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  1. Distal posterior inferior cerebellar artery aneurysm in a child

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    J. Francisco Salomão

    1992-06-01

    Full Text Available The case of a 7-year-old boy presenting with recurrent episodes of subarachnoid hemorrhage due to a distal posterior inferior cerebellar artery aneurysm (PICA, successfully operated, is reported.' The low incidence of intracranial aneurysms in the first decade of life and the rare occurrence of distal PICA aneurysms are unusual features of this case. The theories regarding the origin of intracranial berry aneurysms are discussed.

  2. Distal posterior inferior cerebellar artery aneurysm: case report Aneurisma da artéria cerebelar posterior e inferior distal: relato de caso

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    Ricardo Ramina

    2005-06-01

    Full Text Available The majority of posterior inferior cerebellar artery (PICA aneurysms are usually found on the bifurcation of the vertebral artery (VA - PICA junction. Aneurysms arising from more peripheral PICA segments named distal PICA aneurysm are uncommon. The major clinical manifestation is that of an intracranial bleeding and the site of hemorrhage is related to the PICA segment originating the aneurysm. Lesions originating from distal PICA segments, particularly those arising from the telovelotonsillar segment, are associated with hemorrhage extending into the ventricular system, mainly the IV ventricle. A case of a 50-year-old woman with sudden headaches and vomiting, and intraventricular hemorrhage (four ventricles caused by an aneurysm of the telovelotonsillar segment of the PICA, is presented. No signs of subarachnoidal hemorrhage were found in the computerized tomography. The aneurysm was clipped and the patient presented a favorable outcome. Anatomical aspects and clinical series are reviewed.A maioria dos aneurismas da artéria cerebelar posterior inferior (PICA é geralmente encontrada na junção artéria vertebral (VA - PICA. Aneurismas originando-se nos segmentos mais distais da PICA são considerados raros. A manifestação clínica em geral por hemorragia intracraniana, e o local desta está relacionado ao segmento que origina o aneurisma. Lesões localizadas em segmentos mais distais da PICA, em especial os originados do segmento telovelotonsilar, estão associados a hemorragias no sistema ventricular, particularmente no quarto ventrículo. Relatamos o caso de mulher de 50 anos de idade que desenvolveu quadro de cefaléia súbita e vômitos, com hemorragia nos quatro ventrículos, causada por ruptura de aneurisma localizado no segmento telovelotonsilar da PICA. Não havia sinais de hemorragia subaracnóidea na tomografia computadorizada de crânio. O aneurisma foi clipado e a paciente apresentou evolução favorável. Aspectos anatômicos e

  3. Extracranial aneurysms of the distal posterior inferior cerebellar artery: Resection and primary reanastomosis as the preferred management approach.

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    Chwajol, Markus; Hage, Ziad A; Amin-Hanjani, Sepideh; Charbel, Fady T

    2013-01-01

    Extracranial aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with only 22 reported cases in the English literature. For saccular extracranial distal PICA aneurysms not amenable to coiling, a surgically placed clip is not protected by the cranium postoperatively, and can be subject to movement in the mobile cervical region. Furthermore, fusiform or complex aneurysms cannot be clipped primarily. Resection and primary reanastomosis is a useful surgical approach not previously described for these extracranial lesions. We report three cases of extracranially located distal PICA aneurysms successfully treated with this surgical strategy at our center. One patient harboring a broad necked saccular aneurysm originally underwent successful primary clipping of the aneurysm but sustained a second subarachnoid hemorrhage (SAH) on postoperative day 25 due to clip dislodgement from vigorous neck movement. The other two patients were found to have fusiform and complex aneurysms, respectively. All three patients were ultimately treated with resection and end-to-end PICA anastomosis, which successfully obliterated their aneurysms. Resection and primary reanastomosis of extracranial distal PICA aneurysms averts the risk of clip dislodgement due to neck movement and/or compression by soft tissues in the upper cervical region. It is a safe and efficacious technique, which we propose as the preferred management strategy for these rare vascular lesions.

  4. Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

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    Fang, Yi-Bin, E-mail: fangyibin@163.com; Zhao, Kai-Jun, E-mail: zkjwcfzwh@163.com; Wu, Yi-Na, E-mail: wuyina0923@163.com; Zhou, Yu, E-mail: yzhou-2011@126.com; Li, Qiang, E-mail: lqeimm@126.com; Yang, Peng-Fei, E-mail: 15921196312@163.com; Huang, Qing-Hai, E-mail: ocinhqh@163.com; Zhao, Wen-Yuan, E-mail: doczhaowy@163.com; Xu, Yi, E-mail: xuyichyy@163.com; Liu, Jian-Min, E-mail: chstroke@163.com [Second Military Medical University, Department of Neurosurgery, Changhai Hospital (China)

    2015-06-15

    PurposeThe treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.MethodsA retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.ResultsThe immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 months on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).ConclusionsOur preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.

  5. Parent artery occlusion with Onyx for distal aneurysms of posterior inferior cerebellar artery: A single-centre experience in a series of 15 patients

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    Qi Wu

    2013-01-01

    Full Text Available Background: Aneurysms located at distal posterior inferior cerebellar artery (PICA are rare. These aneurysms are difficult for surgical or endovascular treatment, especially for ruptured aneurysms. Aims: To investigate the clinical and radiologic efficacy of parent artery occlusion (PAO with embolic agent Onyx in the treatment of distal PICA aneurysm. Materials and Methods: Case records of 15 consecutive patients with 15 ruptured distal PICA aneurysms treated with Onyx embolization were reviewed retrospectively. The follow-up ranged between 6 and 52 months. Cerebral angiography or cerebra computed tomography-angiogram (CTA was performed for follow-up radiological study. Two aneurysms had origin from tonsillomedullary segment, nine from telovelotonsillar segments, and four from cortical segments. All patients were treated with Onyx to occlude aneurysm and proximal portion of vessel in front of aneurysm via endovascular approach. Results: Aneurysm was occluded completely in every patient. One patient died because of intra-procedure haemorrhage. Fourteen patients had good recovery and the last follow-up Glasgow outcome scale was 5. Head CT scan was performed in every survived patient before discharge. CT in 3 patients revealed cerebellar infarctions but without any neurological deficits. None of the 14 patients had rebleeding or fresh neurologic deficits during the follow-up period. Aneurysmal recanalization had not been observed in any of the survived patients. Conclusions: Onyx occlusion of proximal parent artery and aneurysm in the treatment of distal PICA aneurysm is safe and effective according to this study. Morphology and location of aneurysm are important to decide the therapeutic strategy.

  6. The bihemispheric posterior inferior cerebellar artery

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    Cullen, Sean P. [Brigham and Women' s Hospital and Children' s Hospital, Department of Radiology and Neurosurgery, Boston, MA (United States); Ozanne, Augustin; Alvarez, Hortensia; Lasjaunias, Pierre [Service de Neuroradiologie Diagnostic et Therapeutique, Hopital de Bicetre-Universite Paris-sud Orsay (France)

    2005-11-01

    Rarely, a solitary posterior inferior cerebellar artery (PICA) will supply both cerebellar hemispheres. We report four cases of this variant. We present a retrospective review of clinical information and imaging of patients undergoing angiography at our institution to identify patients with a bihemispheric PICA. There were four patients: three males and one female. One patient presented with a ruptured arteriovenous malformation, and one with a ruptured aneurysm. Two patients had normal angiograms. The bihemispheric PICA was an incidental finding in all cases. The bihemispheric vessel arose from the dominant left vertebral artery, and the contralateral posterior inferior cerebellar artery was absent or hypoplastic. In all cases, contralateral cerebellar supply arose from a continuation of the ipsilateral PICA distal to the choroidal point and which crossed the midline dorsal to the vermis. We conclude that the PICA may supply both cerebellar hemispheres. This rare anatomic variant should be considered when evaluating patients with posterior fossa neurovascular disease. (orig.)

  7. Eficacia del uso del plasma rico en factores de crecimiento en defectos periodontales distales de segundos molares inferiores, posterior a la extracción de un tercer molar mandibular

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    Carlos Sánchez-Gutiérrez; Juan Antonio Cepeda-Bravo; Víctor Mario Fierro-Serna; Carlos Eduardo García-García; Ricardo Martínez-Rider; Miguel Ángel Noyola-Frías

    2017-01-01

    Objetivo: El propósito de este estudio fue evaluar la eficacia de la aplicación de plasma rico en factores de crecimiento (PRFC), dentro de un defecto periodontal distal, a los segundos molares inferiores después de la extracción de un tercer molar mandibular. Material y métodos: Se realizó un ensayo clínico controlado, doble ciego, aleatorizado en 20 pacientes sanos, con defectos óseos bilaterales posterior a la extracción de un tercer molar retenido. Los pacientes fueron dividos en grupo...

  8. Ruptured aneurysm at the cortical segment of the distal posterior inferior cerebellar artery associated with hemodynamic stress after basilar artery occlusion

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    Akiko Marutani

    2016-01-01

    Conclusion: This report describes a case of de novo development of a saccular distal PICA aneurysm after atherosclerotic basilar artery occlusion. We believe that increased hemodynamic stress at the PICA might have contributed to the occurrence and rupture of the aneurysm. STA-SCA bypass, introduced in the territory of the cerebellar hemisphere, reduces hemodynamic stress, which would prevent the occurrence of de novo aneurysm and recurrent bleeding.

  9. 小脑后下动脉远端动脉瘤的临床治疗%Clinical treatment of aneurysm of distal part of posterior inferior cerebellar artery

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    王云彦; 李学恩; 李刚; 李新钢

    2011-01-01

    目的 总结小脑后下动脉( PICA)远端动脉瘤的临床特点,探讨其临床治疗方式的选择.方法 回顾性研究16例PICA远端动脉瘤的临床特点及治疗.6例行后正中入路开颅动脉瘤夹闭术;4例行枕下远外侧入路动脉瘤夹闭术;6例行血管内栓塞术.结果 术后15例恢复良好,1例死亡,1例合并交通性脑积水,行脑室-腹腔分流术.15例出院时均无神经系统阳性体征,随访患者恢复良好.结论 对于PICA远端动脉瘤的治疗,应根据患者的临床情况及动脉瘤和PICA的形态,可以选择开颅夹闭或血管内栓塞.%Objective To study the clinical features and surgical treatment of aneurysms of distal part of posterior inferior cerebellar artery (PICA).Methods The clinical features and treatment of sixteen cases with aneurysms of distal part of PICA within last 3 years were studied retrospectively.Six patients underwent clipping of aneurysm through the middle posterior approach,four underwent clipping through suboccipital lateral approach,and the other underwent endovascular embolization.Results The postoperative course of fifteen patients was uneventful and one patient dead from the respiratory and circulatory complications.Fifteen patients were discharged without neurological deficits and remained well in follow - up.Conclusions As for a given patient with aneurysms of distal part of PICA,whether surgical or endovascular treatment should be selected depending on the attitude of the neurosurgeon and the patient,especially the clinical condition of the patient and morphology of the artery and aneurysm.

  10. 小脑后下动脉远端动脉瘤破裂的血管内治疗%Endovascular treatment of ruptured distal posterior inferior cerebellar artery aneurysms

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    陈状; 李林; 公方和; 王伟民

    2012-01-01

    Objective To investigate the clinical characteristics and endovascular treatment of ruptured distal posterior inferior cerebellar artery (PICA) aneurysms. Methods Clinical data of 11 patients with ruptured distal PICA aneurysms were analyzed retrospectively, including grade Ⅰ in 1 patient, grade Ⅱ in 5 patients, grade Ⅲ in 4 and grade Ⅳ in 1. All the patients were treated by endovascular treatment with coiling alone. Results Embolization alone of aneurysm was achieved in 7 patients, and embolization of aneurysm and parent artery occlusion at the same time in 4. All the patients were followed up for 1 to 4 years. Recurrence occurred in 1 patient 2 years after surgery, who was retreated by endovascular treatment. The occluded parent artery of 1 patient was recanalized 1 year after surgery without recurrence of aneurysm. The other 9 aneurysms were completely embolized. The modified rankin scale score 1 year after surgery was 0 in 2 patients, 1 in 8 and 2 in 1. Conclusions The embolization of ruptured distal PICA aneurysms by coiling with or without parent arteries occlusion is feasible, relatively safe, and can effectively prevent short- and medium-term rebleeding. Regular DSA follow-up is necessary to find and treat recurrence.%目的 总结小脑后下动脉(posterior inferior cerebellar artery,PICA)远端动脉瘤破裂的临床特征及血管内治疗方法.方法 回顾性分析11例破裂PICA远端动脉瘤病人的临床资料.术前Hunt-Hess分级:Ⅰ级1例,Ⅱ级5例,Ⅲ级4例,Ⅳ级1例.全部以单纯弹簧圈行血管内治疗.结果 单纯闭塞动脉瘤7例,同时闭塞动脉瘤及载瘤动脉4例.所有病人随访1~4年,术后2年复发1例,再次行血管内治疗;术后1年载瘤动脉再通1例,但仍未见动脉瘤复发;余9例动脉瘤均栓塞完全.术后1年改良rankin评分(modified rankin scale,MRS):0分2例,1分8例,2分1例.结论 对于PICA远端动脉瘤,以单纯弹簧圈闭塞动脉瘤或者同时闭塞动脉瘤和载瘤

  11. Eficacia del uso del plasma rico en factores de crecimiento en defectos periodontales distales de segundos molares inferiores, posterior a la extracción de un tercer molar mandibular

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    Carlos Sánchez-Gutiérrez

    2017-07-01

    Conclusiones: No se encontró diferencia significativa con el uso de PRFC en cuanto a ganancia en el nivel clínico de inserción periodontal en el área distal de segundos molares después de la extracción de terceros molares inferiores retenidos.

  12. Alexia caused by a fusiform or posterior inferior temporal lesion.

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    Sakurai, Y; Takeuchi, S; Takada, T; Horiuchi, E; Nakase, H; Sakuta, M

    2000-09-01

    We evaluated the alexia and agraphia of three patients with different lesions using Japanese kanji (morphograms) and kana (phonograms) and made a lesion-to-symptom analysis. Patient 1 (pure alexia for both kanji and kana and minor agraphia for kanji after a fusiform lesion) made more paragraphic errors for kanji, whereas patient 2 (alexia with agraphia for kanji after a posterior inferior temporal lesion) showed severe reading and writing disturbances and more agraphic errors for kanji. Brodmann Area 37 was affected in both patients, but in patient 2 the lesion was located lateral to that in patient 1. Patient 3 showed agraphia without alexia after restricted lesion to the angular gyrus. We believe that pure alexia (patient 1) results from a disconnection between the medial fusiform gyrus and posterior inferior temporal area (the lateral fusiform and inferior temporal gyri), whereas alexia with agraphia for kanji (patient 2), corresponding to lexical agraphia in Western countries, results from damage to the posterior inferior temporal area, in which whole-word images of words are thought to be stored. Furthermore, restricted lesion in the angular gyrus (patient 3) does not produce alexia; the alexic symptom of "angular" alexia with agraphia may be the result of damage to the adjacent lateral occipital gyri.

  13. 载瘤动脉闭塞治疗小脑后下动脉以远椎动脉瘤二例报告并文献复习%Treatment of vertebral aueurysms distal to the origin of posterior inferior cerebellar artery by occluding the parent artery: a report of 2 cases and literature review

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    刘智良; 秦家振; 魏群; 徐如祥; 戴宜武; 邓其峻; 王国福; 罗永春; 卢洪流; 杨志军; 李运军

    2011-01-01

    目的探讨载瘤动脉闭塞治疗小脑后下动脉(PICA)以远椎动脉瘤的方法和效果。方法中山大学附属佛山第一人民医院神经外科自2006年1月至2007年1月对2例PICA以远椎动脉瘤破裂患者行介入载瘤动脉电解可脱弹簧圈(GDC)闭塞治疗,分析患者的临床特征、影像学特点和栓塞疗效。 结果2例患者术后PICA以远载瘤动脉合并动脉瘤均成功获得完全闭塞,无术后并发症发生。术后3个月造影复查证实动脉瘤体无充盈,同时PICA通畅,4年内无再出血发生。 结论对于开颅手术夹必困难的PICA以远椎动脉瘤,在PICA远端处闭塞一侧载瘤椎动脉是一种安全、有效的治疗方法。%Objective To summarize the clinical characteristics, therapeutic strategy and outcome of the vertebral aneurysms distal to the origin of posterior inferior cerebellar artery (PICA).Methods Two patients with vertebral posterior aneurysms distal to the origin of PICA, admitted to our hospital from January 2006 to January 2007 and received endovascular treatment of Gugliemi detachable coils (GDC), were submitted to a retrospective analysis of clinical features, radiological characteristics and therapeutic effects. Results Total occlusion was achieved in these 2 patients and no immediate complication occurred after the treatment. They were followed up for 3 months to 4 years; the postoperative digital subtraction angiography (DSA) revealed that the PICA was unobstructed and no rehaemorrhagia was noted. Conclusion Endovascular therapy with microcoil placement may be a safe and available alternative for the treatment of some complicated aneurysms of vertebral artery aneurysms distal to the origin of PICA, which is difficult to be clipped.

  14. Sudden deafness as an initial presenting symptom of posterior inferior cerebellar artery infarction: two case reports.

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    Lee, E J; Yoon, Y J

    2014-11-01

    This paper reports on two patients with posterior inferior cerebellar artery infarction whose only presenting complaint was acute unilateral hearing loss. In the two cases reported, sudden hearing loss was an initial symptom, with no other neurological signs. Infarction in the territory of the posterior inferior cerebellar artery was diagnosed using brain magnetic resolution imaging. The patients had some degree of hearing improvement 3 or 4 days after initial treatment. In this article, new cases of posterior inferior cerebellar artery infarction presenting as sudden deafness, without prominent neurological signs, are described. Otologists should be aware that hearing loss can sometimes appear as a warning sign of impending posterior inferior cerebellar artery infarction.

  15. Varieties of Alexia From Fusiform, Posterior Inferior Temporal and Posterior Occipital Gyrus Lesions

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    Sakurai, Yasuhisa

    2004-01-01

    Reading impairments of three alexia patients, two pure alexia and one alexia with agraphia, due to different lesions were examined quantitatively, using Kanji (Japanese morphogram) words, Kana (Japanese phonetic writing) words and Kana nonwords. Kana nonword reading was impaired in all three patients, suggesting that widespread areas in the affected occipital and occipitotemporal cortices were recruited in reading Kana characters (corresponding to European syllables). In addition, the findings in patient 1 (pure alexia for Kanji and Kana from a fusiform and lateral occipital gyri lesion) and patient 2 (pure alexia for Kana from a posterior occipital gyri lesion) suggested that pure alexia could be divided into two types, i.e. ventromedial type in which whole-word reading, together with letter identification, is primarily impaired because of a disconnection of word-form images from early visual analysis, and posterior type in which letter identification is cardinally impaired. Another type of alexia, alexia with agraphia for Kanji from a posterior inferior temporal cortex lesion (patient 3), results from deficient whole-word images of words per se, and thus should be designated “orthographic alexia with agraphia”. To account for these impairments, a weighted dual-route hypothesis for reading is suggested. PMID:15201492

  16. Varieties of Alexia From Fusiform, Posterior Inferior Temporal and Posterior Occipital Gyrus Lesions

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    Yasuhisa Sakurai

    2004-01-01

    Full Text Available Reading impairments of three alexia patients, two pure alexia and one alexia with agraphia, due to different lesions were examined quantitatively, using Kanji (Japanese morphogram words, Kana (Japanese phonetic writing words and Kana nonwords. Kana nonword reading was impaired in all three patients, suggesting that widespread areas in the affected occipital and occipitotemporal cortices were recruited in reading Kana characters (corresponding to European syllables. In addition, the findings in patient 1 (pure alexia for Kanji and Kana from a fusiform and lateral occipital gyri lesion and patient 2 (pure alexia for Kana from a posterior occipital gyri lesion suggested that pure alexia could be divided into two types, i.e. ventromedial type in which whole-word reading, together with letter identification, is primarily impaired because of a disconnection of word-form images from early visual analysis, and posterior type in which letter identification is cardinally impaired. Another type of alexia, alexia with agraphia for Kanji from a posterior inferior temporal cortex lesion (patient 3, results from deficient whole-word images of words per se, and thus should be designated “orthographic alexia with agraphia”. To account for these impairments, a weighted dual-route hypothesis for reading is suggested.

  17. Hypothenar hammer syndrome: Distal ulnar artery reconstruction with autologous inferior epigastric artery.

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    Smith, Hadley E; Dirks, Marco; Patterson, Robert B

    2004-12-01

    Digital artery embolization and ulnar artery thrombosis are consequences of repetitive trauma and can lead to digit loss and debility from ischemia and cold intolerance. We postulate that an arterial autograft is a theoretically superior conduit to traditional saphenous vein, and report reconstruction with inferior epigastric artery. Three adult male smokers, ages 39 to 49 years, had severe digital ischemia and cold-induced vasospasm. Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch, distal digital artery embolization, and normal proximal vasculature. All reconstructions were performed from the distal most patent ulnar artery at the wrist to the superficial palmar arch (1 patient) or sequentially to the involved common digital arteries (2 patients), with inferior epigastric artery. Handling characteristics and size match between the arterial autografts and bypassed arteries was excellent. Patency has been confirmed with duplex scanning at follow-up of 8 to 24 months, with resolution of cold intolerance and successful digital preservation.

  18. Extensor mechanism-sparing paratricipital posterior approach to the distal humerus.

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    Schildhauer, Thomas A; Nork, Sean E; Mills, William J; Henley, M Bradford

    2003-05-01

    Adequate exposure of the articular surface of the distal humerus and elbow joint is required for operative stabilization of bicolumnar distal humerus fractures. The transolecranon approach, which provides complete posterior visualization and access to the distal humerus, is commonly used. Nevertheless, an olecranon osteotomy and other extensor mechanism-disrupting approaches have risks and possible complications. Alternative exposures have been described primarily for total elbow arthroplasty, but these involve extensive and potentially devascularizing dissections. In extra-articular (OTA type A) and simple articular distal humeral fractures with simple or multifragmentary metaphyseal involvement (OTA type C1 and C2), extensile approaches may not be necessary. For these fracture patterns, an alternative exposure is the extensor mechanism-sparing paratricipital posterior approach to the distal humerus through a midline posterior incision. This approach avoids an osteotomy and mobilizes the triceps and anconeus muscle off the posterior humerus and the intermuscular septae and provides adequate exposure for open reduction and internal fixation.

  19. Anterior and posterior inferior cerebellar artery infarction with sudden deafness and vertigo.

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    Murakami, Takenobu; Nakayasu, Hiroyuki; Doi, Mitsuru; Fukada, Yasuyo; Hayashi, Miwa; Suzuki, Takeo; Takeuchi, Yuichi; Nakashima, Kenji

    2006-12-01

    We report a patient with anterior and posterior inferior cerebellar artery infarction, which manifested as profound deafness, transient vertigo, and minimal cerebellar signs. We suspect that ischaemia of the left internal auditory artery, which originates from the anterior inferior cerebellar artery, caused the deafness and transient vertigo. A small lesion in the middle cerebellar peduncle in the anterior inferior cerebellar artery territory and no lesion in the dentate nucleus in the posterior inferior cerebellar artery territory are thought to explain the minimal cerebellar signs despite the relatively large size of the infarction. Thus a relatively large infarction of the vertebral-basilar territory can manifest as sudden deafness with vertigo. Neuroimaging, including magnetic resonance imaging, is strongly recommended for patients with sudden deafness and vertigo to exclude infarction of the vertebral-basilar artery territory.

  20. Retrograde Stent Placement for Coil Embolization of a Wide-Necked Posterior Inferior Cerebellar Artery Aneurysm

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    Roh, Hong Gee; Chun, Young IL; Choi, Jin Woo; Cho, Joon; Moon, Won Jin [University College of Medicine, Seoul (Korea, Republic of); Solander, Sten [University of North Carolina School of Medicine, Chapel Hill (United States)

    2012-07-15

    Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.

  1. [A case of left posterior inferior temporal infarction with right homonymous upper quadrantanopsia and alexia with agraphia for Kanji].

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    Ichikawa, Yoshikazu; Takanashi, Taiji; Mihara, Etsuko; Shoji, Takuro; Kinoshita, Kaori; Shimizu, Yasutaka

    2011-06-01

    Alexia with agraphia usually represents damage in angular gyrus. We report an unusual case of alexia with agraphia caused by a posterior inferior temporal lesion. A 82-year-old, right-handed man was admitted because of reading disorder. Visual acuity was 0.7 OD and 0.7 OS. Goldmann perimetry revealed right homonymous upper quadrantanopsia. Standard Language Test of Aphasia revealed mild anomia and severe alexia with agraphia for kanji. Magnetic resonance imaging demonstrated left temporal and posterior infarction in the posterior cerebral artery region. Single photon emission computed tomography revealed decreased blood flow in the left inferior temporal, parahippocampal, fusiform, lingual and inferior occipital gyri. There were no significant lesions nor any decreased of blood flow in the angular gyrus. It is suggested that reading and writing of ideograms such as Kanji is related not only to the angular gyrus but also to the posterior inferior temporal lobe and medial posterior lobe of the visual cortex.

  2. HIV Distal Neuropathic Pain Is Associated with Smaller Ventral Posterior Cingulate Cortex.

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    Keltner, John R; Connolly, Colm G; Vaida, Florin; Jenkinson, Mark; Fennema-Notestine, Christine; Archibald, Sarah; Akkari, Cherine; Schlein, Alexandra; Lee, Jisu; Wang, Dongzhe; Kim, Sung; Li, Han; Rennels, Austin; Miller, David J; Kesidis, George; Franklin, Donald R; Sanders, Chelsea; Corkran, Stephanie; Grant, Igor; Brown, Gregory G; Atkinson, J Hampton; Ellis, Ronald J

    2017-03-01

    . Despite modern antiretroviral therapy, HIV-associated neuropathy is one of the most prevalent, disabling and treatment-resistant complications of HIV disease. The presence and intensity of distal neuropathic pain is not fully explained by the degree of peripheral nerve damage. A better understanding of brain structure in HIV distal neuropathic pain may help explain why some patients with HIV neuropathy report pain while the majority does not. Previously, we reported that more intense distal neuropathic pain was associated with smaller total cerebral cortical gray matter volumes. The objective of this study was to determine which parts of the cortex are smaller. . HIV positive individuals with and without distal neuropathic pain enrolled in the multisite (N = 233) CNS HIV Antiretroviral Treatment Effects (CHARTER) study underwent structural brain magnetic resonance imaging. Voxel-based morphometry was used to investigate regional brain volumes in these structural brain images. . Left ventral posterior cingulate cortex was smaller for HIV positive individuals with versus without distal neuropathic pain (peak P  = 0.017; peak t = 5.15; MNI coordinates x = -6, y = -54, z = 20). Regional brain volumes within cortical gray matter structures typically associated with pain processing were also smaller for HIV positive individuals having higher intensity ratings of distal neuropathic pain. . The posterior cingulate is thought to be involved in inhibiting the perception of painful stimuli. Mechanistically a smaller posterior cingulate cortex structure may be related to reduced anti-nociception contributing to increased distal neuropathic pain.

  3. The right posterior inferior frontal gyrus contributes to phonological word decisions in the healthy brain

    DEFF Research Database (Denmark)

    Hartwigsen, Gesa; Price, Cathy J; Baumgaertner, Annette

    2010-01-01

    There is consensus that the left hemisphere plays a dominant role in language processing, but functional imaging studies have shown that the right as well as the left posterior inferior frontal gyri (pIFG) are activated when healthy right-handed individuals make phonological word decisions. Here we......IFG impaired reaction times and accuracy of phonological but not semantic decisions for visually and auditorily presented words. TMS over left, right or bilateral pIFG disrupted phonological processing to a similar degree. In a follow-up experiment, the intensity threshold for delaying phonological judgements...

  4. Progressive Deconstruction of a Distal Posterior Cerebral Artery Aneurysm Using Competitive Flow Diversion.

    Science.gov (United States)

    Johnson, Andrew K; Tan, Lee A; Lopes, Demetrius K; Moftakhar, Roham

    2016-03-01

    Progressive deconstruction is an endovascular technique for aneurysm treatment that utilizes flow diverting stents to promote progressive thrombosis by diverting blood flow away from the aneurysm's parent vessel. While the aneurysm thromboses, collateral blood vessels develop over time to avoid infarction that can often accompany acute parent vessel occlusion. We report a 37-year-old woman with a left distal posterior cerebral artery aneurysm that was successfully treated with this strategy. The concept and rationale of progressive deconstruction are discussed in detail.

  5. Spontaneous healing and complete disappearance of a ruptured posterior inferior cerebellar artery dissecting aneurysm.

    Science.gov (United States)

    Su, Tsung-Ming; Cheng, Ching-Hsiao; Chen, Wu-Fu; Hsu, Shih-Wei

    2014-05-01

    A 7-month-old baby presented with a 4-day history of drowsiness and vomiting after a falling accident. Magnetic resonance imaging demonstrated diffuse subarachnoid hemorrhage, intraventricular hemorrhage, and variable stages of subdural hematoma in bilateral occipital and left temporal subdural spaces. A partially thrombosed aneurysm was noted in the right craniocervical junction. Ophthalmological examination revealed bilateral retinal petechial hemorrhages. Conventional cerebral angiography revealed a dissecting aneurysm in the right posterior inferior cerebellar artery (PICA). Endovascular embolization was suggested, but the family refused. After conservative treatment, follow-up MRI revealed that the PICA aneurysm had remodeled and ultimately disappeared completely at the 10th month. This case illustrates the relatively plastic nature of intracranial aneurysms in pediatric patients. More studies are necessary to clarify the natural history of spontaneously thrombosed aneurysms to assist in their overall management.

  6. Giant partially thrombosed 4 th ventricular posterior inferior cerebellar artery aneurysm; microsurgical management

    Directory of Open Access Journals (Sweden)

    Forhad Hossain Chowdhury

    2014-01-01

    Full Text Available A 42-year-old woman presented with a 3-month history of progressive occipital headache, vomiting, walking difficulty, and repeated fall. She had no history of sudden and severe headache. She had positive cerebellar signs, predominantly on the right side. Computerized tomography (CT scan, CT angiogram, and magnetic resonance image (MRI of the brain showed suspected partially thrombosed giant 4 th ventricular posterior inferior cerebellar artery aneurysm. Patient developed severe hypersensitivity reaction during both CT scan and MRI after contrast injection. Though needed, digital subtraction angiogram (DSA of cerebral vessels was not done. The aneurysm was managed by microsurgical clipping of the aneurysm neck and partial excision of thrombosed aneurysm. Here, we report the details of management of these difficult giant aneurysm without DSA.

  7. Acute bilateral cerebellar infarction in the territory of the medial branches of posterior inferior cerebellar arteries.

    Science.gov (United States)

    Gurer, G; Sahin, G; Cekirge, S; Tan, E; Saribas, O

    2001-10-01

    The most frequent type of cerebellar infarcts involved the posterior inferior cerebellar artery (PICA) and superior cerebellar artery territories but bilateral involvement of lateral or medial branches of PICA is extremely rare. In this report, we present a 55-year-old male who admitted to hospital with vomiting, nausea and dizziness. On examination left-sided hemiparesia and ataxic gait were detected. Infarct on bilateral medial branch of PICA artery territories was found out with cranial magnetic resonance imaging (MRI) technique and 99% stenosis of the left vertebral artery was found out with digital subtraction arteriography. The patient was put on heparin treatment. After 3 weeks, his complaints and symptoms had disappeared except for mild gait ataxia.

  8. Distal posterior cerebral artery aneurysms: Retrospective review of characteristics and endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Jin Wook [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeong, Bae Woong [Dept. of Diagnostic Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan (Korea, Republic of); Seung, Won Bae [Dept. of Neurosurgery, Kosin University College of Medicine, Gospel Hospital, Busan (Korea, Republic of)

    2016-04-15

    The objective of this study was to review the clinical outcome after treatment of distal posterior cerebral artery (PCA) aneurysms via endovascular approach. Eleven patients with 11 distal PCA aneurysms who were treated via endovascular approach in Inje University Busan Paik Hospital and Kosin University Gospel Hospital from December 2002 to December 2013 were retrospectively reviewed. Among the 11 patients, there were 3 males (27.3%) and 8 females (72.7%). The mean age was 56.6 years (range 44 -72 years) and the mean aneurysm size was 8.45 mm (3 - 30 mm). Four (36.4%) aneurysms were located in the P2 segment, 6 (54.5%) in the P3 segment and 1 (9.1%) in the P1/2 junction. Seven (63.6%) aneurysms were treated with preservation of the parent artery; and the remaining 4 (36.4%) aneurysms were treated with parent artery occlusion. After treatment, the overall complication rate was 27% with the morbidity rate of 9.1% and the mortality rate of 18%. Endovascular treatment of distal PCA aneurysm might be used to minimize neurologic deficit, considering the diverse and rich collaterals of posterior cerebral artery.

  9. Morphometric study of distance between posterior inferior iliac spine and ischial spine of the human hip bone for sex determination

    OpenAIRE

    2014-01-01

    Background: Objective of current study was to study the distance between Posterior Inferior Iliac Spine and Ischial Spine (PIIS-IS) of human hip bone for determination of sex. Methods: The study comprised unpaired 149 adult human hip bones of known sex. The posterior inferior iliac spine and ischial spine were identified in all the hip bones and a vernier calliper was used to measure the distance between the PIIS-IS. Results: It was observed that the mean distance of PIIS-IS in males a...

  10. The isolated inferior glenohumeral labrum injury, anterior to posterior (the ILAP: A case series

    Directory of Open Access Journals (Sweden)

    Val Irion

    2015-01-01

    Full Text Available Introduction: We describe the presentation, exam findings, surgical repair techniques, and short-term outcomes in a series of patients with isolated inferior labral tears. Materials and Methods : A retrospective chart review was performed at a large academic medical center. Isolated inferior labral tears were defined as between the 4 o′clock and 8 o′clock position of the glenoid as determined by direct arthroscopic visualization. Tears that were smaller were also included but were required to cross the 6 o′clock point, having anterior and posterior components. Patients were excluded if they had any other pathology or treatment of the shoulder. 1-year follow-up was required. Results: Of the 17 patients who met inclusion criteria for review, 12 were available for a minimum 1-year follow-up. Average total follow-up for patients to complete the phone interview/Oxford Shoulder Instability Score (OSIS was an average of 37.7 months (range: 16-79 months. Postoperatively, all reported symptom improvement or resolution since surgery. The mean preoperative pain on a scale of 0-10 was 6.3 (range: 0-10. Mean postoperative pain on a scale of 0-10 was 2.25 (range: 0-5. Eleven of 12 patients (91.7% had returned to the level of activity desired. The mean OSIS was 41.4 (median: 43; range: 27-47. Eleven of 12 patients (91.7% had good or excellent scores. Ten of 12 patients (83.3% had a feeling of stability in the shoulder. All 12 patients reached were satisfied with the procedure and would undergo surgery again in a similar situation. Conclusions: We have presented our series of patients with isolated inferior labral injury, and have shown that when surgically treated, outcomes of this uncommon injury are good to excellent and a full return to sports can be expected.

  11. Studio anatomico dei rapporti neurovascolari delle perforanti dell’arteria tibiale posteriore: applicazioni alla chirurgia ricostruttiva dell’arto inferiore

    OpenAIRE

    Bulla, Antonio

    2016-01-01

    Purpose: the aim of this dissection study is to evaluate the anatomic localization of the most distal perforator of the posterior tibial vessels and to study its relationships with saphenous nerve and saphena magna vein to provide an anatomical rationale for the safe harvesting of distal leg flaps. In order to do so, we have developed a new contrast agent for comparative CT and dissection studies of the vascularisation of cadaveric specimens. Methods: The material was an epoxy resin es...

  12. Posterior Nutcracker Syndrome Associated with Interrupted Left Inferior Vena Cava with Azygos Continuation and Retroaortic Right Renal Vein

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Xiao Li; Zhou, Xiao Dong [Xijing Hospital, Fourth Military Medical University, Shaanxi (China); Qian, Gen Nian; Xiao, Hui; Zhao, Chun Lei [Fuzhou General Hospital, Fujian (China)

    2012-06-15

    Various anatomic anomalies have been considered the causes of nutcracker syndrome (NCS). Posterior NCS refers to the condition, in which vascular narrowing was secondary to the compression of the retroaortic left renal vein while it is crossing between the aorta and the vertebral column. Here, we report an unusual case of posterior NCS associated with a complicated malformation of the interrupted left inferior vena cava with azygos continuation and retroaortic right renal vein, diagnosed by both color Doppler ultrasonography and CT angiography.

  13. Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament

    Directory of Open Access Journals (Sweden)

    Rodrigo Pires e Albuquerque

    2015-12-01

    Full Text Available ABSTRACT Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up.

  14. Osteochondroma of the distal tibia complicated by a tibialis posterior tendon tear.

    Science.gov (United States)

    Kim, Yoon-Chung; Ahn, Jae Hoon; Lee, Jung-Woo

    2012-01-01

    Osteochondroma of the bone can irritate the overlying soft tissue, resulting in pain and discomfort. Rarely, a tendon tear can occur by an impinging bony mass. We report a case of osteochondroma of the distal tibia in a 23-year-old female patient that was complicated by a partial tear of the tibialis posterior tendon. She was treated with excision of the bony mass combined with tendon debridement and repair. The follow-up examination at 5 years postoperatively showed successful results. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients.

    Science.gov (United States)

    Abla, Adib A; McDougall, Cameron M; Breshears, Jonathan D; Lawton, Michael T

    2016-05-01

    OBJECT Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. METHODS Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. RESULTS During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. CONCLUSIONS PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one

  16. The prevalence of distal junctional kyphosis following posterior instrumentation and arthrodesis for adolescent idiopathic scoliosis.

    Science.gov (United States)

    Ameri, Ebrahim; Behtash, Hamid; Mobini, Bahram; Ghandhari, Hassan; Vahid Tari, Hossein; Khakinahad, Mohammad

    2011-01-01

    Distal junctional kyphosis (DJK) is a radiographic finding in patients that undergo spinal instrumentation and fusion, since there is an abrupt transition between fixed and mobile spinal segments.The true incidence of DJK is variable in literature and seems that has a multifactorial etiology. A consecutive series of 130 patients (mean age 15.6 years) with adolescent idiopathic scoliosis who underwent posterior spinal fusion and instrumentation were evaluated by analyzing coronal and sagittal angulation and balance measurements from standing radiographs obtained pre-operatively, within 6 weeks post-operation, at two years postoperative and at the latest follow-up. There was 35 male and 95 female. The mean time of follow-up was 36 months. The incidence of DJK at latest follow-up was 6.9% (9 patients). In DJK group, distal junctional angle from pre-operative of -12.5° lordosis (-30 to 0) reached to -5.5° (P=0.015) at 6 weeks postoperation and to -1.4° (-20 to 12°) (P=0.000) at 2 years follow-up,with mean of 12.1° kyphotic change (10-20°). In non DJK group, distal junctional angle from pre-operative angle of -7.5° reached -8.1° at 2 years follow-up (P=0.43). The mean age of DJK group at surgery was 17 years and for non-DJK group was 15.4 years (P=0.022). Distal junctional kyphosis was less common in this study than previous reports and stabilized after two years. The magnitude of coronal cobb angles or multiplicity of coronal curves had no effect in developing DJK that may be prevented by incorporation of the first lordotic disc into the fusion construct.

  17. The Prevalence of Distal Junctional Kyphosis Following Posterior Instrumentation and Arthrodesis for Adolescent Idiopathic Scoliosis

    Directory of Open Access Journals (Sweden)

    Ebrahim Ameri

    2011-06-01

    Full Text Available Distal junctional kyphosis (DJK is a radiographic finding in patients that undergo spinal instrumentation and fusion, since there is an abrupt transition between fixed and mobile spinal segments.The true incidence of DJK is variable in literature and seems that has a multifactorial etiology. A consecutive series of 130 patients (mean age 15.6 years with Adolescent Idiopathic Scoliosis who underwent posterior spinal fusion and instrumentation were evaluated by analyzing coronal and sagittal angulation and balance measurements from standing radiographs obtained pre-operatively, within 6 weeks post-operation, at two years postoperative and at the latest follow-up. There was 35 male and 95 female. The mean time of follow-up was 36 months. The incidence of DJK at latest follow-up was 6.9% (9 patients. In DJK group ,distal junctional angle from pre-operative of -12.5 ̊ lordosis (-30 to 0 reached to -5.5 ̊ (P=0.015 at 6 weeks postoperation and to -1.4 ̊ (-20 to 12 ̊ (P=0.000 at 2 years follow-up,with mean of 12.1 ̊ kyphotic change (10-20 ̊. In non DJK group, distal junctional angle from pre-operative angle of -7.5 ̊ reached -8.1 ̊ at 2 years follow-up (P=0.43. The mean age of DJK group at surgery was 17 years and for non-DJK group was 15.4 years (P=0.022. Distal junctional kyphosis was less common in this study than previous reports and stabilized after two years. The magnitude of coronal cobb angles or multiplicity of coronal curves had no effect in developing DJK that may be prevented by incorporation of the first lordotic disc into the fusion construct.

  18. Complex distal insertions of the tibialis posterior tendon: detailed anatomic and MR imaging investigation in cadavers

    Energy Technology Data Exchange (ETDEWEB)

    Pastore, Daniel; Cerri, Giovanni G. [University of Sao Paulo, Department of Radiology, Sao Paulo, Sao Paulo (Brazil); VA Medical Center, University of California, Department of Radiology, San Diego, CA (United States); Dirim, Berna; Wangwinyuvirat, Mani; Belentani, Clarissa L.; Trudell, Debra J.; Resnick, Donald L. [VA Medical Center, University of California, Department of Radiology, San Diego, CA (United States); Haghighi, Parviz [VA Medical Center, University of California, Department of Radiology, San Diego, CA (United States); VA Medical Center, University of California, Department of Histology, San Diego, CA (United States)

    2008-09-15

    The purpose of this report was to demonstrate the normal complex insertional anatomy of the tibialis posterior tendon (TPT) in cadavers using magnetic resonance (MR) imaging with anatomic and histologic correlation. Ten cadaveric ankles were used according to institutional guidelines. MR T1-weighted spin echo imaging was performed to demonstrate aspects of the complex anatomic distal insertions of the TPT in cadaveric specimens. Findings on MR imaging were correlated with those derived from anatomic and histologic study. Generally, the TPT revealed a low signal in all MR images, except near the level of the medial malleolus, where the TPT suddenly changed direction and ''magic angle'' artifact could be observed. In five out of ten specimens (50%), a type I accessory navicular bone was found in the TPT. In all cases with a type I accessory navicular bone, the TPT had an altered signal in this area. Axial and coronal planes on MR imaging were the best in identifying the distal insertions of the TPT. A normal division of the TPT was observed just proximal to the insertion into the navicular bone in five specimens (100%) occurring at a maximum proximal distance from its attachment to the navicular bone of approximately 1.5 to 2 cm. In the other five specimens, in which a type I accessory navicular bone was present, the TPT directly inserted into the accessory bone and a slip less than 1.5 mm in thickness could be observed attaching to the medial aspect of the navicular bone (100%). Anatomic inspection confirmed the sites of the distal insertions of the components of the TPT. MR imaging enabled detailed analysis of the complex distal insertions of the TPT as well as a better understanding of those features of its insertion that can simulate a lesion. (orig.)

  19. Alexia with agraphia due to the left posterior inferior temporal lobe lesion--neuropsychological analysis and its pathogenetic mechanisms.

    Science.gov (United States)

    Kawahata, N; Nagata, K; Shishido, F

    1988-03-01

    We report three cases of alexia with agraphia due to the left posterior inferior temporal lesions. In Case 1, the reading disability was more prominent in the use of Kana than in the use of Kanji, which is similar to previously reported cases of alexia with agraphia due to angular gyrus lesion. In Cases 2 and 3, by contrast, the reading disability was more prominent in the use of Kanji than in the use of Kana. In spontaneous writing and dictation, the disability was more pronounced in the use of Kanji compared with the use of Kana. In each of the three cases, the CT scan and positron emission tomography showed a localized lesion in the lower part of the left posterior temporal lobe. A typical form of an alexia with agraphia could be caused not only by the left angular lesion but also by the left posterior inferior temporal lesion. We discuss the neuropsychological analysis and pathogenetic mechanisms of alexia with agraphia due to the left posterior inferior temporal lesion in the comparison of alexia with agraphia caused by the left angular lesion.

  20. Anterior spinal and bulbar artery supply to the posterior inferior cerebellar artery revealed by a ruptured aneurysm: case report.

    Science.gov (United States)

    Gabrieli, Joseph; Sourour, Nader-Antoine; Chauvet, Dorian; Di Maria, Federico; Chiras, Jacques; Clarençon, Frédéric

    2017-02-01

    The posterior inferior cerebellar artery (PICA) is a vessel located between the intra- and extracranial circulation. The artery is characterized by a complex embryological development and numerous anatomical variants. The authors present a case of the PICA supplied by both a hypertrophic anterior spinal artery and a hypoplastic bulbar artery. This unusual arrangement somehow completes the list of previously published variants, and the spontaneous rupture of a related aneurysm confirmed the fragility of this network. The authors discuss anatomical and treatment considerations.

  1. Posterior periosteal disruption in Salter-Harris Type II fractures of the distal femur: evidence for a hyperextension mechanism.

    Science.gov (United States)

    Kritsaneepaiboon, Supika; Shah, Rajvee; Murray, Martha M; Kleinman, Paul K

    2009-12-01

    Patterns of periosteal disruption are important factors in assessing the mechanism of injury of radiologically evident Salter-Harris (SH) fractures. The purpose of this study is to assess the frequency of posterior periosteal disruption on MRI in radiographically occult or subtle SH type II fractures of the distal femur and to evaluate associated soft-tissue findings that support a hyperextension mechanism of injury. We found that all children in our experience with occult or subtle SH type II fractures of the distal femur have posterior periosteal disruption and other MRI findings to indicate a hyperextension mechanism of injury. Direct indicators of fracture may be inconspicuous, and the presence of posterior periosteal disruption is a clue that should prompt a search for other features of this serious pediatric injury, which may be followed by limb shortening or angular deformity.

  2. Gravity-dependent nystagmus and inner-ear dysfunction suggest anterior and posterior inferior cerebellar artery infarct.

    Science.gov (United States)

    Shaikh, Aasef G; Miller, Benjamin R; Sundararajan, Sophia; Katirji, Bashar

    2014-04-01

    Cerebellar lesions may present with gravity-dependent nystagmus, where the direction and velocity of the drifts change with alterations in head position. Two patients had acute onset of hearing loss, vertigo, oscillopsia, nausea, and vomiting. Examination revealed gravity-dependent nystagmus, unilateral hypoactive vestibulo-ocular reflex (VOR), and hearing loss ipsilateral to the VOR hypofunction. Traditionally, the hypoactive VOR and hearing loss suggest inner-ear dysfunction. Vertigo, nausea, vomiting, and nystagmus may suggest peripheral or central vestibulopathy. The gravity-dependent modulation of nystagmus, however, localizes to the posterior cerebellar vermis. Magnetic resonance imaging in our patients revealed acute cerebellar infarct affecting posterior cerebellar vermis, in the vascular distribution of the posterior inferior cerebellar artery (PICA). This lesion explains the gravity-dependent nystagmus, nausea, and vomiting. Acute onset of unilateral hearing loss and VOR hypofunction could be the manifestation of inner-ear ischemic injury secondary to the anterior inferior cerebellar artery (AICA) compromise. In cases of combined AICA and PICA infarction, the symptoms of peripheral vestibulopathy might masquerade the central vestibular syndrome and harbor a cerebellar stroke. However, the gravity-dependent nystagmus allows prompt identification of acute cerebellar infarct. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Irreducible Salter Harris type II distal tibial physeal fracture secondary to interposition of the posterior tibial tendon: a case report.

    Science.gov (United States)

    Soulier, Robert; Fallat, Lawrence

    2010-01-01

    Pediatric distal tibial fractures generally occur without significant long-term sequelae, and patients are commonly able to return to their preinjury activities after proper management. The literature reports excellent outcomes after anatomical reduction of distal tibial and ankle physeal fractures with closed or open treatment. Treatment options include simple immobilization of nondisplaced fractures, and closed or open reduction for restoration of anatomic alignment of displaced fractures. Soft tissue interposition within the fracture can threaten successful closed reduction, and may warrant open management if closed reduction fails to produce a satisfactory result. Despite the documented possibility of soft tissue interposition preventing closed reduction of pediatric ankle fractures, there is a paucity of literature reporting this complication. We report a unique case of an irreducible Salter-Harris type II distal tibial physeal fracture secondary to interposition of the posterior tibial tendon. Copyright 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Contribution of inferior temporal and posterior parietal activity to three-dimensional shape perception.

    Science.gov (United States)

    Verhoef, Bram-Ernst; Vogels, Rufin; Janssen, Peter

    2010-05-25

    One of the fundamental goals of neuroscience is to understand how perception arises from the activity of neurons in the brain. Stereopsis is a type of three-dimensional (3D) perception that relies on two slightly different projections of the world onto the retinas of the two eyes, i.e., binocular disparity. Neurons selective for curved surfaces defined by binocular disparity may contribute to the perception of an object's 3D structure. Such neurons have been observed in both the anterior lower bank of the superior temporal sulcus (TEs, part of the inferior temporal cortex [IT]) and the anterior intraparietal area (AIP). However, the specific contributions of IT and AIP to depth perception remain unknown. We simultaneously recorded multiunit activity in IT and AIP while monkeys discriminated between concave and convex 3D shapes. We observed a correlation between the neural activity and behavioral choice that arose early and during perceptual decision formation in IT but later and after perceptual decision formation in AIP. These results suggest a role for IT, but not AIP, in 3D shape discrimination. Furthermore, the results demonstrate that similar neuronal stimulus selectivities in two areas do not imply a similar function.

  5. The Right Posterior Inferior Frontal Gyrus Contributes to Phonological Word Decisions in the Healthy Brain: Evidence from Dual-Site TMS

    Science.gov (United States)

    Hartwigsen, Gesa; Price, Cathy J.; Baumgaertner, Annette; Geiss, Gesine; Koehnke, Maria; Ulmer, Stephan; Siebner, Hartwig R.

    2010-01-01

    There is consensus that the left hemisphere plays a dominant role in language processing, but functional imaging studies have shown that the right as well as the left posterior inferior frontal gyri (pIFG) are activated when healthy right-handed individuals make phonological word decisions. Here we used online transcranial magnetic stimulation…

  6. Unexpected motor axons in the distal superficial radial and posterior interosseous nerves: a cadaver study.

    Science.gov (United States)

    Okwueze, Martina I; Cardwell, Nancy L; Wolfort, Sean L; Nanney, Lillian B

    2007-10-01

    The prevalence of motor variations in the nerves supplying muscles of the first web space was evaluated by a visual dissection and immunohistochemical analysis from 56 cadaver hands. By microscopic visualization, 30% of the superficial radial nerves (SRNs) sent branches into muscles of the first web space. Since these unexpected penetrating branches were expected to be sensory or proprioceptive, markers of sensory and motor axons were used for confirmation. Positive identifications of motor axons (as identified by positive immunostaining for choline acetyltransferase) were made in 30% of SRNs and in 28.5% of posterior interosseous nerves. Classical teachings that the SRNs and PINs are exclusively sensory have been brought into question. Our data are in agreement with the rare clinical finding that motor function occasionally persists following devastating injury to both the ulnar and median nerves. Anatomic prevalence for this variation appears much higher than previous descriptions have indicated.

  7. The localization of the distal perforators of posterior tibial artery: a cadaveric study for the correct planning of medial adipofascial flaps.

    Science.gov (United States)

    Bulla, A; De Luca, L; Campus, G V; Rubino, C; Montella, A; Casoli, V

    2015-01-01

    The adipofascial flap, introduced by Lin in 1994, has many advantages compared to fasciocutaneous or free flaps. Its dissection is relatively easy and fast with low donor-site morbidity, and it does not alter the shape of the leg. The aim of this dissection study is to evaluate the anatomic localization of the most distal perforator of the posterior tibial vessels to provide an anatomical rationale for the safe harvesting of distally based medial adipofascial flaps of the leg. 30 Lower limbs from 15 cadavers were used for this study. The most distal perforator from posterior tibial perforator artery, accompanied by at least one vein, was identified and its distance from the medial malleolus was noted. A distal perforator was found in all specimens; the mean caliber was 0.77 mm. In all cases, the perforator artery passed in the septum between flexor hallucis longus m. and flexor digitorum longus m. and was accompanied by two veins. In our series, the distance between the lowest perforator and the medial malleolus ranged from 3.5 to 8.2 cm. The median was 6.75 cm, the 5th percentile 4 cm and the 95th percentile 8.1 cm. The mean distance of the perforator from the medial tibial border was 1.23 cm. The mean ratio between the distance of perforator from the medial malleolus and the total leg length was 21%. Compared to all previous researches, our study has found more distal perforators from posterior tibial perforator artery. This fact may have important clinical consequences, because the anteromedial adipofascial flap would cover more distal soft tissue defects. Moreover, our data suggest some safety parameters to make the rising of a medial adipofascial leg flap safer in surgical practice.

  8. Alternative to the inferior alveolar nerve block anesthesia when placing mandibular dental implants posterior to the mental foramen.

    Science.gov (United States)

    Heller, A A; Shankland, W E

    2001-01-01

    Local anesthesia block of the inferior alveolar nerve is routinely taught throughout dental education. This commonly used technique eliminates all somatosensory perception of the mandible, mandibular teeth, floor of the mouth, ipsilateral tongue, and all but the lateral (buccal) gingivae. Generally, the dentist or surgeon desires these structures to be anesthetized. However, in the placement of mandibular implants, it may be useful for the patient to be able to sense when the inferior alveolar nerve is in danger of being damaged, possibly producing permanent paresthesia. In this article, the technique of mandibular infiltration prior to mandibular implant placement in the mandible is discussed.

  9. A ruptured aneurysm arising at the leptomeningeal collateral circulation from the extracranial vertebral artery to the posterior inferior cerebellar artery associated with bilateral vertebral artery occlusion.

    Science.gov (United States)

    Chonan, Masashi; Nishimura, Shinjitu; Kimura, Naoto; Ezura, Masayuki; Uenohara, Hiroshi; Tominaga, Teiji

    2014-02-01

    We report an extremely rare case of a small ruptured aneurysm of the leptomeningeal collateral circulation from the vertebral artery (VA) to the posterior inferior cerebellar artery (PICA); this aneurysm was associated with bilateral VA occlusion. A 72-year-old woman with sudden headache, nausea, and subarachnoid hemorrhage (SAH) was admitted to our hospital. On admission, no evidence of cerebral signs or cranial nerve palsy was found. Computed tomography imaging showed SAH predominantly in the posterior fossa, and digital subtraction angiography revealed bilateral VA occlusion and the left VA aneurysm located proximal to the VA union. In addition, a small aneurysm was observed at the leptomeningeal collateral circulation located between the extracranial left VA and the left PICA. The patient underwent radical surgery on the day of the onset of the symptoms associated with SAH. However, the VA aneurysm was unruptured and surgically trapped. The small aneurysm arising at the leptomeningeal collateral circulation was ruptured during the surgery and was electrocoagulated; the collateral circulation was preserved, and no neurologic deficits were observed. The postoperative course was uneventful. SAH with the occlusion of major vessels should be diagnosed with utmost caution to allow preoperative neurologic and radiological assessments.

  10. Parosteal osteosarcoma of the posterior aspect of the distal part of the femur. Oncological and functional results following a new resection technique.

    Science.gov (United States)

    Lewis, V O; Gebhardt, M C; Springfield, D S

    2000-08-01

    Parosteal osteosarcoma is a low-grade malignant bone tumor that arises from the surface of the metaphysis of long bones. Parosteal osteosarcoma is usually well differentiated and displays a low propensity to metastasize. Wide resection of a parosteal osteosarcoma has been shown to provide a relatively risk-free method of preventing local recurrence. We propose a new method of resection of parosteal osteosarcomas located in the popliteal paraosseous space of the distal part of the femur. This method involves resection of the mass through separate medial and lateral incisions, which allows for wide margins yet limits the amount of dissection of the soft tissues and the neurovascular bundle. Six patients with parosteal osteosarcoma located on the posterior aspect of the distal part of the femur underwent resection of the lesion and reconstruction with a posterior hemicortical allograft through dual medial and lateral incisions. The patients were evaluated with regard to pain, postoperative function, union of the allograft (osteosynthesis), and the prevalence of local recurrence. The average time until the last follow-up assessment was 4.3 years. No metastases developed, and there were no local recurrences. All patients were free of disease at the last follow-up evaluation. Postoperatively, the average range of motion of the knee was 0 to 122 degrees. Five of the six patients were free of pain at the time of the latest follow-up. Five of the six patients returned to their preoperative active functional status. We recommend resection of a parosteal osteosarcoma located on the posterior surface of the femur through separate medial and lateral incisions. This approach provides minimal dissection of the neurovascular bundle but ample exposure for reconstruction with a hemicortical allograft.

  11. Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion

    Science.gov (United States)

    Giacomini, Craig; Brooke Jeffrey, R.; Willmann, Juergen K.; Olcott, Eric

    2013-01-01

    Abstract Extrapancreatic perineural spread in pancreatic adenocarcinoma contributes to poor outcomes, as it is known to be a major contributor to positive surgical margins and disease recurrence. However, current staging classifications have not yet taken extrapancreatic perineural spread into account. Four pathways of extrapancreatic perineural spread have been described that conveniently follow small defined arterial pathways. Small field of view three-dimensional (3D) volume-rendered multidetector computed tomography (MDCT) images allow visualization of small peripancreatic vessels and thus perineural invasion that may be associated with them. One such vessel, the posterior inferior pancreaticoduodenal artery (PIPDA), serves as a surrogate for extrapancreatic perineural spread by pancreatic adenocarcinoma arising in the uncinate process. This pictorial review presents the normal and variant anatomy of the PIPDA with 3D volume-rendered MDCT imaging, and emphasizes its role as a vascular landmark for the diagnosis of extrapancreatic perineural invasion from uncinate adenocarcinomas. Familiarity with the anatomy of PIPDA will allow accurate detection of extrapancreatic perineural spread by pancreatic adenocarcinoma involving the uncinate process, and may potentially have important staging implications as neoadjuvant therapy improves. PMID:24434918

  12. Successful Removal of a Metastatic Gastrointestinal Stromal Tumor in the Craniovertebral Junction using an Occipital Artery to Posterior Inferior Cerebellar Artery Bypass

    Directory of Open Access Journals (Sweden)

    Yukitomo Ishi

    2014-05-01

    Full Text Available Gastrointestinal stromal tumors (GISTs are rare mesenchymal neoplasms arising from the gastrointestinal tract. The authors present a case of the successful removal of a metastatic GIST in the craniovertebral junction, using an occipital artery to posterior inferior cerebellar artery (OA-PICA bypass. The patient is a 54-year-old male who underwent his first surgery for a small-bowel tumor at the age of 45 and was diagnosed with GIST. Nine years after his primary diagnosis, the patient suffered from severe neck pain. MRI demonstrated a large demarcated mass adjacent to the right atlas. The right vertebral artery (VA, completely engulfed by the tumor, showed a narrowing and ended in the PICA. Poor collateral blood supply in the right PICA territory was presumed. To prevent ischemic complications, an OA-PICA bypass was performed prior to the tumor resection. After the OA-PICA bypass, the tumor associated with the right VA was successfully removed, and the patient was discharged without any neurological deficits.

  13. A Posteriorly Displaced Distal Metaphyseal Clavicular Fracture (Type IV AC Joint Dislocation-Like in Children: A Case Report and Literature Review Study

    Directory of Open Access Journals (Sweden)

    Ahmed Kotb

    2016-01-01

    Full Text Available Fractures of the lateral end of the clavicle are common in pediatric patients; most of these fractures occur at the physeal level representing Salter Harris injuries. The vast majority of fractures of the lateral end of the clavicle are managed nonoperatively. In this report, we describe a unique type of fracture of the distal end of the clavicle in the pediatric patients in which the fracture occurs in the metaphyseal lateral clavicle with the proximal edge of the fracture displaced posteriorly through the trapezius muscle causing obvious deformity. It is similar in pathology to type IV AC joint dislocation. In this study we report this injury in eleven-year-old boy. Literature review showed that similar injuries were described before three times (two of them in pediatric patients. Due to the significant clinical deformity of this category with entrapment of the bone through the trapezius muscle, reduction (open or closed of the fracture is the recommended treatment.

  14. [Fasciocutaneous flap of the posterior surface of the thigh with distal pedicle. Anatomical study and surgical value. A propos of 3 cases].

    Science.gov (United States)

    Lambert, F; Cariou, J L; Couturaud, B; Bellavoir, A

    1996-04-01

    In the light of previous studies, the authors conducted an anatomical study on 21 cadaveric dissections with injection in order to define the characteristics of the distally based fasciocutaneous flap of the posterior surface of the thigh, described for the first time in 1988 by Maruyama. This leaf-shaped flap extends from the popliteal region to the gluteal sulcus. It possesses an axial arterial network derived from the popliteal artery, reinforced by the perforating arteries derived from the vessel or the profunda femoris artery. The venous return is ensured by venae comitantes and the communicating saphenous vein. The flap raising technique is described. From 1991 to 1994, 3 patients were operated in order to cover a defect of the knee (1 case) and amputation stumps (2 cases). The postoperative course was uneventful and the results were considered to be stable and of excellent quality with a follow-up of 2 to 4 years.

  15. Endovascular treatment of vertebral artery dissecting aneurysm involving posterior inferior cerebellar artery%累及小脑后下动脉椎动脉夹层动脉瘤的血管内介入治疗效果

    Institute of Scientific and Technical Information of China (English)

    何川; 张鹏; 张鸿祺

    2015-01-01

    Objective To analyze stenting and dual catheter technique in protection of posterior inferior cerebellar artery and its imaging and clinical follow-up results in the endovascular treatment of vertebral artery dissecting aneurysms. Methods From January 2012 to December 2014,the clinical data of 4 patients with vertebral artery dissecting aneurysm involving posterior inferior cerebellar artery treated with endovascular method and admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. The whole brain DSA examinations were performed at 6 months after procedure. The clinical follow-up period ranged from 12 to 24 months. Results Three of the 4 patients were treated with posterior inferior cerebellar artery-vertebral artery stenting,one patient was treated by using bidirectional dual catheter technique to protect posterior inferior cerebellar artery. The interventional therapy of 4 patients were all successful. Immediately after procedure,angiography revealed that the posterior inferior cerebellar arteries were patent,no ischemic symptoms were observed. The angiography at 6 months after procedure revealed no recurrence of aneurysms;the posterior inferior cerebellar arteries were patent without in-stent stenosis. No new symptoms of neurological deficit were observed during 12 to 24-month follow-up. Conclusion In the interventional treatment of vertebral artery dissecting aneurysms of posterior inferior cerebellar artery,using the posterior inferior cerebellar artery-vertebral artery stenting technique and bidirectional dual catheter technique may safely and effectively protect the posterior inferior cerebellar artery.%目的:分析椎动脉夹层动脉瘤的血管内介入治疗中支架置入和双导管技术保护小脑后下动脉(PICA)的方法及其影像和临床随访结果。方法回顾性纳入首都医科大学宣武医院神经外科2012年1月至2014年12月收治的4例累及PICA的椎动

  16. Non-invasive neurosensory testing used to diagnose and confirm successful surgical management of lower extremity deep distal posterior compartment syndrome

    Directory of Open Access Journals (Sweden)

    Guyton Gregory P

    2009-05-01

    Full Text Available Abstract Background Chronic exertional compartment syndrome (CECS is characterized by elevated pressures within a closed space of an extremity muscular compartment, causing pain and/or disability by impairing the neuromuscular function of the involved compartment. The diagnosis of CECS is primarily made on careful history and physical exam. The gold standard test to confirm the diagnosis of CECS is invasive intra-compartmental pressure measurements. Sensory nerve function is often diminished during symptomatic periods of CECS. Sensory nerve function can be documented with the use of non-painful, non-invasive neurosensory testing. Methods Non-painful neurosensory testing of the myelinated large sensory nerve fibers of the lower extremity were obtained with the Pressure Specified Sensory Device™ in a 25 year old male with history and invasive compartment pressures consistent with CECS both before and after running on a tread mill. After the patient's first operation to release the deep distal posterior compartment, the patient failed to improve. Repeat sensory testing revealed continued change in his function with exercise. He was returned to the operating room where a repeat procedure revealed that the deep posterior compartment was not completely released due to an unusual anatomic variant, and therefore complete release was accomplished. Results The patient's symptoms numbness in the plantar foot and pain in the distal calf improved after this procedure and his repeat sensory testing performed before and after running on the treadmill documented this improvement. Conclusion This case report illustrates the principal that non-invasive neurosensory testing can detect reversible changes in sensory nerve function after a provocative test and may be a helpful non-invasive technique to managing difficult cases of persistent lower extremity symptoms after failed decompressive fasciotomies for CECS. It can easily be performed before and after

  17. Retalho do músculo tibial anterior para reconstrução de perda musculo cutânea em membro inferior com posterior auto enxerto cutâneo

    Directory of Open Access Journals (Sweden)

    Victor Reis Guil

    2015-10-01

    Full Text Available As lesões traumáticas de membros inferiores podem resultar em uma exposição óssea com perda de tecidos adjacentes. O uso de retalhos musculares é uma opção na reconstrução das partes moles e tratamento integral da exposição óssea. Dentre as possibilidades de uso deste tipo de retalho está o músculo tibial posterior, usado criteriosamente para lesões específicas. A indicação do uso do músculo tibial anterior como retalho depende de fatores como localidade e extensão da lesão, além da capacidade maleável e condição hígida do músculo. Quando as características da lesão permitem sua utilização, o retalho do músculo tibial anterior demonstra ter algumas vantagens, incluindo fácil manejo cirúrgico, espessura e vascularização adequadas para realização deste procedimento. Este relato descreve o caso de um paciente de três anos, do sexo masculino, vítima de atropelamento por carro. O paciente apresentou fratura de tíbia com lesão extensa de partes moles, abrangendo o terço distal da perna e região dorsal do pé. Foi programada, então, a cirurgia reconstrutiva com utilização do músculo tibial anterior como retalho para preenchimento da área de exposição óssea e de perda de tecidos, seguida de auto enxerto de pele em segundo tempo cirúrgico. O relato de caso tem importância significativa devido à indicação da técnica cirúrgica utilizada, sendo realizada em casos específicos, além do resultado benéfico que o paciente vem apresentando em sua evolução até o momento.

  18. Technical Note: Intrafractional changes in time lag relationship between anterior–posterior external and superior–inferior internal motion signals in abdominal tumor sites

    Energy Technology Data Exchange (ETDEWEB)

    Regmi, Rajesh; Lovelock, D. Michael; Zhang, Pengpeng; Pham, Hai; Xiong, Jianping; Yorke, Ellen D.; Mageras, Gig S., E-mail: magerasg@mskcc.org [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065 (United States); Goodman, Karyn A.; Wu, Abraham J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065 (United States)

    2015-06-15

    Purpose: To investigate constancy, within a treatment session, of the time lag relationship between implanted markers in abdominal tumors and an external motion surrogate. Methods: Six gastroesophageal junction and three pancreatic cancer patients (IRB-approved protocol) received two cone-beam CTs (CBCT), one before and one after treatment. Time between scans was less than 30 min. Each patient had at least one implanted fiducial marker near the tumor. In all scans, abdominal displacement (Varian RPM) was recorded as the external motion signal. Purpose-built software tracked fiducials, representing internal signal, in CBCT projection images. Time lag between superior–inferior (SI) internal and anterior–posterior external signals was found by maximizing the correlation coefficient in each breathing cycle and averaging over all cycles. Time-lag-induced discrepancy between internal SI position and that predicted from the external signal (external prediction error) was also calculated. Results: Mean ± standard deviation time lag, over all scans and patients, was 0.10 ± 0.07 s (range 0.01–0.36 s). External signal lagged the internal in 17/18 scans. Change in time lag between pre- and post-treatment CBCT was 0.06 ± 0.07 s (range 0.01–0.22 s), corresponding to 3.1% ± 3.7% (range 0.6%–10.8%) of gate width (range 1.6–3.1 s). In only one patient, change in time lag exceeded 10% of the gate width. External prediction error over all scans of all patients varied from 0.1 ± 0.1 to 1.6 ± 0.4 mm. Conclusions: Time lag between internal motion along SI and external signals is small compared to the treatment gate width of abdominal patients examined in this study. Change in time lag within a treatment session, inferred from pre- to post-treatment measurements is also small, suggesting that a single measurement of time lag at the session start is adequate. These findings require confirmation in a larger number of patients.

  19. Restablecimiento del soporte posterior con prótesis parcial removible inferior y manejo estético anterior con prótesis tipo collar less y carillas directas: reporte de caso

    OpenAIRE

    Mendoza García, Jesús Enrique

    2014-01-01

    Este reporte de caso de elabora con el fin de optar al título de especialización en Operatoria Dental Estética de la Universidad Nacional de Colombia. Paciente masculino de 61 años se presenta en la Clínica de Especialización en Operatoria dental Estética de la UNAL; presenta como características, ausencia de soporte posterior estable, coronas metal cerámicas y temporales acrílicas en zona anterosuperior desadaptada, atrición en zona antero-inferior y removible superior adaptado y fu...

