berka, Germany; 4Department of Internal Medicine, DRK Krankenhaus Sömmerda; Sömmerda, Germany; 5Department of Cardiology and Diabetology, Klinikum Magdeburg, Magdeburg, Germany; 6Department of Internal Medicine III, Martin-Luther-Univeristy Halle-Wittenberg, Halle, Germany Abstract: Association of atrial septal aneurysm (ASA with patent foramen ovale (PFO is considered an important risk factor for cardioembolism frequently forwarding paradoxical embolism in patients with cryptogenic or unexplained cerebral ischemic events. We herein describe the case of a 69-year-old male patient reporting uncontrolled movements of the right arm due to a muscle weakness, slurred speech, and paresthesia in the oral region some seconds after he had blown his nose. These neurological symptoms had improved dramatically within a few minutes and were completely regressive at admission to our hospital about two hours later. On transesophageal echocardiography (TEE a huge ASA associated with PFO was detected. Diagnosis of the large-sized ASA was also confirmed by cardiac magnetic resonance imaging. Due to the early complete recovery from his neurological symptoms, the patient was diagnosed with a transient ischemic attack (TIA. After nine days he was discharged in a good clinical condition under the treatment with oral anticoagulation. It is concluded that in cryptogenic or unexplained stroke or TIA TEE should always be performed to rule out ASA and PFO as potential sources for paradoxical embolism in those inconclusive clinical situations. Keywords: congenital cardiac abnormality, atrial septal

  4. The Relationship amongst Intervertebral Disc Vertical Diameter, Lateral Foramen Diameter and Nerve Root Impingement in Lumbar Vertebra

    Directory of Open Access Journals (Sweden)

    Yusof MI

    2018-03-01

    Full Text Available Introduction: The vertical diameter of the foramen is dependent upon the vertical diameter of the corresponding intervertebral disc. A decrease in disc vertical diameter has direct anatomic consequences to the foraminal diameter and area available for the nerve root passing through it. This study is to establish the relationship amongst the intervertebral disc vertical diameter, lateral foramen diameters and nerve root compression in the lumbar vertebra. Materials and Methods: Measurements of the study parameters were performed using sagittal MRI images. The parameters studied were: intervertebral disc vertical diameter (DVD, foraminal vertical diameter (FVD, foraminal transverse diameter (FTD and nerve root diameter (NRD of both sides. The relationship between the measured parameters were then analyzed. Results: A total of 62 MRI images were available for this study. Statistical analysis showed moderate to strong correlation between DVD and FVD at all the lumbar levels except at left L23 and L5S1 and right L3L4 and L4L5. Correlation between DVD and FTD were not significant at all lumbar levels. Regression analysis showed that a decrease of 1mm of DVD was associated with 1.3, 1.7, 3.3, 3.3 and 1.3mm reduction of FVD at L1L2, L2L3, L3L4, L4L5 and L5S1 respectively. Conclusion: Reduction of DVD was associated with reduction of FVD. However, FVD was relatively wide for the nerve root even with complete loss of DVD. FTD was much narrower than the FVD making it more likely to cause nerve root compression at the exit foramina. These anatomical details should be given consideration in treating patients with lateral canal stenosis.

  5. Online monitoring of Accessories for Underground Electrical Installations through Acoustics Emissions

    Directory of Open Access Journals (Sweden)

    Casals-Torrens P.

    2012-04-01

    Full Text Available The acoustic waves caused by Partial Discharges inside the dielectric materials, can be detected by acoustic emission (AE sensors and analyzed in the time domain. The experimental results presented, show the online detection capability of these sensors in the environment near a cable accessory, such as a splice or terminal. The AE sensors are immune to electromagnetic interference and constitute a detection method non-intrusive and non-destructive, which ensures a galvanic decoupling with respect to electric networks, this technique of partial discharge detection can be applied as a test method for preventive or predictive maintenance (condition-based maintenance to equipments or facilities of medium and high voltage in service and represents an alternative method to electrical detection systems, conventional or not, that continue to rely on the detection of current pulses. This paper presents characterization tests of the sensors AE through comparative tests of partial discharge on accessories for underground power cables.

  6. Terminal phalangeal accessory ossification center of the thumb: an additional radiographic finding in Larsen syndrome

    International Nuclear Information System (INIS)

    Alanay, Yasemin; Utine, Gulen E.; Tuncbilek, Ergul; Lachman, Ralph S.; Krakow, Deborah

    2006-01-01

    Larsen syndrome is an autosomal-dominant disorder characterized by multiple joint dislocations, vertebral anomalies and dysmorphic facies. Both autosomal-dominant and autosomal-recessive forms of the disorder have been proposed. Individuals with autosomal-dominant Larsen syndrome have characteristic ''cylindrical-shape'' thumbs caused by broad, shortened phalanges. Autosomal-dominant Larsen syndrome results from heterozygosity for mutations in filamin B, a cytoskeletal protein involved in multicellular processes. We report here a patient with a duplicated or accessory distal thumb phalanx and multiple large joint dislocations who was shown to be heterozygous for a filamin B mutation predicting the amino acid substitution G1691S. This adds a new radiographic finding, duplicated or accessory distal phalanx, to the radiographic abnormalities seen in this rare dominant disorder. (orig.)

  7. Sclerotic fibroma (storiform collagenoma)-like stroma in a fibroadenoma of axillary accessory breast tissue.

    Science.gov (United States)

    Val-Bernal, José Fernando; González-Vela, María Carmen; De Grado, Mauricio; Garijo, María Francisca

    2012-08-01

    Accessory breast tissue is a subcutaneous remnant persisting after normal embryological development of the breast. It occurs most frequently in the axilla. Fibroadenomas in axillary breast tissue are rare. We report the case of a 29-year-old female patient who presented a fibroadenoma arising in the accessory breast tissue of the right axillary fossa. The neoplasm showed foci of sclerotic fibroma-like stroma. The patient had no signs of Cowden's syndrome. To the best of our knowledge, a lesion of this kind has not been previously reported. This stromal change suggests an uncommon involutional phase of the fibroadenoma with production of sclerotic and hypocellular collagen. The lesion should be differentiated from extraneural perineuroma, from the changes in fibroadenomas in Cowden's syndrome, from sclerosing lobular hyperplasia (fibroadenomatoid mastopathy) and from pseudoangiomatous stromal hyperplasia. Copyright © 2012 John Wiley & Sons A/S.

  8. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries

    Science.gov (United States)

    Gulas, Ewelina; Wysiadecki, Grzegorz; Szymański, Jacek; Majos, Agata; Stefańczyk, Ludomir; Topol, Mirosław

    2016-01-01

    Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons. PMID:29593819

  9. Physician accessories: Doctor, what you carry is every patient′s worry?

    Directory of Open Access Journals (Sweden)

    Pandey Anita

    2010-10-01

    Full Text Available Background: Nosocomial infections are on the rise worldwide and many a times they are carried by the health care personnel. Accessories used by physicians and healthcare personnel can be a potential source of nosocomial infection. Materials and Methods: We designed a survey with the aim to investigate the prevalence of microbial flora of accessories such as pens, stethoscopes, cell phones and white coat used by the physicians working in a tertiary care hospital. Observations: It was observed that 66% of the pens, 55% of the stethoscopes, 47.61% of the cell phones and 28.46% of the white coats used by the doctors were colonized with various microorganisms. Staphylococcus spp. was the predominant isolate followed by Escherichia coli. Methicillin resistance in Staphylococcus aureus was also found, which was a matter of concern. Conclusions: Awareness of appropriate hand hygiene is important in order to prevent potential transmission to patients.

  10. Terminal phalangeal accessory ossification center of the thumb: an additional radiographic finding in Larsen syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Alanay, Yasemin [Hacettepe University, Clinical Genetics Unit, Department of Pediatrics, Faculty of Medicine, Ankara (Turkey); Cedars-Sinai Medical Center, Medical Genetics Institute, Los Angeles, CA (United States); Utine, Gulen E.; Tuncbilek, Ergul [Hacettepe University, Clinical Genetics Unit, Department of Pediatrics, Faculty of Medicine, Ankara (Turkey); Lachman, Ralph S. [Cedars-Sinai Medical Center, Medical Genetics Institute, Los Angeles, CA (United States); David Geffen School of Medicine at UCLA, Department of Radiological Sciences, Los Angeles, CA (United States); David Geffen School of Medicine at UCLA, Department of Pediatrics, Los Angeles, CA (United States); Krakow, Deborah [Cedars-Sinai Medical Center, Medical Genetics Institute, Los Angeles, CA (United States); David Geffen School of Medicine at UCLA, Department of Obstetrics and Gynecology, Los Angeles, CA (United States)

    2006-09-15

    Larsen syndrome is an autosomal-dominant disorder characterized by multiple joint dislocations, vertebral anomalies and dysmorphic facies. Both autosomal-dominant and autosomal-recessive forms of the disorder have been proposed. Individuals with autosomal-dominant Larsen syndrome have characteristic ''cylindrical-shape'' thumbs caused by broad, shortened phalanges. Autosomal-dominant Larsen syndrome results from heterozygosity for mutations in filamin B, a cytoskeletal protein involved in multicellular processes. We report here a patient with a duplicated or accessory distal thumb phalanx and multiple large joint dislocations who was shown to be heterozygous for a filamin B mutation predicting the amino acid substitution G1691S. This adds a new radiographic finding, duplicated or accessory distal phalanx, to the radiographic abnormalities seen in this rare dominant disorder. (orig.)

  11. Preoperative computed tomography and scintigraphy to facilitate the detection of accessory spleen in patients with hematologic disorders

    International Nuclear Information System (INIS)

    Koyanagi, Nobuhiro; Kanematsu, Takashi; Sugimachi, Keizo

    1988-01-01

    Accessory spleens of 1.5 cm in size were preoperatively identified by the combined use of computerized tomography and splenic scintigraphy in two patients with hematologic diseases. After the accessory spleen had been removed from the first patient, who had persistent hereditary spherocytosis and had undergone a splenectomy 15 months before, a postoperative decrease in hyperbilirubinemia was noted. In the other patient who had idiopathic thrombocytopenic purpura, a successful accessory splenectomy was done at the same time as her splenectomy, and was followed by 6 months' complete remission. These events indicate that preoperative investigations using computerized tomography and scintigraphy are indispensable for ruling out an accessory spleen in those patients for whom splenectomy needs to be done in order to alleviate hematologic disorders. (author)

  12. Hybrid vehicle powertrain system with power take-off driven vehicle accessory

    Science.gov (United States)

    Beaty, Kevin D.; Bockelmann, Thomas R.; Zou, Zhanijang; Hope, Mark E.; Kang, Xiaosong; Carpenter, Jeffrey L.

    2006-09-12

    A hybrid vehicle powertrain system includes a first prime mover, a first prime mover driven power transmission mechanism having a power take-off adapted to drive a vehicle accessory, and a second prime mover. The second prime mover is operable to drive the power transmission mechanism alone or in combination with the first prime mover to provide power to the power take-off through the power transmission mechanism. The invention further includes methods for operating a hybrid vehicle powertrain system.

  13. Potential role of Arabidopsis PHP as an accessory subunit of the PAF1 transcriptional cofactor.

    Science.gov (United States)

    Park, Sunchung; Ek-Ramos, Maria Julissa; Oh, Sookyung; van Nocker, Steven

    2011-08-01

    Paf1C is a transcriptional cofactor that has been implicated in various transcription-associated mechanisms spanning initiation, elongation and RNA processing, and is important for multiple aspects of development in Arabidopsis. Our recent studies suggest Arabidopsis Paf1C is crucial for proper regulation of genes within H3K27me3-enriched chromatin, and that a protein named PHP may act as an accessory subunit of Paf1C that promotes this function.

