WorldWideScience

Sample records for femoral vascular closure

  1. Suitability of Exoseal Vascular Closure Device for Antegrade Femoral Artery Puncture Site Closure

    Energy Technology Data Exchange (ETDEWEB)

    Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Liebl, Andrea; Poullos, Nektarios [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Ruppert, Volker [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)

    2013-06-15

    Purpose. To assess the efficacy and safety of the Exoseal vascular closure device for antegrade puncture of the femoral artery. Methods. In a prospective study from February 2011 to January 2012, a total of 93 consecutive patients received a total of 100 interventional procedures via an antegrade puncture of the femoral artery. An Exoseal vascular closure device (6F) was used for closure in all cases. Puncture technique, duration of manual compression, and use of compression bandages were documented. All patients were monitored by vascular ultrasound and color-coded duplex sonography of their respective femoral artery puncture site within 12 to 36 h after angiography to check for vascular complications. Results. In 100 antegrade interventional procedures, the Exoseal vascular closure device was applied successfully for closure of the femoral artery puncture site in 96 cases (96 of 100, 96.0 %). The vascular closure device could not be deployed in one case as a result of kinking of the vascular sheath introducer and in three cases because the bioabsorbable plug was not properly delivered to the extravascular space adjacent to the arterial puncture site, but instead fully removed with the delivery system (4.0 %). Twelve to 36 h after the procedure, vascular ultrasound revealed no complications at the femoral artery puncture site in 93 cases (93.0 %). Minor vascular complications were found in seven cases (7.0 %), with four cases (4.0 %) of pseudoaneurysm and three cases (3.0 %) of significant late bleeding, none of which required surgery. Conclusion. The Exoseal vascular closure device was safely used for antegrade puncture of the femoral artery, with a high rate of procedural success (96.0 %), a low rate of minor vascular complications (7.0 %), and no major adverse events.

  2. Percutaneous suture-mediated closure of femoral access sites deployed through the procedure sheath: initial clinical experience with a novel vascular closure device.

    Science.gov (United States)

    Eggebrecht, Holger; Naber, Christoph; Woertgen, Uta; Ringe, Sonia; Konorza, Thomas F M; Schmermund, Axel; von Birgelen, Clemens; Haude, Michael; Kroeger, Knut; Erbel, Raimund; Baumgart, Dietrich

    2003-03-01

    The objective of this study was to assess the initial safety and feasibility of a novel suture-mediated device for closure of femoral access sites immediately after diagnostic or interventional cardiac catheterization. In a prospective study, 150 patients (mean age, 61.5 years; 109 male) underwent femoral access closure with a novel suture closure device (Superstitch, Sutura) immediately after diagnostic (n = 106) or interventional (n = 44) catheterization procedures, independently of the coagulation status. All patients were monitored for 24 hr after the procedure. The closure device was successfully deployed in 92% of patients. Immediate hemostasis was achieved in 77% of patients with no differences between patients undergoing diagnostic catheterization or coronary interventions (79% vs. 73%; P = 0.659). After 2 min of additional light manual compression, hemostasis was achieved in 92% of patients. There was one major complication requiring vascular surgery (0.7%). The novel suture closure device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.

  3. [Complications after the use of a StarClose® vascular closure device for femoral punctures].

    Science.gov (United States)

    Quintana Martínez, I; Guillén Subirán, M E; Zaragozano Guillén, R; Hilario González, J

    2014-01-01

    The StarClose(®) arterial device (Abbot Vascular Devices, Abbot Laboratories, Redwood City, CA, USA) rapidly seals a femoral artery puncture by means of a nitinol clip in the adventitia of the artery. It is a safe and effective device, with advantages as regards manual compression, but is not free of complications. We present two cases with complications after using a StarClose(®) vascular device.

  4. Efficacy of femoral vascular closure devices in patients treated with anticoagulant, abciximab or thrombolytics during percutaneous endovascular procedures

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ha Young; Choo, Sung Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Roh, Hong Gee [Konkuk University School of Medicine, Seoul (Korea, Republic of)] (and others)

    2006-03-15

    This study assessed the outcomes of using vascular closure devices following percutaneous transfemoral endovascular procedures in the patients who were treated with heparin, abciximab thrombolytics (urokinase or t-PA) during the procedures. From March 28, 2003 to August 31, 2004, we conducted a prospective and randomized study in which 1,676 cases of 1.180 patients were treated with one of the two different closure devices (the collagen plug device was Angio-Seal{sup TM.}, the suture-mediated closure device was The Closer S{sup TM}) at the femoral access site after instituting percutaneous endovascular procedures. Among the 1,676 cases, 108 cases (the drug group) were treated with heparin only (n=94), thrombolytics only (n=10), heparin and thrombolytics (n=3), or abciximab and thrombolytics (n=1) during the procedures; 1,568 cases (the no-drug group) were treated without any medication. We compared the efficacy and complications between the two groups. Of the drug group, 42 cases underwent arterial closures with the collagen plug devices and 66 cases underwent arterial closures with the suture-mediated closure devices. We also compared the efficacy and complications between these two group. The immediate hemostasis rates were 92.9% (1,456/1,568) in the no drug group and 91.7% (99/108) in the drug group. Early complications occurred in four cases of the drug group. These included two episodes of rebleeding with using the Closer S, which required manual compression for at least 10 minutes, and two episodes of minor oozing with using one Angio-Seal and one Closer S, which required two hours of additional bed rest. There was no late complication. So, the total success rates were 90.8% (1,423/1,568) in the no-drug group and 88.0% (95/108) in the drug group. These results were not significantly different between the two groups ({rho}=0.34). In the drug group, the difference of the successful hemostasis rate between the collagen plug devices and the suture

  5. Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery

    Energy Technology Data Exchange (ETDEWEB)

    Gutzeit, Andreas, E-mail: andreas.gutzeit@ksw.ch; Schie, Bram van, E-mail: Bram.vanschie@hotmail.com; Schoch, Eric, E-mail: eric.schoch@ksw.ch [Cantonal Hospital Winterthur, Department of Radiology (Switzerland); Hergan, Klaus, E-mail: k.hergan@salk.at [Paracelsus Medical University Salzburg, Department of Radiology (Austria); Graf, Nicole, E-mail: graf@biostatistics.ch; Binkert, Christoph A., E-mail: christoph.binkert@ksw.ch [Cantonal Hospital Winterthur, Department of Radiology (Switzerland)

    2012-10-15

    Introduction: The purpose of the present study was to analyze complications following antegrade puncture of the common femoral artery (CFA) and the superficial femoral artery (SFA) using vascular closure systems (VCS). Methods: A single-center, retrospective study was performed after obtaining approval from the institutional review board and informed consent from all patients. At our center, the CFA or SFA are used for arterial access. All patients were evaluated clinically on the same day. If there was any suspicion of an access site problem, Duplex ultrasound was performed. Results: Access location was the CFA in 50 patients and the SFA in 130 patients. The sheath size ranged from 4F to 10F. Two patients had to be excluded because of lack of follow-up. Successful hemostasis was achieved in 162 of 178 cases (91 %). The following complications were observed in 16 patients (8.9 %): 4 pseudoaneurysms (2.2 %), 11 hematomas (6.2 %), and 1 vascular occlusion (0.5 %). The two pseudoaneurysms healed spontaneously, in one case an ultrasound-guided thrombin injection was performed, and one aneurysm was compressed manually. No further medical therapy was needed for the hematomas. The one vascular occlusion was treated immediately with angioplasty using a contralateral approach. No significant difference was noted between the CFA and the SFA group with respect to complications (p = 1.000). Conclusions: The use of closure devices for an antegrade approach up to 10F is feasible and safe. No differences in low complication rates were observed between CFA and SFA.

  6. The Use of ExoSeal Vascular Closure Device for Direct Antegrade Superficial Femoral Artery Puncture Site Hemostasis

    Energy Technology Data Exchange (ETDEWEB)

    Rimon, Uri, E-mail: rimonu@sheba.health.gov.il; Khaitovich, Boris, E-mail: borislena@012.net.il [Tel-Aviv University, Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Yakubovich, Dmitry, E-mail: Dmitry.Yakubovitch@sheba.health.gov.il [Tel-Aviv University, Vascular Surgery Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Bensaid, Paul, E-mail: paulbensaid@hotmail.com; Golan, Gil, E-mail: gilgolan201@gmail.com [Tel-Aviv University, Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Silverberg, Daniel, E-mail: Daniel.Silverberg@sheba.health.gov.il [Tel-Aviv University, Vascular Surgery Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel)

    2015-06-15

    PurposeThis study was designed to assess the efficacy and safety of the ExoSeal vascular closure device (VCD) to achieve hemostasis in antegrade access of the superficial femoral artery (SFA).MethodsWe retrospectively reviewed the outcome of ExoSeal VCD used for hemostasis in 110 accesses to the SFA in 93 patients between July 2011 and July 2013. All patients had patent proximal SFA based on computer tomography angiography or ultrasound duplex. Arterial calcifications at puncture site were graded using fluoroscopy. The SFA was accessed in an antegrade fashion with ultrasound or fluoroscopic guidance. In all patients, 5–7F vascular sheaths were used. The ExoSeal VCD was applied to achieve hemostasis at the end of the procedure. All patients were clinically examined and had ultrasound duplex exam for any puncture site complications during the 24 h postprocedure.ResultsIn all procedures, the ExoSeal was applied successfully. We did not encounter any device-related technical failure. There were four major complications in four patients (3.6 %): three pseudoaneurysms, which were treated with direct thrombin injection, and one hematoma, which necessitated transfusion of two blood units. All patients with complications were treated with anticoagulation preprocedure or received thrombolytic therapy.ConclusionsThe ExoSeal VCD can be safely used for antegrade puncture of the SFA, with a high procedural success rate (100 %) and a low rate of access site complications (3.6 %)

  7. Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis

    OpenAIRE

    Jun Jiang; Junjie Zou; Hao Ma; Yuanyong Jiao; Hongyu Yang; Xiwei Zhang; Yi Miao

    2015-01-01

    The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs)...

  8. Suitability of a 7-F ExoSeal Vascular Closure Device for Femoral Artery Punctures Made by 8-F or 9-F Introducer Sheaths.

    Science.gov (United States)

    Goto, Shunsaku; Ohshima, Tomotaka; Ishikawa, Kojiro; Yamamoto, Taiki; Nishizawa, Toshihisa; Shimato, Shinji; Kato, Kyozo

    2017-08-01

    To establish the safety and efficacy of the 7-F ExoSeal device for the closure of femoral puncture sites made by 8-F or 9-F introducer sheaths. Between January 2013 and December 2016, 332 patients (mean age 68.4±12.1 years; 195 men) underwent neurointerventional procedures via percutaneous puncture of the common femoral artery and an 8-F (n=272, 81.9%) or 9-F (n=60, 18.1%) introducer. The access sites were sealed with a 7-F ExoSeal in all cases. Procedure success and closure-related complication rates were evaluated, and risk factors for complications were analyzed by comparing patient characteristics between those who did and did not experience complications. Procedure success rates were 99.3% in the 8-F group and 100% in the 9-F group. The overall complication rate was 6.3% (n=17; all in the 8-F group), of which 13 (4.8%) were minor sequelae, including access-site hematoma (n=8), oozing (n=3), pseudoaneurysm (n=1), and retroperitoneal bleeding (n=1). Among the 4 (1.5%) major complications were 3 instances of bleeding requiring a blood transfusion and 1 surgical vascular repair. No complications were observed in the 9-F group. Patients who experienced complications had significantly longer activated clotting times (262±46 vs 218±55 seconds; pF ExoSeal vascular closure device is safe and effective for the closure of femoral puncture sites made by 8-F or 9-F introducer sheaths.

  9. Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis.

    Science.gov (United States)

    Jiang, Jun; Zou, Junjie; Ma, Hao; Jiao, Yuanyong; Yang, Hongyu; Zhang, Xiwei; Miao, Yi

    2015-09-08

    The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs) and haematomas by calculating the risk ratios and 95% confidence intervals. Forty RCTs including 16868 patients were included. Traditional meta-analysis demonstrated that there was no significant difference in the rate of CAVEs between all the VCDs and manual compression (MC). Subgroup analysis showed that FemoSeal and VCDs reported after the year 2005 reduced CAVEs. Moreover, the use of VCDs reduced the risk of haematomas compared with MC. Network meta-analysis showed that AngioSeal, which might be the best VCD among all the included VCDs, was associated with reduced rates of both CAVE and haematomas compared with MC. In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.

  10. Patient Satisfaction After Femoral Arterial Access Site Closure Using the ExoSeal{sup ®} Vascular Closure Device Compared to Manual Compression: A Prospective Intra-individual Comparative Study

    Energy Technology Data Exchange (ETDEWEB)

    Pieper, Claus Christian, E-mail: claus.christian.pieper@ukb.uni-bonn.de; Thomas, Daniel, E-mail: daniel.thomas@ukb.uni-bonn.de [University of Bonn, Department of Radiology (Germany); Nadal, Jennifer, E-mail: jennifer.nadal@ukb.uni-bonn.de [University of Bonn, Institute for Medical Biometry, Informatics and Epidemiology (Germany); Willinek, Winfried A., E-mail: w.willinek@bk-trier.de; Schild, Hans Heinz, E-mail: hans.schild@ukb.uni-bonn.de; Meyer, Carsten, E-mail: carsten.meyer@ukb.uni-bonn.de [University of Bonn, Department of Radiology (Germany)

    2016-01-15

    PurposeTo intra-individually compare discomfort levels and patient satisfaction after arterial access closure using the ExoSeal{sup ®} vascular closure device (VCD) and manual compression (MC) in a prospective study design.MethodsPatients undergoing two planned interventions from 07/2013 to 09/2014 could participate in the study. Access closure was performed with an ExoSeal{sup ®}-VCD in one and MC in the other intervention. Patients were clinically and sonographically examined and were given questionnaires 1 day after intervention [groin- and back-pain during bedrest (100-point visual analog scale; 0: no pain); comfortability of bedrest (10-point Likert scale, 1: comfortable), satisfaction with closure (10-point Likert scale, 1: very satisfied)]. Results were analyzed in a cross-over design.Results48 patients (29 male, median age 62.5 (32–88) years) were included. An ExoSeal{sup ®}-VCD was used first in 25 cases. As four of these subsequently refused MC as second intervention, data from 44 patients could be analyzed. All closures were technically successful (successful device deployment) without major complications. Groin- and back-pain after VCD-use/MC was 0 (0–15) vs. 10 (0–80) and 0 (0–75) vs. 25 (0–90), respectively (p < 0.0001). Bedrest after VCD-use was more comfortable than after MC [1 (range 1–7) vs. 6 (2–10); p < 0.0001]. Satisfaction with the closure procedure and with the intervention in general was higher after VCD-use compared to MC [1 (1–3) vs. 5 (2–10) and 1 (1–2) vs. 2 (1–4), respectively; p < 0.0001].ConclusionIntra-individual comparison showed pain levels and discomfort to be significantly lower after ExoSeal{sup ®} use compared to MC. VCD closure was associated with higher satisfaction both with the closure itself and with the intervention in general.

  11. The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hvelplund, Anders; Jeger, Raban; Osterwalder, Remo;

    2011-01-01

    Aims: To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device. Methods and results: First, a randomised controlled trial of immediate mobilisation vs. delayed a...

  12. Long Term Outcome after Application of the Angio-Seal Vascular Closure Device in Minipigs

    OpenAIRE

    Kabelitz, Lisa; Nonn, Andrea; Nolte, Kay W.; Nikoubashman, Omid; Othman, Ahmed; Heringer, Sarah; Kramer, Martin; Wiesmann, Martin; Brockmann, Marc A.

    2016-01-01

    Minipigs are frequently used in (neuro-)interventional research. Longitudinal experiments may require repeated vessel access via the femoral artery. Anticoagulation and incompliance of the animals necessitates the use of a vascular closure device (VCD). The effects of the Angio-Seal VCD in minipigs were longitudinally assessed. Minipig (42±8.4 kg body weight) femoral arteries were sealed using the 8F (n = 6) or 6F (n = 7) Angio-Seal VCD. The pre-interventional femoral artery diameter was 5.1±...

  13. From puncture to closure of the common femoral artery in endovascular aortic repair

    DEFF Research Database (Denmark)

    Lönn, Lars; Larzon, Thomas; Van Den Berg, Jos C

    2010-01-01

    or epidural anesthesia. The evolving stent-technology with smaller sheath sizes has broadened the scenario for alternative approaches for access and closure of the common femoral arteries. The following review presents an introduction on technical aspects of puncture of the femoral artery and closure...

  14. Outcomes after External Iliac and Femoral Vascular Injuries.

    Science.gov (United States)

    Kim, Jerry J; Alipour, Hamid; Yule, Arthur; Plurad, David S; Koopmann, Matthew; Putnam, Brant; de Virgilio, Christian; Kim, Dennis Y

    2016-05-01

    Vascular injuries occurring at the junction of the trunk and lower extremity are uncommon yet challenging because of their location and potential for associated truncal injuries. The purpose of this study was to examine and compare outcomes among patients sustaining external iliac and femoral vascular injuries. We performed a 13-year retrospective analysis of our level 1 trauma center database to identify and compare patients with external iliac and femoral vessel injuries. Multiple logistic regression analysis was performed to identify independent predictors for mortality. During the study period, 135 patients with a median (interquartile range [IQR]) age of 25 (20-35) years were identified with external iliac (n = 29) and femoral vascular injuries (n = 106). The majority were male (85.9%) with a penetrating mechanism (84.5%), and the median (IQR) Injury Severity Score (ISS) was 16 (11-26). The overall mortality rate was 14.1%. In comparison with patients with femoral vascular injuries, patients with external iliac injuries presented with higher ISS (25 vs. 16, P vascular injuries, external iliac vascular injuries are associated with higher blood loss, more intense resuscitation, higher disability and mortality in patients sustaining junctional groin injuries. Early recognition and application of damage control techniques and resuscitative practices may result in improved outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Vascular Closure Devices in Interventional Radiology Practice.