  20. New England Medical Center Posterior Circulation registry.

    Science.gov (United States)

    Caplan, Louis R; Wityk, Robert J; Glass, Thomas A; Tapia, Jorge; Pazdera, Ladislav; Chang, Hui-Meng; Teal, Phillip; Dashe, John F; Chaves, Claudia J; Breen, Joan C; Vemmos, Kostas; Amarenco, Pierre; Tettenborn, Barbara; Leary, Megan; Estol, Conrad; Dewitt, L Dana; Pessin, Michael S

    2004-09-01

    Among 407 New England Medical Center Posterior Circulation registry patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs then strokes, and 16% had only TIAs. Embolism was the commonest stroke mechanism (40% of patients including 24% cardiac origin, 14% intraarterial, 2% cardiac and arterial sources). In 32% large artery occlusive lesions caused hemodynamic brain ischemia. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes); the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Severe occlusive lesions (>50% stenosis) involved more than one large artery in 148 patients; 134 had one artery site involved unilaterally or bilaterally. The commonest occlusive sites were: extracranial vertebral artery (52 patients, 15 bilateral) intracranial vertebral artery (40 patients, 12 bilateral), basilar artery (46 patients). Intraarterial embolism was the commonest mechanism of brain infarction in patients with vertebral artery occlusive disease. Thirty-day mortality was 3.6%. Embolic mechanism, distal territory location, and basilar artery occlusive disease carried the poorest prognosis. The best outcome was in patients who had multiple arterial occlusive sites; they had position-sensitive TIAs during months to years.

  1. The distal semimembranosus complex: normal MR anatomy, variants, biomechanics and pathology

    Energy Technology Data Exchange (ETDEWEB)

    Beltran, Javier; Jbara, Marlena; Maimon, Ron [Department of Radiology, Maimonides Medical Center, 4802 Tenth Avenue, NY 11219, Brooklyn (United States); Matityahu, Amir; Hwang, Ki [Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY (United States); Padron, Mario [Department of Radiology, Clinica CEMTRO, Madrid (Spain); Mota, Javier [Department of Radiology, Instituto Clinica Corachan, Barcelona (Spain); Beltran, Luis [New York Medical College, Valhalla, NY (United States); Sundaram, Murali [Department of Radiology, Mayo Clinic, Rochester, MN (United States)

    2003-08-01

    To describe the normal MR anatomy and variations of the distal semimembranosus tendinous arms and the posterior oblique ligament as seen in the three orthogonal planes, to review the biomechanics of this complex and to illustrate pathologic examples. The distal semimembranosus tendon divides into five tendinous arms named the anterior, direct, capsular, inferior and the oblique popliteal ligament. These arms intertwine with the branches of the posterior oblique ligament in the posterior medial aspect of the knee, providing stability. This tendon-ligamentous complex also acts synergistically with the popliteus muscle and actively pulls the posterior horn of the medial meniscus during knee flexion. Pathologic conditions involving this complex include complete and partial tears, insertional tendinosis, avulsion fractures and bursitis. (orig.)

  2. 前臂背侧远端动脉穿支显微解剖与前臂后皮神经营养血管移植皮瓣的设计%Micradissection of distal antebrachial arterial perforators of dorsal forearm and design of flap pedicled with nutrient vessels of posterior antebrachial cutaneous nerve

    Institute of Scientific and Technical Information of China (English)

    张发惠; 郑和平; 张国栋

    2007-01-01

    anterior interosseous artery, radial interosseous cutaneous perforators, radial interosseous cutaneous perforators of posterior interosseous artery, carpal dorsal branch of radial artery and its perforators. The axis of medial muscle interspace, dorsal antebrachial medial vascular plexuses was consisted of medial branch of dorsal carpal branch of anterior interosseous artery, ulnaris interosseous cutaneous perforators, ulnaris interosseous cutaneous perforators of posterior interosseous artery, carpal dorsal branch of ulnaris artery and its perforators. ②Above mentioned arterial perforators sent out cutaneous branches, fascia branches and posterior antebrachial cutaneous nerve nutrient vessel to form vascular chain of cutaneous nerve stem and vascular nets of deep and superficial fascia.Muscle-periosteum branches of posterior interosseous artery had some ulnar periostea whose radial interosseous cutaneous perforators were anastoimosed with periosteum vessels in the middle and inferior segments of radius; therefore,there was an anatomic basis for distal pedicele compound flap.CONCLUSION: Blood supply of distal antebrachial arterial perforators of dorsal forearm is characterized by multiple sources, obviously longitudinal distribution and homologous nutrient vessel; therefore, there are three blood-supplied distal pedicled flap or compound flap of posterior antebrachial cutaneous nerve nutrient vessel. Rotation point of distal pediclde flap can reach wrist joint, and the compound flap can be applied in repairing the injury of distal tissue of hand.%背景:前臂后皮肤很适合手背侧修复,但对前臂后皮神经营养血管皮瓣的远端蒂动脉穿支缺少具体可操作性的研究,临床实际应用起来还较为困难.目的:研究前臂背侧远端的动脉穿支,为前臂后皮神经营养血管远端蒂皮瓣、复合瓣的合理设计提出解剖学理论.设计:单一样本观察.单位:解放军南京军区福州总医院军区骨科研究所临床解

  3. 胫骨下段螺旋型骨折合并后踝骨折的诊断与治疗%Diagnosis and treatment of the distal spiral tibial shaft fracture associated with posterior mal-leolar fracture

    Institute of Scientific and Technical Information of China (English)

    张正廉; 王士波; 高迪; 郑杰; 赵廷虎; 高彦军; 张勇

    2015-01-01

    Objective To explore the cause of leak diagnosis, injury mechanism and treatment strategy of the distal 1/3 spiral tibial shaft fracture associated with occult posterior malleolar fracture. Methods 81 patients with distal third spiral tibia shaft fracture associated posterior malleolar fractures were treated by surgery. The radiology detected 38 posterior malleolar fracture. The rest fractures were determined by CT scan. All cases were fixed with tibial intr-amedulary nailing at the supination foot and the internal-rotation tibia. The posterior malleolar fractures were fixed with ø 4. 5 mm cannulated screws. All cases of distal 1/2 fibular fractures were fixed with plates or Kirschner wires. All of proximal fibular fractures were not fixed. Results 81 cases were all followed up from 4 months to 11 months. 68 cases of posterior malleolar fractures were fixed with cannulated screws, which can prevent displacement during in-tramedullary nailing of tibia shaft fractures, and all showed radiographic evidence of healing. 13 cases were not fixed for small and no displacement fractures. 79 cases of spiral tibial shaft fracture were healed according to plain radio-graphs standard. 2 cases were ununion for excessive gap between fractures and later healed with bone grafting. 1 case occurred ankle traumatic arthritis. The wounds were not contaminated and no osteomyelitis occurred. According to Johner-Wruhs evaluation standard, the results were excellent in 67 cases, good in 10, fair in 3 and poor in 1;the ex-cellent and good rate was 95%. Conclusions Distal spiral tibia shaft fractures are associated with ipsilateral posteri-or malleolar fractures, which plain radiographs are often insufficient for detecting. Using a preoperative CT protocol for spiral tibial shaft fractures can significantly improve the ability to diagnose associated posterior malleolar fractures that may not be evident on plain radiographs. Injury mechanism is the supination foot and the internal

  4. Microsurgical anatomy and clinic significance of posterior inferior cerebellar artery%小脑后下动脉的显微解剖研究及其临床意义

    Institute of Scientific and Technical Information of China (English)

    吴江; 张世明; 徐峰

    2010-01-01

    目的 研究小脑后下动脉的显微解剖,为神经外科手术提供临床解剖资料.方法 手术显微镜下观察测量20具(共40侧)人脑标本的小脑后下动脉(PICA)的起始行径、直径、主要分支、穿动脉及分布,检查PICA与脑神经根的关系.结果 40侧标本共发出PICA 35支,平均管径(1.6±0.6)mm,距离椎基底动脉汇合点平均(16±5)mm.在35支PICA中28支PICA走行在第Ⅻ脑神经根之间,7支走行在第Ⅻ脑神经根下方,32支走行在第Ⅺ脑神经根之间.结论 PICA是椎基动脉系统重要的分支,变异多,走行与脑神经关系密切,熟悉解剖结构,在后颅窝手术中予以保护具有重要意义.%Objective To study the microsurgical anatomy of the posterior inferior cerebellar artery (PICA) for neurosurgery. Methods Twenty Chinese adult brain samples (40 sides) were measured with microscope for the diameters, lengths, origins, courses, and the branches of the PICA. The relationship between the PICA and cranial nerves was also checked. Results There were 35 PICAs in 20 brain samples.The mean diameter of the PICAs was (1.6±0.6) mm, the mean length from PICAs' origin of vertebral artery to the vertebrobasilar junction was (16±5) mm. In 35 PICAs,28 PICAs go through the rootlets of Ⅻ cranial nerves,7 PICAs go inferior Ⅻ cranial nerves, and 32 PICAs go through the rootlets of Ⅺ cranial nerves. Conclusions PICA is an important branch artery with more variation and complex relationship to the cranial nerves trend in the vertebral artery system. It is necessary to master the microsurgical anatomy of PICA and to be careful protection during the neurosurgical operations.

  5. “ EVALUACIÓN IN VITRO DEL GRADO DE FILTRACIÓN COMPARANDO TRES TÉCNICAS DE OBTURACIÓN: CONDENSACIÓN LATERAL, TOUCH'N HEAT Y TERMAFILL, POR MEDIO DE UN CORTE LONGITUDINAL, EN RAÍCES DISTALES DE MOLARES INFERIORES"

    OpenAIRE

    Pérez Negrón Pérez, Paola

    2012-01-01

    En el presente estudio de filtración apical se compararon tres técnicas de obturación: Condensación Lateral, Touch’n Heat y Thermafil. Hasta la actualidad se trata de encontrar la mejor técnica de obturación que ofrezca mejor grado de sellado tridimensional ya que no existe un método que garantice el 100% de eficacia. Se utilizaron 60 raíces distales de molares inferiores de piezas dentarias permanentes, con ápices completamente formados, sin fracturas radiculares y sin t...

  6. Diagnosis value of CTA on posterior inferior cerebellar artery aneurysm(report of 2 cases)%CTA对小脑后下动脉动脉瘤的诊断价值(附2例报告)

    Institute of Scientific and Technical Information of China (English)

    李平

    2014-01-01

    目的:探讨CTA对小脑后下动脉( PICA)动脉瘤的诊断价值。方法对2例PICA动脉瘤患者的临床资料进行回顾性分析。结果2例患者为老年,急性发病,经CT确诊蛛网膜下腔出血,发病后3 h内初次CTA检查均为阴性结果。经防止脑血管痉挛、增高血容量、保护脑细胞等治疗3~7 d后,病情好转1例,无效1例。再次行CTA检查发现PICA动脉瘤3个,其中1例患者为左侧PICA 2个动脉瘤合并脑积水,另1例患者左侧PICA有1个动脉瘤。2例患者的PICA动脉瘤均获得良好的影像信息。结论 CTA可作为PI-CA动脉瘤首选的检查方法,能提供其全面的影像资料。对首次CTA检查阴性者,经短期治疗后进行CTA复查仍为理想的选择。%Objective To explore the diagnosis value of CTA on posterior inferior cerebellar artery ( PICA ) aneurysm.Methods The clinical data of 2 patients with PICA aneurysms were analyzed retrospectively .Results Two patients were elderly,acute onset,CT confirmed subarachnoid hemorrhage ,CTA of the first time were negative within 3 h after the onset .After the treatments of preventing cerebral vasospasm , increasing blood volume , protecting brain cells and etc for 3-7 d, one case improved ,one case were invalid .Given CTA examination again then found 3 aneurysms, one case with 2 aneurysms located on the left side of the PICA , accompanying with hydrocephalus ,and the other case with 1 aneurysm located on the left side of the PICA .Two patients obtained a good image evaluation and rich information .Conclusions In view of the particularity of the PICA aneurysms , CTA can be used as the preferred method of examination , which can provide comprehensive imaging data .When CTA examination of the first time is negative , giving CTA again remains an ideal choice after short-term treatment .

  7. Effect of vertebral artery hypoplasia on the territory-related perfusion of posterior inferior cerebellar artery%椎动脉发育不全对小脑后下动脉供血区脑灌注的影响

    Institute of Scientific and Technical Information of China (English)

    马乾坤; 张道培; 张杰文; 张淑玲; 鹿桂凤; 尹所

    2016-01-01

    目的:探讨椎动脉发育不全(vertebral artery hypoplasia,VAH )对小脑后下动脉供血区脑灌注的影响。方法选择2014-12—2015-07年龄≥30岁并行头颅磁共振灌注成像和头颈部三维对比增强磁共振血管造影检查的头晕或眩晕患者244例。获脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)和达峰时间(TTP)灌注图,测量一侧小脑后下动脉供血区及对侧镜像区的灌注参数值(CBF、CBV、MTT、TTP),计算椎动脉直径较小侧/对侧镜像区的灌注参数相对比值(rCBF、rCBV、rMTT、rTTP)。定义 VAH 为椎动脉直径≤2 mm,或双侧椎动脉不对称比≥1.7:1,分为 VAH 组和 non-VAH(Non-hypoplasitic vertebral artey)组,对临床资料和小脑、延髓灌参数相对比值进行比较。结果共纳入114例患者,男女各57例;VAH 组31例(27.2%),左侧5例(16%),右侧26例(84%);Non-VAH 组83例。2组间 VA 直径较小侧与对侧的 rTTP和 rCBF≤0.85的例数存在显著统计学差异(P 值分别为0.005,0.031);rCBF 倾向于有统计学差异(P =0.098);rCBV、rMTT 及 rCBV≤0.85例数无显著统计学差异。结论VAH 可以造成小脑后下动脉供血区域低灌注改变,且以 TTP 延长或 CBF 降低为主。%Objective To investigate the effect of vertebral artery hypoplasia on the territory perfusion of posterior inferi-or cerebellar artery (PICA).Methods 244 patients with vertigo or dizziness (age≥30 years old)from December 2014 to July 201 5 were selected as subjects who underwent brain perfusion-weighted imaging (pWI)and three-dimensional dynamic con-trast-enhanced MRA (3D DCE-MRA).The perfusion figures of cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)were obtained.The perfusion parameters including CBF,CBV,MTT and TTP val-ues were measured at PICA areas and at the opposite mirror-imaging areas.Relative perfusion parameter values (rCBF,rCBV, rMTT and rTTP)defined as the ratio of the

  8. Multiple muscular variations including tenuissimus and tensor fasciae suralis muscles in the posterior thigh of a human case.

    Science.gov (United States)

    Arakawa, Takamitsu; Kondo, Takahiro; Tsutsumi, Masahiro; Watanabe, Yuko; Terashima, Toshio; Miki, Akinori

    2017-09-01

    The posterior thigh muscles on the right side of an 81-year-old male cadaver had multiple variations, denoted muscles I-IV. Muscle I originated from the posteromedial surface of the greater trochanter and divided into two muscle bellies. These muscle bellies fused with the long head of the biceps femoris and were innervated by two branches from muscular branches of the semitendinosus and the long head of the biceps. Muscle II separated from the medial surface of the long head of the biceps in the proximal third and fused with the semitendinosus in the distal fourth. Muscle III was a biventer muscle. Its superior belly separated from the medial surface of the long head of the biceps in the distal third. The inferior belly of this muscle fused with the posterior surface of the crural fascia and was innervated by the tibial nerve. Muscle IV separated from the adductor magnus muscle, passed between the long and short heads of the biceps, fused with the inferior belly of muscle III, and was innervated by the muscular branch of the common fibular nerve to the short head of the biceps. Peeling off the epineurium of the muscular branches to the inferior belly of muscle III showed that this nerve fascicle divided from the common trunk with branches to the gastrocnemius and soleus muscles. The inferior bellies of muscle III and muscle IV were thought to be equivalent to the tensor fasciae suralis and tenuissimus muscles, respectively.

  9. Preliminary clinical study on endovascular treatment of posterior inferior cerebellar artery aneurysms%小脑后下动脉瘤血管内栓塞治疗的初步临床研究

    Institute of Scientific and Technical Information of China (English)

    赵兵; 钟鸣; 谭显西; 郑匡; 张明升; 尹剑; 何文根

    2009-01-01

    Objective To study the methods and results of endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms. Methods Twenty-one patients with PICA aneurysms were treated with endovascular treatment. The locations of aneurysm on PICA were evaluated through the DSA. Eight patients received single coil embolization, 5 received liquid Glue embolization, 2 received coil embolization combined with liquid Glue, 2 received coil embolization assisted with stents, and 4 underwent ocelasion of the parent PICA. Outcome was evaluated with the Glasgow outcome scale (COS). Results There were complete (100%) occlusion in 5 patients, near complete (>90% ) occlusion in 2, and incomplete (85%) occlusion in 1 in single coil embolization. Seven patients with Glue embolization (n = 5 ) or combination with coils ( n = 2 ) exhibited complete ( 100% ) occlusion. There were near complete ( >90% ) occlusion in 2 cases with coil assisted with stents. Complete occlusion of the parent PICA was achieved in 3 patients, and near complete occlusion of PICA in one case. One patient suffered from new neurological deficits, and one patient treated with coils and stents died. None of the patients suffered from re-bleeding. These patients received follow-up during a mean period of (22±8) months. Overall long-term outcome was good ( GOS score 4 or 5 ) in 17 patients, poor ( COS score 2 or 3) in 3, and fatal ( GOS score 1 ) in one case. Conclusions According to the location of aneurysms on PICA, aneurysms can be effectively and safely treated with endovaecular embolization.%目的 探讨小脑后下动脉(PICA)瘤栓塞治疗的方法及效果.方法 回顾性分析21例PICA瘤经血管内栓塞治疗的临床资料,根据DSA资料估计动脉瘤的解削分段.采取单纯弹簧圈栓塞8例、单纯液体胶栓塞5例、弹簧圈联合液体胶栓塞2例、支架辅助弹簧圈栓塞2例、球囊辅助弹簧圈PICA闭塞4例,用格拉斯哥预后(GOS)评分评估疗效.结果

  10. 枕下远外侧入路治疗小脑后下动脉近端动脉瘤%Management of the proximal posterior inferior cerebellar artery aneurysms via far lateral approach with linear scalp incision

    Institute of Scientific and Technical Information of China (English)

    施铭岗; 佟小光

    2014-01-01

    目的 通过直线切口远外侧入路来治疗小脑后下动脉(PICA)近端动脉瘤.方法 回顾性分析应用枕下直线切口行远外侧入路外科处理PICA近端动脉瘤11例临床资料,并判断其疗效.11例破裂PICA近端动脉瘤,Hunt-Hess分级为Ⅰ~Ⅱ级6例,Ⅲ级3例,Ⅳ级2例.结果 11例破裂PICA近端动脉瘤均因血管内栓塞困难改为开颅夹闭或孤立术.无一例死亡,3例术后出现吞咽困难,出院时症状好转,2例手术直接夹闭困难,行枕动脉(OA)和PICA吻合,动脉瘤孤立术,其余8例无手术并发症.结论 未能行血管内栓塞治疗的PICA近端动脉瘤,可通过直线远外侧入路动脉瘤直接夹闭或行动脉搭桥动脉瘤孤立术,特别是夹层动脉瘤,直线切口远外侧入路治疗PICA动脉瘤,能充分暴露病变并取得较好的临床效果.%Objective To study the efficacyof surgical management of the proximal posterior inferior cerebellar artery(PICA) aneurysms by far lateral approach with linear scalp incision.Methods To manage the proximal PICA aneurysms by the far lateral approach and analyze its clinical outcome.According to Hunt-Hess Grade Score,of all 11 cases with the proximal PICA ruptured aneurysms,6 cases were of Ⅰ-Ⅱ grade,3 cases of Ⅲ and 2 cases of Ⅳ.Results All of 11 cases with the proximal PICA ruptured aneurysms were excluded for endovascular management because of their size,location and morphology,and then underwent craniotomy to clip or trap through OA-PICA bypass via far lateral approach with linear scalp incision.Postoperatively,therewasno mortality,3 cases had swallowing difficulty and improved by the time of discharge,2 cases underwent OA-PICA bypass after failure of direct clipping,the rest (8 cases) had no surgical complications.Condusions The proximal PICA aneurysms can be managed by directly clipping or bypass to trap the aneurysm via the far lateral approach with linear scalp incision,the bypass operation is the more suitable to the

  11. 枕动脉-小脑下后动脉吻合术治疗颅内段椎动脉梭形动脉瘤四例%Fusiform aneurysm of the vertebral artery: treatment by the trapping and occipital artery-posterior inferior cerebellar artery bypass in 4 cases

    Institute of Scientific and Technical Information of China (English)

    张永力; 石祥恩; 周忠清; 刘方军; 孙玉明

    2009-01-01

    @@ 对部分椎动脉瘤,尤其是累及小脑下后动脉(posteriorInferior cerebellar artery,PICA)的梭彤夹层动脉瘤,因无法火闭动脉瘤的同时,保证小脑下后动脉通畅,需要行枕动脉-PICA吻合术.因发病率低,手术困难,治疗风险大,文献报道较少[1].

  12. Biomechanical effectiveness of an arthroscopic posterior bankart repair versus an open bone block procedure for posterior shoulder instability.

    Science.gov (United States)

    Wellmann, Mathias; Bobrowitsch, Evgenij; Khan, Nicklas; Patzer, Thilo; Windhagen, Henning; Petersen, Wolf; Bohnsack, Michael

    2011-04-01

    The most effective surgical treatment for traumatic posterior shoulder instability remains unclear. An arthroscopic posterior Bankart repair is as effective as an open posterior bone block-capsulorrhaphy procedure regarding the restoration of humeral displacement with posterior and inferior forces. Controlled laboratory study. Biomechanical testing of 16 human shoulders was performed in 3 testing conditions: after ventilation (intact joint), after creation of a posteroinferior Bankart lesion with an additional cut of the posterior band of the inferior glenohumeral ligament, and after surgical shoulder stabilization. The shoulder stabilization was performed either by an open posterior bone block procedure and glenoid-based T-capsulorrhaphy or by an arthroscopic Bankart repair. Testing was performed in 2 positions-the sulcus test position and the jerk test position-with a passive humerus load of 50 N applied in the posterior, posteroinferior, and inferior directions. After the arthroscopic repair, there was no significant difference between the translation and the intact state for all tested directions. The bone block repair-capsulorrhaphy caused a significant decrease of posterior translation (sulcus test and jerk test positions) and posteroinferior translation (jerk test position). But the resulting posterior and posteroinferior translation was even significantly lower than the translation measured for the intact joints. However, the reduction of inferior translation, compared with that of the defect condition, was not significant after the bone block repair (sulcus test and jerk test positions). Compared with that of the intact joint, inferior translation after the bone block repair was significantly higher. The posterior bone block repair-capsulorrhaphy overcorrects posterior translation and does not effectively restore inferior stability, whereas the arthroscopic posterior Bankart repair restores posterior and inferior laxity of the intact joint. An arthroscopic

  13. Distal clavicle edema; Distales Klavikulaoedem

    Energy Technology Data Exchange (ETDEWEB)

    Vahlensieck, M.; Schmittke, I. [Radiologie Haydnhaus, Bonn (Germany); Schmidt, H.M. [Universitaet Bonn (Germany). Anatomisches Institut

    2006-07-15

    Distal clavicle marrow edema: frequency, MRI in the early stage and macroscopic correlation to the bone marrow distribution and to evaluate frequency and diagnostic criteria of a posttraumatic clavicula disorder with an edema pattern on MRI. An additional macroscopic study of the clavicle should elucidate anatomic pecularities which could explain the reaction of the distal clavicle. 285 MRI of traumatized patients were analyzed for edema pattern of the distal clavicle. Pattern A edema within the clavicle and the acromion was distinguished from pattern B edema within the clavicle only. Dissection in 20 cadavers should reveal vascular pecularities and the bone marrow distribution within clavicle and acromion or vascular pecularities. In 38 patients (13,3%) we found edema within the distal clavicle. Pattern A was found in 28 (9,8%) and pattern B in 10 patients (3,5%). Pattern A was usually associated with swelling of the AC joint (27 out of 28). Other injuries were not evident. 18 cadavers showed hematopoetic marrow within the distal clavicle and fatty marrow within the acromion. The distale clavicle can frequently react with edema pattern after trauma without evidence for another injury. Distinguish in cases with and cases without synovitis of the AC joint could have impact on therapy. A peculier vascular supply of the distal clavicle could not be found. (orig.) [German] Bestimmung der Haeufigkeit und diagnostischer Kriterien einer posttraumatischen Klavikulaerkrankung, die mit einem MR-tomographischen Oedemmuster auffaellt. Makroskopische Besonderheiten der Markhoehle sollten gesucht werden, die die besondere Reaktionsform der distalen Klavikula mit erklaeren koennten. 285 Patienten mit traumaassoziierten, zeitversetzt nach dem Unfallereignis bestehenden Schulterbeschwerden, wurden auf MR-tomographische Oedemmuster in der distalen Klavikula untersucht. Das Oedemmuster wurde in ''Klavikula allein'' (Muster B) und ''mit Beteiligung des

  14. Repercussões da L-alanil-glutamina sobre as concentrações de lactato e lactato desidrogenase (LDH em pacientes com isquemia crítica dos membros inferiores submetidos a revascularização distal Repercussions of l-alanyl-glutamine upon the concentrations of lactate and lactate dehydrogenase (LDH in patients with critical ischemia of lower limbs subjected to distal revascularization

    Directory of Open Access Journals (Sweden)

    Wellington Forte Alves

    2003-06-01

    Full Text Available OBJETIVO: Investigar efeitos da L-alanil-glutamina nas concentrações musculares de lactato, e nas concentrações sanguíneas de LDH, em pacientes com isquemia crítica dos membros inferiores submetidos à revascularização distal. MÉTODOS: Dezesseis adultos (12-homens/4-mulheres foram distribuídos em 2 grupos (1-controle/2-estudo. Três horas após injeção endovenosa de 250 ml de L-alanil-glutamina a 20% adicionados a 750 ml de soro fisiológico (Grupo 2, ou 1000 ml de solução salina (Grupo 1, iniciava-se a revascularização, sob raquianestesia. Amostras musculares e de sangue (arterial/venoso foram coletadas no início do procedimento (TI, no final (TF, e 10 e 20 minutos após isquemia (T1/T2. RESULTADOS: Observou-se redução significante (pPURPOSE: Investigate the repercussions of L-alanyl-glutamine in muscular tissue concentrations of lactate, and venous and arterial blood concentrations of LDH, in patients with critical ischemia of the lower limbs submitted to distal revascularization. METHODS: Sixteen adults (12 male/4 female were distributed in 2 groups (1-Control/2-Experiment. Three hours after the intravenous injection of 250 ml of a 20% solution of L-alanyl-glutamine added to 750 ml of saline solution (Group 2; or 1000 ml of saline solution (Group 1, distal bypass was carried out under spinal anesthesia. Muscle and blood samples (arterial/venous were collected at the beginning of the surgical procedure (TI, at the end (TF, and 10 and 20 minutes after re-establishment of blood flow. RESULTS: Significant reduction (p<0,05 of lactate concentration was observed in healthy muscle tissue in L-alanyl-glutamine treated patients in comparison to control group, at all times studied. There was a significant reduction (p <0,05 in venous concentrations of LDH in treated patients at all times studied (TI/TFV/T1V/T2V; and in arterial blood during reperfusion (T1A/T2A. CONCLUSIONS: 1. Decreased lactate concentrations in healthy skeletal

  15. Bilateral inferior turbinate osteoma

    Science.gov (United States)

    Sahemey, R.; Warfield, A.T.; Ahmed, S.

    2016-01-01

    Osteomas are the most common benign osteoclastic tumours of the paranasal sinuses. However, nasal cavity and turbinate osteomas are extremely rare. Only nine middle turbinate, three inferior turbinate and one inferior turbinate osteoma cases have been reported to date. The present case report describes the management and follow-up of symptomatic bilateral inferior turbinate osteoma. A 60-year-old female presented with symptoms of bilateral nasal obstruction and right-sided epiphora. Radiological investigation found hypertrophic bony changes involving both inferior turbinates. The patient was managed successfully by endoscopic inferior turbinectomies in order to achieve a patent airway, with no further recurrence of tumour after 3 months postoperatively. To the best of our knowledge, this is the first reported case of bilateral inferior turbinate osteoma. We describe a safe and minimally invasive method of tumour resection, which has a better cosmetic outcome compared with other approaches. PMID:27534890

  16. Distal renal tubular acidosis

    Science.gov (United States)

    Renal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA ... excreting it into the urine. Distal renal tubular acidosis (Type I RTA) is caused by a defect ...

  17. Functional organization of the left inferior precentral sulcus: dissociating the inferior frontal eye field and the inferior frontal junction.

    Science.gov (United States)

    Derrfuss, J; Vogt, V L; Fiebach, C J; von Cramon, D Y; Tittgemeyer, M

    2012-02-15

    Two eye fields have been described in the human lateral frontal cortex: the frontal eye field (FEF) and the inferior frontal eye field (iFEF). The FEF has been extensively studied and has been found to lie at the ventral part of the superior precentral sulcus. Much less research, however, has focused on the iFEF. Recently, it was suggested that the iFEF is located at the dorsal part of the inferior precentral sulcus. A similar location was proposed for the inferior frontal junction area (IFJ), an area thought to be involved in cognitive control processes. The present study used fMRI to clarify the topographical and functional relationship of the iFEF and the IFJ in the left hemispheres of individual participants. The results show that both the iFEF and the IFJ are indeed located at the dorsal part of the inferior precentral sulcus. Nevertheless, the activations were spatially dissociable in every individual examined. The IFJ was located more towards the depth of the inferior precentral sulcus, close to the junction with the inferior frontal sulcus, whereas the iFEF assumed a more lateral, posterior and superior position. Furthermore, the results provided evidence for a functional double dissociation: the iFEF was activated only in a comparison of saccades vs. button presses, but not in a comparison of incongruent vs. congruent Stroop conditions, while the opposite pattern was found at the IFJ. These results provide evidence for a spatial and functional dissociation of two directly adjacent areas in the left posterior frontal lobe.

  18. Lateralization Technique and Inferior Alveolar Nerve Transposition

    Directory of Open Access Journals (Sweden)

    Angélica Castro Pimentel

    2016-01-01

    Full Text Available Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics.

  19. Lateralization Technique and Inferior Alveolar Nerve Transposition

    Science.gov (United States)

    Sanches, Marco Antonio; Ramalho, Gabriel Cardoso; Manzi, Marcello Roberto

    2016-01-01

    Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics. PMID:27433360

  20. Posterior interosseous free flap: various types.

    Science.gov (United States)

    Park, J J; Kim, J S; Chung, J I

    1997-10-01

    The posterior interosseous artery is located in the intermuscular septum between the extensor carpi ulnaris and extensor digiti minimi muscles. The posterior interosseous artery is anatomically united through two main anastomoses: one proximal (at the level of the distal border of the supinator muscle) and one distal (at the most distal part of the interosseous space). In the distal part, the posterior interosseous artery joins the anterior interosseous artery to form the distal anastomosis between them. The posterior interosseous flap can be widely used as a reverse flow island flap because it is perfused by anastomoses between the anterior and the posterior interosseous arteries at the level of the wrist. The flap is not reliable whenever there is injury to the distal forearm or the wrist. To circumvent this limitation and to increase the versatility of this flap, we have refined its use as a direct flow free flap. The three types of free flaps used were (1) fasciocutaneous, (2) fasciocutaneous-fascia, and (3) fascia only. Described are 23 posterior interosseous free flaps: 13 fasciocutaneous flaps, 6 fasciocutaneous-fascial flaps, and 4 fascial flaps. There were 13 sensory flaps using the posterior antebrachial cutaneous nerve. The length and external diameter of the pedicle were measured in 35 cases. The length of the pedicle was on average 3.5 cm (range, 3.0 to 4.0 cm) and the external diameter of the artery averaged 2.2 mm (range, 2.0 to 2.5 mm). The hand was the recipient in 21 patients, and the foot in 2. All 23 flaps covered the defect successfully.

  1. Clinical application of anterior and posterior approaches for distal pancreatectomy with spleen and the splenic vessels preserved%前后入路法行保留脾血管及脾脏的胰体尾切除术12例

    Institute of Scientific and Technical Information of China (English)

    陈曦

    2013-01-01

    Objective To investigate the feasibility and safety of anterior and posterior approaches for distal pancreatectomy with spleen and the splenic vessels preserved. Methods Twelve patients of benign diseases of distal pancreas admitted in Taizhou People's Hospital from July 2008 to March 2013 were given anterior and posterior distal pancreatectomy with spleen and the splenic vessels preserved. Results All patients underwent the operation successfully. The mean operation time was (230±50) minutes. The blood loss was 240-360 ml with a mean of (300±60) ml. No patients needed blood transfusion during the operation. The mean length of post-operative hospital stay was (12±2) days. One patient developed pancreatic fistula and was cured with non-operative management; there was no other complications. All patients were followed up for 6 to 30 months, and there was no death. Conclusion On the basis of mastering the anatomy of splenic artery and vein, anterior and posterior approaches are safe and convenient in performing distal pancreatectomy with spleen and the splenic vessels preserved.%目的:探讨前后入路法行保留脾血管及脾脏的胰体尾切除术的可行性和安全性。方法回顾性分析2008年7月至2013年3月收治的12例胰体尾病变患者,采用前后入路法行保留脾血管及脾脏的胰体尾切除术。结果12例患者均成功完成手术。手术时间180~280 min,平均(230±50)min。术中出血量240~360 ml,平均(300±60)ml,术中均未输血。术后平均住院时间(12±2)d。术后胰瘘1例,引流量20~60 ml/d,经引流后治愈,无其他并发症。术后随访6~30个月,无一例死亡。结论在掌握脾动静脉的解剖基础上,采用前后入路法耐心、细致分离脾动静脉,保留脾血管及脾脏的胰体尾切除术安全、简便,易于实施,值得推广。

  2. An alternative method of osteosynthesis for distal humeral shaft fractures.

    Science.gov (United States)

    Levy, Jonathan C; Kalandiak, Steven P; Hutson, James J; Zych, Gregory

    2005-01-01

    Treatment of extra-articular distal humerus shaft fractures with plating techniques is often difficult, as traditional centrally located posterior plates often encroach on the olecranon fossa, limiting distal osseous fixation. The use of a modified Synthes Lateral Tibial Head Buttress Plate (Synthes, Paoli, PA) allows for a centrally placed posterior plating of the humeral shaft that angles anatomically along the lateral column to treat far distal humeral shaft fractures. Fifteen patients treated in this manner were followed to radiographic and clinical union. There were no cases of instrumentation failure or loss of reduction.

  3. Tratamento cirúrgico do câncer da porção distal do têrço inferior do reto pela ressecção anterior ultrabaixa e interesfinctérica com anastomose coloanal por videolaparoscopia Surgical treatment of ultra-low rectal cancer by laparoscopic coloanal anastomosis and intersphincteric resection

    Directory of Open Access Journals (Sweden)

    José Reinan Ramos

    2009-09-01

    Full Text Available OBJETIVO: Identificar as complicações pós-operatórias, a duração da internação hospitalar, os resultados funcionais clínicos, e os resultados oncológicos num seguimento médio de 2,5 anos nos pacientes com câncer do reto distal submetidosà ressecção anterior ultrabaixa e interesfinctérica com anastomose coloanal por videolaparoscopia. CASUÍSTICA E MÉTODOS: De um total de 491 pacientes operados pelo acesso videolaparoscópico, foram selecionados para esse estudo prospectivo 13 doentes , nove do sexo feminino,com câncer da porção distal do reto inferior entre os 172 pacientes com câncer do reto.Nenhum tumor T4 ou com resposta completa à quimiorradioterapia foi selecionado. A quimiorradioterapia neo-adjuvante foi aplicada em 8 doentes. RESULTADOS: A taxa de complicaçãos pós-operatória foi de 23,1%., sendo de 7,7% o índice de fístula anastomótica. A mortalide foi nula. A alta hospitalar ocorreu até o 7° dia de pós-operatório para 8 pacientes (61,5%, 4 dos quais no quinto dia.. O número médio de linfonodos por peça foi 13. A margem distal média foi de 1,5 cm. A margem circunferencial foi positiva em um caso (7,7%. Evacuação fracionada foi relatada por 11 pacientes (91% e incontinência fecal por 5 pacientes (41%. Onze pacientes (84% estão satisfeitos com a operação. Um paciente continua ileostomizado (7,7%. Em um seguimento médio de 30 meses ocorreu uma recidiva local (7,7% e dois casos de metástase pulmonar (15,4 %. As três pacientes faleceram da doença. Dez pacientes (77% estão sem doença. CONCLUSÕES: Apesar da pequena casuística, a analise permitiu as seguintes conclusões: a A técnica empregada mostrou ser viável e segura, pois apresentou baixo índice de complicação pós-operatória e mortalidade nula; b O emprego dessa técnica permitiu período de internação hospitalar pós-operatório curto; c Apesar dos resultados funcionais com avaliação clínica regular, evitou-se a colostomia

  4. REPAIR OF SOFT TISSUE DEFECTS OF LOWER EXTREMITY BY USING CROSS-BRIDGE CONTRALATERAL DISTALLY BASED POSTERIOR TIBIAL ARTERY PERFORATOR FLAPS OR PERONEAL ARTERY PERFORATOR FLAPS%桥式交叉胫后动脉或腓动脉穿支皮瓣修复对侧下肢软组织缺损

    Institute of Scientific and Technical Information of China (English)

    范存义; 阮洪江; 蔡培华; 刘坤; 黎逢峰; 曾炳芳

    2011-01-01

    目的 探讨采用健侧逆行胫后动脉或腓动脉穿支皮瓣桥式交叉修复下肢软组织缺损的可行性.方法 2007年8月-2010年2月,收治15例下肢软组织缺损患者.男14例,女1例;年龄25~48岁,平均33.9岁.交通事故伤8例,机器伤4例,重物砸伤3例.1例踝部植皮后遗留22 cm×8 cm大小的瘢痕(伤后35个月);余14例软组织缺损位于踝部1例,小腿中下1/3处12例,小腿中上1/3处1例;创面范围8cm×6 cm~26 cm×15 cm;受伤至入院时间为4~28 d,平均14.8 d.采用逆行胫后动脉穿支皮瓣(9例)或腓动脉穿支皮瓣(6例)桥式交叉修复,皮瓣切取范围为10 cm×8 cm~28 cm×17cm.供区创面两端直接缝合,中部残留创面取游离皮片植皮修复.术后5~6周行皮瓣断蒂.结果 术后2例腓动脉穿支皮瓣分别出现远端轻度淤血及边缘部分坏死,经换药后均成活;其余皮瓣断蒂后均顺利成活,受区创面Ⅰ期愈合.供区切口Ⅰ期愈合,植皮均成活.15例均获随访,随访时间7~35个月,平均19.5个月.皮瓣质地、色泽与受区相近,外形较满意.末次随访时根据美国矫形足踝协会(AOFAS)踝与后足功能评分标准,评分为81~92分,平均87.3分.结论 健侧逆行胫后动脉或腓动脉穿支皮瓣桥式交叉可较好修复对侧小腿或足部大面积皮肤软组织缺损,术中无需吻合血管,血管危象发生率低,手术成功率高.%Objective To discuss the feasibility of repairing soft tissue defects of lower extremity with a distally based posterior tibial artery perforator cross-bridge flap or a distally based peroneal artery perforator cross-bridge flap. Methods Between August 2007 and February 2010, 15 patients with soft tissue defect of the legs or feet were treated. There were 14 males and 1 female with a mean age of 33.9 years (range, 25-48 years). The injury causes included traffic accident in 8 cases, crush injury by machine in 4 cases, and crush injury by heavy weights in 3 cases. There was

  5. The Construction and Stability Affecting Factors Analysis of Finite Element Models of Distal Posterior Tibial Fractures%胫骨远端后侧不同类型骨折有限元模型的建立及其稳定性分析

    Institute of Scientific and Technical Information of China (English)

    付苏; 金丹; 梅刚; 邹振吕; 刘松; 王尚冲; 刘军

    2014-01-01

    ligaments in ANSYS software, the validity of the model was verified. The mainly two models of distal tibial posterior fractures in various fragment height and the ratio of articular surfaced involved were cut according to the established methods. The displacements of fragments which reflecting the stability were calculated by finite element analysis and then decided the possible relationship between them and stability. Results The models of distal tibial posterior fractures were established with a relatively good persistence with the results in previous study. Fragment height and the ratio of articular surfaced involved both affect the fracture stability with a similar trend. Both the relationship in the two models was determined. Conclusions The models of distal tibial posterior fractures could be constructed persistent with the real model in the previous study. Fragment height and the ratio of articular surfaced involved both affect the fracture stability with a similar trend for distal tibial posterior fractures.

  6. Microsurgical management of posterior circulation aneurysms

    Directory of Open Access Journals (Sweden)

    SHI Xiang-en

    2012-02-01

    Full Text Available Objective To retrospectively analyze effective methods for surgical management of posterior circulation aneurysms. Methods There were 42 patients with posterior circulation aneurysms [26 cases of basilar aneurysm (27 aneurysms, 16 cases of vertebral aneurysm (17 aneurysms]. There were 15 patients underwent bypass surgery [4 external carotid artery-P2 segment of posterior cerebral artery (ECA-P2, 2 internal carotid artery-P2 segment of posterior cerebral artery (ICA-P2, 2 internal maxillary artery-P2 segment of posterior cerebral artery (IMA-P2, 2 intracranial segment of vertebral artery-extracranial segment of vertebral artery, 5 occipital artery-posterior inferior cerebellar artery (OA-PICA] and 27 patients underwent simple surgical clipping. Results Activities of daily life of 37 patients recovered to normal (14 patients with aneurysm on the top of basilar artery, 3 with aneurysm on the trunk of basilar artery, 9 with vertebral aneurysm, 5 with posterior inferior cerebellar artery aneurysm, 4 with aneurysm on the junction of P1-P2 segment of posterior cerebral artery, 1 with superior cerebellar artery, and 1 with anterior inferior cerebellar aneurysm. None of them occurred operation-related neurological dysfunction. The recovery rate was 88.09% . Among the other patients, 1 with aneurysm on the top of basilar artery presented severe signs and symptoms of neurological defect and cannot take care of oneself, 2 patients (1 with aneurysm on the top of basilar artery, 1 with aneurysm on the trunk of basilar artery occurred brain stem hemorrhage after operation, and died at perioperative period, 2 with vertebral aneurysm relapsed and was cured after treatment. Conclusion Posterior circulation aneurysm which is not suitable for surgical clipping can be treated with intra? and extra?cranial vessel bypass. It may avoid the risk of surgical clipping of aneurysm.

  7. Distal Biceps Tendon Rupture

    Science.gov (United States)

    2010-06-01

    distal tendon . Although these findings overlap with those seen in tendinopathy , the presence of bone marrow edema at the radial tuberosity and fluid in...the bicipitoradial bursa suggests a partial tear rather than tendinopathy .3 When the distal biceps tendon tear is complete, MR imaging shows...Distal Biceps Tendon Rupture Military Medicine Radiology Corner, 2006 Radiology Corner Distal Biceps Tendon Rupture Contributors: CPT Michael

  8. Distally based lateral sural cutaneous nerve nutrient vessels island flap pedicled by posterior tibial artery perforator: anatomical basis and clinical applications%胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣的临床解剖与应用

    Institute of Scientific and Technical Information of China (English)

    张宇; 高秋明; 李泽宇; 刘畅; 时培晟; 邓小文

    2016-01-01

    目的 研究胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣移位修复足踝创面的临床解剖与应用.方法 选取红色乳胶动脉灌注的2侧新鲜和8侧4%甲醛固定下肢标本于手术显微镜下进行解剖研究,观察胫后动脉、腓肠外侧皮动脉及腓肠外侧皮神经的解剖学特征.根据解剖学结果设计皮瓣.纳入2007年2月至2012年6月行胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣修复的患者15例,观察疗效.结果 设计以胫后动脉在小腿远端穿支为蒂的胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣,胫后动脉穿支由腓肠外侧皮神经-腓肠神经营养血管链、穿支与腓肠外侧皮动脉间吻合血管两条供血通路逆行灌注.15例患者中移植皮瓣全部成活13例;9例静脉回流良好,移植皮瓣完全成活,6例术后出现静脉危象,其中2例移植皮瓣远端部分坏死.随访12例,随访34~ 98个月,皮瓣质地及外观良好,术后6个月皮瓣两点辨别觉(12 ±4) mm;踝关节功能优5例、良5例、中3例、差2例.结论 胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣血供充分且受解剖变异影响小,可用于踝周和足底内侧负重区皮肤缺损的修复.%Objective To study the anatomical basis of distally based lateral sural cutaneous nerve nutrient vessels island flap pedicled by posterior tibial artery perforator and its clinical application in foot ankle wound repair.Methods Eight sides of 4% formaldehyde-fixed and 2 sides of fresh cadavers were infused with colored red latex and dissected under operating microscope.The posterior tibial artery,lateral sural cutaneous artery,lateral sural cutaneous nerve were observed.Based on the results of anatomic study,the flaps were designed for clinical reparative application.From February 2007 to June 2012,15 patients underwent reparative operation of in foot ankle wound with distally based lateral sural cutaneous nerve nutrient vessels island flap

  9. Varices en Miembros Inferiores

    OpenAIRE

    Velásquez, Edna

    2015-01-01

    Insuficiencia venosa, es cuando las venas de las extremidades inferiores no son capaces de devolver al corazón toda la sangre que les llega y de hacerlo al ritmo y velocidad debidos, se puede afirmar que sufren insuficiencia venosa.

  10. Inferiority is compex

    Science.gov (United States)

    Wade, Jess

    2017-07-01

    In Inferior: How Science Got Women Wrong and the New Research That's Rewriting the Story, author Angela Saini puts forward the idea that bad science has been used to endorse the cultural prejudice that women are both biologically and psychologically second rate to men.

  11. Varices en Miembros Inferiores

    OpenAIRE

    Velásquez, Edna

    2015-01-01

    Insuficiencia venosa, es cuando las venas de las extremidades inferiores no son capaces de devolver al corazón toda la sangre que les llega y de hacerlo al ritmo y velocidad debidos, se puede afirmar que sufren insuficiencia venosa.

  12. Periosteal osteoid osteoma of the distal femur

    Directory of Open Access Journals (Sweden)

    Mohammed Fahd Amar

    2010-07-01

    Full Text Available Periosteal osteoid osteoma is extremely rare. The diagnosis is not always clear. We report a case of periosteal osteoid osteoma arising from the posterior surface of the right distal femur in a 21-year-old woman. After careful evaluation and excisional biopsy, histological examination confirmed the diagnosis of osteoid osteoma, showing the nidus, surrounding osteosclerosis, and catarrhal synovitis. The lesion was treated successfully with excision of the nidus.

  13. Distal and non-distal NIP theories

    CERN Document Server

    Simon, Pierre

    2011-01-01

    We study one way in which stable phenomena can exist in an NIP theory. We start by defining a notion of 'pure instability' that we call 'distality' in which no such phenomenon occurs. O-minimal theories and the p-adics for example are distal. Next, we try to understand what happens when distality fails. Given a type p over a sufficiently saturated model, we extract, in some sense, the stable part of p and define a notion of stable-independence which is implied by non-forking and has bounded weight. As an application, we show that the expansion of a model by traces of externally definable sets from some adequate indiscernible sequence eliminates quantifiers.

  14. Distal nail embbeding

    Directory of Open Access Journals (Sweden)

    Patricia Chang

    2014-01-01

    Full Text Available Male patient, 35 years old who came to dermatological consultation due to contact dermatitis on back, during his clinical examination alterations of his digits was seen. Dermatological examination reveals a rim of tissue at the distal edge of the nail of both big toenails and thickened nails (Fig.1a – c, 2a, b. Both big toenails were removed due to ingrown nails two times. Diagnosis of distal nail embedding was done. Distal nail embedding is a rim of tissue at the distal edge of the nail. Causes can de acquired or congenital.

  15. Pictorial essay: Distal colostography

    Directory of Open Access Journals (Sweden)

    Rahalkar Mukund

    2010-01-01

    Full Text Available Distal colostography (DC, also called distal colography or loopography, is an important step in the reparative management of anorectal malformations (ARMs with imperforate anus, Hirschsprung′s disease (occasionally and colonic atresia (rarely in children and obstructive disorders of the distal colon (colitis with stricture, carcinoma or complicated diverticulosis in adults. It serves to identify/confirm the type of ARM, presence/absence of fistulae, leakage from anastomoses, or patency of the distal colon. We present a pictorial essay of DC in a variety of cases.

  16. Miastenia grave distal: relato de caso

    Directory of Open Access Journals (Sweden)

    Scola Rosana Herminia

    2003-01-01

    Full Text Available Relatamos o caso de uma mulher de 30 anos com quadro de fraqueza muscular nos membros inferiores com predomínio distal com início há 7 anos. Na evolução apresentou fraqueza muscular nos membros superiores. O exame físico mostrava nervos cranianos sem alterações, hipotrofia bilateral de quadriceps e interósseos dos pés, redução da força muscular mais intensa em tibiais anteriores e interósseos dorsais dos pés e reflexos tendinosos globalmente hipoativos. Foi realizado teste de estimulação repetitiva que mostrou decremento maior que 10% no nervo fibular e ulnar. A dosagem de anticorpos anti-receptor de acetilcolina foi positiva. Tomografia computadorizada de tórax foi normal. Dosagem de hormônios tireoidianos mostrou evidências laboratoriais de hipertireoidismo, porém sem manifestações clínicas. Foi iniciado tratamento com piridostigmina havendo melhora importante do quadro clínico. A fraqueza distal é um sintoma inicial raro na miastenia grave (MG. Contudo, a MG deve entrar no diagnóstico diferencial de doenças que cursam com fraqueza muscular distal de membros superiores ou inferiores.

  17. Incarcerated inferior lumbar (Petit's) hernia.

    Science.gov (United States)

    Astarcioğlu, H; Sökmen, S; Atila, K; Karademir, S

    2003-09-01

    Petit's hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh reinforcement repair.

  18. Posterior circulation revascularization to manage vertebrobasilar occlusion

    Directory of Open Access Journals (Sweden)

    SHANG Yan-guo

    2012-06-01

    Full Text Available Objective To discuss the technique and effect of posterior circulation revascularization to manage vertebrobasilar occlusion. Methods Nine patients with vertebrobasilar occlusion were treated by using occipital artery-posterior inferior cerebellar artery bypass, superficial temporal artery-superior cerebellar artery bypass, superficial temporal artery-posterior cerebral artery bypass and occipital artery-vertebral artery bypass with radial artery graft. Results Intraoperative indocyanine green angiography showed all the bypass arteries were patent. Postoperative DSA or CTA showed bypass arteries patent in 8 patients, among whom seven patients got obvious improvement on MR or CT perfusion. One patient died of heart failure on the 15th day postoperative. During the follow-up of eight patients, no stroke reoccurred, four patients got back to nearly normal life. Conclusion Most of the patients with vertebrobasilar occlusion could benefit from the posterior circulation revascularization, which should be confirmed by randomized controlled clinical trials in the future.

  19. Semicontinuidad Inferior por Redes

    OpenAIRE

    Sanjuán, Arturo; Universidad Distrital Francisco José de Caldas

    2014-01-01

    Se presenta una construcción de la noción de semicontinuidad inferior a través de las redes. Dicha construcción es diferente a las usualmente presentadas, pues no usa imágenes inversas de conjuntos o filtros. Adicionalmente, se demuestra la equivalencia de una definición usual con la definición propuesta y se presenta un ejemplo de funcionales semicontinuos en donde sea útil la definición propuesta.

  20. Posterior Tibial Tendon Dysfunction

    Science.gov (United States)

    .org Posterior Tibial Tendon Dysfunction Page ( 1 ) Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the ...

  1. MK1附着体在老年患者单侧远中游离缺失修复中的临床应用%Clinical application of MK1 attachment in restoration of unilateral posterior distal extension edentulous for the elderly patients

    Institute of Scientific and Technical Information of China (English)

    袁亚娣; 苗松

    2012-01-01

    目的:评价MK1附着体修复老年患者单侧远中游离缺失的临床效果.方法:采用MK1附着体为23例单侧后牙游离缺失的老年患者进行修复治疗,经过8-44个月的随访,从主观感受、临床及X线检查评价修复效果.结果:所有患者对MK1附着体义齿的美观舒适性、固位力、咀嚼效能均感到满意;21例患者认为其摘戴方便.经配对t检验,MK1附着体义齿与原可摘义齿相比在美观舒适性、固位力、咀嚼效能方面均有明显优势(P 0.05). Only 2 cases had gingivitis, which disappeared after periodontal treatment. Among 23 cases, there were 3 cases relined the removable denture due to the absorption of the alveolar bone, while no abnormality on abutments and the alveolar bone was found in other cases. Conclusion: The MK1 attachment was shown to be a quite favorable choice to restore unilateral posterior distal extension edentulous for the elderly patients.

  2. STUDY ON VARIATIONS OF INFERIOR SEGMENTAL BRANCH OF RENAL ARTERY

    Directory of Open Access Journals (Sweden)

    Chandragirish S

    2014-11-01

    Full Text Available Background: The segmental arteries of the kidney supply the organ in such a way that, each renal pole receives its own artery while, the anterior portion between the poles is supplied by an upper and lower segmental vessel. These two arteries also include in their territory the lateral edge of the kidney and adjacent to the strip of parenchyma on the dorsal or posterior aspect of the organ. The knowledge of inferior segmental branch of renal artery is very important for surgeries in its distribution area in kidney. Materials and Methods: 100 kidneys (Fifty pairs intact with abdominal aorta were collected from department of Forensic medicine, JSS Medical College and Mysore Medical College. For study of segmental variation Corrosion cast technique method was used. The variations of inferior segmental branch of renal artery were observed and recorded. Results: In present study type I inferior segmental branch of renal artery were found in - 59% cases, type II in - 6% cases, type III in - 28% cases, type IV in - 2% cases. Conclusion: The inferior segmental artery from the anterior division of the renal artery is the commonest event –arising in 59%. This is Type I, the normal type. It arises from the renal artery (28% or from the posterior division (6% or from the aorta (2%. The knowledge of inferior segmental branch of renal artery helpful in kidney transplantation and renal surgery because these type of surgeries success mainly depends on arterial ligations.

  3. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

    Directory of Open Access Journals (Sweden)

    G Raghavendra Prasad

    2013-01-01

    Full Text Available Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric - inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up.

  4. Distal Radius Fracture (Broken Wrist)

    Science.gov (United States)

    .org Distal Radius Fracture (Broken Wrist) Page ( 1 ) The radius is the larger of the two bones of the forearm. The ... the distal end. A fracture of the distal radius occurs when the area of the radius near ...

  5. The effect of ameloblastoma and keratocystic odontogenic tumor on the displacement pattern of inferior alveolar canal in CBCT examinations

    Science.gov (United States)

    Abdi, Isa; Taheri Talesh, Kourosh; Yazdani, Javad; Keshavarz Meshkin Fam, Sareh; Ghavimi, Mohammad Ali; Arta, Seyed Ahmad

    2016-01-01

    Background. The inferior alveolar canal should be examined as a significant anatomical landmark, particularly in the posterior body and ramus of the mandible, for dental and surgical procedures. In the present study, the effects of two pathological lesions, ameloblastoma and keratocystic odontogenic tumor, on canal displacement were investigated. Methods. This study had a single-blinded design. Twenty-six patients with lesions in the mandible referred to Imam Reza Hospital, Tabriz, Iran, were studied in two equal groups (13 patients with a histopathological diagnosis of ameloblastoma and 13 with a histopathological diagnosis of odontogenic keratocyst). After confirming the initial incisional biopsy and pathological report, cone beam computed tomography (CBCT) of lesions larger than 3 cm mesiodistaly and those involving the mandibular posterior body and ramus were included in the study. Two maxillofacial surgeons in association with an oral and maxillofacial radiologist examined three points on CBCT images to determine the mandibular canal position relative to the lesions from the lingual and buccal aspects. Results. The results of statistical analyses showed that in ameloblastoma, the inferior alveolar canal had been displaced more buccally in the ramus area (point A) (84.6%) but in the distal region (point C), the displacement was less buccal (41.6%). The canal was displaced buccally in 53.8% of cases at point A and in 46.2% of cases at point C in KOT lesions. Finally chi-squared test did not show any statistically significant differences between these two lesions. Conclusion. The results of this study showed no relationship between these lesions and the displacement of the mandibular canal. PMID:27651881

  6. Transphyseal Distal Humerus Fracture.

    Science.gov (United States)

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian

    2016-01-01

    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle.

  7. Giant distal humeral geode

    Energy Technology Data Exchange (ETDEWEB)

    Maher, M.M. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Department of Radiology, St. Vincent' s Hospital, Elm Park, Dublin 4 (Ireland); Kennedy, J.; Hynes, D. [Department of Orthopaedics, Mater Misericordiae Hospital, Dublin (Ireland); Murray, J.G.; O' Connell, D. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland)

    2000-03-30

    We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized. (orig.)

  8. Distal splenorenal shunt

    Science.gov (United States)

    ... path. As a result, swollen blood vessels called varices form. They develop thin walls that can break ... or x-rays show that you have bleeding varices. Distal splenorenal shunt surgery reduces pressure on the ...

  9. Distal humeral epiphyseal separation.

    Science.gov (United States)

    Moucha, Calin S; Mason, Dan E

    2003-10-01

    Distal humeral epiphyseal separation is an uncommon injury that is often misdiagnosed upon initial presentation. To make a timely, correct diagnosis, the treating physician must have a thorough understanding of basic anatomical relationships and an awareness of the existence of this injury. This is a case of a child who sustained a separation of the distal humeral epiphysis, as well as multiple other bony injuries, secondary to child abuse.

  10. 小脑后下动脉动脉瘤的血管内治疗与手术治疗(附21例报道)%Endovascular embolization and microsurgery of posterior inferior cerebellar artery aneurysms (report of 21 cases)

    Institute of Scientific and Technical Information of China (English)

    廖旭兴; 蔡瑜; 王辉; 梁学军; 段成斌; 胡建军; 邓其峻; 马廉亭

    2015-01-01

    Objective To explore the methods to treat posterior inferior cerebellar artery (PICA) aneurysms and their effects. Methods The clinical data of 21 patients with PICA aneurysms, of whom, 7 were treated by surgery, 13 by the endovascular embolization and 1 by conservative treatment from January, 2008 to December, 2013, were analyzed retrospectively. Results Five patients receiving the endovascular treatment died within 7 days after the embolization. Sixteen patients were followed up from 6 to 36 months. One patient receiving coils embolization was treated by stent-assisted coils embolization because the aneurysm recurred 1 year after the coils embolization. One patient undergoing the surgery still had ataxia during the following up. The aneurysm was unchanged 2 years after the conservative treatment in 1 patient. There were no recurrence of the aneurysms and complications in the other 13 patients during the following up. Conclusions The patency of the medullar branch of PICA is a prerequisite for treatment of PICA aneurysms. The method to treat PICA aneurysms should be selected according to the aneurysms and whether PICA is a superior blood vessel or not. The effects of the endovascular embolization and surgery on PICA aneurysms are good if the method to treat them is proper for PICA aneurysms.%目的:探讨小脑后下动脉(PICA)动脉瘤的血管内治疗与手术治疗效果。方法回顾性分析21例PICA动脉瘤患者的临床资料,其中近侧段11例行单纯弹簧圈栓塞1例,支架辅助弹簧圈栓塞7例,开颅夹闭术1例,行枕动脉-PICA血管吻合术1例,保守治疗1例;过渡段5例,行单纯弹簧圈栓塞2例,开颅夹闭术2例,开颅动脉瘤包裹术1例;远侧段5例,行弹簧圈闭塞载瘤动脉1例,NBCA闭塞载瘤动脉1例,Gluba胶闭塞载瘤动脉1例,开颅切除动脉瘤2例。结果术后1周内死亡5例,其余病例随访6~36个月,其中近侧段行单纯弹簧圈栓塞的1例复发,

  11. Posterior ankle impingement.

    Science.gov (United States)

    Giannini, Sandro; Buda, Roberto; Mosca, Massimiliano; Parma, Alessandro; Di Caprio, Francesco

    2013-03-01

    Posterior ankle impingement is a common cause of chronic ankle pain and results from compression of bony or soft tissue structures during ankle plantar flexion. Bony impingement is most commonly related to an os trigonum or prominent trigonal process. Posteromedial soft tissue impingement generally arises from an inversion injury, with compression of the posterior tibiotalar ligament between the medial malleolus and talus. Posterolateral soft tissue impingement is caused by an accessory ligament, the posterior intermalleolar ligament, which spans the posterior ankle between the posterior tibiofibular and posterior talofibular ligaments. Finally, anomalous muscles have also been described as a cause of posterior impingement.

  12. CT in thrombosed dilated posterior epidural vein

    Energy Technology Data Exchange (ETDEWEB)

    Bammatter, S.; Schnyder, P.; Preux, J. de

    1987-05-01

    The authors report a case of thrombosis of the distal end of an enlarged right posterior epidural vein. The patient had a markedly narrow lumbar canal due to L5 spondylolisthesis. The dilated vein and the thrombosis were displayed by computed tomography but remained unrecognized until surgery. Pathogenesis of this condition is discussed. A review of the English, French and German literature revealed no prior radiological reports of a similar condition.

  13. [Aneurysm of the anterior inferior cerebellar artery: case report].

    Science.gov (United States)

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  14. Periosteal osteoblastoma of the distal femur

    Energy Technology Data Exchange (ETDEWEB)

    Nakatani, Tetsuya; Yamamoto, Tetsuji; Akisue, Toshihiro; Marui, Takashi; Hitora, Toshiaki; Kawamoto, Teruya; Nagira, Keiko; Yoshiya, Shinichi; Kurosaka, Masahiro [Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe (Japan); Fujita, Ikuo; Matsumoto, Keiji [Department of Orthopaedic Surgery, Hyogo Medical Center for Adults, Akashi, Hyogo (Japan)

    2004-02-01

    Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a 17-year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors. (orig.)

  15. Estudio en una población de recién nacidos con peso inferior a 1500 gramos en la Comunidad de Cantabria : influencia de la patología neonatal y nutrición en su crecimiento posterior

    OpenAIRE

    Guerra Diez, José Lorenzo

    2013-01-01

    RESUMEN: Introducción: El incremento de la supervivencia actual de los niños nacidos con peso inferior a 1500 gramos ha supuesto un aumento en la demanda asistencial en relación a su crecimiento y desarrollo. Objetivos: Clasificar los pacientes por pequeño / adecuado a su edad gestacional (PEG) recuperador / no recuperador de talla (SDS

  16. Inferior Flap Tympanoplasty: A Novel Technique for Anterior Perforation Closure

    Directory of Open Access Journals (Sweden)

    Haim Gavriel

    2013-01-01

    Full Text Available Objective. To report a novel tympanoplasty modification for anterior tympanic membrane perforation closure. Materials and Methods. A prospective study on 13 patients who underwent inferior tympanoplasty between December 2008 and May 2011 was carried out. In our technique, an inferior rather than a posterior flap is raised and the graft is laid from the inferior direction to obtain better access to the anterior part of the tympanic membrane perforation and provide better support. Results. A total of 13 patients underwent the novel inferior tympanoplasty technique with a mean age of 33 years. Six patients had undergone tympanoplasties and/or mastoidectomies in the past, 3 in the contralateral ear. A marginal perforation was observed in 3 cases, total perforation in 2 and subtotal in 1 case. The mean preoperative pure-tone average was 40.4 dB (10 to 90 dB, compared to 26.5 dB (10 to 55 dB postoperatively. All perforations were found to be closed but one (92.3% success rate. Conclusions. The inferior tympanoplasty technique provides a favorable outcome in terms of tympanic membrane closure and hearing improvement for anterior perforations, even in difficult and complex cases. It is based on a well-known technique and is easy to implement.

  17. Laparoscopic Distal Pancreatectomy

    Science.gov (United States)

    Melotti, Gianluigi; Butturini, Giovanni; Piccoli, Micaela; Casetti, Luca; Bassi, Claudio; Mullineris, Barbara; Lazzaretti, Maria Grazia; Pederzoli, Paolo

    2007-01-01

    Objective: To describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team. Summary Background Data: Laparoscopic distal pancreatic resection has increasingly been described as a feasible and safe procedure, although accompanied by a high rate of conversion and morbidity. Methods: A consecutive series of patients affected by solid and cystic tumors were selected prospectively to undergo laparoscopic distal pancreatectomy performed by the same surgical team. Clinical characteristics as well as diagnostic preoperative assessment and intra- and postoperative data were prospectively recorded. A follow-up of at least 3 months was available for all patients. Results: Fifty-eight patients underwent laparoscopic resection between May 1999 and November 2005. All procedures were successfully performed laparoscopically, and no patient required intraoperative blood transfusion. Splenic vessel preservation was possible in 84.4% of spleen-preserving procedures. There were no mortalities. The overall median hospital stay was 9 days, while it was 10.5 days for patients with postoperative pancreatic fistulae (27.5% of all cases). Follow-up was available for all patients. Conclusions: Our experience in 58 consecutive patients was characterized by the lack of conversions and by acceptable rates of postoperative pancreatic fistulae and morbidity. Laparoscopy proved especially beneficial in patients with postoperative complications as they had a relatively short hospital stay. Solid and cystic tumors of the distal pancreas represent a good indication for laparoscopic resection whenever possible. PMID:17592294

  18. Unilateral maxillary molar distalization with zygoma-gear appliance.

    Science.gov (United States)

    Kilkis, Dogan; Bayram, Mehmet; Celikoglu, Mevlut; Nur, Metin

    2012-08-01

    The aim of this study was to present the orthodontic treatment of a 15-year-old boy with a unilateral maxillary molar distalization system, called the zygoma-gear appliance. It consisted of a zygomatic anchorage miniplate, an inner bow, and a Sentalloy closed coil spring (GAC International, Bohemia, NY). A distalizing force of 350 g was used during the distalization period. The unilateral Class II malocclusion was corrected in 5 months with the zygoma-gear appliance. The maxillary left first molar showed distalization of 4 mm with an inclination of 3°. The maxillary premolars moved distally with the help of the transseptal fibers. In addition, there were slight decreases in overjet (-0.5 mm) and maxillary incisor inclination (-1°), indicating no anchorage loss from the zygoma-gear appliance. Preadjusted fixed appliances (0.022 × 0.028-in, MBT system; 3M Unitek, Monrovia, Calif) were placed in both arches to achieve leveling and alignment. After 14 months of unilateral distalization with the zygoma-gear appliance and fixed appliances, Class I molar and canine relationships were established with satisfactory interdigitation of the posterior teeth. Acceptable overjet and overbite were also achieved. This article shows that this new system, the zygoma-gear appliance, can be used for unilateral maxillary molar distalization without anchorage loss.

  19. Escleritis posterior bilateral Bilateral posterior scleritis

    Directory of Open Access Journals (Sweden)

    A. Zurutuza

    2011-08-01

    Full Text Available La escleritis posterior es un proceso inflamatorio de la parte posterior de la esclera. Su prevalencia es muy baja y el diagnóstico puede resultar complicado por la ausencia de signos oculares externos. Es más frecuente en mujeres. Cuando aparece en pacientes jóvenes no suele tener otras patologías asociadas, pero en mayores de 55 años hasta un tercio de los casos tienen relación con alguna enfermedad sistémica, sobre todo la artritis reumatoide. El diagnóstico de esta patología puede requerir un abordaje multidisciplinar y la colaboración de oftalmólogos con neurólogos, internistas o reumatólogos. En este artículo se describe un caso de escleritis posterior bilateral idiopática.Posterior scleritis is an inflammatory process of the posterior part of the sclera. Its prevalence is very low and its diagnosis can be complicated due to the absence of external ocular signs. It is more frequent in women. In young patients it does not usually have other associated pathologies, but in those over 55 years nearly one-third of the cases have a relation with some systemic disease, above all rheumatoid arthritis. The diagnosis of this pathology can require a multidisciplinary approach and the collaboration of ophthalmologists with neurologists, internists or rheumatologists. This article describes a case of idiopathic bilateral posterior scleritis.

  20. OPTIMAL DISTAL SCREW ALIGNMENT IN THE GAMMA NAIL

    Institute of Scientific and Technical Information of China (English)

    Ching-KongChao; Chun-ChingHsiao; Po-QuangChen

    2002-01-01

    The effect of stress distribution due to the changes of the distal screw alignment in relation to the Gamma nail and the femoral shaft is thoroughly studied in this paper. Failure of the Gamma nail composite occurs through the cranial aperture of the distal screws and the insertion hole for the lag screw due to nonunion, delayed-union and continued weight-bearing. A three-dimensional finite element model was used to study the fractured femur, the Gamma nail, the lag screw and the distal locking screws. The first and the second distal screws were inserted into the Gamma nail in four different configurations. We found that the stress of the Gamma nail composite was substantially reduced with the two screws configured in the anterior to posterior direction. This alignment can bear greater loading in the more demanding fracture types. In the subtrochanteric fracture or the comminuted fractures at the proximal femur, the optimal alignment of the two distal screws was in the anterior to posterior direction.