  14. Mobile instrumentation platform and robotic accessory for real-time screening of hazardous waste

    International Nuclear Information System (INIS)

    Anderson, M.S.; Jaselskis, E.J.

    1992-01-01

    An innovative mobile laboratory for real-time field screening of soils for inorganic hazardous waste using laser ablation-inductively coupled plasma-atomic emission spectrometry sampling and analysis technique is being developed at Ames Laboratory. This sampling technique as well as the concept for installing, monitoring, and controlling the instrumentation and utilities in the mobile laboratory, the robotic sampling accessory, and manual sampling method are discussed. Benefits of this mobile configuration and future development plans also are described

  15. Clinico-pathologic spectrum of accessory axillary breast; case series and literature review

    Directory of Open Access Journals (Sweden)

    Usman Bello

    2017-01-01

    Full Text Available Accessory breast and the diseases affecting these aberrant breast tissues are relatively uncommon, and with variable prevalence among different populations. These are commonly located in the axilla, chest wall, and vulva. The most common disease in these tissues is carcinoma; however, other benign neoplastic and nonneoplastic lesions do occur. In this review, we present a clinicopathologic analysis of all the consecutive cases seen in a major referral teaching hospital over a period spanning 10 years (2006–2015.

  16. Transcription Factors Encoded on Core and Accessory Chromosomes of Fusarium oxysporum Induce Expression of Effector Genes

    Science.gov (United States)

    van der Does, H. Charlotte; Schmidt, Sarah M.; Langereis, Léon; Hughes, Timothy R.

    2016-01-01

    Proteins secreted by pathogens during host colonization largely determine the outcome of pathogen-host interactions and are commonly called ‘effectors’. In fungal plant pathogens, coordinated transcriptional up-regulation of effector genes is a key feature of pathogenesis and effectors are often encoded in genomic regions with distinct repeat content, histone code and rate of evolution. In the tomato pathogen Fusarium oxysporum f. sp. lycopersici (Fol), effector genes reside on one of four accessory chromosomes, known as the ‘pathogenicity’ chromosome, which can be exchanged between strains through horizontal transfer. The three other accessory chromosomes in the Fol reference strain may also be important for virulence towards tomato. Expression of effector genes in Fol is highly up-regulated upon infection and requires Sge1, a transcription factor encoded on the core genome. Interestingly, the pathogenicity chromosome itself contains 13 predicted transcription factor genes and for all except one, there is a homolog on the core genome. We determined DNA binding specificity for nine transcription factors using oligonucleotide arrays. The binding sites for homologous transcription factors were highly similar, suggesting that extensive neofunctionalization of DNA binding specificity has not occurred. Several DNA binding sites are enriched on accessory chromosomes, and expression of FTF1, its core homolog FTF2 and SGE1 from a constitutive promoter can induce expression of effector genes. The DNA binding sites of only these three transcription factors are enriched among genes up-regulated during infection. We further show that Ftf1, Ftf2 and Sge1 can activate transcription from their binding sites in yeast. RNAseq analysis revealed that in strains with constitutive expression of FTF1, FTF2 or SGE1, expression of a similar set of plant-responsive genes on the pathogenicity chromosome is induced, including most effector genes. We conclude that the Fol

  17. Undressing "health fashion": an examination of health-cause clothing and accessories.

    Science.gov (United States)

    Walker, Kandi L; Hart, Joy L; Gregg, Jennifer L; LaJoie, A Scott

    2010-09-01

    Today, fashion items such as rubber wristbands in various colors, pink ribbons, and red dresses represent different health-related causes and can be seen frequently across demographic groups. Complete with pithy slogans (e.g., "Go Red for Women"), these items are part of a larger "health fashion" trend--one that involves wearing, using, and displaying health-cause clothing and accessories. In this article, the authors explore recent interest in "health fashion," examining in particular its origins, effectiveness, and implications.

  18. Can an accessory renal artery be safely covered during endovascular aortic aneurysm repair?

    OpenAIRE

    Antoniou, George A.; Karkos, Christos D.; Antoniou, Stavros A.; Georgiadis, George S.

    2013-01-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was whether coverage of an accessory renal artery (ARA) in patients undergoing endovascular aortic aneurysm repair (EVAR) is associated with increased risk of renal impairment. Altogether, 106 papers were located using the reported searches, of which 5 represented the best evidence to answer the question. The authors, journal, date and country of publication, study type, patient group studied, rel...

  19. Mental Byomdannelse

    DEFF Research Database (Denmark)

    Olsen, Tina Vestermann; Boye, Anne Mette; Borchmann, Inger Haarup

    Formålet med publikationen er at præsentere metoden "Mental byomdannelse". Metoden viser, hvordan man via midlertidig brug af grunde kan undersøge et steds potentialer, tage et område i brug tidligt i en byomdannelsesproces og derved bidrage til at opbygge en ny identitet for området. Mental...... byomdannelse går ud på at skabe bevidsthed om et byudviklingsområde overfor byens borgere, kommende beboere og fremtidige brugere af området allerede mens den fysiske omdannelse er i gang. I publikationen præsenteres en værktøjskasse, som giver redskaber og ideer til, hvordan man kan sætte en mental...... byomdannelsesproces i gang i byens rum. Publikationen udgør en afrapportering fra et støttet forsøgsprojekt hvor metoden ”Mental byomdannelse” er udviklet ved at afprøve ideerne om mental byomdannelse i to cases i Ålborg Kommune, hhv. i Østre Havn og Nibe by. Formålet med at anvende metoden i de to cases har været...

  20. Influence of Telecommunication Modality, Internet Transmission Quality, and Accessories on Speech Perception in Cochlear Implant Users

    Science.gov (United States)

    Koller, Roger; Guignard, Jérémie; Caversaccio, Marco; Kompis, Martin; Senn, Pascal

    2017-01-01

    Background Telecommunication is limited or even impossible for more than one-thirds of all cochlear implant (CI) users. Objective We sought therefore to study the impact of voice quality on speech perception with voice over Internet protocol (VoIP) under real and adverse network conditions. Methods Telephone speech perception was assessed in 19 CI users (15-69 years, average 42 years), using the German HSM (Hochmair-Schulz-Moser) sentence test comparing Skype and conventional telephone (public switched telephone networks, PSTN) transmission using a personal computer (PC) and a digital enhanced cordless telecommunications (DECT) telephone dual device. Five different Internet transmission quality modes and four accessories (PC speakers, headphones, 3.5 mm jack audio cable, and induction loop) were compared. As a secondary outcome, the subjective perceived voice quality was assessed using the mean opinion score (MOS). Results Speech telephone perception was significantly better (median 91.6%, P 15%) were not superior to conventional telephony. In addition, there were no significant differences between the tested accessories (P>.05) using a PC. Coupling a Skype DECT phone device with an audio cable to the CI, however, resulted in higher speech perception (median 65%) and subjective MOS scores (3.2) than using PSTN (median 7.5%, P<.001). Conclusions Skype calls significantly improve speech perception for CI users compared with conventional telephony under real network conditions. Listening accessories do not further improve listening experience. Current Skype DECT telephone devices do not fully offer technical advantages in voice quality. PMID:28438727

  1. Accessory muscle of the flexor digitorum superficialis and its clinical implications

    Directory of Open Access Journals (Sweden)

    Edie Benedito Caetano

    Full Text Available ABSTRACT Anatomical variations of the flexor digitorum superficialis (FDS muscle and tendon unit are frequently reported by anatomists and clinicians. Anatomical muscle variations of the FDS and its tendons may include variations of muscle belly, presence of accessory or duplicate tendons, abnormal tendon connections, and absence of muscle or tendon components. Such variations may or may not have clinical implications. This report presents a case not described previously: a unilateral accessory muscle of the flexor digitorum superficialis which was connected by a thick tendon to the flexor digitorum superficialis muscle; it was directed proximally to the insertion of the medial epicondyle of the humerus, next to the superficialis head of the pronator teres muscle. The belly of the accessory muscle was positioned anterior to the median and anterior interosseous nerve. This anatomical variation is known as type V in the classification of Elliot et al. The knowledge of these anatomical variations helps hand surgeons interpret the clinical examination, particularly in the evaluation of patients who have suffered tendon injuries or show sign s of possible peripheral nerve entrapment.

  2. The Natural Killer Cell Cytotoxic Function Is Modulated by HIV-1 Accessory Proteins

    Directory of Open Access Journals (Sweden)

    Edward Barker

    2011-07-01

    Full Text Available Natural killer (NK cells’ major role in the control of viruses is to eliminate established infected cells. The capacity of NK cells to kill virus-infected cells is dependent on the interactions between ligands on the infected cell and receptors on the NK cell surface. Because of the importance of ligand-receptor interactions in modulating the NK cell cytotoxic response, HIV has developed strategies to regulate various NK cell ligands making the infected cell surprisingly refractory to NK cell lysis. This is perplexing because the HIV-1 accessory protein Vpr induces expression of ligands for the NK cell activating receptor, NKG2D. In addition, the accessory protein Nef removes the inhibitory ligands HLA-A and -B. The reason for the ineffective killing by NK cells despite the strong potential to eliminate infected cells is due to HIV-1 Vpu’s ability to down modulate the co-activation ligand, NTB-A, from the cell surface. Down modulation of NTB-A prevents efficient NK cell degranulation. This review will focus on the mechanisms through which the HIV-1 accessory proteins modulate their respective ligands, and its implication for NK cell killing of HIV-infected cells.

  3. Surface Layer Fluorination-Modulated Space Charge Behaviors in HVDC Cable Accessory

    Directory of Open Access Journals (Sweden)

    Jin Li

    2018-05-01

    Full Text Available Space charges tend to accumulate on the surface and at the interface of ethylene–propylene–diene terpolymer (EPDM, serving as high voltage direct current (HVDC cable accessory insulation, which likely induces electrical field distortion and dielectric breakdown. Direct fluorination is an effective method to modify the surface characteristics of the EPDM without altering the bulk properties too much. In this paper, the surface morphology, hydrophobic properties, relative permittivity, and DC conductivity of the EPDM before and after fluorination treatment were tested. Furthermore, the surface and interface charge behaviors in the HVDC cable accessory were investigated by the pulsed electroacoustic (PEA method, and explained from the point of view of trap distribution. The results show that fluorination helps the EPDM polymer obtain lower surface energy and relative permittivity, which is beneficial to the interface match in composite insulation systems. The lowest degree of space charge accumulation occurs in EPDM with 30 min of fluorination. After analyzing the results of the 3D potentials and the density of states (DOS behaviors in EPDM before and after fluorination, it can be found that fluorination treatment introduces shallower electron traps, and the special electrostatic potential after fluorination can significantly suppress the space charge accumulation at the interface in the HVDC cable accessory.