    Science.gov (United States)

    Patel, Rafiuddin; Muller-Hulsbeck, Stefan; Morgan, Robert; Uberoi, Raman

    2015-08-01

    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  16. Vascular Closure Devices in Interventional Radiology Practice

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rafiuddin, E-mail: rafiuddin.patel@ouh.nhs.uk [John Radcliffe Hospital, Department of Radiology (United Kingdom); Muller-Hulsbeck, Stefan, E-mail: muehue@diako.de [Diakonissen Hospital, Diagnostic and Interventional Radiology/Neuroradiology (Germany); Morgan, Robert, E-mail: robert.morgan@stgeorges.nhs.uk [St George’s Hospital, Department of Radiology (United Kingdom); Uberoi, Raman, E-mail: raman.uberoi@orh.nhs.uk [John Radcliffe Hospital, Department of Radiology (United Kingdom)

    2015-08-15

    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  17. Fluoroscopy-guided snare retrieval of the celt ACD(®) metallic vascular closure device following failed deployment.

    Science.gov (United States)

    Cahill, Thomas J; Choji, Kiyoshi; Kardos, Attila

    2014-03-01

    We report a case of endovascular snare retrieval of a new stainless steel vascular closure device (Celt ACD(®) , Kimal, Middlesex, UK) from the common femoral artery, following device failure after diagnostic coronary angiography. The stainless steel composition of the device aided successful fluoroscopic localization and removal.

  18. Safety and efficacy of femoral artery closure with the FemoSeal(R) device after coronary angiography using a 7 French sheath.

    Science.gov (United States)

    Wanitschek, M M; Suessenbacher, A; Dörler, J; Pachinger, O; Moes, N; Alber, H F

    2011-09-01

    Post-cardiac catheterization femoral artery hemostasis can be accomplished with several mechanisms, including the FemoSeal® hemostasis device which has been designed and approved for closure of 6 French (F) arterial puncture sites. The aim of this study was to investigate whether the FemoSeal® vascular closure device can effectively and safely seal 7F arterial puncture sites after diagnostic and interventional cardiac catheterizations. Femoral artery puncture sites of 50 consecutive patients undergoing cardiac catheterization were closed with the FemoSeal® vascular closure device, according to the manufacturer's instructions. Efficacy endpoints were time to hemostasis and successful ambulation. Safety endpoints included bleeding complications, vessel occlusion and pseudoaneurysms. Mean time to hemostasis was 57.8±26.3 seconds (0-125 seconds). Hemostasis was achieved in 100 percent of the 50 patients. One patient suffered minor bleeding the next day, i.e. local hematoma. This clinical study demonstrates that the FemoSeal® vascular closure device, initially approved for closure of 6F arterial puncture sites, shows promising efficacy and safety to seal a larger (7F) femoral arterial puncture sites after diagnostic and interventional cardiac catheterizations.

  19. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek, E-mail: abhiortho27@gmail.co [Department of Orthopedics, 513, Thermal Colony, Sector-22, Faridabad 121005, Haryana (India); Sankaran, Balu; Varghese, Mathew [Department of Orthopedics, St Stephen' s Hospital, Tis hazari, Delhi, New Delhi 110054 (India)

    2010-09-15

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  20. First clinical experience with Celt ACD(®) : a femoral arterial puncture closure device.

    LENUS (Irish Health Repository)

    Jan, Aftab

    2013-08-01

    This prospective nonrandomized study compared the safety and efficacy of a novel arterial closure device (ACD) in common femoral artery procedures to that of the FDA submitted historical manual pressure control group, who underwent either a diagnostic angiogram (DA) or a percutaneous coronary intervention (PCI) procedure.

  1. Clinical experience with a circumferential clip-based vascular closure device in diagnostic catheterization.

    Science.gov (United States)

    Hermiller, James; Simonton, Charles; Hinohara, Tom; Lee, Daniel; Cannon, Louis; Mooney, Michael; O'Shaughnessy, Charles; Carlson, Harold; Fortuna, Richard; Yarbrough, Carol Anne; Zapien, Michael; Chou, Tony

    2005-10-01

    The StarClose Vascular Closure System (Abbott Vascular Devices, Redwood City, California) utilizes a small, flexible nitinol clip to complete a circumferential, extravascular closure of the femoral arteriotomy site. The StarClose is an investigational device in the United States, limited by Federal law to investigational use. The StarClose is CE Mark approved. The CLIP study was a prospective, randomized, multicenter trial utilizing a noninferiority design to compare the rate of major vascular complications and time-to-hemostasis using the StarClose system versus manual compression. A total of 596 subjects were enrolled, 208 of whom underwent diagnostic angiography. This diagnostic subset is the focus of this report. The primary safety endpoint was major vascular complications and the primary efficacy endpoint was time-to-hemostasis. All patients were followed at 30 days with a clinical exam. Subjects were randomized 2:1 to the StarClose (n = 136) or manual compression (n = 72). There were no major vascular complications in either group. Minor vascular complications occurred in 3 StarClose patients (2.2%), and 1 manual compression patient (1.4%) (p = 1.00). Use of the StarClose device reduced mean time-to-hemostasis from 15.47 +/- 11.4 to 1.46 +/- 4.5 minutes (p manual compression, and reduced the average time-to-ambulation from 269 +/- 135 to 163 +/- 105 minutes (p < or = 0.001). Device success was 94.1% (127/135), and procedural success was 100% (136/136). The clinical results of this study concluded that the StarClose Vascular Closure System is noninferior to standard compression with respect to the the primary safety endpoint of closing arteriotomies in patients who undergo percutaneous diagnostic procedures.

  2. The Vascularized Medial Femoral Corticoperiosteal Flap for Thumb Reconstruction

    Science.gov (United States)

    Amin, Kavit; Darhouse, Nagham; Sivakumar, Bran; Floyd, David

    2015-01-01

    Summary: We present an interesting method of shaping a vascularized medial femoral condyle (MFC) flap into a “neophalanx” for phalangeal reconstruction. Our patient presented with limited strength and function secondary to fracture nonunion of the proximal phalanx of the dominant thumb. Following excision of the pseudarthrosis, an MFC corticoperiosteal flap was harvested, sculpted into a prism shape and inset. The superomedial genicular pedicle was anastomosed to the princeps pollicis artery and a cephalic tributary. On follow-up, new bone growth was seen on radiographs and the patient had substantially improved function, with full metacarpophalangeal extension, a Kapandji score of 9, and a markedly reduced Disabilities of the Arm, Shoulder and Hand score of 2.68. The MFC flap is useful for reconstruction of bony defects, with minimal donor morbidity. This versatile vascularized flap can be crafted to requisite shapes and is useful for small defects in the hand, including phalangeal reconstruction. PMID:26495205

  3. Endobronchial closure of bronchopleural fistulas with Amplatzer vascular plug.

    Science.gov (United States)

    Fruchter, Oren; Bruckheimer, Elchanan; Raviv, Yael; Rosengarten, Dror; Saute, Milton; Kramer, Mordechai R

    2012-01-01

    Bronchopulmonary fistula (BPF) is a severe complication following lobectomy or pneumonectomy and is associated with a high rate of morbidity and mortality. We have developed a novel minimally invasive method of central BPF closure using Amplatzer vascular plug (AVP) device that was originally designed for the transcatheter closure of vascular structures in patients with small BPF. Patients with BPFs were treated under conscious sedation by bronchoscopic closure of BPFs using AVP. After locating the fistula using bronchography, the self-expanding nitinol made AVP occluder to be delivered under direct bronchoscopic guidance over a loader wire into the fistula followed by bronchography to assure correct device positioning and sealing of the BPF. Six AVPs were placed in five patients, four males and one female, with a mean age of 62.3 years (range: 51-82 years). The underlying disorders and etiologies for BPF development were lobectomy (two patients), pneumonectomy for lung cancer (one patient), lobectomy due to necrotizing pneumonia (one patient), and post-tracheostomy tracheo-pleural fistula (one patient). In all the patients, the bronchoscopic procedure was successful and symptoms related to BPF disappeared following closure by the AVP. The results were maintained over a median follow-up of 9 months (range: 5-34 months). Endobronchial closure using the AVP is a safe and effective method for treatment of small postoperative BPF. The ease of their implantation by bronchoscopy under conscious sedation adds this novel technique to the armatorium of minimally invasive modalities for the treatment of small BPF.

  4. Ultrasonographic features of vascular closure devices: initial and 6 month followup results

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Hye Jung; Jeong, Hae Woong; Park, Jin Young; Kim, Sung Tae; Seo, Jung Hwa; Lee, Sun Joo; Park, Young Mi [Inje University Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of); Jin, Sung Chul [Dept. of Neurosurgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2014-12-15

    This study aimed to evaluate the ultrasonographic findings for various types of vascular closure devices (VCDs) immediately after the angiographic procedure and at 6-month follow-up. We included 18 VCDs including Angio-Seal (n=4), FemoSeal (n=8), ExoSeal (n=3), Perclose (n=2), and StarClose (n=1) in this study. Four patients were implanted with 2 VCDs at the each side of bilateral femoral arteries, while the remaining 8 patients were inserted 1 VCD at the right femoral artery. Ultrasonography was performed within 10 days and at approximately 6 months after the angiographic procedure. Ultrasonographic morphology of the attached VCD and its relationship with the arterial wall were analyzed. Initial ultrasonography revealed the attached VCD as the relevant unique structure with successful deployment and hemostasis. Follow-up ultrasonography demonstrated partial absorption of hemostatic materials in cases of Angio-Seal (n=3), FemoSeal (n=5), and ExoSeal (n=3), changes in the soft tissue surrounding the femoral artery in case of Angio-Seal (n=1), arterial intimal hyperplasia in cases of FemoSeal (n=3), and no gross changes as compared with the initial ultrasonographic findings in cases of Perclose (n=2) and StarClose (n=1). Initial ultrasonographic evaluation reflected the unique structure of each VCD, with most of them being easily distinguishable. Follow-up ultrasonography revealed various changes in the affected vessels.

  5. The StarClose Vascular Closure System: interventional results from the CLIP study.

    Science.gov (United States)

    Hermiller, J B; Simonton, C; Hinohara, T; Lee, D; Cannon, L; Mooney, M; O'Shaughnessy, C; Carlson, H; Fortuna, R; Zapien, M; Fletcher, D R; DiDonato, K; Chou, T M

    2006-11-01

    The StarClose Vascular Closure System is a femoral access site closure technology that uses a flexible nitinol clip to complete a circumferential, extravascular arteriotomy close. The Clip CLosure In Percutaneous Procedures study was initiated to study the safety and efficacy of the StarClose device in subjects undergoing diagnostic and interventional catheterization procedures. A total of 17 U.S. sites enrolled 596 subjects, with 483 subjects randomized at a 2:1 ratio to receive StarClose or standard compression of the arteriotomy after the percutaneous procedure. The study included roll-in (n = 113), diagnostic (n = 208), and interventional (n = 275) arms with a primary safety endpoint of major vascular complications through 30 days and a primary efficacy endpoint of postprocedure time to hemostasis. The results of the diagnostic StarClose cohort have been reported separately. Results for the interventional arm revealed major vascular complications occurring in 1.1% of StarClose subjects (2/184) and 1.1% in manual compression subjects (1/91; P = 1.00). No infections were seen in either cohort. Minor complications in the StarClose interventional group occurred at a rate of 4.3% (8/184) and with compression at 9.9% (9/91; P = 0.107). Pseudoaneurysm or arteriovenous fistula was not seen with StarClose. With StarClose, procedural success was 100% (136/136) for the diagnostic group and 98.9% (181/183) in the interventional group. Device success for the treatment group was 86.8%. In the interventional cohort, 87.3% (158/181) of StarClose subjects reported a pain scale of 0-3 compared with 93.3% (84/90) in the compression group, which was not statistically different. The clinical results of this study demonstrate that the StarClose Vascular Closure System is noninferior to manual compression with respect to the primary safety endpoint of major vascular events in subjects who undergo percutaneous interventional procedures. StarClose significantly reduced time to

  6. Effect of the high femoral osteotomy upon the vascularity and blood supply of the hip joint

    Energy Technology Data Exchange (ETDEWEB)

    Day, B.; Shim, S.S.; Leung, G.

    1984-05-01

    This investigation was done to study the effects of high femoral osteotomy upon the vascularity and blood supply of the hip and to further our knowledge of its physiologic basis. We have used established methods of study, including bone scans, microangiography, isotope clearance and perosseous venography, and based upon the results of these studies, we have reached certain conclusions. First, high femoral osteotomy increases the blood flow and vascularity in the hip joint, the femoral head and neck and the great trochanter. Second, bone scanning techniques using /sup 99m/Tc labeled diphosphonate have shown increased uptake in the femoral head and neck after high femoral osteotomy. The localization was done using a Digital Gamma III computer, and the activity on the osteotomy side at two weeks was 3.5 times as great as on the control side. By 16 weeks postoperatively, there was still two times as much activity on the osteotomy side. Third, microangiography showed increased vascularity both at the osteotomy site and in the femoral head and neck and the greater trochanter on that side. Such an increase in vascularity first became evident two weeks after osteotomy and persisted during the four month period studied. Fourth, the results of the /sup 99m/Tc diphosphonate clearance study showed a 25 per cent increase in femoral head blood flow on the operative side. Fifth, perosseous venography of the femoral head and neck showed a marked increase in venous drainage through the osteotomy site in the immediate postosteotomy stage.

  7. Obesity: An Independent Risk Factor for Insufficient Hemostasis Using the AngioSeal Vascular Closure Device After Antegrade Puncture

    Energy Technology Data Exchange (ETDEWEB)

    Minko, Peter, E-mail: peterminko@yahoo.com; Katoh, Marcus [University Hospital Saarland, Department of Diagnostic and Interventional Radiology (Germany); Graeber, Stefan [University Hospital Saarland, Institute of Medical Biometry, Epidemiology and Medical Informatics (Germany); Buecker, Arno [University Hospital Saarland, Department of Diagnostic and Interventional Radiology (Germany)

    2012-08-15

    Purpose: This study was designed to investigate the efficacy of the AngioSeal vascular closure device after antegrade puncture of the femoral artery. Methods: In a prospective study, 120 consecutive patients underwent lower limb vascular intervention by an antegrade access to the common femoral artery (CFA). After intervention, a 6F (n = 88) or an 8F (n = 32) AngioSeal vascular closure device was used to achieve hemostasis. The technical success or the cause of failure was documented. In addition, the coagulation status (platelets, INR, prothrombin time, atrial thromboplastin time (PTT)), hypertonus, locoregional habitus of the groin, body mass index (BMI), presence of calcifications, and history of previous surgical interventions of the CFA were evaluated. Results: Hemostasis was achieved in 97 patients (81%). In 12 patients (10%), persistent bleeding of the puncture site required manual compression. In another nine patients (8%) a kink of the sheath obviated the passage of the collagen plug toward the vessel, and in two patients the anchor dislodged out of the vessel, requiring manual compression. There were no significant differences between the groups of successful and unsuccessful sealing regarding the mean platelets (241 vs. 254 * 10{sup 9}/l; P = 0.86), INR (1.06 vs. 1.02; P = 0.52), prothrombin time (90% vs. 90%; P = 0.86), and PTT (30 vs. 31 s; P = 0.82). However, unsuccessful sealing was more likely in obese patients with an increased BMI (26.6 vs. 28.8 kg/m{sup 2}; P = 0.04). Conclusions: Obesity seems to be an independent risk factor for insufficient sealing using the AngioSeal vascular closure device after antegrade puncture of the CFA. In 8% of our patients, hemostasis could not be achieved due to kink of the flexible sheath.

  8. Routine Use of Fluoroscopic-Guided Femoral Arterial Puncture to Minimise Vascular Complication Rates in CTO Intervention: Multi-centre UK Experience.

    Science.gov (United States)

    Fairley, Sarah L; Lucking, Andrew J; McEntegart, Margaret; Shaukat, Aadil; Smith, David; Chase, Alexander; Hanratty, Colm G; Spratt, James C; Walsh, Simon J

    2016-12-01

    Chronic total occlusion (CTO) revascularisation has a crucial role in contemporary percutaneous coronary intervention (PCI). Procedural success is influenced by disease complexity, calcific burden and patient characteristics but has substantially improved with the implementation of novel hybrid strategies. However, vascular-access related complications remain a cause of morbidity and mortality. This study aimed to assess the effectiveness of fluoroscopic-guided femoral arterial puncture to minimise this risk during CTO PCI. Standardised data were retrospectively collected from four high-volume UK CTO centres between September 2011 and November 2013. Demographic, clinical and procedural data (vascular access site, sheath size, anticoagulation use) was collated. The anatomical location of the femoral puncture in relation to the femoral bifurcation, femoral head position and inferior epigastric artery were recorded. Adverse events related to vascular access were documented. A total of 528 patients were included (676 femoral punctures) with the majority being male (n=432, 81.8%). Large sheaths (8F) were used in 81.2% of cases. Fluoroscopy-enabled punctures were made in the 'safe zone' in over > 93% of cases. Vascular closure devices (VCD) were used in 88.3% of cases. The adverse event rate per puncture was 0.89%. This study demonstrates an extremely low incidence of vascular-access complications in CTO PCI when fluoroscopic guidance is used to obtain femoral arterial access by default radial operators. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  9. Transcatheter closure of small ductus arteriosus with amplatzer vascular plug

    Directory of Open Access Journals (Sweden)

    Eunhyun Cho

    2013-09-01

    Full Text Available Purpose: The purpose of this study was to share our experience of transcatheter closure of small patent ductus arteriosus (PDA by using an Amplatzer vascular plug (AVP.&lt;br&gt; Methods: We reviewed the medical records of 20 patients who underwent transcatheter closure at Samsung Medical Center and Sejong General Hospital from January 2008 to August 2012. The size and shape of the PDAs were evaluated by performing angiograms, and the PDA size and the AVP devices size were compared.&lt;br&gt;Results: The mean age of the patients was 54.9±45.7 months old. The PDAs were of type C (n=5, type D (n=12 and type E (n=3. The mean pulmonary end diameter of the PDA was 1.7±0.6 mm, and the aortic end diameter was 3.6±1.4 mm. The mean length was 7.3±1.8 mm. We used 3 types of AVP devices: AVP I (n=5, AVP II (n=7, and AVP IV (n=8. The ratio of AVP size to the pulmonary end diameter was 3.37±1.64, and AVP size/aortic end ratio was 1.72±0.97. The aortic end diameter was significantly larger in those cases repaired with AVP II than in the others (P =0.002. The AVP size did not significantly correlate with the PDA size, but did correlate with smaller ratio of AVP size to aortic end diameter (1.10±0.31, P =0.032. &lt;br&gt;Conclusion: Transcatheter closure of small PDA with AVP devices yielded satisfactory outcome. AVP II was equally effective with smaller size of device, compared to others.