  1. Distal radioulnar joint injuries

    Directory of Open Access Journals (Sweden)

    Binu P Thomas

    2012-01-01

    Full Text Available Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint , forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments.The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis.

  2. Direct anastomosis of contralateral C7 nerve root transfer with affected-side inferior trunk for repair of brachial plexus avulsion injury

    Institute of Scientific and Technical Information of China (English)

    Houjun Yan; Changqing Hu; Yingli Jia; Chunjie Cui; Xuefeng Li; Jingyang Zhang

    2006-01-01

    AIM:To observe the effect of direct anastomosis of contralateral C7 nerve root transferred through prespinal route with affected-side inferior trunk for repair of brachial plexus avulsion injury,and investigate its feasibility. METHODS:Two male patients.with the age of 24 and 41 years respectively,were retrieved.When admitted to the hospital,they were diagnosed as brachial plexus avulsion injury.They subjected the operation in the 252 Hospital of Chinese PLA in March 2006 and May 2006 respectively.The proximal end of contralateral C7 nerve root was dissociated to nerve root pore and the distal end was dissociated to anterior and posterior divisions of middle trunk.The injured C7 nerve root was widely dissociated to inferior trunk,medial cord,ulnar nerve and medial head of median nerve.When elbow and shoulder joints were in flexion,the injured C7 nerve root was directly anastomosed with contralateral C7 nerve root in the gap between affected-side cervical vagina vasorum and esophagus with no tensions. RESULTS:Durling 3 to 5 hours of operation,little hemorrhage was found,nerves were not used for connection.Dyspnea,hoarse voice and other complications did not appear,either.In the postoperative 7th to 8th months.electremyogram examination showed that the growth velocity of anastomosed nerve was normal.CONCLUSION:Direct anastomosis of contralateral C7 nerve root transferred through prespinal route with affected-side inferior trunk can be used for repair of brachial plexus avulsion injury with satisfying therapeutic effects.

  3. Microsurgical anatomy of the posterior circulation

    Directory of Open Access Journals (Sweden)

    Pai Balaji

    2007-01-01

    Full Text Available Context: The microsurgical anatomy of the posterior circulation is very complex and variable. Surgical approaches to this area are considered risky due to the presence of the various important blood vessels and neural structures. Aims: To document the microsurgical anatomy of the posterior circulation along with variations in the Indian population. Materials and Methods: The authors studied 25 cadaveric brain specimens. Microsurgical dissection was carried out from the vertebral arteries to the basilar artery and its branches, the basilar artery bifurcation, posterior cerebral artery and its various branches. Measurements of the outer diameters of the vertebral artery, basilar artery and posterior cerebral artery and their lengths were taken. Results: The mean diameter of the vertebral artery was 3.4 mm on the left and 2.9 mm on the right. The diameter of the basilar artery varied from 3-7 mm (mean of 4.3 mm. The length varied from 24-35 mm (mean of 24.9 mm. The basilar artery gave off paramedian and circumferential perforating arteries. The origin of the anterior inferior cerebellar artery (AICA varied from 0-21 mm (mean 10.0 mm from the vertebrobasilar junction. The diameter of the AICA varied from being hypoplastic i.e., < 0.5 mm to 2 mm (mean 1.0 mm. The superior cerebellar artery (SCA arises very close to the basilar bifurcation, in our series (1-3 mm from the basilar artery bifurcation. The diameter of the SCA varied from 0.5-2.5 mm on both sides. The posterior cerebral artery (PCA is divided into four segments. The PCA gave rise to perforators (thalamoperforators, thalamogeniculate arteries, circumflex arteries and peduncular arteries, medial posterior choroidal artery, lateral posterior choroidal artery and cortical branches. In 39 specimens the P1 segment was found to be larger than the posterior communicating artery, in six specimens it was found to be equal to the diameter of the posterior communicating artery and in five specimens it

  4. [Epidemiology and management of isolated distal deep venous thrombosis].

    Science.gov (United States)

    Galanaud, J-P; Kahn, S R; Khau Van Kien, A; Laroche, J-P; Quéré, I

    2012-12-01

    Isolated distal deep-vein thromboses (DVT) are infra-popliteal DVT without involvement of proximal veins or pulmonary embolism (PE). They can affect deep calf (tibial anterior, tibial posterior, or peroneal) or muscular (gastrocnemius or soleal) veins. They represent half of all lower limbs DVT. Proximal and distal DVTs differ in terms of risk factor profile, proximal DVT being more frequently associated with chronic risk factors and distal DVT with transient ones. Their natural history (rate of spontaneous proximal extension) is debated leading to uncertainties on the need to diagnose and treat them with anticoagulant drugs. In the long term, the risk of venous thromboembolic recurrence is lower than that of proximal DVT and their absolute risk of post-thrombotic syndrome is unknown. French national guidelines suggest treating with anticoagulants for 6 weeks a first episode of isolated distal DVT provoked by a transient risk factor and treating for at least 3 months unprovoked or recurrent or active cancer-related distal DVT. The use of compression stockings use is suggested in case of deep calf vein thrombosis. Ongoing therapeutic trials should provide important data necessary to establish an evidence-based mode of care, especially about the need to treat distal DVT at low risk of extension with anticoagulants.

  5. The Parasternal Short-Axis View Improves Diagnostic Accuracy for Inferior Sinus Venosus Type of Atrial Septal Defects by Transthoracic Echocardiography.

    Science.gov (United States)

    Snarr, Brian S; Liu, Michael Y; Zuckerberg, Jeremy C; Falkensammer, Christine B; Nadaraj, Sumekala; Burstein, Danielle; Ho, Deborah; Gardner, Monique A; Butto, Arene; Ewing, Stanford G; Pandian, Natesa G; Banerjee, Anirban

    2017-03-01

    Sinus venosus defects (SVD) of the inferior vena cava (IVC) type, or inferior SVDs, are an uncommon form of atrial communication located outside the confines of the fossa ovalis and involve override of the IVC. Despite numerous studies describing the anatomical and echocardiographic features of the inferior SVD, distinguishing this defect from a large secundum atrial septal defect (ASD) by echocardiography is often challenging. Accurate diagnosis of an inferior SVD and correct differentiation from a secundum ASD is essential for appropriate presurgical planning. Absence of the posterior rim in the parasternal short-axis views may serve as a useful clue in diagnosing inferior SVDs. We sought to determine the utility of using the presence or absence of a posterior atrial rim in the parasternal short-axis view to help distinguish an inferior SVD from a secundum ASD. This sign may help clinch the diagnosis when subcostal imaging is suboptimal. We retrospectively reviewed transthoracic echocardiograms from 15 patients with a known surgical diagnosis of an inferior SVD between 2004 and 2015. The presence or absence of a posterior rim in the parasternal short-axis view was determined by two primary investigators. The posterior rim was also evaluated in 14 patients with a secundum ASD repair as controls. Echocardiograms were then reviewed blindly by attending-level echocardiographers and cardiology fellows in training. Diagnostic accuracy was assessed both with and without the use of the posterior rim criterion. Statistical analysis was used to determine the effect of using the rim criterion on inferior SVD diagnosis. We also reviewed all surgically diagnosed secundum ASDs that were incorrectly diagnosed as inferior SVD by preoperative imaging and determined whether use of the posterior rim criterion would have resulted in the correct diagnosis. The posterior rim was absent in all 15 patients with a surgical diagnosis of inferior SVD and present in all 14 patients with a

  6. Noninverted images in inferior mirages

    NARCIS (Netherlands)

    van der Werf, S.Y.

    2011-01-01

    Inferior mirages over sun-exposed roads often appear in isolated strips at their near sides and the reflected scenery exhibits multiple images. This effect is explained as due to slight undulations of the road's surface. At the same time, some of these images, although they are reflections, are not

  7. Posterior cingulate epilepsy: clinical and neurophysiological analysis.

    Science.gov (United States)

    Enatsu, Rei; Bulacio, Juan; Nair, Dileep R; Bingaman, William; Najm, Imad; Gonzalez-Martinez, Jorge

    2014-01-01

    Posterior cingulate epilepsy (PCE) is misleading because the seizure onset is located in an anatomically deep and semiologically silent area. This type of epilepsy is rare and has not been well described yet. Knowledge of the characteristics of PCE is important for the interpretation of presurgical evaluation and better surgical strategy. The purpose of this study was to better characterise the clinical and neurophysiological features of PCE. This retrospective analysis included seven intractable PCE patients. Six patients had postcingulate ictal onset identified by stereotactic EEG (SEEG) evaluations. One patient had a postcingulate tumour. We analysed clinical semiology, the scalp EEG/SEEG findings and cortico-cortical evoked potential (CCEP). The classifications of scalp EEG were various, including non-localisible, lateralised to the seizure onset side, regional parieto-occipital, regional frontocentral and regional temporal. Three of seven patients showed motor manifestations, including bilateral asymmetric tonic seizures and hypermotor seizures. In these patients, ictal activities spread to frontal (lateral premotor area, orbitofrontal cortex, supplementary motor area, anteior cingulate gyrus) and parietal (precuneus, posterior cingulate gyrus, inferior parietal lobule (IPL), postcentral gyrus) areas. Four patients showed dialeptic seizures or automotor seizures, with seizure spread to medial temporal or IPL areas. CCEP was performed in four patients, suggesting electrophysiological connections from the posterior cingulate gyrus to parietal, temporal, mesial occipital and mesial frontal areas. This study revealed that the network from the posterior cingulate gyrus and the semiology of PCE (motor manifestation vs dialeptic/automotor seizure) varies depending upon the seizure spread patterns.

  8. Avoiding injury to the inferior alveolar nerve by routine use of intraoperative radiographs during implant placement.

    Science.gov (United States)

    Burstein, Jeffrey; Mastin, Chris; Le, Bach

    2008-01-01

    Injury to the inferior alveolar nerve during implant placement in the posterior atrophic mandible is a rare but serious complication. Although a preoperative computerized tomography scan can help determine the distance from the alveolar ridge to the nerve canal, variables such as magnification errors, ridge anatomy, and operator technique can increase the chance for complications. The routine use of intraoperative periapical radiographs during the drilling sequence is an inexpensive and reliable tool, allowing the operator to confidently adjust the direction and depth of the implant during placement. Most important, it helps avoid the risk of injury to the inferior alveolar nerve in cases in which there is limited vertical alveolar bone. Using this technique for 21 implants placed in the posterior atrophic mandible, with less than 10 mm of vertical bone to the inferior alveolar nerve canal, the authors observed no incidents of postoperative paresthesia.

  9. Distally based superficial sural artery flap for soft tissue coverage in the distal 2/3 of leg and foot

    Directory of Open Access Journals (Sweden)

    Kamath B

    2005-01-01

    Full Text Available Background: Skin coverage for defects in the lower 2/3 of leg, ankle region and posterior heel has always been a difficult challenge for reconstructive surgeon. Methods: We describe our experience with the distally based superficial sural artery flap coverage in 48 patients with moderate sized defects in these difficult areas. Results: One out of 48 flaps (in 48 patients was lost totally and 3 suffered marginal necrosis which did not require any secondary procedure. These complications could have been avoided by proper selection of cases and refining technical skills. Conclusion: This simple procedure could be an important and versatile tool for any reconstructive surgeon in providing skin coverage in the distal leg and proximal foot. Preservation of major arteries of the lower limb, minimal donor defect, relatively uninjured donor area in compound fracture or poly trauma involving distal leg are some of the advantages of the flap.

  10. Posterior Fossa Syndrome

    Directory of Open Access Journals (Sweden)

    Serhan Kupeli

    2014-08-01

    Full Text Available Posterior fossa syndrome is defined as the temporary and complete loss of speech after posterior fossa surgery which is not related to cerebellar hemorrhage, infection of the cerebellum, degenerative or neoplastic diseases of the cerebellum. In this review, we aimed to outline the incidence of posterior fossa syndrome, to define the risk factors for posterior fossa syndrome, to describe accompanying neurobehavioural and psychologic problems and to speculate about the etiologic mechanisms. The diagnosis of medulloblastoma and midline location of the tumor are important risk factors for the development of posterior fossa syndrome. These findings support the hypothesis that temporary ischemia and edema due to retracted and largely manipulated dentate nuclei and superior cerebellar pedincles may be the cause of mutism. Informing the family and the patient about the posterior fossa syndromemust be a component of the preoperative interview and patients who developed posterior fossa syndrome should be followed for accompanying neurobehavioural and psychologic problems even after mutism improved. [Archives Medical Review Journal 2014; 23(4.000: 636-657

  11. Distal arthrogryposis syndrome

    Directory of Open Access Journals (Sweden)

    Kulkarni K

    2008-01-01

    Full Text Available A 5-month-old male infant presented with weak cry, decreased body movements, tightness of whole body since birth, and one episode of generalized seizure on day 4 of life. He was born at term by elective caesarian section performed for breech presentation. The child had failure to thrive, contractures at elbow and knee joints, hypertonia, microcephaly, small mouth, retrognathia, and camptodactyly. There was global developmental delay. Abdominal examination revealed umbilical and bilateral inguinal hernia. Visual evoked response and brainstem evoked response audiometry were abnormal. Nerve conduction velocity was normal. Magnetic resonance imaging of brain revealed paucity of white matter in bilateral cerebral hemispheres with cerebellar and brain stem atrophy. The differential diagnoses considered in the index patient were distal arthrogryposis (DA syndrome, cerebroculofacioskeletal syndrome, and Pena Shokier syndrome. The index patient most likely represents a variant of DA: Sheldon Hall syndrome.

  12. Estudo da correlação do posicionamento dos incisivos superiores e inferiores com a relação ântero-posterior das bases ósseas Maxillary and mandibular incisor position and the skeletal sagital relationship: a correlation study

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Gregório Cabrera

    2005-12-01

    Full Text Available OBJETIVOS: estudou-se a correlação quanto ao comportamento das bases ósseas através da avaliação Wits e as variações aceitáveis quanto às inclinações vestíbulo-linguais dos incisivos centrais superiores por meio de métodos específicos e distintos para as avaliações cefalométricas e em modelos em gesso. METODOLOGIA: foram utilizadas telerradiografias em norma lateral e modelos em gesso de 57 jovens brasileiros, sendo 26 do gênero masculino e 31 do feminino, com idades de 12 anos e 9 meses a 20 anos e 11 meses, tratados ortodonticamente através de aparelhos Straight Wire - padrão, apresentando as seis chaves para a oclusão perfeita preconizada por Andrews. RESULTADOS: para a avaliação Wits, quanto ao relacionamento entre as bases ósseas, o valor normativo encontrado foi de -2,26mm e desvio padrão de 1,83mm, sem dimorfismo sexual. Para as aferições cefalométricas, os valores das inclinações dos incisivos superiores apresentaram média de +13,35º e os inferiores de +5,14º. Nas aferições em modelos, o valor padrão médio encontrado para as inclinações dos incisivos centrais superiores foi de +7,96º e para os inferiores de +5,03º. CONCLUSÃO: na análise dos resultados foi possível constatar haver uma correlação significante entre o comportamento da variação das bases ósseas e as inclinações dos incisivos centrais superiores e inferiores.AIM: it was studied the behavior of the dentoskeletal relationship through the Wits appraisal and the acceptable variations of the maxillary and mandibular incisor buccolingual inclinations through different methods using teleradiographies and plaster models. METHODS: the sample was comprised by teleradiographs in lateral norm and plasters models from fifty seven brazilian youths, divided in 26 male and 31 females. The age ranged from 15 years and 5 month old for the females and 16 years and 6 month old for the males, orthodontically treated by the Straight

  13. Laparoscopic three-port distal pancreatectomy

    Science.gov (United States)

    Subhas, Gokulakkrishna; Gupta, Natasha; Mittal, Vijay K; Jacobs, Michael J

    2011-01-01

    Aims Laparoscopic distal pancreatectomy is becoming a more commonly used procedure, which may involve the use of four to seven ports, depending on the technique. Initial data on feasibility, safety and outcome with the three-port laparoscopic distal pancreatectomy are presented. Methods The patient is placed in a partial thoracoabdominal position exposing the left flank in a reverse Trendelenberg position. A 10-mm Hassan trocar is inserted through a subcostal anterior axillary incision. A 5-mm midclavicular and 10-mm posterior axillary line trocar are placed. The specimen is retrieved from the anterior axillary line port. Results Ten women and seven men, aged 26–88 years (mean 61 years), were evaluated. Their body mass indexes ranged from 18–37 (mean 27). Pancreatic lesion size ranged from 1.0–5.5 cm (mean 3.0 cm). Operative time was 116–296 min (mean 170 min). Blood loss was 10–300 ml (mean 142 ml). No operation required conversion or additional trocar placement. Post-operative stay was 2–7 days (mean 4 days). No patient developed a pancreatic fistula. Conclusion Operative time, blood loss and post-operative stay of this three-port technique compare favourably with published data. PMID:21492337

  14. Distal corporoplasty for distal cylinders extrusion after penile prosthesis implantation.

    Science.gov (United States)

    Carrino, Maurizio; Chiancone, Francesco; Battaglia, Gaetano; Pucci, Luigi; Fedelini, Paolo

    2017-02-03

    Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Several methods have been proposed for repairing a distal penile erosion. We present our preliminary experience in "Distal corporoplasty" technique. We enrolled 18 consecutive patients whose underwent a distal corporoplasty with simultaneous reimplantation of an "AMS 700 inflatable penile prosthesis (LGX)" from January 2013 to November 2015 at our hospital. All procedures were performed by a single surgical team. Intraoperative and postoperative complications have been classified and reported according to Satava6 and Clavien-Dindo (CD) system.7 Mean values with standard deviations (±SD) were computed and reported for all items. Mean age of the patients was 53.61 (±11.90) years. Mean body max index (BMI) was 24.22 (±2.51). Mean operative time was 85.2 (±13.1) minutes. Blood losses were minimal. No intraoperative complications are reported according to Satava classification. Four out of 18 patients (22.22%) experienced postoperative complications according to CD system. All patients had sexual intercourse for the first time postsurgery after a mean of 59.11 ± 2.08 days. Mean follow-up was 22.11 (±9.95). Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Distal corporoplasty was first described by Mulcahy. He reported a series of 14 patients with a follow-up of about 2 years with optimal functional outcomes. Moreover, distal corporoplasty resulted in shorter operative time, better function, less pain, and fewer recurrences than Gortex windsock repair.10 In our experience, distal corporoplasty is a simple and safe procedure in the treatment of distal cylinders extrusion when the prosthetic material is not exposed to the exterior.

  15. 后循环梗死:病变分布和CT血管造影%Posterior circulation infarction: distribution of lesions and CT angiography

    Institute of Scientific and Technical Information of China (English)

    吉利; 刘贤; 宋玉强; 王倩

    2014-01-01

    Objective To investigate the correlation between the distribution of lesions on MRI and the findings of computerized tomography angiography (CTA) in patients with posterior circulation infarction.Methods Patients with acute posterior circulation infarction were enrolled in the study.The sites of the infarcts were divided into proximal,middle and distal infarctions according to the results of MRI.All the patients received head and neck CTA.The correlation between the distribution of posterior circulation infarcts and the sites of vertebrobasilar system lesions was analyzed.Results A total of 203 patients with acute posterior circulation infarction were enrolled.Their primary clinical symptoms and signs were unilateral limb weakness (n =77,37.93%),dizziness (n =129,63.55%),dysarthria (n =31,15.27%),nausea and vomiting (n =61,30.05%),headache (n =79,38.92%),gait abnormal (n =50,24.63%),nystagmus (n=34,16.75%),and ataxia (n=21,10.34%).Proximal infarction (n=35,17.24%):medullary infarction (n =28,13.79%),posterior inferior cerebellar artery infarction (n =7,3.45%); middle infarction (n =95,46.79%):pontine infarction (n =80,39.4%),anterior inferior cerebellar infarction (n =15,7.39%); distal infarction (n=73,35.96%):middle cerebral infarction (n=6,2.96%),superior cerebellar infarction (n =16,7.88%),thalamic infarction (n =34,(16.75%),occipital lobe infarction (n =10,4.93%),temporal lobe infarction (n =7,3.44%).Extracranial vertebral artery lesions were most common in the distal infarction group.It reached 53.42%,and was significantly higher than 22.86% in the proximal infarction group (P =0.003) and 33.68% in the middle infarction group (P =0.010).Intracranlal vertebral artery lesions were most common in the proximal infarction group.It reached 57.14%,and then followed by the middle infarction (41.05%).They were all significantly higher than 15.07% in the distal infarction group (all P =0.000).Basilar artery lesions

  16. Corrective Osteotomy for Ipsilateral Distal Clavicular and Coracoid Malunions.

    Science.gov (United States)

    Yoshida, Atsushi

    2015-08-01

    Malunion after double disruption injuries of the superior shoulder suspensory complex accompanied by shoulder pain and dysfunction has been reported infrequently. A 37-year-old man had a double disruption injury (fractures of the distal clavicle and the base of the coracoid process). Conservative treatment resulted in malunion. Twelve months after the injury, pain continued in the coracoclavicular interval, and there was only 125° forward shoulder elevation. Radiographs showed 50° inferior angulation of the distal clavicle and elongated base of the coracoid process. Corrective osteotomy was required; however, the concomitant malunion of the coracoid prevented correction of the deformity with osteotomy of the distal clavicle alone. Therefore, osteotomy of the coracoid was performed. Twelve months postoperatively, successful bone union resulted in loss of pain. Forward elevation had recovered to 160°. Distal clavicular fractures with concomitant coracoid fractures are often significantly displaced, which disrupts physiologic coupling of clavicular and scapular motion and limits forward elevation. In the case of such malunions, excessive movement at the clavicle-scapula junction during mobilization causes pain in the coracoclavicular interval. Correction of this deformity requires osteotomy of both the clavicular and coracoid malunions.

  17. Reconstruction of posterior interosseous nerve injury following biceps tendon repair: case report and cadaveric study.

    Science.gov (United States)

    Mokhtee, David B; Brown, Justin M; Mackinnon, Susan E; Tung, Thomas H

    2009-06-01

    Surgical repair of distal biceps tendon rupture is a technically challenging procedure that has the potential for devastating and permanently disabling complications. We report two cases of posterior interosseous nerve (PIN) injury following successful biceps tendon repair utilizing both the single-incision and two-incision approaches. We also describe our technique of posterior interosseous nerve repair using a medial antebrachial cutaneous nerve graft (MABC) and a new approach to the terminal branches of the posterior interosseous nerve that makes this reconstruction possible. Finally, we advocate consideration for identification of the posterior interosseous nerve prior to reattachment of the biceps tendon to the radial tuberosity.

  18. NEGLECTED POSTERIOR KNEE DISLOCATION TREATED WITH CLOSED MANIPULATION AND UNIPLANAR EXTERNAL FIXATOR : A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Manikumar

    2015-06-01

    Full Text Available Neglected traumatic posterior knee dislocations were rare in orthopaedic literature more so after a surgical intervention . Majority of the injuries are associated with vascular trauma and distal or proximal fractures and complete disruption of anterior and posterior cruciate ligaments and nerve traction injuries. Traumatic knee dislocations are therefore treated as an orthopaedic emergency. There were no definitive guide lines to open reduction as well as conservative methods of treatment. The end results of functional recovery are still controversial with residual posterior subluxation. Here we present a case of neglected posterior knee dislocation treated with closed manipulation and uni planar external fixator

  19. Recurrent posterior shoulder instability after rifle shooting.

    Science.gov (United States)

    Cho, Jae-Ho; Chung, Nam-Su; Song, Hyung-Keun; Lee, Doo-Hyung

    2012-11-01

    Rifle shooting produces a sudden counterforce against the body thorough the anterior shoulder, which may produce a traumatic injury in soldiers. Posterior instability of the shoulder can occur in soldiers who practice rifle shooting. To the authors' knowledge, few reports have examined shooting-related injuries in soldiers. This article describes the case of a 27-year-old male soldier who presented with left shoulder pain and instability after rifle training. He developed symptoms, and presented radiographic findings consistent with a posterior Bankart lesion. Intraoperatively, while in the lateral decubitus position, a posterior portal was created 3 cm inferior and 2 cm lateral to the posterolateral corner of acromion for making a proper angle for inserting anchors. A reverse bony Bankart lesion and adjacent cartilage breakdown at the glenoid rim were noted. An arthroscopic capsulolabral repair was performed with 3-mm bioabsorbable anchors to the glenoid rim. No gross reverse Hill-Sachs lesion or hyaline cartilage lesion was noted. Postoperatively, the arm was supported in a sling with an abduction pillow for 5 weeks. Codman's exercises, scapular protraction exercises, and elbow and wrist exercises were started. Physical therapy focused on reestablishing glenohumeral range of motion and rotator cuff and periscapular muscle strength. Six months postoperatively, the patient had normal scapular kinesis and reported no shoulder pain or symptoms of instability associated with a reverse bony Bankart lesion. Copyright 2012, SLACK Incorporated.

  20. Tacrolimus Ointment for Refractory Posterior Blepharitis.

    Science.gov (United States)

    Sakassegawa-Naves, Fernando Eiji; Ricci, Helena Maria Moraes; Moscovici, Bernardo Kaplan; Miyamoto, Daniela Akemi; Chiacchio, Brenda Biagio; Holzchuh, Ricardo; Santo, Ruth Muyuki; Hida, Richard Yudi

    2017-09-18

    This prospective, randomized, double-blind interventional case series was designed to evaluate the short-term efficacy of 0.03% tacrolimus ointment as a new therapeutic approach for refractory cases of posterior blepharitis. Forty eyes (20 patients) with posterior blepharitis refractory to previous treatment were randomized. Eighteen eyes (9 patients) were treated with 0.03% tacrolimus ointment and 20 eyes (10 patients) with placebo ointment twice daily. Patients were evaluated with a questionnaire and slit-lamp examination 14 days and 28 days after treatment, and symptoms and signs of blepharitis were compared to those observed at baseline. We could observe statistical difference in the outcome measurements of meibomian gland secretion, conjunctival hyperemia, telangiectasia of inferior lid, Rose Bengal, and fluorescein scoring for the study group. As for the symptoms score, we observed statistical difference in the symptoms scoring for pruritus and dry eye sensation in the tacrolimus group. This study suggests that topical administration of 0.03% tacrolimus ointment can improve some symptoms and some ocular surface status in patients with refractory posterior blepharitis.

  1. Tuberculosis pulmonar de campos inferiores

    OpenAIRE

    Alejandra González; Marcelo Fernández Casares; Matías Baldini; Alfredo Monteverde

    2010-01-01

    La tuberculosis (TB) que compromete sólo los campos pulmonares inferiores (TBCI) es poco frecuente en el adulto y en general está asociada a alguna causa de inmunodepresión. El objetivo de nuestro trabajo fue determinar la incidencia de TBCI en nuestra población y comparar sus características respecto de la TB pulmonar de localización habitual. Se estudiaron en forma retrospectiva en el período de 2004 a 2008, 42 pacientes con TBCI que fueron comparados con 84 pacientes con TB pulmonar de loc...

  2. Posición del agujero dentario inferior en la rama ascendente en huesos mandibulares secos de adultos

    OpenAIRE

    Gutierrez-Ventura, Fredy; Facultad de Estomatología Roberto Beltrán Universidad Peruana Cayetano Heredia; Tataje Vivanco, Yarim

    2014-01-01

    Objetivos: El presente estudio consistió en observar y definir la ubicación del agujero dentario inferior en la rama ascendente de 53 mandíbulas secas de adultos. Material y métodos: La muestra fue recolectada del laboratorio de anatomía de la Facultad de Estomatología de la UPCH. Se evaluó y midió las distancias del agujero dentaria inferior hacia los bordes limitantes de la rama mandibular, es decir la distancia anterior, posterior, superior e inferior y establecer relación entre las medida...

  3. Spondylolisthesis and Posterior Instability

    Energy Technology Data Exchange (ETDEWEB)

    Niggemann, P.; Beyer, H.K.; Frey, H.; Grosskurth, D. (Privatpraxis fuer Upright MRT, Koeln (Germany)); Simons, P.; Kuchta, J. (Media Park Klinik, Koeln (Germany))

    2009-04-15

    We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI.

  4. Posterior tracheal diverticulosis.

    Science.gov (United States)

    Madan, Karan; Das, Chandan J; Guleria, Randeep

    2014-10-01

    Multiple tracheal diverticulosis is a rare clinical entity. Tracheal diverticula are usually recognized radiologically as solitary right paratracheal air collections on thoracic computed tomography examination. They are usually asymptomatic but can occasionally present with persistent symptoms. We herein report the case of a 50-year-old male patient who underwent extensive evaluation for persistent cough. Multiple posterior right paratracheal air collections were recognized on thoracic multidetector computed tomography examination, which was confirmed as multiple-acquired posterior upper tracheal diverticula on flexible bronchoscopy. The patient improved with conservative medical management.

  5. Distal DVT: worth diagnosing? Yes.

    Science.gov (United States)

    Schellong, S M

    2007-07-01

    Much of the argument for or against diagnosis of distal deep vain thrombosis (DVT) depends on the extra effort that has to be spent on it. This review presents the data on ultrasound of paired calf veins and calf muscle veins (distal ultrasound) in terms of protocols, feasibility, reliability and expected findings. In summary, provided there is adequate and anatomically sound training of sonographers, distal ultrasound is a valid, 4-minute procedure, which can easily be added to the examination of proximal veins. The second part of the review refers to the pathophysiology of ascending DVT, which is the most common type. Adequate patient care in terms of benefit, harm and cost includes a single non-invasive examination followed by risk adopted treatment allocation. This concept ideally should be valid for any type of DVT. The data extending this concept to distal DVT can only be derived from studies that look closely at this entity (i.e. in fact diagnose distal DVT). Even before these data are available, diagnosing distal DVT at least doubles the number of symptomatic patients in which signs and symptoms can be ascribed to a definitive diagnosis, which in itself is a benefit for patient care.

  6. Posterior Urethral Valves

    Directory of Open Access Journals (Sweden)

    Steve J. Hodges

    2009-01-01

    Full Text Available The most common cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although the incidence has remained stable, the neonatal mortality for this disorder has improved due to early diagnosis and intensive neonatal care, thanks in part to the widespread use of prenatal ultrasound evaluations. In fact, the most common reason for the diagnosis of posterior urethral valves presently is the evaluation of infants for prenatal hydronephrosis. Since these children are often diagnosed early, the urethral obstruction can be alleviated rapidly through catheter insertion and eventual surgery, and their metabolic derangements can be normalized without delay, avoiding preventable infant mortality. Of the children that survive, however, early diagnosis has not had much effect on their long-term prognosis, as 30% still develop renal insufficiency before adolescence. A better understanding of the exact cause of the congenital obstruction of the male posterior urethra, prevention of postnatal bladder and renal injury, and the development of safe methods to treat urethral obstruction prenatally (and thereby avoiding the bladder and renal damage due to obstructive uropathy are the goals for the care of children with posterior urethral valves[1].

  7. Neural correlates of cognitive impairment in posterior cortical atrophy.

    Science.gov (United States)

    Kas, Aurélie; de Souza, Leonardo Cruz; Samri, Dalila; Bartolomeo, Paolo; Lacomblez, Lucette; Kalafat, Michel; Migliaccio, Raffaella; Thiebaut de Schotten, Michel; Cohen, Laurent; Dubois, Bruno; Habert, Marie-Odile; Sarazin, Marie

    2011-05-01

    With the prospect of disease-modifying drugs that will target the physiopathological process of Alzheimer's disease, it is now crucial to increase the understanding of the atypical focal presentations of Alzheimer's disease, such as posterior cortical atrophy. This study aimed to (i) characterize the brain perfusion profile in posterior cortical atrophy using regions of interest and a voxel-based approach; (ii) study the influence of the disease duration on the clinical and imaging profiles; and (iii) explore the correlations between brain perfusion and cognitive deficits. Thirty-nine patients with posterior cortical atrophy underwent a specific battery of neuropsychological tests, mainly targeting visuospatial functions, and a brain perfusion scintigraphy with 99mTc-ethyl cysteinate dimer. The imaging analysis included a comparison with a group of 24 patients with Alzheimer's disease, matched for age, disease duration and Mini-Mental State Examination, and 24 healthy controls. The single-photon emission computed tomography profile in patients with posterior cortical atrophy was characterized by extensive and severe hypoperfusion in the occipital, parietal, posterior temporal cortices and in a smaller cortical area corresponding to the frontal eye fields (Brodmann areas 6/8). Compared with patients with Alzheimer's disease, the group with posterior cortical atrophy showed more severe occipitoparietal hypoperfusion and higher perfusion in the frontal, anterior cingulate and mesiotemporal regions. When considering the disease duration, the functional changes began and remained centred on the posterior lobes, even in the late stage. Correlation analyses of brain perfusion and neuropsychological scores in posterior cortical atrophy highlighted the prominent role of left inferior parietal damage in acalculia, Gerstmann's syndrome, left-right indistinction and limb apraxia, whereas damage to the bilateral dorsal occipitoparietal regions appeared to be involved in B

  8. Reverse Distal Transverse Palmar Arch in Distal Digital Replantation.

    Science.gov (United States)

    Wei, Ching-Yueh; Orozco, Oscar; Vinagre, Gustavo; Shafarenko, Mark

    2017-07-22

    Refinements in microsurgery have made distal finger replantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances. We describe a new technique for anastomosis in fingertip replantation, whereby the need for venous grafts is eliminated. Applying the reverse distal transverse palmar arch technique, 11 cases of distal digital replantation were performed between January 2011 and July 2016. The described procedure was used for arterial anastomosis in 10 cases and arteriovenous shunting for venous drainage in 1 case. A retrospective case review was conducted. The technical description and clinical outcome evaluations are presented. Ten of the 11 replanted digits survived, corresponding to an overall success rate of 91%. One replant failed due to venous insufficiency. Blood transfusions were not required for any of the patients. Follow-up (range, 1.5-5 months) revealed near-normal range of motion and good aesthetic results. All of the replanted digits developed protective sensation. The average length of hospital admission was 5 days. All patients were satisfied with the results and were able to return to their previous work. The use of the reverse distal transverse palmar arch is a novel and reliable technique in distal digital replantation when an increase in vessel length is required, allowing for a tension-free arterial repair without the need for vein grafts.

  9. Non-compliance Appliances for Upper Molar Distalization: An Overview.

    Science.gov (United States)

    Noorollahian, Saeed; Alavi, Shiva; Shirban, Farinaz

    2015-01-01

    Tooth Size Arch-length Discrepancy (TSALD) is a common problem in orthodontics. Its clinical signs are tooth crowding, impaction and incisor proclination. The treatment options are dental arch expansion or tooth mass reduction (stripping or extraction). The "extraction versus non-extraction" controversy has been widely debated in the orthodontic literature. Distalization is a kind of arch expansion in anetro-posterior dimension. Several studies have evaluated both the therapeutic effectiveness and the side effects of the appliances for this method of space gaining. In some cases molar distalization is preferred, e.g., a patient with acceptable profile and skeletal pattern and half cusp Class II molar malocclusion or even less. In some cases molar distalization is the only way, e.g., the patient with previous upper premolar extraction and excessive overijet, or a skeletal Class III patient with previous upper premolar extraction needed upper anterior teeth retraction to create reverse overjet aspre surgical orthodontic decompensation. In this review article, we described non-compliance upper molar distalizing appliances.

  10. Implant Size Availability Affects Reproduction of Distal Femoral Anatomy.

    Science.gov (United States)

    Morris, William Z; Gebhart, Jeremy J; Goldberg, Victor M; Wera, Glenn D

    2016-07-01

    A total knee arthroplasty system offers more distal femoral implant anterior-posterior (AP) sizes than its predecessor. The purpose of this study is to investigate the impact of increased size availability on an implant system's ability to reproduce the AP dimension of the native distal femur. We measured 200 cadaveric femora with the AP-sizing guides of Zimmer (Warsaw, IN) NexGen (8 sizes) and Zimmer Persona (12 sizes) total knee arthroplasty systems. We defined "size deviation" as the difference in the AP dimension between the anatomic size of the native femur and the closest implant size. We defined satisfactory reproduction of distal femoral dimensions as Persona (p Persona. Only 1/200 specimens (0.5%) was a poor fit by Persona, but a satisfactory fit by NexGen (p < 0.001). The novel knee system with 12 versus 8 sizes reproduces the AP dimension of the native distal femur more closely than its predecessor. Further study is needed to determine the clinical impact of these differences.

  11. Lateralization of the inferior alveolar nerve with simultaneous implant placement: surgical techniques.

    Science.gov (United States)

    Garg, A K; Morales, M J

    1998-01-01

    In the event of moderate to severe mandibular bone resorption posterior to the mental foramen, repositioning of the inferior alveolar nerve provides a greater amount of available bone for implant placement and reduces the risk of nerve injury. While neural paresthesia may initially occur, this altered sensation generally resolves spontaneously. Alveolar nerve repositioning may be possible in cases in which other procedures cannot be performed due to the extent of atrophy of the posterior mandibular alveolar crest. This article presents the surgical technique to achieve this objective.

  12. Distal basilar artery aneurysms: conditions for safe and secure clipping.

    Science.gov (United States)

    Nakagomi, Tadayoshi

    2014-01-01

    In general, vertebro-basilar aneurysms are good indications for endovascular treatment. However, basilar artery (BA) bifurcation aneurysms, BA-superior cerebellar artery (SCA) aneurysms, and sometimes mid-basilar aneurysms are also good indications for clipping. In this paper, conditions for safe and secure clipping for distal basilar aneurysms are discussed.There are several tips for the clipping of distal BA aneurysms. Among them, the following are very important: patency of the perforators, posterior cerebral artery (P1), and SCA must always be maintained. Several modalities including micro-Doppler ultrasonography and indocyanine green video-angiography (ICGVA) should be used to confirm the patency of these vessels. Each confirmation of patency of the vessels after clipping must be compared to those from before the clipping. Intra-operative digital subtraction angiography (DSA) is needed for large or giant aneurysms.

  13. Clinical features of a rare anatomical variation of the posterior tibial and fibular arteries

    Directory of Open Access Journals (Sweden)

    Pedro Oliveira Portilho

    Full Text Available Abstract The posterior tibial artery normally arises from tibial-fibular trunk at the popliteal fossa, together with the fibular artery. The classic course of the posterior tibial artery is to run between the triceps surae muscle and muscles of the posterior compartment of the leg before continuing its course posteriorly to the medial malleolus, while the fibular artery runs through the lateral margin of the leg. Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course. The two arteries joined in an unusual “X” format, before division of the posterior tibial artery into plantar branches. We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels.

  14. Differential roles for left inferior frontal and superior temporal cortex in multimodal integration of action and language

    NARCIS (Netherlands)

    Willems, R.M.; Özyürek, A.; Hagoort, P.

    2009-01-01

    Several studies indicate that both posterior superior temporal sulcus/middle temporal gyrus (pSTS/MTG) and left inferior frontal gyrus (LIFG) are involved in integrating information from different modalities. Here we investigated the respective roles of these two areas in integration of action and l

  15. Reconstruction of Posterior Interosseous Nerve Injury Following Biceps Tendon Repair: Case Report and Cadaveric Study

    OpenAIRE

    Mokhtee, David B.; Brown, Justin M.; Mackinnon, Susan E.; Tung, Thomas H.

    2008-01-01

    Surgical repair of distal biceps tendon rupture is a technically challenging procedure that has the potential for devastating and permanently disabling complications. We report two cases of posterior interosseous nerve (PIN) injury following successful biceps tendon repair utilizing both the single-incision and two-incision approaches. We also describe our technique of posterior interosseous nerve repair using a medial antebrachial cutaneous nerve graft (MABC) and a new approach to the termin...

  16. [Posterior cortical atrophy].

    Science.gov (United States)

    Solyga, Volker Moræus; Western, Elin; Solheim, Hanne; Hassel, Bjørnar; Kerty, Emilia

    2015-06-02

    Posterior cortical atrophy is a neurodegenerative condition with atrophy of posterior parts of the cerebral cortex, including the visual cortex and parts of the parietal and temporal cortices. It presents early, in the 50s or 60s, with nonspecific visual disturbances that are often misinterpreted as ophthalmological, which can delay the diagnosis. The purpose of this article is to present current knowledge about symptoms, diagnostics and treatment of this condition. The review is based on a selection of relevant articles in PubMed and on the authors' own experience with the patient group. Posterior cortical atrophy causes gradually increasing impairment in reading, distance judgement, and the ability to perceive complex images. Examination of higher visual functions, neuropsychological testing, and neuroimaging contribute to diagnosis. In the early stages, patients do not have problems with memory or insight, but cognitive impairment and dementia can develop. It is unclear whether the condition is a variant of Alzheimer's disease, or whether it is a separate disease entity. There is no established treatment, but practical measures such as the aid of social care workers, telephones with large keypads, computers with voice recognition software and audiobooks can be useful. Currently available treatment has very limited effect on the disease itself. Nevertheless it is important to identify and diagnose the condition in its early stages in order to be able to offer patients practical assistance in their daily lives.

  17. [Distal humerus fractures in children].

    Science.gov (United States)

    Schneidmueller, D; Boettger, M; Laurer, H; Gutsfeld, P; Bühren, V

    2013-11-01

    Fractures of the distal humerus belong to the most common injuries of the upper arm in childhood. Most frequently occurring is the supracondylar fracture of the distal humerus. In these cases and in the second most common epicondylar fractures, the metaphysis is affected and these fractures are therefore extra-articular. They have to be distinguished from articular fractures regarding therapy and prognosis. The growth potential of the distal epiphysis is very limited as is the possibility of spontaneous correction so that major dislocations should not be left uncorrected. Unstable and especially dislocated articular fractures must be anatomically reconstructed employing various osteosynthetic techniques, mostly combined with immobilization. Insufficient reconstruction, growth disturbance and non-union can result in axial deformities, such as cubitus valgus and varus, restriction of motion, pain and nerve palsy.

  18. PTFE bypass to below-knee arteries: distal vein collar or not? A prospective randomised multicentre study

    DEFF Research Database (Denmark)

    Lundgren, Fredrik; Bergqvist, David; Norgren, Lars

    2010-01-01

    Patency and limb salvage after synthetic bypass to the arteries below-knee are inferior to that which can be achieved with autologous vein. Use of a vein collar at the distal anastomosis has been suggested to improve patency and limb salvage, a problem that is analysed in this randomised clinical...

  19. Traumatic Distal Ulnar Artery Thrombosis

    Directory of Open Access Journals (Sweden)

    Ahmet A. Karaarslan

    2014-01-01

    Full Text Available This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases.

  20. Salter-Harris I fracture of the distal humerus in a neonate: imaging appearance of radiographs, ultrasound, and arthrography

    Directory of Open Access Journals (Sweden)

    Nicholas M. Beckmann, MD

    2017-09-01

    Full Text Available Neonatal Salter-Harris I fractures of the distal humerus are a rare injury. This injury can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. We present a case of a neonate with a distal humerus Salter-Harris I fracture secondary to trauma during delivery. The patient presented with pseudoparesis of the left arm following birth. Posterior displacement of the elbow was identified on radiographs. Ultrasound of the elbow was performed after a gentle closed reduction of the left elbow was unsuccessful. A transphyseal supracondylar distal humerus fracture was identified on ultrasound. The patient subsequently had an intraoperative left elbow arthrogram to assist in visualization of the supracondylar fracture during closed reduction and percutaneous pinning. At 2-month follow-up, the patient was neurologically intact with full passive range of motion and had normal alignment of the capitellar ossification center and distal humerus on follow-up radiographs.

  1. Salter-Harris I fracture of the distal humerus in a neonate: imaging appearance of radiographs, ultrasound, and arthrography.

    Science.gov (United States)

    Beckmann, Nicholas M; Crawford, Lindsay

    2017-09-01

    Neonatal Salter-Harris I fractures of the distal humerus are a rare injury. This injury can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. We present a case of a neonate with a distal humerus Salter-Harris I fracture secondary to trauma during delivery. The patient presented with pseudoparesis of the left arm following birth. Posterior displacement of the elbow was identified on radiographs. Ultrasound of the elbow was performed after a gentle closed reduction of the left elbow was unsuccessful. A transphyseal supracondylar distal humerus fracture was identified on ultrasound. The patient subsequently had an intraoperative left elbow arthrogram to assist in visualization of the supracondylar fracture during closed reduction and percutaneous pinning. At 2-month follow-up, the patient was neurologically intact with full passive range of motion and had normal alignment of the capitellar ossification center and distal humerus on follow-up radiographs.

  2. Colgajo de pectoral mayor basado en perforantes internas inferiores: Doble plano invertido Pectoral muscle flap based on inferior-internal perforators: Inverted dual plane

    OpenAIRE

    V. O. Vassaro; A. H. Ali; D. M. Capponi

    2010-01-01

    El polo inferior de la mama en ocasiones puede estar afectado en su espesor por diferentes causas, como el simple paso del tiempo, resecciones oncológicas, extrusiones protésicas por infección, seromas, fístulas, etc. Describimos en este trabajo una alternativa quirúrgica para brindar una mayor cobertura al cuadrante ínferointerno de la glándula mamaria, utilizando un colgajo de músculo pectoral en su porción distal, basado en la irrigación de sus perforantes internas.Some times, the mammary ...

  3. Distal esophageal spasm: an update.

    Science.gov (United States)

    Achem, Sami R; Gerson, Lauren B

    2013-09-01

    Distal esophageal spasm (DES) is an esophageal motility disorder that presents clinically with chest pain and/or dysphagia and is defined manometrically as simultaneous contractions in the distal (smooth muscle) esophagus in ≥20% of wet swallows (and amplitude contraction of ≥30 mmHg) alternating with normal peristalsis. With the introduction of high resolution esophageal pressure topography (EPT) in 2000, the definition of DES was modified. The Chicago classification proposed that the defining criteria for DES using EPT should be the presence of at least two premature contractions (distal latencylong acting), calcium-channel blockers, anticholinergic agents, 5-phosphodiesterase inhibitors, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation. Acid suppression therapy is frequently used, but clinical outcome trials to support this approach are not available. Injection of botulinum toxin in the distal esophagus may be effective, but further data regarding the development of post-injection gastroesophageal reflux need to be assessed. Heller myotomy combined with fundoplication remains an alternative for the rare refractory patient. Preliminary studies suggest that the newly developed endoscopic technique of per oral endoscopic myotomy (POEM) may also be an alternative treatment modality.

  4. Tuberculosis pulmonar de campos inferiores

    Directory of Open Access Journals (Sweden)

    Alejandra González

    2010-10-01

    Full Text Available La tuberculosis (TB que compromete sólo los campos pulmonares inferiores (TBCI es poco frecuente en el adulto y en general está asociada a alguna causa de inmunodepresión. El objetivo de nuestro trabajo fue determinar la incidencia de TBCI en nuestra población y comparar sus características respecto de la TB pulmonar de localización habitual. Se estudiaron en forma retrospectiva en el período de 2004 a 2008, 42 pacientes con TBCI que fueron comparados con 84 pacientes con TB pulmonar de localización habitual (grupo control. Se excluyeron pacientes con HIV. La TBCI representó el 6% del total de TB pulmonar. No se encontraron diferencias significativas en cuanto a edad, sexo, presencia de cavidades en la radiografía, días de evolución y nivel de albúmina. La TBCI tuvo significativamente mayor proporción de comorbilidades (p < 0.001, presencia de condensación (p < 0.001 y compromiso unilateral (p < 0.001 en la radiografía de tórax, junto con mayor número de internaciones (p = 0.02. Cabe destacar que sólo16 de los 42 pacientes con TBCI (38% tenían alguna comorbilidad demostrada. La TBCI puede presentarse aun sin comorbilidades asociadas y debe sospecharse en neumonías de evolución tórpida independientemente de su localización.

  5. Reversible posterior leukoencephalopathy syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Ja; Yu, Won Jong; Ahn, Kook Jin; Jung, So Lyung; Lee, Yeon Soo; Kim, Ji Chang; Kang, Si Won [The Catholic Univ. of Korea, Taejon (Korea, Republic of); Song, Chang Joon [Chungnam National Univ. School of Medicine, Cheonju (Korea, Republic of); Song, Soon-Young; Koo, Ja Hong [Kwandong Univ. College of Medicine, Myungji Hospital, Seoul (Korea, Republic of); Kim, Man Deuk [College of Medicine Pochon CHA Univ., Seoul (Korea, Republic of)

    2001-10-01

    To review reversible posterior leukoencephalopathy syndrome. We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine ; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes ; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement ; in one, enhancement was mild, and in tow, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions ; in two, small infarctions remained but the extent of the lesions had decreased. Reversible posterior

  6. Right posterior approach for pancreaticoduodenectomy: a new technical approach.

    Science.gov (United States)

    Okabayashi, Takehiro; Shima, Yasuo; Sumiyoshi, Tatsuaki; Kozuki, Akihito; Tokumaru, Teppei; Saisaka, Yuichi

    2015-01-31

    The major goals that must be achieved during pancreaticoduodenectomy (PD) include reduction of postoperative hemorrhage and/or operating time. We herein describe a new technique for PD examining right posterior approach PD. From January 2012 to December 2013, 116 patients underwent PD for periampullary or pancreatic disease. Of these 116 patients, 56 cases were surgically treated for pancreas head or periampullary malignancy and were studied for blood loss volume and length of operation. An interesting issue in the present study was related to operating time and intra-operative blood loss. The median blood loss volume and operating time were 349 mL (35-3,636 mL) and 276 min (188-467 min), respectively, in patients who underwent a right posterior-approach PD. The estimated operative blood loss volume and operative time are lower in right posterior approach PD, probably due to clearly detection a route of the inferior pancreaticoduodenal artery from the SMA and following early ligation of the inferior pancreaticoduodenal artery and reduced congestion of the pancreatic head.

  7. Dual joint space arthrography in temporomandibular joint disorders: Comparison with single inferior joint space arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hyung Sik; Chang, Duk Soo; Lee, Kyung Soo; Kim, Woo Sun; Sung, Jung Ho; Jun, Young Hwan [Capital Armed Forces General Hospital, Seoul (Korea, Republic of)

    1989-02-15

    The temporomandibular joint(TMJ) is really a complex of two synovial space separated by fibrocartilaginous disc. Single inferior joint space arthrography is commonly performed for evaluation of TMJ disorders, which is known to be superior in demonstrating joint dynamics. But it reveals only the inferior surface of the disc. Therefore, dual space arthrography is superior to demonstrate the soft tissue anatomic feature of the joint such as disc position and shape. Authors performed 83 TMJ arthrograms in TMJ problems. Initially, the inferior joint space was done and then the superior space was sequentially contrasted. The follow results were noted: 1. In all cases, dual space arthrography revealed accurate disc shape and positions. 2. Concordant findings between the two techniques: 68 cases (82%). Discordance between the two techniques: 15 cases (18%) 3. Possible causes of discordance between inferior and dual space arthrography. a) Normal varians of anterior recess: 3 cases b) Posterior disc displacement: 4 cases c) Influence of the patient's head position change :4 cases d) False perforation: 2 cases e) Reduction change: 2 cases 4. In 5 cases with anterior displacement, dual space arthrography gave additional findings such as adhesion within the superior space, which could not be evaluated by single inferior space.

  8. Growth in the area of the inferior dental foramen of rats.

    Science.gov (United States)

    Engel, G; West, V C

    1983-01-01

    The object of the present investigation was to see if the bone around the inferior dental nerve remodelled during mandibular growth and development. The investigation was carried out by injecting 27 albino Lewis rats with three fluorescent bone seeking dyes--oxytetracycline HCl (OTC), alizarin red S (ARS), and 2,4 bis-[N,N'-di' (carbomethyl-aminomethyl)] fluorescein (DCAF)--and then studying the bone around the inferior dental foramen. The mandibles of the animals were studied both macroscopically and microscopically under ultraviolet light to investigate the growth processes occurring and to see if the inferior dental foramen was relocated during growth. A quantitative analysis utilizing two specimens was also carried out for the same purpose. The results of both the qualitative and the quantitative analyses showed that the bone around the inferior dental nerve remodeled during mandibular growth. The mandible grew in an upward and backward direction, and the inferior dental foramen was correspondingly relocated in an upward and backward direction to maintain exactly the same position relative to the condyle and the posterior border of the ramus. This study, then, supports Moss's concept of the "unloaded" nerve, and is in keeping with his view of mandibular growth based on the functional matrix theory.

  9. Traumatismos de veia cava inferior

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    Cleinaldo de Almeida Costa

    Full Text Available OBJETIVO: Avaliar a incidência, o perfil clínico e as estratégias operatórias dos ferimentos de Veia Cava Inferior (VCI. MÉTODOS: Foram analisados retrospectivamente os prontuários de 76 doentes com ferimento de VCI atendidos nos dois prontossocorros de Manaus, no período de janeiro de 1997 a julho de 2002. Mecanismo de lesão, mortalidade, estado hemodinâmico, índice de trauma abdominal penetrante (PATI, achados intra-operatórios e conduta cirúrgica foram estudados. RESULTADOS: Quarenta e nove (65% doentes sofreram lesão por arma branca, 26 (34% por arma de fogo e um por traumatismo abdominal fechado. Quarenta e um (54% doentes sobreviveram. Quase todos chegaram acordados, entretanto 40% estavam hipotensos (pressão arterial sistólica < 70mmHg. O índice de trauma abdominal penetrante (PATI médio foi maior que 40. À laparotomia, todos demonstraram sangramento retroperitoneal ativo ou hematoma retroperitoneal em expansão. Vinte e um pacientes possuíam lesão de VCI retro-hepática, enquanto nos outros 55 a lesão era infra-hepática. O reparo operatório predominante foi a venorrafia lateral em 65 doentes. Houve necessidade de tóraco-freno-laparotomia em quatro doentes do total de oito doentes que foram à toracotomia direita por lesão retro-hepática. Foram realizados shunts átrio-cavais em seis doentes, dos quais três sobreviveram. CONCLUSÕES: O ferimento de VCI é uma lesão de alta letalidade e possui uma relação intrínseca com a violência urbana. A sobrevivência depende de uma imediata e vigorosa reposição de volume, um manejo operatório adequado e todo esforço em evitar-se hipotermia.

  10. Dupla ampliação anterior e posterior do anel aórtico para substituição valvar Anterior and posterior enlargement of the aortic annulus for valve replacement

    Directory of Open Access Journals (Sweden)

    João Ricardo SANT´ANNA

    2002-03-01

    Full Text Available OBJETIVO: Apresentar técnica de dupla ampliação anterior e posterior do anel aórtico, que difere das previamente descritas por utilizar enxertos distintos, para implante de prótese valvar e avaliar os resultados obtidos em 26 pacientes. MÉTODO: O procedimento é realizado com circulação extracorpórea convencional. Para substituição de valva nativa ou prótese aórtica estenótica, ampliação anelar posterior decorre da incisão no ponto médio do seio não coronário, que é estendida ao folheto mitral anterior; ampliação anterior resulta de incisão no anel aórtico anterior, estendida por 2 cm no septo interventricular, não transfixado. Reconstrução aórtica (e ampliação anelar é realizada mediante enxertos de pericárdio bovino distintos, sendo um triangular para incisão anterior e outro elíptico para incisão posterior. Após a fixação da prótese (mecânica ou biológica, a aorta ascendente é suturada com auxílio destes enxertos. Defeitos cardíacos associados são corrigidos. RESULTADOS: A operação aumentou o diâmetro do anel aórtico de 18,0 + 2,6 mmHg para 24,5 + 2,1 mmHg (pOBJECTIVES: To present a technique for anterior and posterior enlargement of the aortic anulus using individual patches and results in 26 patients. METHOD: Aortic valve surgery is performed with conventional cardiopulmonary bypass. For posterior enlargement, the longitudinal aortotomy is extended inferiorly and posteriosly in the mean portion of the noncoronary sinus, until the anterior mitral leaflet. Anterior enlargement results from incision between the two coronary ostium, extended in the left side of the ventricular septum for 2 cm. Two patches of bovine pericardium are sutured in the distal portion of the anterior and posterior incisions and the aortic prosthesis is fixed. Aorta is reconstructed with the patchs. Combined cardiac defects are corrected. RESULTS: Procedure resulted in increase of the annulus diameter from 18.0 + 2.6 mm

  11. Distal adding-on Phenomenon in Lenke 1A Scoliosis : Risk Factor Identification and Treatment Strategy Comparison

    DEFF Research Database (Denmark)

    Wang, Yu; Hansen, Ebbe Stender; Høy, Kristian

    2011-01-01

    STUDY DESIGN: Retrospective study. OBJECTIVE: To identify risk factors for the presence of distal adding-on in Lenke 1A scoliosis and compare different treatment strategies. SUMMARY OF BACKGROUND DATA: Distal adding-on is often accompanied by unsatisfactory clinical outcome and high risk...... of reoperation. However, very few studies have focused on distal adding-on and its attendant risk factors and optimal treatment strategies remain controversial. METHODS: All surgically treated patients with adolescent idiopathic scoliosis were retrieved from a single institutional database. Inclusion criteria...... included: (1) Lenke 1A scoliosis patients treated with posterior pedicle screw-only constructs, (2) minimum 1-year radiographic follow-up. Distal adding-on was defined as a progressive increase in the number of vertebrae included distally within the primary curve combined with either an increase of more...

  12. Microvascular decompression of the posterior inferior cerebellar artery for intermediate nerve neuralgia

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    Humberto Kluge Schroeder

    2015-01-01

    Conclusion: INN should be considered as a differential diagnosis in cases with atypical facial neuralgia, and microvascular decompression is an effective treatment option that can provide optimal pain relief.

  13. Distal clavicle fractures in children☆

    Science.gov (United States)

    Labronici, Pedro José; da Silva, Ricardo Rodrigues; Franco, Marcos Vinícius Viana; Labronici, Gustavo José; Pires, Robinson Esteves Santos; Franco, José Sergio

    2015-01-01

    Objective To analyze fractures of the distal clavicle region in pediatric patients. Methods Ten patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. Results All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. Conclusion The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments. PMID:26962489

  14. Distal clavicle fractures in children

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To analyze fractures of the distal clavicle region in pediatric patients. METHODS: Ten patients between the ages of five to eleven years (mean of 7.3 years were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. RESULTS: All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. CONCLUSION: The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments.

  15. [Inferior vestibular neuritis: diagnosis using VEMP].

    Science.gov (United States)

    Walther, L E; Repik, I

    2012-02-01

    Vestibular evoked myogenic potentials (VEMP) are a new method to establish the functional status of the otolith organs. The sacculocollic reflex of the cervical VEMP to air conduction (AC) reflects predominantly saccular function due to saccular afferents to the inferior vestibular nerve. We describe a case of inferior vestibular neuritis as a rare differential diagnosis of vestibular neuritis. Clinical signs were a normal caloric response, unilaterally absent AC cVEMPs and bilaterally preserved ocular VEMPs (AC oVEMPs).

  16. Distalization of maxillary molars using a lever arm and mini-implant.

    Science.gov (United States)

    Gurgel, Júlio de Araújo; Pinzan-Vercelino, Célia Regina Maio; Bramante, Fausto Silva; Rivera, Alan Poy

    2013-01-01

    This article describes the orthodontic treatment of a young woman with a Class II malocclusion and maxillomandibular prognathism. One orthodontic mini- implant was placed in the posterior area of the palate to provide anchorage for?a transpalatal arch. The force for molar distalization was applied using an elastic chain from the lever arm inserted on the transpalatal arch to the mini-implant. Two sliding jigs were applied buccally as a complement for Class II malocclusion correction. This system created an efficient mechanotherapy for maxillary molar distalization. The active treatment period was 19 months. Normal overjet and reduction of maxillomandibular prognathism were obtained, and labial balance was improved.

  17. [Posterior reversible encephalopathy syndrome].

    Science.gov (United States)

    Petrović, Branko; Kostić, Vladimir; Sternić, Nadezda; Kolar, Jovo; Tasić, Nebojsa

    2003-01-01

    Reversible Posterior Leukoencephalopathy Syndrome was introduced into clinical practice in 1996 in order to describe unique syndrome, clinically expressed during hypertensive and uremic encephalopathy, eclampsia and during immunosuppressive therapy [1]. First clinical investigations showed that leucoencephalopathy is major characteristic of the syndrome, but further investigations showed no significant destruction in white cerebral tissue [2, 3, 4]. In majority of cases changes are localise in posterior irrigation area of the brain and in the most severe cases anterior region is also involved. Taking into consideration all above mentioned facts, the suggested term was Posterior Reversible Encephalopathy Syndrome (PRES) for the syndrome clinically expressed by neurological manifestations derived from cortical and subcortical changes localised in posterior regions of cerebral hemispheres, cerebral trunk and cerebellum [5]. Patient, aged 53 years, was re-hospitalized in Cardiovascular Institute "Dediwe" two months after successful aorto-coronary bypass performed in June 2001 due to the chest bone infection. During the treatment of the infection (according to the antibiogram) in September 2001, patient in evening hours developed headache and blurred vision. The recorded blood pressure was 210/120 mmHg so antihypertensive treatment was applied (Nifedipin and Furosemid). After this therapy there was no improvement and intensive headache with fatigue and loss of vision developed. Neurological examination revealed cortical blindness and left hemiparesis. Manitol (20%, 60 ccm every 3 hours) and i.v. Nytroglicerin (high blood pressure). Brain CT revealed oedema of parieto-occipital regions of both hemispheres, more emphasized on the right. (Figure 1a, b, c). There was no sign of focal ischemia even in deeper sections (Figure 1d, e, f). Following three days enormous high blood pressure values were registered. On the fourth day the significant clinical improvement occurred

  18. Progressive posterior cortical dysfunction

    Directory of Open Access Journals (Sweden)

    Fábio Henrique de Gobbi Porto

    Full Text Available Abstract Progressive posterior cortical dysfunction (PPCD is an insidious syndrome characterized by prominent disorders of higher visual processing. It affects both dorsal (occipito-parietal and ventral (occipito-temporal pathways, disturbing visuospatial processing and visual recognition, respectively. We report a case of a 67-year-old woman presenting with progressive impairment of visual functions. Neurologic examination showed agraphia, alexia, hemispatial neglect (left side visual extinction, complete Balint's syndrome and visual agnosia. Magnetic resonance imaging showed circumscribed atrophy involving the bilateral parieto-occipital regions, slightly more predominant to the right . Our aim was to describe a case of this syndrome, to present a video showing the main abnormalities, and to discuss this unusual presentation of dementia. We believe this article can contribute by improving the recognition of PPCD.

  19. Chondroblastoma of the distal phalanx.

    Science.gov (United States)

    Gregory, James R; Lehman, Thomas P; White, Jeremy R; Fung, Kar-Ming

    2014-05-01

    Chondroblastoma is a rare, benign primary bone tumor that usually occurs at the epiphysis of long bones. The authors present an example of the diagnosis and successful treatment of this neoplasm in an exceedingly rare location in the distal phalanx. Clinical and radiographic outcomes after 68 months of follow-up are presented. A 15-year-old, right hand-dominant, boy developed painful swelling of the right ring finger. Radiographs revealed a radiolucent lesion of the distal phalanx with expansile remodeling of the bone. An excisional biopsy was performed with curettage and bone grafting of the lesion. The diagnosis of chondroblastoma was made based on pathologic evaluation of the biopsy specimen. Sixty-six months after surgical treatment, the patient was free of recurrence and metastatic disease with excellent clinical and functional outcomes. To the authors' knowledge, this represents only the second reported case of chondroblastoma of the distal phalanx. The diagnosis of chondroblastoma in this rare location was made by pathologic review of the resection specimen. It is imperative to confirm the diagnosis of any resected bone specimen even when the concern for an aggressive or malignant lesion is low. A tumor presenting in an unusual location may require a change in treatment or surveillance.

  20. The Simplified Posterior Interosseous Flap.

    Science.gov (United States)

    Cavadas, Pedro C; Thione, Alessandro; Rubí, Carlos

    2016-09-01

    Several technical modifications have been described to avoid complications and simplify dissection. The authors describe some technical tips that make posterior interosseous flap dissection safer and more straightforward.

  1. Cognitive priming in sung and instrumental music: activation of inferior frontal cortex.

    Science.gov (United States)

    Tillmann, B; Koelsch, S; Escoffier, N; Bigand, E; Lalitte, P; Friederici, A D; von Cramon, D Y

    2006-07-15

    Neural correlates of the processing of musical syntax-like structures have been investigated via expectancy violation due to musically unrelated (i.e., unexpected) events in musical contexts. Previous studies reported the implication of inferior frontal cortex in musical structure processing. However - due to the strong musical manipulations - activations might be explained by sensory deviance detection or repetition priming. Our present study investigated neural correlates of musical structure processing with subtle musical violations in a musical priming paradigm. Instrumental and sung sequences ended on related and less-related musical targets. The material controlled sensory priming components, and differences in target processing required listeners' knowledge on musical structures. Participants were scanned with functional Magnetic Resonance Imaging (fMRI) while performing speeded phoneme and timbre identification judgments on the targets. Behavioral results acquired in the scanner replicated the facilitation effect of related over less-related targets. The blood oxygen level-dependent (BOLD) signal linked to target processing revealed activation of right inferior frontal areas (i.e., inferior frontal gyrus, frontal operculum, anterior insula) that was stronger for less-related than for related targets, and this was independent of the material carrying the musical structures. This outcome points to the implication of inferior frontal cortex in the processing of syntactic relations also for musical material and to its role in the processing and integration of sequential information over time. In addition to inferior frontal activation, increased activation was observed in orbital gyrus, temporal areas (anterior superior temporal gyrus, posterior superior temporal gyrus and sulcus, posterior middle temporal gyrus) and supramarginal gyrus.

  2. Choroid is thinner in inferior region of optic disks of normal eyes.

    Science.gov (United States)

    Tanabe, Hirotaka; Ito, Yasuki; Terasaki, Hiroko

    2012-01-01

    To determine the thickness of the choroid across the posterior pole of normal eyes. Twenty-eight clinic-based normal eyes (54.1 ± 20.0 years, -3.6 ± 4.1 diopter) were studied. The macula and retina around the optic disk were scanned with a spectral-domain optical coherence tomographic instrument. The retinal mapping program with the enhanced depth imaging technique was used, and the borders of the choroid were drawn manually in each optical coherence tomographic image. A choroidal thickness map was constructed by the built-in program, and the choroidal thickness in the different sectors of the Early Treatment Diabetic Retinopathy Study grid was measured and compared. The choroid inferior to the optic disk was significantly thinner than that in the other sectors of the outer ring of the Early Treatment Diabetic Retinopathy Study grid (superior, 196 ± 62 μm; inferior, 146 ± 47 μm; nasal, 183 ± 80 μm; and temporal, 193 ± 64 μm, P choroidal thickness at the nasal sector of the macular region was significantly thinner than other regions of the Early Treatment Diabetic Retinopathy Study grid (superior, 268 ± 74 μm; inferior, 245 ± 73 μm; nasal, 190 ± 68 μm; temporal, 268 ± 63 μm; and central, 258 ± 88 μm; P Choroidal thickness maps showed that the thinner choroidal area spreads around the optic disk and the inferior part of the posterior pole. The thinner choroid inferior to the optic disk may be a natural anatomical architecture of normal eyes, and this area may be more susceptible to hypoxia or to elevated intraocular pressures.

  3. Anatomy of Mandibular Vital Structures. Part I: Mandibular Canal and Inferior Alveolar Neurovascular Bundle in Relation with Dental Implantology

    Directory of Open Access Journals (Sweden)

    Hom-Lay Wang

    Full Text Available Objectives: It is critical to determine the location and configuration of the mandibular canal and related vital structures during the implant treatment. The purpose of the present study was to review the literature concerning the mandibular canal and inferior alveolar neurovascular bundle anatomical variations related to the implant surgery.Material and Methods: Literature was selected through the search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular canal, inferior alveolar nerve, and inferior alveolar neurovascular bundle. The search was restricted to English language articles, published from 1973 to November 2009. Additionally, a manual search in the major anatomy, dental implant, prosthetic and periodontal journals and books were performed.Results: In total, 46 literature sources were obtained and morphological aspects and variations of the anatomy related to implant treatment in posterior mandible were presented as two entities: intraosseous mandibular canal and associated inferior alveolar neurovascular bundle.Conclusions: A review of morphological aspects and variations of the anatomy related to mandibular canal and mandibular vital structures are very important especially in implant therapy since inferior alveolar neurovascular bundle exists in different locations and possesses many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that osteotomies in implant dentistry should not be developed in the posterior mandible until the position of the mandibular canal is established.

  4. Anatomy of posterior pathways in reading: a reassessment.

    Science.gov (United States)

    Henderson, V W

    1986-09-01

    Contemporary accounts of the neurology of reading stem from Dejerine's original visual-verbal disconnection hypothesis of pure alexia. Reassessment of Dejerine's traditional formulations for posterior left hemisphere pathways in reading suggests that the occipital cortex-left angular gyrus-Wernicke's area scheme is undoubtedly oversimplified. The role of left angular gyrus cortex in reading is unsettled, and although clinically undefined, more inferior portions of the left temporal lobe may also contribute to the reading process. Nevertheless, to a surprising extent, the neuroanatomic edifice erected by Dejerine remains largely intact.