  4. Newborn Interneurons in the Accessory Olfactory Bulb Promote Mate Recognition in Female Mice

    Directory of Open Access Journals (Sweden)

    Livio eOboti

    2011-09-01

    Full Text Available In the olfactory bulb of adult rodents, local interneurons are constantly replaced by immature precursors derived from the subventricular zone. Whether any olfactory sensory process specifically relies on this cell renewal remains largely unclear. By using the well-known model of mating-induced imprinting, we demonstrate that this olfactory memory formation critically depends on the presence of newborn granule neurons in the accessory olfactory bulb. Accordingly, we show that, in adult female mice, exposure to male pheromones increases the number of new granule cells surviving in the accessory olfactory bulb. This neuronal addition depends on the detection of sensory cues by the vomeronasal organ and requires centrifugal feedback activity from the amygdala. The stimuli affecting neuronal survival are contained in the low molecular weight fraction of urine and are implied in pheromonal recognition during mating. By chemical depletion of newly generated bulbar interneurons, we show a direct role of renewed granule cells in the accessory olfactory bulb in preventing pregnancy block by mating male odours. Taken together, our results indicate that adult neurogenesis is essential for specific brain functions such as persistent odour learning and mate recognition.

  5. MENTAL HEALTH: ISLAMIC PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Muzdalifah M. Rahman

    2015-02-01

    of mental health, especially mental health needs to be developed with an Islamic perspective various studies and research, especially the development of mental health recovery means Islamic perspective.

  6. 颈静脉孔的应用解剖学%Applied anatomy of jugular foramen

    Institute of Scientific and Technical Information of China (English)

    肖明; 丁炯; 韩群颖; 王鹤鸣; 左国平

    2001-01-01

    Objective: To provide anatomic data for imaging diagnosis and microsurgical treatment of jugular foramen (JF) lesions.Methods: The JF was observed and measured from internal and external aspects in 80 adult skulls.The anatomic relationships between the nerves and vessles in this region were observed in detail by dissecting 20 adult cephalic specimens.Results: ①In 62.3% of all these cases the right JF was larger than the left.In 15.9% the left was larger and in 21.8% they were equal in size. ②Bone bridges could be seen in 14.38% and could not in 85.62%. ③Measured from extracranial aspect, the average distance from midsagittal plane to the medial and lateral border of the JF (medial 26.11mm, lateral 33.41mm), was larger than those measured from intracramial aspect (medial 22.29mm, lateral 27.52mm).④Ⅸ cranial nerve made its exit through the anterior superior border of the JF in most cases, meanwhile Ⅹ and Ⅺ cranial nerve through the medial border, they were distinctly separated from each other by a band of fibrous tissue (account for 87.5%) or a bone bridge (12.5%). ⑤Just outside the JF,Ⅸ cranial nerve appeared at the anterior border and made a loop downward and forward superficial to the internal carotid artery.Ⅸ cranial nerve run downward and backward deep (account for 57.5%), or superficially (42.5%) to the internal jugular vein.Conclusions: The right JF is usually larger than the left, and not symmetry on both sides.The key to imaging diagnosis of nerves and vessels in the JF region is to select the sectional plane correctly.%目的:为与颈静脉孔相关的影像诊断和临床治疗提供解剖学资料。方法:从颅底内、外面,对80具成年颅骨的颈静脉孔进行观测;并对20具成人尸头进行解剖,观察该区域神经血管解剖关系。结果:①62.3%右侧颈静脉孔较左侧大,15.9%左侧较大,21.8%两侧大小一致;②14.38%的颈静脉孔有骨桥,85.62%无骨桥;③颈静脉孔内、外

  7. Microsurgical resection of ventral foramen magnum meningiomas via a far-lateral suboccipital approach

    Institute of Scientific and Technical Information of China (English)

    Zhihua Cheng; Zhilin Guo; Meixiu Ding

    2006-01-01

    BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial.OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treatedvia a far lateral suboccipital approach.DESIGN: Retrospectively clinic case investigation. SElrING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University.PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm,mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three.METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to

  8. Characterization of the β-barrel assembly machine accessory lipoproteins from Borrelia burgdorferi.

    Science.gov (United States)

    Dunn, Joshua P; Kenedy, Melisha R; Iqbal, Henna; Akins, Darrin R

    2015-03-24

    Like all diderm bacteria studied to date, Borrelia burgdorferi possesses a β-barrel assembly machine (BAM) complex. The bacterial BAM complexes characterized thus far consist of an essential integral outer membrane protein designated BamA and one or more accessory proteins. The accessory proteins are typically lipid-modified proteins anchored to the inner leaflet of the outer membrane through their lipid moieties. We previously identified and characterized the B. burgdorferi BamA protein in detail and more recently identified two lipoproteins encoded by open reading frames bb0324 and bb0028 that associate with the borrelial BamA protein. The role(s) of the BAM accessory lipoproteins in B. burgdorferi is currently unknown. Structural modeling of B. burgdorferi BB0028 revealed a distinct β-propeller fold similar to the known structure for the E. coli BAM accessory lipoprotein BamB. Additionally, the structural model for BB0324 was highly similar to the known structure of BamD, which is consistent with the prior finding that BB0324 contains tetratricopeptide repeat regions similar to other BamD orthologs. Consistent with BB0028 and BB0324 being BAM accessory lipoproteins, mutants lacking expression of each protein were found to exhibit altered membrane permeability and enhanced sensitivity to various antimicrobials. Additionally, BB0028 mutants also exhibited significantly impaired in vitro growth. Finally, immunoprecipitation experiments revealed that BB0028 and BB0324 each interact specifically and independently with BamA to form the BAM complex in B. burgdorferi. Combined structural studies, functional assays, and co-immunoprecipitation experiments confirmed that BB0028 and BB0324 are the respective BamB and BamD orthologs in B. burgdorferi, and are important in membrane integrity and/or outer membrane protein localization. The borrelial BamB and BamD proteins both interact specifically and independently with BamA to form a tripartite BAM complex in B

  9. A rare case of spinal cord compression due to cervical spine metastases from paraganglioma of the jugular foramen-how should it be treated?

    Science.gov (United States)

    Kapetanakis, Stylianos; Chourmouzi, Danai; Gkasdaris, Grigorios; Katsaridis, Vasileios; Eleftheriadis, Eleftherios; Givissis, Panagiotis

    2018-02-01

    Paragangliomas are benign neoplasms that arise from the autonomic nervous system and the associated paraganglia. Although benign, they have been shown to possess metastatic potential. Involvement of the spine is rare. Even rarer is considered the involvement of the cervical spine. We report a case of a patient with a history of an extra-adrenal non-functional paraganglioma of the jugular foramen which was initially treated with intra-arterial embolization. After a 3-year disease-free follow-up, the patient was presented with symptoms of spinal cord compression due to spinal metastases in C2 and C3 vertebrae. The patient was then treated with surgical decompression and external beam radiation. Therapeutic management with additional treatment options is now under discussion by a multidisciplinary team. Paraganglioma of the jugular foramen with spinal metastasis is an uncommon presentation where increased physician awareness and long-term follow-up are mandatory for all patients with history of paraganglioma.

  10. Mental health

    NARCIS (Netherlands)

    Lagerveld, S.; Houtman, I.L.D.

    2014-01-01

    The article will describe factors of influence on return to work RTW and evidence-based interventions that enhance return to work (RTW) after sick leave due to common mental health disorders (CMD). First the concepts of both RTW and CMD are outlined. Second, the sense of urgency for effective RTW

  11. Control mental

    OpenAIRE

    Bueno i Torrens, David, 1965-

    2013-01-01

    La revista especialitzada NeuroReport ha publicat un article que m'ha aportat nous elements de reflexió sobre els mecanismes neurals de control mental que, de forma innata, realitzem les persones com a part de la nostra vida social.

  12. Incremental Value of Three-Dimensional Transesophageal Echocardiography over the Two-Dimensional Technique in the Assessment of a Thrombus in Transit through a Patent Foramen Ovale.

    Science.gov (United States)

    Thind, Munveer; Ahmed, Mustafa I; Gok, Gulay; Joson, Marisa; Elsayed, Mahmoud; Tuck, Benjamin C; Townsley, Matthew M; Klas, Berthold; McGiffin, David C; Nanda, Navin C

    2015-05-01

    We report a case of a right atrial thrombus traversing a patent foramen ovale into the left atrium, where three-dimensional transesophageal echocardiography provided considerable incremental value over two-dimensional transesophageal echocardiography in its assessment. As well as allowing us to better spatially characterize the thrombus, three-dimensional transesophageal echocardiography provided a more quantitative assessment through estimation of total thrombus burden. © 2015, Wiley Periodicals, Inc.

  13. Evaluation of the Location of Mandibular Foramen as an Anatomic Landmark Using CBCT Images: A Pioneering Study in an Iranian Population

    OpenAIRE

    Shokri, Abbas; Department of Oral & Maxillofacial Radiology – School of Dentistry – Hamadan University of Medical Sciences – Hamadan – Iran.; Falah-Kooshki, Sepideh; Department of Oral & Maxillofacial Radiology – School of Dentistry – Hamadan University of Medical Sciences – Hamadan – Iran.; Poorolajal, Jalal; Research Center for Modeling of Noncommunicable Diseases – Department of Epidemiology & Biostatistics – School of Public Health – Hamadan University of Medical Sciences – Hamadan – Iran.; Karimi, Atena; Department of Oral & Maxillofacial Radiology – School of Dentistry – Hamadan University of Medical Sciences – Hamadan – Iran.; Ostovarrad, Farzaneh; Department of Oral & Maxillofacial Radiology – School of Dentistry – Hamadan University of Medical Sciences – Hamadan – Iran.

    2014-01-01

    Objective: Mandibular foramen (MF) is located on the internal surface of the ramus through which blood vessels and nerves pass. Determination of the anatomic position of the MF is very important in inferior alveolar nerve block anesthesia (IANBA), ramus osteotomy and surgical procedures of the posterior angle of mandibular ramus. The aim of this study was to determine anatomic position of the MF using anatomic landmarks on the three dimensional CBCT images. Material and Methods: A total of 10...

  14. Evaluation of the reinforcement effect on teeth with different apical foramen diameters of retrograde or orthograde MTA application with internal matrix

    Directory of Open Access Journals (Sweden)

    Emre Bayram

    2016-01-01

    Full Text Available OBJECTIVE: The aim of this study was to determine the effect of the apical foramen diameter and different application methods of Mineral Trioxide Aggregate (MTA on the fracture resistance of simulated immature teeth using a Universal Testing Machine. MATERIALS AND METHOD: Ninety extracted human teeth were used for the fracture resistance test. The apical foramen was prepared to a diameter of 1.0 mm or 1.4 mm to simulate the open apex of immature teeth. MTA was mixed according to manufacturer's recommendations and placed into the root canals with different apical foramen diameter by four different root filling techniques: retrograde, two-phased orthograde, and ortograde with or without internal matrix. Prepared roots were marked 2 mm below the cemento-enamel junction and embedded in transparent acrylic resin in cylinder moulds. Vertical force was applied along the long axis of the tooth at a speed of 5 mm/min, and the maximum resistance to fracture for each tooth was determined in Newton. A software package was used for the statistical analysis. The data were analyzed by using one-way ANOVA and post-hoc Tukey tests. RESULTS: A statistically significant difference could not be observed between the groups (p>0.05 whereas statistically significant differences were found between the test groups and the control groups (p<0.05. CONCLUSION: There was no significant difference between different vertical root filling techniques in increasing the fracture strength of the teeth. The diameter of the apical foramen did not have a significant effect on the fracture resistance.

  15. Neurotization of the phrenic nerve with accessory nerve for high cervical spinal cord injury with respiratory distress: an anatomic study.