  10. Bilateral vascularized femoral bone transplant: a new model of vascularized bone marrow transplantation in rats, part I.

    Science.gov (United States)

    Agaoglu, Galip; Carnevale, Kevin A; Zins, James E; Siemionow, Maria

    2006-06-01

    We present a new model of vascularized bone marrow transplantation-bilateral vascularized femoral bone (BVFB) isograft transplant based on abdominal aorta and inferior vena cava. A total of 7 BVFB isograft transplants were performed between Lewis (RT1) rats. In the donor, both femoral bones were harvested based on the abdominal aorta and inferior vena cava. In the recipient, the harvested isograft transplants were transferred into the inguinal region (in 3 animals) and into the abdominal cavity (in 4 animals). The mean operation time was 3 hours and 35 minutes. The mean warm ischemic time was 35 minutes. The vascular pedicles of the transplants that were transferred into the inguinal region were thrombosed at day 7 posttransplantation. The vascular pedicles of transplants into the abdominal cavity were patent and the bones were viable during the follow-up period of 63 days posttransplant. We have confirmed the feasibility of BVFB transplantation based on abdominal aorta and inferior vena cava.

  11. The Observation on Efficacy of Angio-seal Closure Device in the Femoral Arterial Puncture Site after PCI

    Institute of Scientific and Technical Information of China (English)

    Zhang Bin; Jin Lijun; Wei Shuishen; Fang Xianhong; Wu Handong; Dong Taiming; Yan hong; Liao Hongtao

    2006-01-01

    Objective To evaluatereliability and safety of Angio-seal hemostasis device applied to the femoral arterial puncture site after percutaneous coronary intervention (PCI). Methods In 40 patients after PCI in our institute during the period between May 2002 and December 2003, Angioseal device were used to seal the femoral arterial puncture site. Results All the Angioseal devices were successfully deployed in 40 patients (successful rate:100%); the mean time to hemostasis was 45±12 sec;the mean time to ambulate after angioseal closure was 1.9±0.5 hours. No major groin and systemic complication was observed. There was minor groin oozing in 2 cases and small hemotoma in 1 patient.Conclusions Angio-seal closure device of the femoral artery puncture site after a percutaneous coronary procedure is safe. It can shorten the time to hemostasis,leads to early mobilization, and reduce groin complication. The disadvantage is relatively expensive.

  12. Major femoral vascular access complications after coronary diagnostic and interventional procedures

    DEFF Research Database (Denmark)

    Dencker, Ditte; Pedersen, Frants; Engstrøm, Thomas

    2016-01-01

    BACKGROUND: Vascular access complications after coronary angiography (CAG) and percutaneous coronary intervention (PCI) are known to increase morbidity, prolong hospitalization and raise hospital costs. Therefore, risk factor identification and improvement of safety strategies for vascular...... management are important. We aimed to assess the incidence of major vascular complications related to femoral access, and to identify potential risk factors. METHODS: Over a period of six years, 23,870 index procedures (CAG) were performed in two centres, prospectively entered in the database...... and retrospectively analysed. Data was obtained from the Eastern Danish Heart Registry and cross-matched with data from the Danish Vascular Registry. Index procedures were defined as the first trans-femoral procedure. Demographic, procedural and mortality data, as well as information on access complications requiring...

  13. Vascular complications following therapeutic and diagnostic cardiac catheterisation by the femoral artery

    DEFF Research Database (Denmark)

    Bitsch, M; Liisberg-Larsen, Ole Christian; Schroeder, T V

    1994-01-01

    Twenty-one of 6327 (0.33%) patients undergoing cardiac catheterisation via the femoral artery had an acute vascular complication requiring surgical intervention. The complication rate was 0.1% after coronary angiography, 2% after PTCA and 6% after aortic ballon dilatation. The size of the cathete...... and evaluation of vascular injuries following diagnostic and therapeutic invasive interventions could have a self limitating effect on the complication rate....

  14. Vascular reactivity of rabbit isolated renal and femoral resistance arteries in renal wrap hypertension.

    Science.gov (United States)

    Khammy, Makhala M; Angus, James A; Wright, Christine E

    2016-02-15

    In rabbits with cellophane renal wrap hypertension, hindquarter and total vascular resistance changes to pressor and depressor agents are amplified compared to those of normotensive rabbits. The aim of the present study was to evaluate the in vitro pharmacodynamics of hypertensive and normotensive rabbit small artery segments isolated from the renal and hindquarter vascular beds. Using wire myography, the full range (Emax) and sensitivity (EC50) to a range of agonists of segments of renal interlobar (≈ 600 µm i.d.), renal arcuate (≈ 250 µm i.d.) and deep femoral branch (≈ 250 µm i.d.) arteries were assessed under normalised conditions of passive tension. Interlobar arteries from hypertensive rabbits were more sensitive (EC50) than those from normotensive rabbits to noradrenaline (6-fold), methoxamine (3-fold) and angiotensin II (3-fold). Arcuate artery reactivity was largely unaffected by hypertension. Deep femoral arteries from hypertensive rabbits had enhanced sensitivity only to noradrenaline (2-fold) and methoxamine (4-fold). Sensitivity to relaxation by acetylcholine was unaffected by hypertension in all arteries. Deep femoral arteries from hypertensive rabbits were more sensitive to sodium nitroprusside than normotensive counterparts. Adenosine caused little relaxation in renal arteries, but full relaxation in deep femoral arteries, unaltered by hypertension. This study found substantial heterogeneity in the pharmacodynamic profile of vessels isolated from different vascular beds and between arterial segments within the kidney. These profiles were differentially affected by hypertension suggesting that hypertension per se is not a resultant of general vascular dysfunction.

  15. Short- and midterm results of the fascia suture technique for closure of femoral artery access sites after endovascular aneurysm repair.

    Science.gov (United States)

    Montán, Carl; Lehti, Leena; Holst, Jan; Björses, Katarina; Resch, Timothy A

    2011-12-01

    To evaluate the midterm outcomes and potential risk factors associated with the fascia suture technique (FST) for closure of femoral artery access sites after percutaneous endovascular aneurysm repair (EVAR). Between April 2007 and April 2008, 100 consecutive EVAR cases were evaluated retrospectively. A third of the procedures were emergent (16 ruptured aneurysms). Of the 187 femoral access sites, 160 (85.5%) were closed by the FST as a first choice. Pre- and postoperative chart and imaging data were collected from computerized medical records for analysis of demographics and the rate of complications (bleeding, infection, thrombosis, pseudoaneurysms, and stenosis). Preoperative risk factors for FST failure were analyzed with regard to obesity (based on the subcutaneous fat layer), plaque at the femoral access site, and stenosis based on the pre- and 1-year postoperative computed tomography scans. Of the 160 FST closures, 146 (91.3%) were technically successful. The 14 (8.8%) technical failures were converted to open cutdown intraoperatively because of bleeding (11, 6.8%), inadequate limb perfusion (2, 1.2%), and a broken guidewire (1, 0.6%). Two (1.2%) pseudoaneurysms required surgical repair after 2 weeks. Data from the 1-year follow-up showed no signs of increased stenosis, thrombosis, or formation of plaque. Nine small (<1 cm(3)) pseudoaneurysms were detected and managed conservatively. No preoperative risk factors were associated with FST failure. The fascia suture technique seems to be safe, effective, and simple to use for closing percutaneous access sites after EVAR. Complications are rare, and the outcome is not affected by obesity, femoral calcification, or femoral artery stenosis.

  16. Morphologic features of puncture sites after exoseal vascular closure device implantation: Changes on follow-up computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Hwa Seong; Jang, Joo Yeon; Kim, Tae Un; Lee, Jun Woo; Park, Jung Hwan; Choo, Ki Seok; Cho, Mong; Yoon, Ki Tae; Hong, Young Ki; Jeon, Ung Bae [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2017-05-15

    The study aimed to evaluate the morphologic changes in transarterial chemoembolization (TACE) puncture sites implanted with an ExoSeal vascular closure device (VCD) using follow-up computed tomography (CT). 16 patients who used ExoSeal VCD after TACE were enrolled. Using CT images, the diameters and anterior wall thicknesses of the puncture sites in the common femoral artery (CFA) were compared with those of the contralateral CFA before TACE, at 1 month after every TACE session, and at the final follow-up period. The rates of complications were also evaluated. There were no puncture- or VCD-related complications. Follow-up CT images of the CFA's of patients who used ExoSeal VCDs showed eccentric vascular wall thickening with soft-tissue densities considered to be hemostatic plugs. Final follow-up CT images (mean, 616 days; range, 95–1106 days) revealed partial or complete resorption of the hemostatic plugs. The CFA puncture site diameters did not differ statistically from those of the contralateral CFA on the final follow-up CT (p > 0.05), regardless of the number of VCDs used. Follow-up CT images of patients who used ExoSeal VCDs showed no significant vascular stenosis or significant vessel wall thickening.

  17. French multicenter experience with the GORE TIGRIS Vascular Stent in superficial femoral and popliteal arteries.

    Science.gov (United States)

    Sibé, Maxime; Kaladji, Adrien; Boirat, Claire; Cardon, Alain; Chaufour, Xavier; Bossavy, Jean-Pierre; Saint-Lebes, Bertrand

    2017-05-01

    Preliminary results in small single-center studies after stenting with the GORE TIGRIS Vascular Stent (W. L. Gore & Associates, Flagstaff, Ariz) show promising short-term primary patency rates, but larger, multicenter studies are needed. This study therefore investigated the performance of the GORE TIGRIS Vascular Stent at three different centers in France in patients with symptomatic peripheral artery disease. This retrospective, single-arm, multicenter cohort study included 215 patients with peripheral artery disease (Rutherford-Becker category 2-6) who were treated with the GORE TIGRIS Vascular Stent, a dual-component stent consisting of a nitinol wire frame combined with a fluoropolymer-interconnecting structure. The efficacy end point was primary patency defined by freedom from binary restenosis as derived by duplex ultrasound imaging until 2 years after the intervention. Primary, secondary, and primary assisted patency rates at 3, 6, 12, 18, and 24 months were estimated by Kaplan-Meier analysis. The GORE TIGRIS Vascular Stent was used to successfully treat 239 lesions, of which 141 lesions were located in the superficial femoral artery and 98 in the popliteal artery. Patients were a mean age of 74 ± 12 years. Mean lesion length was 86.8 ± 44.7 mm. After 12 and 24 months, the overall primary patency rates were 81.5% and 67.2%, respectively, and primary assisted patency was 94.9% and 84.8%. Secondary patency was achieved in 99.1% at 24 months. Our multicenter experience with the GORE TIGRIS Vascular Stent demonstrates continued good results at 2 years for endovascular treatment of challenging obstructive superficial femoral artery and popliteal artery disease. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  18. Safety and effectiveness of a circumferential clip-based vascular closure device for hemostasis in off-label applications: Comparison with standard applications

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Chan; Kim, Chang Won [Dept. of Radiology, Pusan National University School of Medicine, Pusan National University Hospital, Busan (Korea, Republic of); Jeon, Ung Bae [Dept. of Radiology, Pusan National University School of Medicine, Yangsan Pusan National University Hospital, Yangsan (Korea, Republic of)

    2016-09-15

    We investigated the efficacy and safety of a circumferential nitinol clip based arterial closure device following arteriotomy, especially in off-label applications. Consecutive patients who underwent the procedure with arteriotomy from January 2011 to February 2014 were included in this study. We defined standard use as the use of StarClose for retrograde puncture of the common femoral artery (CFA) and off-label use as the use of StarClose for retrograde puncture of the superficial femoral artery (SFA), antegrade puncture of the CFA or SFA, puncture of the brachial artery or puncture of the vascular graft. The procedures performed included percutaneous transluminal angioplasty and thrombolysis. Technical success was defined as complete hemostasis achieved within 3 minute after the closure. Complications, and laboratory findings associated with coagulation function, were also investigated. There were 146 cases of standard applications and 111 cases of off-label applications. Technical success was achieved in all cases. The off-label group comprised the use of StarClose for retrograde puncture of the SFA (n = 19), antegrade puncture of the CFA or SFA (n = 74), brachial artery puncture (n = 5), larger sheath than 6 Fr (n = 7) and vascular graft puncture (n = 6). Minor complications were noted in both groups (standard group: 7.5%, off-label group: 2.7%). Off-label use of StarClose is safe and feasible.

  19. Vascular endothelial growth factor gene transfection to enhance the repair of avascular necrosis of the femoral head of rabbit

    Institute of Scientific and Technical Information of China (English)

    杨操; 杨述华; 杜靖远; 李进; 许伟华; 熊宇芳

    2003-01-01

    Objective To explore a new method for the therapy of avascular necrosis of the femoral head.Methods The recombinant plasmid pCD-hVEGF165 was mixed with collagen and was implanted in the necrotic femoral head. The expression of vascular endothelial growth factor (VEGF) was examined by RNA dot hybridization and immunohistochemical techniques. Repair of the femoral head was observed by histological and histomorphometric analysis.Results The expression of VEGF was detected in the femoral head transfected with the VEGF gene. The femoral head transfected with the VEGF gene showed a significant increase in angiogenesis 2 and 4 weeks after gene transfection and a significant increase in bone formation 6 and 8 weeks after gene transfection on histomorphometric analysis (P<0.01).Conclusions Transfection of the VEGF gene enhances bone tissue angiogenesis. Repair of osteonecrosis could be accelerated accordingly, thus providing a potential method for therapy of osteonecrosis.

  20. Prospective comparison of collagen plug (angio-seal{sup TM}) and suture-mediated (the closer S{sup TM}) closure devices at femoral access sites

    Energy Technology Data Exchange (ETDEWEB)

    Park, Yulri; Roh, Hong Gee; Choo, Sung Wook; Lee, Sung Hoon; Shin, Sung Wook; Do, Young Soo; Byun, Hong Sik; Park, Kwang Bo; Jeon, Pyoung [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2005-12-15

    Rapid and effective hemostasis at femoral puncture sites minimizes both the hospital stay and patient discomfort. Therefore, a variety of arterial closure devices have been developed to facilitate the closure of femoral arteriotomy. The objective of this prospective study was to compare the efficacy of two different closure devices; a collagen plug device (Angio-Seal) and a suture-mediated closure device (the Closer S). From March 28, 2003 to August 31, 2004, we conducted a prospective study in which 1,676 cases of 1,180 patients were treated with two different types of closure device. Angio-Seal was used in 961 cases and the Closer S in 715 cases. The efficacy of the closure devices was assessed, as well as complications occurring at the puncture sites. Successful immediate hemostasis was achieved in 95.2% of the cases treated with Angio-Seal, and in 89.5% of the cases treated with the Closer S ({rho} < 0.05). The rates of minor and major complications occurring between the two groups were not significantly different. In the Closer S group, we observed four major complications (0.6%), that consisted of one massive retroperitoneal hemorrhage (surgically explored) and three pseudoaneurysms. In the Angio-Seal group, we observed three major complications (0.3%) that consisted of one femoral artery occlusion, one case of infection treated with intravenous antibiotics and one pseudoaneurysm. The use of Angio-Seal was found to be more effective than that of the Closer S with regard to the immediate hemostasis of the femoral puncture sites. However, we detected no significant differences in the rate at which complications occurred.

  1. Ultrasonographic features of vascular closure devices: initial and 6-month follow-up results

    OpenAIRE

    Hye Jung Choo; Hae Woong Jeong; Jin Young Park; Sung-Chul Jin; Sung Tae Kim; Jung Hwa Seo; Sun Joo Lee; Young Mi Park

    2014-01-01

    Purpose:

    This study aimed to evaluate the ultrasonographic findings for various types of vascular closure devices (VCDs) immediately after the angiographic procedure and at 6-month follow-up.

    Methods:

    We included 18 VCDs including Angio-Seal (n=4), FemoSeal (n=8), ExoSeal (n=3), Perclose (n=...

  2. Notch signal reception is required in vascular smooth muscle cells for ductus arteriosus closure.

    Science.gov (United States)

    Krebs, Luke T; Norton, Christine R; Gridley, Thomas

    2016-02-01

    The ductus arteriosus is an arterial vessel that shunts blood flow away from the lungs during fetal life, but normally occludes after birth to establish the adult circulation pattern. Failure of the ductus arteriosus to close after birth is termed patent ductus arteriosus, and is one of the most common congenital heart defects. Our previous work demonstrated that vascular smooth muscle cell expression of the Jag1 gene, which encodes a ligand for Notch family receptors, is essential for postnatal closure of the ductus arteriosus in mice. However, it was not known what cell population was responsible for receiving the Jag1-mediated signal. Here we show, using smooth muscle cell-specific deletion of the Rbpj gene, which encodes a transcription factor that mediates all canonical Notch signaling, that Notch signal reception in the vascular smooth muscle cell compartment is required for ductus arteriosus closure. These data indicate that homotypic vascular smooth muscle cell interactions are required for proper contractile smooth muscle cell differentiation and postnatal closure of the ductus arteriosus in mice.