  5. Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H.M.; Shih, H.C.; Huang, Y.C.; Wang, Y.H. [Dept. of Medical Imaging, National Taiwan University Hospital, Taipei (Taiwan)

    2001-05-01

    We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

  6. Defining the non-inferiority margin and analyzing non-inferiority: An overview.

    Science.gov (United States)

    Althunian, Turki A; de Boer, Anthonius; Groenwold, Rolf H H; Klungel, Olaf H

    2017-03-02

    Non-inferiority trials are used to assess whether the effect of a new drug is not worse than an active comparator by more than a non-inferiority margin. If the difference between the new drug and the active comparator does not exceed this pre-specified margin, non-inferiority can be concluded. This margin must be specified based on clinical and statistical reasoning; however, it is considered as one the most challenging step in the design of non-inferiority trials. Regulators recommend that the margin should be defined based on the historical evidence of the active comparator (the latter is often the well-established standard treatment of the disease), which can be performed by different approaches. There are several factors and assumptions that need to be accounted for during the process of defining the margin and during the analysis of non-inferiority. Three methods are commonly used to analyze non-inferiority trials: the fixed-margin method, the point-estimate method, and the synthesis method. This article provides an overview of analyzing non-inferiority inferiority and choosing the non-inferiority margin.

  7. Veia gástrica posterior: hipertensão porta Posterior gastric vein: portal hipertension

    Directory of Open Access Journals (Sweden)

    Alcino Lázaro da Silva

    1999-10-01

    Full Text Available A veia gástrica posterior não é muito citada nos livros de anatomia e nos trabalhos sobre hipertensão porta. Estudou-se sua anatomia, freqüência e desembocadura. Ela foi encontrada em 54% dos casos e, em 100%, desembocava na veia esplênica. Discute-se a vantagem ou não de sua ligadura ou preservação no tratamento cirúrgico da hipertensão porta.The posterior gastric vein has not been mentioned very often neither in anatomy textbooks nor in portal hypertension papers. The authors studied the anatomy, frequency and confluence of this vein because is a huge variety in the presentation of esophageal varices. Twenty-six adult preserved corpses (twenty females and six males had a wide abdominal incision allowing the dissection of the portal system, identifying the frequency and confluence of its tributaries, notably the posterior gastric vein. The portal vein, in all cases, was formed by the confluence of the superior mesenteric vein with the splenic vein and had a mean length of 6.4 cm. The splenic vein had a mean length of 6.5 cm. The left gastric vein was tributary of the portal vein in 50% of the cases and in 30% of the cases in the splenic vein. The right gastric vein had it's confluence to portal vein in 30 % of the cases and to the splenic vein in 4 %. The inferior mesenteric vein was tributary of the splenic vein in 54% of the cases and in the superior mesenteric vein in 46%. The left gastro-omental vein had its confluence to the splenic vein in 50% of the cases and to the inferior polar vein in 34 %. The middle colic vein had its confluence to superior mesenteric vein in 42% of the cases, to inferior mesenteric vein in 12% and to splenic vein in 8%. The posterior gastric vein was found in 54% of the corpses, and in all cases it was a tributary of the splenic vein, in retropancreatic position, coming from the esophageal-gastric junction. These findings agree with previous papers describing a prevalence of 60% of posterior gastric

  8. Dinosaurios del Cretácico inferior de Galve (Teruel, España

    Directory of Open Access Journals (Sweden)

    Santafé, J. V.

    1987-12-01

    Full Text Available The aim of this paper is to complete the study of the Dinosaur fauna of the syncline of Galve (Teruel, Spain. Most of the outcrops are Early Barremian in age. Nevertheless, the outcrop called Las Zabacheras could be Hauterivian and El Pelejón Hauterivian-Early Barremian in age. Theropod Dinosaurs are poorly represented. Three vertebral centra are described. They are identified as Theropoda indet. The several outcrops of Galve have yielded four forms of Sauropods. Three of them (cf. Astrodon sp., Camarasauridae indet., form A, Camarasauridae indet., form B have been identified based on isolated teeth. The Sauropod from Las Zabacheras (Lapparent, 1960; Sanz, 1982 has been proposed as a new taxon, Aragosaurus ischiaticus n. gen. et n. sp. The material which the new taxon is based on are the bones studied by Lapparent (Museo de la Diputación de Teruel and new ones: caudal vertebrae, chevrones, seapula, ilium, femur and autopodial material. After a research on evolutive polarity of some traits within the Sauropoda, the apomorphic character-states which define the new taxon are as follows: First caudal vertebrae with a great transversal development of the neuroapophysis (club-like, seapular blade terminally expansioned, with an intermediate development (for example between Cetiosaurs and Brachiosaurus or Rebbachisaurus. Great dorso-ventral development (acromio-glenoideus of the anterior seapular zone (ratio miminal width of the seapular blade/maximal acromio-glenoideus height of 0.27. lliac process of ischium well developed. Pubic process of ischium with great dorso-ventral development (ratio antero-posterior length of this process/lenght of ischiadic contact with pubis, 0.63. Ischiadic process of ischium with a conspicuous final expansion. Lenght ratio humerus/femur 0.82. Lateral bulge just distal to the femoral greater trochanter. Medial condyle of femur relatively developed (ratio maximal antero-posterior diameter of medial condyle

  9. Effect of tilted and short distal implants on axial forces and bending moments in implants supporting fixed dental prostheses: an in vitro study.

    Science.gov (United States)

    Ogawa, Toru; Dhaliwal, Sandra; Naert, Ignance; Mine, Atsushi; Kronstrom, Mats; Sasaki, Keiichi; Duyck, Joke

    2010-01-01

    The aim of this study was to evaluate the axial forces (AFs) and bending moments (BMs) on implants supporting a fixed dental prosthesis (FDP) with a distal cantilever (10 mm) compared to an FDP supported by a tilted or short (7 mm instead of 13 mm) posterior implant by means of in vitro strain gauge measurements. Nine titanium Branemark implants were placed in an edentulous composite mandible. The mechanical loading conditions were evaluated for the following three situations: (1) short distal implants supporting a cantilever, (2) long tilted distal implants, and (3) no distal implants supporting a cantilever. A vertical load of 50 N was applied at the first molar position, and the resultant AFs and BMs were measured for the three different situations, three different numbers of supporting implants (three, four, or five), and three different prosthesis materials (titanium, acrylic, and fiber-reinforced acrylic). The mean BMs, as well as the maximum AFs and BMs, were significantly higher in the model with a cantilever compared to that having the tilted or short distal implants (P models with a distally tilted implant versus a short distal implant. The use of posterior implants reduced the AFs and BMs on implants supporting an FDP compared to that with a distal cantilever. No difference in mechanical loading was observed between short tilted distal implants.

  10. Clinical studies on inferior right hepatic veins

    Institute of Scientific and Technical Information of China (English)

    Xue Xing; Hong Li; Wei-Guo Liu

    2007-01-01

    BACKGROUND:Many small veins are called accessory, short hepatic veins in addition to the right, middle and left hepatic veins. The size of these veins varied from a pinhole to 1 cm; the size of inferior right hepatic veins (IRHVs) is thicker than that of short hepatic veins or more than 1 cm occasionally. Adults have a higher incidence rate of the IRHV. DATA SOURCES:A literature search of the PubMed database was conducted and research articles were reviewed. RESULTS:The size of IRHVs is related to the size of the right hepatic vein, i.e. the larger the diameter of the right hepatic vein, the smaller the diameter of the IRHVs, and vice versa. The IRHVs are divided into superior, medial and inferior groups, separately named the superior, medial and inferior right hepatic veins according to the position of the IRHV entering the inferior vena cava. The superior right hepatic vein mainly drains the superior part of segmentⅦ, and the medial right hepatic vein drains the middle part of segmentⅦ. A thicker IRHV mainly drains segmentⅥ and the inferior part of segmentⅦ and a thinner IRHV drains the inferior part of segmentⅤ. CONCLUSIONS:The clinical signiifcance of these studies on IRHVs is varied: (1) Hepatic caudate lobe resection could be introduced after study on the veins of that lobe. (2) It is very important to identify the draining region of the IRHV for guiding hepatic segmentectomy. The postero-inferior area of the right lobe can be preserved along with the hypertrophic IRHV even if the entire main right hepatic vein is resected during segmentectomy ofⅦ andⅧwith right hepatic vein resection for patients with primary liver cancer. (3) The ligation of the major hepatic vein for the treatment of juxtahepatic vein injury is recommended because of severe hemorrhagic shock and dififculty in

  11. Subcomponents and connectivity of the inferior fronto-occipital fasciculus revealed by diffusion spectrum imaging fiber tracking

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    Yupeng Wu

    2016-09-01

    Full Text Available The definitive structure and functional role of the inferior fronto-occipital fasciculus (IFOF are still controversial. In this study, we aimed to investigate the connectivity, asymmetry and segmentation patterns of this bundle. High angular diffusion spectrum imaging (DSI analysis was performed on ten healthy adults and a 90-subject DSI template (NTU-90 Atlas. In addition, a new tractography approach based on the anatomic subregions and two regions of interest (ROI was evaluated for the fiber reconstructions. More widespread anterior-posterior connections than previous standard definition of the IFOF were found. This distinct pathway demonstrated a greater inter-subjects connective variability with a maximum of 40% overlap in its central part. The statistical results revealed no asymmetry between the left and right hemispheres and no significant differences existed in distributions of the IFOF according to sex. In addition, five subcomponents within the IFOF were identified according to the frontal areas of originations. As the subcomponents passed through the anterior floor of the external capsule, the fibers radiated to the posterior terminations. The most common connection patterns of the subcomponents were as follows: IFOF-I, from frontal polar cortex to occipital pole, inferior occipital lobe, middle occipital lobe, superior occipital lobe and pericalcarine; IFOF-II, from orbito-frontal cortex to occipital pole, inferior occipital lobe, middle occipital lobe, superior occipital lobe and pericalcarine; IFOF-III, from inferior frontal gyrus to inferior occipital lobe, middle occipital lobe, superior occipital lobe, occipital pole and pericalcarine; IFOF-IV, from middle frontal gyrus to occipital pole and inferior occipital lobe; IFOF-V, from superior frontal gyrus to occipital pole, inferior occipital lobe and middle occipital lobe. Our work demonstrates the feasibility of high resolution diffusion tensor tractography with sufficient

  12. The effectiveness of posterior knee capsulotomies and knee extension osteotomies in crouched gait in children with cerebral palsy.

    Science.gov (United States)

    Taylor, Daveda; Connor, Justin; Church, Chris; Lennon, Nancy; Henley, John; Niiler, Tim; Miller, Freeman

    2016-11-01

    Crouched gait is common in children with cerebral palsy (CP), and there are various treatment options. This study evaluated the effectiveness of single-event multilevel surgery including posterior knee capsulotomy or distal femoral extension osteotomy to correct knee flexion contracture in children with CP. Gait analyses were carried out to evaluate gait preoperatively and postoperatively. Significant improvements were found in physical examination and kinematic measures, which showed that children with CP and crouched gait who develop knee flexion contractures can be treated effectively using single-event multilevel surgery including a posterior knee capsulotomy or distal femoral extension osteotomy.

  13. Midline suboccipital burr hole for posterior fossa craniotomy.

    Science.gov (United States)

    Grover, Keshav; Sood, Sandeep

    2010-07-01

    Posterior fossa craniotomy is generally done starting with two lateral burr holes. Single midline burr hole is often avoided for the fear of injury to the venous sinuses. In this paper, we retrospectively evaluated the risk of dural tear or venous sinus injury with the latter approach. Patients who had a posterior fossa craniotomy at the Children's Hospital of Michigan between 2003 and 2009 were analyzed. Seventy-one patients had been operated for a posterior fossa lesion, and 154 had a Chiari I decompression. Suboccipital craniotomy was performed utilizing a starting midline suboccipital burr hole. The craniotomy was completed using Midas Rex with B1 footplate starting laterally from the burr hole and then over to the foramen magnum including the foramen magnum lip. Inpatients who had a tumor resection, the bone flap was replaced and secured with plates on both sides. One patient had a dural tear along the inferior aspect of the craniotomy not extending into the foramen magnum. There was no instance of venous sinus injury or undue bleeding from the burr hole. none of the patients had an infection requiring removal of the bone flap. This paper confirms the safety of utilizing midline burr hole for starting a posterior fossa craniotomy.

  14. STUDY OF POSTERIOR DIVISION OF INTERNAL ILIAC ARTERY

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    Pavan P Havaldar

    2014-06-01

    Full Text Available Background: The internal iliac artery originates from the common iliac artery at the level of sacroiliac joint. The internal iliac artery descends posterior to the greater sciatic foramen thereby dividing into anterior and posterior divisions. The posterior division of the internal iliac artery is known to give rise to three main branches i.e. iliolumbar artery, lateral sacral artery. Accidental haemorrhage is common during erroneous interpretation of anomalous blood vessels. The knowledge of the normal and the abnormal anatomy of the branches of the internal iliac artery is essential for obstetric surgeons. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: Out of 50 specimens, ilio-lumbar artery took origin from posterior division, directly in 22 specimens (44%, with obturator artery in 5 specimens (10% and with superior gluteal artery in 2 specimens (4%. From anterior division, with obturator artery in 6 specimens (12% and with inferior gluteal artery in 1 specimen (2%. From common trunk, as direct branch in 10 specimens (20%, with lateral sacral artery in 1 specimen (2%, with vertebral branch in 1 specimen (2%, with superior gluteal artery in 1 specimen (2% and was found to be absent in 1 specimen (2%. Posterior division of internal iliac artery given origin directly to superior gluteal artery in 44 specimens (88%, with ilio-lumbar artery in 1 specimen (2%, with obturator artery in 2 specimens (4%. Lateral sacral artery from posterior division was observed in 38 specimens (76% and unpaired origin was observed in 7 specimens (14%. Conclusion: Internal iliac artery supplies the pelvic viscera and musculature the knowledge of its branches helpful in pelvis surgeries.

  15. Posterior cruciate ligament reconstruction by means of tibial tunnel: anatomical study on cadavers for tunnel positioning

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    Antônio Altenor Bessa de Queiroz

    2014-08-01

    Full Text Available Objective:To determine the reference points for the exit of the tibial guidewire in relation to the posterior cortical bone of the tibia.Methods:Sixteen knees from fresh cadavers were used for this study. Using a viewing device and a guide marked out in millimeters, three guidewires were passed through the tibia at 0, 10 and 15 mm distally in relation to the posterior crest of the tibia. Dissections were performed and the region of the center of the tibial insertion of the posterior cruciate ligament (PCL was determined in each knee. The distances between the center of the tibial insertion of the PCL and the posterior tibial border (CB and between the center of the tibial insertion of the PCL and wires 1, 2 and 3 (CW1, CW2 and CW3 were measured.Results:In the dissected knees, we found the center of the tibial insertion of the PCL at 1.09 ± 0.06 cm from the posterior tibial border. The distances between the wires 1, 2 and 3 and the center of the tibial insertion of the PCL were respectively 1.01 ± 0.08, 0.09 ± 0.05 and 0.5 ± 0.05 cm.Conclusion:The guidewire exit point 10 mm distal in relation to the posterior crest of the tibia was the best position for attempting to reproduce the anatomical center of the PCL.

  16. Pure alexia for kana. Characterization of alexia with lesions of the inferior occipital cortex.

    Science.gov (United States)

    Sakurai, Yasuhisa; Terao, Yasuo; Ichikawa, Yaeko; Ohtsu, Hiroshi; Momose, Toshimitsu; Tsuji, Shoji; Mannen, Toru

    2008-05-15

    To characterize reading impairments caused by lesions in the posterior occipital cortices. We gave six patients with these lesions reading and writing tests and located a critical site for alexia using MRI and SPECT. The patients read three-character kana (Japanese syllabograms) nonwords, and five-character kana nonwords significantly or at a near significant level more poorly and slowly than normal subjects, whereas they read kanji (Japanese morphograms) almost correctly but more slowly. Letter-by-letter reading with a single-kana character identification impairment (in five patients), a word-length effect, kinesthetic facilitation, a lexicality effect, and minor to mild agraphia for kanji (in three patients) were observed. These deficits were characteristic of pure alexia. Alexia disappeared within a few months except in one patient who had extensive hypoperfusion in the left occipital lobe. A shared lesion was located in the left posterior fusiform/inferior occipital gyri (Area 18/19) on MRI, and there was blood flow reduction around this area on SPECT. This area coincided with the activation site for kana word covert reading in our previous study. These results suggest that pure alexia particularly for kana, or more generally pure alexia for letters, is caused by a lesion in the posterior inferior occipital cortex, characterized primarily by impaired kana character or letter identification, with relatively preserved kanji or word recognition.

  17. The preperitoneal approach to the groin and the inferior epigastric vessels.

    Science.gov (United States)

    Read, R C

    2005-03-01

    Preperitoneal, a word coined by Nyhus in the 1960s, has been applied not only to posterior approaches that he, Stoppa, and Wantz popularized but to anterior exposures of the groin, which divide the transversalis fascia. This assumes that all give similar views of the easily cleaved space of Bogros. However, accumulated anatomical observations reveal the transversalis fascia as having not one but two layers. The inferior epigastric vessels run between rather than in the preperitoneal space, which is avascular and has its own fascia lining the peritoneum. Historical evidence shows that both the midline Cheatle-Henry and lateral Ugahary-Kugel approaches, which transect the abdominal wall, provide excellent exposure of the avascular preperitoneal space. However, neither the unilateral posterior McEvedy approach nor the anterior approach does, as only part of the musculature and fasciae are retracted. The inferior epigastric vasculature and posterior lamina transversalis fascia, which remain in situ, block the view. Unless they are disrupted or circumvented, neither of the latter approaches or subsequent repairs should be labeled preperitoneal.

  18. Biomechanical comparison of different stabilization constructs for unstable posterior wall fractures of acetabulum. A cadaveric study.

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    Yuntong Zhang

    Full Text Available PURPOSE: Operative treatment of unstable posterior wall fractures of acetabulum has been widely recommended. This laboratory study was undertaken to evaluate static fixation strength of three common fixation constructs: interfragmentary screws alone, in combination with conventional reconstruction plate, or locking reconstruction plate. METHODS: Six formalin-preserved cadaveric pelvises were used for this investigation. A posterior wall fracture was created along an arc of 40-90 degree about the acetabular rim. Three groups of different fixation constructs (two interfragmentary screws alone; two interfragmentary screws and a conventional reconstruction plate; two interfragmentary screws and a locking reconstruction were compared. Pelvises were axial loaded with six cycles of 1500 N. Dislocation of superior and inferior fracture site was analysed with a multidirectional ultrasonic measuring system. RESULTS: No statistically significant difference was found at each of the superior and inferior fracture sites between the three types of fixation. In each group, the vector dislocation at superior fracture site was significantly larger than inferior one. CONCLUSIONS: All those three described fixation constructs can provide sufficient stability for posterior acetabular fractures and allow early mobilization under experimental conditions. Higher posterior acetabular fracture line, transecting the weight-bearing surface, may indicate a substantial increase in instability, and need more stable pattern of fixation.

  19. Relationship Between the Middle Genicular Artery and the Posterior Structures of the Knee

    Science.gov (United States)

    de Carvalho, Rogério Teixeira; Ramos, Leonardo Addêo; Novaretti, João Victor; Ribeiro, Leandro Masini; Szeles, Paulo Roberto de Queiroz; Ingham, Sheila Jean McNeill; Abdalla, Rene Jorge

    2016-01-01

    Background: The middle genicular artery (MGA) is responsible for the blood supply to the cruciate ligaments and synovial tissue. Traumatic sports injuries and surgical procedures (open and arthroscopic) can cause vascular damage. Little attention has been devoted to establish safe parameters for the MGA. Purpose: To investigate the anatomy of the MGA and its relation to the posterior structures of the knees, mainly the posterior capsule and femoral condyles, and to establish safe parameters to avoid harming the MGA. Study Design: Descriptive laboratory study. Methods: Dissection of the MGA was performed in 16 fresh, unpaired adult human cadaveric knees with no macroscopic degenerative or traumatic changes and no previous surgeries. The specimens were meticulously evaluated with emphasis on preservation of the MGA. The distances from the MGA to the medial and lateral femoral condyles were measured. The Mann-Whitney test was used for statistical analysis. Results: In all specimens, the MGA emerged from the anterior aspect of the popliteal artery, distal to the superior genicular arteries, and had a short distal trajectory toward the posterior capsule where it entered proximal to the oblique popliteal ligament. The artery lay in the midportion between the condyles. The distance between the posterior aspect of the tibia and the point of entry of the MGA into the posterior joint capsule was 23.8 ± 7.3 mm (range, 14.72-35.68 mm). There was no correlation between an individual’s height and the distance of the entrance point of the MGA into the posterior joint capsule to the posterior superior corner of the tibia. Conclusion: The middle genicular artery lies in the midportion between the medial and lateral femoral condyles. Clinical Relevance: This knowledge is important for the preservation of the blood supply during posterior knee surgical procedures and to settle a secure distance between the posterior aspect of the tibia and the MGA input. This could decrease and

  20. Portal Decompression Using the Inferior Mesenteric Vein

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    Paolo Gorini

    1998-01-01

    Full Text Available We report five patients with variceal hemorrhage, in three cases secondary to diffuse thrombosis of the portal, superior mesenteric and splenic veins. Mesenteric angiography demonstrated patency of the inferior mesenteric vein (IMV in each, and successful portal decompression by anastomosis of the IMV to the left renal vein (n=4 or the inferior vena cava (n=1 was accomplished. Bleeding was permanently controlled: four patients have survived from one to eight years post-operatively. Because shunt procedures utilizing the IMV are technically straightforward, subtotally decompress the portal system and avoid the right upper quadrant, they may be advantageous in certain clinical settings.

  1. Treatment of physeal fractures of the distal radius by volar intrafocal Kapandji method: surgical technique.

    Science.gov (United States)

    Rubin, Guy; Orbach, Hagay; Chezar, Avi; Rozen, Nimrod

    2017-01-01

    Distal radial physeal fractures with volar displacement are rare. Several methods of operative treatment include volar plate without inserting distal screws, percutaneous technique using two anterior skin incisions and reversed Kapandji technique with pins introduced through a posterior approach and locked at the anterior cortex of the fracture. We report three cases along with a literature review of the surgical techniques described in the past and a novel surgical technique for this uncommon fracture termed "Volar Kapandji". All patients had anatomic reduction at the last follow-up radiography, and all patients had a full range of motion and VAS 0 at the last follow-up. No complications were recorded. This case study presents the minimally invasive option for treating rare cases of physeal distal radius fractures with volar displacement. V.

  2. C-orthodontic microimplant for distalization of mandibular dentition in Class III correction.

    Science.gov (United States)

    Chung, Kyurhim; Kim, Seong-Hun; Kook, Yoonah

    2005-01-01

    A 16-year-old male patient with a Class III malocclusion and 2 lower missing central incisors presented for treatment. The treatment plan consisted of asymmetrically distalizing the lower dentition and regaining space for lower anterior prosthetic work. C-implants were to be used as anchorage for Class III intermaxillary elastics, and two C-orthodontic microimplants (C-implants) were placed in the interdental spaces between the upper second premolars and first molars. The particular design of the C-implant head minimized gingival irritation during the orthodontic treatment. Sliding jigs were applied on the buccal for distalization of the lower posterior teeth. The correct overbite and overjet were obtained by distalizing the entire lower dentition into its proper position with C-implant anchorage, which contributed to an improvement in facial balance. It took 15 months to treat this case. The application of this new microimplant, considerations for case selection, and the sequence of treatment are presented.

  3. Classification of posterior vitreous detachment

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    Kakehashi A

    2013-12-01

    Full Text Available Akihiro Kakehashi,1 Mikiko Takezawa,1 Jun Akiba21Department of Ophthalmology, Jichi Medical University, Saitama Medical Center, Saitama, 2Kanjodori Eye Clinic, Asahikawa, JapanAbstract: Diagnosing a posterior vitreous detachment (PVD is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography (OCT. By biomicroscopy, the vitreous condition is determined based on the presence or absence of a PVD. The PVD then is classified as either a complete posterior vitreous detachment (C-PVD or a partial posterior vitreous detachment (P-PVD. A C-PVD is further divided into a C-PVD with collapse and a C-PVD without collapse, while a P-PVD is divided into a P-PVD with shrinkage of the posterior hyaloid membrane (P-PVD with shrinkage and a P-PVD without shrinkage of the posterior hyaloid membrane (P-PVD without shrinkage. A P-PVD without shrinkage has a subtype characterized by vitreous gel attachment through the premacular hole in a posterior hyaloid membrane to the macula (P-PVD without shrinkage [M]. By OCT, a shallow PVD is classified as the absence of a shallow PVD or as a shallow PVD. A shallow PVD is then subclassified as a shallow PVD without shrinkage of the posterior vitreous cortex, a shallow PVD with shrinkage of the posterior vitreous cortex, and a peripheral shallow PVD. A shallow PVD without shrinkage of the posterior vitreous cortex has two subtypes: an age-related shallow PVD and a perifoveal PVD associated with a macular hole.Keywords: classification, optical coherence tomography, PVD, slit-lamp biomicroscopy

  4. Classification of posterior vitreous detachment.

    Science.gov (United States)

    Kakehashi, Akihiro; Takezawa, Mikiko; Akiba, Jun

    2014-01-01

    Diagnosing a posterior vitreous detachment (PVD) is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography (OCT). By biomicroscopy, the vitreous condition is determined based on the presence or absence of a PVD. The PVD then is classified as either a complete posterior vitreous detachment (C-PVD) or a partial posterior vitreous detachment (P-PVD). A C-PVD is further divided into a C-PVD with collapse and a C-PVD without collapse, while a P-PVD is divided into a P-PVD with shrinkage of the posterior hyaloid membrane (P-PVD with shrinkage) and a P-PVD without shrinkage of the posterior hyaloid membrane (P-PVD without shrinkage). A P-PVD without shrinkage has a subtype characterized by vitreous gel attachment through the premacular hole in a posterior hyaloid membrane to the macula (P-PVD without shrinkage [M]). By OCT, a shallow PVD is classified as the absence of a shallow PVD or as a shallow PVD. A shallow PVD is then subclassified as a shallow PVD without shrinkage of the posterior vitreous cortex, a shallow PVD with shrinkage of the posterior vitreous cortex, and a peripheral shallow PVD. A shallow PVD without shrinkage of the posterior vitreous cortex has two subtypes: an age-related shallow PVD and a perifoveal PVD associated with a macular hole.

  5. Colgajo en hélice de perforante interósea posterior: Un nuevo procedimiento reconstructivo Propeller interoseous posterior perforator flap: A new reconstructive procedure

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    A. Fernández García

    2009-03-01

    Full Text Available El colgajo interóseo posterior de pedículo distal se basa en el arco anastomótico dorsal formado por las arterias interóseas anterior y posterior. Cuando dicha arcada está interrumpida, no es posible elevar un colgajo interóseo posterior de pedículo distal. Presentamos un colgajo de perforante interósea posterior diseñado en hélice, disponible en ausencia de la arcada vascular dorsal y útil en la cobertura de tercio distal del antebrazo, carpo y mano. Detallamos la técnica quirúrgica, sus aplicaciones, ventajas e inconvenientes y analizamos el empleo de este tipo de colgajo en diferentes casos. Presentamos el caso de un paciente con exposición de material de osteosíntesis en tercio distal de radio y trombosis de las anastomosis de revascularización tras sufrir aplastamiento severo de su miembro superior izquierdo; el examen con Doppler reveló ausencia de flujo reverso en la arteria interósea posterior. Se practicó un colgajo en hélice de perforante interósea posterior para cubrir el nuevo by-pass y la osteosíntesis. También otro paciente que tras un accidente de automóvil sufrió fracturas cerradas de cúbito y radio en su miembro superior izquierdo. La columna radial del carpo presentaba una severa lesión por aplastamiento. Tras las osteosíntesis, se practicó un colgajo en hélice de perforante interósea posterior para cobertura de la cara dorso-radial del carpo. En los casos clínicos presentados el colgajo en hélice de perforante interósea posterior proporcionó excelente cobertura del carpo y de la mano con escasa morbilidad de la zona donante. El colgajo en hélice de perforante interósea posterior se presenta como una opción versátil y segura para la cobertura del tercio distal de miembro superior, pudiendo ser elevado en ausencia de flujo reverso y sin sacrificio de la arteria interósea posterior.The distally-based posterior interosseous flap is a versatile and useful technique in upper limb

  6. Functional organization of the left inferior precentral sulcus: dissociating the inferior frontal eye field and the inferior frontal junction

    NARCIS (Netherlands)

    Derrfuss, J.; Vogt, V.L.; Fiebach, C.J.; Cramon, D.Y. von; Tittgemeyer, M.

    2012-01-01

    Two eye fields have been described in the human lateral frontal cortex: the frontal eye field (FEF) and the inferior frontal eye field (iFEF). The FEF has been extensively studied and has been found to lie at the ventral part of the superior precentral sulcus. Much less research, however, has focuse

  7. Evaluation of Distal Femoral Rotational Alignment with Spiral CT Scan before Total Knee Arthroplasty (A Study in Iranian Population

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    Mahmoud Jabalameli

    2016-04-01

    Full Text Available Background: Evaluating the landmarks for rotation of the distal femur is a challenge for orthopedic surgeons. Although the posterior femoral condyle axis is a good landmark for surgeons, the surgical transepicondylar axis may be a better option with the help of preoperative CT scanning. The purpose of this study was to ascertain relationships among the axes’ guiding distal femur rotational alignment in preoperative CT scans of Iranian patients who were candidates for total knee arthroplasty and the effects of age, gender, and knee alignment on these relationships. Methods: One hundred and eight cases who were admitted to two university hospitals for total knee arthroplasty were included in this study. The rotation of the distal femur was evaluated using single axial CT images through the femoral epicondyle. Four lines were drawn digitally in this view: anatomical and surgical transepicondylar axes, posterior condylar axis and the Whiteside anteroposterior line. The alignment of the extremity was evaluated in the standing alignment view. Then the angles were measured along these lines and their relationship was evaluated. Results: The mean angle between the anatomical transepicondylar axis and posterior condylar axis and between the surgical transepicondylar axis and posterior condylar axis were 5.9 ± 1.6 degrees and 1.6±1.7 degrees respectively. The mean angle between the Whiteside’s anteroposterior line and the line perpendicular to the posterior condylar axis was 3.7±2.1 degrees. Significant differences existed between the two genders in these relationships. No significant correlation between the age of patients and angles of the distal femur was detected. The anatomical surgical transepicondylar axis was in 4.3 degrees external rotation in relation to the surgical transepicondylar axis. Conclusion: Preoperative CT scanning can help accurately determine rotational landmarks of the distal femur. If one of the reference axes cannot be

  8. Geometry of inferior endplates of the cervical spine.

    Science.gov (United States)

    Lou, Jigang; Liu, Hao; Rong, Xin; Li, Huibo; Wang, Beiyu; Gong, Quan

    2016-03-01

    Device subsidence is a well-known complication following cervical disc arthroplasty. Its occurrence has been closely tied with the endplate-implant contact interface. But current literature on the geometry of cervical endplate is very scarce. The aim of this anatomical investigation was to analyze geometry of inferior endplates of the cervical vertebrae, thereby identifying the common endplate shape patterns and providing morphological reference values consummating the design of the implant. Reformatted CT scans of 85 individuals were analyzed and endplate concave depth, endplate concave apex location, sagittal diameter of endplate, coronal concave angle, as well as transverse diameter of endplate were measured in mid-sagittal plane and specified coronal plane. According to the endplate concave apex location, the inferior endplates in mid-sagittal plane were classified into 3 types: type I with posteriorly positioned apex, type II with middle situated concave apex and type III with anteriorly positioned apex. Moreover, the inferior endplates in specified coronal plane were also classified into three types: concave, flat and irregular. Based on visual assessment, for the mid-sagittal plane, type I endplate accounted for 26.9% of all the 510 endplates of 85 individuals, while the proportion of type II and type III endplates were 53.9 and 19.2% respectively. For the specified coronal plane, 68.6% of all the 510 endplates were evaluated as concave, 26.9% as flat and the remaining 4.5% as irregular. Among all measured segments, C3 had the largest endplate concave depth values in mid-sagittal plane, while C7 the least; C5 and C6 had the largest sagittal endplate diameter values, while C2 the least. For each level, the sagittal endplate concave depth and endplate diameter of females were significantly smaller than those of males (P0.05). Increasing from C2 to C7, the endplate transverse diameters of females were significantly smaller than those of males (Psagittal and

  9. Transvenous embolization of a dural carotid-cavernous sinus fistula via the inferior ophthalmic vein.

    Science.gov (United States)

    Michels, Kevin S; Ng, John D; Falardeau, Julie; Roberts, Warren G; Petersen, Bryan; Nesbit, Gary M; Barnwell, Stanley L

    2007-01-01

    A 76-year-old woman presented with an acute onset of right periocular pain, diplopia, ocular injection, progressive proptosis, and periocular swelling. She had an unremarkable past medical history, and the erythrocyte sedimentation rate and complete blood count were normal. A carotid-cavernous sinus fistula was suspected, and an MRI demonstrated enlargement of the superior ophthalmic vein posterior to the globe and enlargement of the inferior ophthalmic vein throughout its entire course. Cerebral arteriography demonstrated a dural cavernous sinus fistula. The inferior ophthalmic vein was accessed via the inferonasal orbital space and was catheterized for delivery of multiple platinum coils to the cavernous sinus fistula. Follow-up venograms demonstrated occlusion of the fistula. At 2-month follow-up, there was a residual sixth nerve palsy and resolution of symptoms, including proptosis and periocular swelling.

  10. Distichiasis following transconjunctival approach to the inferior orbital rim and orbital floor

    Directory of Open Access Journals (Sweden)

    Saoussen Salhi

    2015-09-01

    Full Text Available Zygoma fractures are often associated with orbital floor fractures, which can be approached through a transconjunctival or transcutaneous incision. The transconjunctival approach has gained popularity over the transcutaneous one for its overall lower complication rate. We describe a patient with a zygoma fracture where the inferior orbital rim and orbital floor were exposed, reduced and fixated through a transconjunctival incision. Postoperatively, the patient developed a row of eyelashes posterior to the normal lash line, a condition termed distichiasis, causing corneal irritation and ulceration. This is believed to be caused by the postoperative eyelid inflammation induced by the transconjunctival incision. The condition was treated by electrolysis with no recurrence of symptoms. This condition has never been described as a postoperative complication of a transconjunctival approach to an inferior orbital rim and orbital floor fracture.

  11. Thalamo-cortical projections to the posterior parietal cortex in the monkey.

    Science.gov (United States)

    Matsuzaki, Ryuichi; Kyuhou, Shin-ichi; Matsuura-Nakao, Kazuko; Gemba, Hisae

    2004-01-23

    Thalamo-cortical projections to the posterior parietal cortex (PPC) were investigated electrophysiologically in the monkey. Cortical field potentials evoked by the thalamic stimulation were recorded with electrodes chronically implanted on the cortical surface and at a 2.0-3.0 mm cortical depth in the PPC. The stimulation of the nucleus lateralis posterior (LP), nucleus ventralis posterior lateralis pars caudalis (VPLc), and nucleus pulvinaris lateralis (Pul.l) and medialis (Pul.m) induced surface-negative, depth-positive potentials in the PPC. The LP and VPLc projected mainly to the superior parietal lobule (SPL) and the anterior bank of the intraparietal sulcus (IPS), and the Pul.m mainly to the inferior parietal lobule (IPL) and the posterior bank of the IPS. The Pul.l had projections to all of the SPL, the IPL and both the banks. The significance of the projections is discussed in connection with motor functions.

  12. COMPARISON OF PARTIAL INFERIOR TURBINECTOMY AND SUBMUCOSAL DIATHERMY FOR HYPERTROPHIED INFERIOR TURBINATE IN ALLERGIC RHINITIS PATIENTS

    Directory of Open Access Journals (Sweden)

    Smitha Chandra

    2015-07-01

    Full Text Available BACKGROUND : The inferior turbinate is the first point of contact of allergen in the nose. In patients with allergic rhinitis the turbinate hypertrophies and its mucosa becomes purplish edematous. This leads to significant obstruction of airway. Hence reduction of this hypertrophied inferior turbinate is essential. AIM: To analyze & evaluate the efficacy of sub mucosal diathermy and partial inferior turbinectomy in the treatment of symptomatic hypertrophied inferior turbinates in allergic rhinitis patients in a rural setup. METHODS AND MATERIAL S: A prospective clinical study of 132 patients between age group of 15 - 55 years of eith er sex were enrolled in the study with bilateral Inferior. Turbinate Hypertrophy who had history of failed medical line of treatment. After informing , the patients were randomized into two groups to eliminate bias byallotting them alternately into the groups. Patients in Group I underwent. Submucosal diathermy and Group II patients underwent Partial Inferior. Turbinectomy. Postoperative follow up was done at regular intervals by objective& subjective assessment. STATISTICAL ANALYSIS USED: Friedman test and Ch i Square test were used for statistical analysis. RESULTS: In group I significant improvement of nasal airflow was seen in 14% patients & 85.9% had moderate improvement. In group II 41.3% of patients had significant improvement & 58.6% had moderate i mprovement. Statistically by analyzing the ranks of subjective nasal obstruction and objective nasal obstruction of Group - I & Group - IIwe conclude that Group - II subjects showed more improvement than Group I. CONCLUSIONS: Various surgical methods have been t ried for enlarged inferior turbinate secondary to allergic rhinitis. Of them the well - known techniques are s ubmucosal Diathermy & Partial Inferior Turbinectomy. In this study Partial Inferior Turbinectomy was found to be more effective in relieving nasal ob structionin allergic rhinitis patients for

  13. Iatrogenic injury to the inferior alveolar nerve

    DEFF Research Database (Denmark)

    Hillerup, Søren

    2008-01-01

    The purpose of this prospective, non-randomised, descriptive study is to characterise the neurosensory deficit and associated neurogenic discomfort in 52 patients with iatrogenic injury to the inferior alveolar nerve (IAN). All patients were examined and followed up according to a protocol assess...

  14. A case of inferior lumbar hernia

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    Vidhyasagar M. Sharma

    2013-02-01

    Full Text Available In this article we report a case of inferior lumbar hernia. The patient underwent preperitoneal meshplasty. The patient is well on follow up with no recurrence. The relevant literature has been reviewed and management discussed in brief. [Int J Res Med Sci 2013; 1(1.000: 33-35

  15. 距腓前韧带与踝间后韧带的解剖学研究及其临床意义%Anterior talofibular and the posterior intermalleolar ligaments: anatomy and clinical significance

    Institute of Scientific and Technical Information of China (English)

    许涛; 刘志刚; 宋良松; 陈雷

    2012-01-01

    目的 研究距腓前韧带和踝间后韧带的解剖学特点,探讨其功能与临床意义.方法 10侧成人踝关节标本解剖观测距腓前韧带和踝间后韧带起止、走行和比邻,并分析其作用. 结果 10侧标本中,有7侧的距腓前韧带呈双束结构,占70%,在此结构中,两束宽度之和大于单束结构的韧带的宽度.双束呈类“人”字形走行,两个束支在足处于不同的位置时呈不同的状态,当足跖屈时,下束松弛,上束绷紧;背屈位时则反之.踝间后韧带起自外踝腓骨尖后下缘向内侧走行,大体分为3束,分别止于胫骨后下缘、胫后肌腱腱鞘、距骨后结节及其内侧,此韧带对维持踝关节稳定,防止距骨后脱位有重要的作用.结论 距腓前韧带的双束结构能加强其强度,踝间后韧带的生物力学及其参与踝后软组织撞击综合征的机理值得进一步探讨.%Objective To study anatomic characteristics of the anterior talofibular and the posterior intermalleolar ligaments, and explore their functions and clinic significance. Methods 10 ankle joint specimens from adult fresh cadavers were used. The anterior talofibular and the posterior intermalleolar ligaments were carefully dissected. The origin, insertion points, coruse and the adjacent structures were observed, the functions of those ligaments were analyzed. Results The anterior talofibular ligaments of 7 cases (70% )presented the double-banded shape, with the increased width of two bands compared to that of one-banded ligaments, the course of two bands formed the shape of " 人 ". In plantar flexion, the inferior band of the ligament remains relaxed while the upper band became taut. In dorsiflexion, the upper band remains relaxed, and the inferior band became tight. The posterior intermalleolar ligament ran obliquely from lateral to medial. The medial arising sites of the ligament included the lateral border of the medial malleolar sulcus, the medial border of the medial

  16. Distal realignment (tibial tuberosity transfer).

    Science.gov (United States)

    Feller, Julian Ashley

    2012-09-01

    Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans.

  17. Posterior scleral tuberculoma: case report

    Directory of Open Access Journals (Sweden)

    Antonio Augusto Velasco e Cruz

    2011-02-01

    Full Text Available Posterior scleral tuberculoma formation is an extremely rare condition. The few reports on scleral involvement in tuberculosis refer to cases of anterior scleritis. In the present manuscript we describe a patient who had rheumatoid arthritis and developed a large posterior scleral tuberculoma. The lesion provoked retinal detachment and visual loss and was diagnosed only after enucleation due to a misdiagnosis of choroidal melanoma.

  18. [Treatment of recurrent posterior epistaxis].

    Science.gov (United States)

    Bro, Søren Pauli; Bille, Jesper; Petersen, Kristian Bruun

    2017-08-21

    30% of the patients presenting with epistaxis at emergency wards and otorhinolaryngeal specialist departments have posterior bleeding. Traditional treatment with packing often leads to initial treatment failure, and many patients experience recurrent bleeding within the following month. Recurrent posterior epistaxis should be treated with local electrocautery or endoscopic ligation of the sphenopalatine artery to reduce patient discomfort, hospital stay, risk of treatment failure and recurrence.

  19. Point-of-Care Ultrasound in Diagnosis and Treatment of Luxatio Erecta (Inferior Shoulder Dislocation

    Directory of Open Access Journals (Sweden)

    Abraham Flinders

    2016-06-01

    Why an emergency physician should be aware of this: POC-US is a useful tool for the emergency physician when confronted with shoulder dislocation. US not only confirms the dislocation, but also differentiates between anterior versus posterior versus inferior dislocation. POC-US can guide the placement of intraarticular lidocaine for anesthesia which then potentially reduces time, expense, and risk of procedural sedation. Finally, POC-US may reduce failed reductions by providing immediate visual confirmation and in the case of reductions performed under sedation, may prevent the need for repeat sedation.

  20. Variaciones de la anatomía del nervio dentario inferior. Revisión bibliográfica

    OpenAIRE

    Granollers Torrens, M.; Berini Aytés, Leonardo; Gay Escoda,Cosme

    1997-01-01

    La correcta identificación del conducto dentario inferior o conducto mandibular, por el que discurre el nervio dentario inferior, es esencial cuando se precisa realizar cualquier intervención de Cirugía Bucal en la región mandibular posterior. En este artículo se revisa la literatura publicada referida a la anatomía del nervio dentario inferior y se relaciona con las diferentes técnicas de diagnóstico por la imagen (radiología y tomografía) así como con la disección anatómica de mandíbulas de...

  1. Variaciones de la anatomía del nervio dentario inferior. Revisión bibliográfica

    OpenAIRE

    Granollers Torrens, M.; Berini Aytés, Leonardo; Gay Escoda, Cosme

    1997-01-01

    La correcta identificación del conducto dentario inferior o conducto mandibular, por el que discurre el nervio dentario inferior, es esencial cuando se precisa realizar cualquier intervención de Cirugía Bucal en la región mandibular posterior. En este artículo se revisa la literatura publicada referida a la anatomía del nervio dentario inferior y se relaciona con las diferentes técnicas de diagnóstico por la imagen (radiología y tomografía) así como con la disección anatómica de mandíbulas de...

  2. FIXATION OF ADULT EXRTA –ARTICULAR DISTAL THIRD DIA PHYSEAL FRACTURE OF HUMERUS-A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Ahmed

    2013-05-01

    Full Text Available ABSTRACT : Distal humerus fracture in adult is very difficul t to treat. It is very difficult to achieve alignment, anatomical reduction, rigid fixation, im mediate mobilization and fracture union in such patient MATERIAL AND METHOD-We operate 41 patient o f close extra articular fracture of distal third of humerus, using posterior approach. 10 case s were fixed with single locking plate,6 cases by single distal multiple hole plate,12 cases by two r econstruction plate,6 cases by simple T plate,7case s by oblique metaphyseal locking plate. RESULT- Doubl e plating with reconstruction plates provide a more rigid fixation than a single-locked plate. CON CLUSION- Fixation of extra articular distal humerus, diaphyseal fracture in adult are better w ith double plating than single plating, which provide more rigid fixation with early mobilization and higher mayo elbow score

  3. Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques

    Directory of Open Access Journals (Sweden)

    Boris Abayev

    2015-03-01

    Full Text Available Objectives: The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. Material and Methods: A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN repositioning with a minimum 6 months of follow-up. Results: A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Conclusions: Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments.

  4. Inferior alveolar nerve lateralization and transposition for dental implant placement. Part I: a systematic review of surgical techniques.

    Science.gov (United States)

    Abayev, Boris; Juodzbalys, Gintaras

    2015-01-01

    The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN) repositioning with a minimum 6 months of follow-up. A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments.

  5. Inferior Alveolar Nerve Injury in Trauma-Induced Mandible Fractures.

    Science.gov (United States)

    Tay, Andrew Ban Guan; Lai, Juen Bin; Lye, Kok Weng; Wong, Wai Yee; Nadkarni, Nivedita V; Li, Wenyun; Bautista, Dianne

    2015-07-01

    This prospective observational cohort study sought to determine the prevalence of inferior alveolar nerve (IAN) injury after mandibular fractures before and after treatment and to elucidate factors associated with the incidence of post-treatment IAN injury and time to normalization of sensation. Consenting patients with mandibular fractures (excluding dentoalveolar, pathologic, previous fractures, or mandibular surgery) were prospectively evaluated for subjective neurosensory disturbance (NSD) and underwent neurosensory testing before treatment and then 1 week, 1.5, 3, 6, and 12 months after treatment. Eighty patients (men, 83.8%; mean age, 30.0 yr; standard deviation, 12.6 yr) with 123 mandibular sides (43 bilateral) were studied. Injury etiology included assault (33.8%), falls (31.3%), motor vehicle accidents (25.0%), and sports injuries (6.3%). Half the fractures (49.6%) involved the IAN-bearing posterior mandible; all condylar fractures (13.0%) had no NSD. Treatment included open reduction and internal fixation (ORIF; 74.8%), closed reduction and fixation (22.0%), or no treatment (3.3%). Overall prevalence of IAN injury was 33.7% (95% confidence interval [CI], 24.8-42.6) before treatment and 53.8% (95% CI, 46.0-61.6) after treatment. In the IAN-bearing mandible, the prevalence was 56.2% (95% CI, 43.2-69.2) before treatment and 72.9% (95% CI, 63.0-82.7) after treatment. In contrast, this prevalence in the non-IAN-bearing mandible was 12.6% (95% CI, 4.1-21.1) before treatment and 31.6% (95% CI, 20.0-43.3) after treatment. Factors associated with the development of post-treatment IAN injury included fracture site and gap distance (a 1-mm increase was associated with a 27% increase in odds of post-treatment sensory alteration). Time to normalization after treatment was associated with type of treatment (ORIF inhibited normalization) and fracture site (IAN-bearing sites took longer to normalize). IAN injury was 4 times more likely in IAN-bearing posterior mandibular

  6. Trabajos experimentales sobre los efectos de las experiencias tempranas en la conducta posterior

    OpenAIRE

    Ardila, Rubén

    2012-01-01

    Las primeras experiencias en la vida de un ser humano o de un animal inferior repercuten ampliamente sobre su conducta posterior. Esto se conoce desde hace  varios siglos. Freud fue uno de los primeros, en la época moderna, en postular este factor como básico en la formación de la personalidad, y en la etiología de las neurosis. Los zoólogos europeos insistieron en la parte decisiva que tienen las primeras experiencias de un organismo sobre su vida posterior. La obra de O. Heiroth, K. Lorenz,...

  7. Cerebello-thalamo-cortical projections to the posterior parietal cortex in the macaque monkey.

    Science.gov (United States)

    Amino, Y; Kyuhou, S; Matsuzaki, R; Gemba, H

    2001-08-17

    The cerebello-thalamo-posterior parietal cortical projections were investigated electrophysiologically and morphologically in macaque monkeys. In anesthetized monkeys, electrical stimulation of every cerebellar nucleus evoked marked surface-positive, depth-negative (s-P, d-N) cortical field potentials in the superior parietal lobule and the cortical bank of the intraparietal sulcus, but no responses in the inferior parietal lobule. Tract-tracing experiments combining the anterograde method with the retrograde one indicated that the interposed and lateral cerebellar nuclei projected to the posterior parietal cortex mainly through the nucleus ventral lateralis caudalis of the thalamus. The significance of the projections is discussed in connection with cognitive functions.

  8. The prognosis of splinted restoration of the most-distal implants in the posterior region

    Science.gov (United States)

    2016-01-01

    PURPOSE The aim of this study was to compare the efficacies of two-implant splinting (2-IS) and single-implant restoration (1-IR) in the first and second molar regions over a mean functional loading period (FLP) of 40 months, and to propose the appropriate clinical considerations for the splinting technique. MATERIALS AND METHODS The following clinical factors were examined in the 1-IR and 2-IS groups based on the total hospital records of the patients: sex, mean age, implant location, FLP, bone grafting, clinical crown-implant ratio, crown height space, and horizontal distance. The mechanical complications [i.e., screw loosening (SL), screw fracture, crown fracture, and repeated SL] and biological complications [i.e., peri-implant mucositis (PM) and peri-implantitis (PI)] were also evaluated for each patient. In analysis of two groups, the chi-square test and Student's t-test were used to identify the relationship between clinical factors and complication rates. The optimal cutoff value for the FLP based on complications was evaluated using receiver operating characteristics analysis. RESULTS In total, 234 patients with 408 implants that had been placed during 2005 - 2014 were investigated. The incident rates of SL (P<.001), PM (P=.002), and PI (P=.046) differed significantly between the 1-IR and 2-IS groups. The FLP was the only meaningful clinical factor for mechanical and biological complication rates in 2-IS. CONCLUSION The mechanical complication rates were lower for 2-IS than for 1-IR, while the biological complication rates were higher for 2-IS. FLP of 39.80 and 46.57 months were the reference follow-up periods for preventing biological and mechanical complications, respectively. PMID:28018568

  9. Movimentação de molares inferiores ancorados em mini-parafusos Mandibular molar uprighting, using mini-screw as anchorage

    Directory of Open Access Journals (Sweden)

    Rosana Canteras Di Matteo

    2005-08-01

    posterior to the tooth. Three pacients with ages between 40 and 48 years old (two females and one male were selected. The three of them presented mesially tipped molars, positioned posterior to the edentulous areas, on both sides of the mandible. These patients received orthodontic treatment during a period of 6 and 12 months with the MD3 technique. Titanium mini-screws were positioned bilaterally, under local anesthesia. One incision with 1 cm was done in each side of the mandibular external oblique line, distally to the tipped molars. After that, the mini-screws were positioned and sutures were done, leaving the mini-screws heads exposed. After one week, orthodontic loads (between 150 and 200 grams/force were applied to the mini-screws through elastics. A certain degree of inflammation around the mini-screws was noticed, but it was controlled by hygienic procedure. This surgery procedure was simple and could be done easily by the orthodontist. The dimensions and shapes of the mini-screws proved to be appropriate and their removal after the orthodontic movement were done without difficulty. The result was time reduction on the molars uprighting, without side effects on the others teeth. The use of mini-screws seems to be a good alternative for an effective orthodontic anchorage on the uprighting mandibular molars.

  10. Skeletal stability after inferior maxillary repositioning without interpositional graft.

    Science.gov (United States)

    Santos, S E; Moreira, R W F; de Moraes, M; Asprino, L; Araujo, M M

    2012-04-01

    True vertical maxillary deficiency is a characteristic of short face syndrome. In these patients, inferior repositioning of the maxilla (IRM) is indicated to improve facial aesthetics and function, but this procedure has been described as the most unstable. The aim of this study was to evaluate the long term, post surgical stability of IRM, fixed with four 2.0mm L-shaped miniplates, without any type of graft. A cephalometric study was performed, analysing linear measurements (anterior nasal spine, the A point, top of the incisor, top of the buccal-mesial cusp of the first molar, and posterior nasal spine on an X-Y coordinate system) traced immediately preoperatively, immediately postoperatively and at least 6 months post operatively. Eight young adult patients who underwent IRM were studied. The average results of this study were: surgical movement of 4.65 mm at I point, 5.32 mm at anterior nasal spine (ANS) point, and 4.70 mm at A point and relapses of 1.60 mm (35%), 2.23 mm (43%) and 2.10 mm (46%), respectively. It was concluded, that IRM using this type of internal rigid fixation without graft is unstable.

  11. Reconstrucción de la extremidad inferior con colgajos de perforantes locales Perforator local flaps in lower limb reconstruction

    Directory of Open Access Journals (Sweden)

    T. C. Teo

    2006-12-01

    Full Text Available Las innovaciones técnicas en el diseño y elevación de colgajos y los recientes avances en el conocimiento de la perfusión arterial de los mismos, ha conducido hacia un tipo de reconstrucción más refinada para todas las partes del cuerpo. El concepto de colgajos basados en vasos perforantes ha evolucionado a partir de estos avances. La reconstrucción de la extremidad inferior se ha beneficiado particularmente de este desarrollo de los colgajos de perforantes, tanto pediculados como libres. El colgajo fasciocutáneo en isla de base distal, basado en una sola perforante, permite la reconstrucción de defectos del tercio inferior de la extremidad inferior, con una técnica de rápida ejecución y con una instrumentación básica. Describimos la anatomía, diseño, ejecución, aplicaciones y ventajas de los colgajos de perforantes locales en la reconstrucción del miembro inferior.Technical innovations in the approach to flap design and dissection and recent advances in unders tanding of the arterial basis of flap perfusion have led to more refined reconstruction in all areas of the body. The concept of perforator vessel based flap has evol ved from this improved knowledge. Lower limb reconstruction has certainly benefited from this development of perforator flaps, both pedi cled and free. The distally based island fasciocutane ous flap, based on a single perforator, has allowed defects on the often awkward distal third of the lower limb to be covered reliably, with a quicker procedure and the simplest of instrtuments. We describe the anatomy, design, technique, appli cations and advantages of perforator local flaps in lower limb reconstruction.

  12. Distal insertions of the semimembranosus tendon: MR imaging with anatomic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Maeseneer, Michel de [Universitair Ziekenhuis Brussel, Department of Radiology, Jette, Brussels (Belgium); Vrije Universiteit Brussel, Department of Experimental Anatomy, Brussels (Belgium); Shahabpour, Maryam; Milants, Annemieke; Ridder, Filip de; Mey, Johan de [Universitair Ziekenhuis Brussel, Department of Radiology, Jette, Brussels (Belgium); Lenchik, Leon [Wake Forest University, Department of Radiology, Winston-Salem, NC (United States); Cattrysse, Erik [Vrije Universiteit Brussel, Department of Experimental Anatomy, Brussels (Belgium)

    2014-06-15

    The purpose of this study is to investigate the distal insertions of the semimembranosus tendon with MR imaging, correlated with findings in cadavers. Four fresh cadaveric specimens were studied with 3-T MR imaging. Sequences included proton density (PD) sequences (TE, 13; TR, 4957; FOV, 170 x 170; matrix, 424 x 413; NA, 2; slice thickness, 2.5 mm) in the axial, coronal, and sagittal planes and 3D fast field echo (FFE) sequences (TR 9.4; TE 6.9; FOV, 159 x 105; matrix, 200 x 211; NA, 2; slice thickness, 0.57 mm). One specimen was dissected and three specimens were sectioned with a bandsaw in the axial, coronal, and sagittal plane. The sections were photographed and correlated with MR images. To standardize the analysis, the semimembranosus muscle and tendon were assessed at seven levels for the axial sections, and at three levels for the coronal and sagittal sections. Anatomic dissection revealed six insertions of the distal semimembranosus tendon: direct arm, anterior arm, posterior oblique ligament extension, oblique popliteal ligament extension, distal tibial expansion (popliteus aponeurosis), and meniscal arm. Axial MR images showed five of six insertions: direct arm, anterior arm, oblique popliteal ligament extension, posterior oblique ligament extension, and distal tibial expansion. Sagittal MR images showed four of six insertions: direct arm, anterior arm, oblique popliteal ligament arm, and distal tibial expansion. Sagittal MR images were ideal for showing the direct arm insertion, but were less optimal than the axial images for showing the other insertions. The anterior arm was seen but volume averaging was present with the gracilis tendon. Coronal MR images optimally revealed the anterior arm, although magic angle artifact was present at its posterior aspect. The common semimembranosus tendon and meniscal arm were also well depicted. The division in anterior arm, direct arm, and oblique popliteal ligament arm was poorly seen on coronal images due to

  13. The Use of Accessory Portals in Bankart Repair With Posterior Extension in the Lateral Decubitus Position.

    Science.gov (United States)

    Cvetanovich, Gregory L; Hamamoto, Jason T; Campbell, Kevin J; McCarthy, Mark; Higgins, John D; Verma, Nikhil N

    2016-10-01

    The Bankart lesion, in which the anteroinferior labrum is detached from the glenoid, is the critical anatomic lesion in the majority of patients with anterior glenohumeral instability. Some patients with anterior glenohumeral instability will have Bankart lesions with posterior extension beyond the 6-o'clock position, and achieving anatomic labral repair in these cases can present a technical challenge. In our experience, the lateral decubitus position and use of accessory portals allow superior visualization of the inferior half of the glenohumeral joint for glenoid and labral preparation, anchor placement, and suture management. The use of double-loaded suture anchors at the inferior glenoid provides multiple points of fixation at this challenging location while limiting the number of anchors required. The purpose of this article is to present a simple and reproducible technique for arthroscopic repair of Bankart lesions with posterior extension, emphasizing the use of accessory 5-o'clock trans-subscapularis and 7-o'clock portals.

  14. Posterior Ankle Structure Injury During Total Ankle Replacement.

    Science.gov (United States)

    Reb, Christopher W; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2016-01-01

    Total ankle replacement studies have focused on reporting complications that are directly observed clinically or radiographically, including wound problems, technical errors, implant loosening, subsidence, infection, bone fractures, and heterotopic ossification. However, patients can still experience unresolved pain even when these problems have been ruled out. We initiated a study to more clearly define the relative risk of injury to the anatomic structures in the posterior ankle during total ankle replacement using a third-generation implant system. Ten fresh-frozen adult cadaveric below-the-knee specimens were positioned in the intraoperative positioning frame of an approved total ankle replacement system and adjusted to achieve proper foot alignment using fluoroscopic imaging. The relationship between the tibial cutting guide pins and the posterior neurovascular and tendon structures was measured using digital calipers. High rates of posterior structural injury were found. Nearly all proximal-medial pins encountered a posteromedial neurovascular structure, most commonly the tibial nerve. The distal-medial pins mainly encountered posteromedial tendinous structures, in particular, the flexor digitorum longus tendon. The proximal lateral pins were highly likely to encounter the Achilles tendon and the sural nerve. Our results support our hypothesis that the tibial neurovascular structures are at the greatest risk when preparing for and completing the bony resection, particularly with the medial and proximal cuts. Posterior ankle soft tissue structure injuries can occur during implantation but currently with unknown frequency and undetermined significance. Further study of posterior structural injuries could result in a more informed approach to post-total ankle replacement complications and management.

  15. Interlocking nailing in fractures of distal tibia

    Directory of Open Access Journals (Sweden)

    Akshay Phadke

    2016-04-01

    Conclusions: Intramedullary nailing is an effective alternative for the treatment of distal metaphyseal tibial fractures. A proper patient selection, adjuvant fixation of fibula and use of at least two distal interlocking screws is suggested for better outcome. [Int J Res Med Sci 2016; 4(4.000: 1132-1135

  16. Giant cell tumour of distal ulna.

    Science.gov (United States)

    Archik, Shreedhar; Tripathi, Sanjay Kumar; Nanda, Saurav Narayan; Choudhari, Ashlesh

    2017-01-01

    Giant cell tumor (GCT) of distal end epiphysis ulna is a rare presentation, and only few cases are reported in the scientific literature. We report a case of GCT of distal end epiphysis ulna treated at our Tertiary Care Hospital, Mumbai.

  17. Radical surgery for Budd-Chiari syndrome through exposure of the entire inferior vena cava of the hepatic segment

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xiao-ming; LI Qing-Le

    2007-01-01

    Background Several kinds of radical surgery for the treatment of Budd-Chiari syndrome (BCS) have been devised. We have described preliminary efforts to treat BCS using a novel radical resection technique to expose the entire inferior vena cava (IVC) of the hepatic segment.Methods Sixty patients with BCS were treated by radical resection, including 46 men and 14 women. BCS patients ranged in age from 11 to 62 years, with 3 months to 11 years since the BCS diagnosis. The lesions included membrane occlusion of the IVC in 16 patients, double membranes within the IVC in 2 patients, double membranes within the IVC and the hepatic vein (HV) in 3 patients, IVC membrane with distal thrombosis in 10 patients, long segment thrombosis of the IVC in 5 patients (organized thrombosis in 2 patients, fresh thrombosis in 3 patients), occlusion of the outlet of the HVs due to mural thrombosis in 2 patients, segmental occlusion of the IVC in 3 patients, membranes within the HV with IVC stenosis due to protrusion of HV stent in 1 patient, HV membranes in 11 patients, extensive occlusion of HVs in 1 patient, the whole IVC tumor thrombus with tumor thrombus of 2/3 right atrium resulting from a posterior peritoneum tumor in 1 patient, IVC leiomyosarcoma in 2 patients, IVC leiomyosarcoma with tumor thrombus into 1/2 right atrium in 1 patient, IVC thrombosis extending into right atrium in 1 patient, compression of supra-hepatic segment of IVC due to fiber trabs in 1 patient.Results All lesions were successfully resected under direct supervision. Three procedures were performed under extracorporeal circulation, 52 patients with catheterization of the right atrium, 4 patients with a cell saver, and one patient with auto-retrieval of blood. The retrieved blood was from 300 ml to 4000 ml. Transfusion of banked blood was from 400 ml to 2000 ml for 14 patients. For the other patients no transfusion of banked blood was required. One patient died of renal failure peri-operatively. Newly formed IVC

  18. Combined posterior Bankart lesion and posterior humeral avulsion of the glenohumeral ligaments associated with recurrent posterior shoulder instability.

    Science.gov (United States)

    Hill, J David; Lovejoy, John F; Kelly, Robert A

    2007-03-01

    Recurrent posterior glenohumeral instability is uncommon and is often misdiagnosed. Damage to the posterior capsule, posteroinferior glenohumeral ligament, and posterior labrum have all been implicated as sources of traumatic posterior instability. We describe a case of traumatic recurrent posterior instability resulting from a posterior Bankart lesion accompanied by posterior humeral avulsion of the glenohumeral ligaments. The Bankart lesion was repaired using a single arthroscopic suture anchor at the glenoid articular margin. The posterior humeral avulsion of the glenohumeral ligaments was addressed with 3 suture anchors placed at the capsular origin at the posterior humeral head. Using these anchors, the posterior capsule was advanced laterally and superiorly for a secure repair. Arthroscopic anatomic reconstruction of both lesions resulted in an excellent clinical outcome.

  19. Robotic distal pancreatectomy: a valid option?

    Science.gov (United States)

    Jung, M K; Buchs, N C; Azagury, D E; Hagen, M E; Morel, P

    2013-10-01

    Although reported in the literature, conventional laparoscopic approach for distal pancreatectomy is still lacking widespread acceptance. This might be due to two-dimensional vision and decreased range of motion to reach and safely dissect this highly vascularized retroperitoneal organ by laparoscopy. However, interest in minimally invasive access is growing ever since and the robotic system could certainly help overcome limitations of the laparoscopic approach in the challenging domain of pancreatic resection, notably in distal pancreatectomy. Robotic distal pancreatectomy with and without spleen preservation has been reported with encouraging outcomes for benign and borderline malignant disease. As a result of upgraded endowristed manipulation and three-dimensional visualization, improved outcome might be expected with the launch of the robotic system in the procedure of distal pancreatectomy. Our aim was thus to extensively review the current literature of robot-assisted surgery for distal pancreatectomy and to evaluate advantages and possible limitations of the robotic approach.

  20. Leiomyosarcoma of the inferior vena cava level II involvement: curative resection and reconstruction of renal veins

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    Wang Quan

    2012-06-01

    Full Text Available Abstract Leiomyosarcoma of the inferior vena cava (IVCL is a rare retroperitoneal tumor. We report two cases of level II (middle level, renal veins to hepatic veins IVCL, who underwent en bloc resection with reconstruction of bilateral or left renal venous return using prosthetic grafts. In our cases, IVCL is documented to be occluded preoperatively, therefore, radical resection of tumor and/or right kidney was performed and the distal end of inferior vena cava was resected and without caval reconstruction. None of the patients developed edema or acute renal failure postoperatively. After surgical resection, adjuvant radiation therapy was administrated. The patients have been free of recurrence 2 years and 3 months, 9 months after surgery, respectively, indicating the complete surgical resection and radiotherapy contribute to the better survival. The reconstruction of inferior vena cava was not considered mandatory in level II IVCL, if the retroperitoneal venous collateral pathways have been established. In addition to the curative resection of IVCL, the renal vascular reconstruction minimized the risks of procedure-related acute renal failure, and was more physiologically preferable. This concept was reflected in the treatment of the two patients reported on.

  1. Posterior bicondylar tibial plateau fractures.

    Science.gov (United States)

    Carlson, DuWayne A

    2005-02-01

    To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct fracture exposure and fixation through dual incisions. Retrospective clinical study. Level 1 trauma centers. Eight patients were identified that had posterior bicondylar tibial plateau fractures. Two patients had depressed posterolateral tibial plateau fractures with contained defects and did not have direct fracture exposure. One patient died of medical problems leaving 5 patients who underwent direct fracture exposure, reduction, and fixation. Posteromedial followed by posterolateral open reduction and internal fixation of posterior bicondylar tibial plateau fractures. At 6 to 24 months follow-up (mean 13 months), all patients returned to near full activities, each with aching after prolonged standing (8-hour shift). Range of motion averaged 2 degrees to 121 degrees of flexion. Three of 5 returned to manual labor jobs; the others were not employed at the time of injury. Posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and can be associated with anterior cruciate ligament injury. Reduction of the posterior plateau condyles is easiest with the knee in full extension. Flexion contractures can be a problem, and patients should be encouraged to regain/maintain knee extension. The dual-incision approach to these challenging fractures can result in good to excellent knee function for these patients.

  2. Accidental macular hole following Neodymium:YAG posterior capsulotomy

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    Munteanu Mihnea

    2014-01-01

    Full Text Available Introduction. Posterior capsular opacification (PCO is the commonest complication of cataract surgery, occurring in up to one-third of patients in a period of five years. The treatment of choice is the Neodymium:YAG laser posterior capsulotomy. This treatment can be associated with several complications, some of them severe. A rare complication of this procedure is the accidental induced macular hole. Case Outline. A 54-year-old female patient was referred to our Department because of a severe loss of vision and a central scotoma at the right eye. The patient underwent a Nd:YAG posterior capsulotomy 2 days ago, for a PCO. The fundus examination at presentation revealed a round retinal defect in the macular region, a massive inferior preretinal hemorrhage and a mild vitreous hamorrhage. A 6-months follow-up of the case, including retinography and fluorescein angiography, is presented. Conclusion. Although the Nd:YAG laser capsulotomy is a safe, noninvasive, and effective outpatient procedure to improve vision hindered by PCO, it must be recognized that it carries a low but definite risk of serious complications. Physicians and patients should be aware of these rare but severe complications regarding this otherwise safe procedure. Fortunately, most of the complications related to this procedure are transient and can be managed by proper medication.

  3. Reconstrucción de extremidad inferior

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    M. Parrett Brian, M.D.

    2010-01-01

    Full Text Available La reconstrucción de la extremidad inferior es parte esencial de la cirugía plástica y se concentra en el tratamiento de heridas y defectos causados por trauma, cáncer, o procesos de enfermedades crónicas. Durante los últimos 25 años, los avances en técnicas de cirugía plástica tales como la transferencia libre de tejidos tecnologías más avanzadas de cuidado de heridas han revolucionado este campo, permitiendo salvar extremidades que de otro modo habrían sido amputadas. Este documento analizará el campo de la reconstrucción de extremidades inferiores concentrándose en la evaluación de defectos y heridas de pierna y las variadas opciones de tratamiento.