    Science.gov (United States)

    Wang, Ce; Zhang, Ying; Nicholas, Tsai; Wu, Guoxin; Shi, Sheng; Bo, Yin; Wang, Xinwei; Zhou, Xuhui; Yuan, Wen

    2014-01-01

    High cervical spinal cord injury is associated with high morbidity and mortality. Traditional treatments carry various complications such as infection, pacemaker failure and undesirable movement. Thus, a secure surgical strategy with fewer complications analogous to physiological ventilation is still required. We hope to offer one potential method to decrease the complications and improve survival qualities of patients from the aspect of anatomy. The purpose of the study is to provide anatomic details on the accessory nerve and phrenic nerve for neurotization in patients with high spinal cord injuries. 38 cadavers (76 accessory and 76 phrenic nerves) were dissected in the study. The width, length and thickness of each accessory nerve and phrenic nerve above clavicle were measured. The distances from several landmarks on accessory nerve to the origin and the end of the phrenic nerve above clavicle were measured too. Then, the number of motor nerve fibers on different sections of the nerves was calculated using the technique of immunohistochemistry. The accessory nerves distal to its sternocleidomastoid muscular branches were 1.52 ± 0.32 mm ~1.54 ± 0.29 mm in width, 0.52 ± 0.18 mm ~ 0.56 ± 0.20mm in thickness and 9.52 ± 0.98 cm in length. And the phrenic nerves above clavicle were 1.44 ± 0.23 mm ~ 1.45 ± 0.24 mm in width, 0.47 ± 0.15 mm ~ 0.56 ± 0.25 mm in thickness and 6.48 ± 0.78 cm in length. The distance between the starting point of accessory nerve and phrenic nerve were 3.24 ± 1.17 cm, and the distance between the starting point of accessory nerve and the end of the phrenic nerve above clavicle were 8.72 ± 0.84 cm. The numbers of motor nerve fibers in accessory nerve were 1,038 ± 320~1,102 ± 216, before giving out the sternocleidomastoid muscular branches. The number of motor nerve fibers in the phrenic nerve was 911 ± 321~1,338 ± 467. The accessory nerve and the phrenic were similar in width, thickness and the number of motor nerve fibers. And

  16. Evaluation of accessory cell heterogeneity. I. Differential accessory cell requirement for T helper cell activation and for T-B cooperation.

    Science.gov (United States)

    Ramila, G; Studer, S; Kennedy, M; Sklenar, I; Erb, P

    1985-01-01

    Several Ia+ tumor cell lines and peritoneal exudate macrophages were tested as accessory cells (AC) for the activation of antigen-specific T cells and for T-B cooperation. The macrophages and all the Ia+ tumor lines tested induced the release of lymphokines from T cells in a major histocompatibility complex (MHC)-restricted fashion and reconstituted the antibody responses of AC-depleted spleen cells or of purified T and B cells. However, only the normal macrophages but none of the tumor lines induced carrier-specific T helper (Th) cells which help B cells for specific antihapten antibody responses by linked recognition. For T-B cooperation accessory cells were also required, but in contrast to Th cell activation any type of Ia+ AC (e.g. macrophage or tumor line) was effective. Strong MHC-restriction between the lymphocytes and the AC was seen if antigen-pulsed AC were added into the AC-depleted T-B cooperation cultures. If the AC and antigen were concomitantly added to the AC-depleted T-B cultures, MHC-restriction was less obvious. Concanavalin A supernatant reconstituted the response of AC-depleted T-B cultures provided antigen-specific Th cells and the hapten-carrier conjugate were present. If, however, tumor line-activated T cells were added instead of macrophage-induced Th cells, no cooperation with B cells took place even in the presence of Con A supernatant. The results obtained demonstrate a differential AC requirement for the induction of Th cells depending on the differentiation stage of the Th cells.

  17. Accessory Renal Artery Stenosis and Hypertension: Are These Correlated? Evaluation Using Multidetector-Row Computed Tomographic Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Saba, L.; Sanfilippo, R.; Montisci, R.; Conti, M.; Mallarini, G. (Dept. of Imaging Science and Dept. of Vascular Surgery, Policlinico Universitario, Cagliari (Italy))

    2008-04-15

    Background: Renal artery stenosis may produce hypertension, and this condition is referred to as renovascular hypertension (RVH). Purpose: To evaluate, by using multidetector-row spiral computed tomographic angiography (MDCTA), whether a relationship between accessory renal artery stenosis and hypertension may be hypothesized. Material and Methods: 214 patients (142 males, 72 females; mean age 66 years) who had previously undergone an MDCTA to study the abdominal vasculature were retrospectively studied. Patients with renal artery stenosis (RAS) were excluded from this analysis. The patients were studied by means of a four-detector-row CT, and scans were obtained after intravenous bolus administration of 110-140 ml of a nonionic contrast material with a 3-6 ml/s flow rate. As a second step, by means of statistical analysis, hypertension data were compared with findings of accessory artery stenosis. Two radiologists first independently reviewed the MDCTA images and then, in case of disagreement, in consensus. Interobserver agreement was calculated for all measurements. Results: The overall number of detected accessory renal arteries was 74 in 56 of the 214 patients. Accessory renal artery stenosis was detected in 21 of the 56 patients. There was a difference in the prevalence of hypertension between patients with (n = 21) and without (n = 35) accessory renal artery stenosis (P = 0.0187). Interobserver agreement was good (kappa value 0.733). Conclusion: Any statistical association between the presence of accessory renal artery stenosis and hypertension could not be disclosed. However, accessory renal artery stenosis, detected by MDCTA, is an important pathological sign that the radiologist has to assess in the light of its possible association with hypertension

  18. Accessory Renal Artery Stenosis and Hypertension: Are These Correlated? Evaluation Using Multidetector-Row Computed Tomographic Angiography

    International Nuclear Information System (INIS)

    Saba, L.; Sanfilippo, R.; Montisci, R.; Conti, M.; Mallarini, G.

    2008-01-01

    Background: Renal artery stenosis may produce hypertension, and this condition is referred to as renovascular hypertension (RVH). Purpose: To evaluate, by using multidetector-row spiral computed tomographic angiography (MDCTA), whether a relationship between accessory renal artery stenosis and hypertension may be hypothesized. Material and Methods: 214 patients (142 males, 72 females; mean age 66 years) who had previously undergone an MDCTA to study the abdominal vasculature were retrospectively studied. Patients with renal artery stenosis (RAS) were excluded from this analysis. The patients were studied by means of a four-detector-row CT, and scans were obtained after intravenous bolus administration of 110-140 ml of a nonionic contrast material with a 3-6 ml/s flow rate. As a second step, by means of statistical analysis, hypertension data were compared with findings of accessory artery stenosis. Two radiologists first independently reviewed the MDCTA images and then, in case of disagreement, in consensus. Interobserver agreement was calculated for all measurements. Results: The overall number of detected accessory renal arteries was 74 in 56 of the 214 patients. Accessory renal artery stenosis was detected in 21 of the 56 patients. There was a difference in the prevalence of hypertension between patients with (n = 21) and without (n = 35) accessory renal artery stenosis (P = 0.0187). Interobserver agreement was good (kappa value 0.733). Conclusion: Any statistical association between the presence of accessory renal artery stenosis and hypertension could not be disclosed. However, accessory renal artery stenosis, detected by MDCTA, is an important pathological sign that the radiologist has to assess in the light of its possible association with hypertension

  19. Oxygen isotopes in garnet and accessory minerals to constrain fluids in subducted crust

    Science.gov (United States)

    Rubatto, Daniela; Gauthiez-Putallaz, Laure; Regis, Daniele; Rosa Scicchitano, Maria; Vho, Alice; Williams, Morgan

    2017-04-01

    Fluids are considered a fundamental agent for chemical exchanges between different rock types in the subduction system. Constraints on the sources and pathways of subduction fluids thus provide crucial information to reconstruct subduction processes. Garnet and U-Pb accessory minerals constitute some of the most robust and ubiquitous minerals in subducted crust and can preserve multiple growth zones that track the metamorphic evolution of the sample they are hosted in. Microbeam investigation of the chemical (major and trace elements) and isotopic composition (oxygen and U-Pb) of garnet and accessory minerals is used to track significant fluid-rock interaction at different stages of the subduction system. This approach requires consideration of the diffusivity of oxygen isotopes particularly in garnet, which has been investigated experimentally. The nature of the protolith and ocean floor alteration is preserved in relict accessory phases within eclogites that have been fully modified at HP conditions (e.g. Monviso and Dora Maira units in the Western Alps). Minerals in the lawsonite-blueschists of the Tavsanli zone in Turkey record pervasive fluid exchange between mafic and sedimentary blocks at the early stage of subduction. High pressure shear zones and lithological boundaries show evidence of intense fluid metasomatism at depth along discontinuities in Monviso and Corsica. In the UHP oceanic crust of the Zermatt-Saas Zone, garnet oxygen isotopes and tourmaline boron isotopes indicate multistage fluid infiltration during prograde metamorphism. Localized exchanges of aqueous fluids are also observed in the subducted continental crust of the Sesia-Lanzo Zone. In most cases analyses of distinct mineral zones enable identification of multiple pulses of fluids during the rock evolution.

  20. Ventricular Dyssynchrony and Function Improve following Catheter Ablation of Nonseptal Accessory Pathways in Children

    Directory of Open Access Journals (Sweden)

    Sylvia Abadir

    2013-01-01

    Full Text Available Introduction. Paradoxical or hypokinetic interventricular septal motion has been described in patients with septal or paraseptal accessory pathways. Data regarding nonseptal pathways is limited. Methods and Results. We quantified left ventricular dyssynchrony and function in 16 consecutive children, 14.2±3.7 years, weighing 53 ± 17 kg, prior to and following catheter ablation of bidirectional septal (N=6 and nonseptal (N=10 accessory pathways. Following ablation, the left ventricular ejection fraction increased by 4.9±2.1% (P=0.038 from a baseline value of 57.0%±7.8%. By tissue Doppler imaging, the interval between QRS onset and peak systolic velocity (Ts decreased from a median of 33.0 ms to 18.0 ms (P=0.013. The left ventricular ejection fraction increased to a greater extent following catheter ablation of nonseptal (5.9%±2.6%, P=0.023 versus septal (2.5%±4.1%, P=0.461 pathways. The four patients with an ejection fraction 50% after ablation. Similarly, the improvement in dyssynchrony was more marked in patients with nonseptal versus septal pathways (difference between septal and lateral wall motion delay before and after ablation 20.6±7.1 ms (P=0.015 versus 1.4±11.4 ms (P=0.655. Conclusion. Left ventricular systolic function and dyssynchrony improve after ablation of antegrade-conducting accessory pathways in children, with more pronounced changes noted for nonseptal pathways.

  1. Novel percutaneous suture-mediated patent foramen ovale closure technique. Early results of the NobleStitch EL Italian Registry.

    Science.gov (United States)

    Gaspardone, Achille; De Marco, Federico; Sgueglia, Gregory A; De Santis, Antonella; Iamele, Maria; D'Ascoli, Emanuela; Tusa, Maurizio; Corciu, Anca; Mullen, Michael; Nobles, Anthony; Carminati, Mario; Bedogni, Francesco

    2018-04-03

    To assess the efficacy of a novel percutaneous "device-less" suture mediated patent foramen ovale (PFO) closure system. Between June 2016 and October 2017, a prospective registry aimed at assessing the safety and efficacy of the NobleStitch EL (HeartStitch, Fountain Valley, CA) suture-based PFO closure system was carried out at 12 sites in Italy. Among 200 consecutive evaluated patients, 192 were considered suitable for suture-mediated PFO closure (44±13 years, 114 women). Suture of the septum with the NobleStitch EL system was carried out successfully in 186 (96%) patients. Median fluoroscopy time was 16.1 (13.0-22.5) minutes and contrast volume 200 (150-270) ml. At 206±130 days follow-up, microbubbles transthoracic echocardiography with Valsalva maneuver revealed no RLS (grade 0) in 139 (75%) patients and RLS grade ≤1 in 166 (89%) patients. Significant RLS was present in 20 (11%) patients (grade 2 and 3 in 11 and 9 patients, respectively). There were no device-related complications. The early results of this first Italian Registry indicates that the suture mediated "deviceless" closure of PFO is feasible in the majority of septal anatomies, provides an effective closure of PFO comparable to traditional devices with an excellent safety profile at medium term follow-up.