  3. Novel use of the medtronic micro vascular plug for PDA closure in preterm infants.

    Science.gov (United States)

    Wang-Giuffre, Elizabeth W; Breinholt, John P

    2017-05-01

    To describe a single institution experience with a new endovascular occlusion device used for transcatheter patent ductus arteriosus (PDA) closure in preterm infants. The PDA is a defect largely treated via cardiac catheterization except for the smallest patients. Medical records and catheterization reports of all premature neonates who underwent PDA device closure with the Medtronic Micro Vascular Plug (MVP) (Medtronic, Minneapolis, MN) between September 2015 and June 2016 were reviewed. Procedural details, complications, and short term outcomes were recorded. Eight premature neonates born at a median gestational age of 28 weeks (23 to 35 weeks) underwent PDA closure with a Medtronic MVP. All devices were deployed via a 4F angled Glide catheter in prograde fashion without arterial access. Median age and weight was 52 days (15-112 days) and 2,550 g (1,800-3,500 g), respectively. Fluoroscopy and echocardiography were utilized for the procedure. Complete closure was achieved in all patients with no procedural complications, pulmonary artery or aortic obstruction or death. One device embolized 9 days after deployment and was successfully retrieved. This study describes transcatheter PDA closure with the Medtronic MVP. The major advantage is the ability to deliver the device via a standard catheter in prograde fashion, and avoid the hemodynamic instability produced by rigid delivery sheaths. It also further validates the ability to close the PDA without arterial access, providing improved access to this procedure to smaller and more vulnerable children. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. Bilateral femoral hernia in a male cadaver with vascular variations: case report and review of the literature.

    Science.gov (United States)

    Natsis, K; Totlis, T; Papadopoulou, A L; Apostolidis, S; Skandalakis, P

    2006-08-01

    Femoral hernia, which is a less common occurrence than inguinal hernia, is not congenital in most cases and is uncommon in young males. It is considered to be more common in females than in males due to an enlarged femoral ring in the former. A case of bilateral femoral hernia in a 64-year-old male cadaver is described within the framework of an anatomical approach. On the right side, the protrusion of the viscus appeared as a small intestine coil, whereas on the left side the protruded viscus appeared as a pelvic colon's appendix appiplocae. On both sides, the protruded viscus was located in front of an aberrant obturator artery, which oriented from the external iliac artery and not from the internal iliac artery as should be the case. The puberal branch of the inferior epigastric artery was absent. The cadaver's medical history and his skin examination excluded an abdominal surgery. In the literature, case reports of bilateral femoral hernia appear only seldom, especially those of male patients who had not undergone inguinal hernia repair surgery. In femoral hernias more often than in other types of hernia, the protruded viscus is strangulated and undergoes a tissue necrosis. Morbidity and mortality for complicated femoral hernia is high. Knowledge of vascular variation such as presented by the cadaver under study is extremely useful to the surgeon because any iatrogenic injury of the aberrant obturator artery during a laparoscopic repair may result in dangerous hemorrhage.

  5. Efficacy and Safety of a Novel Vascular Closure Device (Glubran 2 Seal) After Diagnostic and Interventional Angiography in Patients with Peripheral Arterial Occlusive Disease

    Energy Technology Data Exchange (ETDEWEB)

    Del Corso, Andrea [University of Pisa, Department of Vascular Surgery (Italy); Bargellini, Irene, E-mail: irenebargellini@hotmail.com; Cicorelli, Antonio; Perrone, Orsola [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy); Leo, Michele [University of Pisa, Department of Vascular Surgery (Italy); Lunardi, Alessandro [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy); Alberti, Aldo; Tomei, Francesca [University of Pisa, Department of Vascular Surgery (Italy); Cioni, Roberto [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy); Ferrari, Mauro [University of Pisa, Department of Vascular Surgery (Italy); Bartolozzi, Carlo [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy)

    2013-04-15

    To prospectively evaluate safety and efficacy of a novel vascular closure device (Glubran 2 Seal) after peripheral angiography in patients with peripheral arterial occlusive disease (PAOD). From December 2010 to June 2011, all consecutive patients with PAOD undergoing peripheral angiography were prospectively enrolled onto the study after percutaneous antegrade or retrograde puncture of the common femoral artery. After angiography, the Glubran 2 Seal device was used to achieve hemostasis. The following data were registered: technical success and manual compression duration, patients' discomfort (scale 0-5), operators' technical difficulty (scale 0-5), and vascular complications. The site of hemostasis was evaluated by clinical inspection and color-coded Duplex ultrasound performed 1 day and 1 month after the procedure. One hundred seventy-eight patients were enrolled (112 male, mean age 70.8 years) with a total of 206 puncture sites, including 104 (50.5 %) antegrade accesses. The device was successful in 198(96.1 %) of 206 procedures, with 8 cases of manual compression lasting longer than 5 min (maximum 20 min). No major vascular complications were observed, resulting in 100 % procedural success. Minor complications occurred in seven procedures (3.4 %), including two cases of pseudoaneurysms, successfully treated by ultrasound-guided glue injection. The mean {+-} standard deviation score for patients' discomfort was 0.9 {+-} 0.7, whereas the mean score for operators' difficulty was 1.2 {+-} 0.9. In patients with PAOD, the Glubran 2 Seal represents a simple, painless, and efficient vascular closure device, able to achieve hemostasis both in antegrade and retrograde accesses.

  6. Closure

    NARCIS (Netherlands)

    Stigter, C.J.

    1988-01-01

    At least an easier task than I have carried out the previous hour when we discussed the preliminary conclusions and recommendations has, as a compensation I guess, been given to me as well. To say a few words as a closure of this symposium. The beginning of such a series of closing statements is mos

  7. MRI after implantation of a novel femoral closure device following intra-arterial catheterisation: implications for subsequent contrast-enhanced MR angiography.

    Science.gov (United States)

    Mohrs, Oliver K; Petersen, Steffen E; Nowak, Bernd; Kauczor, Hans-Ulrich; Voigtlaender, Thomas

    2010-05-01

    To assess MRI safety aspects and artefacts of a novel femoral artery closure device during contrast-enhanced MR angiography in patients following intra-arterial catheterisation. Ten consecutive patients underwent MRI within 24 h of coronary angiography and placement of a femoral artery closure device. We used a T2-weighted gradient-echo MRI sequence to measure the device-related artefact size in comparison with a phantom image, phase-contrast flow measurement proximal to, at the level of and distal to the device to quantify potential differences in flow velocity and contrast-enhanced 3D gradient-echo MR angiography to differentiate potential femoral artery stenosis from device-related artefacts. The mean size of the oval-shaped artefact was 8.4 x 6.6 mm (+/-1.0 x 0.8 mm) and was almost identical to the maximum artefact size of the phantom measurement (8.3 x 5.7 mm). Device placement did not result in an increased peak velocity (proximal 69 +/- 23 cm/s, at the level of 64 +/- 11 cm/s and distal to the device 63 +/- 12 cm/s, p = 0.67). The mean artefact penetration into the vessel lumen was 0.5 +/- 0.5 mm (percentage vessel narrowing 7.0 +/- 6%; range 0-16%). The MR conditional StarClose femoral artery closure device was used safely within 24 h of deployment at 1.5 T. Despite clip-related artefacts MR angiography will allow for easy differentiation of clip-related artefacts from high-grade atherosclerotic stenosis.

  8. MRI after implantation of a novel femoral closure device following intra-arterial catheterisation: implications for subsequent contrast-enhanced MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Mohrs, Oliver K. [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Darmstadt Radiology, Department of Cardiovascular Imaging at Alice-Hospital, Darmstadt (Germany); Petersen, Steffen E. [The London Chest Hospital, William Harvey Research Institute, Centre Lead for Advanced Cardiovascular Imaging, London (United Kingdom); Nowak, Bernd; Voigtlaender, Thomas [Cardiovascular Center Bethanien (CCB), Frankfurt/Main (Germany); Kauczor, Hans-Ulrich [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany)

    2010-05-15

    To assess MRI safety aspects and artefacts of a novel femoral artery closure device during contrast-enhanced MR angiography in patients following intra-arterial catheterisation. Ten consecutive patients underwent MRI within 24 h of coronary angiography and placement of a femoral artery closure device. We used a T2-weighted gradient-echo MRI sequence to measure the device-related artefact size in comparison with a phantom image, phase-contrast flow measurement proximal to, at the level of and distal to the device to quantify potential differences in flow velocity and contrast-enhanced 3D gradient-echo MR angiography to differentiate potential femoral artery stenosis from device-related artefacts. The mean size of the oval-shaped artefact was 8.4 x 6.6 mm ({+-}1.0 x 0.8 mm) and was almost identical to the maximum artefact size of the phantom measurement (8.3 x 5.7 mm). Device placement did not result in an increased peak velocity (proximal 69 {+-} 23 cm/s, at the level of 64 {+-} 11 cm/s and distal to the device 63 {+-} 12 cm/s, p = 0.67). The mean artefact penetration into the vessel lumen was 0.5 {+-} 0.5 mm (percentage vessel narrowing 7.0 {+-} 6%; range 0-16%). The MR conditional StarClose femoral artery closure device was used safely within 24 h of deployment at 1.5 T. Despite clip-related artefacts MR angiography will allow for easy differentiation of clip-related artefacts from high-grade atherosclerotic stenosis. (orig.)

  9. Vacuum-assisted wound closure in vascular surgery - clinical and cost benefits in a developing country

    Directory of Open Access Journals (Sweden)

    Končar Igor

    2016-01-01

    Full Text Available Background/Aim. Surgical and chronic wounds in vascular patients might contribute to limb loss and death. Vacuum-assisted closure (VAC - Kinetic Concepts, Inc. (KCI, has been increasingly used in Western Europe and the USA clinical practice for 15 years. Advantages of this method are faster wound healing, wound approximation, lower wound related treatment costs and improved quality of life during treatment. Evidence related to the usage of VAC therapy in vascular patients and cost effectiveness of VAC therapy in a developing country are lacking. The aim of this study was to explore results of VAC therapy in vascular surgery comparing to conventional methods and to test cost effects in a developing country like Serbia. Methods. All patients with wound infection or dehiscence operated at the tertiary vascular university clinic in the period from January 2011 - January 2012, were treated with VAC therapy. The primary endpoint was wound closure, while secondary endpoints were hospital stay, the number of weekly dressings, costs of wound care, working time of medical personnel. The patients were divided into groups according to the wound type and location: wound with exposed synthetic vascular implant (25%, laparotomy (13%, foot amputation (29%, major limb amputation (21%, fasciotomy (13%. The results of primary and secondary endpoint were compared with the results of conventional treatment during the previous year. Results. There was one death (1/42, 2.38% and one limb loss (1/12, 2.38% in the VAC group, and 8 deaths (8/38, 21.05% and 5 (5/38, 13.15% limb losses in the patients treated with conventional therapy. In the VAC group there was one groin bleeding (1/12, 2.38%, one groin reinfection (1/12, 2.38% and one resistance to therapy with a consequent limb loss. Costs of hospital stay (p < 0.001 and nursing time (p < 0.001 were reduced with VAC therapy in the group with exposed graft. Conclusion. VAC therapy is the effective method for care of

  10. Adipose inflammation initiates recruitment of leukocytes to mouse femoral artery: role of adipo-vascular axis in chronic inflammation.

    Directory of Open Access Journals (Sweden)

    Sumihiko Hagita

    Full Text Available BACKGROUND: Although inflammation within adipose tissues is known to play a role in metabolic syndrome, the causative connection between inflamed adipose tissue and atherosclerosis is not fully understood. In the present study, we examined the direct effects of adipose tissue on macro-vascular inflammation using intravital microscopic analysis of the femoral artery after adipose tissue transplantation. METHODS AND RESULTS: We obtained subcutaneous (SQ and visceral (VIS adipose tissues from C57BL/6 mice fed normal chow (NC or a high fat diet (HF, then transplanted the tissues into the perivascular area of the femoral artery of recipient C57/BL6 mice. Quantitative intravital microscopic analysis revealed an increase in adherent leukocytes after adipose tissue transplantation, with VIS found to induce significantly more leukocyte accumulation as compared to SQ. Moreover, adipose tissues from HF fed mice showed significantly more adhesion to the femoral artery. Simultaneous flow cytometry demonstrated upregulation of CD11b on peripheral granulocyte and monocytes after adipose tissue transplantation. We also observed dominant expressions of the inflammatory cytokine IL-6, and chemokines MCP-1 and MIP-1β in the stromal vascular fraction (SVF of these adipose tissues as well as sera of recipient mice after transplantation. Finally, massive accumulations of pro-inflammatory and dendritic cells were detected in mice with VIS transplantation as compared to SQ, as well as in HF mice as compared to those fed NC. CONCLUSION: Our in vivo findings indicate that adipose tissue stimulates leukocyte accumulation in the femoral artery. The underlying mechanisms involve upregulation of CD11b in leukocytes, induction of cytokines and chemokines, and accumulation of pro-inflammatory cells in the SVF.

  11. Endovascular repair of inadvertent arterial injury induced by central venous catheterization using a vascular closure device: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, So Hee; Jang, Woo Jin; Oh, Ju Heyon; Song, Yun Gyu [Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Korea, Republic of)

    2017-04-15

    Central venous catheterization can cause various complications. Inadvertent subclavian artery catheterization was performed during insertion of a central venous catheter in a 73-year-old man suffering from panperitonitis due to small-bowel perforation. Endovascular treatment was conducted to treat the injured subclavian artery with a FemoSeal vascular closure device.

  12. A national Vascular Quality Initiative database comparison of hybrid and open repair for aortoiliac-femoral occlusive disease.

    Science.gov (United States)

    Zavatta, Marco; Mell, Matthew W

    2017-08-16

    We sought to analyze the outcomes of revascularization for aortoiliac-femoral occlusive disease by comparing hybrid repair by endovascular revascularization and open common femoral endarterectomy (ER-CFE) with open aortoiliac reconstruction and CFE (OR-CFE). Using the national Society for Vascular Surgery Vascular Quality Initiative database from 2009 to 2015, we identified all patients receiving open or endovascular revascularization of the aortoiliac system and who additionally underwent CFE. Patients with concomitant infrainguinal procedures were excluded, as were procedures performed at centers with CFE group and 1472 in the ER-CFE group with follow-up of at least 9 months. Patients with ER-CFE were older (68 ± 9 years vs 63 ± 9 years; P CFE were more likely to have received a previous inflow procedure (27% vs 21%; P CFE (5.2 ± 1.6 vs 2.9 ± 1.0; P CFE was associated with lower 30-day mortality (1.8% vs 3.4%; P = .01), shorter length of stay (median 3 vs 7 days; P CFE had greater ABI improvement at long-term follow-up (0.39 ± 0.37 vs 0.26 ± 0.23; P CFE appeared to have improved short-term outcomes and equivalent freedom from major amputation compared with open surgical repair with CFE. Conversely, open repair with CFE was associated with better long-term improvement in ABI and ambulatory status. Open repair should therefore be considered for patients with aortoiliac-femoral occlusive disease and reasonable surgical risk. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  13. Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems.

    Science.gov (United States)

    Hagberg, K; Brånemark, R

    2001-12-01

    Individuals with unilateral trans-femoral amputations due to non-vascular causes were studied in a mailed survey designed to investigate health-related quality of life (HRQL), prosthetic use and problems. The Swedish SF-36 Health Survey and a structured questionnaire designed for trans-femoral amputees were used. The series consisted of 97 subjects (60 men, 37 women), aged 20 to 69 years with a mean of 22 years since the amputation. Trauma was the cause of amputation in 55%, tumour in 35% and other causes in 10%. Ninety-two (92) subjects (95%) had a prosthesis and 80 (82%) used it daily. General HRQL was significantly lower than Swedish age- and gender-matched norms in all dimensions as measured by SF-36. Most frequently reported problems that had led to reduction in quality of life were heat/sweating in the prosthetic socket (72%), sores/skin irritation from the socket (62%), inability to walk in woods and fields (61%) and inability to walk quickly (59%). Close to half were troubled by stump pain (51%), phantom limb pain (48%), back pain (47%) and pain in the other leg (46%). One fourth considered themselves to have a poor or extremely poor overall situation. Transfemoral amputation, due to non-vascular causes, has an evident impact on quality of life and there are considerable problems related to the amputation and the prosthesis. Efforts to improve the physical and the psychological well-being for this group, with a long life expectancy, are needed.

  14. The dangers of damage control orthopedics: a case report of vascular injury after femoral fracture external fixation

    Directory of Open Access Journals (Sweden)

    Staeheli Gregory R

    2012-03-01

    Full Text Available Abstract Background Placement of external fixation frames is an expedient and minimally invasive method of achieving bone and joint stability in the setting of severe trauma. Although anatomic safe zones are established for placement of external fixation pins, neurovascular structures may be at risk in the setting of severe trauma. Case report We present a case of a 21-year-old female involved in a high speed motorcycle accident who sustained a Type IIIB open segmental femur fracture with significant thigh soft tissue injury. Damage control orthopedic principals were applied and a spanning external fixator placed for provisional femoral stabilization. Intraoperative vascular examination noted absent distal pulses, however an intraoperative angiogram showed arterial flow distal to the trifurcation. Immediately postoperatively the dorsalis pedis pulse was detected using Doppler ultrasound but was then non-detectable over the preceding 12-hours. Femoral artery CT angiogram revealed iatrogenic superficial femoral artery occlusion due to kinking of the artery around an external fixator pin. Although the pin causing occlusion was placed under direct visualization, the degree of soft tissue injury altered the appearance of the local anatomy. The pin was subsequently revised allowing the artery to travel in its anatomic position, restoring perfusion. Conclusion This case highlights the dangers associated with damage control orthopedics, especially when severe trauma alters normal local anatomy. Careful assessment of external fixator pin placement is crucial to avoiding iatrogenic injury. We recommend a thorough vascular examination pre-operatively and prior to leaving the operating room, which allows any abnormalities to be further evaluated while the patient remains in a controlled environment. When an unrecognized iatrogenic injury occurs, serial postoperative neurovascular examinations allow early recognition and corrective actions.