  4. Distal Adding-on and Risk Factors in Severe and Rigid Scoliosis.

    Science.gov (United States)

    Zang, Lei; Hai, Yong; Yuan, Shuo; Su, Qingjun; Yang, Jincai; Guan, Li; Kang, Nan; Meng, Xianglong; Liu, Yuzeng; Fan, Ning

    2017-02-01

    A retrospective study. The aim of this study was to identify associated risk factors of distal adding-on in severe and rigid scoliosis. Previous work has evaluated the challenges in the treatment of patients with severe and rigid scoliosis and the risks of complications. Furthermore, although several studies have investigated postoperative distal adding-on and attendant risk factors in Lenke type 1A scoliosis, very few have focused on distal adding-on in severe and rigid scoliosis. In this study, 48 consecutive patients with severe and rigid scoliosis underwent posterior spinal fusion surgery. The parameters of preoperative, immediately postoperative, and minimum 2-year follow-up radiographs were evaluated. The patients were classified as positive or negative for distal adding-on at follow-up, and risk factors were comparatively analyzed in the two groups. The average Cobb angle and flexibility of the main thoracic curve (MTC) were 107.4° ± 15.9° and 16.4% ± 10.2%, respectively, before surgery. Distal adding-on was observed in 12 patients (25.0%) at follow-up. Univariate analysis identified several factors significantly associated with distal adding-on. Furthermore, significant independent risk factors identified by stepwise logistic regression analysis included the correction rate of the MTC immediately after surgery (odds ratio: 1.107, 95% confidence interval: 1.024-1.197, P = 0.011) and the difference between the lower instrumented vertebra (LIV) and last touching vertebra (LTV) levels (odds ratio: 0.121, 95% confidence interval: 0.028-0.518, P = 0.004). In severe and rigid scoliosis, a high correction rate of the MTC immediately after surgery and the LIV level above the LTV were significantly associated with distal adding-on. 3.

  5. Does Wal-Mart Sell Inferior Goods?

    OpenAIRE

    Emek Basker

    2008-01-01

    I estimate the aggregate income elasticity of Wal-Mart's and Target's revenues using quarterly data for 1997-2006. I find that Wal-Mart's revenues increase during bad times, whereas Target's revenues decrease, consistent with Wal-Mart selling "inferior goods" in the technical sense of the term. An upper bound on the aggregate income elasticity of demand for Wal-Mart's wares is -0.5.

  6. Treatment of distal clavicle fracture with distal radius volar locking compression plate

    Institute of Scientific and Technical Information of China (English)

    YU Chao; SUN Yue-hua; ZHAO Chang-qing; SHI Ding-wei; WANG You

    2009-01-01

    Objective: To observe the early clinical outcomes of the internal fixation with distal radius volar locking compression plate (LCP) in treatment of distal clavicle fracture.Methods: Six patients with unilateral distal clavicle fractures, identified as type Ⅱ according to Neer classification system, including 4 males and 2 females, were treated with open reduction and internal fixation using a distal radius volar LCP. Bone union was evaluated by routine X-ray radiography, and shoulder joint function were assessed by Constant score system.Results: All fractures achieved bone union at 6 to 8 weeks postoperatively, and Constant scores ranged from 95 to 100 at the postoperative 10 to 12 weeks.Conclusion: Fixation of distal clavicle fracture with distal radius volar LCP demonstrates excellent effects of bone union with rarely early complications, thus providing a new technique to treat distal clavicle fracture.

  7. Surgical treatment for ruptured anterior inferior cerebellar artery aneurysms

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    TONG Xiao-guang

    2013-03-01

    Full Text Available Background Anterior inferior cerebellar artery (AICA aneurysm is an extremely raretumor, which can cause severe results after ruptured. This article retrospectively analyzed the clinical symptoms, imaging manifestations, surgical approaches, endovascular therapy and postoperative outcomes of 12 cases with AICA aneurysms, so as to provide reference for clinical practice. Methods Clinical data of patients with AICA aneurysms, who were treated in our hospital between June 2004 and June 2012, were carefully collected and studied. Glasgow Outcome Scale (GOS scores were used to evaluate the patients' living status. Results There were 12 patients (the average age was 54 years old with 13 ruptured aneurysms, accounting for 0.19% of all aneurysms (6467 cases treated in the same period. CT showed simple subarachnoid hemorrhage (SAH in 6 patients, simple ventricular hemorrhage in 1 patient and SAH complicated with ventricular hemorrhage in 5 patients. According to Hunt-Hess Grade, 2 patients were classified as Grade Ⅰ; 7 were Grade Ⅱ; 3 were Grade Ⅲ. Digital subtraction angiography (DSA showed there were 10 saccular aneurysms and 3 fusiform aneurysms. Three aneurysms were located in the proximal segment of AICA (the junction of AICA and basilar artery, 3 premeatal segment (first bifurcation of AICA, 3 meatal and 4 postmeatal. The mean diameter was 3.90 mm. Three patients with 4 aneurysms were treated with microsurgery, of which clipping was carried out in 2 patients with 3 aneurysms and trapping in 1 case. Other 9 patients were treated with endovascular therapy, of which 2 cases underwent coil embolization, 3 stent-assisted coil, and 4 parent artery occlusion (PAO. Postoperative complications included facial paralysis (1 case, dysphagia and coughing when drinking (1 case and contralateral hemianopia in both eyes (1 case. Follow-up was available in all of these cases for a mean of 36.41 months, with GOS scores 3 in 1 case, 4 in 2 cases and 5 in 9

  8. Vascular Complications in Arthroscopic Repair Of Posterior Cruciate Ligament

    Science.gov (United States)

    Agotegaray, Juan Ignacio; Comba, Ignacio; Bisiach, Luciana; Grignaffini, María Emilia

    2017-01-01

    Introduction: Posterior cruciate ligament is the primary stabilizer of the knee. Among the potential complications in arthroscopic repair of this ligament, there are vascular lesions, due to laceration, thrombosis and injury of the intima of the popliteal artery. We used one case to show the vascular complications that may arise in arthroscopic repair of the posterior cruciate ligament, how to handle it and the results. Methods: One patient, 33 years old, with a history of traffic accident. In a physical exam the patient shows pain and swelling of the knee, positive posterior drawer test and positive Godfrey test. X-rays on the knee show posterior tibial translation and MRI a complete fibers rupture at the middle third of the posterior cruciate ligament. An arthroscopic repair surgery was scheduled three weeks after trauma, with PCL reconstruction using simple band technique.After surgical intervention, hemostatic cuff was released, no peripheral pulse, paleness and coldness of the member was confirmed. An arteriography was carried out, which confirmed absences of distal vascular filling in the popliteal artery. An urgent referral was carried out with Vascular Surgery Services, who had been informed of the surgery previously (a notification that is part of our routine for this kind of interventions). Arteriorrhaphy and venorrhaphy of the popliteal arteries was fulfilled 12 hours later, with a leg fasciotomy. Daily monitoring was performed, and after 72 hours, muscle necrosis is seen with wound drainage, analysis shows presence of gram-negative bacilli, Proteus Mirabilis-Pseudomonas spp and the lab results showed leukocytes: 8.700/ml, ESR: 58, CRP: 48. A new surgery is performed with complete resection of the anterior external compartment of the leg, and a system of continuous cleansing is applied with physiological saline solution and boric acid for 14 days until drainage is eliminated. Vancomycin and ceftazidime EV was indicated for 14 days and, after a good

  9. Epidural hematomas of posterior fossa

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    Radulović Danilo

    2004-01-01

    Full Text Available Background. Posterior fossa epidural hematomas represent 7-14% of all traumatic intracranial epidural hematomas. They are most frequently encountered posttraumatic mass lesions in the posterior fossa. The aim of this study was to identify clinical features that could lead to the early diagnosis of posterior fossa epidural hematoma. Methods. Between 1980 and 2002, 28 patients with epidural hematoma of the posterior fossa were operated on at the Institute for Neurosurgery, Belgrade. Clinical course neuroradiological investigations, and the results of surgical treatment of the patients with posterior fossa epidural hematomas were analyzed retrospectively. Results. Almost two thirds of patients were younger than 16 years of age. In 20 cases injury was caused by a fall, in 6 cases by a traffic accident, and in 2 by the assault. Clinical course was subacute or chronic in two thirds of the patients. On the admission Glasgow Coma Scale was 7 or less in 9 injured, 8-14 in 14 injured, and 15 in 5 injured patients. Linear fracture of the occipital bone was radiographically evident in 19 patients, but was intraoperatively encountered in all the patients except for a 4-year old child. In 25 patients the diagnosis was established by computer assisted tomography (CAT and in 3 by vertebral angiography. All the patients were operated on via suboccipital craniotomy. Four injured patients who were preoperatively comatose were with lethal outcome. Postoperatively, 24 patients were with sufficient neurologic recovery. Conclusion. Posterior fossa epidural hematoma should be suspected in cases of occipital injury, consciousness disturbances, and occipital bone fracture. In such cases urgent CAT-scan is recommended. Early recognition early diagnosis, and prompt treatment are crucial for good neurological recovery after surgery.

  10. Molecular genetics of distal hereditary motor neuropathies.

    Science.gov (United States)

    Irobi, Joy; De Jonghe, Peter; Timmerman, Vincent

    2004-10-01

    Inherited peripheral neuropathies comprise a wide variety of diseases primarily affecting the peripheral nervous system. The best-known peripheral neuropathy is Charcot-Marie-Tooth disease (CMT) described in 1886 by J.-M. Charcot, P. Marie and H.H. Tooth. In 1980, A.E. Harding and P.K. Thomas showed that in a large group of individuals with CMT, several only had motor abnormalities on clinical and electrophysiological examination, whereas sensory abnormalities were absent. This exclusively motor variant of CMT was designated as spinal CMT or hereditary distal spinal muscular atrophy, and included in the distal hereditary motor neuropathies (distal HMN). The distal HMN are clinically and genetically heterogeneous and are subdivided according to the mode of inheritance, age at onset and clinical evolution. Since the introduction of positional cloning, 12 chromosomal loci and seven disease-causing genes have been identified for autosomal dominant and recessive distal HMN. Most of the genes involved have housekeeping functions, as in RNA processing, translation synthesis, glycosylation, stress response, apoptosis, but also axonal trafficking and editing. Functional characterization of the mutations will help to unravel the cellular processes that underlie the specificity of motor neuropathies leading to neurogenic muscular atrophy of distal limb muscles. Here we review the recent progress of the molecular genetics of distal HMN and discuss the genes implicated.

  11. Maxillary antral lavage using inferior meatal cannula anaesthesia.

    Science.gov (United States)

    Mochloulis, G; Hern, J D; Hollis, L J; Tolley, N S

    1996-08-01

    Antral puncture and lavage through the inferior meatus is a minor but common otolaryngological procedure, usually performed under local anaesthesia. We describe a new method of introducing local anaesthetic into the inferior meatus, via the use of a soft intravenous cannula connected to a syringe containing 10 per cent cocaine paste. We have called this new technique inferior meatal cannula anaesthesia (IMCA).

  12. Inferior venacaval compression due to excessive abdominal packing

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    M.C.B. Santhosh

    2014-06-01

    Full Text Available Inferior venacaval compression is a common problem in late pregnancy. It can also occur due to compression of inferior venacava by abdominal or pelvic tumors. We report a case of acute iatrogenic inferior venacaval compression due to excessive abdominal packing during an intraabdominal surgery.

  13. Pseudotumor of the distal common bile duct at endoscopic retrograde cholangiopancreatography

    Science.gov (United States)

    Tan, Justin H.; Coakley, Fergus V; Wang, Zhen J.; Poder, Liina; Webb, Emily; Yeh, Benjamin M.

    2010-01-01

    Background Prior studies have described a pseudocalculus appearance in the distal common bile duct as a normal variant at cholangiography. The objective of this study is to describe the occurrence of pseudotumor in the distal common bile duct at endoscopic retrograde cholangiopancreatography (ERCP). Methods Nine patients who underwent ERCP between May 2004 and July 2008 were identified as having a transient eccentric mural-based filling defect in the distal common bile duct. A single reader systematically reviewed all studies and recorded the imaging findings. Results The mean diameter of the filling defect was 9 mm (range, 5 to 11). Eight patients had resolution of the filling defect during the same ERCP or on a subsequent ERCP, and in 2 of these patients the inferior border of the filling defect was not well visualized. The other patient underwent surgical resection of a presumed tumor with no evidence of malignancy on surgical pathology. Conclusion An eccentric mural-based filling defect in the distal common bile duct can be artifactual in nature and may reflect transient contraction of the sphincter of Oddi. Recognition of this pseudotumor may help avoid unnecessary surgery. PMID:21724120

  14. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports.

    Science.gov (United States)

    Chen, Bin; Li, Runguang; Zhang, Sheng

    2012-08-01

    Neglected rupture of the patellar tendon is rare but becomes more difficult to repair the longer it is left untreated. The most common rupture sites are the inferior pole of the patella and distal insertion. Proximal retraction of the patella and extensor mechanism adhesions makes the treatment more difficult than acute tendon rupture. We report two patients with neglected patellar tendon rupture treated by reconstruction and restoration using semitendinosus-gracilis (STG) tendons with preserved distal insertions. Preserved distal insertion provided sufficient blood supply to accelerate healing, while combined fixation with tension-reducing wire, offered the initial stability of the closed-loop sutured tendon. Both patients reacquired near normal strength and stability of the patellar tendon and restoration of function after operation and rehabilitation. Copyright © 2011 Elsevier B.V. All rights reserved.

  15. Penatalaksanaan Sinus Preaurikuler Tipe Varian Dengan Pit pada Heliks Desenden Postero-Inferior

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    Jacky Munilson

    2013-01-01

    Full Text Available AbstrakSinus preaurikuler merupakan kelainan kongenital berupa adanya lubang kecil pada telinga luar yangbiasanya terdapat di anterior dari heliks asendens. Disamping lokasi tersebut, sinus preaurikuler juga dapatditemukan posterior dari liang telinga luar yang dikenal sebagai sinus preaurikuler tipe varian. Sinus preaurikulertipe varian merupakan kasus yang jarang dilaporkan. Kebanyakan kasus tidak menunjukkan gejala, sebagianlainnya mengalami masalah infeksi berupa keluarnya cairan, atau terbentuknya abses. Penatalaksanaan sinuspreaurikuler adalah dengan pengangkatan sinus secara lengkap. Kekambuhan merupakan masalah yang dapattimbul jika tidak diangkat secara lengkap.Dilaporkan satu kasus sinus preaurikuler tipe varian dengan pitberada pada heliksdesendens postero-inferior dekatlobulus pada seorang anak laki-laki umur 3 tahun 6 bulan dan ditatalaksana dengan sinektomi.Kata kunci: Sinus preaurikuler, sinus preaurikuler tipe varian, sinektomi.AbstractPreauricular sinusis a congenital malformation that manifests as pit in the extenal ear, usually located in theanterior limb of ascending helix. In additional to these location, preauricular sinus can also be found in the posterior ofthe external ear canal, known as the preauricular sinus with variant type. Preauricular sinus variant type is a rarelyreported. Almost cases are asymptomatic, but others are infectious with discharge or abscess formation. Themanagement of preauricular sinus is excision sinus completely. Recurrence is the problem that happen if the excisionwas not complete.One case of preauricular sinus variant type with pit on the postero-inferior decending helixnearlobulus in a boy 3 years and 6 months old and managed bysinectomy.Keywords: Preauricular sinus, Preauricular sinus variant type, sinectom

  16. Unilateral Molar Distalization: A Nonextraction Therapy

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    M. Bhanu Prasad

    2012-01-01

    Full Text Available In the recent years, nonextraction treatment approaches and noncompliance therapies have become more popular in the correction of space discrepancies. One of the conventional approaches for space gaining in the arches without patient compliance is done by using certain extra oral appliances or intraoral appliance. The greatest advantage of certain appliances like fixed functional and molar distalization appliances is that they minimize the dependence on patient cooperation. Molar distalization appliances like pendulum appliance which distalizes the molar rapidly without the need of head gear can be used in patients as a unilateral space gaining procedure due to buccal segment crowding.

  17. The distal hereditary motor neuropathies.

    Science.gov (United States)

    Rossor, Alexander M; Kalmar, Bernadett; Greensmith, Linda; Reilly, Mary M

    2012-01-01

    The distal hereditary motor neuropathies (dHMN) comprise a heterogeneous group of diseases that share the common feature of a length-dependent predominantly motor neuropathy. Many forms of dHMN have minor sensory abnormalities and/or a significant upper-motor-neuron component, and there is often an overlap with the axonal forms of Charcot-Marie-Tooth disease (CMT2) and with juvenile forms of amyotrophic lateral sclerosis and hereditary spastic paraplegia. Eleven causative genes and four loci have been identified with autosomal dominant, recessive and X-linked patterns of inheritance. Despite advances in the identification of novel gene mutations, 80% of patients with dHMN have a mutation in an as-yet undiscovered gene. The causative genes have implicated proteins with diverse functions such as protein misfolding (HSPB1, HSPB8, BSCL2), RNA metabolism (IGHMBP2, SETX, GARS), axonal transport (HSPB1, DYNC1H1, DCTN1) and cation-channel dysfunction (ATP7A and TRPV4) in motor-nerve disease. This review will summarise the clinical features of the different subtypes of dHMN to help focus genetic testing for the practising clinician. It will also review the neuroscience that underpins our current understanding of how these mutations lead to a motor-specific neuropathy and highlight potential therapeutic strategies. An understanding of the functional consequences of gene mutations will become increasingly important with the advent of next-generation sequencing and the need to determine the pathogenicity of large amounts of individual genetic data.

  18. Indirect reduction of posterior wall fragment using a suture anchor in acetabular posterior wall fracture with posterior labral root tear.

    Science.gov (United States)

    Yoo, Je-Hyun; Chang, Jun-Dong; Lee, Ho-Won

    2015-02-01

    Posterior wall fractures, which are the most common type of acetabulum fracture, are frequently accompanied with an avulsion tear of the posterior labral root as well as hip dislocation due to the injury mechanism. In the treatment of these fractures with an avulsed posterior labral root attached to posterior wall fragment, the use of a suture anchor can induce indirect reduction of a posterior wall fragment as well as direct repair of a labral root tear simultaneously. We describe the simple and efficient technique using a suture anchor in posterior wall acetabular fractures and surgical outcomes of two cases treated with this technique.

  19. Prevention of posterior capsular opacification

    NARCIS (Netherlands)

    Nibourg, Lisanne M; Gelens, Edith; Kuijer, Roelof; Hooymans, Johanna Mm; van Kooten, Theo G; Koopmans, Steven A

    2015-01-01

    Posterior capsular opacification (PCO) is a common complication of cataract surgery. The development of PCO is due to a combination of the processes of proliferation, migration, and transdifferentiation of residual lens epithelial cells (LECs) on the lens capsule. In the past decades, various forms

  20. Significance of precordial ST-segment depression in inferior acute myocardial infarction as determined by echocardiography.

    Science.gov (United States)

    Piérard, L A; Sprynger, M; Gilis, F; Carlier, J

    1986-01-01

    Despite numerous studies, the significance of precordial ST-segment depression in inferior wall acute myocardial infarction (AMI) remains unclear. No clinical studies have used 2-dimensional (2-D) echocardiography to compare AMI location in patients with or without so-called reciprocal ST changes. Therefore, the clinical, electrocardiographic, echocardiographic and angiographic features of 22 patients with their first transmural inferior AMI were prospectively examined. During the first day of AMI an echocardiographic mapping of the area of necrosis was obtained using all conventional views and a ventricular segmentation related to anatomic landmarks. Patients were categorized according to the presence (group I, n = 13) or absence (group II, n = 9) of precordial ST-segment depression, defined as more than 1 mm, measured 80 ms after the J point in at least 2 of the leads V1 to V4. Basal posterolateral akinesia was observed in 11 of the 13 patients in group I and in no patient in group II (p less than 0.001). Posterior right ventricular free wall akinesia was more frequent in group II (p less than 0.02). There was no difference in the prevalence of significant left anterior descending artery (LAD) narrowing (group I, 4 patients; group II, 3 patients). Posterolateral involvement should be strongly considered in the presence of precordial ST-segment depression in association with transmural inferior AMI.

  1. A Rare Location of Angiofibroma in the Inferior Turbinate in Young Woman

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    Salimov, Asif

    2015-01-01

    Full Text Available Introduction Juvenile nasopharyngeal angiofibroma is a rare benign neoplasm in the nasopharynx. The tumor tends to be locally aggressive and is typically seen in adolescent boys. Extranasopharyngeal angiofibromas have been reported sporadically in the literature. They most commonly originate from the maxillary sinus. Objectives A 26-year-old woman was referred to our clinic with intermittent epistaxis from the right nasal passage for the previous 2 months. Maxillofacial magnetic resonance imaging showed a lobular, contoured mass originating from the right inferior turbinate and hanging in the right nasal cavity, with dense contrast enhancement denoting hypervascularity. Resumed Report Vascular feeding of the mass was seen from the right internal maxillary artery with angiography, and this branch was embolized. On the following day, the patient underwent transnasal endoscopic excision of the mass. An approximately 3-cm-diameter mass was excised by partial turbinectomy, and the posterior edge of the remaining turbinate was cauterized. Conclusion Extranasopharyngeal angiofibromas are rarely seen, and the inferior turbinate is an extremely rare location for them. This young woman is the first case reported in the English literature of angiofibroma originating from the inferior turbinate. We should consider these neoplasms can be found in female, nonadolescent patients with extranasopharyngeal localization, and we should not perform biopsy because of its massive bleeding.

  2. Cobertura do terço distal da perna com retalhos de perfurantes pediculados Covering the distal third of the leg with pedicled perforating vessels patches

    Directory of Open Access Journals (Sweden)

    Marcelo Rosa de Rezende

    2008-01-01

    Full Text Available Os retalhos de vasos perfurantes representam um avanço no tratamento das perdas cutâneas. No terço distal da perna as opções para a cobertura cutânea são poucas e muitas vezes devemos recorrer a microcirurgia. Neste trabalho realizou-se uma avaliação prospectiva de 20 pacientes submetidos ao tratamento de áreas cruentas no terço distal da perna através de retalhos pediculados em artéria perfurante. A localização das artéria perfurantes foi feita , no pré-operatório , através do exame de eco-doppler. Os retalhos foram planejados de forma a permitir sua rotação junto à área cruenta em até 180 graus. Em 6 casos os vasos perfurantes tinham como origem a artéria fibular, em 10 a artéria tibial posterior e 4 a artéria tibial anterior. O índice de acerto do eco-doppler foi de 88,2%. Em pacientes jovens com lesões traumáticas houve 15,4% de falha do procedimento e 33,3% em pacientes com morbidades associadas. Baseado em nossos resultados concluímos ser o retalho de perfurante uma boa opção de tratamento das perdas cutâneas no segmento distal da perna.Perforating vessels patches represent an advancement in terms of skin failures treatment. On the distal third of the leg, the alternatives for skin covering are scarce, often requiring microsurgery. In this study, we aimed to make a prospective assessment of 20 patients submitted to treatment of bloody areas of leg's distal third by means of pedicled patches in perforating arteries. The location of the perforating arteries was preoperatively found using the ecodoppler test. The patches were planned to allow up to 180-degree rotation in the bloody area. In 6 cases, perforating vessels had the fibular artery as source; in 10, the posterior tibial artery, and; in 4, the anterior tibial artery. The accuracy rate of the ecodoppler was 88.2%. For young patients presenting injuries caused by trauma, procedure failures were found in 15.4%, and for those with associated

  3. [Hemiplegia in posterior cerebral artery infarctions: analysis of various responsible mechanisms].

    Science.gov (United States)

    Ortiz, N; Barraquer Bordas, L; Dourado, M; Rey, A; Avila, A

    1993-01-01

    When cerebral infarction determines hemiplegia or hemiparesia which accompany a hemilateral sensitive deficit and hemianopsia and even neuropsychologic symptoms (aphasic alterations in the case of injury to the left hemisphere, heminegligence and anosognosy in the case of injury to the right hemisphere) the involvement of a sylvian artery syndrome is usually considered. Nonetheless, recent contributions have reported that such symptoms may appear in infarctions of the territory of the posterior cerebral artery. Two clinical-radiologic observations in this line are presented. Nuclear magnetic resonance demonstrated injury to the posterior arm of the internal capsule in one case and in the other the lesion developed over three times, in the latter of which injury to the cerebral peduncle was produced causing hemiparesia. The authors emphasize that hemiplegia or hemiparesia in some infarctions of the posterior cerebral artery may be due to 1) mesencephalic infarction in the posterior plane of the retromamillar Foix and Hillemand pediculum (or G. Lazorthes interpedunculum), 2) infarction or "ischemic penumbra" in the internal capsule by involvement of any of the perforating branches of the posterior cerebrum irrigating the thalamus, except for the medial posterior choroid artery or even of the Foix and Hillemand thalamus-tuberian pediculum (or Lazorthes inferior and anterior) which principally initiates at the posterior communicating branch with a fragment of the posterior branch of the internal capsule perhaps not always being under its control. In this case, the thrombus occupying the posterior cerebrum may extend to the cited communicating branch or a hemodynamic deficit may be produced in the territory of the same.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Villous adenoma of the distal appendix.

    Science.gov (United States)

    Taylor, J V; Thomas, M G; Kelly, S; Sutton, R

    1997-04-01

    Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.

  5. Genetics Home Reference: distal arthrogryposis type 1

    Science.gov (United States)

    ... This Page Bamshad M, Bohnsack JF, Jorde LB, Carey JC. Distal arthrogryposis type 1: clinical analysis of ... 5. Citation on PubMed Bamshad M, Jorde LB, Carey JC. A revised and extended classification of the ...

  6. Design of Phase II Non-inferiority Trials.

    Science.gov (United States)

    Jung, Sin-Ho

    2017-09-01

    With the development of inexpensive treatment regimens and less invasive surgical procedures, we are confronted with non-inferiority study objectives. A non-inferiority phase III trial requires a roughly four times larger sample size than that of a similar standard superiority trial. Because of the large required sample size, we often face feasibility issues to open a non-inferiority trial. Furthermore, due to lack of phase II non-inferiority trial design methods, we do not have an opportunity to investigate the efficacy of the experimental therapy through a phase II trial. As a result, we often fail to open a non-inferiority phase III trial and a large number of non-inferiority clinical questions still remain unanswered. In this paper, we want to develop some designs for non-inferiority randomized phase II trials with feasible sample sizes. At first, we review a design method for non-inferiority phase III trials. Subsequently, we propose three different designs for non-inferiority phase II trials that can be used under different settings. Each method is demonstrated with examples. Each of the proposed design methods is shown to require a reasonable sample size for non-inferiority phase II trials. The three different non-inferiority phase II trial designs are used under different settings, but require similar sample sizes that are typical for phase II trials.

  7. Çocuklarda Distal Hipospadias Cerrahisi: Deneyimlerimiz

    OpenAIRE

    2013-01-01

    Objective: In this study, patients treated with distal hypospadias and discuscion of our results with literature were aimed. Material and Methods: 46 patients, who underwent distal hypospadias repair in the recent 2,5 years, were avaluated according to age, meatal localization, chordee status, the type of operation technique, postoperative urethral catheterization and hospitalization time, associated genitourinary anomalies, early and late complications. Results: 4 of 46 cases were treated wi...

  8. PERFORATION OF INFERIOR ALVEOLAR NERVE BY MAXILLARY ARTERY. Perforation of inferior alveolar nerve by maxillary artery

    Directory of Open Access Journals (Sweden)

    Prakash B Billakanti

    2016-03-01

    Full Text Available La fosa infratemporal es un área anatómica clínicamente importante para la administración de agentes anestésicos locales en odontología y cirugía maxilofacial. Fueron estudiadas variaciones en la anatomía del nervio alveolar inferior y la arteria maxilar en la disección infratemporal. Durante la disección rutinaria de la cabeza en el cadáver de un varón adulto, fue observada una variación excepcional en el origen del nervio alveolar inferior y su relación con las estructuras circundantes. El nervio alveolar inferior se originaba en el nervio mandibular por dos raíces y la primera parte de la arteria maxilar estaba incorporada entre ambas. El origen embriológico de esta variación y sus implicaciones clínicas es debatido. Dado que la arteria maxilar transcurría entre las dos raíces del nervio alveolar inferior, y el nervio estaba fijado entre el foramen oval y el foramen mandibular, el atrapamiento vásculo-nervioso pudo causar entume-cimiento o dolor de cabeza e interferir con la inyección de anestésicos locales en la fosa infratemporal.  Variaciones anatómicas en esta región deben ser tenidas en cuenta, especialmente en casos de tratamiento fallido de neuralgia del trigémino. Infratemporal fossa is clinically important anatomical area for the delivery of local anesthetic agents in dentistry and maxillofacial surgery. Variations in the anatomy of the inferior alveolar nerve and maxillary artery were studied in infratemporal dissection. During routine dissection of the head in an adult male cadaver an unusual variation in the origin of the inferior alveolar nerve and its relationship with the surrounding structures was observed. The inferior alveolar nerve originated from the mandibular nerve by two roots and the first part of the maxillary artery was incorporated between them. An embryologic origin of this variation and its clinical implications is discussed. Because the maxillary artery runs between the two roots of

  9. Decompression of inferior alveolar nerve: case report.

    Science.gov (United States)

    Marques, Tiago Miguel Santos; Gomes, Joana Marques

    2011-01-01

    Paresthesia as a result of mechanical trauma is one of the most frequent sensory disturbances of the inferior alveolar nerve. This case report describes surgical treatment for paresthesia caused by a compressive phenomenon within the mandibular canal. The cause of the compression, a broken instrument left in the patient's mouth during previous endodontic therapy, was identified during routine radiography and computed tomography. Once the foreign object was removed by surgery, the paresthesia resolved quickly. This case highlights the potential for an iatrogenic mechanical cause of paresthesia.

  10. Modified Kocher-Langenbeck approach for the stabilization of posterior wall fractures of the acetabulum.

    Science.gov (United States)

    Magu, Narender Kumar; Rohilla, Rajesh; Arora, Sanjay; More, Hament

    2011-04-01

    This article describes a modification of Kocher-Langenbeck approach for the treatment of select posterior wall fractures of acetabulum. The technique aims at achieving osteosynthesis by creating two windows: between the gluteus medius and piriformis superiorly and between the external rotators and ischial tuberosity inferiorly. The approach spares the division of external rotators and of the abductors of the hip, thus preventing iatrogenic damage to the vascularity of the head of the femur and of the fracture fragments. The reconstruction plate can be slid under the piriformis and the short external rotators, thus preserving the soft tissue sleeve of the hip posteriorly. The gluteus minimus is not stripped from the ilium. The technique is ideally suited for isolated, displaced, noncomminuted posterior wall fractures of acetabulum of less than 10 days' duration without marginal impaction. The technique is biologic, takes a shorter operative time in our hands, and prevents further damage to vascularity of the head of the femur and heterotopic ossification.

  11. Translational and rotational knee joint stability in anterior and posterior cruciate-retaining knee arthroplasty.

    Science.gov (United States)

    Lo, JiaHsuan; Müller, Otto; Dilger, Torsten; Wülker, Nikolaus; Wünschel, Markus

    2011-12-01

    This study investigated passive translational and rotational stability properties of the intact knee joint, after bicruciate-retaining bi-compartmental knee arthroplasty (BKA) and after posterior cruciate retaining total knee arthroplasty (TKA). Fourteen human cadaveric knee specimens were used in this study, and a robotic manipulator with six-axis force/torque sensor was used to test the joint laxity in anterior-posterior translation, valgus-varus, and internal-external rotation. The results show the knee joint stability after bicruciate-retaining BKA is similar to that of the native knee. On the other hand, the PCL-retaining TKA results in inferior joint stability in valgus, varus, external rotation, anterior and, surprisingly, posterior directions. Our findings suggest that, provided functional ligamentous structures, bicruciate-retaining BKA is a biomechanically attractive treatment for joint degenerative disease.

  12. Estudo anatômico da inserção femoral do ligamento cruzado posterior Femoral insertion of the posterior cruciate ligament: an anatomical study

    Directory of Open Access Journals (Sweden)

    Ricardo de Paula Leite Cury

    2011-10-01

    Full Text Available OBJETIVO: Identificar parâmetros objetivos para guiar a correta localização do LCP no fêmur. MÉTODOS: Os LCP de 20 cadáveres humanos foram ressecados. As seguintes porções foram medidas: da porção mais distal do ligamento, próximo ao teto, até a borda da cartilagem mais anterior (AB; distância da porção mais proximal do ligamento, próximo ao teto, até a cartilagem mais anterior (AC; distância entre as duas porções do ligamento próximo ao teto (BC; distância da borda distal do ligamento na sua porção posterior até a borda articular mais posterior (D-E; distância da borda distal do ligamento na sua porção posterior até o teto intercondilar (DF; e, finalmente, o formato da inserção ligamentar e área de abrangência no côndilo femoral. RESULTADOS: O LCP tem a forma de um quarto de elipse, com área de, em média, 153,5mm². As distâncias médias encontradas foram: AB de 2,1mm; AC de 10,7mm, BC de 8,6mm, D-E de 12.4mm e DF de 16,8mm. CONCLUSÕES: A borda próxima ao teto do feixe anterolateral é mais próxima da cartilagem articular (2,1mm comparada com o feixe posteromedial, que mede 12,4mm a partir de sua borda proximal da cartilagem. Estas referências devem ajudar em um posicionamento melhor e mais acurado dos túneis femorais na reconstrução do LCP.OBJECTIVE: To identify objective parameters to guide correct location of the posterior cruciate ligament (PCL in the femur. METHODS: The PCLs of 20 human cadavers were resected. The following portions were measured: distance from the most distal portion of the PCL, close to the roof, to the most anterior edge of the cartilage (AB; distance from the most proximal portion of the PCL, close to the roof, to the most anterior cartilage (AC; distance between the two parts of the ligament close to the roof (BC; distance from the distal edge in its posterior portion, to the more posterior joint edge (DE; distance from the distal edge of the ligament in its posterior

  13. A light and electron microscopic study of the inferior olivary nucleus of the squirrel monkey, Saimiri sciureus.

    Science.gov (United States)

    Rutherford, J G; Gwyn, D G

    1980-01-01

    This study provides a description of the normal morphology of the inferior olive of the squirrel monkey, Saimiri sciureus, at the light and electron imcroscopic level. The cytoarchitecture of the inferior olive was maped from serial transverse sections stained with cresyl violet. In common with other mammals, the inferior olive of the squirrel monkey consists of three subdivisions. The medial accessory olive includes seven subnuclei. Both the dorsal and medial accessory olives extend through approximately 90% of the total length of the inferior olivary complex. The principal olive, consisting of a dorsal and ventral lamella continuous with one another laterally, extends through the rostral 55% of the inferior olive. It is somewhat less convoluted than the principal olive of the macaque (Bowman and Sladek, '73). In most other respects, the inferior olive of the two primates is quite similar. Two patterns of dendritic arborization are noted in Golgi preparations from the caudal principal and accessory olives. Dendrites streaming away from the soma, and dendrites curling around the soma in a "ball-like" pattern were observed in all three subdivisions of the inferior olive caudally. Simple spines are occasionally seen on the soma, and a few simple or club-shaped spines were noted on the proximal portion of the dendritic arborization. Spines are more numerous on distal portions of the dendritic tree, however, and include simple, filiform, club-shaped and occasionally complex, or racemous, spiny appendages. Viewed in the electron microscope, most inferior olivary neurons are seen to contain the typical organelles with the usual conformation and distribution. Rarely, a neuron with an indented nucleus and a thin rim of cytoplasm containing a paucity of organelles and a wispy endoplasmic reticulum is encountered. Axon terminals containing either clear round or clear pleomorphic vesicles are seen in all three olivary subdivisions. In a random survey of 706 axon terminals, 54

  14. The complex arrangement of an "aorto-jejunal paraduodenal" fossa, as revealed by dissection of human posterior parietal peritoneum.

    Science.gov (United States)

    Barberini, Fabrizio; Zani, Augusto; Ripani, Maurizio; Di Nitto, Valentina; Brunone, Francesca

    2007-01-01

    Peritoneal fossae derive from normal or anomalous coalescence of the peritoneum during fetal development, or from the course of retroperitoneal vessels. Clinically, internal abdominal hernias may be housed inside these fossae. In this report from an autopsy, a singular peritoneal fossa was delimited superiorly by an arcuate serous fold, raised up by the inferior mesenteric vein, and infero-posteriorly by two (right and left) avascular folds, extending from the abdominal aorta to the jejunum. The right fold reached the duodeno-jejunal flexure, which was located on the right side of the aorta. The left fold subdivided into two, anterior and posterior, secondary folds. The anterior fold reached the superior edge of the first jejunal loop, and the posterior fold turned medially to connect with the inferior edge of the proximal limb of the same loop. This fossa consisted of three recesses: superior, Located behind the subserous vascular arch, antero-inferior and postero-inferior, separated by interposition of the left posterior secondary fold, between the jejunum and aorta. The complex arrangement of this fossa suggests that it might have originated from a coalescence arising beyond the duodeno-jejunal flexure and including the first jejunal loop, and from the subserous course of the inferior mesenteric vein. Because of displacement to the right of the flexure, processes of coalescence in a location normally occupied by the ascending duodenum might have occurred in a similar pattern for the jejunum, involving the mesoduodenum and the proximal part of the mesentery. Labyrinthine fossae like this might cause strangulation of internal abdominal hernias and hinder intraoperative maneuvers.

  15. Cerebral blood flow in posterior cortical nodes of the default mode network decreases with task engagement but remains higher than in most brain regions.

    Science.gov (United States)

    Pfefferbaum, Adolf; Chanraud, Sandra; Pitel, Anne-Lise; Müller-Oehring, Eva; Shankaranarayanan, Ajit; Alsop, David C; Rohlfing, Torsten; Sullivan, Edith V

    2011-01-01

    Functional neuroimaging studies provide converging evidence for existence of intrinsic brain networks activated during resting states and deactivated with selective cognitive demands. Whether task-related deactivation of the default mode network signifies depressed activity relative to the remaining brain or simply lower activity relative to its resting state remains controversial. We employed 3D arterial spin labeling imaging to examine regional cerebral blood flow (CBF) during rest, a spatial working memory task, and a second rest. Change in regional CBF from rest to task showed significant normalized and absolute CBF reductions in posterior cingulate, posterior-inferior precuneus, and medial frontal lobes . A Statistical Parametric Mapping connectivity analysis, with an a priori seed in the posterior cingulate cortex, produced deactivation connectivity patterns consistent with the classic "default mode network" and activation connectivity anatomically consistent with engagement in visuospatial tasks. The large task-related CBF decrease in posterior-inferior precuneus relative to its anterior and middle portions adds evidence for the precuneus' heterogeneity. The posterior cingulate and posterior-inferior precuneus were also regions of the highest CBF at rest and during task performance. The difference in regional CBF between intrinsic (resting) and evoked (task) activity levels may represent functional readiness or reserve vulnerable to diminution by conditions affecting perfusion.

  16. Descripción anatómica de la irrigación del colgajo sural a pedículo distal en piezas cadavéricas

    OpenAIRE

    Quinteros P,Juan Pablo; Sousa R,Jussara; Rapiman G,Andrea; VALDÉS G,FABIO

    2012-01-01

    El colgajo sural fasciomiocutáneo es ampliamente utilizado en la reparación de defectos profundos de tejidos blandos del miembro inferior distal. Este estudio describe su base anatómica mediante la morfometría de las arterias perforantes en una muestra de nuestra población chilena. Material y Método: Se utilizaron 8 miembros inferiores de amputaciones supracondileas. Previa repleción con látex coloreado vía poplítea, se procedió a disecar los miembros inferiores para así obtener un colgajo fa...

  17. Evaluación de 80 implantes, sometidos a carga inmediata en desdentados inferiores tras un seguimiento de dos años

    OpenAIRE

    2006-01-01

    Objetivo: Analizar el comportamiento tanto clínico como radiológico de ochentas implantes con una nueva superficie tratada mediante una disolución de ácido sulfúrico y fluorhídrico con posterior tratamiento térmico, que han sido sometidos a carga inmediata en pacientes rehabilitados con sobredentaduras inferiores. Diseño del artículo: Estudio observacional, prospectivo en 20 pacientes rehabilitados con sobredentaduras inferiores, soportadas sobre cuatro implantes de 13 milímetros de longit...

  18. Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar

    Directory of Open Access Journals (Sweden)

    Rudy Scala

    2014-01-01

    Full Text Available Endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve (IAN. We report a case of disabling dysesthesia and paresthesia of a 70-year-old man after endodontic treatment of his mandibular left third molar that caused leakage of root canal filling material into the mandibular canal. After radiographic evaluation, extraction of the third molar and distal osteotomy, a surgical exploration was performed and followed by removal of the material and decompression of the IAN. The patient reported an improvement in sensation and immediate disappearance of dysesthesia already from the first postoperative day.

  19. Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar.

    Science.gov (United States)

    Scala, Rudy; Cucchi, Alessandro; Cappellina, Luca; Ghensi, Paolo

    2014-01-01

    Endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve (IAN). We report a case of disabling dysesthesia and paresthesia of a 70-year-old man after endodontic treatment of his mandibular left third molar that caused leakage of root canal filling material into the mandibular canal. After radiographic evaluation, extraction of the third molar and distal osteotomy, a surgical exploration was performed and followed by removal of the material and decompression of the IAN. The patient reported an improvement in sensation and immediate disappearance of dysesthesia already from the first postoperative day.

  20. Aneurisma da artéria cerebelar ântero-inferior: relato de caso Aneurysm of the anterior inferior cerebellar artery: case report

    Directory of Open Access Journals (Sweden)

    Juan Oscar Alarcón Adorno

    2002-12-01

    Full Text Available Os aneurismas intracranianos do sistema vértebro-basilar representam cerca de 5 a 10% de todos os aneurismas cerebrais. Os aneurismas da artéria cerebelar ântero-inferior (AICA são considerados raros, podendo causar síndrome do ângulo ponto cerebelar, com ou sem hemorragia subaracnóidea. Desde 1948, foram descritos poucos casos na literatura. Apresentamos o caso de uma paciente, de 33 anos, na qual, após investigação de quadro de hemorragia subaracnóidea, diagnosticou-se aneurisma sacular da AICA esquerda. Foi submetida a clipagem do aneurisma, com ótimo resultado pós operatório.The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA are considered rare, can cause cerebello pontine angle (CPA syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  1. Distal calcarine fusiform aneurysm : a case report and review of literature.

    Directory of Open Access Journals (Sweden)

    Ramakrishnamurthy T

    1999-10-01

    Full Text Available A 50 year old female who was operated for atrial septal defect 8 years back, presented with clinical features suggestive of subarachnoid haemorrhage (grade I, Hunt and Hess. CT scan of brain revealed haemorrhage in all the supratentorial basal cisterns, sylvian cistern and small haematoma in the left occipital lobe. Conventional CT and MR angiography revealed aneurysm in relation to distal part of the calcarine branch of the left posterior cerebral artery (PCA. Left occipital craniotomy in prone position followed by deep dissection in the occipital lobe showed fusiform aneurysm of the distal part of the calcarine branch. PCA aneurysms constitute only 0.2 to 1% of all intracranial aneurysms and among them distal PCA aneurysms are most rare, constituting only 1.3%. They too are mostly seen at the bifurcation of the PCA. The present case however, is unique in the sense that it has developed as a fusiform aneurysm in the distal part of the calcarine branch. To the best of our knowledge this is rare among the rarest.

  2. FUNCTIONAL OUTCOME OF UNSTABLE DISTAL RADIUS FRACTURES - TREATED BY PERCUTANEOUS K-WIRE FIXATION

    Directory of Open Access Journals (Sweden)

    Chatla

    2015-10-01

    Full Text Available BACKGROUND: Distal radius fractures are very common and increasing in incidence, especially in older age group. There are various methods of treatment available each one has its own merits and demerits. Our technique involves closed reduction, percutaneous K-wire fixation, and POP immobilzation of the unstable distal radius fracture for 4-6 weeks. This study aims to examine the functional outcome of percutaneous pinning of these unstable distal radius fractures. MATERIAL AND METHODS: This is a prospective study of 48 patients aged between 35years to 74years, with unstable distal radius fracture. Patients were treated by closed reduction, percutaneous pinning using two to three k-wires. The wires are cut and bent to the outside. A posterior below elbow POP slab was applied for 4-6 weeks. All the patients were fallowed up at regular intervals of 3weeks, 6 weeks, 12 weeks and 24 weeks. The functional evaluation was done at 24 weeks follow-up. We used Sarmiento’s modification of Lindstrom criteria and Gartland & Warley’s criteria for evaluation of results. RESULTS: Excellent to good results were seen in 91.66% of cases, fair results in 8.34%. CONCLUSION: Percutaneous pinning is a simple, functionally effective, safe method to maintain the fracture reduction and prevent stiffness of wrist and hand.

  3. stabilisation of posterior sternoclavicular joint dislocation using ...

    African Journals Online (AJOL)

    Posterior sternoclavicular joint dislocation is a rare injury. It is usually sustained acutely in ... structure for preventing both anterior and posterior translation of the .... healed well and she was commenced on physiotherapy with good functional ...

  4. Posterior scleritis associated with systemic tuberculosis

    Directory of Open Access Journals (Sweden)

    Gupta Amit

    2003-01-01

    Full Text Available Infective isolated posterior scleritis is rare. We report a case of isolated posterior scleritis associated with histopathologically documented systemic tuberculosis, a hitherto unreported association. The patient responded well to a combination of oral corticosteroids with antituberculosis therapy.

  5. Classification of posterior vitreous detachment

    OpenAIRE

    Kakehashi A; Takezawa M; Akiba J

    2013-01-01

    Akihiro Kakehashi,1 Mikiko Takezawa,1 Jun Akiba21Department of Ophthalmology, Jichi Medical University, Saitama Medical Center, Saitama, 2Kanjodori Eye Clinic, Asahikawa, JapanAbstract: Diagnosing a posterior vitreous detachment (PVD) is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography...

  6. The normal posterior atlantoaxial relationship

    Energy Technology Data Exchange (ETDEWEB)

    Lovelock, J.E. (Rochester General Hospital, NY (USA)); Schuster, J.A. (Rochester Univ. Medical Center, NY (USA))

    1991-02-01

    The relationship of the posterior aspects of the atlas and the axis were studied in 100 normal adult volunteers. The ratio of the height of the atlantal spinolaminar line to the atlantoaxial interspinous distance was found to be remarkably constant and was less than 2.0 in all men and women. This ratio should prove helpful in detecting hyperflexion injuries isolated to the atlantoaxial level. (orig.).

  7. Repair of the torn distal biceps tendon by endobutton fixation

    Directory of Open Access Journals (Sweden)

    Ravi K Gupta

    2012-01-01

    Full Text Available Background: A number of techniques have been described to reattach the torn distal biceps tendon to the bicipital tuberosity. We report a retrospective analysis of single incision technique using an endobutton fixation in sports persons. Materials and Methods: The present series include nine torn distal biceps tendons in eight patients, fixed anatomically to the radial tuberosity with an endobutton by using a single incision surgical technique; seven patients had suffered the injuries during contact sports. The passage of the endobutton was facilitated by using a blunt tipped pin in order to avoid injury to the posterior interosseous nerve. The patients were evaluated by Disabilities of the Arm, Shoulder and Hand (DASH score and Mayo elbow score. Results: The average age of the patients was 27.35 years (range 21-42 years. Average follow-up was 41.5 months (range 24-102 months. The final average flexion extension arc was 0°-143°, while the average pronation and supination angles were 77° (range 70°-82° and 81° (range 78°-85°, respectively at the last followup. All the patients had a Disabilities of the Arm, Shoulder and Hand (DASH score of 0 and a Mayo elbow score of 100 each. All the seven active sports persons were able to get back to their respective game. There was no nerve injury or any other complication. Conclusions: The surgical procedure used by us is a simple, safe and reproducible technique giving minimal morbidity and better cosmetic results.

  8. Visual attention in posterior stroke

    DEFF Research Database (Denmark)

    Fabricius, Charlotte; Petersen, Anders; Iversen, Helle K

    Objective: Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere. However, attentional effects of more posterior lesions are less clear. The aim of this study was to characterize visual processing speed and appre......Objective: Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere. However, attentional effects of more posterior lesions are less clear. The aim of this study was to characterize visual processing speed...... and apprehension span following posterior cerebral artery (PCA) stroke. We also relate these attentional parameters to visual word recognition, as previous studies have suggested that reduced visual speed and span may explain pure alexia. Methods: Nine patients with MR-verified focal lesions in the PCA......-territory (four left PCA; four right PCA; one bilateral, all >1 year post stroke) were compared to 25 controls using single case statistics. Visual attention was characterized by a whole report paradigm allowing for hemifield-specific speed and span measurements. We also characterized visual field defects...

  9. Posterior asymmetry and idiopathic scoliosis

    CERN Document Server

    Rousie, D L; Berthoz, A

    2009-01-01

    Study design Are there neuro-anatomical abnormalities associated with idiopathic scoliosis (IS)? Posterior Basicranium (PBA) reflects cerebellum growth and contains vestibular organs, two structures suspected to be involved in scoliosis. Objective The aim of this study was to compare posterior basicranium asymmetry (PBA) in Idiopathic scoliosis (IS) and normal subjects. Method: To measure the shape of PBA in 3D, we defined an intra-cranial frame of reference based on CNS and guided by embryology of the neural tube. Measurements concerned three directions of space referred to a specific intra cranial referential. Data acquisition was performed with T2 MRI (G.E. Excite 1.5T, mode Fiesta). We explored a scoliosis group of 76 women and 20 men with a mean age of 17, 2 and a control group of 26 women and 16 men, with a mean age of 27, 7. Results: IS revealed a significant asymmetry of PBA (Pr>|t|<.0001) in 3 directions of space compared to the control group. This asymmetry was more pronounced in antero-posterior...

  10. Surgical treatment of Lenke 5 adolescent idiopathic scoliosis: Comparison of anterior vs posterior approach

    Science.gov (United States)

    Abel, Mark F; Singla, Anuj; Feger, Mark A; Sauer, Lindsay D; Novicoff, Wendy

    2016-01-01

    AIM To compare the posterior vs anterior approaches for fusion of Lenke 5 adolescent idiopathic scoliosis curves, matched for curve magnitude and for the distal level of fixation (dLOF) standardized to the third lumbar vertebrae (L3). METHODS A prospectively collected multicenter database was used for this retrospective comparative study. Our dependent variables included sagittal and coronal radiographic measurements, number of fused vertebrae, estimated blood loss, length of hospitalization and SRS total and individual domain scores at the two-year follow-up. Subject demographics were similar for all group comparisons. Independent t-test was used to compare groups for all analyses at P < 0.01. RESULTS For all matched cases of Lenke 5 curves, a selective approach was used only 50% of the time in cases undergoing a posterior fusion. When comparing a posterior selective approach to an anterior selective approach, surgeons utilizing a posterior approach fused significantly more levels than surgeons using an anterior approach with no other significant differences in radiographic or SRS outcomes (Ant = 4.8 ± 1.0 levels vs post = 6.1 ± 1.0 levels, P < 0.0001). When the dLOF was standardized to L3, the anterior approached provided significantly greater lumbar Cobb percent correction than the posterior approach (Ant = 69.1% ± 12.6% vs post = 54.6% ± 16.4%, P = 0.004), with no other significant radiographic or SRS score differences between approaches. CONCLUSION Surgeons treating Lenke 5c curves with a posterior instrumentation and fusion vs an anterior approach include more motion segments, even with a selective fusion. When controlled for the distal level of fixation, the anterior approach provides greater correction of the thoracolumbar curve. PMID:27672568

  11. Microdissection of distal artery perforator of the medial leg and design of skin flap pedicled with nutrient vessels of the saphenous nerve%小腿内侧远端动脉穿支显微解剖与隐神经营养血管皮瓣设计

    Institute of Scientific and Technical Information of China (English)

    张发惠; 郑和平; 张国栋

    2007-01-01

    blood supplying sources were as follows:Intermuscular perforator of posterior tibial artery, superior malleolar branches of anterior tibial artery, osteocutaneous perforators of peroneal artery or posterior tibial artery, medial malleolar branch of medial anterior malleolar artery, tarsal tunnel branch of posterior tibial artery, medial malleolar branch of medial plantar artery, medial malleolar branch of lateral plantar artery, medial malleolar branch of the superficial branch of medial plantar artery and medial maleolar branch of medial tarsal artery. ② The above-mentioned artery perforators sent out cutaneous branches, fascial branches, periosteal branches, nutrient vessels of saphenous nerve and great saphenous vein, thus formed a superior and inferior vascular net of deep fascia, vascular chain of superficial fascia and neurocutaneous superficial vein, and periosteal vascular network. Artery perforators constituted 3 distal longitudinally distributed fascial vascular plexus in medial leg (anterior, middle and posterior), including anterior longitudinally distributed fascial vascular plexus of medial anterior malleolar artery and superior malleolar branch of anterior tibial artery; middle longitudinally distributed fascial vascular plexus of osteocutaneous perforators; posterior longitudinally distributed fascial vascular plexus of malleolar canal artery perforators and intermuscular perforators of posterior tibial arteries.CONCLUSION: The blood supply of distal medial leg, which makes the anatomical basis for distally pedicled compound flaps, has the anatomical characteristics of multiple-sources, longitudinal distribution and homogeneity of nutrient vessels.Three kinds of distally pedicled skin flap supplied by nutrient vessels of saphenous nerve-great saphenous vein can be designed by taking the intermuscular perforator of posterior tibial artery, fascial perforators of medial anterior malleolar artery and artery perforators of tarsal tunnel perforators as

  12. Arthroscopic resection of the distal clavicle in osteoarthritis of the acromioclavicular joint

    Directory of Open Access Journals (Sweden)

    Tae-Soo Park

    2016-01-01

    Full Text Available Background: Symptomatic acromioclavicular joint (ACJ lesions are a common cause of shoulder complaints that can be treated successfully with both conservative and surgical methods. There are several operative techniques, including both open and arthroscopic surgery, for excising the distal end of the clavicle. Here, we present a new modified arthroscopic technique for painful osteoarthritis of the ACJ and evaluate its clinical outcomes. Our hypothesis was that 4- to 7-mm resection of the distal clavicle in an en bloc fashion would have several advantages, including no bony remnants, maintenance of stability of the ACJ, and reduced prevalence of heterotopic ossification, in addition to elimination of the pathologic portion of the distal clavicle. Materials and Methods: 20 shoulders of 20 consecutive patients with painful and isolated osteoarthritis of the ACJ who were treated by arthroscopic en bloc resection of the distal clavicle were included in the study. There were 10 males and 10 females with an average age of 56 years (range 42-70 years. The mean duration of followup was 6 years and 2 months (range 4-8 years 10 months. The results were evaluated using the University of California Los Angeles (UCLA shoulder rating score. Results: The overall UCLA score was 13.7 preoperatively, which improved to 33.4 postoperatively. All subscores were improved significantly ( P < 0.001. There were no specific complications at the latest followup. Conclusion: It is critical in this procedure to resect the distal clavicle evenly from superior to inferior in an en bloc fashion without any small bony remnants and to preserve the capsule and acromioclavicular ligament superoposteriorly. This arthroscopic procedure is a reliable and reproducible technique for painful osteoarthritis of the ACJ lesions in active patients engaged in overhead throwing sports and heavy labor.

  13. LMCA thrombosis presenting as inferior wall myocardial infarction successfully treated with intracoronary tenecteplase

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    Tom Devasia

    2016-01-01

    Full Text Available Received: 23/10/15, Reviewed: 9/11/15, Accepted: 8/12/15 Keywords: DOI: ABSTRACT We report a case of 40 year old male who presented with chest pain and diaphoresis. General and systemic examination was unremarkable. Electrocardiogram was suggestive of inferior wall myocardial infarction. Coronary angiogram revealed large thrombus in left main coronary artery. In view of risk of distal embolisation with thrombectomy, intracoronary tenecteplase was administered following which there was complete resolution of thrombus in left main system. A thorough workup of the cause including thrombotic panel (Protein C, Protein S was carried out and was negative. Patient made a successful recovery and is doing well on follow-up.

  14. Postpartum Uterine Bleeding from the Inferior Mesenteric Artery: Case Report and Review of the Literature.

    Science.gov (United States)

    Shin, Sun Mi; Yi, Kyong Wook; Chung, Hwan Hoon

    2015-01-01

    Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. The common causes of primary PPH include uterine atony, abnormal placentation, retained placenta, and birth canal injury. The inferior mesenteric artery (IMA) arises from the aorta and is the main artery to supply the descending and sigmoid colon, as well as the rectum. We present a case of immediate, severe uterine bleeding after a normal vaginal delivery; angiography determined that hemorrhage originated from the IMA, and there were no anastomoses between the IMA and other pelvic arteries. The patient was successfully managed by selective embolization of a distal branch of the IMA. Our case report presents a new and interesting variation of pelvic vascular anatomy; moreover, it is the first report to present a case of postpartum uterine bleeding originating from the IMA.

  15. Anatomic dissection of the inferior fronto-occipital fasciculus revisited in the lights of brain stimulation data.

    Science.gov (United States)

    Martino, Juan; Brogna, Christian; Robles, Santiago G; Vergani, Francesco; Duffau, Hugues

    2010-05-01

    Despite electrostimulation studies of the white matter pathways, supporting the role of the inferior fronto-occipital fasciculus (IFOF) in semantic processing, little is known about the precise anatomical course of this fascicle, especially regarding its exact cortical terminations. Here, in the lights of these new functional data, we dissected 14 post-mortem human hemispheres using the Klingler fiber dissection technique, to study the IFOF fibers and to identify their actual cortical terminations in the parietal, occipital and temporal lobes. We identified two different components of the IFOF: (i) a superficial and dorsal subcomponent, which connects the frontal lobe with the superior parietal lobe and the posterior portion of the superior and middle occipital gyri, (ii) a deep and ventral subcomponent, which connects the frontal lobe with the posterior portion of the inferior occipital gyrus and the posterior temporo-basal area. Thus, our results are in line with the hypothesis of the functional role of the IFOF in the semantic system, by showing that it is mainly connected with two areas involved in semantics: the occipital associative extrastriate cortex and the temporo-basal region. Further combined anatomical (dissection and Diffusion Tensor Imaging) and functional (intraoperative subcortical stimulation) studies are needed, to clarify the exact participation of each IFOF subcomponent in semantic processing.

  16. Posterior Fossa Tumor in Children

    Directory of Open Access Journals (Sweden)

    Seyed Mahmoud TABATABAEI

    2012-06-01

    Full Text Available How to Cite this Article: Tabatabaei SM, Seddighi A, Seddighi AS. Posterior Fossa Tumor in Children. Iran. J. Child. Neurol 2012;6(2: 19-24. Objective Primary brain tumors are the most common solid neoplasms of childhood, representing 20% of all pediatric tumors. The best current estimates place the incidence between 2.76 and 4.28/100,000 children per year. Compared with brain tumors in adults, a much higher percentage of pediatric brain tumors arise in the posterior fossa. Infratentorial tumors comprise as many as two thirds of all pediatric brain tumors in some large series. Tumor types that most often occur in the posterior fossa include medulloblastoma, ependymoma, cerebellar astrocytoma and brainstem glioma. Materials & Methods All pediatric cases of posterior fossa tumor that were considered for surgery from 1981 to 2011 were selected and the demographic data including age, gender and tumor characteristics along with the location and pathological diagnosis were recorded. The surgical outcomes were assessed according to pathological diagnosis. Results Our series consisted of 84 patients (52 males, 32 females. Cerebellar symptoms were the most common cause of presentation (80.9% followed by headache (73.8% and vomiting (38.1%. The most common histology was medulloblastoma (42.8% followed by cerebellar astrocytoma (28.6%, ependymoma (14.3%, brainstem glioma (7.2% and miscellaneous pathologies (e.g., dermoid,  andtuberculoma (7.2%. Conclusion The diagnosis of brain tumors in the general pediatric population remains challenging. Most symptomatic children require several visits to a physician before the correct diagnosis is made. These patients are often misdiagnosed for gastrointestinal disorders. Greater understanding of the clinical presentation of these tumors and judicious use of modern neuroimaging techniques should lead to more efficacious therapies.References 1. Mehta V, Chapman A, McNeely PD, Walling S, Howes WJ. Latency between

  17. Sextant of Sapphires for Molar Distalization

    Science.gov (United States)

    Palla, Yudistar Venkata; Ganugapanta, Vivek Reddy

    2016-01-01

    Introduction Space analysis quantifies the amount of crowding within the arches estimating the severity of space discrepancy. The space gaining procedures include extraction and non-extraction procedures like expansion, proximal stripping and molar distalization. Aim To identify features seen in molar distalization cases. Materials and Methods The sample size comprised 20 patients in whom molar distalization was decided as the treatment plan. The study models and lateral cephalograms of all the patients were taken. Occlusograms were obtained. Model analysis and cephalometric analysis were performed. Descriptive statistical analysis like mean, standard deviation, standard error and mode were done. Results The parameters in Question gave following results. The Bolton analysis showed anterior mandibular excess with mean value of 1.56mm±1.07. The first order discrepancy between maxillary central and lateral incisors was 5±1.95. The premolar rotation showed mean value of 16.58±5.12. The molar rotation showed the value of 7.66±2.26. The nasolabial angle showed the mean of 101.25±8.7 IMPA of 101.4±5.74. Conclusion The six features studied in molar distalization cases [First order discrepancy between upper central and lateral incisors; Rotation of premolars and molars; Bolton’s discrepancy in anterior dentition; Average to horizontal growth pattern; Proclined lower incisors and Obtuse nasolabial angle] can be taken as patterns seen in molar distalization cases and considered as a valid treatment plan. PMID:27656572

  18. Preliminary experience with Piccolo Composite™, a radiolucent distal fibula plate, in ankle fractures.

    Science.gov (United States)

    Caforio, Marco; Perugia, Dario; Colombo, Massimiliano; Calori, Giorgio Maria; Maniscalco, Pietro

    2014-12-01

    The radiolucent plate has many advantageous properties in the treatment of complex ankle fractures, particularly trimalleolar fractures. Surgeons may sometimes have difficulty observing the posterior malleolus after synthesis of lateral malleolus with a traditional plate because common materials of conventional plates are not radiolucent. In this study, the authors highlight the importance of the radiolucent property in the treatment of ankle fractures and describe their preliminary experience with a carbon fibre-reinforced polyetheretherketone distal fibula plate, with good results at 4 months' follow-up and no signs of tissue inflammatory reaction.

  19. Dual plating for fractures of the distal third of the humeral shaft.

    Science.gov (United States)

    Prasarn, Mark L; Ahn, Jaimo; Paul, Omesh; Morris, Elizabeth M; Kalandiak, Stephen P; Helfet, David L; Lorich, Dean G

    2011-01-01

    In this study, we present a novel method for performing dual plating of extra-articular fractures of the distal third of the humerus. Since 2006, we have treated 15 such fractures with dual plates from a single posterior midline incision. In the first part of the study, we provide the surgical protocol we have used in addressing these fractures. In the second part, the charts of these patients were reviewed retrospectively to examine their clinical and radiographic outcomes. Using this technique, we have achieved an excellent union rate without significant complications while allowing early and aggressive range of motion.

  20. Inferior alveolar nerve injuries associated with mandibular fractures.

    Science.gov (United States)

    Bede, Salwan Yousif Hanna; Ismael, Waleed Khaleel; Al-Assaf, Dhuha A; Omer, Saad Salem

    2012-11-01

    The study evaluates the incidence of inferior alveolar nerve injuries in mandibular fractures, the duration of their recovery, and the factors associated with them. Fifty-two patients with mandibular fractures involving the ramus, angle, and body regions were included in this study; the inferior alveolar nerve was examined for neurological deficit posttraumatically using sharp/blunt differentiation method, and during the follow-up period the progression of neural recovery was assessed. The incidence of neural injury of the inferior alveolar nerve was 42.3%, comminuted and displaced linear fractures were associated with higher incidence of inferior alveolar nerve injury and prolonged recovery time, and recovery of inferior alveolar nerve function occurred in 91%.Fractures of the mandible involving the ramus, angle, and body regions, and comminuted and displaced linear fractures are factors that increase the incidence of inferior alveolar nerve injuries. Missile injuries can be considered as another risk factor.

  1. Total laparoscopic retrieval of inferior vena cava filter

    Directory of Open Access Journals (Sweden)

    Ehsan Benrashid

    2015-08-01

    Full Text Available While there is some local variability in the use of inferior vena cava filters and there has been some evolution in the indications for filter placement over time, inferior vena cava filters remain a standard option for pulmonary embolism prophylaxis. Indications are clear in certain subpopulations of patients, particularly those with deep venous thrombosis and absolute contraindications to anticoagulation. There are, however, a variety of reported inferior vena cava filter complications in the short and long term, making retrieval of the filter desirable in most cases. Here, we present the case of a morbidly obese patient complaining of chronic abdominal pain after inferior vena cava filter placement and malposition of the filter with extensive protrusion outside the inferior vena cava. She underwent successful laparoscopic retrieval of her malpositioned inferior vena cava filters after failure of a conventional endovascular approach.

  2. [Py-Desmanet pinning in distal radius fractures].

    Science.gov (United States)

    Alexa, O; Popia, I

    2009-01-01

    Internal fixation by pinning is one of the most used methods of surgical treatment in fractures of the distal extremity of the radius. As in stable fractures a styloid pinning is satisfactory, in unstable fractures however we must resort to different patterns of pin insertion, in order to effectively prevent the secondary displacement of the fractured fragments. The elastic pinning described by Py and Desmanet is one of the possibilities of inserting the pins. The principle of this method is to use the bending-induced tension in the pins to counteract the postero-lateral displacing forces. The authors have treated by this technique five patients with distal radius fractures (3 women and 2 men) about 56 years of average age, all with good-quality bone, all with Colles' fracture pattern (2-4 cm above the radio-carpal articulation, no articular involvement, posterior displacement of the distal fragment). The reduction of the fractures was achieved by closed manipulation and controlled intraoperatively with the C-arm. We preferred to reduce the fractures before inserting the pins, although this is not compulsory, according to the authors of the technique. The approach was minimally-invasive, through two 1-cm long incisions. The pins, previously blunted and curved along the last centimeters, were introduced using a "T"-shaped handle. The potential complications, consisting of injuries of the many elements which cross the region, were avoided by sufficiently long incisions and identification and retraction of these elements (tendons, nervous branches) in order not to penetrate them with the pins. The aftertreatment consisted of immediate mobilization of the wrist in one patient, 21-day splinting in other two and 30-day splinting in the last two, depending on the intraoperative assessment of the stability of the fixation. The pins were removed at 45 days postoperatively in all cases. There were no complications such as loss of reduction or pin migration. In all cases

  3. Topographic matching of distal radius and proximal fibula articular surface for distal radius osteoarticular reconstruction.

    Science.gov (United States)

    Zhang, H; Chen, S; Wang, Z; Guo, Y; Liu, B; Tong, D

    2016-07-01

    During osteoarticular reconstruction of the distal radius with the proximal fibula, congruity between the two articular surfaces is an important factor in determining the quality of the outcome. In this study, a three-dimensional model and a coordinate transformation algorithm were developed on computed tomography scanning. Articular surface matching was performed and parameters for the optimal position were determined quantitatively. The mean radii of best-fit spheres of the articular surfaces of the distal radius and proximal fibula were compared quantitatively. The radial inclination and volar tilt following reconstruction by an ipsilateral fibula graft, rather than the contralateral, best resembles the values of the native distal radius. Additionally, the ipsilateral fibula graft reconstructed a larger proportion of the distal radius articular surface than did the contralateral. The ipsilateral proximal fibula graft provides a better match for the reconstruction of the distal radius articular surface than the contralateral, and the optimal position for graft placement is quantitatively determined.

  4. Bilateral inferior petrosal sinus sampling using vasopressin

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    Narendra Kotwal

    2016-01-01

    Full Text Available Context: Anatomical localization of pituitary adenoma can be challenging in adrenocorticotropic hormone (ACTH-dependent Cushing's syndrome, and bilateral inferior petrosal sinus sampling (BIPSS is considered gold standard in this regard. Stimulation using corticotrophin-releasing hormone (CRH improves the sensitivity of BIPSS, however, same is not easily available in India. Therefore, we undertook this study of BIPPS using vasopressin as agent for stimulation owing to its ability to stimulate V3 receptors present on corticotrophs. Aims: To study the tumor localization and lateralization in difficult to localize cases of ACTH-dependent Cushing's syndrome by bilateral inferior petrosal sinus sampling using vasopressin for corticotroph stimulation. Settings and Design: Prospective observational study. Subjects and Methods: Six patients (5 females meeting inclusion criteria underwent BIPSS using vasopressin for stimulation. Results: All six patients had nonsuppressible overnight and low dose dexamethasone suppression test with elevated plasma ACTH levels suggestive of ACTH-dependent Cushing's syndrome. High dose dexamethasone suppression test showed suppressible cortisol in two cases, and microadenoma was seen in two patients on magnetic resonance imaging pituitary. Contrast enhanced computed tomography of the abdomen showed left adrenal hyperplasia in one case and anterior mediastinal mass with bilateral adrenal hyperplasia another. Using BIPSS four patients were classified as having Cushing's disease that was confirmed histopathologically following surgery. Of the remaining two, one had primary pigmented nodular adrenocortical disease, and another had thymic carcinoid with ectopic ACTH production as the cause of Cushing's syndrome. No serious adverse events were noted. Conclusions: Vasopressin may be used instead of CRH and desmopressin for stimulation in BIPSS.