  2. Endocardial Device Leads in Patients with Patent Foramen Ovale: Echocardiographic Correlates of Stroke/TIA and Mortality.

    Science.gov (United States)

    Ponamgi, Shiva P; Vaidya, Vaibhav R; Desimone, Christopher V; Noheria, Amit; Hodge, David O; Slusser, Joshua P; Ammash, Naser M; Bruce, Charles J; Rabinstein, Alejandro A; Friedman, Paul A; Asirvatham, Samuel J

    2017-03-01

    Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO. In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram. Of 250 patients with a baseline echocardiogram, 9.6% (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42% (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95% confidence interval [CI] 1.447-2.189, P 10 mm Hg (HR 2.018, 95% CI 1.593-2.556, P TIA. However, a significantly higher TR or RVSP was associated with higher mortality. © 2016 Wiley Periodicals, Inc.

  3. Assessment of Hypercoagulation State in Patients with Embolic Cerebrovascular or Transient Ischemic Attack and Patent Foramen Ovale

    Directory of Open Access Journals (Sweden)

    D Nikfarjam

    2010-03-01

    Full Text Available Background: Patent foramen ovale (PFO causes a right-to-left shunt in about a quarter of normal population. Hypercoagulation may be a risk factor for embolic cerebrovascular accidents (CVA in these patients by paradoxical emboli. In this study, we checked hypercoagulation states in the embolic CVA patients with PFO. Methods: In a cross- sectional study, 40 patients with CVA or transient ischemic attack ( TIA and PFO participated in the study. Serum level of Homocystein, lupus anticoagulant screening test, Factor V leiden, Anti Cardiolipin Antibody (ACLA (IgG, IgM , Anti- thrombin III, protein C, protein S,Anti B2 glycoprotein1 and platelet count were checked in all patients. The data were analyzed using the statistical package for social science series (SPSS 15.0 and descriptive statistical method.Results: The mean age was 42.4± 12.1. Seventeen (42.5% patients were females. Twenty- two (55% cases were diagnosed as having CVA and the others as TIA. Three (7.5% of the patients were diabetic and 8 (20% had a history of different stages of hypertension. Hyperlipidemia was detected in 6 (15% patients and according to the laboratory data none had any signs of hypercoagulation.Conclusion: According to the present study, hypercoagulation as a cofactor in CVA patients with PFO did not seem to be a direct risk factor for embolic CVA at least any higher than for normal population.

  4. Surgical treatment of type I Chiari malformation: the role of Magendie’s foramen opening e tonsils manipulation

    Directory of Open Access Journals (Sweden)

    Claudio Henrique Fernandes Vidal

    2015-02-01

    Full Text Available The treatment for type 1 Chiari malformation (CM 1 is one of the most controversial topics in the neurosurgical field. The present study evaluated two of the most applied surgical techniques to treat CM 1. Method 32 patients were evaluated and divided in two groups: group 1 had 16 patients that were submitted to decompression of occipital bone and dura mater of the craniovertebral junction (CVJ; group 2 also had 16 patients and in addition to the previous procedure, they were submitted to Magendie’s foramen opening e tonsils manipulation. The comparison between the groups included neurological exam and cerebrospinal fluid flow imaging during pre and postoperative periods. Results Both techniques were equivalents in terms of neurological improvement of the patients (p > 0.05, but the group 2 had more surgical complications, with relative risk of 2.45 (CI 1.55-3.86 for adverse events. Whatever the cerebrospinal fluid flow at CVJ, the patients of the group 1 achieved greater amount of flow than the group 2 (p < 0.05 during the postoperative period. Conclusion The cranial and dural decompression of the CVJ without arachnoidal violation was the best surgical intervention for treatment of CM 1, between these two compared techniques.

  5. Patent foramen ovale does not have a negative impact on early outcomes in patients undergoing liver transplantation.

    Science.gov (United States)

    Alba, Ana Carolina; Verocai Flaman, F; Granton, J; Delgado, D H

    2011-01-01

    To identify the impact of the presence of patent foramen ovale (PFO) in patients undergoing liver transplantation. Twenty-seven pre-liver transplant patients who had a PFO (PFO group) were identified and compared with 61 patients without PFO (NoPFO group). Patients were matched according to age, gender and cause of liver disease. The diagnosis of PFO was made by transthoracic echocardiography prior to liver transplantation. Patient baseline characteristics and complications during the early post-transplant period were analyzed. The mean age in the PFO group was 47 ± 14 (range 18-68) yr and 50 ± 11 (range 12-65) yr in the NoPFO group. The PFO group had a mean model for end-stage liver disease (MELD) score of 15 ± 10 whereas in the NoPFO group the MELD score was 19 ± 10 (p = 0.08). There were non-significant differences in echocardiographic parameters between groups. Duration of mechanical ventilation and the incidence of neurological complications were similar. Thirty-day mortality rate was similar in both groups; only one patient in the NoPFO group died within the first 30 days post-transplantation. The presence of PFO in patients with end-stage liver disease undergoing liver transplantation does not appear to affect patient outcomes during the peri-operative period. © 2010 John Wiley & Sons A/S.

  6. Patent foramen ovale in a large population of ischemic stroke patients: diagnosis, age distribution, gender, and race.

    Science.gov (United States)

    Gupta, Vishal; Yesilbursa, Dilek; Huang, Wen Ying; Aggarwal, Kul; Gupta, Vijaya; Gomez, Camilo; Patel, Vinod; Miller, Andrew P; Nanda, Navin C

    2008-02-01

    Patent foramen ovale (PFO) is a well-recognized risk factor for ischemic strokes. The true prevalence of PFO among stroke patients is still under debate. Transesophageal echocardiography (TEE) is the "gold standard" in diagnosing PFO but the physiology requires right-to-left atrial shunting. In this report, we evaluate the prevalence of PFO in a diverse group of ischemic stroke patients studied by TEE. TEE of 1,663 ischemic stroke patients were reviewed for cardiac source of embolism, including PFO and atrial septal aneurysm (ASA). Agitated saline bubble injection was performed to look for right to left atrial shunting. Success of maneuvers to elevate right atrial pressure (RAP) was noted by looking at the atrial septal bulge. Among 1,435 ischemic stroke patients analyzed, the presence or absence of PFO could not be determined in 32.1% because bulging of the septum could not be demonstrated in patients with negative contrast study despite aggressive maneuvers to elevate RAP. Of the remaining 974 patients, 294 patients (30.2%) had a PFO. The mean age was 61.5 years in both groups, with a bimodal distribution of PFO and the highest prevalence occurring in gender or racial difference in the prevalence of PFO, but there was a bimodal distribution in prevalence with age.

  7. Maximal potential patent foramen diameter does not correlate with the type or frequency of the neurologic event prior to closure.

    Science.gov (United States)

    Kutty, Shelby; Brown, Kimberly; Qureshi, Athar M; Latson, Larry A

    2009-01-01

    We analyzed our data on patients undergoing transcatheter patent foramen ovale (PFO) closure to determine if the maximal potential PFO diameter (MPPD) by balloon sizing correlates with important clinical characteristics in this population. We defined stroke as a focal neurologic deficit lasting >24 h, or focal deficit of shorter duration associated with permanent MRI/CT changes consistent with a focal infarction. Parameters analyzed included age, gender, anticoagulation, hypertension, smoking, MRI/CT findings and MPPD at catheterization. We specifically analyzed the type of neurologic event (stroke/transient ischemic attack, TIA), and number of recorded preceding clinical neurologic events. In 216 consecutive patients, 167 suffered a stroke. MRI/CT changes consistent with one or more embolic events were seen in 156 patients; 49 had a clinical TIA. There was no significant difference in MPPD between stroke (11.0 +/- 3.6 mm) and TIA groups (10.9 +/- 3.9 mm; 95% confidence interval for difference: -1.33 to 1.00). MPPD did not differ between MRI/CT-positive vs. -negative strokes, and had no correlation with the number of identified pre-closure clinical neurologic events. Continued investigation is needed to determine whether other PFO characteristics, or other anatomic/physiologic parameters, may be useful to identify patients at high risk for cryptogenic stroke/TIA, even before they have their first neurologic event. Copyright 2008 S. Karger AG, Basel.

  8. Patent Foramen Ovale in Patients with Sickle Cell Disease and Stroke: Case Presentations and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sheila Razdan

    2013-01-01

    Full Text Available Although individuals with sickle cell disease (SCD are at increased risk for stroke, the underlying pathophysiology is incompletely understood. Intracardiac shunting via a patent foramen ovale (PFO is associated with cryptogenic stroke in individuals without SCD. Recent evidence suggests that PFOs are associated with stroke in children with SCD, although the role of PFOs in adults with stroke and SCD is unknown. Here, we report 2 young adults with SCD, stroke, and PFOs. The first patient had hemoglobin SC and presented with a transient ischemic attack and a subsequent ischemic stroke. There was no evidence of cerebral vascular disease on imaging studies and the PFO was closed. The second patient had hemoglobin SS and two acute ischemic strokes. She had cerebral vascular disease with moyamoya in addition to a peripheral deep venous thrombosis (DVT. Chronic transfusion therapy was recommended, and the DVT was managed with warfarin. The PFO was not closed, and the patients' neurologic symptoms were stabilized. We review the literature on PFOs and stroke in SCD. Our cases and the literature review illustrate the dire need for further research to evaluate PFO as a potential risk factor for stroke in adults with SCD.

  9. Accessory soleus muscle: a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Palaniappan, M. (Leicester Royal Infirmary (United Kingdom). Dept. of Radiology Royal Liverpool Children' s Hospital (United Kingdom). Dept. of Radiology); Rajesh, A.; Rickett, A. (Leicester Royal Infirmary (United Kingdom). Dept. of Radiology); Kershaw, C.J. (Leicester Royal Infirmary (United Kingdom). Dept. of Orthopaedics)

    1999-08-01

    Accessory soleus muscle is a rare condition which presents as a soft-tissue mass medial to the calcaneum and distal Achilles tendon. Though congenital in origin, it manifests in the second and third decades of life as a soft-tissue mass due to muscle hypertrophy. Patients may be asymptomatic or present with a painful ankle mass. It is important to be aware of this condition when interpreting CT or MRI of the ankle, which show characteristic findings of a normal muscle in an abnormal location. (orig.) With 4 figs., 12 refs.

  10. Wongabel Rhabdovirus Accessory Protein U3 Targets the SWI/SNF Chromatin Remodeling Complex

    Science.gov (United States)

    Joubert, D. Albert; Rodriguez-Andres, Julio; Monaghan, Paul; Cummins, Michelle; McKinstry, William J.; Paradkar, Prasad N.; Moseley, Gregory W.