  15. Coaxial electrospinning of P(LLA-CL)/heparin biodegradable polymer nanofibers: potential vascular graft for substitution of femoral artery.

    Science.gov (United States)

    Zhai, Wei; Qiu, Li-Jun; Mo, Xiu-Mei; Wang, Sheng; Xu, Yun-Fei; Peng, Bo; Liu, Min; Huang, Jun-Hua; Wang, Guang-Chun; Zheng, Jun-Hua

    2013-06-07

    Electrospinning is one of the most simple and effective methods to prepare polymer fibers with the diameters ranging from nanometer to several micrometers. Poly(L-lactide)-co-poly (ɛ-caprolactone) (P(LLA-CL)) fibers and P(LLA-CL)/heparin coaxial composite fibers herein were successfully prepared by single electrospinning and coaxial electrospinning, respectively. The prepared endothelialized P(LLA-CL) and P(LLA-CL)/heparin vascular grafts were used in the Beagle dogs experiment to evaluate the feasibility of thus made different scaffolds for substitution of dog femoral artery in early period, medium term, and long term, meanwhile the pure P(LLA-CL) vascular graft was used as the control group during all the experiments. The animal model was established by using the graft materials to anastomose both femoral arteries of dogs. The vascular grafts patency rates (i.e., the unobstructed capacity of blood vessel) were detected by color Doppler flow imaging technology and digital subtraction angiography. To observe the histological morphology at different periods, the vascular grafts were removed after 7, 14, and 30 days, and the corresponding histological changes were evaluated by hematoxylin and eosin staining. The experimental results show that in the early period, the patency rates of pure P(LLA-CL) graft, endothelial P(LLA-CL) graft, and P(LLA-CL)/heparin graft were 75%, 75%, and 100%, respectively; in the medium term, the patency rates of pure P(LLA-CL) graft and endothelial P(LLA-CL) graft were 25%, whereas that of P(LLA-CL)/heparin graft was 50%; the patency rates of pure P(LLA-CL) graft and endothelial P(LLA-CL) graft were down to 0%, whereas the patency rate of P(LLA-CL)/heparin graft was 25% in the long term. This preliminary study has demonstrated that P(LLA-CL)/heparin coaxial composite fiber maybe a reliable artificial graft for the replacement of femoral artery. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2013.

  16. Emergency Percutaneous Coronary Intervention Through the Left Radial Artery is Associated with Less Vascular Complications than Emergency Percutaneous Coronary Intervention Through the Femoral Artery.

    Science.gov (United States)

    Qi, Guoqing; Sun, Qi; Xia, Yue; Wei, Liye

    2017-01-01

    To compare the advantages and disadvantages of emergency percutaneous coronary intervention through the left radial artery with those of emergency percutaneous coronary intervention through the femoral artery. A total of 206 patients with acute myocardial infarction who required emergency percutaneous coronary intervention and were admitted to our hospital between January 2011 and August 2013 were divided into the following two groups: a group that underwent percutaneous coronary intervention through the left radial artery and a group that underwent percutaneous coronary intervention through the femoral artery. The times required for angiographic catheter and guiding catheter placement, the success rate of the procedure and the incidence of vascular complications in the two groups were observed. There was no significant difference in catheter placement time or the ultimate success rate of the procedure between the two groups. However, the left radial artery group showed a significantly lower incidence of vascular complications than the femoral artery group (pEmergency percutaneous coronary intervention through the left radial artery is associated with less vascular complications than emergency percutaneous coronary intervention through the femoral artery and is thus potentially advantageous for patients.

  17. MANTA, a novel plug-based vascular closure device for large bore arteriotomies: technical report.

    Science.gov (United States)

    van Gils, Lennart; Daemen, Joost; Walters, Greg; Sorzano, Todd; Grintz, Todd; Nardone, Sam; Lenzen, Mattie; De Jaegere, Peter P T; Roubin, Gary; Van Mieghem, Nicolas M

    2016-09-18

    Catheter-based interventions have become a less invasive alternative to conventional surgical techniques for a wide array of cardiovascular diseases but often create large arteriotomies. A completely percutaneous technique is attractive as it may reduce the overall complication rate and procedure time. Currently, large bore arteriotomy closure relies on suture-based techniques. Access-site complications are not uncommon and often seem related to closure device failure. The MANTA VCD is a novel collagen-based closure device that specifically targets arteriotomies between 10 and 22 Fr. This technical report discusses the MANTA design concept, practical instructions for use and preliminary clinical experience.

  18. Twelve-month experience with the GORE® TIGRIS® Vascular Stent in the superficial femoral and popliteal arteries.

    Science.gov (United States)

    Piorkowski, M; Freitas, B; Steiner, S; Botsios, S; Bausback, Y; Scheinert, D; Schmidt, A

    2015-02-01

    The aim of this paper was to report the continued mid-term follow-up of the first patients world-wide treated with the GORE(®) TIGRIS(®) Vascular Stent, a dual component stent consisting of a nitinol wire frame combined with a fluoropolymer-interconnecting structure. From December 2011 until November 2012, 32 consecutive patients (20 men, mean age 72.8 years) with 40 atherosclerotic femoropopliteal lesions (5% occlusions) underwent angioplasty and implantation of a GORE(®) TIGRIS(®) Vascular Stent. The patients were scheduled for follow-up at 3, 6 and 12 months after stent implantation for duplex ultrasound and assessment of Rutherford-Becker class (RBC) and Ankle-Brachial Index (ABI). Here we report the completed 6-month follow-up and, for the first time, a 12-month follow-up. The median follow-up was 418 days. During the 12-month follow-up 4 patients died. Restenosis or reocclusion of the stent in this time period was observed in 5 lesions (12.5%), resulting in a cumulative primary patency rate of 85.5±6.0%. The ABI increased pre-interventionally from 0.65±0.18 to 0.91±0.18 (PGORE(®) TIGRIS(®) Vascular Stent showed promising results with high 12-month primary patency rates after femoropopliteal endovascular interventions. These first clinical data are very promising compared to other stent concepts in the superficial femoral and popliteal artery.

  19. Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

    DEFF Research Database (Denmark)

    Krähenbühl, B; Nielsen, S L; Lassen, N A

    1977-01-01

    Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers...... by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure...... also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients...

  20. Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

    DEFF Research Database (Denmark)

    Krähenbühl, B; Nielsen, S L; Lassen, N A

    1977-01-01

    Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers...... by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure...... also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients...

  1. Caveolar disruption causes contraction of rat femoral arteries via reduced basal NO release and subsequent closure of BKCa channels

    Directory of Open Access Journals (Sweden)

    AY Al-Brakati

    2015-05-01

    Full Text Available Background and Purpose. Caveolae act as signalling hubs in endothelial and smooth muscle cells. Caveolar disruption by the membrane cholesterol depleting agent methyl-β-cyclodextrin (M-β-CD has various functional effects on arteries including (i impairment of endothelium-dependent relaxation, and (ii alteration of smooth muscle cell (SMC contraction independently of the endothelium. The aim of this study was to explore the effects of M-β-CD on rat femoral arteries.Methods. Isometric force was measured in rat femoral arteries stimulated to contract with a solution containing 20 mM K+ and 200 nM Bay K 8644 (20 K/Bay K or with one containing 80 mM K+(80 K.Results. Incubation of arteries with M-β-CD (5 mM, 60 min increased force in response to 20 K/Bay K but not that induced by 80 K. Application of cholesterol saturated M-β-CD (Ch-MCD, 5 mM, 50 min reversed the effects of M-β-CD. After mechanical removal of endothelial cells M-β-CD caused only a small enhancement of contractions to 20 K/Bay K. This result suggests M-β-CD acts via altering release of an endothelial-derived vasodilator or vasoconstrictor. When nitric oxide synthase was blocked by pre-incubation of arteries with L-NAME (250 µM the contraction of arteries to 20 K/Bay K was enhanced, and this effect was abolished by pre-treatment with M-β-CD. This suggests M-β-CD is inhibiting endothelial NO release. Inhibition of large conductance voltage- and Ca2+-activated (BKCa channels with 2 mM TEA+ or 100 nM Iberiotoxin (IbTX enhanced 20 K/Bay K contractions. L-NAME attenuated the contractile effect of IbTX, as did endothelial removal.Conclusions. Our results suggest caveolar disruption results in decreased release of endothelial-derived nitric oxide in rat femoral artery, resulting in a reduced contribution of BKCa channels to the smooth muscle cell membrane potential, causing depolarisation and contraction.

  2. Therapeutic effect of osteogenically induced adipose derived stem cells on vascular deprivation-induced osteonecrosis of the femoral head in rabbits

    Institute of Scientific and Technical Information of China (English)

    Abudusaimi Aimaiti; Yilixiati Saiwulaiti; Maimaitiming Saiyiti; WANG Yun-hai; CUI Lei; Aihemaitijiang Yusufu

    2011-01-01

    Objective: To explore the therapeutic effect of osteogenically induced adipose-derived stem cells (ADSCs) on vascular deprivation-induced osteonecrosis of the femoral head (ONFH) in rabbit model. Methods: Vascular deprivation-induced ONFH was established by intramuscular injection of methylprednisolone, and vascular occlusion of the capital femoral epiphysis by electrocoagulation in adult New Zealand white rabbits. Eight weeks after the establishment of vascular deprivation-induced ONFH, animals were randomly divided into three equal groups. In Group A (control), no therapy was given. In Group B, core decompression was performed by drilling a hole (1.2 mm in diameter) from the outer cortex 2.5 cm distal to the proximal end of the greater trochanter. In Group C, 1 ×107 osteogenically induced ADSCs were resuspended in 0.5 ml PBS, and then injected directly into the femoral head. Femoral head specimens were obtained at postoperative 8 weeks. The bone formation and three-dimensional microstructure of the femoral head was evaluated by micro-computed tomography scans (μ-CT). Immunohistochemical analysis was performed to detect the expression of osteocalcin. Angiogenesis and repair of the femoral head were observed histologically. Results: In trabecular bone at the proximal femur region, the trabecular volume was higher in Group C (130.70 mm3± 4.33 mm3) than that in Groups A (101.07 mm3±7.76 mm3) and B (107.89 mm3±8.68 mm3, P<0.01). Bone volume was significantly increased in Group C (40.09 mm3±6.35 mm3) than in Groups A (29.65 mm3±4.61 mm3) and B (31.80 mm3± 4.01 mm3, P<0.01). The trabecular number was higher in Groups C (1.58±0.25) than other two groups (1.15±0.18, 1.16± 0.21, P<0.01). Bone mineral density showed statistically significant difference between Groups C and A or B (375.38± 23.06) mg HA/ccm, vs (313.73 ±19.30) mg HA/ccm and (316.09± 16.45) mg HA/ccm, P<0.01). Histological examination indicated that there was more new bone formation in

  3. Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture.

    Science.gov (United States)

    Pereira, Julio Leonardo Barbosa; Vieira, Gerival; de Albuquerque, Lucas Alverne Freitas; Mendes, George de Albuquerque Cavalcanti; Salles, Ludmila Rezende; de Souza, André Felipe Ferreira; Dellaretti, Marcos; de Sousa, Atos Alves

    2012-01-01

    The craniotomy performed with minimal hair removal and closure with intradermal suture alone is an option in neurosurgical procedures, which can help faster psychological recovery of the patient, as it allows a better cosmetic result. This study is aimed at evaluating if such method is safe and effective, compared with continuous skin sutures with 2-0 nylon. We analyzed the sutures in 117 patients undergoing craniotomies for cerebral aneurysm clipping. In the case group (n = 49), closure of the scalp was performed only with intradermal absorbable sutures using wire Monocryl(®) 2-0. In the control group (n = 68), closure was performed with continuous suture using 2-0 nylon. The case group was composed of 49 patients in whom just intradermal suture was performed. One (2.2%) patient developed wound infection and was given proper medical treatment. No cases of dehiscence or cerebrospinal fluid leaks were observed. The control group was composed of 68 patients in whom the skin was closed with 2-0 nylon continuous suture. Three (5.3%) patients developed wound infection and were given proper medical treatment. There were no cases of wound dehiscence. The overall infection rate in the control group was 4%. There was no statistically significant difference in the number of wound infections between the two groups (P = 0.73). The closure with intradermal suture alone in craniotomies is as safe as the traditional skin closure with nylon sutures, besides eliminating the need for suture removal and providing a cosmetic advantage.

  4. 24h and 30 day outcome of Perclose Proglide suture mediated vascular closure device: An Indian experience.

    Science.gov (United States)

    Vinayakumar, Desabandhu; Kayakkal, Shajudeen; Rajasekharan, Sandeep; Thottian, Julian Johny; Sankaran, Prasanth; Bastian, Cicy

    Advantages of vascular closure device over manual compression include patient comfort, early mobilisation and discharge, avoidance of interruption of anticoagulation, avoidance of local compression and its sequelae and less time constraint on staff. No published Indian data exist regarding Perclose Proglide suture mediated vascular closure device (SMC). To study the 24h and 30 day outcome of Perclose Proglide SMC retrospectively. Retrospective observational study conducted in the Department of Cardiology, Government Medical College, Calicut, Kerala from June 2013 to June 2015. All consecutive patients with Perclose Proglide SMC deployment done by a single operator for achieving access site haemostasis where 24h and 30 day post-procedure data were available were included. Major and minor complications, procedure success, device failure were predefined. 323 patients were analysed. Procedure success rate was 99.7% (322/323). Transient oozing occurred in 44 patients (13.6%), minor and major complications occurred in 2% and 1.5% of patients respectively. Major complication included one case of retroperitoneal bleed, one access site infection, one pseudo aneurysm formation and two access site arterial stenosis. There was no death or complication requiring limb amputation. "Preclose" technique was used successfully in six patients. Primary device failure occurred in 12 cases which were tackled successfully with second Proglide in all except one. Perclose Proglide SMC is a safe and effective method to achieve haemostasis up to 22F with less complication rate. Copyright © 2016. Published by Elsevier B.V.

  5. Vasodilator activity of 2-(p-chloro-alpha-hydroxybenzyl)benzimidazole (HBBPC) on femoral vascular bed of the rabbit.

    Science.gov (United States)

    Demenge, P; Silice, C; Luu Duc, C; Carraz, G

    1979-01-01

    The effects of 2-(p-chloro-alpha-hydroxybenzyl) benzimidazole HCl (HBBPC) have been studied on the femoral peripheral resistance (i.v. route) and only femoral blood flow (local i.a. injection), in comparison with other vasodilators, i.e., sodium nitroprusside, dihydralazine and piribedil. The vasomotor activity of HBBPC, namely, decreased peripheral resistance and increased femoral blood flow, seems interesting because it begins after pressure has returned to normal. This substance is likely to induce a vasoconstriction in other areas (increased femoral blood flow with decreased peripheral resistance without a fall of blood pressure).

  6. Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture

    OpenAIRE

    Pereira, Julio Leonardo Barbosa; Vieira,Gerival; de Albuquerque, Lucas Alverne Freitas; Mendes, George de Albuquerque Cavalcanti; Salles, Ludmila Rezende; de Souza, André Felipe Ferreira; Dellaretti, Marcos; Sousa,Atos Alves de

    2012-01-01

    Background: The craniotomy performed with minimal hair removal and closure with intradermal suture alone is an option in neurosurgical procedures, which can help faster psychological recovery of the patient, as it allows a better cosmetic result. This study is aimed at evaluating if such method is safe and effective, compared with continuous skin sutures with 2-0 nylon. Methods: We analyzed the sutures in 117 patients undergoing craniotomies for cerebral aneurysm clipping. In the case group (...

  7. Safety and Efficacy of the Prostar XL Vascular Closing Device for Percutaneous Closure of Large Arterial Access Sites

    Directory of Open Access Journals (Sweden)

    Christoph Thomas

    2013-01-01

    Full Text Available Purpose. The purpose of this study is to retrospectively evaluate the efficacy and safety of the Prostar XL device for percutaneous large access site closure in an unselected patient and operator collective. Materials and Methods. All patients ( who had received percutaneous vascular closing with the Prostar XL device in our institution with follow-up data of at least 6 months were retrospectively included. Primary (freedom from surgical conversion and continued (freedom from groin surgery in further course technical success and major (deviations from expected outcome requiring surgery and minor (other deviations from expected outcome complications were assessed. Success and complications rates were correlated with delivery system size (Mann-Whitney Rank Sum Tests and operator experience (paired samples t-test. Results. Rates of primary and continued technical success as well as major and minor complications were 93.6%, 89.7%, 10.3%, and 10.3% (groin based and 90.0%, 84.0%, 16.0%, and 16.0% (patient based, respectively. No correlation of success and complications rate was found with delivery system sizes and operator experience. Conclusions. Application of the Prostar XL device for percutaneous closure of large arterial access sites is safe with a relatively high rate of technical success and low rate of major complications. Sizes of the delivery systems and the experience of the operator did not influence the results.

  8. Femoral pseudoaneurysms in drug addicts

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Rørdam, Peter; Jensen, L P

    1997-01-01

    OBJECTIVE: To evaluate the outcome of treatment of femoral pseudoaneurysms in drug addicts. METHODS: The records of eight patients undergoing vascular surgery for femoral pseudoaneurysms from substance abuse identified from a vascular database were reviewed. RESULTS: Were good in four out of five...

  9. Isocyanate-functional adhesives for biomedical applications. Biocompatibility and feasibility study for vascular closure applications.