  5. Use of a Bicortical Button to Safely Repair the Distal Biceps in a Two-Incision Approach: A Cadaveric Analysis.

    Science.gov (United States)

    Barlow, Jonathan D; McNeilan, Ryan J; Speeckaert, Amy; Beals, Corey T; Awan, Hisham M

    2017-07-01

    No consensus has been reached on the most effective anatomic approach or fixation method for distal biceps repair. It is our hypothesis that, using a cortical biceps button through a 2-incision technique, the distal biceps can be safely and anatomically repaired. A 2-incision biceps button distal biceps repair was completed on 10 fresh-frozen cadavers. The proximity of the guide pin to the critical structures of the forearm, including the posterior interosseous nerve and recurrent radial artery, was measured. The location of repair was mapped and compared with anatomic insertion. The average distance from the tip of the guide pin to the posterior interosseous nerve was 11.4 mm (range, 8-14 mm). The average distance from the tip of the guide pin to the recurrent radial artery was 12.5 mm (range, 8-19 mm). The distal biceps tendon was repaired to the anatomic insertion site on the tuberosity using the biceps button technique in all specimens. The 2-incision biceps button repair described here allows safe and accurate repair of the tendon to the radial tuberosity in this cadaveric study. The goal of distal biceps repair is to safely, securely, and anatomically repair the torn biceps tendon to the radial tuberosity. The most commonly performed techniques (single anterior incision with cortical button and the double-incision procedure with bone tunnels and trough) have limitations. A 2-incision button repair safely and anatomically repairs the distal biceps tendon. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Dyslexic children lack word selectivity gradients in occipito-temporal and inferior frontal cortex

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    O.A. Olulade

    2015-01-01

    Full Text Available fMRI studies using a region-of-interest approach have revealed that the ventral portion of the left occipito-temporal cortex, which is specialized for orthographic processing of visually presented words (and includes the so-called “visual word form area”, VWFA, is characterized by a posterior-to-anterior gradient of increasing selectivity for words in typically reading adults, adolescents, and children (e.g. Brem et al., 2006, 2009. Similarly, the left inferior frontal cortex (IFC has been shown to exhibit a medial-to-lateral gradient of print selectivity in typically reading adults (Vinckier et al., 2007. Functional brain imaging studies of dyslexia have reported relative underactivity in left hemisphere occipito-temporal and inferior frontal regions using whole-brain analyses during word processing tasks. Hence, the question arises whether gradient sensitivities in these regions are altered in dyslexia. Indeed, a region-of-interest analysis revealed the gradient-specific functional specialization in the occipito-temporal cortex to be disrupted in dyslexic children (van der Mark et al., 2009. Building on these studies, we here (1 investigate if a word-selective gradient exists in the inferior frontal cortex in addition to the occipito-temporal cortex in normally reading children, (2 compare typically reading with dyslexic children, and (3 examine functional connections between these regions in both groups. We replicated the previously reported anterior-to-posterior gradient of increasing selectivity for words in the left occipito-temporal cortex in typically reading children, and its absence in the dyslexic children. Our novel finding is the detection of a pattern of increasing selectivity for words along the medial-to-lateral axis of the left inferior frontal cortex in typically reading children and evidence of functional connectivity between the most lateral aspect of this area and the anterior aspects of the occipito-temporal cortex. We

  7. Physeal arrest of the distal radius.

    Science.gov (United States)

    Abzug, Joshua M; Little, Kevin; Kozin, Scott H

    2014-06-01

    Fractures of the distal radius are among the most common pediatric fractures. Although most of these fractures heal without complication, some result in partial or complete physeal arrest. The risk of physeal arrest can be reduced by avoiding known risk factors during fracture management, including multiple attempts at fracture reduction. Athletes may place substantial compressive and shear forces across the distal radial physes, making them prone to growth arrest. Timely recognition of physeal arrest can allow for more predictable procedures to be performed, such as distal ulnar epiphysiodesis. In cases of partial arrest, physeal bar excision with interposition grafting can be performed. Once ulnar abutment is present, more invasive procedures may be required, including ulnar shortening osteotomy or radial lengthening.

  8. CHONDROBLASTOMA IN DISTAL TIBIA - A CASE REPORT

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    Chinmaya

    2013-04-01

    Full Text Available INTRODUCTION: Chondroblastoma was first described as calcified gi ant cell tumour by Ewing. Codman described it as epiphyseal chondromatous giant cell tumour. Jaffe and Lichtenstein named it as chondroblastoma, a rare benign cartilag inous tumour. It represents less than 1% of all primary bone tumours and most commonly originate from the epiphyses of long bones, particularly from the epiphyses of the proximal and dis tal parts of the femur, the proximal part of the humerus, and the proximal part of the tibia. O ther reported sites are talus, scapula , patella, pelvis, distal radius, distal tibia , ribs, proximal fibula, calcaneum. Its occurrence in distal tibia is very rare with 2 documented cases in UK from 1974 to 2000, 3 documented cases in FRANCE from 1950 to 200 5 , no documented case from 1977 to 2000 in Harvard, USA. The purpose is to present a rare tumour occurring at an unusual site.

  9. Posterior commissure of the human larynx revisited.

    Science.gov (United States)

    Tucker, John A; Tucker, Sean T

    2010-05-01

    The existence of the posterior commissure (PC) of the human larynx has been disputed (Hirano M, Sato K, et al. The posterior glottis. Trans Am Laryngol Assoc. 1986;107:70-75). "The term posterior commissure has no relevance to anatomical structure. The term commissure means a joining together. The bilateral vocal folds never join at their posterior ends. The posterior aspect of the glottis is a wall. The posterior lateral aspect of the posterior glottis is also the lateral wall of the posterior glottis" (Hirano M, Sato K, et al. The posterior glottis. Trans Am Laryngol Assoc. 1986;107:70-75). This study is intended to clarify the development of anatomical and morphological aspects of the PC in conjunction with a clinical classification of the larynx in sagittal view. This study uses human embryo and fetal laryngeal sections from the Carnegie Collection of Human Embryos (the world standard) and whole organ laryngeal sections from the Tucker Laryngeal Fetal Collection. Correlation of histologic and gross anatomical structure is made with the Hirano et al atlas, the Vidić Photographic Atlas of the Human Body, and the O'Rahilly Embryonic Atlas. Embryologic data clearly describe and illustrate the posterior union of the cricoid cartilage with formation of the PC. The anatomical functional aspects of the posterior lateral cricoid lamina as the supporting buttress of the articulating arytenoid cartilages are illustrated.

  10. Management of Malunions of the Distal Radius

    OpenAIRE

    Yaniel Truffin Rodriguez; Osmany Pérez Martínez; Rafael Esmandy Gómez Arregoitía; Indira L. Gómez Gil

    2015-01-01

    Fractures of the distal radius often present with a group of major complications. Of these, malunion is one of the most disabling. Its management through salvage procedures is essential for its correction. The case of a 60-year-old healthy woman of urban origin treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos because of a malunion of the distal end of the left radius as a result of a previous Colles' fracture is presented. The patient complained of severe p...

  11. Contemporary Management of Primary Distal Urethral Cancer.

    Science.gov (United States)

    Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim

    2016-11-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Calcifying aponeurotic fibroma of the distal phalanx.

    Science.gov (United States)

    Schonauer, Fabrizio; Avvedimento, Stefano; Molea, Guido

    2013-02-01

    Calcifying aponeurotic fibroma is a rare benign soft tissue tumor that primarily occurs on the distal portion of the extremities of children and adolescents. It appears like a firm, painless and slowly growing mass with high local recurrence rates. The lesion has characteristic histological features with areas of proliferative plumps of fibroblasts, chondrocytes and foci of calcification. We present a case of calcifying aponeurotic fibroma of the sub-ungual area of the index finger distal phalanx with bone erosion, surgically treated. A 2 year follow up showed satisfactory functional result and no evidence of recurrence.

  13. Distal splenorenal shunt with partial spleen resection

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    Gajin Predrag

    2007-01-01

    Full Text Available Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%, while in the second group there were 13 patients with splenomegaly (68%. Before surgery, the mean platelet count in the first group was 51.6±18.3x109/l, to 118.6±25.4x109/l postoperatively. The mean platelet count in the second group was 67.6±22.8x109/l, to 87.8±32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p<0.05. Comparing the

  14. Partial breast reconstruction with mini superficial inferior epigastric artery and mini deep inferior epigastric perforator flaps.

    Science.gov (United States)

    Spiegel, Aldona J; Eldor, Liron

    2010-08-01

    In this study, partial breast reconstruction was undertaken after breast conservation therapy using mini abdominal free flaps on both an immediate and delayed basis.Patient demographics, oncologic status, reconstructive data, and complications were collected from medical records.Twelve patients (age range 39-60) were included in this study with a mean follow-up time of 5 years. Ten mini superficial inferior epigastric artery flaps and 2 mini deep inferior epigastric perforator flaps were used (7 immediate and 5 delayed reconstructions). No flap lost, 1 minor abdominal wound dehiscence, and no local or distant recurrences were noted. Good to excellent results were reported by 91% of the women.In properly selected patients with high motivation toward breast conservation, tailored abdominal mini-free flaps can safely and satisfactorily be implemented for the reconstruction of partial mastectomy defects. Patients should be comprehensively educated on the potential future implications of using the abdominal donor site for partial breast reconstruction.

  15. Posterior ankyloglossia: a case report.

    Science.gov (United States)

    Chu, Michael W; Bloom, David C

    2009-06-01

    Ankyloglossia, or tongue-tie, refers to an abnormally short lingual frenulum. Ankyloglossia is a recognized but poorly defined condition and has been reported to cause feeding difficulties, dysarthria, dyspnea, and social or mechanical problems. In infants, the most concerning symptoms are feeding difficulties and inability to breastfeed. While a recent trend toward breastfeeding has brought frenulectomy back into favor, the literature regarding treatment remains inconclusive. We report a case of posterior ankyloglossia with anterior mucosal hooding and a simple, safe, and effective way to treat it to improve breastfeeding.

  16. Reconstrucción de extremidades inferiores con colgajo sural diferido

    Directory of Open Access Journals (Sweden)

    Victor Huiman Lazo

    2004-07-01

    Full Text Available Objetivo: Evaluar la viabilidad del colgajo sural, en lesiones de extremidades inferiores que comprometen la zona de su pedículo vascular utilizando la técnica quirúrgica de transposición diferida o de retardo. Materiales y Métodos: Se estudiaron 08 pacientes sometidos a cirugía reconstructiva con colgajo sural diferido por lesiones en tercio distal de extremidades inferiores que comprometían la zona de su pedículo vascular, desde junio 2001 a mayo 2003, en el Servicio de Cirugía Plástica del Hospital Nacional Cayetano Heredia. Resultados: El 100% de colgajos estuvo viable al momento de realizar la transposición. Las complicaciones encontradas fueron menores, siendo la más frecuente la necrosis parcial. Conclusiones: La técnica diferida utilizada en el colgajo sural, cuando la lesión compromete la zona de su pedículo vascular, es adecuada para mantener la viabilidad del colgajo.(Rev Med Hered 2004;15:155-158.

  17. Q-ball of inferior fronto-occipital fasciculus and beyond.

    Directory of Open Access Journals (Sweden)

    Eduardo Caverzasi

    Full Text Available The inferior fronto-occipital fasciculus (IFOF is historically described as the longest associative bundle in the human brain and it connects various parts of the occipital cortex, temporo-basal area and the superior parietal lobule to the frontal lobe through the external/extreme capsule complex. The exact functional role and the detailed anatomical definition of the IFOF are still under debate within the scientific community. In this study we present a fiber tracking dissection of the right and left IFOF by using a q-ball residual-bootstrap reconstruction of High-Angular Resolution Diffusion Imaging (HARDI data sets in 20 healthy subjects. By defining a single seed region of interest on the coronal fractional anisotropy (FA color map of each subject, we investigated all the pathways connecting the parietal, occipital and posterior temporal cortices to the frontal lobe through the external/extreme capsule. In line with recent post-mortem dissection studies we found more extended anterior-posterior association connections than the "classical" fronto-occipital representation of the IFOF. In particular the pathways we evidenced showed: a diffuse projections in the frontal lobe, b fronto-parietal lobes connections trough the external capsule in almost all the subjects and c widespread connections in the posterior regions. Our study represents the first consistent in vivo demonstration across a large group of individuals of these novel anterior and posterior terminations of the IFOF detailed described only by post-mortem anatomical dissection. Furthermore our work establishes the feasibility of consistent in vivo mapping of this architecture with independent in vivo methodologies. In conclusion q-ball tractography dissection supports a more complex definition of IFOF, which includes several subcomponents likely underlying specific function.

  18. PERFORATION OF INFERIOR ALVEOLAR NERVE BY MAXILLARY ARTERY. LA PERFORACION DEL NERVIO ALVEOLAR INFERIOR POR LA ARTERIA MAXILAR

    OpenAIRE

    Vanishree S Nayak; Ramachandra Bhat K; Prakash Billakanti Babu

    2011-01-01

    Infratemporal fossa is clinically important anatomical area for the delivery of local anesthetic agents in dentistry and maxillofacial surgery. Variations in the anatomy of the inferior alveolar nerve and maxillary artery were studied in infratemporal dissection. During routine dissection of the head in an adult male cadaver an unusual variation in the origin of the inferior alveolar nerve and its relationship with the surrounding structures was observed. The inferior alveolar nerve originate...

  19. Radiology of posterior lumbar apophyseal ring fractures: Report of 13 cases

    Energy Technology Data Exchange (ETDEWEB)

    Dietemann, J.L.; Beaujeux, R.; Wackenheim, A.; Runge, M.; Bonneville, J.F.; Badoz, A.; Dosch, J.C.

    1988-08-01

    The authors report radiological findings in 13 cases of avulsion of the posterior lumbar apophyseal ring. The lesion affected young adults in 10 cases and adolescents in 3 cases. The lesion involved the inferior endplate of L4 in 11, and of L5 in 2 patients. 6 patients presented with unilateral sciatica, 3 with bilateral sciatica, and 4 with low back pain. Acute spinal trauma was evident only in 2 adolescents. Radiological recognition of the lesion was possible on plain films in 9 cases. CT demonstrates association of avulsion of the posterior vertebral apophyseal ring and herniated disc in all cases. Avulsion of the posterior apophyseal ring has to be differentiated from posterior longitudinal ligament, annulus, or herniated disc calcifications, as well as from posterior degenerative ridge osteophytes. Controversy about physiopathology of the lesion remains: Weakness of the apophyseal ring during childhood and in patients with Scheuermann's disease may explain avulsion of the apophyseal ring in association with median disc herniation.

  20. Quantitative regional validation of the visual rating scale for posterior cortical atrophy

    Energy Technology Data Exchange (ETDEWEB)

    Moeller, Christiane; Benedictus, Marije R.; Koedam, Esther L.G.M.; Scheltens, Philip [VU University Medical Center, Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, P.O. Box 7057, Amsterdam (Netherlands); Flier, Wiesje M. van der [VU University Medical Center, Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, P.O. Box 7057, Amsterdam (Netherlands); VU University Medical Center, Department of Epidemiology and Biostatistics, Neuroscience Campus Amsterdam, P.O. Box 7057, Amsterdam (Netherlands); Versteeg, Adriaan; Wattjes, Mike P.; Barkhof, Frederik [VU University Medical Center, Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, P.O. Box 7057, Amsterdam (Netherlands); Vrenken, Hugo [VU University Medical Center, Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, P.O. Box 7057, Amsterdam (Netherlands); VU University Medical Center, Department of Physics and Medical Technology, Neuroscience Campus Amsterdam, P.O. Box 7057, Amsterdam (Netherlands)

    2014-02-15

    Validate the four-point visual rating scale for posterior cortical atrophy (PCA) on magnetic resonance images (MRI) through quantitative grey matter (GM) volumetry and voxel-based morphometry (VBM) to justify its use in clinical practice. Two hundred twenty-nine patients with probable Alzheimer's disease and 128 with subjective memory complaints underwent 3T MRI. PCA was rated according to the visual rating scale. GM volumes of six posterior structures and the total posterior region were extracted using IBASPM and compared among PCA groups. To determine which anatomical regions contributed most to the visual scores, we used binary logistic regression. VBM compared local GM density among groups. Patients were categorised according to their PCA scores: PCA-0 (n = 122), PCA-1 (n = 143), PCA-2 (n = 79), and PCA-3 (n = 13). All structures except the posterior cingulate differed significantly among groups. The inferior parietal gyrus volume discriminated the most between rating scale levels. VBM showed that PCA-1 had a lower GM volume than PCA-0 in the parietal region and other brain regions, whereas between PCA-1 and PCA-2/3 GM atrophy was mostly restricted to posterior regions. The visual PCA rating scale is quantitatively validated and reliably reflects GM atrophy in parietal regions, making it a valuable tool for the daily radiological assessment of dementia. (orig.)

  1. The Neuroanatomical Basis for Posterior Superior Parietal Lobule Control Lateralization of Visuospatial Attention.

    Science.gov (United States)

    Wu, Yan; Wang, Jiaojian; Zhang, Yun; Zheng, Dingchen; Zhang, Jinfeng; Rong, Menglin; Wu, Huawang; Wang, Yinyan; Zhou, Ke; Jiang, Tianzi

    2016-01-01

    The right hemispheric dominance in visuospatial attention in human brain has been well established. Converging evidence has documented that ventral posterior parietal cortex (PPC) plays an important role in visuospatial attention. The role of dorsal PPC subregions, especially the superior parietal lobule (SPL) in visuospatial attention is still controversial. In the current study, we used repetitive transcranial magnetic stimulation (rTMS) and diffusion magnetic resonance imaging (MRI) techniques to test the role of posterior SPL in visuospatial attention and to investigate the potential neuroanatomical basis for right hemisphere dominance in visuospatial function. Transcranial magnetic stimulation (TMS) results unraveled that the right SPL predominantly mediated visuospatial attention compared to left SPL. Anatomical connections analyses between the posterior SPL and the intrahemispheric frontal subregions and the contralateral PPC revealed that right posterior SPL has stronger anatomical connections with the ipsilateral middle frontal gyrus (MFG), with the ipsilateral inferior frontal gyrus (IFG), and with contralateral PPC than that of the left posterior SPL. Furthermore, these asymmetric anatomical connections were closely related to behavioral performances. Our findings indicate that SPL plays a crucial role in regulating visuospatial attention, and dominance of visuospatial attention results from unbalanced interactions between the bilateral fronto-parietal networks and the interhemispheric parietal network.

  2. Surgical extraction of impacted inferior third molars at risk for inferior alveolar nerve injury.

    Science.gov (United States)

    Gallesio, Cesare; Berrone, Mattia; Ruga, Emanuele; Boffano, Paolo

    2010-11-01

    The objective of the study was to prospectively assess the intraoperative findings and the radiographic signs of a study population of patients with impacted third molars at risk of inferior alveolar nerve injury. One hundred thirty-four patients with impacted mandibular third molars at risk for nerve injury were included in the study. Radiographic signs of possible close relationship between the 2 structures and intraoperative exposition or damage of the inferior alveolar nerve were recorded. The follow-up controls comprised clinical examinations and assessment for the sensation of the lower lip and chin. In 24 patients, a real contiguity was encountered between the third molars and nerve. Among these, intraoperative neural exposition was observed in 19 patients. Four patients complained of postoperative temporary hypoesthesia. No deficit of sensibility was found in cases with no exposition of the nerve. The accidental exposition of the inferior alveolar nerve is associated with an increased risk for neural injuries. At panoramic radiograph, the presence of signs of bifid and radiolucent apex, superimposition, and radiolucent root band should be considered at high risk for neural damage.

  3. Neurofibromatosis Type 2 Presenting with Oculomotor Ophthalmoplegia and Distal Myopathy

    Directory of Open Access Journals (Sweden)

    Jessica Mani Penny Tevaraj

    2016-01-01

    Full Text Available Neurofibromatosis type 2 usually presents with bilateral acoustic schwannomas. We highlight the rare presentation of neurofibromatosis initially involving third nerve. A 23-year-old Malay female presented with left eye drooping of the upper lid and limitation of upward movement for 8 years. It was associated with right-sided body weakness, change in voice, and hearing disturbance in the right ear for the past 2 years. On examination, there was mild ptosis and limitation of movement superiorly in the left eye. Both eyes had posterior subcapsular cataract. Fundoscopy showed generalised optic disc swelling in both eyes. She also had palsy of the right vocal cord, as well as the third and eighth nerve. There was wasting of the distal muscles of her right hand, with right-sided decreased muscle power. Pedunculated cutaneous lesions were noted over her body and scalp. MRI revealed bilateral acoustic and trigeminal schwannomas with multiple extra-axial lesions and intradural extramedullary nodules. Patient was diagnosed with neurofibromatosis type 2 and planned for craniotomy and tumour debulking, but she declined treatment. Neurofibromatosis type 2 may uncommonly present with isolated ophthalmoplegia, so a thorough physical examination and a high index of suspicion are required to avoid missing this condition.

  4. Magnetic resonance imaging in a juvenile type of distal and segmental muscular atrophy of the upper extremities

    Energy Technology Data Exchange (ETDEWEB)

    Hasuo, K. [Dept. of Radiology, Faculty of Medicine, Kyushu Univ., Fukuoka (Japan); Uchino, A. [Dept. of Radiology, Faculty of Medicine, Kyushu Univ., Fukuoka (Japan); Matsumoto, S. [Dept. of Radiology, Faculty of Medicine, Kyushu Univ., Fukuoka (Japan); Yoshida, K. [Dept. of Radiology, Faculty of Medicine, Kyushu Univ., Fukuoka (Japan); Kira, J. [Dept. of Neurology, Faculty of Medicine, Kyushu Univ., Fukuoka (Japan); Masuda, K. [Dept. of Radiology, Faculty of Medicine, Kyushu Univ., Fukuoka (Japan)

    1994-04-01

    Eight patients with a juvenile type of distal and segmental muscular atrophy of the upper extremities (DSMA), a type of cervical flexion myelopathy, were evaluated using MR imaging. In the neutral position there was no spinal cord compression, but in flexion the spinal cord was displaced anteriorly and was compressed by the posterior surfaces or margins of the vertebrae and/or any herniated disks in all cases. In flexion, compression of the cord was exaggerated in seven patients by the anterior displacement of the posterior margin of the thecal sac, which was accompanied by dilated posterior internal vertebral veins. In patients suspected of having DSMA, MR images made in flexion are regarded essential for verifying the diagnosis. (orig.)

  5. PARTIAL INFERIOR TURBINECTOMY FOR INFERIOR TURBINATE HYPERTROPHY: REVIEW OF 30 CASES

    Directory of Open Access Journals (Sweden)

    Vishnu

    2016-05-01

    Full Text Available OBJECTIVES To compare the preoperative and postoperative subjective, objective parameters and postoperative complications of 30 patients with nasal obstruction due to inferior turbinate hypertrophy following partial inferior turbinectomy. PATIENTS AND METHODS A prospective observational study involving 30 patients with nasal obstruction due to inferior turbinate hypertrophy was done at SGMC, TVM from January 2014 to June 2015. Patients were evaluated preoperatively and postoperatively based on subjective and objective parameters. Postoperative evaluation was done at day 1, 1 week, 1 month and 3 months based on subjective and objective parameters and postoperative complications. RESULTS Snoring among the study population decreased from 26.7% to 10% at the end of 1 month and was further reduced 3.3% at the end of 3 months. Feeling of nasal obstruction, present in all patients, preoperatively was reduced to 36.7%, 16.7% and 3.3% at the end of 1 week, 1 month, and 3 months respectively. Among preoperative objective parameters, cold spatula test which was showing decreased fogging for all patients initially, following the procedure showed improvement in fogging in 70%, 90%, 100% of patients at the end of 1 week, 1 month and 3 months postoperatively. Anterior rhinoscopy showing large turbinate in all patients preoperatively, showed reduction in turbinate size in 70%, 86.73% and 96.7% at the end of 1 week, 1 month and 3 months respectively. Radiological evidence of enlarged inferior turbinate present in all patients was reduced to 3.3% at the end of 3 months. Occurrence of postoperative reactionary haemorrhage on day 1 was 43.3%. Nasal crust formation was not seen in 6.7% of the patients by the end of 3 months. Nasal pain was seen in 6.7% of the patients at the end of 1 week. Remote sequelae like synechiae and atrophic rhinitis were not reported in any of the patients during the assessment time period. CONCLUSION PIT is an effective technique for

  6. Hyperextension trauma to the elbow joint induced through the distal ulna or the distal radius

    DEFF Research Database (Denmark)

    Tyrdal, Stein; Olsen, Bo Sanderhoff

    1998-01-01

    Loads applied to the forearm result in hyperextension of the elbow. The pathomechanics of hyperextension trauma with load applied to the distal radius and ulna were studied in 10 macroscopically normal cadaver elbow joint specimens to reveal patterns of injury with radial traction (n = 5) compared...... trauma to the elbow joint induced through the distal ulna or the distal radius produced the same pattern of injury as reported in hyperextension of the elbow with traction to the forearm when free rotation of the radius relative to the ulna was allowed....

  7. Intramedullary nailing in distal tibial fracture

    Directory of Open Access Journals (Sweden)

    Damian Arroquy

    2015-11-01

    Methods The inclusion criteria of this study were skeletally mature patients with displaced fractures of the distal tibia treated with intramedullary nail with a minimum follow up of one year. Gustilo III open fractures and type C fractures of the AO classification (complete articular Stroke were excluded. The sample comprised 35 patients remained. The follow-up was 29.2 months. We evaluated the time of consolidation, malunion and complications. The functional results were described according to the AOFAS score. Results Of the 35 patients with fracture of the distal third of the tibia all of them presented fracture healing. The average time to union was 17.2 weeks (range: 11-26. Of the total sample, 5 patients had delayed union, requiring dynamic nail on average at 12 weeks. The malunion was present in 4 (11.4% patients. We found no  difference (p = 0.201 in the time to union between fractures associated with fractures of the fibula treated (13sem or not (17sem. The AOFAS score was 86 points. Conclusion Intramedullary nailing with multiple distal locks like a good alternative treatment for distal tibia fractures AO type A or B, with low complication rate and a high rate of consolidation.

  8. Conceptualizing distal drivers in land use competition

    DEFF Research Database (Denmark)

    Niewhöner, Jörg; Nielsen, Jonas Ø; Gasparri, Gasparri

    2016-01-01

    This introductory chapter explores the notion of ‘distal drivers’ in land use competition. Research has moved beyond proximate causes of land cover and land use change to focus on the underlying drivers of these dynamics. We discuss the framework of telecoupling within human–environment systems...

  9. Double Plating of Distal Fibula Fractures.

    Science.gov (United States)

    Vance, Danica D; Vosseller, J Turner

    2017-02-01

    Distal fibula fractures are common orthopaedic injuries that often require open reduction internal fixation (ORIF) to anatomically reduce the fracture and minimize the risk of posttraumatic arthritis. In certain clinical situations, stouter fixation may be advantageous to decrease the risk of fixation failure. In this study, the authors report on 12 patients who underwent distal fibula ORIF with 2 one-third tubular plates. Twelve consecutive patients who underwent distal fibula ORIF with 2 one-third tubular plates were retrospectively reviewed. Clinical and radiographic outcomes were reviewed, and functional outcomes were obtained using the Foot and Ankle Outcome Score (FAOS). Institutional review board approval was obtained. All 12 fractures healed clinically and radiographically. One patient was lost to follow-up after healing of the fracture. One patient had removal of fibular hardware at 15 months after surgery. Ten patients had no hardware related pain and good ankle function. FAOS scores were obtained at a mean of 25.6 months after surgery and were as follows: pain (87.6, SD = 9.5), activities of daily living (90.4, SD = 14.5), symptoms (93.3, SD = 9.5), sports (89.5, SD = 18.1), and quality of life (57.4, SD = 21.3). Double plating of distal fibula fractures is a viable technique for problem fractures that potentially provides a readily accessible, low-cost alternative to other means of enhancing fixation. Level IV.

  10. Potassium secretion in mammalian distal colon

    DEFF Research Database (Denmark)

    Sørensen, Mads Vaarby

    2009-01-01

    pre-mRNA splicing and that at least one splice variant could be activated with cAMP. Using molecular biological techniques two different BK subunit splice variants both expressed in the distal colonic epithelial were identified. By the use of two different knock-out mice models, the BK-/- and the CFTR...

  11. Retrodiaphragmatic portion of the lung: how deep is the posterior costophrenic sulcus on posteroanterior chest radiography?

    Energy Technology Data Exchange (ETDEWEB)

    Oh, J.K. [Department of Radiology, Kangnam St Mary' s Hospital, Seoul (Korea, Republic of); Ahn, M.I. [Department of Radiology, Kangnam St Mary' s Hospital, Seoul (Korea, Republic of)], E-mail: ami@catholic.ac.kr; Kim, H.L.; Park, S.H. [Department of Radiology, Kangnam St Mary' s Hospital, Seoul (Korea, Republic of); Shin, E. [Department of Preventive Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2009-08-15

    Aim: To determine the depth of the posterior costophrenic sulcus (CPS) on posteroanterior (PA) chest radiography in relation to the diaphragmatic dome and lateral CPS. Materials and methods: Five hundred and forty consecutive PA chest radiographs that were performed for general health screenings were retrospectively reviewed. Among them 282 radiographs were selected that met the following criteria: visualization of the inferior boundary of the posterior CPS behind the right hemidiaphragm; and no abnormal findings that affected the shape and level of the diaphragm. The selected chest radiographs were from 155 men and 127 women with a mean age of 40.7 {+-} 8.4 years. On 282 PA chest radiographs, the distances between the right diaphragmatic dome and posterior CPS (total diaphragmatic height), the diaphragmatic dome and lateral CPS (diaphragmatic dome height), and the lateral and posterior CPS (posterior CPS depth) were measured. In addition levels of the right lateral and posterior CPS were scored in relation to levels of the thoracic and lumbar spines. The relationships between the posterior CPS depth and demographic and physical data and other radiographic measurements were analysed. Results: The mean right posterior CPS depth was 29.2 {+-} 15.6 mm. The average level of the posterior CPS in relation to the spine was 13.5 {+-} 0.6, i.e., the level of lower half of the L1 vertebral body. The posterior CPS depth had a tendency to be deeper in those participants who were taller (r = 0.17, p < 0.01), had a higher body mass index (BMI; r = 0.25, p < 0.01), longer total diaphragmatic height (r = 0.55, p < 0.01), and shorter diaphragmatic dome height (r = -0.18, p < 0.01). Conclusion: As the posterior CPS is deeper than the lateral CPS by approximately 3 cm, and reaches, on average, to L1, the standard chest PA radiograph must include >3 cm below the level of lateral CPS, or should include the L1 spine.

  12. Apophysitis of the lower limbs: imaging findings; Apofisites dos membros inferiores: aspectos de imagem

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa, Priscila Rodrigues; Santos, Durval C. Barros; Longo, Carlos Henrique; Luna, Rodrigo de Castro; Kim, Nelson Ji Tae; Rosemberg, Laercio A.; Funari, Marcelo Gusmao Buarque [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil). Dept. de Imagem]. E-mail: pill-rb@uol.com.br

    2005-07-01

    Apophyses are secondary ossification centers that appear during growth. These ossification centers are under traction forces because of insertion of muscles and ligaments. When traction stress become greater in magnitude and frequency irritation of physis (growth plate) may occur resulting in apophysitis. Apophysitis injuries typically occur in active adolescents and usually presents as peri-articular pain associated with growth, skeletal immaturity, repetitive microtrauma and muscle-tendon imbalance. The most common types of apophysitis of the include Osgood-Schlatter disease (tibial tuberosity), apophysitis of the hip (iliac crest, ischial tuberosity), Sever's disease (posterior calcaneus), Sindig-Larsen-Johansson syndrome (inferior patella), and Iselin's disease (fifth metarsal base). The aim of this study was to show the main magnetic resonance imaging and X-rays findings in patients with these diseases and to discuss the frequent differential diagnosis. (author)

  13. [EFFECTIVENESS OF DEEP INFERIOR EPIGASTRIC ARTERY PERFORATOR FLAP FOR REPAIR OF PERINEAL AND PERIANAL CICATRICIAL CONTRACTURE].

    Science.gov (United States)

    Du, Liping; You, Xiaobo; Tang, Kuangyun; Fu, Rong

    2015-08-01

    To discuss the effectiveness of deep inferior epigastric artery perforator flap to repair perineal and perianal cicatricial contracture. Between March 2007 and December 2013, 23 patients with perineal and perianal cicatricial contracture were treated with deep inferior epigastric artery perforator flap. There were 15 males and 8 females, aged from 21 to 62 years (mean, 42 years). Burn depth was III degree. The burning scars involved in the fascia, even deeper, which was rated as peripheral type (mild stenosis of the anal region and perianal cicatricial contracture) in 13 cases and as central type (severe stenosis of the anal region and anal canal with shift or defect of external genitalia) in 10 cases. All patients had limited hip abduction and squatting. Repair operation was performed at 3 months to 2 years (mean, 6 months) after wound healing. The size of soft tissue defects ranged from 10 cmx6 cm to 28 cm x 13 cm after scar excision and release. The size of flaps ranged from 12 cmx7 cm to 30 cmx15 cm. The donor site was sutured directly in 16 cases and repaired by autograft of skin in 7 cases. The flap had distal necrosis, distal cyanosis, and spotted necrosis in 1 case, 2 cases, and 1 case respectively, which were cured after symptomatic treatment; the other flaps survived and wound healed primarily. Twenty-one patients were followed up 6 months to 2 years (mean, 1 year). Nineteen patients had good appearance of the perinea and position of external genitalia, normal function of defecation function; stenosis of the anal region was relived, and the flaps had good texture and elasticity. Linear scar contracture was observed at the edge of flap in 2 cases, and the appearance of the perineum was restored after Z plasty. The hip abduction reached 30-40°. No abdominal hernia was found at donor site. Deep inferior epigastric artery perforator flap has stable blood supply and flexible design, which is similar to the perianal and perineal tissues. The good effectiveness

  14. Through the looking glass: understanding non-inferiority

    Directory of Open Access Journals (Sweden)

    Wittes Janet T

    2011-05-01

    Full Text Available Abstract Non-inferiority trials test whether a new product is not unacceptably worse than a product already in use. This paper introduces concepts related to non-inferiority, and discusses the regulatory views of both the European Medicines Agency and the United States Food and Drug Administration.

  15. Frontal terminations for the inferior fronto-occipital fascicle: anatomical dissection, DTI study and functional considerations on a multi-component bundle.

    Science.gov (United States)

    Sarubbo, Silvio; De Benedictis, Alessandro; Maldonado, Igor L; Basso, Gianpaolo; Duffau, Hugues

    2013-01-01

    The anatomy and functional role of the inferior fronto-occipital fascicle (IFOF) remain poorly known. We accurately analyze its course and the anatomical distribution of its frontal terminations. We propose a classification of the IFOF in different subcomponents. Ten hemispheres (5 left, 5 right) were dissected with Klingler's technique. In addition to the IFOF dissection, we performed a 4-T diffusion tensor imaging study on a single healthy subject. We identified two layers of IFOF. The first one is superficial and antero-superiorly directed, terminating in the inferior frontal gyrus. The second is deeper and consists of three portions: posterior, middle and anterior. The posterior component terminates in the middle frontal gyrus (MFG) and dorso-lateral prefrontal cortex. The middle component terminates in the MFG and lateral orbito-frontal cortex. The anterior one is directed to the orbito-frontal cortex and frontal pole. In vivo tractography study confirmed these anatomical findings. We suggest that the distribution of IFOF fibers within the frontal lobe corresponds to a fine functional segmentation. IFOF can be considered as a "multi-function" bundle, with each anatomical subcomponent subserving different brain processing. The superficial layer and the posterior component of the deep layer, which connects the occipital extrastriate, temporo-basal and inferior frontal cortices, might subserve semantic processing. The middle component of the deep layer could play a role in a multimodal sensory-motor integration. Finally, the anterior component of the deep layer might be involved in emotional and behavioral aspects.

  16. [Surgery of AVM of the inferior medullary velum by the uvulotonsillar approach--advantage of moving of the cerebellar tonsil: technical case report].

    Science.gov (United States)

    Shigeno, Taku; Kumai, Junichiro; Endo, Masaru; Hotta, Shinji

    2002-01-01

    An incidentally found arteriovenous malformation (AVM) of the inferior medullary velum behind the medulla was removed by the lateral approach to the fourth ventricle originally described by Seeger in 1980. A wide posterior fossa craniotomy was performed to move the cerebellar tonsil laterally with C-1 laminectomy. The tela chroidea and inferior medullary velum, the two main sheets of tissue that form the lower half of the roof of the fourth ventricle can be exposed by gently displacing the tonsils laterally without splitting the vermis. Both the cerebellomedullary and uvulotonsillar spaces were exposed. Because the lateral cerebellomedullary cistern was also exposed, the moving of the cerebellar tonsil in a lateral direction was easy to do without injuring the cerebellar tissues. The nidus was located mainly in the extrapial plane that received feeding arteries from the posterior inferior cerebellar artery. The nidus was removed in a dry field without bleeding. This report is the first report of surgical removal of unruptured AVM of the inferior medullary velum through the so-called telovelar or transcerebellomedullary fissure approach. We propose to call this approach the uvulotonsillar approach to emphasize the dissecting plane between the uvula and the tonsil.

  17. Diver CE versus Guardwire Plus for thrombectomy in patients with inferior myocardial infarction: a trial of aspiration of thrombus during primary angioplasty for inferior myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    YAN Hong-bing; ZHANG Hong; WANG Jian; LI Nan; ZHU Xiao-ling; GAO Hai; AI Hui; LI Xiang; YE Ming; CHI Yun-peng

    2007-01-01

    Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice.The efficiency and safety of adjunct thrombectomy using Diver CE device (Invatec, Italy) versus Guardwire Plus device(Medtronic, USA) before percutaneous coronary intervention (PCI) were compared in patients with acute inferior ST-segment-elevation myocardial infarction (STEMI) for less than 12 hours, thrombolysis in myocardial infarction (TIMI)flow grade 0 to 1, and total occlusion of the proximal right coronary artery (≥3 mm in diameter) in a prospective randomized single-center study.Methods The primary end point was the magnitude of ST-segment resolution (STR) (>70%) measured immediately, 90minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume (LVEDV), left ventricle ejection fraction (LVEF) and major adverse cardiac events (MACEs) including death, myocardial infarction, target vessel revascularization and stroke at 30 days.Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age ((60± 14) years vs (60± 13) years), male (82% vs 84%), diabetes (31% vs 28%), previous coronary artery disease (25% vs 23%), onset-to-angiogram ((350± 185) min vs (345± 180) min), and use of glycoprotein Ⅱb/Ⅲa inhibitor (11% vs 13%). The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution >70% (57% vs 59%; P>0.05). Similar slow flow/no-reflow rates were observed in the Diver CE group (8%) and the Guardwire Plus group (7%). TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively (P>0.05). Myocardial blush grade 3 was similar (70% vs 72%; P>0.05). Thirty-day clinical outcome was comparable (LVEF, 0.54±0.12 vs 0.53±0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target vessel revascularization, 2% vs 2%; P>0.05,respectively

  18. Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students.

    Science.gov (United States)

    Hager, Shaun; Backus, Timothy Charles; Futterman, Bennett; Solounias, Nikos; Mihlbachler, Matthew C

    2014-05-01

    Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection. Copyright © 2014 Elsevier GmbH. All rights reserved.

  19. Inferior patellar pole fragmentation in children: just a normal variant?

    Energy Technology Data Exchange (ETDEWEB)

    Kan, J.H.; Vogelius, Esben S.; Orth, Robert C.; Guillerman, R.P.; Jadhav, Siddharth P. [Texas Children' s Hospital, E.B. Singleton Pediatric Radiology, Houston, TX (United States)

    2015-06-15

    Fragmentary ossification of the inferior patella is often dismissed as a normal variant in children younger than 10 years of age. The purpose of this study was to determine whether fragmentary inferior patellar pole ossification is a normal variant or is associated with symptoms or signs of pathology using MRI and clinical exam findings as reference. A retrospective review was performed on 150 patients ages 5-10 years who underwent 164 knee radiography and MRI exams (45.1% male, mean age: 7.8 years). The presence or absence of inferior patellar pole fragmentation on radiography was correlated with the presence or absence of edema-like signal on MR images. Clinical notes were reviewed for the presence of symptoms or signs referable to the inferior patellar pole. These data were compared with a 1:1 age- and sex-matched control group without inferior pole fragmentation. Statistical analysis was performed using two-tailed t-tests. Forty of 164 (24.4%) knee radiographs showed fragmentary ossification of the inferior patella. Of these 40 knees, 62.5% (25/40) had edema-like signal of the inferior patellar bone marrow compared with 7.5% (3/40) of controls (P = 0.035). Patients with fragmentary ossification at the inferior patella had a significantly higher incidence of documented focal inferior patellar pain compared with controls (20% vs. 2.5%, P = 0.015). Inferior patellar pole fragmentation in children 5 to 10 years of age may be associated with localized symptoms and bone marrow edema-like signal and should not be routinely dismissed as a normal variant of ossification. (orig.)

  20. Posterior lip traction caused by intravitreal gas

    Energy Technology Data Exchange (ETDEWEB)

    Lincoff, H.; Kreissig, I.

    1981-08-01

    Traction on the posterior edge of a large tear may be an irreparable consequence of an intraocular gas tamponade used in the first instance to treat the tear. In two of three patients treated with octofluorocyclobutane (C4F8) and perfluoromethane (CF4), redetachment of a retinal tear occurred as a result of traction on the posterior edge of the tear when, prior to the operation, the posterior edge seemed to be free of any traction. With redetachment, a membrane became visible between the anterior and posterior lips of the tear. The membrane was probably posterior hyaloid augmented by cellular proliferation. The gas bubble, which had been intended to press the retina against the pigment epithelium, probably brought the detached posterior hyaloid into contact with the retina as well, and an adhesion between the hyaloid and retina formed.

  1. Three dimensional finite element analysis of anatomic distal radius Nitinol memory connector treating distal radius fracture

    Institute of Scientific and Technical Information of China (English)

    苏佳灿; 张春才; 禹宝庆; 许硕贵; 王家林; 纪方; 张雪松; 吴建国; 王保华; 薛召军; 丁祖泉

    2003-01-01

    Objective: To study the memory biomechanical character of anatomic distal radius Nitinol memory connector (DRMC) in treating distal radius fracture. Methods: Establishing three dimensional model and finite element analysis, we calculated the stress in and around the fracture faces when distal radius fracture was fixated with DRMC. Results: Axial holding stress produced by holding part of DRMC on distal radius was 14.66 MPa. The maximum stress of holding part was 40-70 MPa, the minimum stress was 3-7 MPa,and the stress of compression part was 20-40 MPa. Conclusion: The distribution of stress produced by DRMC around the fracture line is reasonable, and axial holding stress can help stabilize fracture during earlier period. The existence of longitudal compression and memory effect can transfer fixated disused section into developed section and enhance fracture healing.

  2. The Posterior Fossa and Foreign Accent Syndrome: Report of Two New Cases and Review of the Literature.

    Science.gov (United States)

    Keulen, Stefanie; Mariën, Peter; van Dun, Kim; Bastiaanse, Roelien; Manto, Mario; Verhoeven, Jo

    2017-08-01

    Foreign accent syndrome is a rare motor speech disorder that causes patients to speak their language with a non-native accent. In the neurogenic condition, the disorder develops after lesions in the language dominant hemisphere, often affecting Broca's area, the insula, the supplementary motor area and the primary motor cortex. Here, we present two new cases of FAS after posterior fossa lesions. The first case is a 44-year-old, right-handed, Dutch-speaking man who suffered motor speech disturbances and a left hemiplegia after a pontine infarction. Quantified SPECT showed a bilateral hypoperfusion in the inferior lateral prefrontal and medial inferior frontal regions as well as a significant left cerebellar hypoperfusion. Further clinical investigations led to an additional diagnosis of brainstem cognitive affective syndrome which closely relates to Schmahmann's syndrome. The second patient was a 72-year-old right-handed polyglot English man who suffered a stroke in the vascular territory of the left posterior inferior cerebellar artery (PICA) and developed a foreign accent in his mother tongue (English) and in a later learnt language (Dutch). In this paper, we discuss how the occurrence of this peculiar motor speech disorder can be related to a lesion affecting the posterior fossa structures.

  3. Configuration of the inferior alveolar canal as detected by cone beam computed tomography

    Directory of Open Access Journals (Sweden)

    Umadevi P Nair

    2013-01-01

    Full Text Available Aims: The aim of this study is to evaluate the course of the inferior alveolar canal (IAC including its frequently seen variations in relation to root apices and the cortices of the mandible at fixed pre-determined anatomic reference points using cone beam volumetric computed tomography (CBVCT. Material and Methods: This retrospective study utilized CBVCT images from 44 patients to obtain quantifiable data to localize the IAC. Measurements to the IAC were made from the buccal and lingual cortical plates (BCP/LCP, inferior border of the mandible and the root apices of the mandibular posterior teeth and canine. Descriptive analysis was used to map out the course of the IAC. Results: IACs were noted to course superiorly toward the root apices from the second molar to the first premolar and closer to the buccal cortical plate anteriorly. The canal was closest to the LCP at the level of the second molar. In 32.95% of the cases, the canal was seen at the level of the canine. Conclusions: This study indicates that caution needs to be exercised during endodontic surgical procedures in the mandible even at the level of the canine. CBVCT seems to provide an optimal, low-dose, 3D imaging modality to help address the complexities in canal configuration.

  4. A novel technique for advancing the inferior labrum in a bankart repair.

    Science.gov (United States)

    Adams, Brook A; Garrett, William H; Wright, Garth B; Khan, Maher W; Taylor, Jonathon B; Nord, Keith D

    2013-05-01

    Passing suture during a Bankart repair can be a difficult task. A key component of a Bankart repair involves shifting the anteroinferior capsule and labrum superiorly. This technical note describes a new technique of reaching the inferior aspect of the Bankart lesion from posterior. Typical suture passers push the tissue further away. Using a SutureLasso through the low posterolateral portal allows one to push the tissue from inferior toward the suture anchor, making it simpler to advance the capsulolabral complex. Three suture anchors are used in the anteroinferior quadrant. The lowest suture anchor is the critical anchor for advancing the capsule and labrum. The SutureLasso is placed into the axillary recess through the low posterolateral portal, and the nitinol wire is advanced through the capsule and labrum, retrieving the suture and pulling it back through the tissue for tying with a sliding locking knot. This ensures good superior advancement of the tissue and helps obtain an optimal arthroscopic result in Bankart repair. Additional anchors are placed, and suture passage for the middle and superior anchors is then completed from anterior. The advancement and restoration of the tissue tightness provide the optimal components for an excellent result.

  5. Efeito posterior em dieletricos solidos

    OpenAIRE

    Scarpa, Paulo Cesar do Nascimento

    1989-01-01

    Dissertação (mestrado) - Universidade Federal do Parana Resumo: A macro e a micro-estrutura dos materiais dielétricos são sensíveis a sua historia térmica, mecânica e elétrica. Foi estudada, do ponto de vista teórico e experimental, a teoria da resposta dielétrica de Curie-Schweidler-Gross, vista tanto pela abordagem da teoria de circuito como da teoria de campo. O assunto e visto dentro da teoria geral da relaxação dielétrica, particularmente o efeito posterior em materiais dielétricos só...

  6. Dysregulated left inferior parietal activity in schizophrenia and depression: functional connectivity and characterization

    Directory of Open Access Journals (Sweden)

    Veronika I. Müller

    2013-06-01

    Full Text Available The inferior parietal cortex (IPC is a heterogeneous region that is known to be involved in a multitude of diverse different tasks and processes, though its contribution to these often-complex functions is yet poorly understood. In a previous study we demonstrated that patients with depression failed to deactivate the left IPC during processing of congruent audiovisual information. We now found the same dysregulation (same region and condition in schizophrenia. By using task-independent (resting state and task-dependent (MACM analyses we aimed at characterizing this particular region with regard to its connectivity and function. Across both approaches, results revealed functional connectivity of the left inferior parietal seed region with bilateral IPC, precuneus and posterior cingulate cortex (PrC/PCC, medial orbitofrontal cortex (mOFC, left middle frontal (MFG as well as inferior frontal (IFG gyrus. Network-level functional characterization further revealed that on the one hand, all interconnected regions are part of a network involved in memory processes. On the other hand, sub-networks are formed when emotion, language, social cognition and reasoning processes are required. Thus, the IPC-region that is dysregulated in both depression and schizophrenia is functionally connected to a network of regions which, depending on task demands may form sub-networks. These results therefore indicate that dysregulation of left IPC in depression and schizophrenia might not only be connected to deficits in audiovisual integration, but is possibly also associated to impaired memory and deficits in emotion processing in these patient groups.

  7. [Dynamic study of the distal radioulnar joint with computerized tomography].

    Science.gov (United States)

    Martelli, A; Zanlungo, M; Egitto, M G; Sibilla, L; Uggetti, C; Zappoli, F

    1996-05-01

    The authors describe a CT technique which allows the dynamic study of the inferior radioulnar joint. The examination consists of 4 CT slices, three of them acquired at the same level-i.e., the radioulnar joint- in the prone, intermediate and supine positions, respectively. The last slice is acquired, with the patient in the prone position, at the base of the styloid process where the triangular fibrocartilage is demonstrated. The distal radioulnar ligaments are not directly visible. Nineteen patients complaining of painfully impaired pronation and supination because of previous trauma (11 Colles fractures, 7 distortions and 1 Galeazzi lesion) were examined with this technique. In all patients, both wrists were studied to obtain normal parameters. The radioulnar joint was evaluated superimposing a draft on the dynamic images, which demonstrated that, in healthy limbs, during movement the ulnar epiphysis is always contained between two parallel lines drawn on the volar and dorsal surfaces of the radial epiphysis, respectively. It was also confirmed that supination is possible up to 110-135 degrees from the support plane. CT demonstrated different causes of impaired movements in the affected joints: in 12 cases some fibrous density tissue was seen at the ulnar epiphysis on the volar aspect and considered to be the evolution of a traumatic hematoma; 6 patients presented dorsal subluxation of the ulna during movement; finally, volar subluxation was detected only in one case. In 6 patients the triangular fibrocartilage was detached; in 1 patient an intraarticular fluid collection was demonstrated. In 3 patients CT detected no abnormalities. The fibrous tissue is responsible for impaired movements and causes the detached triangular fibrocartilage to shrink. The authors believe that this simple CT technique can yield useful pieces of information for accurate surgical planning.

  8. Biomechanical in vitro validation of intramedullary cortical button fixation for distal biceps tendon repair: a new technique.

    Science.gov (United States)

    Siebenlist, Sebastian; Lenich, Andreas; Buchholz, Arne; Martetschläger, Frank; Eichhorn, Stefan; Heinrich, Petra; Fingerle, Alexander; Doebele, Stefan; Sandmann, Gunther H; Millett, Peter J; Stöckle, Ulrich; Elser, Florian

    2011-08-01

    Extramedullary cortical button-based fixation for distal biceps tendon ruptures exhibits maximum load to failure in vitro but cannot restore the anatomic footprint and has the potential risk for injury to the posterior interosseous nerve. Double intramedullary cortical button fixation repair provides superior fixation strength to the bone when compared with single extramedullary cortical button-based repair. Controlled laboratory study. The technique of intramedullary cortical button fixation with 1 or 2 buttons was compared with single extramedullary cortical button-based repair using 12 paired human cadaveric elbows. All specimens underwent computed tomography analysis to determine intramedullary dimensions of the radial tuberosity as well as the thickness of the anterior and posterior cortices before biomechanical testing. Maximum load to failure and failure modes were recorded. For baseline measurements, the native tendon was tested for maximum load to failure. The intramedullary area of the radial tuberosity provides sufficient space for single or double intramedullary cortical button implantation. The mean thickness of the anterior cortex was 1.13 ± 0.15 mm, and for the posterior cortex it was 1.97 ± 0.48 mm (P button fixation with a mean load to failure of 455 ± 103 N, versus 275 ± 44 N for single intramedullary cortical button fixation (P button-based technique (P = .003). There were no statistically significant differences between single intramedullary and single extramedullary button fixation repair (P = .081). The mean load to failure for the native tendon was 379 ± 87 N. Double intramedullary cortical button fixation provides the highest load to failure in the specimens tested. Double intramedullary cortical button fixation provides reliable fixation strength to the bone for distal biceps tendon repair and potentially minimizes the risk of posterior interosseous nerve injury. Further, based on a 2-point-fixation, this method may offer a wider, more

  9. Isolated unilateral oculomotor nerve neuropraxia following a trivial fall in a patient with calcified posterior petroclinoid ligament

    Science.gov (United States)

    Patwardhan, Maneesha Anil

    2015-01-01

    Isolated traumatic oculomotor nerve palsy caused by a trivial fall is extremely rare. We report a case of this condition. A 49-year-old woman had distal radius fracture and ptosis on the same side after having a trivial domestic fall. She did not show any clinical or radiological signs of head injury. Computerized tomography revealed a calcified posterior petroclinoid ligament which has direct anatomical and pathological relation with the oculomotor nerve. PMID:25767590

  10. INDICATIONS FOR DISTAL RADIOULNAR ARTHROPLASTY: REPORT ON THREE CLINICAL CASES

    Science.gov (United States)

    Santos, Cláudia; Pereira, Alexandre; Sousa, Marco; Trigeuiros, Miguel; Silva, César

    2015-01-01

    Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up. PMID:27047827

  11. Does computer use affect the incidence of distal arm pain?

    DEFF Research Database (Denmark)

    Mikkelsen, Sigurd; Lassen, Christina Funch; Vilstrup, Imogen;

    2012-01-01

    To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers.......To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers....

  12. Experiencia en reconstrucción de tercio distal de pierna con colgajo libre de músculo gracilis

    OpenAIRE

    A. Conejero; B. Dagnino; Pereira, N.

    2013-01-01

    En los defectos de cobertura distales de la pierna con exposición ósea o articular, la transferencia de tejidos libres es frecuentemente la única opción viable. Se utilizan en el rescate de extremidades inferiores en riesgo por trauma, infección, ulceración, quemaduras y tumores. El colgajo libre de músculo gracilis está descrito en la literatura como una excelente alternativa. El objetivo de este estudio es describir las características de los pacientes y resultados de la utilización del col...

  13. Novel gene expression patterns along the proximo-distal axis of the mouse embryo before gastrulation

    Directory of Open Access Journals (Sweden)

    Greenfield Andy

    2007-02-01

    Full Text Available Abstract Background To date, the earliest stage at which the orientation of the anterior-posterior axis in the mouse embryo is distinguishable by asymmetric gene expression is shortly after E5.5. At E5.5, prospective anterior markers are expressed at the distal tip of the embryo, whereas prospective posterior markers are expressed more proximally, close to the boundary with the extraembryonic region. Results To contribute to elucidating the mechanisms underlying the events involved in early patterning of the mouse embryo, we have carried out a microarray screen to identify novel genes that are differentially expressed between the distal and proximal parts of the E5.5 embryo. Secondary screening of resulting candidates by in situ hybridisation at E5.5 and E6.5 revealed novel expression patterns for known and previously uncharacterised genes, including Peg10, Ctsz1, Cubilin, Jarid1b, Ndrg1, Sfmbt2, Gjb5, Talia and Plet1. The previously undescribed gene Talia and recently identified Plet1 are expressed specifically in the distal-most part of the extraembryonic ectoderm, adjacent to the epiblast, and are therefore potential candidates for regulating early patterning events. Talia and the previously described gene XE7 define a gene family highly conserved among metazoans and with a predicted protein structure suggestive of a post-transcriptional regulative function, whilst Plet1 appears to be mammal-specific and of unknown function. Conclusion Our approach has allowed us to compare expression between dissected parts of the egg cylinder and has identified multiple genes with novel expression patterns at this developmental stage. These genes are potential candidates for regulating tissue interactions following implantation.

  14. Distal displacement of the maxilla and the upper first molar.

    Science.gov (United States)

    Baumrind, S; Molthen, R; West, E E; Miller, D M

    1979-06-01

    Data from a sample of 198 Class II cases treated with various appliances which deliver distally directed forces to the maxilla were examined to determine the frequency of absolute distal displacement of the upper first molar and of the maxilla. Analysis revealed that such distal displacement is possible and that it is, in fact, a frequent finding following treatment. Long-range stability of distal displacement was not assessed.

  15. Morphometric study of distance between posterior inferior iliac spine and ischial spine of the human hip bone for sex determination

    Directory of Open Access Journals (Sweden)

    Abhishek Prasad Sinha

    2014-04-01

    Conclusion: It was observed that out of 149 hip bones taken for study 75 were of males and 74 were of females. The Mean distance in females was observed to be greater in comparison to males. Statistically calculated T- test reveals that the parameter taken for study is very highly significant in terms of sex differentiation. [Int J Res Med Sci 2014; 2(2.000: 718-720

  16. [Fracture endoprosthesis of distal humerus fractures].

    Science.gov (United States)

    Müller, L P; Wegmann, K; Burkhart, K J

    2013-08-01

    The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.

  17. [Progressive external ophthalmoplegia and distal myopathy].

    Science.gov (United States)

    Damian, C

    1993-01-01

    A patient, 58 years old, presents progressive blepharoptosis, in both eyes and external ophthalmoplegia. The general somatic examination, shows, at the level of the higher limbs, distal myopathy with muscular hypotony and articular deformities fibrosis and tendinous retraction. On examining the eye bottom we found colloid degeneration in the muscle region. Within the same family a ten-year-old nephew presents congenital ptosis. The muscular biopsy from the levator palpebrae shows muscular degenerative lesions with the reduction of nuclei and the proliferation of conjunctive tissue. It is shown that progressive external ophthalmoplegia must be interpreted as an ocular myopathy. The association with the distal myopathy at the level of the higher limbs, in the presented observation, upholds this pathogeny.

  18. Dyscalculia, dysgraphia, and left-right confusion from a left posterior peri-insular infarct.

    Science.gov (United States)

    Bhattacharyya, S; Cai, X; Klein, J P

    2014-01-01

    The Gerstmann syndrome of dyscalculia, dysgraphia, left-right confusion, and finger agnosia is generally attributed to lesions near the angular gyrus of the dominant hemisphere. A 68-year-old right-handed woman presented with sudden difficulty completing a Sudoku grid and was found to have dyscalculia, dysgraphia, and left-right confusion. Magnetic resonance imaging (MRI) showed a focus of abnormal reduced diffusivity in the left posterior insula and temporoparietal operculum consistent with acute infarct. Gerstmann syndrome from an insular or peri-insular lesion has not been described in the literature previously. Pathological and functional imaging studies show connections between left posterior insular region and inferior parietal lobe. We postulate that the insula and operculum lesion disrupted key functional networks resulting in a pseudoparietal presentation.

  19. Dyscalculia, Dysgraphia, and Left-Right Confusion from a Left Posterior Peri-Insular Infarct

    Directory of Open Access Journals (Sweden)

    S. Bhattacharyya

    2014-01-01

    Full Text Available The Gerstmann syndrome of dyscalculia, dysgraphia, left-right confusion, and finger agnosia is generally attributed to lesions near the angular gyrus of the dominant hemisphere. A 68-year-old right-handed woman presented with sudden difficulty completing a Sudoku grid and was found to have dyscalculia, dysgraphia, and left-right confusion. Magnetic resonance imaging (MRI showed a focus of abnormal reduced diffusivity in the left posterior insula and temporoparietal operculum consistent with acute infarct. Gerstmann syndrome from an insular or peri-insular lesion has not been described in the literature previously. Pathological and functional imaging studies show connections between left posterior insular region and inferior parietal lobe. We postulate that the insula and operculum lesion disrupted key functional networks resulting in a pseudoparietal presentation.

  20. Distal renal tubular acidosis with hereditary spherocytosis.

    Science.gov (United States)

    Sinha, Rajiv; Agarwal, Indira; Bawazir, Waleed M; Bruce, Lesley J

    2013-07-01

    Hereditary spherocytosis (HS) and distal renal tubular acidosis (dRTA), although distinct entities, share the same protein i.e. the anion exchanger1 (AE1) protein. Despite this, their coexistence has been rarely reported. We hereby describe the largest family to date with co-existence of dRTA and HS and discuss the molecular basis for the co-inheritance of these conditions.

  1. Distal biceps tendon injuries: diagnosis and management.

    Science.gov (United States)

    Ramsey, M L

    1999-01-01

    Rupture of the distal biceps tendon occurs most commonly in the dominant extremity of men between 40 and 60 years of age when an unexpected extension force is applied to the flexed arm. Although previously thought to be an uncommon injury, distal biceps tendon ruptures are being reported with increasing frequency. The rupture typically occurs at the tendon insertion into the radial tuberosity in an area of preexisting tendon degeneration. The diagnosis is made on the basis of a history of a painful, tearing sensation in the antecubital region. Physical examination demonstrates a palpable and visible deformity of the distal biceps muscle belly with weakness in flexion and supination. The ability to palpate the tendon in the antecubital fossa may indicate partial tearing of the biceps tendon. Plain radiographs may show hypertrophic bone formation at the radial tuberosity. Magnetic resonance imaging is generally not required to diagnose a complete rupture but may be useful in the case of a partial rupture. Early surgical reattachment to the radial tuberosity is recommended for optimal results. A modified two-incision technique is the most widely used method of repair, but anterior single-incision techniques may be equally effective provided the radial nerve is protected. The patient with a chronic rupture may benefit from surgical reattachment, but proximal retraction and scarring of the muscle belly can make tendon mobilization difficult, and inadequate length of the distal biceps tendon may necessitate tendon augmentation. Postoperative rehabilitation must emphasize protected return of motion for the first 8 weeks after repair. Formal strengthening may begin as early as 8 weeks, with a return to unrestricted activities, including lifting, by 5 months.

  2. [Laparoscopic distal resection of the pancreas].

    Science.gov (United States)

    Gürlich, R; Sixta, B; Oliverius, M; Kment, M; Rusina, R; Spicák, J; Sváb, J

    2005-09-01

    During the last two years, reports on laparoscopic procedures of the pancreas have been on increase. Laparoscopic resection of the pancreatic cauda is indicated, primarily, for benign cystic lesions of the cauda of the pancreas and for neuroendocrine tumors of the pancreas (mainly insulinomas). We have not recorded any report on the above procedure in the Czech literature. Therefore, in our case review, we have described laparoscopic distal resection of the pancreas with splenectomy for a pseudopapillary tumor of the pancreas.

  3. The left occipitotemporal system in reading: disruption of focal fMRI connectivity to left inferior frontal and inferior parietal language areas in children with dyslexia.

    Science.gov (United States)

    van der Mark, Sanne; Klaver, Peter; Bucher, Kerstin; Maurer, Urs; Schulz, Enrico; Brem, Silvia; Martin, Ernst; Brandeis, Daniel

    2011-02-01

    Developmental dyslexia is a severe reading disorder, which is characterized by dysfluent reading and impaired automaticity of visual word processing. Adults with dyslexia show functional deficits in several brain regions including the so-called "Visual Word Form Area" (VWFA), which is implicated in visual word processing and located within the larger left occipitotemporal VWF-System. The present study examines functional connections of the left occipitotemporal VWF-System with other major language areas in children with dyslexia. Functional connectivity MRI was used to assess connectivity of the VWF-System in 18 children with dyslexia and 24 age-matched controls (age 9.7-12.5 years) using five neighboring left occipitotemporal regions of interest (ROIs) during a continuous reading task requiring phonological and orthographic processing. First, the results revealed a focal origin of connectivity from the VWF-System, in that mainly the VWFA was functionally connected with typical left frontal and parietal language areas in control children. Adjacent posterior and anterior VWF-System ROIs did not show such connectivity, confirming the special role that the VWFA plays in word processing. Second, we detected a significant disruption of functional connectivity between the VWFA and left inferior frontal and left inferior parietal language areas in the children with dyslexia. The current findings add to our understanding of dyslexia by showing that functional disconnection of the left occipitotemporal system is limited to the small VWFA region crucial for automatic visual word processing, and emerges early during reading acquisition in children with dyslexia, along with deficits in orthographic and phonological processing of visual word forms. Copyright © 2010 Elsevier Inc. All rights reserved.

  4. Distal Adding On in Lenke 1A Scoliosis

    DEFF Research Database (Denmark)

    Wang, Yu; Bünger, Cody Eric; Zhang, Yanqun;

    2013-01-01

    to determine the onset of distal adding-on in Lenke 1A scoliosis. Such questions as: "Which radiographical parameters should be used for measuring the extent of distal adding-on?" and "What criteria should be applied in determining the onset of distal adding-on?" need to be answered. METHODS: We reviewed all...

  5. Distal symmetrical polyneuropathy: definition for clinical research.

    Science.gov (United States)

    England, J D; Gronseth, G S; Franklin, G; Miller, R G; Asbury, A K; Carter, G T; Cohen, J A; Fisher, M A; Howard, J F; Kinsella, L J; Latov, N; Lewis, R A; Low, P A; Sumner, A J

    2005-01-01

    The objective of this report was to develop a case definition of "distal symmetrical polyneuropathy" to standardize and facilitate clinical research and epidemiological studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetrical polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiological studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach for defining distal symmetrical polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiological research studies will ensure greater consistency of case selection.

  6. Novel topical therapies for distal colitis

    Institute of Scientific and Technical Information of China (English)

    Ian; Craig; Lawrance

    2010-01-01

    Distal colitis(DC) can be effectively treated with topical 5ASA agents.Suppositories target the rectum while enemas can reliably reach the splenic flexure.Used in combination with oral 5ASAs,the control of the inflammation is even more effective.Unfortunately,resistant DC does occur and can be extremely challenging to manage.In these patients,the use of steroids,immunosuppressants and the anti-tumor necrosis factor α agents are often required.These,however,can be associated with systemic side effects and are not always effective.The investigation of new topical therapeutic agents is thus required as they are rarely associated with significant blood drug levels and side effects are infrequent.Some of the agents that have been proposed for use in resistant distal colitis include butyrate,cyclosporine and nicotine enemas as well as tacrolimus suppositories and tacrolimus,ecabet sodium,arsenic,lidocaine,rebamipide and Ridogrel enemas.Some of these agents have demonstrated impressive results but the majority of the agents have only been assessed in small open-labelled patient cohorts.Further work is thus required with the investigation of promising agents in the context of randomized double-blinded placebo controlled trials.This review aims to highlight those potentially effective therapies in the management of resistant distal colitis and to promote interest in furthering their investigation.

  7. Distal tendinosis of the tibialis anterior tendon.

    Science.gov (United States)

    Beischer, Andrew D; Beamond, Ben M; Jowett, Andrew J L; O'Sullivan, Richard

    2009-11-01

    Disorders of the tibialis anterior (TA) tendon have infrequently been reported but spontaneous rupture of this tendon is well recognized. The clinical presentation of tendinosis without rupture of the distal TA has not previously been reported and is the basis of this paper. A study of 29 patients diagnosed with distal TA tendinosis was undertaken. Data collected included, patient demographics, weight, height, pain profile and examination findings. All patients underwent MRI of the symptomatic foot. Operative findings of those patients undergoing surgery for this condition were collected. Twenty-nine patients (32 feet) were included in the study group. Their mean age was 62 years and 27 patients were female. Twenty-one patients were overweight. The usual presenting symptom was burning medial midfoot pain that was often reported to be worst at night. Swelling over the TA tendon was frequently observed. On MRI the TA was thickened in all patients. Longitudinal split tears were observed in 19 feet. Chondral thinning and/or osteophyte formation at the first tarsometatarsal or medial naviculocuneiform joints was observed in 11 feet. Eleven feet underwent surgery. Universally the TA tendon was macroscopically thickened and had lost its normal fibrillary appearance. Longitudinal split tears were observed in eight tendons. Pathology was typical of a degenerative tendinosis. Distal TA tendinosis is a condition that seems to predominantly affect overweight elderly women. It often presents with nocturnal burning medial midfoot pain.

  8. DISTAL TRICEPS AVULSION: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Ramkumar Reddy

    2015-05-01

    Full Text Available Triceps rupture is an uncommon injury. Fracture of olecranon or a dislocation / fracture is most often common injury for similar mechanism of fall. It is commonly associated with anabolic steroid use, weight lifting, and direct laceration. Risk factors include local steroid injection, olecranon bursitis, and hyperparathyroidism. Distal triceps rupture is usually caused by a fall on an outstretched hand. Eccentric loading of a contracting triceps has been implicated. Initial diagnosis may be difficult because a palpable defect is not always present. Pain and swelling may limit the ability to evaluate strength and elbow range of motion. Although plain radiographs are helpful in ruling out other elbow pathology, MRI is used to confirm the diagnosis, classify the injury, and plan management. Incomplete tears with active elbow extension against resistance are managed non - surgically. Surgical repair is indicated in active persons with complete tears and for incomplete tears with concomitant loss of strength. Good to excellent results have been reported with surgical repair in triceps, even for chronic tears. BACKGROUND: Distal triceps tendon avulsions occur very infrequently, and the diagnosis is often missed when the injury is acute. The literature provides little guidance regarding treatment or the outcome of these injuries. The goal of this report was to report our experience with the diagnosis, timing and technique of surgical treatment, and outcome of treatment of distal triceps tendon rupture.

  9. Management and treatment of distal ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Andrea Calafiore

    2013-12-01

    Full Text Available Ulcerative colitis (UC is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms.