    2014-01-01

    ABSTRACT Wongabel virus (WONV) is an arthropod-borne rhabdovirus that infects birds. It is one of the growing array of rhabdoviruses with complex genomes that encode multiple accessory proteins of unknown function. In addition to the five canonical rhabdovirus structural protein genes (N, P, M, G, and L), the 13.2-kb negative-sense single-stranded RNA (ssRNA) WONV genome contains five uncharacterized accessory genes, one overlapping the N gene (Nx or U4), three located between the P and M genes (U1 to U3), and a fifth one overlapping the G gene (Gx or U5). Here we show that WONV U3 is expressed during infection in insect and mammalian cells and is required for efficient viral replication. A yeast two-hybrid screen against a mosquito cell cDNA library identified that WONV U3 interacts with the 83-amino-acid (aa) C-terminal domain of SNF5, a component of the SWI/SNF chromatin remodeling complex. The interaction was confirmed by affinity chromatography, and nuclear colocalization was established by confocal microscopy. Gene expression studies showed that SNF5 transcripts are upregulated during infection of mosquito cells with WONV, as well as West Nile virus (Flaviviridae) and bovine ephemeral fever virus (Rhabdoviridae), and that SNF5 knockdown results in increased WONV replication. WONV U3 also inhibits SNF5-regulated expression of the cytokine gene CSF1. The data suggest that WONV U3 targets the SWI/SNF complex to block the host response to infection. IMPORTANCE The rhabdoviruses comprise a large family of RNA viruses infecting plants, vertebrates, and invertebrates. In addition to the major structural proteins (N, P, M, G, and L), many rhabdoviruses encode a diverse array of accessory proteins of largely unknown function. Understanding the role of these proteins may reveal much about host-pathogen interactions in infected cells. Here we examine accessory protein U3 of Wongabel virus, an arthropod-borne rhabdovirus that infects birds. We show that U3 enters the

  11. Special servicing equipment for reactor pressurized vessel stud hole and stud accessories

    International Nuclear Information System (INIS)

    Li Jianglian

    1999-01-01

    The author briefly introduces the design and manufacture of nuclear island special servicing equipment of Nuclear Power Institute of China. Maintenance process of reactor pressurized vessel (RPV) stud hold and stud accessories the special servicing equipment include RPV flange dummy, closed-circuit television (CCTV) inspection equipment, RPV stud hole expandable comb, RPV stud hole polisher, RPV stud hold thread lubricating equipment, RPV stud hole thread miller and RPV stud hole camera. It is presented how eight kinds of special servicing equipment perform the maintenance process concerning their function, structure, and characteristics, their practical use on site is also introduced

  12. Gastroenterology-Urology Devices; Manual Gastroenterology-Urology Surgical Instruments and Accessories. Final rule; technical amendment.

    Science.gov (United States)

    2017-03-01

    The Food and Drug Administration (FDA) is amending the identification of manual gastroenterology-urology surgical instruments and accessories to reflect that the device does not include specialized surgical instrumentation for use with urogyencologic surgical mesh specifically intended for use as an aid in the insertion, placement, fixation, or anchoring of surgical mesh during urogynecologic procedures ("specialized surgical instrumentation for use with urogynecologic surgical mesh"). These amendments are being made to reflect changes made in the recently issued final reclassification order for specialized surgical instrumentation for use with urogynecologic surgical mesh.

  13. Posterior Coronary Vein as the Substrate for an Epicardial Accessory Pathway

    Directory of Open Access Journals (Sweden)

    Laura Cipoletta, MD

    2013-07-01

    Full Text Available Catheter ablation of Wolff-Parkinson-White syndrome is associated with up to 5% of failure. Coronary sinus (CS abnormalities or connections between CS myocardial coat and left ventricular epicardium are associated with posteroseptal and left posterior accessory pathways (AP. A 41-year-old patient with WPW syndrome was referred to our hospital after three unsuccessful ablations. The 12-lead ECG suggested a left posteroseptal AP. CT imaging and electro-anatomic mapping showed a relationship between AP electrical course and CS posterior branch. This finding supports the hypothesis CSAPs lie in the myocardial coat around CS and represent an extensive connection between atrial and ventricular epicardial surface.

  14. A rare case of fibrocystic disease at vulval accessory breast tissue.

    Science.gov (United States)

    Das, Sudip; Roy, Alok Kumar; Kar, Chinmoy; Giri, Parag Prasun

    2007-11-01

    A 40-year-old female presented with a non-itchy ulcerative nodular lesion at left labium majus since last 1 1/2 years. The lesion progressed to increase in size from 0.5 cm to 1.5 cm in diameter. It was incised and drained. After that a non-healing ulcerative nodule formed. The nodule was firm in consistency and movable on all sides. The ulcer healed with a 5 days course of ceftriaxone. If was excised and biopsy of the lesion showed fibrocystic changes of accessory breast tissue. It is a rare disease entity for which the case report is presented.

  15. The male genital accessory gland complex of the cattle tick Boophilus microplus (Canestrini, 1887) (Acari: Ixodidae)

    OpenAIRE

    GARCIA-FERNANDEZ, CASIMIRO; GARCIA, SONIA M. LAUER DE; GARCIA, ROSANE NUNES

    1998-01-01

    A topographical and histological study of the male genital accessory gland complex of Boophilus microplus was undertaken. Ten lobes were found, the most prominent of which is the single dorso-median lobe, subdivided into antero-dorsal and postero-dorsal lobes. The other lobes are: a pair of postero-ventral lobes, a pair of lateral lobes (subdivided into dorso-lateral and postero-lateral lobes), a pair of antero-ventral lobes, a single medio-ventral lobe and a pair of latero-ventral lobes. The...

  16. Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy

    Science.gov (United States)

    Bonilla, Alvaro G.; Santschi, Elizabeth M.

    2015-01-01

    A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging. PMID:25694665

  17. Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy.

    Science.gov (United States)

    Bonilla, Alvaro G; Santschi, Elizabeth M

    2015-02-01

    A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging.

  18. Abnormal Origin and Course of the Accessory Phrenic Nerve: Case Report.

    Science.gov (United States)

    Paraskevas, George; Koutsouflianiotis, Konstantinos; Kitsoulis, Panagiotis; Spyridakis, Ioannis

    In the current cadaveric study an unusual sizeable accessory phrenic nerve (APN) was encountered emerging from the trunk of the supraclavicular nerves and forming a triangular loop that was anastomosing with the phrenic nerve. That neural loop surrounded the superficial cervical artery which displayed a spiral course. The form of a triangular loop of APN involving the aforementioned artery and originating from the supraclavicular nerve to the best of our knowledge has not been documented previously in the literature. The variable morphological features of the APN along with its clinical applications are briefly discussed.

  19. Abnormal Origin and Course of the Accessory Phrenic Nerve: Case Report

    Directory of Open Access Journals (Sweden)

    George Paraskevas

    2016-08-01

    Full Text Available In the current cadaveric study an unusual sizeable accessory phrenic nerve (APN was encountered emerging from the trunk of the supraclavicular nerves and forming a triangular loop that was anastomosing with the phrenic nerve. That neural loop surrounded the superficial cervical artery which displayed a spiral course. The form of a triangular loop of APN involving the aforementioned artery and originating from the supraclavicular nerve to the best of our knowledge has not been documented previously in the literature. The variable morphological features of the APN along with its clinical applications are briefly discussed.

  20. Thermistor guided radiofrequency ablation of atrial insertion sites in patients with accessory pathways.

    Science.gov (United States)

    Tracy, C M; Moore, H J; Solomon, A J; Rodak, D J; Fletcher, R D

    1995-11-01

    Radiofrequency ablation has gained acceptance in the treatment of patients with symptomatic Wolff-Parkinson-White syndrome. The purpose of this study was to characterize the relation between temperature and other electroconductive parameters in patients undergoing atrial insertion accessory pathway ablation utilizing a thermistor equipped catheter. The mean temperature and power at sites of atrial insertion ablation are lower than has been previously associated with creation of radiofrequency lesions in the ventricle. While high cavitary blood flow in the atrium may result in cooling, the thinner atrial tissue may require less energy to achieve adequate heating than ventricular myocardium.

  1. High-resolution mapping and ablation of recurrent left lateral accessory pathway conduction

    Directory of Open Access Journals (Sweden)

    Francesco Solimene, MD

    2017-08-01

    Full Text Available Proper localization of the anatomical target during ablation of the accessory pathways (AP and the ability to detect clear AP potentials on the ablation catheter are crucial for successful AP ablation. We report a case of recurring AP conduction that was finally eliminated using a novel ablation catheter equipped with high-resolution mini-electrodes. Smaller and closer electrodes result in high mapping resolution with less signal averaging and cancellation effects. Owing to improved sensitivity, the new catheter seems effective in detecting fragmented and high frequency signals, thus allowing more effective radiofrequency application and improving ablation success.

  2. Comparison of the accuracy of three algorithms in predicting accessory pathways among adult Wolff-Parkinson-White syndrome patients.

    Science.gov (United States)

    Maden, Orhan; Balci, Kevser Gülcihan; Selcuk, Mehmet Timur; Balci, Mustafa Mücahit; Açar, Burak; Unal, Sefa; Kara, Meryem; Selcuk, Hatice

    2015-12-01

    The aim of this study was to investigate the accuracy of three algorithms in predicting accessory pathway locations in adult patients with Wolff-Parkinson-White syndrome in Turkish population. A total of 207 adult patients with Wolff-Parkinson-White syndrome were retrospectively analyzed. The most preexcited 12-lead electrocardiogram in sinus rhythm was used for analysis. Two investigators blinded to the patient data used three algorithms for prediction of accessory pathway location. Among all locations, 48.5% were left-sided, 44% were right-sided, and 7.5% were located in the midseptum or anteroseptum. When only exact locations were accepted as match, predictive accuracy for Chiang was 71.5%, 72.4% for d'Avila, and 71.5% for Arruda. The percentage of predictive accuracy of all algorithms did not differ between the algorithms (p = 1.000; p = 0.875; p = 0.885, respectively). The best algorithm for prediction of right-sided, left-sided, and anteroseptal and midseptal accessory pathways was Arruda (p algorithms were similar in predicting accessory pathway location and the predicted accuracy was lower than previously reported by their authors. However, according to the accessory pathway site, the algorithm designed by Arruda et al. showed better predictions than the other algorithms and using this algorithm may provide advantages before a planned ablation.

  3. Higiene mental

    Directory of Open Access Journals (Sweden)

    Francisco Gomez Pinzón

    1940-08-01

    Full Text Available El número cada día mayor de enfermos mentales, que hace “contraste con  la evidente disminución de enfermedades infecto-contagiosas, -lograda a favor de los modernos métodos de curación y profilaxis- es un hecho que está siendo comprobado “en todos los países civilizados y que constituye motivo de justificada alarma para cuantos se preocupan por cuestiones del orden biológico y social”

  4. Identification and subcellular localization of porcine deltacoronavirus accessory protein NS6

    International Nuclear Information System (INIS)

    Fang, Puxian; Fang, Liurong; Liu, Xiaorong; Hong, Yingying; Wang, Yongle; Dong, Nan; Ma, Panpan; Bi, Jing; Wang, Dang; Xiao, Shaobo

    2016-01-01

    Porcine deltacoronavirus (PDCoV) is an emerging swine enteric coronavirus. Accessory proteins are genus-specific for coronavirus, and two putative accessory proteins, NS6 and NS7, are predicted to be encoded by PDCoV; however, this remains to be confirmed experimentally. Here, we identified the leader-body junction sites of NS6 subgenomic RNA (sgRNA) and found that the actual transcription regulatory sequence (TRS) utilized by NS6 is non-canonical and is located upstream of the predicted TRS. Using the purified NS6 from an Escherichia coli expression system, we obtained two anti-NS6 monoclonal antibodies that could detect the predicted NS6 in cells infected with PDCoV or transfected with NS6-expressing plasmids. Further studies revealed that NS6 is always localized in the cytoplasm of PDCoV-infected cells, mainly co-localizing with the endoplasmic reticulum (ER) and ER-Golgi intermediate compartments, as well as partially with the Golgi apparatus. Together, our results identify the NS6 sgRNA and demonstrate its expression in PDCoV-infected cells. -- Highlights: •The leader-body fusion site of NS6 sgRNA is identified. •NS6 sgRNA uses a non-canonical transcription regulatory sequence (TRS). •NS6 can be expressed in PDCoV-infected cell. •NS6 predominantly localize to the ER complex and ER-Golgi intermediate compartment.