    Science.gov (United States)

    Hadba, Ahmad R; Belcheva, Nadya; Jones, Fatima; Abuzaina, Ferass; Calabrese, Allison; Kapiamba, Mbiya; Skalla, Walter; Taylor, Jack L; Rodeheaver, George; Kennedy, John

    2011-10-01

    Biodegradable isocyanate-functional adhesives based on poly(ethylene glycol)-adipic acid esters were synthesized, characterized, and evaluated in vitro and in vivo. Two types of formulations, P2TT and P2MT, were developed by functionalization with 2,4-tolylene diisocyanate (TDI) or 4,4'-methylene-bis(phenyl isocyanate) (MDI), respectively, and branching with 1,1,1-trimethylolpropane (TMP). The biocompatibility of the synthesized adhesive formulations was evaluated as per ISO 10993. Cytotoxicity, systemic toxicity, pyrogenicity, genotoxicity (reverse mutation of Salmonella typhimurium and Escherichia coli), hemolysis, intracutaneous reactivity, and delayed-type hypersensitivity were evaluated. All formulations met the requirements of the conducted standard tests. The biological behavior and ability of the adhesive formulations to close an arteriotomy and withstand arterial pressure following partial approximation with a single suture were evaluated in a rat abdominal aorta model. Animals were evaluated at 1, 2, 3, and 4 weeks after surgery. Macroscopic and histopathologic evaluation of explanted arteries suggested that the P2TT formulation had better in vivo performance than the P2MT formulation. Additionally, the P2TT formulation resulted in less tissue reaction than P2MT formulation. To our knowledge, this is the first study demonstrating the potential of this new class of isocyanate-functional degradable adhesives for vascular applications. Copyright © 2011 Wiley Periodicals, Inc.

  10. Treatment of delayed jejunal perforation after irreducible femoral hernia repair with open abdomen management and delayed abdominal closure with skin flap approximation

    Directory of Open Access Journals (Sweden)

    Fahri Yetişir

    2015-01-01

    Conclusion: Delayed bowel perforation may develop after irreducible femoral hernia surgery. OA management with NPT and DAC with skin flap approximation are optimal treatment modalities for the hemodynamically instable patient.

  11. p21-Activated Kinase 4 Promotes Intimal Hyperplasia and Vascular Smooth Muscle Cells Proliferation during Superficial Femoral Artery Restenosis after Angioplasty

    Directory of Open Access Journals (Sweden)

    Liangxi Yuan

    2017-01-01

    Full Text Available The aim of this study is to explore the function of p21-activated kinase 4 (PAK4 in intimal hyperplasia (IH and vascular smooth muscle cells (VSMCs proliferation. We choose vascular samples from patients undergoing angioplasty in superficial femoral artery (SFA as the experimental group and vascular samples from donors without clinical SFA restenosis as the control group, respectively. We draw from the results that both levels of mRNA and protein of PAK4 in the experimental group increased dramatically compared with the control group. IH arose from angioplasty of SFA. Moreover, overexpression of PAK4 dramatically contributed to cell proliferation of VSMCs and promoted cell cycle progression from G0/G1 phase (71.12±0.69% versus 58.77±0.77%, P<0.001 into S phase (23.99±0.21% versus 31.35±0.33%, P<0.001. Besides, PAK4 downregulated the level of p21 and enhanced the activity of Akt as well. And we conclude that PAK4 acts as a regulator of cell cycle progression of VSMC by mediating Akt signaling and controlling p21 levels, which further modulate IH and VSMCs’ proliferation.

  12. Differential effects of the adenosine A1 receptor agonist adenosine amine congener on renal, femoral and carotid vascular conductance in preterm fetal sheep.

    Science.gov (United States)

    Booth, Lindsea C; Tummers, Leonie; Jensen, Ellen C; Barrett, Carolyn J; Malpas, Simon C; Gunn, Alistair J; Bennet, Laura

    2008-11-01

    1. Adenosine A(1) receptor activation is critical for endogenous neuroprotection from hypoxia-ischaemia, raising the possibility that treatment with A(1) receptor agonists may be an effective physiological protection strategy for vulnerable preterm infants. However, the A(1) receptor can mediate unwanted systemic effects, including vasoconstriction of the afferent glomerular arteriole. There is limited information on whether this occurs at doses that improve cerebral perfusion in the immature brain. 2. Therefore, in the present study, we examined whether infusion of the selective A(1) receptor agonist adenosine amine congener (ADAC) is associated with reduced renal perfusion in chronically instrumented preterm (0.7 gestation) fetal sheep. In the present study, ADAC was given in successive doses of 2.5, 5.0 and 15.0 microg, 45 min apart. 3. Treatment with ADAC was associated with a marked reduction in renal vascular conductance (and blood flow), whereas carotid conductance was increased and there was no significant effect on femoral conductance. In contrast with the stable effects of increasing ADAC dose on vascular conductance, there was a significant dose-related fall in fetal heart rate and blood pressure. 4. In conclusion, these short-term data support the concern that A(1) receptor agonist infusion can selectively impair renal perfusion, even at low doses.

  13. 吻合血管腓骨移植治疗陈旧性股骨颈骨折%Treatment of Non-union Femoral Neck Fractures with Vascularized Fibula Grafting

    Institute of Scientific and Technical Information of China (English)

    王春生; 王坤正; 党晓谦; 陈君长; 张开放; 金辽沙

    2003-01-01

    Objective: To investigate the value of transplantation of vascularized fibula intreating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Meth-ods:Vascularized heterotopic fibula was transplanted to the anterior-lateral part of the femoral neck.The fibula artery and vein were anastomosised with lateral circumflex artery and vein. Results:Onehundred and twenty-nine cases of non-union femoral neck fracture were treated with vascularized fibulagraft in our hospital from 1982 to 2002. Eighty-seven cases of them were followed up for 3 to 19years with functional and X-ray examination. The percentage of fracture healing and effect were 94. 3and 81.6, respectively. Conclusion:The fibula with blood supply has a synergistic fixation impacton the non-union femoral neck fractures. The fibula is solid enough for supporting the femoral headand preventing it from collapse. The vascularized fibula grafting, by providing blood supply to the af-fected femoral head and neck, could promote the femoral head restoration and reconstruction. In addi-tion, the periosteum of fibula plays a role in fracture healing.%目的:了解吻合血管腓骨移植治疗陈旧性股骨颈骨折和预防股骨头坏死的效果.方法:带血管腓骨移植到股骨颈的前外侧,腓动静脉与旋股外动静脉吻合.结果:1982~2002年间共吻合血管腓骨移植治疗陈旧性股骨颈骨折129例.获得随访89例,随访时间3~19年,随访患者进行X线和功能检查.按骨折愈合和功能情况分析,有效率和良好率分别是95.4%和85.1%.结论:对股骨颈骨折,腓骨有协同固定作用,对股骨头坏死腓骨作为皮质骨有支撑和防止塌陷的作用,吻合的腓骨血管为股骨头颈部提供血供,促进了股骨颈骨折的愈合和股骨头的恢复与重建.腓骨骨膜在骨折的愈合中可能起一定的作用.

  14. Expanding the utility of modified vascularized femoral periosteal bone-flaps: An analysis of its form and a comparison with a conventional-bone-graft

    Science.gov (United States)

    Hamada, Yoshitaka; Hibino, Naohito; Kobayashi, Anna

    2014-01-01

    Background Vascularized medial femoral condyle (MFC) corticoperiosteal bone-flap is a well-accepted technique when dealing with tissue defects or infection. Its role in refractory conditions and in the possible use for options concerning modifications of this bone-flap compared to a conventional iliac bone graft (conventional-graft) are rarely discussed. Methods We reviewed 21 consecutive cases concerning alternatives with some modifications of original MFC bone-flap surgery used to treat refractory conditions with bone defects, necrosis, or infection in the extremities. We present our devised approaches for this boneflap, and especially modifications of the grafted bone (including strut bone, perforator to the vastus medialis muscle, and the use of one vascular pedicle for some bone flaps) as well as the combined use of artificial bone as hybrid bone transplantation. We also compared the clinical results of 21 cases that received a conventional-graft. Results and Conclusions Following flap placement, 100% of the nonunion sites healed in an average of 2 months, which was significantly shorter than 5.5 months for the conventional-graft. The results showed the expanding possibility for options with regard to the form and options of this bone-flap as well as the shortening the duration of treatment, especially at the site of an infected distal tibia, insertion of the Achilles tendon on the posterior aspect of calcaneal osteomyelitis, distal end of the clavicle, clavicle or forearm with a bone defect, small bones with refractory conditions, and a femur without implant failure. However, it was not efficient for treating a forearm without bone defect. PMID:25983463

  15. A Retrospective Review of the Outcomes of Vacuum-assisted Closure Therapy in a Vascular Surgery Unit.

    Science.gov (United States)

    Ha, Jennifer; Phillips, Michael; Sieunarine, Kishore

    2008-08-01

     Wound problems are common in vascular surgery. They pose a therapeutic dilemma due to multiple etiologies. The use of vacuum-assisted closure (V.A.C.®, KCI, San Antonio, Tex), or negative pressure wound therapy (NPWT) has increased despite conflicting reports regarding its effectiveness. A retrospective review of 74 patients was conducted from 2002 to 2006 to assess the success of NPWT usage. Thirty-four (45.9%) patients were women and 40 (54.1%) men with median age of 65.5. There were 77 wounds in total: 25 foot, 13 toe and groin, 9 leg and thigh, 7 trunk, and 1 neck. Twenty-nine (37.7%) of these wounds were a result of surgical incision breakdown. Majority (n = 42, 54.5%) were infected secondary wounds. Six (7.8%) were infected wounds that broke down after initial closure. Overall surface area was 18.7 cm2: toe (15 cm2), foot (20 cm2), leg (32 cm2), thigh (57.5 cm2), groin (20 cm2), trunk (15 cm2), and neck (1.5 cm2). The median duration of NPWT was 11 days: toe (7.4), foot (12.2), leg (11.4), thigh (19), groin (15.6), trunk (18.4), and neck (1). The median length of stay in hospital was 36 days: toe (29.9), foot (44.5), leg (39.4), thigh (59.8), groin (35.2), trunk (45), and neck (35). The median healing time was 86 days. Overall healing was 75.4% (n ≥ 46). The predictors of poor healing were distal location, higher left dorsalis pedis value, stroke, peripheral vascular disease, retinopathy, dietary input, and supplementation. Weight gain, high dependency area (HDA) admission, combination hypoglycemic therapy, and steroid use were associated with faster healing. The success of vacuum-assisted closure is best above the ankle where the blood supply is usually adequate in vascular patients. .

  16. Um novo substituto vascular: arterioplastia femoral em cães com remendo de membrana de biopolímero de cana-de-açúcar - avaliação hemodinâmica e histopatológica A new vascular substitute: femoral artery angioplasty in dogs using sugarcane biopolymer membrane patch - hemodynamic and histopathologic evaluation

    Directory of Open Access Journals (Sweden)

    Silvio Romero de Barros Marques

    2007-12-01

    Full Text Available CONTEXTO: A obtenção de um substituto arterial ideal para o emprego nas reconstruções das artérias de pequeno e médio calibre é ainda o principal objetivo da maioria das pesquisas científicas desenvolvidas no campo dos substitutos vasculares. A membrana de biopolímero de cana-de-açúcar pode ser de grande utilidade para a realização das reconstruções arteriais em vasos de calibre inferior a 4 mm e assim permitir o tratamento de doenças que afetam milhões de pessoas no Brasil e em todo o mundo. OBJETIVO: Avaliar do ponto de vista hemodinâmico e histopatológico o comportamento da membrana do biopolímero de cana-de-açúcar quando utilizada com remendo em arterioplastias femorais em cães. MÉTODO: Oito cães adultos mestiços sob anestesia geral foram submetidos no Núcleo de Cirurgia Experimental do Centro de Ciências da Saúde-UFPE a velocimetria Doppler percutânea das artérias femorais direita e esquerda para controle pré-operatório. Sob condições de assepsia e anti-sepsia, os cães foram submetidos a arterioplastia femoral bilateral com remendos da membrana de biopolímero de cana-de-açúcar no lado esquerdo e de PTFE expandido (e-PTFE no lado direito. Na primeira semana pós-operatória, os cães foram submetidos a avaliação clínica diária e semanal a partir do oitavo dia. A avaliação clínica consistiu no exame dos pulsos femorais, na avaliação da marcha e na observação da presença de tumor pulsátil, hematoma ou hemorragia e infecção da ferida operatória. Após 180 dias das arterioplastias, sob anestesia geral, procedeu-se nova fluxometria Doppler percutânea das artérias femorais. Os animais foram submetidos à dissecção das artérias femorais, medido o diâmetro arterial e realizada velocimetria Doppler trans-operatória em pontos proximal e distal à arterioplastia. A seguir foi realizada laparotomia e exposição da aorta abdominal para acesso arteriográfico. Os segmentos das art

  17. Closure of multiple types of K+ channels is necessar to induce changes in renal vascular resistance in vivo in rats

    DEFF Research Database (Denmark)

    Sørensen, Charlotte Mehlin; Giese, Isaiah; Braunstein, Thomas Hartig

    2011-01-01

    flow (RBF) in vivo in anesthetized Sprague-Dawley rats. Test agents were infused directly into the renal artery to avoid systemic effects. Inhibition of BK(Ca) and K(ir) channels (with TEA and Ba(2+), respectively) caused small and transient reductions in RBF (to 93¿±¿2% and 95¿±¿1% of baseline...... the vasoconstriction induced by bolus injections of norepinephrine or angiotensin II (by 33¿±¿5% and 60¿±¿5%, respectively). Our results indicate that closure of numerous types of K(+) channels could participate in the mediation of agonist-induced renal vasoconstriction. Our results also suggest that renal...

  18. 股腘动脉血管搭桥术的中西医结合围手术期处理%The Perioperative Care of the Femoral Popliteal Artery Vascular Bypass Operation using Combination of Chinese and Western Medicine

    Institute of Scientific and Technical Information of China (English)

    王秋风; 狄长安

    2013-01-01

    目的:总结股腘动脉人工血管搭桥术治疗股浅动脉闭塞症的中西医结合围手术期处理经验.方法:观察62例股浅动脉闭塞症股腘动脉人工血管搭桥术的中西医结合围手术期处理对疗效的影响.结果:足背动脉搏动恢复,症状消失46例,症状明显改善16例,术后足趾溃疡愈合10例,第一、二趾截趾4例.结论:中西医结合围手术期处理是股腘动脉人工血管搭桥术康复过程中不可忽视的重要环节.%Objective:To summarize the perioperative care experience of combination of Chinese and western medicine on the femoral popliteal artery vascular bypass operation in the treatment of strands of shallow atherosclerosis block. Methods: The impact of perioperative care of Chinese and western medicine on femoral popliteal artery vascular bypass operation for 62 patients with strands of shallow arterial occlusive disease was observed. Results: In terms of pulsation of foot dorsal artery, 46 patients had symptoms disappeared, 16 patients significantly improved, 10 patients had toes ulcer healed, 4 patients had cut the first or the second toes. Conclusion:The perioperative care of combination of Chinese and western medicine is an innegligible important link in the rehabilitation process of the femoral popliteal artery vascular bypass operation.

  19. Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

    Directory of Open Access Journals (Sweden)

    CK Chan

    2013-07-01

    Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

  20. Effect of Chinese Drugs for Promoting Blood Circulation and Eliminating Blood Stasis on Vascular Endothelial Growth Factor Expression in Rabbits with Glucocorticoid-induced Ischemic Necrosis of Femoral Head

    Institute of Scientific and Technical Information of China (English)

    QI Zhen-xi; CHEN Lei

    2009-01-01

    Objective:To probe into the mechanism of Chinese drugs for promoting blood circulation and eliminating blood stasis in the prevention and treatment of glueocorticoid-induced ischemic necrosis of femoral head.Methods: Thirty New Zealand adult white rabbits were randomly divided into a normal control group (n=5)and a model group (n=25). Hydroxyprednisone acetate was intramuscularly administered to the rabbits in the model group in a dosage of 7.5 mg/kg, twice per week for 6 weeks, to induce ischemic necrosis of femoral head and normal saline of the equal volume was intramuscularly administered to the rabbits in the normal control group, twice per week for 6 weeks. Then, the 5 rabbits from the normal control group and 5 rabbits selected randomly from the model group were sacrificed and the changes in histopathology and the expression of Vascular Endothelial Growth Factor (VEGF) were observed. The other 20 rabbits in the model group were randomly divided into the treatment group 1 and the treatment group 2, and the control group 1 and the control group 2, 5 rabbits in every group. Taohong Siwu Tang (桃红四物汤 Decoction of Four Drugs with Addition of Peach Kernel and Safflower) was orally administered to the rabbits in the treatment group 1 and the treatment group 2 in a dosage of 7 ml/kg, once daily and normal saline of the equal volume was orally administered to the rabbits in the control groupl and the control group, 2 once daily. After 10 weeks the rabbits in the treatment group 1 and the control group 1 were sacrificed and after 13 weeks the rabbits in the treatment group 2 and the control group 2 were sacrificed, and the expression of VEGF was detected in these rabbits. Results: The expression of VEGF was significantly enhanced in rabbits of the model group as compared with the normal control group (P<0.01), and gradually reduced with the lapse of time. The expression of VEGF in the control groups was significantly reduced as compared with the treatment

  1. Bypass grafting with vascular prosthesis for treatment of infected femoral artery pseudoaneurysm%人工血管旁路移植治疗感染性股动脉假性动脉瘤

    Institute of Scientific and Technical Information of China (English)

    武国; 陈开; 郑江华; 戴毅

    2011-01-01

    目的 探讨人工血管旁路移植术治疗感染性股动脉假性动脉瘤的效果.方法 回顾性分析2005年1月-2010年12月40例感染性股动脉假性动脉瘤的临床资料,40例患者均为吸毒者,均接受了假性动脉瘤切除、彻底清创及人工血管旁路移植术.结果 围手术期内无死亡患者,且均保肢成功,创口均二期愈合.34例(85.0%)术后获得随访3 ~12个月,平均7.4个月.随访期内发生移植物感染3例(8.8%),取出感染的移植物后2例保肢成功,1例最终因肢体缺血坏死而接受截肢术;彩超检查发现人工血管腔内部分血栓形成4例(11.8%),给予抗血小板治疗,远端肢体均无缺血坏死.结论 人工血管旁路移植术是治疗注射吸毒所致感染性股动脉假性动脉瘤的安全、有效的方法.%Objective To evaluate the effect of the treatment of infected femoral artery pseudoaneurysm using bypass grafting with vascular prosthesis. Methods The clinical data of 40 patients with infected femoral artery pseudoaneurysm admitted to our hospital from January 2005 to December 2010 were analyzed retrospectively. All the 40 patients were drug abusers, and underwent pseudoaneurysm excision, radical debridement and vascular prosthesis bypass grafting operation. Results No death occurred and the patients' limbs were all successfully salvaged during the perioperative period. All wounds were healed by secondary intervention. Thirty-four patients were followed up for 3 to 12 months ( average of 7. 4 months ). Prosthetic graft infection occurred in three patients (8.8%) during the follow-up period, two of whom had their limbs salvaged after removal of the infected graft, and one finally underwent amputation because of ischemic limb necrosis. Thrombus formation was detected by color Doppler ultrasound in some parts of the lumen of prosthetic graft in four patients (11.8%), however, no ischemic necrosis occurred in the affected limbs of the four patients after

  2. Tension free femoral hernia repair with plug

    Institute of Scientific and Technical Information of China (English)

    Milivoje Vukovi; Neboja Moljevi; Sinia Crnogorac

    2013-01-01

    Objective: To investigate the conventional technique involves treatment of femoral hernia an approximation inguinal ligament to pectineal ligament. In technique which uses mesh closure for femoral canal without tissue tension. Method: A prospective study from January 01. 2007-May 30. 2009. We analyzed 1 042 patients with inguinal hernia, of which there were 83 patients with 86 femoral hernia. Result: Femoral hernias were present in 7.96% of cases. Males were 13 (15.66%) and 70 women (84.34%). The gender distribution of men: women is 1:5.38. Urgent underwent 69 (83%), and the 14 election (17%) patients. Average age was 63 years, the youngest patient was a 24 and the oldest 86 years. Ratio of right: left hernias was 3.4:1. With bilateral femoral hernias was 3.61% of cases. In 7 patients (8.43%) underwent femoral hernia repair with 9 Prolene plug. Conclusions: The technique of closing the femoral canal with plug a simple. The plug is made from monofilament material and is easily formed. This technique allows the reduction of recurrence and can be used safely, quickly and easily in elective and emergency situations.