  10. Postoperative rehabilitation of the posterior cruciate ligament.

    Science.gov (United States)

    Edson, Craig J; Fanelli, Gregory C; Beck, John D

    2010-12-01

    Diagnosis and management of posterior cruciate ligament injuries has evolved, and now the treatment often includes surgical intervention. The purpose of this paper is to define the current approach to postsurgical management after the posterior cruciate ligament reconstruction, review conservative management, and discuss surgical outcomes using a specified program.

  11. Meibography for eyes with posterior blepharitis

    Directory of Open Access Journals (Sweden)

    Abdulrahman AlDarrab

    2017-07-01

    Conclusion: Meibography can be a helpful non-invasive tool for the clinical evaluation of the extent of the anatomical damage in patients having meibomian glands loss due to posterior blepharitis. Knowing the extent of damage in meibomian glands may help in selecting the appropriate treatment modality and expect the response to treatment in patients with posterior blepharitis.

  12. [Suprasegmental effects of selective posterior rhizotomy].

    Science.gov (United States)

    Horínek, D; Tichý, M; Cerný, R; Vlková, J

    2004-01-01

    The occurrence of spasticity is most commonly attributed to the lack of presynaptic inhibition. Perinatal damage to the central nervous system, as it happens in cerebral palsy, leads to pathological reflex response both on segmental and polysegmental levels. It results not only in clinical signs typical for spasticity but also in alterations of brainstem function, such as dysarthria or congenital nystagmus. Selective posterior rhizotomy is a neurosurgical method, routinely used in the treatment of spasticity. The lumbosacral posterior roots are partially cut under perioperative neurophysiological control. The aim of the treatment is the reduction of afferentation for posterior horns resulting in a decrease of pathological reflex responses. Selective posterior rhizotomy consequently decreases lower limbs spasticity. The improvement of upper extremities fine skills, the improvement of speech and cognitive functions has been also observed after selective posterior rhizotomy. The possible pathophysiological explanations of these so-called suprasegmental effects are discussed in the article.

  13. Continence after posterior sagittal anorectoplasty.

    Science.gov (United States)

    Langemeijer, R A; Molenaar, J C

    1991-05-01

    Posterior sagittal anorectoplasty (PSARP) was introduced in 1982 by Peña and De Vries as a new operation for patients with a high anorectal malformation. The degree of postoperative continence is reported to be high. During the past decade, too, new insights have been gained into the embryology of anorectal malformations. Evaluation of PSARP in relation to current understanding of the development and anatomy of the anorectum and the pelvic floor has led us to conclude that optimal continence cannot be expected. Fifty patients with a high anorectal malformation underwent PSARP between June 1983 and May 1990. Postoperative follow-up consisted of anamnesis (subjective) and electrostimulation, defecography, and anorectal manometry (objective). All patients are alive, and all but one are being evaluated regularly. Subjectively, the majority of patients were more or less incontinent, with soiling of pants at least once a day. On the basis of objective criteria, virtually all patients appeared to be incontinent, and in only one patient was the mechanism of defecation almost unimpaired after PSARP. From this study, we conclude that although PSARP provides a good aesthetic result, patients will never acquire normal continence.

  14. Aneurisma gigante da artéria cerebral posterior: (segmento P3) Relato de caso

    OpenAIRE

    1995-01-01

    Apresentamos caso de aneurisma gigante do segmento distal (P3) da artéria cerebral posterior. O aneurisma foi tratado microcirurgicamente pela via combinada proposta por Sano com clipagem do ramo terminal da artéria cerebral posterior próximo ao aneurisma. A paciente teve evolução pós operatória favorável, com lesão parcial e transitória do III nervo craniano. Revisão da literatura e discussão a respeito da anatomia e da abordagem cirúrgica são feitas. A raridade desta patologia justifica o r...

  15. Spontaneous fracture of an implanted posterior chamber polyimide intraocular lens haptic: A case report

    Directory of Open Access Journals (Sweden)

    Haemin Kang

    2014-01-01

    Full Text Available A 57-year-old male patient visited our clinic for decreased visual acuity in the right eye for 10 days. He denied any trauma history, but recalled that the symptom developed after straining. He had undergone uncomplicated phacoemulsification and posterior chamber intraocular lens (IOL implantation in the bag of the right eye 11 years ago. The IOL was a three-piece silicone polyimide-haptics design. On slit-lamp examination, the IOL optic and proximal part of nasal fractured haptic were found in the anterior chamber. The distal part of fractured haptic was observed in the capsular bag. He underwent IOL exchange. The fracture site of the haptic was near the optic-haptic junction. This is the unique case report of a spontaneous fracture of an implanted posterior chamber polyimide IOL haptic, which implies the possibility of IOL haptic fracture in various haptic materials.

  16. Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia.

    LENUS (Irish Health Repository)

    Leonard, M

    2012-02-01

    The pilon fracture is a complex injury. The purpose of this study was to evaluate the outcome of minimally invasive techniques in management of these injuries. This was a prospective study of closed AO type C2 and C3 fractures managed by early (<36 hours) minimally invasive surgical intervention and physiotherapist led rehabilitation. Thirty patients with 32 intra-articular distal tibial fractures were treated by the senior surgeon (GK). Our aim was to record the outcome and all complications with a minimum two year follow-up. There were two superficial wound infections. One patient developed a non-union which required a formal open procedure. Another patient was symptomatic from a palpable plate inferiorly. An excellent AOFAS result was obtained in 83% (20\\/24) of the patients. Early minimally invasive reduction and fixation of complex high velocity pilon fractures gave very satisfactory results at a minimum of two years follow-up.

  17. Trautmann's triangle anatomy with application to posterior transpetrosal and other related skull base procedures.

    Science.gov (United States)

    Tubbs, R Shane; Griessenauer, Christoph; Loukas, Marios; Ansari, Shaheryar F; Fritsch, Michael H; Cohen-Gadol, Aaron A

    2014-10-01

    Trautmann's triangle (TT) faces the cerebellopontine angle and is exposed during posterior transpetrosal approaches. However, reports on the morphometric analysis of this structure are lacking in the literature. The goal was to better understand this important operative corridor. TT was exposed from an external approach (transmastoid) in ten cadavers (20 sides) and from an internal approach on 20 dry adult temporal bones. Measurements included calculation of the area of TT and the distance of the endolymphatic sac from the anterior border of the sigmoid sinus. The area range of TT was 45-210 mm(2) (mean 151 mm(2); SD 37 mm(2)). Three types of triangles were identified based on area. Type I triangles had areas less than 75 mm(2), Type II areas were 75-149 mm(2), and Type III areas were 150 mm(2) and greater. These types were observed in 37.5%, 35%, and 27.5% of sides, respectively. The distance from the jugular bulb's anterior border to the posterior border of the posterior semicircular canal ranged from 6 to 11 mm (mean 8.5 mm). The endolymphatic sac was located in the inferior portion of TT and traveled anterior to the sigmoid sinus. The horizontal distance from the anterior edge of the sigmoid sinus to the posterior edge of the endolymphatic sac ranged from 0 to 13.5 mm (mean 9 mm). Additional anatomic knowledge regarding TT may improve neurosurgical procedures in this region by avoiding intrusion into the endolymphatic sac and sigmoid sinus.

  18. An innovative technique to distalize maxillary molar using microimplant supported rapid molar distalizer

    Directory of Open Access Journals (Sweden)

    Meenu Goel

    2013-01-01

    Full Text Available Introduction: In recent years, enhancements in implants have made their use possible as a mode of absolute anchorage in orthodontic patients. In this paper, the authors have introduced an innovative technique to unilaterally distalize the upper left 1 st molar to obtain an ideal Class I molar relationship from a Class II existing molar relationship with an indigenous designed distalizer. Clinical Innovation: For effective unilateral diatalization of molar, a novel cantilever sliding jig assembly was utilized with coil spring supported by a buccally placed single micro implant. The results showed 3 mm of bodily distalization with 1 mm of intrusion and 2° of distal tipping of upper left 1 st molar in 1.5 months. Discussion: This appliance is relatively easy to insert, well-tolerated, and requires minimal patient cooperation compared to other present techniques of molar distalization. Moreover, it is particularly useful in cases that are Class II on one side and Class I on the other, with a minor midline discrepancy and nominal overjet. Patient acceptance level was reported to be within patients physiological and comfort limits.

  19. Distal renal tubular acidosis in recurrent renal stone formers

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent...... metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available...

  20. Anterior-inferior capsular shift of the shoulder: a biomechanical comparison of glenoid-based versus humeral-based shift strategies.

    Science.gov (United States)

    Deutsch, A; Barber, J E; Davy, D T; Victoroff, B N

    2001-01-01

    This study compared the biomechanical effects of an anterior-inferior capsular shift based at the humeral side with one on the glenoid side of the joint on resultant multidirectional glenohumeral translation and rotation. Nine matched pairs of fresh cadaveric shoulders were placed in a testing apparatus that constrained 3 rotations but allowed simultaneous free translation of the humeral head with respect to the glenoid. The right and left shoulders of each of the matched pairs were randomized to undergo either a glenoid-based or humeral-based anterior capsular shift. The shoulders were tested vented and following the capsular shift procedure. Translational testing was performed at 0 degrees, 45 degrees, and 90 degrees of glenohumeral elevation with the humerus in neutral rotation, 30 degrees internal rotation, and 30 degrees external rotation. Sequential loads of 30 N in anterior, posterior, and inferior directions were applied while maintaining a 22-N joint compressive load. The maximum arc of internal and external rotation after application of a 1-newton-meter moment was determined for the vented specimens and then after the capsular shift procedure. Both shift strategies resulted in significant limitation of anterior, posterior, and inferior translation in all of the tested positions. No significant differences were noted between the 2 shift strategies with respect to restriction of translation in the anterior or inferior directions. The glenoid-based shift caused a significantly greater decrease in posterior translation at 45 degrees and 90 degrees of abduction. With respect to rotation, the glenoid-based shift exerted significantly greater restriction on external rotation than the humeral-based shift. This study supports the use of either a humeral-based or glenoid-based shift to control multidirectional glenohumeral instability. Greater reduction in external rotation was demonstrated after the glenoid-based shift. Specific differences demonstrated in

  1. Colgajo libre interóseo posterior para reconstrucción de mano: a propósito de un caso Posterior interosseous free flap for hand reconstruction: case report

    Directory of Open Access Journals (Sweden)

    E. Cabrera Sánchez

    2008-06-01

    Full Text Available La cobertura de la mano es un desafío para el cirujano plástico, debido a las múltiples opciones disponibles. El colgajo interóseo posterior de base distal es una de las opciones más útiles para la reconstrucción de esta clase de defectos. Sin embargo, debido a su inconstante anatomía vascular pueden acontecer problemas en su disección. Las variaciones anatómicas son bien conocidas y son básicamente de dos tipos: la ausencia de anastomosis distal con la arteria interósea anterior o la hipoplasia o aplasia en el tercio distal del antebrazo de la arteria interósea posterior, provocando un porcentaje relativamente alto de necrosis parcial, que puede acarrear un fallo en la cobertura de esta zona. Con objeto de prevenir un resultado desfavorable, hemos usado un colgajo interóseo posterior en forma de transferencia libre para el tratamiento quirúrgico de una mujer que fue remitida a nuestro Servicio con un defecto de 7 x 7 cm de diámetro en el dorso de la mano izquierda.Hand coverage is a challenge for plastic surgeons, because there are many therapeutic options available. The distally based posterior interosseous artery flap is one of the most useful elections for reconstruction of this defect. However, we can find problems in dissecting the flap due to an inconstant vascular anatomy. Anatomical variants are well known and they can be of two types: the absence of the distal anastomosis with the anterior interosseous artery and the hypoplasia or aplasia of the middle third of fhe posterior interosseous artery, with a relatively high rate of partial flap loss which may result in coverage failure. In order to prevent an unsuccessful flap harvest, we have used an interosseous free flap for a woman with a 7 x 7 cm defect in the dorsum of her left hand.

  2. A comparison between orthogonal and parallel plating methods for distal humerus fractures: a prospective randomized trial.

    Science.gov (United States)

    Lee, Sang Ki; Kim, Kap Jung; Park, Kyung Hoon; Choy, Won Sik

    2014-10-01

    With the continuing improvements in implants for distal humerus fractures, it is expected that newer types of plates, which are anatomically precontoured, thinner and less irritating to soft tissue, would have comparable outcomes when used in a clinical study. The purpose of this study was to compare the clinical and radiographic outcomes in patients with distal humerus fractures who were treated with orthogonal and parallel plating methods using precontoured distal humerus plates. Sixty-seven patients with a mean age of 55.4 years (range 22-90 years) were included in this prospective study. The subjects were randomly assigned to receive 1 of 2 treatments: orthogonal or parallel plating. The following results were assessed: operating time, time to fracture union, presence of a step or gap at the articular margin, varus-valgus angulation, functional recovery, and complications. No intergroup differences were observed based on radiological and clinical results between the groups. In our practice, no significant differences were found between the orthogonal and parallel plating methods in terms of clinical outcomes, mean operation time, union time, or complication rates. There were no cases of fracture nonunion in either group; heterotrophic ossification was found 3 patients in orthogonal plating group and 2 patients in parallel plating group. In our practice, no significant differences were found between the orthogonal and parallel plating methods in terms of clinical outcomes or complication rates. However, orthogonal plating method may be preferred in cases of coronal shear fractures, where posterior to anterior fixation may provide additional stability to the intraarticular fractures. Additionally, parallel plating method may be the preferred technique used for fractures that occur at the most distal end of the humerus.

  3. OPERATIVE MANAGEMENT OF INTRA-ARTICULAR DISTAL HUMERAL FRACTURES WITH LOCKING PLATES

    Directory of Open Access Journals (Sweden)

    Abhilekh

    2015-11-01

    Full Text Available BACKGROUND: Intra-articular distal humeral fractures are common, but complex elbow injuries. To obtain good results, anatomical reduction with rigid fixation and early range of mobilization is required. Treatment of these fractures with conventional plates is associated with many complications such as non-anatomic reduction of articular surfaces, malunion, non-union, loosening of implant, residual stiffness of the elbow and post-traumatic osteoarthrosis. In this situation the application of locking plates having a fixed angle plate screw construct can minimise most of the above complications. OBJECTIVE: To evaluate radiological and functional outcome of locking plate application for the management of intra-articular distal humeral fractures. MATERIAL AND METHODS: This prospective study was conducted from January 2013 to December 2014. We operated 20 patients of AO type-C intra-articular distal humeral fractures. Fracture was exposed using modified Campbell’s posterior approach in less comminuted fractures and a V-shaped Olecranon osteotomy was done to get better exposure of the articular surface in cases with severe articular comminution. The fracture was stabilized using an intercondylar screw, pre-contoured locking compression plates and/or locking reconstruction plates as per preoperative planning. Patients were reviewed at monthly interval for clinical-radiological evaluation. Final outcome measures included radiological assessment, range of motion and Mayo elbow performance score (MEPS. RESULTS: All the fractures were united at an average 12 weeks. Two patients developed numbness in the distribution of ulnar nerve and one patient developed superficial infection in immediate postoperative period. None of the patients had malunion and loosening of implant. The average arc of flexion-extension was 105`, although no patient had loss of supination/pronation. Mayo Elbow Performance Score was excellent in 15 (75%, good in 3 (15%, fair in 1 (5

  4. The Versatility of Perforator-Based Propeller Flap for Reconstruction of Distal Leg and Ankle Defects

    Directory of Open Access Journals (Sweden)

    Durga Karki

    2012-01-01

    Full Text Available Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result.

  5. The effect of shoulder position on inferior glenohumeral mobilization.

    Science.gov (United States)

    Witt, Dexter W; Talbott, Nancy R

    2017-03-09

    Cross-sectional clinical measurement study. Inferior mobilizations are used to treat patients with shoulder dysfunctions. Common positions recommended for promoting an inferior glide include: (1) an open-packed position (OPP) in which the shoulder is in 55° of abduction, 30° of horizontal adduction, and no rotation; (2) neutral position (NP) of the shoulder; and (3) position of 90° of shoulder abduction (ABDP). Studies comparing the impact of position on inferior mobilization are lacking. To determine the effect of shoulder position on humeral movement and mobilization force during inferior mobilizations. Twenty-three subjects were tested bilaterally. Subjects were placed in the OPP, and an ultrasound transducer placed over the superior glenohumeral joint. As inferior mobilization forces were applied through a dynamometer, ultrasound images were taken at rest and during 3 grades of inferior mobilization. This process was repeated in the NP and the ABDP. In the NP, movements during grade 1, 2, and 3 mobilizations were 1.8, 3.8, and 4.5 mm, respectively. Movements measured in the OPP (1.0, 2.4, and 3.6 mm, respectively) and in the ABDP (1.0, 2.2, and 2.3 mm, respectively) were less. Forces were higher in the NP during grade 1, 2, and 3 mobilizations (51.8, 138.7, and 202.1 N, respectively) than in the OPP (37.2, 91.2, and 139.9 N, respectively) and the ABPD (42.5, 115.3, and 165.5 N, respectively). Mobilization position altered the movement and force during inferior mobilizations. Shoulder position should be considered when utilizing inferior mobilizations. NA. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  6. Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report.

    Science.gov (United States)

    Shin, Yooseok; Roh, Byoung-Duck; Kim, Yemi; Kim, Taehyeon; Kim, Hyungjun

    2016-02-01

    During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

  7. Traumatic posterior L4-L5 fracture dislocation of the lumbar spine: a case report.

    Science.gov (United States)

    Zarate-Kalfopulos, Baron; Romero-Vargas, Samuel; Alcántara-Canseco, Cesar; Rosales-Olivarez, Luis Miguel; Alpizar-Aguirre, Armando; Reyes-Sánchez, Alejandro

    2012-12-01

    Study Design Case report. Objective The diagnosis and surgical management of a patient with traumatic bilateral posterior dislocation of L4-L5 is presented with a thorough review of the existing literature. Summary of Background Data Traumatic dislocation of L4-L5 has been reported in the English literature in only five cases; of these, only two were retrolisthesis. Methods A 20-year-old patient was involved in a high-energy vehicular accident and presented with back pain and inability to ambulate. Neurological assessment showed motor strength grade 2/5 in the proximal lower-extremity muscle groups (L1-L3 myotomes) and 0/5 strength distally (L4-S1 myotomes); in addition, incontinence of sphincters was found. X-rays and computed tomography (CT) scan revealed a three-column ligamentous injury with posterior fracture-dislocation of the L4 vertebral body with complete posterior displacement of L4 to L5 vertebral body. The patient underwent posterior approach with reduction, transpedicular fixation, and posterolateral fusion with autologous bone graft. Results At 1-year follow-up, the patient had recovered muscular strength in proximal lower-extremities muscle groups, sphincter function had fully recovered, and he was able to ambulate with crutches. There was no recovery of distal extremity sensorimotor function. Plain radiograph and CT scan showed good alignment and progressive maturation of his fusion procedure. Conclusion Traumatic retrolisthesis of L4-L5 is a high-energy unstable fracture; reduction of the dislocation is challenging because of the heavy forces acting in the lower lumbar spine. Instrumented fusion restores alignment and maintains segmental stability.

  8. Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

    Directory of Open Access Journals (Sweden)

    Zhi-Xin Zhao

    2015-01-01

    Full Text Available Background: The goal of total knee arthroplasty (TKA is to restore knee kinematics. Knee prosthesis design plays a very important role in successful restoration. Here, kinematics models of normal and prosthetic knees were created and validated using previously published data. Methods: Computed tomography and magnetic resonance imaging scans of a healthy, anticorrosive female cadaver were used to establish a model of the entire lower limbs, including the femur, tibia, patella, fibula, distal femur cartilage, and medial and lateral menisci, as well as the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments. The data from the three-dimensional models of the normal knee joint and a posterior-stabilized (PS knee prosthesis were imported into finite element analysis software to create the final kinematic model of the TKA prosthesis, which was then validated by comparison with a previous study. The displacement of the medial/lateral femur and the internal rotation angle of the tibia were analyzed during 0-135° flexion. Results: Both the output data trends and the measured values derived from the normal knee′s kinematics model were very close to the results reported in a previous in vivo study, suggesting that this model can be used for further analyses. The PS knee prosthesis underwent an abnormal forward displacement compared with the normal knee and has insufficient, or insufficiently aggressive, "rollback" compared with the lateral femur of the normal knee. In addition, a certain degree of reverse rotation occurs during flexion of the PS knee prosthesis. Conclusions: There were still several differences between the kinematics of the PS knee prosthesis and a normal knee, suggesting room for improving the design of the PS knee prosthesis. The abnormal kinematics during early flexion shows that the design of the articular surface played a vital role in improving the kinematics of the PS knee prosthesis.

  9. Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

    Institute of Scientific and Technical Information of China (English)

    Zhi-Xin Zhao; Liang Wen; Tie-Bing Qu; Li-Li Hou; Dong Xiang; Jia Bin

    2015-01-01

    Background:The goal of total knee arthroplasty (TKA) is to restore knee kinematics.Knee prosthesis design plays a very important role in successful restoration.Here,kinematics models of normal and prosthetic knees were created and validated using previously published data.Methods:Computed tomography and magnetic resonance imaging scans of a healthy,anticorrosive female cadaver were used to establish a model of the entire lower limbs,including the femur,tibia,patella,fibula,distal femur cartilage,and medial and lateral menisci,as well as the anterior cruciate,posterior cruciate,medial collateral,and lateral collateral ligaments.The data from the three-dimensional models of the normal knee joint and a posterior-stabilized (PS) knee prosthesis were imported into finite element analysis software to create the final kinematic model of the TKA prosthesis,which was then validated by comparison with a previous study.The displacement of the medial/lateral femur and the internal rotation angle of the tibia were analyzed during 0-135° flexion.Results:Both the output data trends and the measured values derived from the normal knee's kinematics model were very close to the results reported in a previous in vivo study,suggesting that this model can be used for further analyses.The PS knee prosthesis underwent an abnormal forward displacement compared with the normal knee and has insufficient,or insufficiently aggressive,"rollback" compared with the lateral femur of the normal knee.In addition,a certain degree of reverse rotation occurs during flexion of the PS knee prosthesis.Conclusions:There were still several differences between the kinematics of the PS knee prosthesis and a normal knee,suggesting room for improving the design of the PS knee prosthesis.The abnormal kinematics during early flexion shows that the design of the articular surface played a vital role in improving the kinematics of the PS knee prosthesis.

  10. Corrección de mordida cruzada posterior vestibular en dentición primaria. Reporte de dos casos clínico

    Directory of Open Access Journals (Sweden)

    Jerusalén E. Mata T.

    2016-07-01

    Full Text Available La mordida cruzada posterior vestibular cruzada bucal o mordida en tijera ocurre cuando las cúspides linguales de los molares superiores ocluyen vestibularmente a las fosas centrales de los molares inferiores o cuando las caras palatinas de los dientes superiores están en contacto con las caras vestibulares de los dientes inferiores. Pueden ser funcionales, causadas por inclinación de los molares inferiores hacia lingual o por asimetrías mandibulares. El tratamiento temprano es recomendado para normalizar las relaciones transversales y promover un correcto desarrollo de la oclusión. Se presentan dos casos de mordida cruzada posterior vestibular unilateral en dentición primaria y mixta temprana. Caso 1: paciente masculino de 5 años de edad, presentó lesiones extensas de caries, normoclusión, mordida cruzada posterior vestibular unilateral derecha y fue tratado mediante aparato fijo tipo Bi-Helix con bandas cementadas a los segundos molares primarios. Caso 2: paciente masculino de 5 años de edad, presentó lesiones extensas de caries, normoclusión y mordida cruzada posterior vestibular unilateral Izquierda. Fueron colocadas pistas directas de resina. En ambos casos se logró una relación trasversal satisfactoria, corrigiendo la mordida cruzada vestibular. Conclusión: La mordida cruzada posterior vestibular puede presentarse debido a desviación mandibular por interferencias oclusales y a inclinaciones inapropiadas de los molares primarios. Cuando esta es la etiología, el tratamiento es exitoso al utilizar pistas directas de resina, eliminación de contactos prematuros y expansor inferior tipo Bi-Helix.

  11. Anterior transposition of the inferior oblique muscle as the initial treatment of a snapped inferior rectus muscle.

    Science.gov (United States)

    Aguirre-Aquino, B I; Riemann, C D; Lewis, H; Traboulsi, E I

    2001-02-01

    Snapping or tearing of an extraocular muscle refers to its rupture across its width, usually at the junction between muscle and tendon several millimeters behind the insertion. Tearing occurs during strabismus or retinal reattachment surgery, or after trauma. If the proximal end of the muscle cannot be located, transposition procedures are necessary to achieve ocular realignment. These surgical procedures carry the risk of anterior segment ischemia, especially in the elderly. Anterior transposition of the inferior oblique muscle has been used for the treatment of inferior oblique overaction, especially in the presence of a dissociated vertical deviation, and in patients with fourth nerve palsy. We transposed the inferior oblique muscle insertion in a 73-year-old woman with a snapped inferior rectus muscle.

  12. Posterior labral injury in contact athletes.

    Science.gov (United States)

    Mair, S D; Zarzour, R H; Speer, K P

    1998-01-01

    Nine athletes (seven football offensive linemen, one defensive lineman, and one lacrosse player) were found at arthroscopy to have posterior labral detachment from the glenoid. In our series, this lesion is specific to contact athletes who engage their opponents with arms in front of the body. All patients had pain with bench pressing and while participating in their sport, diminishing their ability to play effectively. Conservative measures were ineffective in relieving their symptoms. Examination under anesthesia revealed symmetric glenohumeral translation bilaterally, without evidence of posterior instability. Treatment consisted of glenoid rim abradement and posterior labral repair with a bioabsorbable tack. All patients returned to complete at least one full season of contact sports and weightlifting without pain (minimum follow-up, > or = 2 years). Although many injuries leading to subluxation of the glenohumeral joint occur when an unanticipated force is applied, contact athletes ready their shoulder muscles in anticipation of impact with opponents. This leads to a compressive force at the glenohumeral joint. We hypothesize that, in combination with a posteriorly directed force at impact, the resultant vector is a shearing force to the posterior labrum and articular surface. Repeated exposure leads to posterior labral detachment without capsular injury. Posterior labral reattachment provides consistently good results, allowing the athlete to return to competition.

  13. Posterior encephalopathy with vasospasm: MRI and angiography

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    Weidauer, S.; Gaa, J.; Lanfermann, H.; Zanella, F.E. [Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528, Frankfurt (Germany); Sitzer, M.; Hefner, R. [Department of Neurology, University of Frankfurt, Schleusenweg 2-16, 60528, Frankfurt (Germany)

    2003-12-01

    Posterior encephalopathy is characterised by headache, impairment of consciousness, seizures and progressive visual loss. MRI shows bilateral, predominantly posterior, cortical and subcortical lesions with a distribution. Our aim was to analyse the MRI lesion pattern and angiographic findings because the pathophysiology of posterior encephalopathy is incompletely understood. We report three patients with clinical and imaging findings consistent with posterior encephalopathy who underwent serial MRI including diffusion-weighted imaging (DWI) and construction of apparent diffusion coefficient (ADC) maps, and four-vessel digital subtraction angiography (DSA). DWI revealed symmetrical subcortical and cortical parieto-occipital high signal. High and also low ADCs indicated probable vasogenic and cytotoxic oedema. On follow-up there was focal cortical laminar necrosis, while the white-matter lesions resolved almost completely, except in the arterial border zones. DSA revealed diffuse arterial narrowing, slightly more marked in the posterior circulation. These findings suggest that posterior encephalopathy may in some cases be due to diffuse, severe vasospasm affecting especially in the parieto-occipital grey matter, with its higher vulnerability to ischemia. Cerebral vasospasm due to digitoxin intoxication, resulting in posterior encephalopathy, has not yet been described previously. (orig.)

  14. Distal Femoral Locking Compression Plate Fixation in Distal Femoral Fractures: Early Results

    Directory of Open Access Journals (Sweden)

    EJ Yeap

    2007-05-01

    Full Text Available We conducted a retrospective review on eleven patients who were treated for Type A and C distal femoral fractures (based on AO classification between January 2004 and December 2004. All fractures were fixed with titanium distal femoral locking compression plate. The patient’s ages ranged from 15 to 85 with a mean of 44. Clinical assessment was conducted at least 6 months post-operatively using the Schatzker scoring system. Results showed that four patients had excellent results, four good, two fair and one failure.

  15. Effect of modified inferior oblique anterior transposition on dissociated vertical strabismus patients with inferior oblique muscle hyperfunction

    Directory of Open Access Journals (Sweden)

    Xi-Lang Wang

    2017-02-01

    Full Text Available AIM: To investigate the effect of anterior transposition of inferior oblique muscle on the treatment of dissociated vertical deviation(DVDin children with inferior oblique overaction(IOOAand unequal inferior oblique transposition of the treatment of IOOA with the eyes of the asymmetry of DVD efficacy, associated with the lower oblique hyperfunction DVD patients to provide more effective treatment. METHODS: Eighty patients with hyperfunction who were treated in our hospital from January 2014 to December 2015 were randomly selected and treated with anterior transposition of inferior oblique muscle. Patients were followed up for 1 to 30mo. We compared the vertical incline at the original incline from far(5m, near(33cmdistance and IOOA degree before and after operations, and the correlation between the two. We also compared the vertical incline at the original incline from far(5m, near(33cmdistance and IOOA degree before and after operations in 30 eyes(20 patientswith bilateral asymmetry DVD and IOOA who received unequal inferior oblique transposition. The incidence of antielevation syndrome(AESwas observed after operations. RESULTS: The mean prism diopters(PDat 5m before operations was 19.5±0.15, the average PD after operations was 3.5±0.18, at 5m the original incline was 16±0.21PD. The mean PD at 33cm was 18.6±0.20 before operation, 4.5±0.26 after operations, and 14.1±0.16 at 33cm the original incline, the difference was statistically significant(Pr=0.554, Pr=0.454, P PPCONCLUSION: Anterior transposition of the inferior oblique muscle has a good therapeutic effect on isolated vertical strabismus patients with inferior oblique hyperfunction. While the incidence of postoperative AES is low in patients received unequal inferior oblique muscle transposition.

  16. Anaesthetic management in thoracoscopic distal tracheal resection.

    Science.gov (United States)

    Acosta Martínez, J; Beato López, J; Domínguez Blanco, A; López Romero, J L; López Villalobos, J L

    2017-03-01

    Surgical resection of tracheal tumours, especially distal tracheal tumours, is a challenge for the anaesthesiologists involved, mainly due to difficulties in ensuring adequate control of the airway and ventilation. We report the case of a patient undergoing tracheal resection and anastomosis by VATS, emphasizing the anaesthetic management. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Salter Harris Fractures of the Distal Femur

    Science.gov (United States)

    Hamilton, Steven W.; Barker, Simon L.

    2013-01-01

    Salter Harris–type injuries of the distal femur should be treated as a dislocation of the knee and therefore as a medical emergency. Senior medical staff should be involved early, ankle–brachial index ratio should be measured in all patients and the clinician should have a high index of suspicion for a vascular injury. Ideally reduction, stabilization, and vascular repair, if necessary, should be carried out within 6 hours of the initial event. There should be a low threshold for fasciotomies. These 2 cases demonstrate the importance of having a high index of suspicion for vascular injury and the need for continued reassessment. PMID:26425580

  18. Salter Harris Fractures of the Distal Femur

    Directory of Open Access Journals (Sweden)

    Sean M. McKenna

    2013-07-01

    Full Text Available Salter Harris–type injuries of the distal femur should be treated as a dislocation of the knee and therefore as a medical emergency. Senior medical staff should be involved early, ankle–brachial index ratio should be measured in all patients and the clinician should have a high index of suspicion for a vascular injury. Ideally reduction, stabilization, and vascular repair, if necessary, should be carried out within 6 hours of the initial event. There should be a low threshold for fasciotomies. These 2 cases demonstrate the importance of having a high index of suspicion for vascular injury and the need for continued reassessment.

  19. Distal Renal Tubular Acidosis and Calcium Nephrolithiasis

    Science.gov (United States)

    Moe, Orson W.; Fuster, Daniel G.; Xie, Xiao-Song

    2008-09-01

    Calcium stones are commonly encountered in patients with congenital distal renal tubular acidosis, a disease of renal acidification caused by mutations in either the vacuolar H+-ATPase (B1 or a4 subunit), anion exchanger-1, or carbonic anhydrase II. Based on the existing database, we present two hypotheses. First, heterozygotes with mutations in B1 subunit of H+-ATPase are not normal but may harbor biochemical abnormalities such as renal acidification defects, hypercalciuria, and hypocitraturia which can predispose them to kidney stone formation. Second, we propose at least two mechanisms by which mutant B1 subunit can impair H+-ATPase: defective pump assembly and defective pump activity.

  20. Distal extremity necrosis in captive birds.

    Science.gov (United States)

    Calle, P P; Montali, R J; Janssen, D L; Stoskopf, M K; Strandberg, J D

    1982-10-01

    The necropsy files of the National Zoological Park and Baltimore Zoological Society were reviewed for cases of distal extremity necrosis (DEN) in birds. Nineteen cases of DEN occurred following either trauma or frostbite. Six birds developed an apparently primary type of DEN in which no predisposing factors were obvious clinically. The toes and feet were most commonly involved, and in several cases the beak was also affected. Some pathologic evidence is provided that certain cardiovascular lesions may predispose birds to DEN by compromising circulation of the extremities.

  1. Distal fibula fracture diagnosed with ultrasound imaging.

    Science.gov (United States)

    Kardouni, Joseph R

    2012-10-01

    The patient was a 31-year-old man serving in a military special forces unit at a remote location. He presented to a physical therapist with a chief complaint of worsening right lateral ankle pain that limited his ability to bear weight. Because the patient met the Ottawa ankle rules and there was concern for a fracture, radiographs were indicated. However, the nearest facility with radiographic capabilities was only available through air medical evacuation. Therefore, the physical therapist assessed the patient's ankle with an onsite portable ultrasound imaging unit, which demonstrated cortical irregularity along the distal fibula.

  2. Aneurisma gigante da artéria cerebral posterior: (segmento P3 Relato de caso Giant aneurysm of the posterior cerebral artery (P3 segment: case report

    Directory of Open Access Journals (Sweden)

    Ronaldo Pereira

    1995-09-01

    Full Text Available Apresentamos caso de aneurisma gigante do segmento distal (P3 da artéria cerebral posterior. O aneurisma foi tratado microcirurgicamente pela via combinada proposta por Sano com clipagem do ramo terminal da artéria cerebral posterior próximo ao aneurisma. A paciente teve evolução pós operatória favorável, com lesão parcial e transitória do III nervo craniano. Revisão da literatura e discussão a respeito da anatomia e da abordagem cirúrgica são feitas. A raridade desta patologia justifica o relato deste caso.A rare case of giant aneurysm of the P3 segment of the posterior cerebral artery is presented. The aneurysm was acessed through a combined approach proposed by Sano and the aneurysm was treated by proximal clipping. The patient had a good postoperative recovery without any neurological deficit. The anatomy and the operative approaches are discussed and the neurosurgical literature reviewed.

  3. Functional Connectivity of Ventral and Dorsal Visual Streams in Posterior Cortical Atrophy.

    Science.gov (United States)

    Migliaccio, Raffaella; Gallea, Cécile; Kas, Aurélie; Perlbarg, Vincent; Samri, Dalila; Trotta, Laura; Michon, Agnès; Lacomblez, Lucette; Dubois, Bruno; Lehericy, Stéphane; Bartolomeo, Paolo

    2016-01-01

    Posterior cortical atrophy (PCA) induces progressive dysfunction of ventral and dorsal visual networks. Little is known, however, about corresponding changes in functional connectivity (FC). To investigate FC changes in the visual networks, their relationship with cortical atrophy, and the association with Alzheimer's disease (AD) pathology. Ten PCA patients and 28 age-matched controls participated in the study. Using resting state fMRI, we measured FC in ventral and dorsal cortical visual networks, defined on the basis of a priori knowledge of long-range white matter connections. To assess the relationships with AD, we determined AD biomarkers in cerebrospinal fluid and FC in the default mode network (DMN), which is vulnerable to AD pathology. Voxel-based morphometry analysis assessed the pattern of grey matter (GM) atrophy. PCA patients showed GM atrophy in bilateral occipital and inferior parietal regions. PCA patients had lower FC levels in a ventral network than controls, but higher FC in inferior components of the dorsal network. In particular, the increased connectivity correlated with greater GM atrophy in occipital regions. All PCA patients had positive cerebrospinal fluid biomarkers for AD; however, FC in global DMN did not differ from controls. FC in PCA reflects brain structure in a non-univocal way. Hyperconnectivity of dorsal networks may indicate aberrant communication in response to posterior brain atrophy or processes of neural resilience during the initial stage of brain dysfunction. The lack of difference from controls in global DMN FC highlights the atypical nature of PCA with respect to typical AD.

  4. Unravelling Boléro: progressive aphasia, transmodal creativity and the right posterior neocortex.

    Science.gov (United States)

    Seeley, William W; Matthews, Brandy R; Crawford, Richard K; Gorno-Tempini, Maria Luisa; Foti, Dean; Mackenzie, Ian R; Miller, Bruce L

    2008-01-01

    Most neurological lesion studies emphasize performance deficits that result from focal brain injury. Here, we describe striking gains of function in a patient with primary progressive aphasia, a degenerative disease of the human language network. During the decade before her language deficits arose, Anne Adams (AA), a lifelong scientist, developed an intense drive to produce visual art. Paintings from AA's artistic peak revealed her capacity to create expressive transmodal art, such as renderings of music in paint, which may have reflected an increased subjective relatedness among internal perceptual and conceptual images. AA became fascinated with Maurice Ravel, the French composer who also suffered from a progressive aphasia, and painted his best-known work, 'Boléro', by translating its musical elements into visual form. Later paintings, achieved when AA was nearly mute, moved towards increasing photographic realism, perhaps because visual representations came to dominate AA's mental landscape during this phase of her illness. Neuroimaging analyses revealed that, despite severe degeneration of left inferior frontal-insular, temporal and striatal regions, AA showed increased grey matter volume and hyperperfusion in right posterior neocortical areas implicated in heteromodal and polysensory integration. The findings suggest that structural and functional enhancements in non-dominant posterior neocortex may give rise to specific forms of visual creativity that can be liberated by dominant inferior frontal cortex injury.

  5. Cystic dilation of the distal end of the nasolacrimal duct: underrated cause of epiphora in adults and its endoscopic treatment.

    Science.gov (United States)

    Eloy, P; Poirrier, A L; Nicoli, T; Marlair, C; Delahaut, G; Leruth, E; Rombaux, P

    2012-12-01

    Epiphora is a frequent reason for ophthalmologic consultation. Among the multiple causes, obstructions of the lacrimal excretory system are common. Sacal and postsacal obstructions are much more frequent than presacal obstructions. Obstruction at the level of the Hasner's valve is rare and likely underestimated. The authors report the clinical history and the imaging of 3 patients with a cystic dilation of the distal end of the nasolacrimal duct (NLD). These patients were easily managed by an ENT surgeon. In one case, the surgery consisted of an endonasal DCR where in the 2 other cases, a marsupialisation of the cystic expansion of the nasolacrimal duct was successfully performed with the micro- debrider. The authors review the world literature on this specific topic. They conclude that a coronal sinus CT scan and an inferior meatus endoscopy should be included in the ophthalmologic work-up performed in all cases of low obstruction of the lacrimal system. When there is a dilation of the distal end of the NLD the marsupialisation of the cystic expansion in the inferior meatus is the option of treatment instead of performing a DCR. ENTs must play a role in the assessment and treatment of low obstructions of the lacrimal excretory system.

  6. Isquemia grave de membros inferiores por arterite por HIV Severe ischemia of lower limbs due to arteritis caused by HIV infection

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    Guilherme Benjamin Brandão Pitta

    2011-12-01

    Full Text Available A isquemia aguda de membros pode se manifestar, embora de forma incomum, como consequência à vasculite associada ao vírus da imunodeficiência humana (HIV. O presente caso descreve a evolução de uma paciente soropositiva para o HIV, que apresentou quadro de isquemia distal bilateral, com diminuição da temperatura de terço distal das pernas e pés, dor intensa, cianose fixa de pododátilos e ausência de pulsos distais. Submetida ao tratamento com terapia trombolítica, apresentou sinais de lesões decorrentes da isquemia e lesão tecidual de reperfusão com perda tecidual em regiões distais dos dedos, porém com melhora dos sinais e sintomas dos membros inferiores. Trata-se de um caso raro na literatura em função da associação da vasculite com o HIV e do acometimento dos vasos distais nos membros inferiores. Entretanto, o conhecimento desta associação é de extrema importância devido à repercussão na vida dos pacientes acometidos.The acute limb ischemia may manifest itself, albeit unusual, as a consequence of vasculitis associated with human immunodeficiency virus (HIV. This case report described a patient seropositive for HIV who developed bilateral distal ischemia with temperature decrease of distal legs and feet, severe pain, cyanosis of fixed toes, and absence of distal pulses. She underwent treatment with thrombolytic therapy, showed signs of injury resulting from ischemia and reperfusion tissue injury with tissue loss in the distal regions of the fingers, but with improvement of the signs and symptoms of lower limbs. It is a rare case in literature due to the association of vasculitis with HIV and to the torment of distal vases of the lower limbs. Despite of that, the knowledge of the pathology is extremely important because of the repercussion in the patients' lives.

  7. Posterior cruciate ligament rehabilitation: how slow should we go?

    Science.gov (United States)

    Fanelli, Gregory C

    2008-02-01

    Outcomes after posterior cruciate ligament (PCL) reconstructive surgery have historically been inferior to outcomes after reconstruction of the anterior cruciate ligament (ACL). As such, some surgeons may be reluctant to recommend reconstruction of the PCL. However, recent technologic advances have substantially improved PCL reconstructive surgical outcomes. These advances include better understanding of PCL diagnosis and surgical indications; recognition of the need for repair or reconstruction of associated injuries, especially injuries to the posterolateral and posteromedial corners of the knee; PCL-specific surgical instruments including mechanical tensioning devices to restore anatomic tibial step-off; improved graft fixation techniques including primary and backup methods of fixation; use of strong graft material including advances in the procurement, processing, and usage of allograft tissue; improved surgical techniques; and advances in the understanding of knee ligament structure and biomechanics, resulting in more accurate surgical tunnel placement, achieving anatomic graft insertion sites while minimizing graft bending. Today, PCL reconstructive surgery often results in excellent function with a return to the patient's preinjury level of activity. In contrast to accelerated rehabilitation after ACL reconstructive surgery, slow and deliberate postoperative rehabilitation is recommended to allow early healing to occur after PCL reconstructive surgery.

  8. [Posterior atlantoaxial fixation using vertex multiaxial screw system].

    Science.gov (United States)

    Zhong, Dejun; Song, Yueming

    2007-06-01

    This study aims to assess the effectiveness and advantages of Vertex multiaxial screw system in use for stabilizing the atlanto-axial junction. The entry point of the atlas was located 18-20 mm lateral to the midline and 2.0 mm superior to the inferior border of posterior arch, and the direction of screw was chosen to be about 10 degrees medial to the sagittal plane and about 5 degrees cephalad to the transverse plane. In odontoid vertebra (C2), the direction of the drill bit was guided directly by the medial and superior aspect of the individual C2 pedicle. All screws were placed properly without incidence of nerve or blood vessel injury, and no complication appeared in operation and after surgery. All cases were followed up for an average of 9 months, all cases achieved well reposition and fixation of atlantoaxial joint, average JOA grade was 9.6 before preoperation and 15.9 after operation. Fixation of the atlantoaxial complex using Vertex multiaxial screw system seemed to be a reliable technique and should be considered a good alternative in atlantoaxial fusion. The technique could be used in young patiens.

  9. Convergence of posteriors for discretized log Gaussian Cox processes

    DEFF Research Database (Denmark)

    Waagepetersen, Rasmus Plenge

    2004-01-01

    In Markov chain Monte Carlo posterior computation for log Gaussian Cox processes (LGCPs) a discretization of the continuously indexed Gaussian field is required. It is demonstrated that approximate posterior expectations computed from discretized LGCPs converge to the exact posterior expectations...

  10. Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part II: a Systematic Review of Neurosensory Complications

    Directory of Open Access Journals (Sweden)

    Boris Abayev

    2015-03-01

    Full Text Available Objectives: This article, the second in a two-part series, continues the discussion of inferior alveolar nerve lateralization/transposition for dental implant placement. The aim of this article is to review the scientific literature and clinical reports in order to analyse the neurosensory complications, risks and disadvantages of lateralization/transposition of the inferior alveolar nerve followed by implant placement in an edentulous atrophic posterior mandible. Material and Methods: A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC databases, as well as academic sites and books. The articles were searched from January 1997 to July 2014. Articles in English language, which included adult patients between 18 - 80 years of age who had minimal residual bone above the mandibular canal and had undergone inferior alveolar nerve (IAN repositioning, with minimum 6 months of follow-up, were included. Results: A total of 21 studies were included in this review. Ten were related to IAN transposition, 7 to IAN lateralization and 4 to both transposition and lateralization. The IAN neurosensory disturbance function was present in most patients (99.47% [376/378] for 1 to 6 months. In total, 0.53% (2/378 of procedures the disturbances were permanent. Conclusions: Inferior alveolar nerve repositioning is related to initial transient change in sensation in the majority of cases. The most popular causes of nerve damage are spatula-caused traction in the mucoperiosteal flap, pressure due to severe inflammation or retention of fluid around the nerve and subsequent development of transient ischemia, and mandibular body fracture.

  11. Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part II: a Systematic Review of Neurosensory Complications.

    Science.gov (United States)

    Abayev, Boris; Juodzbalys, Gintaras

    2015-01-01

    This article, the second in a two-part series, continues the discussion of inferior alveolar nerve lateralization/transposition for dental implant placement. The aim of this article is to review the scientific literature and clinical reports in order to analyse the neurosensory complications, risks and disadvantages of lateralization/transposition of the inferior alveolar nerve followed by implant placement in an edentulous atrophic posterior mandible. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC databases, as well as academic sites and books. The articles were searched from January 1997 to July 2014. Articles in English language, which included adult patients between 18 - 80 years of age who had minimal residual bone above the mandibular canal and had undergone inferior alveolar nerve (IAN) repositioning, with minimum 6 months of follow-up, were included. A total of 21 studies were included in this review. Ten were related to IAN transposition, 7 to IAN lateralization and 4 to both transposition and lateralization. The IAN neurosensory disturbance function was present in most patients (99.47% [376/378]) for 1 to 6 months. In total, 0.53% (2/378) of procedures the disturbances were permanent. Inferior alveolar nerve repositioning is related to initial transient change in sensation in the majority of cases. The most popular causes of nerve damage are spatula-caused traction in the mucoperiosteal flap, pressure due to severe inflammation or retention of fluid around the nerve and subsequent development of transient ischemia, and mandibular body fracture.

  12. Ruptures of the distal biceps tendon.

    Science.gov (United States)

    Ward, James P; Shreve, Mark C; Youm, Thomas; Strauss, Eric J

    2014-01-01

    Distal biceps ruptures occur most commonly in middle-aged males and result from eccentric contraction of the biceps tendon. The injury typically presents with pain and a tearing sensation in the antecubital fossa with resultant weakness in flexion and supination strength. Physical exam maneuvers and diagnostic imaging aid in determining the diagnosis. Nonoperative management is reserved for elderly, low demand patients, while operative intervention is generally pursued for younger patients and can consist of nonanatomic repair to the brachialis or anatomic repair to the radial tuberosity. Anatomic repair through a one-incision or two-incision approach is commonplace, while the nonanatomic repairs are rarely performed. No clear advantage exists in operative management with a one-incision versus two-incision techniques. Chronic ruptures present a more difficult situation, and allograft augmentation is often necessary. Common complications after repair include transient nerve palsy, which often resolves, and heterotopic ossification. Despite these possible complications, most studies suggest that better patient outcomes are obtained with operative, anatomic reattachment of the distal biceps tendon.

  13. Osteoid osteoma of the distal clavicle

    Directory of Open Access Journals (Sweden)

    Bernardo Barcellos Terra

    Full Text Available ABSTRACT The osteoid osteoma is a bone tumor that accounts for 10% of benign tumors. It was described in 1935 by Jaffe, as a tumor that affects the young adult population, with a predominance of males. This study aims to present a case of late diagnosis of a patient with osteoid osteoma of the distal clavicle region. Female patient, 44 years old, non-professional volleyball player, reported pain in the anterior and superior region of the shoulder girdle, specifically in the acromioclavicular joint, which worsened at night and had been treated for nine months as tendinitis of the rotator cuff and acromioclavicular joint arthritis. After confirming the diagnosis, the patient underwent open surgery with resection of the distal clavicle. At two years of follow-up, the patient presents without local pain. In the radiographic evaluation, coracoclavicular distance is preserved and there are no signs of recurrence. Tumors of the shoulder girdle are rare and are often diagnosed late. A high degree of suspicion for the diagnosis of tumors of the shoulder girdle is needed in order to avoid late diagnosis.

  14. Role of dopamine in distal retina.

    Science.gov (United States)

    Popova, E

    2014-05-01

    Dopamine is the most abundant catecholamine in the vertebrate retina. Despite the description of retinal dopaminergic cells three decades ago, many aspects of their function in the retina remain unclear. There is no consensus among the authors about the stimulus conditions for dopamine release (darkness, steady or flickering light) as well as about its action upon the various types of retinal cells. Many contradictory results exist concerning the dopamine effect on the gross electrical activity of the retina [reflected in electroretinogram (ERG)] and the receptors involved in its action. This review summarized current knowledge about the types of the dopaminergic neurons and receptors in the retina as well as the effects of dopamine receptor agonists and antagonists on the light responses of photoreceptors, horizontal and bipolar cells in both nonmammalian and mammalian retina. Special focus of interest concerns their effects upon the diffuse ERG as a useful tool for assessment of the overall function of the distal retina. An attempt is made to reveal some differences between the dopamine actions upon the activity of the ON versus OFF channel in the distal retina. The author has included her own results demonstrating such differences.

  15. Distal vacuolar myopathy in nephropathic cystinosis.

    Science.gov (United States)

    Charnas, L R; Luciano, C A; Dalakas, M; Gilliatt, R W; Bernardini, I; Ishak, K; Cwik, V A; Fraker, D; Brushart, T A; Gahl, W A

    1994-02-01

    Nephropathic cystinosis is a lysosomal storage disorder leading to renal failure by age 10 years. Prolonged patient survival following renal transplantation has allowed the development of previously unknown long-term complications. Muscle involvement has been reported in a single posttransplant cystinosis patient, but the range of clinical, electrophysiologic, and histologic features has not been fully described. Thirteen of 54 post-renal-transplant patients that we examined developed weakness and wasting in the small hand muscles, with or without facial weakness and dysphagia. Tendon reflexes were preserved and sensory examinations were normal. Electrophysiologic studies in 11 affected patients showed normal nerve conduction velocities and preserved sensory action potentials. The voluntary motor units in the affected distal muscles had reduced amplitude and brief duration, confirmed with quantitative electromyography in 4 patients. Biopsy of the severely affected abductor digiti minimi or extensor carpi radialis brevis muscles in 2 patients revealed marked fiber size variability, prominent acid phosphatase-positive vacuoles, and absence of fiber type grouping or inflammatory cells. Crystals of cystine were detected in perimysial cells but not within the muscle cell vacuoles. The muscle cystine content of clinically affected muscles was markedly elevated. We conclude that a distal vacuolar myopathy is a common late complication of untreated nephropathic cystinosis. Although the cause is unclear, the general lysosomal defect in this disease may also affect the lysosomes within muscle fibers.

  16. Patellar instability treated with distal femoral osteotomy.

    Science.gov (United States)

    Swarup, Ishaan; Elattar, Osama; Rozbruch, S Robert

    2017-06-01

    Patellar instability can cause significant disability in both pediatric and adult patients, and it is associated with several factors including genu valgum. In this study, we describe the role of a lateral opening wedge distal femoral osteotomy (DFO) combined with lateral retinacular release in addressing genu valgum with associated patellar instability. The rationale for this approach is to medialize the patellar tendon insertion and decrease the Q angle with DFO. A consecutive series of patients were studied, and our outcomes of interest included improvements in radiographic measures and patient outcomes. Radiographic improvement was assessed using patella congruency angle (PCA), mechanical axis deviation (MAD), and lateral distal femoral angle (LDFA). Patient outcomes were assessed using Oxford Knee scores, KOOS-PS scores, VAS pain scores, and Kujala scores. We studied eight patients (10 knees) that underwent a lateral opening wedge DFO for genu valgum and patellar instability. Mean follow-up duration was 27 months. PCA improved from 30.4° lateral preoperatively to 5.7° lateral postoperatively (p=0.016). Similarly, MAD improved from 33.1mm lateral to 6.5mm medial, and LDFA improved from 82.4° to 92.7° after surgery (p=0.002). There were significant improvements in VAS pain and Kujala scores after surgery (pgenu valgum. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. DIAGNÓSTICO ECOCARDIOGRÁFICO DE VENTANA AORTOPULMONAR DISTAL / Echocardiographic diagnosis of distal aortopulmonary window

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    Adel E. González Morejón

    2013-04-01

    Full Text Available Resumen: La ventana aortopulmonar es una comunicación entre la aorta ascendente y la arteria pulmonar, con válvulas sigmoideas bien diferenciadas.Los defectos distales son menos frecuentes y se presentan aproximadamente en 25 % de todos los pacientes con ventana aortopulmonar. Aunque la ecocardiografía transtorácica bidimensional puede proveer un diagnóstico certero en la mayoría de los casos, algunos autores solicitan la realización de otros estudios. Se presenta una lactante de 40 días de edad con diagnóstico ecocardiográfico de ventana aortopulmonar distal, que fue confirmado en el quirófano, sin necesidad de realizar otros estudios. A los 9 meses de seguimiento clínico y ecocardiográfico, la paciente se mantiene asintomática. / Abstract: The aortopulmonary window is a communication between the ascending aorta and the pulmonary artery, with well differentiated semilunar valves. Distal defects are less common and occur in approximately 25% of all patients with aortopulmonary window. Although two-dimensional transthoracic echocardiography can provide an accurate diagnosis in most cases, some authors ask for further studies. This is the case of a 40-day-old infant with echocardiographic diagnosis of distal aortopulmonary window that was confirmed in the operating room without further studies. At 9 months of clinical and echocardiographic follow-up, the patient remains asymptomatic.

  18. Post-partum posterior reversible encephalopathy syndrome

    DEFF Research Database (Denmark)

    Aaen, Anne Albers; Jeppesen, Jørgen; Obaid, Hayder

    2015-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a complex clinical condition with vasogenic subcortical oedema caused by hypertension. Oedema is often seen on magnetic resonance imaging. The wide clinical spectrum ranges from headaches to vision loss and even death. Early diagnosis...

  19. Posterior alien hand syndrome: case report

    Energy Technology Data Exchange (ETDEWEB)

    Rohde, S.; Weidauer, S.; Lanfermann, H.; Zanella, F. [Institute of Neuroradiology, Johann Wolfgang Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main (Germany)

    2002-11-01

    The alien hand syndrome (AHS) is involuntary uncontrolled movement of an arm with a sense of estrangement from the limb itself. AHS was initially used to describe interhemispheric disconnection phenomena in patients with lesions in the anterior corpus callosum, but it has been found in patients with posterior cerebral lesions without involvement of the corpus callosum, for example parietal infarcts or corticobasal degeneration. The posterior alien hand syndrome is less frequent and presents with nonpurposive behaviour like lifting the arm or writhing fingers. We report an 80-year-old woman with a posterior AHS of the dominant right hand. MRI showed atrophy of the pre- and postcentral gyri without involvement of the corpus callosum. We discuss the aetiology of the posterior AHS and the differences from the anterior varieties. (orig.)

  20. Complications of acute posterior vitreous detachment.

    Science.gov (United States)

    Kanski, J J

    1975-07-01

    Of 201 patients whose presenting symptoms were acute entoptic phenomena or photopsia, or both, 150 patients had posterior vitreous detachment; 69 patients (46%) had retinal breaks; 18 (12%) had a vitreous hemorrhage without detectable retinal breaks; and two (1.3%) had peripheral retinal hemorrhages without retinal breaks or vitreous hemorrhage. Retinal breaks that occur in eyes in conjunction with acute posterior vitreous detachment are potentially dangerous and there is a possibility of delayed break formation.

  1. Posterior cruciate ligament and posterolateral corner reconstruction.

    Science.gov (United States)

    Fanelli, Gregory C; Edson, Craig J; Reinheimer, Kristin N; Garofalo, Raffaele

    2007-12-01

    The keys to successful posterior cruciate ligament reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft-tensioning device, use primary and backup graft fixation, and employ the appropriate postoperative rehabilitation program. Adherence to these technical points results in successful single and double bundle arthroscopic transtibial tunnel posterior cruciate ligament reconstruction documented with stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.

  2. Application of the rotational path design concept to a removable partial denture with a distal-extension base.

    Science.gov (United States)

    Asher, M L

    1992-10-01

    Biomechanical considerations for use of the rotational path design concept to construct a removable partial denture for a patient with a tooth-bounded ridge on one side and a distal-extension ridge on the opposite side are presented. The various axes and arcs of rotation that occur during masticatory function are identified and their effects on the prosthesis and supporting structures are analyzed. Sequential steps in the necessary surveys of the master cast are enumerated. Critical details for the most effective and least deleterious placement of the rigid retentive element on the mesial surface of the posterior molar abutment (on the tooth-bounded ridge) are described.

  3. Biomechanical comparison of osteoporotic distal radius fractures fixed by distal locking screws with different length.

    Science.gov (United States)

    Liu, Xiong; Wu, Wei-dong; Fang, Ya-feng; Zhang, Mei-chao; Huang, Wen-hua

    2014-01-01

    To evaluate the postoperative stability of osteoporotic distal radius fractures fixed with distal locking screws with different length. A comminuted extra-articular dorsally unstable distal radius fracture, treated with volar locking plate system, was created. The 18 specimens were randomized into 3 groups based on distal locked screws with different length: Group A had unicortical screws with 50% length to the dorsal cortex. Group B had unicortical screws with 75% length to the dorsal cortex. Group C had bicortical screws. Axial compression and bending loads were imposed on the models before and after cycling testing as well as load to clinical and catastrophic failure. Minimum change in stiffness was observed before and after fatigue for all groups. The final stiffness to bending forces was statistically similar in all groups, but stiffness to axial compression was statistically significant different: Group A approached significance with respect to groups B and C (P = 0.017, 0.009), whereas stiffness in group B and C was statistically similar (P = 0.93). Load to clinical failure was significantly less for group A (456.54±78.59 N) compared with groups B (580.24±73.85 N) and C (591.07±38.40 N). Load to catastrophic failure was statistically similar between groups, but mean values for Group A were 18% less than means for Group C. The volar locking plate system fixed with unicortical locking screws with at least 75% length not only produced early stability for osteoporotic distal radius fractures, but also avoided extensor tendon complications due to dorsal screw protrusion.

  4. Biomechanical comparison of osteoporotic distal radius fractures fixed by distal locking screws with different length.

    Directory of Open Access Journals (Sweden)

    Xiong Liu

    Full Text Available To evaluate the postoperative stability of osteoporotic distal radius fractures fixed with distal locking screws with different length.A comminuted extra-articular dorsally unstable distal radius fracture, treated with volar locking plate system, was created. The 18 specimens were randomized into 3 groups based on distal locked screws with different length: Group A had unicortical screws with 50% length to the dorsal cortex. Group B had unicortical screws with 75% length to the dorsal cortex. Group C had bicortical screws. Axial compression and bending loads were imposed on the models before and after cycling testing as well as load to clinical and catastrophic failure.Minimum change in stiffness was observed before and after fatigue for all groups. The final stiffness to bending forces was statistically similar in all groups, but stiffness to axial compression was statistically significant different: Group A approached significance with respect to groups B and C (P = 0.017, 0.009, whereas stiffness in group B and C was statistically similar (P = 0.93. Load to clinical failure was significantly less for group A (456.54±78.59 N compared with groups B (580.24±73.85 N and C (591.07±38.40 N. Load to catastrophic failure was statistically similar between groups, but mean values for Group A were 18% less than means for Group C.The volar locking plate system fixed with unicortical locking screws with at least 75% length not only produced early stability for osteoporotic distal radius fractures, but also avoided extensor tendon complications due to dorsal screw protrusion.

  5. Amputações de extremidades inferiores por diabetes mellitus: estudo caso-controle

    Directory of Open Access Journals (Sweden)

    Gamba Mônica Antar

    2004-01-01

    Full Text Available OBJETIVO: As amputações de extremidades inferiores são cada vez mais freqüentes em pessoas com diabetes mellitus, tornando-se importante problema de saúde pública, no Brasil e no mundo. O estudo objetivou detectar fatores associados a amputações de extremidades inferiores, em pessoas com diabetes mellitus. MÉTODOS: Realizou-se estudo caso controle emparelhado. Foram identificados 117 pessoas com diabetes mellitus e submetidas a amputações de extremidades inferiores, na rede de serviços do Município de São Paulo. Os casos foram comparados com 234 controles, pessoas com diabetes mellitus, mas não submetidas a amputações. As variáveis consideradas no emparelhamento foram sexo, idade e duração da doença. Características sociodemográficas, de hábitos de vida, clínicas e relativas à educação em saúde em diabetes mellitus foram incluídas. Inicialmente, foi realizada análise univariada, verificando a presença de associações entre amputações e variáveis exploratórias. Foi utilizado modelo de regressão logística condicional para a análise multivariada, com adoção do odds ratio como medida de associação. RESULTADOS: Observou-se existência de associação entre amputação e hábito de fumar, última glicemia (superior a 200 mg/dl, presença da polineuropatia simétrica distal e da vasculopatia periférica. O tratamento do diabetes mellitus e o comparecimento às consultas de enfermagem foram importantes fatores associados à prevenção dessas amputações. CONCLUSÕES: O reconhecimento dos determinantes e dos fatores intervenientes para o acometimento desse agravo levarão à redução dos custos na área e à melhoria da qualidade da assistência prestada na rede de serviços de saúde pública.

  6. The effects of inferior olive lesion on strychnine seizure

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, M.C.; Chung, E.Y.; Van Woert, M.H. (Mount Sinai School of Medicine, New York, NY (USA))

    1990-10-01

    Bilateral inferior olive lesions, produced by systemic administration of the neurotoxin 3-acetylpyridine (3AP) produce a proconvulsant state specific for strychnine-induced seizures and myoclonus. We have proposed that these phenomena are mediated through increased excitation of cerebellar Purkinje cells, through activation of glutamate receptors, in response to climbing fiber deafferentation. An increase in quisqualic acid (QA)-displaceable ({sup 3}H)AMPA ((RS)-alpha-amino-3-hydroxy-5-methyl-isoxazole-4-propionic acid) binding in cerebella from inferior olive-lesioned rats was observed, but no difference in ({sup 3}H)AMPA binding displaced by glutamate, kainic acid (KA) or glutamate diethylester (GDEE) was seen. The excitatory amino acid antagonists GDEE and MK-801 ((+)-5-methyl-10,11-dihydro-5H-dibenzo(a,d)cyclo-hepten-5,10 imine) were tested as anticonvulsants for strychnine-induced seizures in 3AP inferior olive-lesioned and control rats. Neither drug effected seizures in control rats, however, both GDEE and MK-801 produced a leftward shift in the strychnine-seizure dose-response curve in 3AP inferior olive-lesioned rats. GDEE also inhibited strychnine-induced myoclonus in the lesioned group, while MK-801 had no effect on myoclonus. The decreased threshold for strychnine-induced seizures and myoclonus in the 3AP-inferior olive-lesioned rats may be due to an increase in glutamate receptors as suggested by the ({sup 3}H)AMPA binding data.

  7. Inferior oblique muscle paresis as a sign of myasthenia gravis.

    Science.gov (United States)

    Almog, Yehoshua; Ben-David, Merav; Nemet, Arie Y

    2016-03-01

    Myasthenia gravis may affect any of the six extra-ocular muscles, masquerading as any type of ocular motor pathology. The frequency of involvement of each muscle is not well established in the medical literature. This study was designed to determine whether a specific muscle or combination of muscles tends to be predominantly affected. This retrospective review included 30 patients with a clinical diagnosis of myasthenia gravis who had extra-ocular muscle involvement with diplopia at presentation. The diagnosis was confirmed by at least one of the following tests: Tensilon test, acetylcholine receptor antibodies, thymoma on chest CT scan, or suggestive electromyography. Frequency of involvement of each muscle in this cohort was inferior oblique 19 (63.3%), lateral rectus nine (30%), superior rectus four (13.3%), inferior rectus six (20%), medial rectus four (13.3%), and superior oblique three (10%). The inferior oblique was involved more often than any other muscle (pmyasthenia gravis can be difficult, because the disease may mimic every pupil-sparing pattern of ocular misalignment. In addition diplopia caused by paresis of the inferior oblique muscle is rarely encountered (other than as a part of oculomotor nerve palsy). Hence, when a patient presents with vertical diplopia resulting from an isolated inferior oblique palsy, myasthenic etiology should be highly suspected.

  8. PHILOS humerus plate for a distal tibial fracture.

    Science.gov (United States)

    Twaij, Haider; Damany, Dev

    2013-01-04

    This report discusses the use of an alternative implant in the emergency fixation of a distal tibial fracture. We planned to fix the shear-type medial malleolar fracture in a closed, tri-malleolar fracture with a locking distal tibial plate. Intra-operatively, it was noted that the required plate was unavailable. A PHILOS humeral plate seemed to fit the contours of the distal tibia. The broad end of the PHILOS, when placed distally, gave options to place locking screws in the medial malleolar fragment. The fracture was stable after fixation. The patient made a full post-operative recovery and follow-up at 4 months was satisfactory. Despite adequate planning, there will be instances where one has to improvise. An understanding of the principles of fracture management can aid in finding solutions. PHILOS humeral plate may be used to stabilize a distal tibial fracture if an appropriate distal tibial locking plate is not available.

  9. Salter-Harris type III fracture of the lateral femoral condyle with a ruptured posterior cruciate ligament: an uncommon injury pattern.

    Science.gov (United States)

    Rafee, Asan; Kumar, A; Shah, S V

    2007-01-01

    We report a case of an obscure injury to the distal femoral epiphysis with an uncommon pattern in a 12-year-old boy following a road traffic accident. Initial plain radiographs of the knee were inconclusive. Further investigation with magnetic resonance imaging revealed Salter-Harris type III fracture of the lateral femoral condyle with a gap at the fracture site associated with avulsion of the posterior cruciate ligament. This potentially serious injury can be underestimated on plain radiographs and therefore any suspected injury to the distal femoral epiphysis should be thoroughly assessed and investigated to institute appropriate treatment and minimise the risk of long-term complications.

  10. Echocardiographic Wall Motion Abnormality in Posterior Myocardial Infarction: The Diagnostic Value of Posterior Leads

    Directory of Open Access Journals (Sweden)

    A Darehzereshki

    2008-06-01

    Full Text Available Background: For the purpose of ascertaining myocardial infarction (MI and ischemia, the sensitivity of the initial 12-lead ECG is inadequate. It is risky to diagnose posterior MI using only precordial reciprocal changes, since the other leads may be more optimally positioned for the identification of electrocardiographic changes. In this study, we evaluated the relationship between electrocardiography changes and wall motion abnormalities in patients with posterior MI for earlier and better diagnosis of posterior MI.Methods: In this prospective cross-sectional study, we enrolled patients with posterior MI who had come to the Emergency Department of Shariati Hospital with their first episode of chest pain. A 12-lead surface electrocardiogram using posterior leads (V7-V9 was performed for all participants. Patients with ST elevation >0.05 mV or pathologic Q wave in the posterior leads, as well as those with specific changes indicating posterior MI in V1-V2, were evaluated by echocardiography in terms of wall motion abnormalities. All data were analyzed using SPSS and p<0.05 were considered statistically significant.Results: Of a total 79 patients enrolled, 48 (60.8% were men, and the mean age was 57.35±8.22 years. Smoking (54.4% and diabetes (48% were the most prevalent risk factors. In the echocardiographic evaluation, all patients had wall motion abnormalities in the left ventricle and 19 patients (24.1% had wall motion abnormalities in the right ventricle. The most frequent segment with motion abnormality among the all patients was the mid-posterior. The posterior leads showed better positive predictive value than the anterior leads for posterior wall motion abnormality.Conclusion: Electrocardiography of the posterior leads in patients with acute chest pain can help in earlier diagnosis and in time treatment of posterior MI.

  11. Clinico-anatomical correlations of left posterior cerebral artery occlusion. Alexia without agraphia, color anomia, and memory disturbance

    Energy Technology Data Exchange (ETDEWEB)

    Isono, Osamu; Shiota, Junichi; Kawamura, Mitsuru; Hirayama, Keizou; Maki, Toshiyuki.