  5. Care of astronomical telescopes and accessories a manual for the astronomical observer and amateur telescope maker

    CERN Document Server

    Pepin, M Barlow

    2005-01-01

    Commercially-made astronomical telescopes are better and less expensive than ever before, and their optical and mechanical performance can be superb. When a good-quality telescope fails to perform as well as it might, the reason is quite probably that it needs a little care and attention! Here is a complete guide for anyone who wants to understand more than just the basics of astronomical telescopes and accessories, and how to maintain them in the peak of condition. The latest on safely adjusting, cleaning, and maintaining your equipment is combined with thoroughly updated methods from the old masters. Here, too, are details of choosing new and used optics and accessories, along with enhancements you can make to extend their versatility and useful lifetime. This book is for you. Really. Looking after an astronomical telescope isn't only for the experts - although there are some things that only an expert should attempt - and every serious amateur astronomer will find invaluable information here, gleaned from ...

  6. Accuracy of algorithms to predict accessory pathway location in children with Wolff-Parkinson-White syndrome.

    Science.gov (United States)

    Wren, Christopher; Vogel, Melanie; Lord, Stephen; Abrams, Dominic; Bourke, John; Rees, Philip; Rosenthal, Eric

    2012-02-01

    The aim of this study was to examine the accuracy in predicting pathway location in children with Wolff-Parkinson-White syndrome for each of seven published algorithms. ECGs from 100 consecutive children with Wolff-Parkinson-White syndrome undergoing electrophysiological study were analysed by six investigators using seven published algorithms, six of which had been developed in adult patients. Accuracy and concordance of predictions were adjusted for the number of pathway locations. Accessory pathways were left-sided in 49, septal in 20 and right-sided in 31 children. Overall accuracy of prediction was 30-49% for the exact location and 61-68% including adjacent locations. Concordance between investigators varied between 41% and 86%. No algorithm was better at predicting septal pathways (accuracy 5-35%, improving to 40-78% including adjacent locations), but one was significantly worse. Predictive accuracy was 24-53% for the exact location of right-sided pathways (50-71% including adjacent locations) and 32-55% for the exact location of left-sided pathways (58-73% including adjacent locations). All algorithms were less accurate in our hands than in other authors' own assessment. None performed well in identifying midseptal or right anteroseptal accessory pathway locations.

  7. Accessory pathway location affects brain natriuretic peptide level in patients with Wolff-Parkinson-White syndrome.

    Science.gov (United States)

    Nakatani, Yosuke; Kumagai, Koji; Naito, Shigeto; Nakamura, Kohki; Minami, Kentaro; Nakano, Masahiro; Sasaki, Takehito; Kinugawa, Koichiro; Oshima, Shigeru

    2017-01-01

    The purpose of this study was to investigate the relationship between the accessory pathway location and brain natriuretic peptide (BNP) level in patients with Wolff-Parkinson-White (WPW) syndrome. We divided 102 WPW syndrome patients with normal left ventricular systolic function into four groups: those with manifest right (MR, n = 14), manifest septal (MS, n = 11), manifest left (ML, n = 30), and concealed (C, n = 47) accessory pathways. BNP level and electrophysiological properties, including difference in timing of the ventricular electrogram between the His bundle area and the distal coronary sinus area (His-CS delay), which indicate intraventricular dyssynchrony, were compared. BNP levels (pg/dl) were higher in the MR and MS groups than in the ML and C groups (MR, 64 ± 58; MS, 55 ± 45; ML, 17 ± 15; C, 25 ± 21; P syndrome patients with normal cardiac function.

  8. Identification and subcellular localization of porcine deltacoronavirus accessory protein NS6

    Energy Technology Data Exchange (ETDEWEB)

    Fang, Puxian; Fang, Liurong; Liu, Xiaorong; Hong, Yingying; Wang, Yongle; Dong, Nan; Ma, Panpan [State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070 (China); The Cooperative Innovation Center for Sustainable Pig Production, Wuhan 430070 (China); Bi, Jing [State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070 (China); Department of Immunology and Aetology, College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan 430065 (China); Wang, Dang [State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070 (China); The Cooperative Innovation Center for Sustainable Pig Production, Wuhan 430070 (China); Xiao, Shaobo, E-mail: vet@mail.hzau.edu.cn [State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070 (China); The Cooperative Innovation Center for Sustainable Pig Production, Wuhan 430070 (China)

    2016-12-15

    Porcine deltacoronavirus (PDCoV) is an emerging swine enteric coronavirus. Accessory proteins are genus-specific for coronavirus, and two putative accessory proteins, NS6 and NS7, are predicted to be encoded by PDCoV; however, this remains to be confirmed experimentally. Here, we identified the leader-body junction sites of NS6 subgenomic RNA (sgRNA) and found that the actual transcription regulatory sequence (TRS) utilized by NS6 is non-canonical and is located upstream of the predicted TRS. Using the purified NS6 from an Escherichia coli expression system, we obtained two anti-NS6 monoclonal antibodies that could detect the predicted NS6 in cells infected with PDCoV or transfected with NS6-expressing plasmids. Further studies revealed that NS6 is always localized in the cytoplasm of PDCoV-infected cells, mainly co-localizing with the endoplasmic reticulum (ER) and ER-Golgi intermediate compartments, as well as partially with the Golgi apparatus. Together, our results identify the NS6 sgRNA and demonstrate its expression in PDCoV-infected cells. -- Highlights: •The leader-body fusion site of NS6 sgRNA is identified. •NS6 sgRNA uses a non-canonical transcription regulatory sequence (TRS). •NS6 can be expressed in PDCoV-infected cell. •NS6 predominantly localize to the ER complex and ER-Golgi intermediate compartment.

  9. Brief communication: Population variation in human maxillary premolar accessory ridges (MxPAR).

    Science.gov (United States)

    Burnett, Scott E; Hawkey, Diane E; Turner, Christy G

    2010-02-01

    The purpose of this brief communication is to report the results of an analysis of maxillary premolar accessory ridges (MxPAR), a common but understudied accessory ridge that may occur both mesial and distal to the central ridge of the buccal cusp of upper premolars. We developed a new five-grade scoring plaque to better categorize MxPAR variation. Subsequently, we conducted a population analysis of MxPAR frequency in 749 dental casts of South African Indian, American Chinese, Alaskan Eskimo, Tohono O'odham (Papago), Akimel O'odham (Pima), Solomon Islander, South African Bantu, and both American and South African Whites. Northeast Asian and Asian-derived populations exhibited the highest MxPAR frequencies while Indo-European samples (South African Indians, American and South African Whites) exhibited relatively low frequencies. The Solomon Islanders and South African Bantu samples exhibited intermediate frequencies. Our analysis indicates that statistically significant differences in MxPAR frequency exist between major geographic populations. As a result, the MxPAR plaque has now been added to the Arizona State University Dental Anthropology System, an important contribution as maxillary premolar traits are underrepresented in analyses of dental morphology. 2009 Wiley-Liss, Inc.

  10. Impact of infection on the secretory capacity of the male accessory glands

    Directory of Open Access Journals (Sweden)

    M. Marconi

    2009-06-01

    Full Text Available INTRODUCTION: Studies that compare the impact of different infectious entities of the male reproductive tract (MRT on the male accessory gland function are controversial. MATERIAL AND METHODS: Semen analyses of 71 patients with proven infections of the MRT were compared with the results of 40 healthy non-infected volunteers. Patients were divided into 3 groups according to their diagnosis: chronic prostatitis NIH type II (n = 38, chronic epididymitis (n = 12, and chronic urethritis (n = 21. RESULTS: The bacteriological analysis revealed 9 different types of microorganisms, considered to be the etiological agents, isolated in different secretions, including: urine, expressed prostatic secretions, semen and urethral smears: E. Coli (n = 20, Klebsiella (n = 2, Proteus spp. (n = 1, Enterococcus (n = 20, Staphylococcus spp. (n = 1, M. tuberculosis (n = 2, N. gonorrhea (n = 8, Chlamydia tr. (n = 16 and, Ureaplasma urealyticum (n = 1. The infection group had significantly (p < 0.05 lower: semen volume, alpha-glucosidase, fructose, and zinc in seminal plasma and, higher pH than the control group. None of these parameters was sufficiently accurate in the ROC analysis to discriminate between infected and non-infected men. CONCLUSION: Proven bacterial infections of the MRT impact negatively on all the accessory gland function parameters evaluated in semen, suggesting impairment of the secretory capacity of the epididymis, seminal vesicles and prostate. These findings were associated with an infectious related significant increase of semen pH. None of the semen parameters evaluated can be suggested as a diagnostic tool for infection.

  11. Uranium in accessory sphene from granitoids and its behaviour during mineral's alteration (Muzbekskij pluton at Mogol-Tau, Central Asia)

    International Nuclear Information System (INIS)

    Simonova, L.I.; Maksimova, I.G.; Nad'yarnykh, V.G.; Voronikhin, V.A.

    1982-01-01

    Uranium behaviour in accessory spbene and products of its alteration at different stages of granitoid transformation with characteristic association of zirconium-apatite-sphene and magnetite of accessory minerals, is shown. The products of sphene alteration (due to propylitization of granatoids the sphene is replaced by leucoxene) are determined by MS-46 electron probe microanalyzer and MA-1 lazer microanalyzer. Uranium distribution in leucoxene is studied by the method of fragmentary radiography. Leucoxene pseudomorphoses at a high oxygen potential are capable of giving into solution Uranium previously sorbed by leucoxene. This fact should be taken into account when determining source of metal of hydrogenous deposits

  12. Bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma and bilateral gigantomastia in HIV-positive patient.

    Science.gov (United States)

    Singh, Saumya; Mishra, Anand K; Tewari, S; Kumar, Sanjeev

    2013-06-24

    Accessory breast is a rare entity that can present as asymptomatic masses or can cause symptoms like heaviness, pain, restriction of arm movement and limitation in daily pursuits with allied apprehension and anxiety for the patient. We present a case of bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma in a 28 years, nulliparous, Indian woman who is HIV positive, which proves to be a diagnostic dilemma. Excisional biopsy was diagnostic. The rarity of such cases imposes challenges on the management in terms of diagnosis, prognosis and therapeutic options.

  13. Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis

    International Nuclear Information System (INIS)

    Mellado, J.M.; Ramos, A.; Salvado, E.; Camins, A.; Sauri, A.; Danus, M.