  3. Immediate mobilization after coronary angiography or percutaneous coronary intervention following hemostasis with the AngioSeal vascular closure device (the MOBS study)

    DEFF Research Database (Denmark)

    Larsen, Ellen Nyholm; Hansen, Charlotte Bak; Thayssen, Per

    2014-01-01

    Intervention (MOBS) study we compared bleeding complications after cardiac catheterization with femoral artery access after mobilization immediately off the angiographic table or standard care with1 hour (MOBS I after a diagnostic angiogram) or 2 hours of bed rest before mobilization (MOBS II after PCI......). METHODS: Bleeding complications were defined as major (requiring surgery of the femoral artery, transfusion or increased hospital stay) and minor (hematoma bleeding that could be compressed manually). RESULTS: In the MOBS I cohort (100 patients were...... mobilized immediately and 100 patients followed standard care) no major bleeding complications were seen. In the immediate mobilization group 2.0% experienced minor bleeding compared to 4.0% in the standard care group (p=0.41). In the MOBS II cohort after PCI (158 patients were mobilized immediately and 161...

  4. 带血管蒂骨膜瓣移植治疗幼犬股骨头坏死实验研究%An experiment study of the vascular pedicled periosteum transfer for the treatment of femoral head necrosis in young dogs

    Institute of Scientific and Technical Information of China (English)

    官建中; 周建生; 肖玉周; 刘振华

    2010-01-01

    Objective To explore an effective method for establishing femoral head necrosis models in young dog and to evaluate osteogenesis of vascular pedicled periosteum transplanted in the repairment offemoral head necrosis of young dogs.Methods Animal models of femoral head necrosis were established by liguting and destroying femoral neck artery circles as well as freezing femoral heads with liquid nitrogen in 29 dogs.At 4 weeks, the animal models of femoral head necrosis were evaluated through X-ray, MRI, ECT,and 2 dogs were randomly executed and detectd by histology examination, then 29 dogs were divided randomly into experimental group(n = 12), control group(n = 9 )and blank group(n = 8).Dogs in the experimental group were treated with the vascular pedicled periosteum from isolateral great trochanter, dogs in the control group were treated with the vascular pedicled bone from isolateral great trochanter, and the blank group were without any treatment.4,8, 12 weeks postoperation,these femoral heads were examined morphologically, radiologieally(X-ray, MRI, ECT) and histologically.All animals were executed and detectd by histology at 12 weeks to observe the repairs of necrotic femoral heads at different periods.Results Twelve weeks postoperation, dogs femoral head figurations in the experimental group were normal, MRI signals were odds in femoral head, ECT studies shows decreased radionuclide compared with contralateral femoral head;capillary vessel and osteoblast multiplication and new traboeulacs were matured in histology examination.Dogs femoral head figurations in the contral group were irregular, MRI revealed high-low signals intermix in femoral head, ECT revealed obviously decreased radionuclide, osteoblast actived, new trabeculac and lipocyte were observed in histology examination.In blank group, femoral head figurations were distorted and sunk, while MRI signals were low, ECT showed no radionuclide uptaking.Collapsed trabeculas and many vacant bone lacuna were

  5. The safety and efficacy of hemostasis with Clo-Sur P.A.D. after transcatheter arterial chemoembolization

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Chai; Jae, Hwan Jun; Kim, Sang Youn; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2007-04-15

    We wanted to evaluate the safety and efficacy of a new hemostatic device, Clo-Sur P.A.D., at an arterial access site after performing femoral arterial catheterization to achieve transcatheter arterial chemoembolization (TACE). From August 2002 to March 2005, 113 patients who underwent TACE and agreed on using the Clo-Sur P.A.D. were enrolled in this study. We evaluated the mean time interval from compression to the first movement and also to the first walk. We also evaluated such complications as rebleeding, pseudoaneurysm, vascular occlusion, hematoma, infection and pain. For 92 patients who had previous experiences with manual compression, we evaluated their preference of hemostatic method by asking them. Successful hemostasis was achieved with the Clo-Sur P.A.D. in 105 subjects (92%). The mean time interval from compression to the first movement was 201 minutes, and that to the first walk was 267 minutes. There was no statistical difference between the complicated and the uncomplicated groups for the mean time, prothrombin time, Child-Pugh class and platelet count ({rho} > 0.05). Rebleeding occurred in 3 patients (2.7%) and mild hematoma around puncture site was noted in 5 patients (5.4%). Eighty-seven patients (95%) preferred Clo-Sur P.A.D. to the manual compression method. The Clo-Sur P.A.D. is a safe and effective hemostatic device and it provides early ambulation after TACE.

  6. Surgical management of multiple posttraumatic arteriovenous fistulas of femoral vessels.

    Science.gov (United States)

    Pokrovsky, A V; Shubin, A A; Kuntsevich, G I; Subbotin, V V; Suntsov, D S

    2008-01-01

    Presented herein are two case reports concerning surgical management of posttraumatic arteriovenous fistulas of femoral vessels. Case 1. A 45-year-old female patient attended with a history of a shotgun injury wound of her left femur and crus sustained when a girl of eight. She sought medical attention for a progressively deteriorating condition, accompanied by pain, and breathlessness dyspnea at rest. Detected were multiple fistulas between the deep femoral artery and superficial femoral artery and femoral vein. Management consisted in separation of the arteriovenous fistulas, followed by prosthetic repair of the deep femoral artery. Case 2. A 32-year-old male patient after an accidentally inflicted shotgun injury of the his left femur underwent within a time period of 3 year three vascular operations including ligation of the deep femoral artery and femoral vein followed by having later on developed secondary lymphedema of his left lower limb and pronounced manifested chronic venous insufficiency. Management included dissociation of the numerous arteriovenous fistulas between the branches of the deep femoral artery and the common femoral artery, as well as between the superficial femoral artery and femoral vein.

  7. 股静脉作为血管移植材料可行性与安全性的应用解剖研究%APPLIED ANATOMICAL STUDY ON FEASIBILITY AND SAFETY OF FEMORAL VEIN AS A VASCULAR GRAFT MATERIAL

    Institute of Scientific and Technical Information of China (English)

    颜井伟; 任为

    2012-01-01

    目的 探讨股静脉作为血管移植材料的可行性与安全性.方法 取60具成人尸体共114侧下肢标本,解剖观察股静脉、股深静脉、腘静脉及静脉交通支,测量股深静脉汇入股静脉处至收肌腱裂孔下缘的股静脉段长度,即股静脉可切取的解剖长度,以及静脉压扁外径.分析2010年3月-2011年5月收治的120例下肢股静脉段血栓形成患者CT静脉造影(computed tomography venography,CTV)检查资料,观察其下肢静脉回流通路.结果 男性尸体身高平均158.3 cm,股静脉可切取长度为(18.8±2.3)cm,相对长度为0.118±0.013,静脉压扁外径为(15.8±0.8)mm;女性尸体分别为149.2 cm、(15.1±1.5)cm、0.101±0.010、(14.0±1.1)mm.男女股静脉可切取长度比较,差异有统计学意义(t=6.354,P=0.000):静脉压扁外径比较差异有统计学意义(t=5.555,P=0.000).股静脉可切取长度与身高成正相关(r=0.964,P=0.000),股静脉压扁外径与身高成正相关(r=0.382,P=0.003).解剖观察见16侧(14.0%)肢体存在双股静脉变异支,48侧(42.1%)肢体存在1支股-腘静脉交通支,38侧(33.3%)肢体存在1支股深-腘静脉交通支.CTV检查示,下肢股静脉血栓形成以后,大隐静脉及股-腘或股深-腘静脉交通支可代偿股静脉.结论 大隐静脉和股-腘静脉交通支或股深-腘静脉交通支的存在,保证了切取股静脉作为血管移植材料的可靠性及安全性.%Objective To explore the feasibility and safety of the femoral vein as a vascular graft material. Methods A total of 114 specimens of lower limbs were harvested from 60 adult cadavers; the lower extremity femoral veins, popliteal vein, deep femoral vein, and the communicating branch were dissected and observed; the length of the available femoral vein, from the point at which deep femoral vein and femoral vein joint to the lower edge of abductor hiatus, and squash vein diameter were measured. Computed tomography venography (CTV) data from 120

  8. Femoral bowing plane adaptation to femoral anteversion

    Directory of Open Access Journals (Sweden)

    Alp Akman

    2017-01-01

    Full Text Available Background: Femoral bowing plane (FBP is the unattended subject in the literature. More over the femoral shaft with its bowing is neglected in established anteversion determination methods. There is limited information about the relationship between FBP and anteversion. Thus we focused on this subject and hypothesized that there could be an adaptation of FBP to anteversion. Materials and Methods: FBP is determined on three-dimensional solid models derived from the left femoral computerized tomography data of 47 patients which were taken before for another reason and comparatively evaluated with anteversion. There were 20 women and 27 men. The mean age of patients was 56 years (range 21-84 years. Results: The anteversion values were found as the angle between a distal condylar axis (DCA and femoral neck anteversion axis (FNAA along an imaginary longitudinal femoral axis (LFA in the true cranio-caudal view. The FBP was determined as a plane that passes through the centre-points of three pre-determinated sections on the femoral shaft. The angles between DCA, FNAA and FBP were comparatively evaluated. The independent samples t-test was used for statistical analysis. At the end, it was found that FBP lies nearly perpendicular to the anteversion axis for the mean of our sample which is around 89° in females and 93° in males (range 78-102°. On the other hand, FBP does not lie close to the sagittal femoral plane (SFP; instead, there is an average 12.5° external rotation relative to the SFP. FBP is correlated well with anteversion in terms of FBP inclination from SFP and femoral torsion (i.e., angle between FBP and femoral neck anteversion axis (P0 < 0.001; r = 0.680 and r = −0.682, respectively. Combined correlation is perfect (R[2] = 1 as the FBP, SFP, and posterior femoral plane forms a triangle in the cranio-caudal view. Conclusions: We found that FBP adapts to anteversion. As FBP lies close to perpendicularity for the mean, femoral component

  9. Femoral bowing plane adaptation to femoral anteversion

    Science.gov (United States)

    Akman, Alp; Demirkan, Fahir; Sabir, Nuran; Oto, Murat; Yorukoglu, Cagdas; Kiter, Esat

    2017-01-01

    Background: Femoral bowing plane (FBP) is the unattended subject in the literature. More over the femoral shaft with its bowing is neglected in established anteversion determination methods. There is limited information about the relationship between FBP and anteversion. Thus we focused on this subject and hypothesized that there could be an adaptation of FBP to anteversion. Materials and Methods: FBP is determined on three-dimensional solid models derived from the left femoral computerized tomography data of 47 patients which were taken before for another reason and comparatively evaluated with anteversion. There were 20 women and 27 men. The mean age of patients was 56 years (range 21–84 years). Results: The anteversion values were found as the angle between a distal condylar axis (DCA) and femoral neck anteversion axis (FNAA) along an imaginary longitudinal femoral axis (LFA) in the true cranio-caudal view. The FBP was determined as a plane that passes through the centre-points of three pre-determinated sections on the femoral shaft. The angles between DCA, FNAA and FBP were comparatively evaluated. The independent samples t-test was used for statistical analysis. At the end, it was found that FBP lies nearly perpendicular to the anteversion axis for the mean of our sample which is around 89° in females and 93° in males (range 78–102°). On the other hand, FBP does not lie close to the sagittal femoral plane (SFP); instead, there is an average 12.5° external rotation relative to the SFP. FBP is correlated well with anteversion in terms of FBP inclination from SFP and femoral torsion (i.e., angle between FBP and femoral neck anteversion axis (P < 0.001; r = 0.680 and r = −0.682, respectively). Combined correlation is perfect (R2 = 1) as the FBP, SFP, and posterior femoral plane forms a triangle in the cranio-caudal view. Conclusions: We found that FBP adapts to anteversion. As FBP lies close to perpendicularity for the mean, femoral component positioning

  10. Ensayo clínico de asignación aleatoria, para evaluar la eficacia de dos técnicas de compresión en la disminución de complicaciones en el sitio de acceso vascular femoral, posterior a cateterismo diagnóstico y terapéutico

    OpenAIRE

    Ramírez-Gutiérrez,Álvaro Eduardo; Eid-Lidt,Guering; Esquinca-Vera,Juan Carlos; Damas-de los Santos,Félix; Pérez-González,Alberto; Kimura-Hayama, Eric; Bacilio-Pérez,Ulises; Gaspar-Hernández,Jorge

    2012-01-01

    Objetivo: Comparar la incidencia de falla en la hemostasia y frecuencia de eventos vasculares, durante y después de la compresión con dos maniobras diferentes. Métodos: Se realizó un ensayo clínico de asignación aleatoria a compresión mecánica o compresión manual, para el retiro de introductor en arteria femoral posterior a cateterismo diagnóstico o terapéutico. Resultados: Se incluyeron 100 pacientes en el grupo de compresión con compresor (grupo uno) y 112 de forma manual (grupo dos). La fa...

  11. Ensayo clínico de asignación aleatoria, para evaluar la eficacia de dos técnicas de compresión en la disminución de complicaciones en el sitio de acceso vascular femoral, posterior a cateterismo diagnóstico y terapéutico

    OpenAIRE

    Ramírez-Gutiérrez,Álvaro Eduardo; Eid-Lidt,Guering; Esquinca-Vera,Juan Carlos; Damas-de los Santos,Félix; Pérez-González,Alberto; Kimura-Hayama,Eric; Bacilio-Pérez,Ulises; Gaspar-Hernández,Jorge

    2012-01-01

    Objetivo: Comparar la incidencia de falla en la hemostasia y frecuencia de eventos vasculares, durante y después de la compresión con dos maniobras diferentes. Métodos: Se realizó un ensayo clínico de asignación aleatoria a compresión mecánica o compresión manual, para el retiro de introductor en arteria femoral posterior a cateterismo diagnóstico o terapéutico. Resultados: Se incluyeron 100 pacientes en el grupo de compresión con compresor (grupo uno) y 112 de forma manual (grupo dos). La fa...

  12. Restaurant closures

    CERN Multimedia

    Novae Restauration

    2012-01-01

    Christmas Restaurant closures Please note that the Restaurant 1 and Restaurant 3 will be closed from Friday, 21 December at 5 p.m. to Sunday, 6 January, inclusive. They will reopen on Monday, 7 January 2013.   Restaurant 2 closure for renovation To meet greater demand and to modernize its infrastructure, Restaurant 2 will be closed from Monday, 17 December. On Monday, 14 January 2013, Sophie Vuetaz’s team will welcome you to a renovated self-service area on the 1st floor. The selections on the ground floor will also be expanded to include pasta and pizza, as well as snacks to eat in or take away. To ensure a continuity of service, we suggest you take your break at Restaurant 1 or Restaurant 3 (Prévessin).

  13. Femoral hernia causing pneumoperitoneum.

    OpenAIRE

    King, H. A.; Boulter, P. S.

    1986-01-01

    Richter's hernia, in which only a portion of the circumference of the intestine lies within the sac, is a common complication of femoral hernia. This case report is of 39 year old female who presented with a pneumoperitoneum and was found at laparotomy to have a right femoral Richter's hernia containing a knuckle of perforated small bowel. This is a previously unreported presentation of femoral hernia.

  14. Femoral hernia repair

    Science.gov (United States)

    Femorocele repair; Herniorrhaphy; Hernioplasty - femoral ... During surgery to repair the hernia, the bulging tissue is pushed back in. The weakened area is sewn closed or strengthened. This repair ...