    1988-11-01

    The relation between neurological signs and symptoms and computed tomography (CT) and magnetic resonance imaging (MRI) was examined in 11 cases of occlusion of the left posterior cerebral artery. All the patients were righthanded. Right homonimous hemianopia was noted in 8 cases, right upper quadrantanopia in 2 cases, and right lower quadrantanopia in 1 case. Of the 11 cases, alexia without agraphia was noted in 9 cases, all 9 of which showed lesions of inferior occipital cortex (lingual and fusiform gyri) and subjacent white matter. Lesions of splenium were found in only 5 of the cases of alexia without agraphia. In 2 cases with neither alexia nor agraphia, lesions were seen in the medial occipital cortex and the subjacent white matter but not in the inferior occipital lobe. Three patients had color anomia which was accompanied by memory disturbances and alexia without agraphia. In 2 of these 3, lesions were widespread in the region of the left posterior cerebral artery. Memory disturbances were observed in 6 cases, all of which also showed alexia without agraphia. The lesions extended not only of the inferior surface of the occipital lobe and along the interhemispheric fissure, but also of hippocampal and parahippocampal gyri. In 3 cases of alexia without agraphia in which no memory distrubance was found, the symptoms of alexia were slight and disappeared at an early stage. (J.P.N.).

  12. Distal Xq duplication and functional Xq disomy

    Directory of Open Access Journals (Sweden)

    Schluth-Bolard Caroline

    2009-02-01

    Full Text Available Abstract Distal Xq duplications refer to chromosomal disorders resulting from involvement of the long arm of the X chromosome (Xq. Clinical manifestations widely vary depending on the gender of the patient and on the gene content of the duplicated segment. Prevalence of Xq duplications remains unknown. About 40 cases of Xq28 functional disomy due to cytogenetically visible rearrangements, and about 50 cases of cryptic duplications encompassing the MECP2 gene have been reported. The most frequently reported distal duplications involve the Xq28 segment and yield a recognisable phenotype including distinctive facial features (premature closure of the fontanels or ridged metopic suture, broad face with full cheeks, epicanthal folds, large ears, small and open mouth, ear anomalies, pointed nose, abnormal palate and facial hypotonia, major axial hypotonia, severe developmental delay, severe feeding difficulties, abnormal genitalia and proneness to infections. Xq duplications may be caused either by an intrachromosomal duplication or an unbalanced X/Y or X/autosome translocation. In XY males, structural X disomy always results in functional disomy. In females, failure of X chromosome dosage compensation could result from a variety of mechanisms, including an unfavourable pattern of inactivation, a breakpoint separating an X segment from the X-inactivation centre in cis, or a small ring chromosome. The MECP2 gene in Xq28 is the most important dosage-sensitive gene responsible for the abnormal phenotype in duplications of distal Xq. Diagnosis is based on clinical features and is confirmed by CGH array techniques. Differential diagnoses include Prader-Willi syndrome and Alpha thalassaemia-mental retardation, X linked (ATR-X. The recurrence risk is significant if a structural rearrangement is present in one of the parent, the most frequent situation being that of an intrachromosomal duplication inherited from the mother. Prenatal diagnosis is performed by

  13. Ultrasound-Assisted Distal Radius Fracture Reduction

    Science.gov (United States)

    Socransky, Steve; Skinner, Andrew; Bromley, Mark; Smith, Andrew; Anawati, Alexandre; Middaugh, Jeff; Ross, Peter

    2016-01-01

    Introduction Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction. Methods  We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph. Results  There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3

  14. Primary Intraventricular Brain Abscess Resulting in Isolated Dilation of the Inferior Horn and Unilateral Hydrocephalus

    Directory of Open Access Journals (Sweden)

    Joji Inamasu

    2015-07-01

    Full Text Available Primary intraventricular brain abscesses are rare, and there are no established treatment guidelines for this condition. We report a case in which isolated ventricular dilatation and unilateral hydrocephalus developed after seemingly successful conservative management and which required surgical diversion of the cerebrospinal fluid. A 59-year-old woman presented to our emergency department with high-grade fever and headache. Brain magnetic resonance imaging (MRI revealed abscesses in the bilateral posterior horn. Although surgical evacuation of the abscesses was considered, conservative management with antibiotics was selected because of the paucity of severe neurological deficits and the concern that an attempt to evacuate the intraventricular abscess might lead to inadvertent rupture of the abscess capsule and acute ventriculitis. Despite reduction in the abscess volume, the patient developed an altered mental status 4 weeks after admission. Follow-up MRI revealed isolated dilation of the left inferior horn, compressing the brainstem. Emergency fenestration of the dilated inferior horn was performed, and endoscopic observation revealed an encapsulated abscess with adhesion to the ventricular wall which was thought responsible for the ventricular dilation and unilateral hydrocephalus. Two weeks after the initial surgery, the unilateral hydrocephalus was treated by placement of a ventriculoperitoneal shunt. Eradication of the intraventricular brain abscesses without surgical evacuation may justify the conservative management of this patient. However, the possibility that earlier surgical evacuation might have prevented development of the isolated ventricular dilation cannot be denied. Additional clinical experience is required to determine which treatment (surgical vs. conservative is more appropriate in patients with primary intraventricular brain abscesses.

  15. Symptomatic duodenal perforation by inferior vena cava filter.

    Science.gov (United States)

    Baptista Sincos, Anna Pw; Sincos, Igor R; Labropoulos, Nicos; Donegá, Bruno C; Klepacz, Andrea; Aun, Ricardo

    2017-01-01

    Objectives Duodenal perforation by an inferior vena cava filter is rare and life threatening. Our objective is to find out number of occurrences and compare diagnosis and treatments. Method The reference list of Malgor's review in 2012 was considered as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE, Web of Sciences, and Literatura Latino-Americana e do Caribe em Ciências da Saúde. Results Most of the patients presented with upper abdominal pain and the use of radiologic studies was crucial for diagnosis. The most common treatment was laparotomy with filter or strut removal plus duodenum repair. However, clinical conditions of patients must be considered and the endovascular technique with endograft deployment into inferior vena cava may be an alternative. Conclusion Duodenal perforation by an inferior vena cava filter is uncommon and in high-risk surgical patients endovascular repair must be considered.

  16. Isquemia aguda de miembros inferiores secundaria a ergortismo

    Directory of Open Access Journals (Sweden)

    Franco J. Vallejo, MD

    2011-11-01

    Full Text Available Paciente de género femenino, de 21 años de edad, quien ingresó por dolor progresivo e intenso en miembros inferiores, y refirió antecedente reciente de ingestión de derivados del ergot. Al examen físico se observó ausencia de pulsos en ambos miembros inferiores. Por angiotomografia se documentó disminución severa, generalizada y bilateral, del calibre de los vasos arteriales de miembros inferiores. Se diagnosticó isquemia arterial aguda secundaria a ergotismo y se inició tratamiento con vasodilatadores y calcio-antagonistas, que resolvió los síntomas en su totalidad.

  17. Traumatic neuroma of the inferior alveolar nerve: a case report.

    Science.gov (United States)

    Arribas-García, Ignacio; Alcalá-Galiano, Andrea; Gutiérrez, Ramón; Montalvo-Moreno, Juan José

    2008-03-01

    Traumatic neuromas are rare entities which characteristically arise subsequently to surgery and are usually accompanied by pain, typically neuralgic. We present an unusual case of an intraosseous traumatic neuroma of the inferior alveolar nerve following tooth extraction. A 56-year-old man consulted for paresthesias and hyperesthesia in the left mandibular region following extraction of the left mandibular third molar (#38). The panoramic radiograph revealed a radiolucent lesion in the inferior alveolar nerve canal, and CT demonstrated the existence of a mass within the canal, producing widening of the same. Nerve-sparing excisional biopsy was performed. Histopathology and immunohistochemistry were consistent with traumatic neuroma of the left inferior alveolar nerve. After 3 years of follow-up, the patient is asymptomatic and there are no signs of recurrence.

  18. Agenesia de veia cava inferior associada à trombose venosa profunda Agenesis of inferior vena cava associated with deep venous thrombosis

    Directory of Open Access Journals (Sweden)

    Clovis Luis Konopka

    2010-09-01

    Full Text Available A agenesia da veia cava inferior é uma anomalia congênita rara, que foi recentemente identificada como um importante fator de risco para o desenvolvimento e a recorrência de trombose venosa profunda de membros inferiores em jovens. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou trombose venosa profunda dois meses após a realização de cirurgia de varizes. A angiotomografia computadorizada demonstrou a presença de anomalia venosa complexa com ausência da veia cava inferior.The agenesis of the inferior vena cava is a rare congenital anomaly, which was recently identified as an important risk factor for the development and recurrence of deep venous thrombosis especially in young people. The goal of this work was to report the case of a patient who presented deep venous thrombosis approximately two months after varicose vein surgery. The computerized angiotomography demonstrated the presence of a complex venous anomaly with absence of the inferior vena cava.

  19. Post-transplant distal limb syndrome

    Directory of Open Access Journals (Sweden)

    María Florencia Borghi Torzillo

    2017-02-01

    Full Text Available The post-transplant distal limb syndrome is a not well known entity, with a prevalence of 5% in patients with renal transplant. Its diagnosis is based on clinical symptoms, bone scintigraphy and MRI, it has a benign course and the patient recovers without sequel. We present the case of a 37-year-old male, with medical history of hypertension, Berger's disease in 1999 that required dialysis three times a week for four years (2009-2013 and renal transplant in 2013. The patient consults on January 2014 referring severe pain in both feet, with sudden onset; he remembers the exact date of the beginning of the pain and denies trauma, pain prevents ambulation. The bone scintigraphy shows pathological uptake in both feet with no difference between the two. Although there is no treatment for this disease, it has a benign course

  20. Implant arthroplasty for the distal radioulnar joint.

    Science.gov (United States)

    Scheker, Luis R

    2008-11-01

    The distal radioulnar joint (DRUJ) is a weight-bearing joint; the ulnar head is frequently excised either totally or partially and in some cases is fused because of degenerative, rheumatoid, or posttraumatic arthritis and treated with a "salvage procedure." The result of these procedures is the inability of those patients to lift even minor weight. Articles about these procedures report the ability to pronate and supinate, but they rarely discuss grip strength or lifting capacity. We present an alternative to the salvage procedures that allows full range of motions as well as the ability to grip and lift weights encountered in daily living, such as a gallon of milk. The Aptis total DRUJ replacement prosthesis (Aptis Medical, Louisville, KY), a bipolar self-stabilizing DRUJ endoprosthesis, restores the forearm function. The technique of implantation is presented here.

  1. Anatomical study and clinical applications of free posterior tibial flap in the head and neck region.

    Science.gov (United States)

    Chan, Yu Wai; Ng, Raymond Wai Man; Wei, William Ignace

    2011-09-01

    The purpose of this study was to examine the anatomical features, clinical applications, and donor-site morbidities of the free posterior tibial flap. The posterior tibial vascular system was examined in 30 fresh cadaver legs. This was followed by a clinical study involving patients with free posterior tibial flap reconstruction of defects in the head and neck region after tumor extirpation. Potential donor-site morbidities were studied at 1 year after surgery. The mean caliber of the posterior tibial artery and the venae comitantes in the cadaveric limbs was 2.7, 2.9, and 2.17 mm, respectively. The mean number of septocutaneous perforators was 2.85 per leg, clustering in the middle and distal thirds of the medial surface of the leg. The mean thickness of the skin and subcutaneous fat in the region was 4.43 mm. In the clinical study, 64 patients with superficial cutaneous and mucosal defects were recruited. The majority of the patients had carcinoma of the oral cavity. All flaps survived. Three patients (4.7 percent) developed mild infection of the donor site. None of the patients have problems walking on level ground. There was no significant reduction in range of ankle movement, nor was there evidence of vascular compromise of the lower limb, either at rest or after exercise. The free posterior tibial flap is reliable because of its constant vascular anatomy. It is thin and pliable, making it particularly suitable for resurfacing superficial cutaneous and mucosal defects. Although skin grafting is required to repair the donor site, the associated morbidity is low. Therapeutic, IV.

  2. Posterior intercostal artery tortuosity and collateral branch points: a cadaveric study.

    Science.gov (United States)

    Shurtleff, E; Olinger, A

    2012-11-01

    Publications report observing tortuosity in the posterior intercostal arteries of elderly patients. Studies also describe the size and course of the collateral intercostal arteries. This information is clinically significant when performing thoracentesis and video-assisted thorascopic surgery. To the best of our knowledge, no studies have examined arterial tortuosity or described collateral artery origins relative to bony landmarks. The purpose of this study was to define a safe surgical zone for thoracic access using palpable external bony landmarks. A total of 348 intercostal spaces (3rd-8th) of 29 male and female embalmed cadavers were dissected from the vertebral body to the mid-axillary line to observe the posterior intercostal artery and its collateral branch. The origins of the collateral intercostal arteries relative to the midline of thoracic spinous processes were measured. Mild to moderate tortuosity (arterial curves covering 25- -50% of the intercostal space) was observed in at least one posterior intercostal artery in the majority of cadavers. The origins of the collateral intercostal arteries were variable relative to the midline. Additional collateral intercostal arteries distal to the primary collateral branch were observed, most commonly in the 5th intercostal space, which is used in video-assisted thorascopic surgery and thoracentesis. Tortuosity is common in the 3rd to the 8th posterior intercostal arteries, especially in individuals over the age of 60 years. Given the findings of this study, we recommend that any procedure involving placement of a surgical instrument into these intercostal spaces does so at least 120 mm lateral to the midline of the spinous processes. We also recommend pre-procedure ultrasound (intercostal scan) of the posterior and collateral intercostal arteries when performing non-emergent thoracentesis and video-assisted thorascopic surgery, particularly in patients over 60 years of age.

  3. Tilting of posterior mandibular and maxillary implants for improved prosthesis support.

    Science.gov (United States)

    Krekmanov, L; Kahn, M; Rangert, B; Lindström, H

    2000-01-01

    Rehabilitation of atrophied edentulous arches with endosseous implants in the posterior regions is often associated with anatomic problems such as jaw shape and location of the mental loop, mandibular canal, and maxillary sinuses. The purpose of this investigation was to modify the method for implant placement in the posterior part of the jaws to extend fixed implant-connected prostheses further distally, and to reduce the length of cantilevers in complete-arch prostheses without transpositioning the mandibular nerve or performing bone grafting in the maxilla. Forty-seven consecutive patients were treated with implants (25 patients/36 mandibular implants, 22 patients/30 maxillary implants) placed in tilted positions. They were followed a mean of 40 months (mandibles) and 53 months (maxillae). In the mandible, implants close to the mental foramina were tilted posteriorly approximately 25 to 35 degrees. In the maxilla, the posterior implants were placed close to and parallel with the sinus walls and were titled anteriorly/posteriorly approximately 30 to 35 degrees. Patients gained a mean distance of 6.5 mm of prosthesis support in the mandible and 9.3 mm in the maxilla, as a result of implant tilting. There were no implant failures in mandibles. The cumulative success rates in the maxilla at 5 years were 98% for tilted implants and 93% for non-tilted implants. Paresthesias of the mental nerve were observed on 4 sides during the first 2 to 3 weeks after implant placement. Analysis of the load distribution in one mandibular case showed no significant difference between tilted and the non-tilted implants, and the improved prosthesis support was confirmed. Satisfactory medium-term results concerning osseointegration and significant extension of prosthesis support show that the method can be recommended. This technique may allow for longer implants to be placed with improved bone anchorage.

  4. Inferior glenohumeral joint dislocation with greater tuberosity avulsion

    Institute of Scientific and Technical Information of China (English)

    Mohd Faizan; Latif Zafar Jilani; Mazhar Abbas; Yasir Salam Siddiqui; Aamir Bin Sabir; M.K.A.Sherwani; Saifullah Khalid

    2015-01-01

    Inferior glenohumeral dislocation is the least common type of glenohumeral dislocations.It may be associated with fractures of the adjacent bones and neurovascular compromise.It should be treated immediately by close reduction.The associated neuropraxia usually recovers with time.Traction-counter traction method is commonly used for reduction followed by immobilization of the shoulder for three weeks.Here,we report a case of inferior glenohumeral joint dislocation with greater tuberosity fracture with transient neurovascular compromise and present a brief review of the literature.

  5. Maksilektomi Inferior pada Karsinoma Sel Skuamosa Palatum Durum

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    Sukri Rahman

    2016-01-01

    Full Text Available Abstrak          Karsinoma Palatum Durum adalah keganasan daerah kepala dan leher yang jarang terjadi dimana setengah diantaranya merupakan Karsinoma Sel Skuamosa. Pada fase awal keganasan ini dapat bersifat asimptomatis namun dapat juga menimbulkan gejala berupa ulkus yang terasa nyeri pada perkembangan penyakitnya. Operasi maksilektomi inferior merupakan salah satu pilihan tindakan yang dapat dilakukan dalam tatalaksana kasus ini, diikuti oleh pemberian radioterapi. Kasus ini dibuat untuk memahami penatalaksanaan karsinoma palatum durum. Dilaporkan kasus seorang laki-laki 45 tahun dengan diagnosis Karsinoma Sel Skuamosa Palatum Durum (Well to Moderately Differentiated Keratinized stadium IVa (T4aN0M0 dilakukan operasi maksilektomi inferior, namun tidak diikuti dengan radioterapi karena pasien menolak. Maksilektomi inferior merupakan pilihan pembedahan pada tumor yang terbatas pada palatum, lantai sinus maksila dan kavum nasi. Prognosis karsinoma sel skuamosa palatum durum cukup baik dan angka harapan hidup lima tahun akan bertambah bila dilakukan operasi diikuti dengan pemberian radioterapi. Kata kunci: Karsinoma sel skuamosa, maksilektomi inferior, radioterapi AbstractCarcinoma of the hard palate is a rare head and neck cancer in which half of it was Squamous Cell Carcinoma. In the initial phase of this malignancy may be asymptomatic, but can also cause symptoms such as painful ulcers in the development of the disease. Inferior maxillectomy is one of the choice of operation that can be performed, followed by radiotherapy to understand the management of carcinoma of the hard palate. Reported one case of a man 45 years old with diagnosis Squamous Cell Carcinoma of hard palate (Well to Moderately Differentiated Keratinized stage IVa (T4aN0M0 treated by inferior maxillectomy surgery, but not followed by radiotherapy because the patient refused. Inferior Maksilektomi is a surgical option in tumor that limited to the palate, floor of the

  6. Suprarenal symplastic leiomyoma of the inferior vena cava.

    Science.gov (United States)

    Kepenekci, Ilknur; Demirkan, Arda; Sözener, Ulas; Cakmak, Atil; Demirer, Seher; Alaçayir, Iskender; Ekinci, Cemil

    2009-01-01

    We report on a case of a leiomyoma in the inferior vena cava that appeared in the image to be located in the adrenal gland. En bloc excision of the tumor with the right adrenal gland and the involved segment of the vena cava was carried out. Histopathological work-up of the tumor revealed smooth muscle fibers and marked nuclear pleomorphism consistent with symplastic leiomyoma. This case report presents a distinct histological variant of the rarely seen primary smooth muscle tumor of the inferior vena cava.

  7. Pseudo-dissection of ascending aorta in inferior myocardial infarction.

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    Grahame K. Goode

    2011-06-01

    Full Text Available Acute aortic dissection is a cardiac emergency which can present as inferior myocardial infarction. It has high morbidity and mortality requiring prompt diagnosis and treatment. Rapid advances in noninvasive imaging modalities have facilitated the early diagnosis of this condition and in ruling out this potentially catastrophic illness. We report an interesting case of a 57 year- old -man who presented with inferior myocardial infarction requiring thrombolysis and temporary pacing wire for complete heart block. An echocardiogram was highly suspicious of aortic dissection. CT scan confirmed that the malposition of the temporary pacing wire through the aorta mimicked aortic dissection.

  8. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction.

    Science.gov (United States)

    Serrano, C V; Bortolotto, L A; César, L A; Solimene, M C; Mansur, A P; Nicolau, J C; Ramires, J A

    1999-01-01

    Differentiation of right coronary artery (RCA) from left circumflex artery (LCxA) occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction (IMI). We studied 133 patients with IMI, 92 patients with RCA occlusion and 41 patients with LCxA occlusion. Risk factors such as previous MI, arterial hypertension, diabetes, smoking, and dislipemia, were similar for RCA and LCxA occlusions. Patients with RCA occlusion had a higher incidence of isolated IMI than patients with LCxA occlusion, 50% vs. 17%, respectively (P<0.001). Arterial hypotension was more prevalent (P<0.05) among patients with RCA (18%) rather than those with LCxA occlusion (2%). RCA occlusion presented an association with sinus bradycardia, an association not observed with LCxA occlusion (15% vs. 0%, respectively; P<0.01). Total atrioventricular block was only present among patients with RCA (18%). Proximal occlusions of the RCA presented lower heart rates (sinus bradycardia) than medial and distal occlusions (13% vs. 1% and 1%, respectively; P<0.0001 and P<0.001). Therefore, regarding patients with IMI: (1) sinus bradycardia is more frequent when the infarct-related artery is the RCA; (2) proximal occlusions of the right coronary predispose low heart rates; and (3) occlusion of the LCxA rarely induces sinus bradycardia.

  9. Acute injuries of the distal radioulnar joint.

    Science.gov (United States)

    Nicolaidis, S C; Hildreth, D H; Lichtman, D M

    2000-08-01

    Distal radioulnar joint injuries can occur in isolation or in association with distal radius fractures, Galeazzi fractures, Essex-Lopresti injuries, and both-bone forearm fractures. The authors have classified DRUJ/TFCC injuries into stable, partially unstable (subluxation), and unstable (dislocation) patterns based on the injured structures and clinical findings. Clinical findings and plain radiographs are usually sufficient to diagnose the lesion, but axial CT scans are pathognomonic. Diagnostic arthroscopy is the next test of choice to visualize stable and partially unstable lesions. Stable injuries of the DRUJ/TFCC unresponsive to conservative measures require arthroscopic debridement of the TFCC tear, along with ulnar shortening if there is ulnar-positive variance. Partially unstable injuries, on the other hand, are treated with direct arthroscopic or open repair of the TFCC tear, once again, along with ulnar shortening if ulnar-positive variance is present. Unstable injuries include simple and complex DRUJ dislocations. A simple DRUJ dislocation is easily reducible but may be stable or unstable. In complex dislocation, reduction is not possible because there is soft tissue interposition or a significant tear. After the associated injury is dealt with, treatment for complex injuries requires exploration of the DRUJ, extraction of the interposed tissue, repair of the soft tissues, and open reduction and internal fixation of the ulnar styloid fracture (if present and displaced). The early recognition and appropriate treatment of an acute DRUJ injury are critical to avoid progression to a chronic DRUJ disorder, the treatment of which is much more difficult and much less satisfying.

  10. Structure and strength of the distal radius in female patients with rheumatoid arthritis: a case-control study.

    Science.gov (United States)

    Zhu, Tracy Y; Griffith, James F; Qin, Ling; Hung, Vivian W Y; Fong, Tsz-Ning; Au, Sze-Ki; Tang, Xiao Lin; Kwok, Anthony W; Leung, Ping-Chung; Li, Edmund K; Tam, Lai-Shan

    2013-04-01

    The purpose of this work was to investigate the volumetric bone mineral density (vBMD), bone microstructure, and mechanical indices of the distal radius in female patients with rheumatoid arthritis (RA). We report a cross-sectional study of 66 middle-aged female RA patients and 66 age-matched healthy females. Areal BMD (aBMD) of the hip, lumbar spine, and distal radius was measured by dual-energy X-ray absorptiometry (DXA). High-resolution peripheral quantitative computed tomography (HR-pQCT) was performed at the distal radius, yielding vBMD, bone microstructure, and mechanical indices. Cortical and trabecular vBMD were 3.5% and 10.7% lower, respectively, in RA patients than controls, despite comparable aBMD. Trabecular microstructural indices were -5.7% to -23.1% inferior, respectively, in RA patients compared to controls, with significant differences in trabecular bone volume fraction, separation, inhomogeneity, and structural model index. Cortical porosity volume and percentage were 128% and 93% higher, respectively, in RA patients, with stress being distributed more unevenly. Fourteen RA patients had exaggerated periosteal bone apposition primarily affecting the ulnovolar aspect of the distal radius. These particular patients were more likely to have chronic and severe disease and coexisting wrist deformity. The majority of the differences in density and microstructure between RA patients and controls did not depend on menstrual status. Recent exposure to glucocorticoids did not significantly affect bone density and microstructure. HR-pQCT provides new insight into inflammation-associated bone fragility in RA. It detects differences in vBMD, bone microstructure, and mechanical indices that are not captured by DXA. At the distal radius, deterioration in density and microstructure in RA patients involved both cortical and trabecular compartments. Excessive bone resorption appears to affect cortical more than trabecular bone at distal radius, particularly

  11. The antero-inferior (transmuscular) approach for arthroscopic repair of the Bankart lesion: an anatomic and clinical study.

    Science.gov (United States)

    Resch, H; Wykypiel, H F; Maurer, H; Wambacher, M

    1996-06-01

    In order to find a direct approach to the antero-inferior third of the glenoid rim, an anatomic study was performed on a total of 89 shoulders (48 cadavers). To obtain defined reference points for the anterior inferior third of the glenoid cavity, it was compared with the hour markings on a clock face. The 4:30 position on the right shoulder and the 7:30 position on the left shoulder were defined as the relevant reference points. The average distance between the palpable end of the coracoid process and the 4:30 and 7:30 positions was 19 mm. The average distance to the point of intersection of the musculocutaneous nerve with the medial margin of the conjoined tendon was more than 5 cm, and was never less than 2 cm. The average distance of the axillary nerve from the 4:30 position was 2.5 cm in the horizontal plane, with a minimum of 1.5 cm. Radially, the average distance of the axillary nerve was 1.7 cm, with a minimum of 1.3 cm. The anatomic study was followed by a clinical study of 264 patients. An antero-inferior portal located maximum 2 cm distal from the palpable coracoid tip was selected for the introduction of a trocar sheath and blunt trocar, passing through the subscapularis muscle to access the antero-inferior area of the glenoid rim. As additional protection for the musculocutaneous nerve, the direction of the trocar was adjusted during introduction. Reattachment of the labrum-capsule complex was performed extra-articularly. In all cases, at least one implant was located inferior to the 4:30 or 7:30 position. No neurovascular complications arose out of the choice of portal. Out of the 264 patients, the first 100 shoulders (98 patients) were followed-up after an average time of 35 months (18 to 62 months). The recurrence rate was 9%. Excluding the first 30 shoulders (30 patients) from the development phase of the technique, the recurrence rate is only 5.7%. The rate of return to overhead sports activities was 62% and to collision sports activities 70%.

  12. Functional topography of the right inferior parietal lobule structured by anatomical connectivity profiles.

    Science.gov (United States)

    Wang, Jiaojian; Zhang, Jinfeng; Rong, Menglin; Wei, Xuehu; Zheng, Dingchen; Fox, Peter T; Eickhoff, Simon B; Jiang, Tianzi

    2016-12-01

    The nature of the relationship between structure and function is a fundamental question in neuroscience, especially at the macroscopic neuroimaging level. Although mounting studies have revealed that functional connectivity reflects structural connectivity, whether similar structural and functional connectivity patterns can reveal corresponding similarities in the structural and functional topography remains an open problem. In our current study, we used the right inferior parietal lobule (RIPL), which has been demonstrated to have similar anatomical and functional connectivity patterns at the subregional level, to directly test the hypothesis that similar structural and functional connectivity patterns can inform the corresponding topography of this area. In addition, since the association between the RIPL regions and particular functions and networks is still largely unknown, post-hoc functional characterizations and connectivity analyses were performed to identify the main functions and cortical networks in which each subregion participated. Anatomical and functional connectivity-based parcellations of the RIPL have consistently identified five subregions. Our functional characterization using meta-analysis-based behavioral and connectivity analyses revealed that the two anterior subregions (Cl1 and Cl2) primarily participate in interoception and execution, respectively; whereas the posterior subregion (Cl3) in the SMG primarily participates in attention and action inhibition. The two posterior subregions (Cl4, Cl5) in the AG were primarily involved in social cognition and spatial cognition, respectively. These results indicated that similar anatomical and functional connectivity patterns of the RIPL are reflected in corresponding structural and functional topographies. The identified cortical connectivity and functional characterization of each subregion may facilitate RIPL-related clinical research. Hum Brain Mapp 37:4316-4332, 2016. © 2016 Wiley Periodicals

  13. Posterior Chamber Hemorrhage during Fluorescein Angiography

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    Manuel A. P. Vilela

    2015-01-01

    Full Text Available This paper provides the first reported case of acute posterior chamber hemorrhage during fluorescein angiography (FA. This is a case review with serial color photographs of the anterior segment. A 76-year-old male was referred for angiographic control of age-related macular degeneration. He was pseudophakic OU, BCVA 20/40 OU. He had mild hypertension, but not diabetes. He had had two previous angiograms without adverse effects. Difficulty was experienced in obtaining the images owing to a progressive reduction in the transparency of the media. A dense hemorrhage in the posterior chamber of the right eye was found, involving the visual axis. Thorough biomicroscopy, gonioscopy, and ultrasonic biomicroscopy showed that part of one of the haptics of the right intraocular lens (IOL was touching and tearing the posterior face of the iris, without any visible synechiae, iris, or angle neovascularization. Anterior segment FA and posterior ultrasonography were normal. No similar case has been described in the literature involving dense progressive bleeding located in the capsular bag and posterior chamber, without any detectable triggering ocular event other than mydriasis and fluorescein injection. Contact of the iris or sulcus with part of the intraocular lens, aggravated by the intense use of mydriatics during the FA procedure, probably caused bleeding to happen.

  14. Advances and disputes of posterior malleolus fracture

    Institute of Scientific and Technical Information of China (English)

    FU Su; ZOU Zhen-yu; MEI Gang; JIN Dan

    2013-01-01

    Objective The objective of this article is to summarize the development of evaluation and treatment of posterior malleolus fracture (PMF).Data sources Data used in this review were mainly from English literature of PubMed data base.Study selection Articles were included in this review if they were related to the PMF or trimalleolar fracture.Results No consensus was found regarding what sizes of posterior malleolus fragments would lead to ankle instability thus affecting prognosis and should be fixed.Ⅹ-ray measurement is unreliable,while CT scan is widely recommended and it can recognize the occult posterior malleolus fractures associated with tibia shaft fractures,which are always undetected previously.Direct posterior malleolus fixation is suitable to stabilize syndesmotic injury.The basic and clinical researches support direct reduction and buttress plate fixation of posterior malleolus fracture through the posterolateral approach.Operative indications and timing of weight bearing are still in discussion.Conclusions Knowing whether ankle instability occurs and the proper methods to diagnose,evaluate,and operate can help manage the fracture.Further biomechanical research on ankle stability and clinical study to compare various treatment methods are required.

  15. Ophthalmic imaging features of posterior scleritis

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    Zhi Li

    2014-07-01

    Full Text Available AIM: To analyze, summarize and describe ophthalmic imaging features of posterior scleritis. METHODS: Clinical data of 16 patients(21 eyeswith posterior scleritis diagnosed in our hospital from October 2008 to June 2013 were retrospectively analyzed. The results of type-B ultrasonic, fundus chromophotograph, fundus fluorescein angiography, CT were recorded for comprehensive evaluation and analysis of ophthalmic imaging features of posterior scleritis. RESULTS: All patients underwent type-B ultrasonic examination and manifested as diffuse and nodular types. The diffuse type showed diffusely thickened sclera and a dark hypoechoic area that connected with the optic nerve to form a typical “T”-shaped sign. The nodular type showed scleral echogenic nodules and relatively regular internal structure. FFA showed that relatively weak mottled fluorescences were visible in the arterial early phase and strong multiple needle-like fluorescences were visible in the arteriovenous phase, which were then progressively larger and fused; fluorescein was leaked to the subretinal tissue in the late phase; varying degrees of strong fluorescences with less clear or unclear boundaries were visible in the optic disk. CT results showed thickened eyeball wall. CONCLUSION: Posterior scleritis is common in young female patients, whose ophthalmic imaging features are varied and more specific in type-B ultrasonic. Selection of rational ophthalmic imaging examination method, combined with clinical manifestations, can accurately diagnose posterior scleritis and avoid the incidence of missed and delayed diagnosis.

  16. Video-assisted thoracic surgery for superior posterior mediastinal neurogenic tumour in the supine position

    Directory of Open Access Journals (Sweden)

    Darlong Laleng

    2009-01-01

    Full Text Available Video-assisted thoracic surgery (VATS for a superior posterior mediastinal lesion is routinely done in the lateral decubitus position similar to a standard thoracotomy using a double-lumen endotracheal tube for one-lung ventilation. This is an area above the level of the pericardium, with the superior thoracic opening as its superior limit and its inferior limit at the plane from the sternal angle to the level of intervertebral disc of thoracic 4 to 5 vertebra lying behind the great vessels. The lateral decubitus position has disadvantages of the double-lumen endotracheal tube getting malpositioned during repositioning from supine position to the lateral decubitus position, shoulder injuries due to the prolonged abnormal fixed posture and rarer injuries of the lower limb. There is no literature related to VATS in the supine position for treating lesions in the posterior mediastinum because the lung tissue falls in the dependent posterior mediastinum and obscures the field of surgery; however, VATS in the supine position is routinely done for lesions in the anterior mediastinum and single-stage bilateral spontaneous pneumothorax. Thus, in the selected cases, ′VATS in supine position′ allows an invasive procedure to be completed in the most stable anatomical posture.

  17. Closed reduction and K-wiring with the Kapandji technique for completely displaced pediatric distal radial fractures.

    Science.gov (United States)

    Satish, Bhava R J; Vinodkumar, Muniramaiah; Suresh, Masilamani; Seetharam, Prasad Y; Jaikumar, Krishnaraj

    2014-09-01

    In completely displaced pediatric distal radial fractures, achieving satisfactory reduction with closed manipulation and maintenance of reduction with casting is difficult. Although the Kapandji technique of K-wiring is widely practiced for distal radial fracture fixation in adults, it is rarely used in pediatric acute fractures. Forty-six completely displaced distal radial fractures in children 7 to 14 years old were treated with closed reduction and K-wire fixation. One or 2 intrafocal K-wires were used to lever out and reduce the distal fragment's posterior and radial translation. One or 2 extrafocal K-wires were used to augment intrafocal fixation. Postoperative immobilization was enforced for 3 to 6 weeks (with a short arm plaster of Paris cast for the first half of the time and a removable wrist splint for the second half), after which time the K-wires were removed. Patients were followed for a minimum of 4 months. Mean patient age was 9.5 years. Near-anatomical reduction was achieved easily with the intrafocal leverage technique in all fractures. Mean procedure time for K-wiring was 7 minutes. On follow-up, there was no loss of reduction; remanipulation was not performed in any case. There were no pin-related complications. All fractures healed, and full function of the wrist and forearm was achieved in every case. The Kapandji K-wire technique consistently achieves easy and near-anatomical closed reduction by a leverage reduction method in completely displaced pediatric distal radial fractures. Reduction is maintained throughout the fracture-healing period. The casting duration can be reduced without loss of reduction, and good functional results can be obtained. Copyright 2014, SLACK Incorporated.

  18. Dynamic Finite Element Analysis of Impulsive Stress Waves Propagating from Distal End of Femur

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    Sarai,Takaaki

    2012-10-01

    Full Text Available The human femur is subjected to an impulsive load at its distal end during daily life. Femoral bone fracture caused by impact loading is common in elderly women. It is important to clarify the dynamic response of the femur and to evaluate the change in its stress state during impact loading. A 3-dimensional model of the femur was prepared in the present study, and the impulsive stress waves propagating from the distal end of the femur were analyzed by the dynamic finite element method. This model showed that the von Mises equivalent stress is large on the anterior and posterior sides of the mid-diaphysis when the impact direction is different from that of the bone axis. As for the femoral neck, the absolute value of minimum principal stress initially increases on the medial side;slightly later the maximum principal stress increases on the lateral side. In this case, the absolute value of the maximum principal stress was found to be larger than that of the minimum principal stress, and the absolute value of the principal stress decreased as the impact angle increased. Further, the femoral neck and the trochanter were shown to have a higher risk of bone fracture when the impact direction is coincident with the bone axis.

  19. Results of distal revascularization in elderly patients for critical ischemia of the lower limbs.

    Science.gov (United States)

    Illuminati, G; Calio, F G; Bertagni, A; Piermattei, A; Vietri, F; Martinelli, V

    1999-04-01

    Thirty eight patients over 75 years of age were operated upon of 40 distal arterial revascularizations for critical ischaemia of the lower limbs. Arterial reconstruction was proposed to ambulatory, self sufficient patients, with a patent artery of the leg or the foot in continuity with pedal arch, at arteriography. The revascularized artery was the peroneal in 14 cases, the anterior tibial in 11, the posterior tibial in 9, the dorsalis pedis in 5, and the external plantar artery in 1 case. Postoperative mortality was 2.6%. No postoperative arterial occlusion occurred and no postoperative amputation needed to be performed. The mean follow-up of 37 patients surviving operation was 21 months (ext. 2-52 months). At 36 months interval, patients' survival was 43%, primary patency rate was 57%, and limb salvage rate was 76%, at life-table analysis. Distal revascularization enables a good number of elderly patients in critical ischaemia of the lower limb, to enjoy an active, independent life, with a viable limb.

  20. The Role of Computed Tomography in Evaluating Intra-Articular Distal Humerus Fractures.

    Science.gov (United States)

    Nolan, Betsy M; Sweet, Stephan J; Ferkel, Eric; Udofia, Aniebet-Abasi; Itamura, John

    2015-09-01

    Computed tomography (CT) is often used to evaluate intra-articular distal humerus fracture patterns, but it increases radiation exposure and cost. We conducted a study to determine the effect of adding CT evaluation to plain radiographic evaluation on the classification of, and treatment plans for, intra-articular distal humerus fractures. Nine blinded orthopedic surgeons evaluated 30 consecutive fractures for classification and surgical approach. Evaluations were performed first using plain radiographs and then again using the same radiographs plus CT images. Statistical analysis was performed using the κ correlation coefficient and Cramer V testing. We hypothesized that adding CT images to plain radiographs would change the classification and treatment of these fractures and would improve interobserver agreement on classification and treatment. Intraobserver reliability (Cramer V) was fair (.393) for classification and moderate (.426) for treatment. Interobserver reliability (Cohen κ) did not improve with CT: For classification, κ was .21 without CT and .20 with CT; for treatment, κ was .28 without CT and .27 with CT. When classifying the fractures, attending surgeons chose the multiplanar fracture pattern 25.6% of the time without CT, and remained consistent at 23.3% with CT. Trainees chose this fracture pattern much less often without CT than with CT. Use of CT changed the treatment for multiplanar fractures (73.7% lateral approach vs 51.9% posterior approach with olecranon osteotomy). When added to plain radiographic evaluation, CT evaluation changes classification and treatment plans. Interobserver reliability did not improve. Less experienced surgeons were more likely to identify multiplanar fracture patterns with use of CT. We recommend performing CT for all intra-articular distal humerus fractures.

  1. [Results after internal fixation of humerus distal fractures in patients over than 65 years old].

    Science.gov (United States)

    Serrano-Mateo, L; Lopiz, Y; León-Serrano, C; García-Fernández, C; López-Durán-Stern, L; Marco, F

    2014-01-01

    Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  2. C7 pars fracture subadjacent to C7 pedicle screw instrumentation at the caudal end of a posterior cervical instrumentation construct.

    Science.gov (United States)

    Halim, Andrea; Grauer, Jonathan

    2014-07-01

    We report a case of a C7 pars fracture subadjacent to C7 pedicle screw instrumentation at the caudal end of posterior cervical instrumentation construct. To date, posterior cervical instrumentation has been "off label"; however, the US Food and Drug Administration is considering approving label indication of such instrumentation for this common surgical practice. Complications related to the techniques are reported to be relatively low. We know of no previous reports of pars fractures occurring subadjacent to such instrumentation. A 43-year-old man underwent posterior C5-C7 instrumented fusion. Postoperatively, the patient experienced cervical spine injury after a mechanical fall down stairs. Work-up detected bilateral C7 pars fractures subadjacent to the posterior instrumentation construct. After we treated the pars fracture with distal extension of the posterior fusion to the level of T2, the patient progressed to union and marked improvement of initial clinical symptoms that was maintained 2.5 years after posterior instrumentation. To our knowledge, a C7 pars fracture subadjacent to posterior cervical instrumentation construct has not been reported. We hypothesize that the pars may have been vulnerable to fracture because of excessive bone resection during foraminotomy or decortication. This complication was successfully treated by extending the fusion caudally.

  3. Pars plana vitrectomy with posterior iris claw implantation for posteriorly dislocated nucleus and intraocular lens

    Directory of Open Access Journals (Sweden)

    Kishor B Patil

    2011-01-01

    Full Text Available We evaluated the safety and efficacy of pars plana vitrectomy (PPV with primary posterior iris claw intraocular lens (IOL implantation in cases of posterior dislocation of nucleus and IOL without capsular support. This was a retrospective interventional case series. Fifteen eyes underwent PPV with primary posterior iris claw IOL implantation performed by a single vitreoretinal surgeon. The main outcome measures were changes in best corrected visual acuity and anterior and posterior segment complications. A total of 15 eyes were included in this study. Eight had nucleus drop, three had IOL drop during cataract surgery and four had traumatic posterior dislocation of lens. The final postoperative best corrected visual acuity was 20/60 or better in 11 patients. This procedure is a viable option in achieving good functional visual acuity in eyes without capsular support.

  4. Desempeño operacional posterior a la oferta pública inicial de acciones de las empresas chilenas

    Directory of Open Access Journals (Sweden)

    Marcelo González

    2009-01-01

    Full Text Available En general, la evidencia empírica internacional ha documentado que las empresas que efectúan una IPO (Initial Public Offering, oferta pública inicial de acciones presentan en el largo plazo un inferior desempeño financiero y operacional al mostrado por empresas de similares características. Pese a las pruebas internacionales, las empresas IPO chilenas no han mostrado un peor desempeño financiero (véase, por ejemplo, Aggarwal et al, 1993; Celis y Maturana, 1998. En cuanto al desempeño operacional, éste no ha sido estudiado para el caso chileno. En este artículo se documenta que las empresas IPO chilenas no mostraron un inferior desempeño operacional y tampoco presentaron un incremento en los costos de agencia posterior a la IPO. Posibles causas y efectos de estos resultados son comentados por los autores.

  5. Endodontic-related inferior alveolar nerve and mental foramen paresthesia.

    Science.gov (United States)

    Morse, D R

    1997-10-01

    Paresthesia is a condition that involves perverted sensations of pain, touch, or temperature. It has a variety of possible causes. This article presents a literature review and case reports of endodontically related inferior alveolar nerve and mental foramen paresthesia. Nondrug prevention methods and the dental uses of dexamethasone are also discussed.

  6. Renal Angiomyolipoma Associated with Inferior Vena Cava Thrombus

    Directory of Open Access Journals (Sweden)

    Xavier Durand

    2009-01-01

    Full Text Available A 57-year-old woman was found to have an inferior vena cava involvement of a known sinusal angiomyolipoma incompletely resected three years beforehand. Intravascular extension into the IVC of angiomyolipoma has rarely been reported. We present a new case and reconsider the literature about this uncommon complication of a benign renal tumor.

  7. Transhepatic approach for extracardiac inferior cavopulmonary connection stent fenestration.

    LENUS (Irish Health Repository)

    Kenny, Damien

    2012-02-01

    We report on a 3-year-old male who underwent transcatheter stent fenestration of the inferior portion of an extracardiac total cavopulmonary connection in the setting of hypoplastic left heart syndrome. Transhepatic approach, following an unsuccessful attempt from the femoral vein facilitated delivery of a diabolo-shaped stent.

  8. INVOLVEMENT OF THE INFERIOR CAVAL VEIN IN ADRENAL METASTASIS

    NARCIS (Netherlands)

    VANDALEN, KC; VANDRIEL, MF; MENSINK, HJA

    1992-01-01

    A patient was referred to our hospital for resection of a large renal cell carcinoma with invasion of the inferior caval vein, diagnosed as such with CT, angiography and cavography. The history mentioned partial resection of the left lung for lung carcinoma 16 months before. At operation the tumor c

  9. [Resection of leiomyosarcoma of the inferior vena cava].

    Science.gov (United States)

    Zotov, S P; Pyshkin, S A; Malyshev, M Iu; Safuanov, A Kh; Borovikov, D A; Siniukov, D M; Tereshin, O S; Panov, I O

    2013-01-01

    Experience in treatment of leiomyosarcoma of the retrohepatic segment of the inferior vena cava at any separately taken clinic is scarce. Given a rare nature of the pathology involved, whose diagnosis and management require joint participation of various-specialty physicians, we have considered it wise to present our own clinical case report.

  10. INFERIOR VENA-CAVA OBSTRUCTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

    NARCIS (Netherlands)

    BROUWERS, MAM; DEJONG, KP; PEETERS, PMJG; BIJLEVELD, CMA; KLOMPMAKER, IJ; SLOOFF, MJH

    1994-01-01

    Post-operative inferior vena cava (IVC) obstruction is reported as an uncommon complication after orthotopic liver transplantation (OLT). We report 6 cases after 245 OLT's in the period between March '79 and December '92. Compression or torsion of the IVC or a technical problem were underlying cause

  11. INVOLVEMENT OF THE INFERIOR CAVAL VEIN IN ADRENAL METASTASIS

    NARCIS (Netherlands)

    VANDALEN, KC; VANDRIEL, MF; MENSINK, HJA

    1992-01-01

    A patient was referred to our hospital for resection of a large renal cell carcinoma with invasion of the inferior caval vein, diagnosed as such with CT, angiography and cavography. The history mentioned partial resection of the left lung for lung carcinoma 16 months before. At operation the tumor c

  12. Pulmonary embolism presenting with ST segment elevation in inferior leads

    Directory of Open Access Journals (Sweden)

    Muzaffer Kahyaoğlu

    2017-03-01

    Full Text Available Acute pulmonary embolism is a form of venous thromboembolism that is widespread and sometimes mortal. The clinical presentation of pulmonary embolism is variable and often nonspecific making the diagnosis challenging. In this report, we present a case of pulmonary embolism characterized by ST segment elevation in inferior leads without reciprocal changes in the electrocardiogram.

  13. An unusual delayed complication of inferior alveolar nerve block.

    Science.gov (United States)

    Smyth, Joanna; Marley, John

    2010-01-01

    Systemic and localised complications after administration of local anaesthetic for dental procedures are well recognised. We present two cases of patients with trismus and sensory deficit that arose during resolution of trismus as a delayed complication of inferior alveolar nerve block.

  14. Probabilities of exoplanet signals from posterior samplings

    CERN Document Server

    Tuomi, Mikko

    2011-01-01

    Estimating the marginal likelihoods is an essential feature of model selection in the Bayesian context. It is especially crucial to have good estimates when assessing the number of planets orbiting stars when the models explain the noisy data with different numbers of Keplerian signals. We introduce a simple method for approximating the marginal likelihoods in practice when a statistically representative sample from the parameter posterior density is available. We use our truncated posterior mixture estimate to receive accurate model probabilities for models with differing number of Keplerian signals in radial velocity data. We test this estimate in simple scenarios to assess its accuracy and rate of convergence in practice when the corresponding estimates calculated using deviance information criterion can be applied to receive trustworthy results for reliable comparison. As a test case, we determine the posterior probability of a planet orbiting HD 3651 given Lick and Keck radial velocity data. The posterio...

  15. "Distal common pathway in atrioventricular node reentrant tachycardia "

    Directory of Open Access Journals (Sweden)

    "Moghaddam M

    2001-06-01

    Full Text Available Anotomical boundary of atrioventricular node reentrant tachycardia (AVNRT is composed of fast and slow pathways right atrium in upper turnaround and common distal pathway in lower turnaround. We performed electophsiologic study (EPS in 152 patients and could show the existence of distal common pathway with decremental conduction properties in approximately 40 patients.

  16. Clinical relevance of distal biceps insertional and footprint anatomy

    NARCIS (Netherlands)

    van den Bekerom, Michel P J; Kodde, Izaäk F.; Aster, Asir; Bleys, Ronald L A W; Eygendaal, Denise

    2016-01-01

    Purpose: The aim of this review was to present an overview, based on a literature search, of surgical anatomy for distal biceps tendon repairs, based on the current literature. Methods: A narrative review was performed using Pubmed/Medline using key words: Search terms were distal biceps,

  17. Distal radius fractures: what determines the outcome after surgery?

    NARCIS (Netherlands)

    Teunis, T.

    2016-01-01

    This thesis addresses current issues in the outcome of operatively treated distal radius fractures. The general aim was to determine factors associated with adverse events, loss of motion, functional limitations, and opioid use after surgery. Injury In 3D complete articular distal radius fracture mo

  18. Young Children's Sibling Relationship Quality: Distal and Proximal Correlates

    Science.gov (United States)

    Kretschmer, Tina; Pike, Alison

    2009-01-01

    Background: Relationships within families are interdependent and related to distal environmental factors. Low socioeconomic status (SES) and high household chaos (distal factors) have been linked to less positive marital and parent-child relationships, but have not yet been examined with regard to young children's sibling relationships. The…

  19. Distal clavicular osteolysis: MR evidence for subchondral fracture

    Energy Technology Data Exchange (ETDEWEB)

    Kassarjian, Ara; Palmer, William E. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Radiology, Yawkey Center, Boston, MA (United States); Llopis, Eva [Hospital de la Ribera, Department of Radiology, Valencia (Spain)

    2007-01-15

    To investigate the association between distal clavicular osteolysis and subchondral fractures of the distal clavicle at MRI. This study was approved by the hospital human research committee, which waived the need for informed consent. Three radiologists retrospectively analyzed 36 shoulder MR examinations in 36 patients with imaging findings of distal clavicular osteolysis. The presence of a subchondral fracture of the distal clavicle, abnormalities of the acromioclavicular joint, rotator cuff tears and labral tears were assessed by MRI. These cases were then compared with 36 age-matched controls. At MRI, 31 of 36 patients (86%) had a subchondral line within the distal clavicular edema, consistent with a subchondral fracture. Of the 36 patients, 32 (89%) had fluid in the acromioclavicular joint, while 27 of 36 patients (75%) had cysts or erosions in the distal clavicle. There were 13 patients (36%) with associated labral tears, while eight patients (22%) had partial-thickness rotator cuff tears. In the control group one of 36 (3%) had a subchondral line (P<0.05), while ten of 36 (28%) had rotator cuff tears and 13 of 36 (36%) had labral tears. These latter two were not statistically significant between the groups. A distal clavicular subchondral fracture is a common finding in patients with imaging evidence of distal clavicular osteolysis. These subchondral fractures may be responsible for the propensity of findings occurring on the clavicular side of the acromioclavicular joint. (orig.)

  20. Lower leg electrical impedance after distal bypass surgery

    DEFF Research Database (Denmark)

    Belanger, G K; Bolbjerg, M L; Heegaard, N H;

    1998-01-01

    Electrical impedance was determined in 13 patients following distal bypass surgery to evaluate lower leg oedema as reflected by its circumference. Tissue injury was assessed by the plasma concentration of muscle enzymes. After surgery, the volume of the control lower leg increased from 1250 (816...... to be a useful method for the evaluation of lower leg oedema after distal bypass surgery....

  1. Comparison of load-fatigue performance of posterior ceramic onlay restorations under different preparation designs.

    Science.gov (United States)

    Kois, Dean E; Chaiyabutr, Yada; Kois, John C

    2012-06-01

    The objective of this study was to evaluate the load-fatigue performance of posterior ceramic onlay restorations relative to two variables: preparation design (with or without buccal veneers); and the existing amount of tooth structure (non-worn tooth, worn tooth). Sixty extracted third molars were divided into five groups. One group received a mesial-occlusal-distal (MOD) gold onlay restoration (control). The other four experimental groups were prepared for ceramic onlay restorations. Two of the groups additionally received 2-mm occlusal reduction to simulate occlusal wear. All restored teeth were subjected to thermocycling prior to fatigue testing. A fatigue load of 150 N was applied on the occlusal surface at a frequency of 1.2 hz, at an angle of 135 degrees to the long axis of the tooth. Specimen failure was defined as the occurrence of crack propagation in the luting cement layer. This was monitored by the strain gauge on the specimen. All specimens restored on worn tooth had significantly lower fatigue failure cycle counts than those of non-worn tooth. The fracture mode analysis revealed that ceramic fracture tended to be demonstrated only in the group of worn tooth groups. The addition of a buccal veneer component had no significant effect on the load-fatigue performance of posterior ceramic onlay restorations, but the existing amount of tooth structure did have a significant effect on the load-fatigue performance of posterior ceramic onlay restorations. Catastrophic failures (ceramic fracture) occurred only in the group of worn tooth.

  2. The distal radial decompression osteotomy for ulnar impingement syndrome.

    Science.gov (United States)

    Krimmer, Hermann; Unglaub, Frank; Langer, Martin F; Spies, Christian K

    2016-01-01

    The decompression of the distal radioulnar joint (DRUJ) is performed by ulnar translation of the radial shaft proximal to the sigmoid notch, i.e. detensioning of the distal part of the interosseous membrane (DIOM) while containment of the DRUJ is achieved by closed wedge osteotomy of the radius. The osteotomy shortens the radius which entails detensioning of the triangular fibrocartilage complex (TFCC). Facilitating the modified Henry approach to the distal palmar radius a radial based wedge osteotomy is applied. The proximal osteotomy is proximal to the ulnar head and distal osteotomy is proximal to the sigmoid notch to prevent iatrogenic impingement. Ulnar translation of the radial shaft is performed to loosen the DIOM. The closed wedge osteotomy reduces radial inclination which will foster containment of the DRUJ. Distal radial decompression osteotomy of the DRUJ preserves DRUJ function while relieving painful impingement. Further surgical interventions are not compromised in case of failure.

  3. An intrinsic timer specifies distal structures of the vertebrate limb.

    Science.gov (United States)

    Saiz-Lopez, Patricia; Chinnaiya, Kavitha; Campa, Victor M; Delgado, Irene; Ros, Maria A; Towers, Matthew

    2015-09-18

    How the positional values along the proximo-distal axis (stylopod-zeugopod-autopod) of the limb are specified is intensely debated. Early work suggested that cells intrinsically change their proximo-distal positional values by measuring time. Recently, however, it is suggested that instructive extrinsic signals from the trunk and apical ectodermal ridge specify the stylopod and zeugopod/autopod, respectively. Here, we show that the zeugopod and autopod are specified by an intrinsic timing mechanism. By grafting green fluorescent protein-expressing cells from early to late chick wing buds, we demonstrate that distal mesenchyme cells intrinsically time Hoxa13 expression, cell cycle parameters and the duration of the overlying apical ectodermal ridge. In addition, we reveal that cell affinities intrinsically change in the distal mesenchyme, which we suggest results in a gradient of positional values along the proximo-distal axis. We propose a complete model in which a switch from extrinsic signalling to intrinsic timing patterns the vertebrate limb.

  4. Reversible cortical blindness: posterior reversible encephalopathy syndrome.

    Science.gov (United States)

    Bandyopadhyay, Sabyasachi; Mondal, Kanchan Kumar; Das, Somnath; Gupta, Anindya; Biswas, Jaya; Bhattacharyya, Subir Kumar; Biswas, Gautam

    2010-11-01

    Cortical blindness is defined as visual failure with preserved pupillary reflexes in structurally intact eyes due to bilateral lesions affecting occipital cortex. Bilateral oedema and infarction of the posterior and middle cerebral arterial territory, trauma, glioma and meningioma of the occipital cortex are the main causes of cortical blindness. Posterior reversible encephalopathy syndrome (PRES) refers to the reversible subtype of cortical blindness and is usually associated with hypertension, diabetes, immunosuppression, puerperium with or without eclampsia. Here, 3 cases of PRES with complete or partial visual recovery following treatment in 6-month follow-up are reported.

  5. Preformed posterior stainless steel crowns: an update.

    Science.gov (United States)

    Croll, T P

    1999-02-01

    For almost 50 years, dentists have used stainless steel crowns for primary and permanent posterior teeth. No other type of restoration offers the convenience, low cost, durability, and reliability of such crowns when interim full-coronal coverage is required. Preformed stainless steel crowns have improved over the years. Better luting cements have been developed and different methods of crown manipulation have evolved. This article reviews stainless steel crown procedures for primary and permanent posterior teeth. Step-by-step placement of a primary molar stainless steel crown is documented and permanent molar stainless steel crown restoration is described. A method for repairing a worn-through crown also is reviewed.

  6. Transverse posterior element fractures associated with torsion

    Energy Technology Data Exchange (ETDEWEB)

    Abel, M.S.

    1989-01-01

    Six examples of a previously undescribed class of transverse vertebral element fractures are presented. These fractures differ from Chance and Smith fractures and their variants in the following respects: (1) the etiology is torsion and not flexion; (2) there is neither distraction of posterior ring fragments nor posterior ligament tears; (3) in contrast to Chance and Smith fractures, extension of the fracture into the vertebral body is absent or minimal; (4) the transverse process of the lumbar vertebra is avulsed at its base with a vertical fracture, not split horizontally. These fractures occur in cervical, lumbar, and sacral vertebrae in normal or compromised areas of the spine.

  7. Posterior cortical atrophy: a brief review.

    Science.gov (United States)

    Kirshner, Howard S; Lavin, Patrick J M

    2006-11-01

    Posterior cortical atrophy is a striking clinical syndrome in which a dementing illness begins with visual symptoms. Initially, the problem may seem to be loss of elementary vision, but over time the patient develops features of visual agnosia, topographical difficulty, optic ataxia, simultanagnosia, ocular apraxia (Balint's syndrome), alexia, acalculia, right-left confusion, and agraphia (Gerstmann's syndrome), and later a more generalized dementia. Occasional patients have visual hallucinations and signs of Parkinson's disease or Lewy body dementia. A number of different neuropathologic disorders are associated with posterior cortical atrophy.

  8. A 3-Dimensional Anatomic Study of the Distal Biceps Tendon

    Science.gov (United States)

    Walton, Christine; Li, Zhi; Pennings, Amanda; Agur, Anne; Elmaraghy, Amr

    2015-01-01

    Background Complete rupture of the distal biceps tendon from its osseous attachment is most often treated with operative intervention. Knowledge of the overall tendon morphology as well as the orientation of the collagenous fibers throughout the musculotendinous junction are key to intraoperative decision making and surgical technique in both the acute and chronic setting. Unfortunately, there is little information available in the literature. Purpose To comprehensively describe the morphology of the distal biceps tendon. Study Design Descriptive laboratory study. Methods The distal biceps terminal musculature, musculotendinous junction, and tendon were digitized in 10 cadaveric specimens and data reconstructed using 3-dimensional modeling. Results The average length, width, and thickness of the external distal biceps tendon were found to be 63.0, 6.0, and 3.0 mm, respectively. A unique expansion of the tendon fibers within the distal muscle was characterized, creating a thick collagenous network along the central component between the long and short heads. Conclusion This study documents the morphologic parameters of the native distal biceps tendon. Reconstruction may be necessary, especially in chronic distal biceps tendon ruptures, if the remaining tendon morphology is significantly compromised compared with the native distal biceps tendon. Knowledge of normal anatomical distal biceps tendon parameters may also guide the selection of a substitute graft with similar morphological characteristics. Clinical Relevance A thorough description of distal biceps tendon morphology is important to guide intraoperative decision making between primary repair and reconstruction and to better select the most appropriate graft. The detailed description of the tendinous expansion into the muscle may provide insight into better graft-weaving and suture-grasping techniques to maximize proximal graft incorporation. PMID:26665092

  9. Vertical splitting of the mandibular body as an alternative to inferior alveolar nerve lateralization.

    Science.gov (United States)

    Rodriguez, J G; Eldibany, R M

    2013-09-01

    The aim of this study was to present and evaluate a modified technique to inferior alveolar nerve lateralization (IANL) that allows the placement of longer implants in the posterior mandibular region. One hundred and forty-three consecutive patients were enrolled in this study; these patients had between 1.8 and 8mm residual crestal height above the mandibular canal. Vertical splitting of the mandibular body was performed using piezoelectric surgery followed by bone expansion and insertion of special conical implants of 10 and/or 12mm in length. Two hundred and sixty-nine osteotomies were performed and 636 implants were inserted, with a survival rate of 99% at the end of 12 months. Immediately postoperative there was an alteration of sensation in the lip/chin area in 8.5% of cases; 4.1% regained full sensation within 10-14 days, 2.6% after 8 weeks, and 0.7% had persistent paresthesia that did not affect their daily activities. Progressively increasing pain and numbness was present in 1.1%; the implants were removed 6 months postoperatively. This is a relatively simple procedure that has no limitations in clinical situations with minimal bone height. It allows for greater implant stability, and the risk of neurological disturbance is minimal.

  10. AN ACCESSORY/ABERRANT LEFT INFERIOR POLAR ARTERY AR ISING FROM THE AORTIC BIFURCATION

    Directory of Open Access Journals (Sweden)

    Sreekanth

    2013-04-01

    Full Text Available ABSTRACT: The frequently to rarely occurring wide range of va riations in the renal vasculature are considered critical issue that surgeons should have a thorough envision and appreciation of the condition. During the routine prosection hours for the preclinical MBBS students at Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, while dissecting a male cadaver revealed an interesting variation. The Main Renal Artery (MRA was arising from the aorta about 1.8 cm below the Superior Mesentric Arte ry (SMA extending laterally towards the hilum of the kidney. At about 1.5 cm below the orig in of the Inferior Mesenteric Artery (IMA from the antero lateral aspect of the Aortic Bifurca tion, an aberrant renal artery measuring 4.5 cm in length, was seen coursing upwards, backwards a nd laterally & made its portal of entry by penetrating into the medial border and extending on to the posterior surface by piercing the capsule just half cm. above its lower pole. The urete r and the gonadal vessels were superficial to it. A thorough knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal tra nsplantation, renal artery embolization, surgery for abdominal aortic aneurysm and conservat ive or radical renal surgery.

  11. Life-Threatening Retropharyngeal Hemorrhage Secondary to Rupture of the Inferior Thyroid Artery

    Directory of Open Access Journals (Sweden)

    Cristina G. Calogero

    2015-01-01

    Full Text Available Inferior thyroid artery (ITA rupture is rare and may progress to life-threatening conditions. We present a patient who visited the emergency department after an episode of syncope and dizziness in which he had a mechanical fall that resulted in abrasions and a hematoma to his left forehead. The patient presented with dysphagia and anterior neck swelling that progressed rapidly into airway compromise requiring endotracheal intubation. Emergent computed tomography revealed a large retropharyngeal hematoma, with active arterial extravasation that was thought to be arising from the thyrocervical trunk on the left. The hematoma measured approximately 6.7 cm transversely and 3.2 cm anteroposteriorly and extended from the level of the lower nasopharynx, down the neck into the retropharyngeal and danger space and into the mediastinum posterior to the esophagus, overall approximately 25 cm. The larynx was deviated anteriorly and there was esophageal compression. An emergent arteriogram and catheterization confirmed bleeding from branches of the ITA, and successful embolization was performed. It is important to recognize the ITA rupture as a potential etiology of an acute airway compromise. In emergent situations, while securing an airway is a priority, rapidly initiating diagnostic testing to confirm the diagnosis and arranging for arterial embolization can be life-saving.

  12. Rotura del ligamento cruzado posterior de la rodilla asociada a fractura de fémur o tibia homolateral

    OpenAIRE

    1989-01-01

    Los autores llaman la atención sobre la frecuente asociación de roturas del ligamento cruzado posterior (LCP) a ciertos tipos de fractura del miembro inferior Se revisan 10 casos: 6 asociados a fractura de fémur, y 4 casos asociados a fractura de tibia. Destacan en todos la igualdad en el mecanismo de producción y la frecuencia con que pasa desapercibida la lesión del ligamento hasta la completa resolución de la fractura acompañante, con un peor pronóstico del tratamiento mediante plastias...

  13. Colgajo libre interóseo posterior para reconstrucción de mano: a propósito de un caso

    Directory of Open Access Journals (Sweden)

    E. Cabrera Sánchez

    Full Text Available La cobertura de la mano es un desafío para el cirujano plástico, debido a las múltiples opciones disponibles. El colgajo interóseo posterior de base distal es una de las opciones más útiles para la reconstrucción de esta clase de defectos. Sin embargo, debido a su inconstante anatomía vascular pueden acontecer problemas en su disección. Las variaciones anatómicas son bien conocidas y son básicamente de dos tipos: la ausencia de anastomosis distal con la arteria interósea anterior o la hipoplasia o aplasia en el tercio distal del antebrazo de la arteria interósea posterior, provocando un porcentaje relativamente alto de necrosis parcial, que puede acarrear un fallo en la cobertura de esta zona. Con objeto de prevenir un resultado desfavorable, hemos usado un colgajo interóseo posterior en forma de transferencia libre para el tratamiento quirúrgico de una mujer que fue remitida a nuestro Servicio con un defecto de 7 x 7 cm de diámetro en el dorso de la mano izquierda.

  14. Posterior moments computed by mixed integration

    NARCIS (Netherlands)

    H.K. van Dijk (Herman); T. Kloek (Teun); C.G.E. Boender

    1985-01-01

    textabstractA flexible numerical integration method is proposed for the computation of moments of a multivariate posterior density with different tail properties in different directions. The method (called mixed integration) amounts to a combination of classical numerical integration and Monte Carlo

  15. Posterior Predictive Model Checking in Bayesian Networks

    Science.gov (United States)

    Crawford, Aaron

    2014-01-01

    This simulation study compared the utility of various discrepancy measures within a posterior predictive model checking (PPMC) framework for detecting different types of data-model misfit in multidimensional Bayesian network (BN) models. The investigated conditions were motivated by an applied research program utilizing an operational complex…

  16. [Posterior longitudinal ligament ossification: case report].

    Science.gov (United States)

    Tella, Oswaldo Inácio de; Herculano, Marco Antonio; Paiva Neto, Manoel Antonio; Faedo Neto, Atílio; Crosera, João Francisco

    2006-03-01

    Posterior longitudinal ligament ossification of cervical spine is a rare condition among caucasians. A 42 years old japanese patient with progressive walking difficulty was diagnosed with this pathology by CT scan and MRI and treated surgically by an anterior approach with arthrodesis. Pathophysiology, racial prevalence, clinical picture, radiological characteristics and surgical approaches options are revised.

  17. Posterior skulderluksation--en diagnostisk udfordring

    DEFF Research Database (Denmark)

    Trollegaard, Anton Mitchell

    2009-01-01

    A case of posterior shoulder dislocation is described. The dislocation was misinterpreted twice clinically and radiographically in two different casualty departments before it was diagnosed and treated with closed reposition in a third facility. Treatment was conservative and the arm was placed...

  18. Restoration of the endodontically treated posterior tooth

    Directory of Open Access Journals (Sweden)

    Andrea Polesel

    2014-06-01

    Results and conclusions: Direct adhesive restorations, indirect bonded restorations and traditional full crown are three therapeutic options for the single posterior endodontically treated teeth. The amount of remaining sound tooth structure is the most significant factor influencing the therapeutic approach. The clinician's operative skill is a determining aspect for long-term success of adhesive inlays.

  19. New concepts on posterior fossa malformations

    Energy Technology Data Exchange (ETDEWEB)

    Jaspan, Tim [Imaging Centre, University Hospital, Nottingham (United Kingdom)

    2008-06-15

    A full description of the embryology of the posterior fossa (PF) is beyond the scope of this review; several recent publications are recommended. Specific aspects of the processes involved are, however, reviewed as a background to malformations that involve defects or errors occurring at critical stages during the embryogenesis of the PF structures. (orig.)

  20. FLAIR vascular hyperintensities and dynamic 4D angiograms for the estimation of collateral blood flow in posterior circulation occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Foerster, Alex; Wenz, Holger; Kerl, Hans Ulrich; Al-Zghloul, Mansour; Habich, Sonia; Groden, Christoph [University of Heidelberg, Department of Neuroradiology, Universitaetsmedizin Mannheim, Mannheim (Germany)

    2014-09-15

    The objectives of this paper are to assess collateral blood flow in posterior circulation occlusion by MRI-based approaches (fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs), collateralization on dynamic 4D angiograms) and investigate its relation to ischemic lesion size and growth. In 28 patients with posterior cerebral artery (PCA) and 10 patients with basilar artery (BA) occlusion, MRI findings were analyzed, with emphasis on distal FVH and collateralization on dynamic 4D angiograms. In PCA occlusion, distal FVH was observed in 18/29 (62.1 %), in BA occlusion, in 8/10 (80 %) cases. Collateralization on dynamic 4D angiograms was graded 1 in 8 (27.6 %) patients, 2 in 1 (3.4 %) patient, 3 in 12 (41.4 %) patients, and 4 in 8 (27.6 %) patients with PCA occlusion and 0 in 1 (10 %) patient, 2 in 3 (30 %) patients, 3 in 1 (10 %) patient, and 4 in 5 (50 %) patients with BA occlusion. FVH grade showed neither correlation with initial or follow-up diffusion-weighted image (DWI) lesion size nor DWI-perfusion-weighted imaging (PWI) mismatch ratio. Collateralization on dynamic 4D angiograms correlated inversely with initial DWI lesion size and moderately with the DWI-(PWI) mismatch ratio. The combination of distal FVH and collateralization grade on dynamic 4D angiograms correlated inversely with initial as well as follow-up DWI lesion size and highly with the DWI-PWI mismatch ratio. In posterior circulation occlusion, FVH is a frequent finding, but its prognostic value is limited. Dynamic 4D angiograms are advantageous to examine and graduate collateral blood flow. The combination of both parameters results in an improved characterization of collateral blood flow and might have prognostic relevance. (orig.)