    2003-01-01

    Accessory ossicles and sesamoid bones are frequent findings in routine radiographs of the ankle and foot. They are commonly considered fortuitous and unrelated to the patient's complaint; however, they may eventually cause painful syndromes or degenerative changes in response to overuse and trauma. They may also suffer or simulate fractures. Our aim was to review, illustrate and discuss the imaging findings of some of the more frequent accessory ossicles and sesamoid bones of the ankle and foot region, with particular emphasis on those that may be of clinical significance or simulate fractures. (orig.)

  14. 26 CFR 48.4063-2 - Tax-free sales of parts or accessories sold for resale on or in connection with the first retail...

    Science.gov (United States)

    2010-04-01

    ... must be adhered to in substance. Exemption Certificate (For use by ultimate purchaser who purchase... furnished to vendee. A vendor (including the manufacturer) selling light-duty truck parts and accessories... vendor. A manufacturer or vendor selling light-duty truck parts or accessories tax free under section...

  15. Patent foramen ovale, ischemic stroke and migraine: systematic review and stratified meta-analysis of association studies.

    Science.gov (United States)

    Davis, Daniel; Gregson, John; Willeit, Peter; Stephan, Blossom; Al-Shahi Salman, Rustam; Brayne, Carol

    2013-01-01

    Observational data have reported associations between patent foramen ovale (PFO), cryptogenic stroke and migraine. However, randomized trials of PFO closure do not demonstrate a clear benefit either because the underlying association is weaker than previously suggested or because the trials were underpowered. In order to resolve the apparent discrepancy between observational data and randomized trials, we investigated associations between (1) migraine and ischemic stroke, (2) PFO and ischemic stroke, and (3) PFO and migraine. Eligibility criteria were consistent; including all studies with specifically defined exposures and outcomes unrestricted by language. We focused on studies at lowest risk of bias by stratifying analyses based on methodological design and quantified associations using fixed-effects meta-analysis models. We included 37 studies of 7,686 identified. Compared to reports in the literature as a whole, studies with population-based comparators showed weaker associations between migraine with aura and cryptogenic ischemic stroke in younger women (OR 1.4; 95% CI 0.9-2.0; 1 study), PFO and ischemic stroke (HR 1.6; 95 CI 1.0-2.5; 2 studies; OR 1.3; 95% CI 0.9-1.9; 3 studies), or PFO and migraine (OR 1.0; 95% CI 0.6-1.6; 1 study). It was not possible to look for interactions or effect modifiers. These results are limited by sources of bias within individual studies. The overall pairwise associations between PFO, cryptogenic ischemic stroke and migraine do not strongly suggest a causal role for PFO. Ongoing randomized trials of PFO closure may need larger numbers of participants to detect an overall beneficial effect. Copyright © 2012 S. Karger AG, Basel.

  16. [Stroke. are there any difference between patients with or without patent foramen ovale in left atrial appendage systolic function?].

    Science.gov (United States)

    Contreras, Alejandro E; Perrote, Federico; Concari, Ignacio; Brenna, Eduardo J; Lucero, Cecilia

    2012-01-01

    The aim of this study was to evaluate the systolic function of the left atrial appendage (LAA) in a group with and without patent foramen ovale (PFO) who suffered ischemic cerebrovascular events. Between September 2010 and October 2011, 17 patients were referred for transesophageal echocardiography (TEE) after suffering a stroke. PFO was defined as the passage of at least one bubble through atrial septum with bubble test. We compared systolic velocity in the appendage between patients with and without PFO and a control group. Were 8 women and 9 men, mean age 54.1 ± 19.5 years and 8 patients were under 55 years of age. All patients had suffered a ischemic cerebrovascular events, 41.2% had stroke, 52.9% transient ischemic attack and amaurosis fugax 5.9%. In the assessment of TEE, 11.8% had atrial septal aneurysm and 35.3% PFO. Mean LAA systolic velocity was 66.3 ± 20.3 cm / sec. There was no difference in systolic velocity of the LAA between patients with and without PFO (67.5 ± 11.8 cm / sec vs 65.7 ± 24.3 cm / sec respectively, p = 0.87). The control group of 8 patients, 5 women and 3 men, mean age 39.5 ± 18 years, had a LAA systolic velocity of 77.6 ± 28.9 cm / sec, no significant differences with ischemic patients. There were no differences in systolic function of the LAA between patients with and without PFO with ischemic cerebrovascular event.

  17. Patent foramen ovale closure using a bioabsorbable closure device: safety and efficacy at 6-month follow-up.

    Science.gov (United States)

    Van den Branden, Ben J; Post, Martijn C; Plokker, Herbert W; ten Berg, Jurriën M; Suttorp, Maarten J

    2010-09-01

    The aim of this study was to assess the mid-term safety and efficacy of percutaneous patent foramen ovale (PFO) closure using a bioabsorbable device (BioSTAR, NMT Medical, Boston, Massachusetts). Closure of PFO in patients with cryptogenic stroke has proven to be safe and effective using different types of permanent devices. All consecutive patients who underwent percutaneous PFO closure with the bioabsorbable closure device between November 2007 and January 2009 were included. Residual shunt was assessed using contrast transthoracic echocardiography. Sixty-two patients (55% women, mean age 47.7 ± 11.8 years) underwent PFO closure. The in-hospital complications were a surgical device retrieval in 2 patients (3.2%), device reposition in 1 (1.6%), and a minimal groin hematoma in 6 patients (9.7%). The short-term complications at 1-month follow-up (n = 60) were a transient ischemic attack in the presence of a residual shunt in 1 patient and new supraventricular tachycardia in 7 patients (11.3%). At 6-month follow-up (n = 60), 1 patient without residual shunt developed a transient ischemic attack and 1 developed atrial fibrillation. A mild or moderate residual shunt was noted in 51.7%, 33.9%, and 23.7% after 1-day, 1-month, and 6-month follow-up, respectively. A large shunt was present in 8.3%, 3.4%, and 0% after 1-day, 1-month, and 6-month follow-up. Closure of PFO using the bioabsorbable device is associated with a low complication rate and a low recurrence rate of embolic events. However, a relatively high percentage of mild or moderate residual shunting is still present at 6-month follow-up. Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Left atrial dysfunction in patients with patent foramen ovale and atrial septal aneurysm: an alternative concurrent mechanism for arterial embolism?

    Science.gov (United States)

    Rigatelli, Gianluca; Aggio, Silvio; Cardaioli, Paolo; Braggion, Gabriele; Giordan, Massimo; Dell'avvocata, Fabio; Chinaglia, Mauro; Rigatelli, Giorgio; Roncon, Loris; Chen, Jack P

    2009-07-01

    We postulate that, in patients with large patent foramen ovales (PFO) and atrial septal aneurysms (ASA), left atrial (LA) dysfunction simulating "atrial fibrillation (AF)-like" pathophysiology might represent an alternate mechanism in the promotion of arterial embolism. Despite prior reports concerning paradoxical embolism through a PFO, the magnitude of this phenomenon as a risk factor for stroke remains undefined, because deep venous thrombosis is infrequently detected in such patients. To test our hypothesis, we prospectively enrolled 98 consecutive patients with previous stroke (mean age 37 +/- 12.5 years, 58 women) referred to our center for catheter-based PFO closure. Baseline values of LA passive and active emptying, LA conduit function, LA ejection fraction, and spontaneous echocontrast (SEC) in the LA and LA appendage were compared with those of 50 AF patients as well as a sex/age/cardiac risk-matched population of 70 healthy control subjects. Pre-closure PFO subjects demonstrated significantly greater reservoir function as well as passive and active emptying, with significantly reduced conduit function and LA ejection fraction, when compared with AF and control patients. Furthermore, in PFO patients, 66.3% (65 of 98) had moderate-to-severe ASA and basal shunt; SEC was observed in 52% of PFO plus ASA patients before closure. Multivariate stepwise logistic regression revealed moderate-to-severe ASA (odds ratio: 9.4, 95% confidence interval: 7.0 to 23.2, p < 0.001) as the most powerful predictor of LA dysfunction. After closure, all LA parameters normalized to the levels of control subjects: no SEC, device-related thrombosis, or aortic erosion were observed on follow-up echocardiography. This study suggests that moderate-to-severe ASA might be associated with LA dysfunction in patients with PFO. The resultant similarities to the pathophysiology of AF might represent an additional contributing mechanism for arterial embolism in such patients.

  19. Patent Foramen Ovale Closure in the Setting of Cryptogenic Stroke: A Meta-Analysis of Five Randomized Trials.

    Science.gov (United States)

    Garg, Lohit; Haleem, Affan; Varade, Shweta; Sivakumar, Keithan; Shah, Mahek; Patel, Brijesh; Agarwal, Manyoo; Agrawal, Sahil; Leary, Megan; Kluck, Bryan

    2018-05-24

    The clinical benefit of patent foramen ovale (PFO) closure after cryptogenic stroke has been a topic of debate for decades. Recently, 3 randomized controlled trials of PFO closure in patients with cryptogenic stroke demonstrated a significantly reduced risk of recurrent stroke compared with standard medical therapy alone. This meta-analysis was performed to clarify the efficacy of PFO closure for future stroke prevention in this population. A systematic literature search was undertaken. Published pooled data from 5 large randomized clinical trials (CLOSE, RESPECT, Gore REDUCE, CLOSURE I, and PC) were combined and then subsequently analyzed. Enrolled patients with cryptogenic stroke were assigned to receive standard medical care or to undergo endovascular PFO closure, with a primary outcome of reduction in stroke recurrence rate. Secondary outcomes included rates of transient ischemic attack (TIA), composite outcome of stroke, TIA, and death from all causes, and rates of atrial fibrillation events. We analyzed data for 3412 patients. Transcatheter PFO closure resulted in a statistically significant reduced rate of recurrent stroke, compared with medication alone. Patients undergoing closure were 58% less likely to have another stroke. The number needed to treat with PFO closure to reduce recurrent stroke for 1 patient was 40. Endovascular PFO closure was associated with a reduced risk of recurrent stroke in patients with a prior cryptogenic cerebral infarct. Although the absolute stroke reduction was small, these findings are clinically significant, given the young age of this patient population and the patients' lifetime risk of recurrent stroke. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Morphometric analysis of diameter and relationship of vertebral artery with respect to transverse foramen in Indian population

    Directory of Open Access Journals (Sweden)

    Binit Sureka

    2015-01-01

    Full Text Available Purpose: To study the location, origin, size and relationship of the vertebral artery and the transverse foramina in the lower cervical spine by computed tomographic angiography (CTA measurements in the Indian population. Materials and Methods: A retrospective review of multi-detector CT (MDCT cerebral angiography scans was done between June 2011 and February 2014. A total of 120 patients were evaluated. The diameter of the vertebral artery (AL and the shortest distance between the vertebral artery and the medial (M, lateral (L, anterior (A, and posterior (P borders of transverse foramen were studied. In addition, the shortest distance between the vertebral artery and pedicle (h was also analyzed. Statistical Analysis: The means and their standard deviations (SD were calculated in both the sexes. The t-tests were performed to look for significant sexual difference. Results: The largest vertebral artery diameter (AL was at level C7 on the right side (3.5 ± 0.8 and at the level of C5 on the left side (3.7 ± 0.4. Statistically significant difference between males and females were seen at levels C4, C5, and C7. The diameter of the vertebral artery was smaller in females than males. The L value was greater than other parameters (M, A, P at the same level in all the measurements. The h value was greatest at C6 level and shortest at C5. Conclusion: CTA is necessary before pedicle screw fixation due to variation in measurements at all levels. The highest potential risk of vertebral artery injury during cervical pedicle screw implantation may be at C5, then at C4, and the safest is at C7.