  15. Outcome of Kidney Allografts in Recipients With a Femoral Arteriovenous Fistula: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Denise M.D. Özdemir-van Brunschot

    2016-09-01

    Full Text Available Two patients, who were on hemodialysis over a femoral arteriovenous fistula, were transplanted in our center. Despite adequate blood pressure, perfusion of the renal allograft remained poor after completion of the vascular anastomoses. Ligation of the femoral arteriovenous fistula (1.6 L/min led to adequate perfusion. Initial graft function was good. Although it remains unclear whether ischemia of a renal allograft is caused by venous hypertension or vascular steal due to a femoral arteriovenous fistula, it might be necessary to ligate a femoral arteriovenous fistula to obtain adequate graft perfusion.

  16. Transcatheter closure of a residual aortopulmonary window through internal jugular vein access.

    Science.gov (United States)

    Prem Sekar, R; Bhima Shankar, P R; Cherian, Kotturathu Mamman

    2012-01-01

    The use of Amplatzer septal occluder for closing a residual aortopulmonary defect has been described. This is usually performed by femoral access. We report closure of a residual aortopulmonary defect using right internal jugular vein access in a patient who had no femoral access as a result of previous cannulation for surgical repair. The 1 cm defect was closed successfully using a 10 mm Amplatzer septal occluder. Technical difficulty anticipated was unfounded although it was more cumbersome than femoral access. Left to right cardiac defects including PDA and AP window are amenable to transcatheter closure through internal jugular vein access.

  17. Radiographic femoral varus measurement is affected unpredictably by femoral rotation

    DEFF Research Database (Denmark)

    Miles, James Edward

    Radiographic measurements of femoral varus are used to determine if intervention to correct femoral deformity is required, and to calculate the required correction. The varus angle is defined as the angle between the proximal femoral long axis (PFLA) and an axis tangential to the distal femoral c...

  18. Design of closure works

    NARCIS (Netherlands)

    Verhagen, H.J.

    2007-01-01

    This chapter discusses the design aspects of estuary and river closures and those of reservoir dams and certain other hydraulic structures. The focus of this chapter is on closures, not on the situation after the closure has been completed.

  19. Experimental study on vascular bundle implantation combined with cellular transplantation in treating rabbit femoral head necrosis%血管束植入联合细胞移植治疗兔股骨头坏死模型的实验研究

    Institute of Scientific and Technical Information of China (English)

    陈双涛; 张卫平; 刘长安; 王俊江; 宋恒义; 柴志文

    2013-01-01

    目的:探讨血管束植入联合同种异体骨髓基质干细胞移植治疗兔股骨头坏死骨缺损模型的可行性,探索治疗股骨头坏死的一种新方法.方法:36只新西兰大耳白兔随机分成A、B、C3组,每组12只,所有动物的双侧股骨头均参加实验.用液氮冷冻法造模,股骨头钻孔造成骨缺损.A组为空白对照组,B组为同种异体骨髓基质干细胞移植组,C组为同种异体骨髓基质干细胞移植联合血管束植入组.分别于术后2、4、8、12用处死3只实验动物.所获的股骨头标本分别做组织切片HE染色,进一步测算股骨头冠状截面的血管密度及新生骨小梁在骨缺损区所占的面积百分比,做统计分析.结果:C组股骨头缺损区2周时可见新生骨小梁和原始毛细血管形成,8周时新生骨小梁板层状或编织状,毛细血管丰富,12周时骨小梁变宽变粗,排列规则,可见成熟的骨小梁及新生骨髓.B、C两组股骨头冠状截面的血管密度及新生骨小梁在骨缺损区所占的面积比,2周时差异无统计学意义,4、8、12周时C组股骨头冠状截面的血管密度及新生骨小梁在骨缺损区所占的面积比均比同时期B组大.结论:体外培养的同种异体骨髓基质干细胞能在股骨头坏死骨缺损区形成新生骨小梁,可以用作异体移植.植入股骨头坏死骨缺损区的血管束可以有效改善股骨头的血运,促进新生骨小梁的形成.%Objective:To discuss the feasibility of vascular bundle implantation combined with allogeneic bone marrow stromal cells (BMSCs) transplantation in treating rabbit femoral head osteonecrosis and bone defect, in order to explore a new method for the treatment of femoral head necrosis. Methods: Thirty-six New Zealand rabbits were randomly divided into three groups, with 12 rabbits in each group. Bilateral femoral heads of the rabbits were studied in the experiment. The models were made by liquid nitrogen frozen,and the femoral heads

  20. Medial circumflex femoral artery flap for ischial pressure sore

    Science.gov (United States)

    Palanivelu, S.

    2009-01-01

    A new axial pattern flap based on the terminal branches of the medial circumflex femoral artery is described for coverage of ischial pressure sore. Based on the terminal branches of the transverse branch of medial circumflex femoral artery, which exit through the gap between the quadratus femoris muscle above and the upper border of adductor magnus muscle below, this fascio cutaneous flap is much smaller than the posterior thigh flap but extremely useful to cover ischeal pressure sores. The skin redundancy below the gluteal fold allows a primary closure of the donor defect. It can also be used in combination with biceps femoris muscle flap. PMID:19881020

  1. Hybrid approach to limb salvage in the setting of an infected femoral-femoral bypass graft.

    Science.gov (United States)

    Jones, Douglas W; Meltzer, Andrew J; Schneider, Darren B

    2014-08-01

    Prosthetic vascular graft infection in patients with advanced peripheral arterial disease can lead to multiple additional procedures, including extra-anatomic bypass or even amputation. We report the case of an 88-year-old woman with critical limb ischemia and an infected prosthetic femoral-femoral bypass graft. Using a planned hybrid 2-stage approach, we performed endovascular recanalization of the native left iliac arterial system using remote access via the superficial femoral artery to avoid infected groin wounds. Recanalization of the patient's Trans-Atlantic Inter-Society Consensus II D chronic iliac occlusion allowed for removal of the infected graft and placement of a profunda femoris artery to proximal posterior tibial artery bypass, thereby restoring inflow and avoiding the infected left groin. Newer endovascular techniques coupled with open surgical options may lead to limb salvage in patients with previously unreconstructable peripheral arterial disease.

  2. Treatment of the femoral neck peudoarthrosis in childhood: Case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2013-01-01

    Full Text Available Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5­year­old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X­ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit®. Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow­up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X­ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults can prevent the occurrence of femoral neck pseudoarthrosis.

  3. Radographic changes of the revascularized femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Rindell, K. (Orthopaedic Hospital of the Invalid Foundation, Helsinki (Finland). Department of Orthopeadic Surgery); Tallroth, K. (Orthopaedic Hospital of the Invalid Foundation, Helsinki (Finland). Department of Radiology); Lindholm, T.S. (Tampere University Central Hospital (Finland). Department of Surgery, Section of Orthopaedics and Traumatology)

    Twenty-two nerotic femoral heads in young adults were radiologically followed-up after grafting with vascularized bone by comparing the preoperative and the postoperative state of the hip joint. Three parameters were observed and followed; the flattening of the femoral head: the degree of osteoarthrosis of the joints; and the degree of incorporation of the graft into the recipient bone. The results, expressed by index figures, showed that the femoral head flattened during the first two years postoperatively; that the maximal incorporation occurred during the same period of time; and that the appearance of postoperative osteoarthrosis was slow during the first year and increased subsequently. This numerical characterization of radiological finding allows systematic individual analysis after revascularization of the femoral head with bone grafts. It is also suited for comparisons between patients, between series of patients and of various treatment techniques. Furthermore, this quatification provides a numerical index that seems to correlate with the outcome of the treated hip joint. (author). 12 refs.; 6 figs.; 1 tab.

  4. Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation

    DEFF Research Database (Denmark)

    De Backer, Ole; Arnous, Samer; Sandholt, Benjamin

    2015-01-01

    -induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48...... were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn...... stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency...

  5. [Subtrochanteric femoral fractures].

    Science.gov (United States)

    Ulmar, B; Simon, S; Eschler, A; Mittlmeier, T

    2013-12-01

    Subtrochanteric femoral fractures are proximal femoral fractures which are located between the trochanter minor and an area of 3 cm below the minor trochanter on the femoral shaft. About 10-15% of all proximal femoral fractures correspond to this fracture site. Elderly or geriatric patients are generally affected and the injury is often the result of a fall in the home, while high-energy trauma is the cause in a small group of generally younger patients. Clinical evaluation of the affected extremity shows disability of axial weight-bearing and pain during compression and rotation of the hip joint. Basic diagnostics include conventional x-rays of the injured femur in the anterior-posterior and lateral planes. These subtrochanteric femoral fractures are almost always treated surgically due to the inherent high degree of instability. The main goals of surgical intervention are to achieve anatomic fracture reduction and primary full weight-bearing stability of the corresponding leg. Intramedullary interlocking nails are used for primary treatment, while extramedullary implants are often used in revision surgery. Early mobilization and intensive respiratory exercises are necessary to prevent early postoperative complications.

  6. Laceration of femoral vessels by an avulsion fracture fragment of the lesser trochanter after bipolar hemiarthroplasty.

    Science.gov (United States)

    Ha, Yong-Chan; Luminita, Simion; Cho, Se-Hyun; Choi, Jun-Young; Koo, Kyung-Hoi

    2005-08-01

    Femoral vessel injuries after bipolar hemiarthroplasty have not been reported. The current report describes a case of a dual major vessel (superficial femoral artery and vein) injury associated with an avulsion fracture fragment of the lesser trochanter in a 76-year-old woman who had been treated with bipolar hemiarthroplasty because of a femoral neck fracture. The superficial femoral artery was repaired and the defect of the superficial femoral vein was reconstructed with a Gore-Tex graft (WL Gore and Associates Inc, Flagstaff, Ariz). The clinical result was satisfactory and there was no vascular problem at 1-year follow-up. Early diagnosis of this vascular injury prevents serious complications including gangrene of the injured limb.

  7. Femoral varus: what's the angle

    DEFF Research Database (Denmark)

    Miles, James Edward; Svalastoga, Eiliv Lars; Eriksen, Thomas

    Agreement and reliability of femoral varus measurements: a comparison of four techniques Three different techniques have been described for measuring femoral varus radiographically in the dog, but how the measurements from these techniques compare is unknown. Further, measurement reliability has ...

  8. A comparison of Percutaneous femoral access in Endovascular Repair versus Open femoral access (PiERO) : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Vierhout, Bastiaan P.; Saleem, Ben R.; Ott, Alewijn; van Dijl, Jan Maarten; de Kempenaer, Ties D. van Andringa; Pierie, Maurice E. N.; Bottema, Jan T.; Zeebregts, Clark J.

    2015-01-01

    Background: Access for endovascular repair of abdominal aortic aneurysms (EVAR) is obtained through surgical cutdown or percutaneously. The only devices suitable for percutaneous closure of the 20 French arteriotomies of the common femoral artery (CFA) are the Prostar (TM) and Proglide (TM) devices

  9. MORPHOLOGICAL STUDY OF MEDIAL CIRCUMFLEX FEMORAL ARTERY IN HUMAN CADAVERS

    Directory of Open Access Journals (Sweden)

    Brijesh R. Aghera

    2014-10-01

    Full Text Available Background: Medial circumflex femoral artery is an important branch of Profunda femoris artery. It is an important artery in supplying blood to the head and neck of the femur, the adductor muscles and form anastomosis around head of femur. So study of variation of medial circumflex femoral artery great value for surgeon and orthopaedic surgeries. Materials and Methods: The present study includes 102 lower limbs of adult formalin fixed human cadavers used for the routine dissection procedure for under graduate and post graduate students in the department of Anatomy, M.R. Medical College, KBN Medical college and H K E Homeopathic College, Gulbarga (India during 2011-2014.The study was done by dissection method as per Cunningham’s manual of practical Anatomy. Result: In present study, we found that 25 extremities (25.49% medial circumflex femoral artery was originated directly from femoral artery. In 10 extremities (9.80% a common trunk was observed form medial circumflex femoral with femoral artery. Normal study was observed in 66 extremities (64.70%. Conclusion: In present study and other past studies we conclude that knowledge of variation in this artery is very important to preventing injury to vessels during surgical procedures around hip joint and also has important value in plastic surgery operations as the vascular pedicle of grafts such as the transverse upper gracilis (TUG flap, medial thigh flap and medial circumflex femoral (gracilis perforator free flap. During case of selective arteriography in ischaemic necrosis of the femoral head to know the arterial supply of the femoral head it is used.

  10. Laparoscopic repair of femoral hernia

    OpenAIRE

    Yang, Xue-Fei; Liu, Jia-Lin

    2016-01-01

    Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. Femoral hernia could be repaired through the laparoscopic procedures for inguinal hernia. These procedures have clear anatomic view in the operation and preoperatively undiagnosed femoral hernia could be confirmed and treated. Lower recurrence ratio was reported in laparoscopic procedures compared with open procedures for repair of femoral hernia. The technical details of laparoscopic repair of femoral hernia, ...

  11. Progressive slip after removal of screw fixation in slipped capital femoral epiphysis: two case reports

    Directory of Open Access Journals (Sweden)

    Engelsma Yde

    2012-11-01

    Full Text Available Abstract Introduction In slipped capital femoral epiphysis the femoral neck displaces relative to the head due to weakening of the epiphysis. Early recognition and adequate surgical fixation is essential for a good functional outcome. The fixation should be secured until the closure of the epiphysis to prevent further slippage. A slipped capital femoral epiphysis should not be confused with a femoral neck fracture. Case presentation Case 1 concerns a 15-year-old boy with an adequate initial screw fixation of his slipped capital femoral epiphysis. Unfortunately, it was thought that the epiphysis had healed and the screw was removed after 11 weeks. This caused new instability with a progressive slip of the femoral epiphysis and subsequently re-fixation and a subtrochanteric correction osteotomy was obligatory. Case 2 concerns a 13-year-old girl with persistent hip pain after screw fixation for slipped capital femoral epiphysis. The screw was removed as lysis was seen around the screw on the hip X-ray. This operation created a new unstable situation and the slip progressed resulting in poor hip function. A correction osteotomy with re-screw fixation was performed with a good functional result. Conclusion A slipped epiphysis of the hip is not considered ‘healed’ after a few months. Given the risk of progression of the slip the fixation material cannot be removed before closure of the growth plate.

  12. Successful percutaneous transcatheter patent foramen ovale closure through the right internal jugular vein using a steerable catheter.

    Science.gov (United States)

    Hascoet, Sebastien; Fraisse, Alain; Elbaz, Meyer

    2013-10-01

    Percutaneous transcatheter closure of a patent foramen ovale (PFO) remains challenging when femoral venous approach is not available. We describe the successful closure of a PFO using the right internal jugular venous approach and a deflectable catheter delivery system in a patient with a PFO, recurrent stroke, and an inferior vena cava filter.

  13. Vascularized greater trochanter bone flap combined with bone grafting for the treatment of femoral head necrosis%带血管蒂大转子骨瓣联合植骨治疗股骨头坏死

    Institute of Scientific and Technical Information of China (English)

    朱绍灵; 曾意荣

    2012-01-01

    10.3969/j.issn.2095-4344.2012.44.022%  背景:由显微外科技术在股骨头坏死治疗的运用中发展而来的带血管蒂大转子骨瓣联合植骨为治疗中青年股骨头缺血性坏死的主要方法之一。目的:通过回顾及分析对于大转子骨瓣移植治疗股骨头缺血性坏死的相关临床及基础研究,从不同层面对大转子骨瓣移植术的研究进行探讨。方法:以“Osteonecrosis Femoral Head、greater trochanter bone flap ”或“Osteonecrosis Femoral Head、 bone flap”或“Osteonecrosis Femoral Head、finite element analysis”为检索词,检索pubmed数据库(1972年1月至2011年10月);以“股骨头坏死、大转子骨瓣”为检索词,检索 CNKI 数据库(1979年1月至2011年10月)。选择以大转子骨瓣移植治疗股骨头坏死相关,同一领域文献则选择近期发表或发表在权威杂志文章。根据纳入标准共46篇文章进行综述。结果与结论:关于目前较常用的病灶清除+带旋股外侧动脉横支大转子骨瓣联合打压植骨+游离髂骨瓣植骨治疗股骨头缺血性坏死报道甚少,此术式结合了皮质骨的生物力学优势,同时又有带旋股外侧动脉横支大转子骨瓣加松质骨粒提供良好的血供环境,能很好的解决血供与力学重建的平衡性,达到股骨头的生理重建。

  14. Comparison of psychological symptoms in post-cryptogenic cerebral-vascular accident (CVA) and/or transient ischemic attack (TIA) patients who have undergone foramen ovale closure, and in post-CVA patients.

    Science.gov (United States)

    Cohen, Miri; Telman, Gregory; Mansoor, Daniela; Lorber, Avraham

    2011-01-01

    The patent foramen ovale (PFO) is a controversial risk factor for CVA or TIA. In our center, adult PFO patients diagnosed with post cryptogenic CVA/TIA undergo trans-catheter closure of the PFO to decrease the risk of recurrent stroke. The aim of the study was to compare levels of functioning, depression and anxiety in post PFO closure patients following cryptogenic CVA/TIA and in other patients post CVA/TIA without PFO. Eighty-nine patients who had undergone trans-catheter PFO closure and 56 non-PFO post-CVA patients completed demographic, functioning, anxiety and depression questionnaires. Additional medical data were recorded from the medical files. Patients who had undergone trans-catheter PFO closure post CVA or TIA reported better level of functioning and substantially lower levels of depression and anxiety. The 70% of depression and 55% of anxiety variances were explained by female gender, older age, lower education, lower functioning level and additional health problems. Functioning level was the strongest contributor to the explained variance of psychological symptoms. We conclude that patients who have undergone trans-catheter PFO closure following cryptogenic CVA/TIA, which may prevent stroke recurrence, show good functioning and low levels of psychological symptoms. The procedure helps to keep these patients in a good physical and psychological health. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  15. Closure Issues with Families.

    Science.gov (United States)

    Craig, Steven E.; Bischof, Gary H.

    Closure of the counseling relationship constitutes both an ending and a beginning. Although closure signifies the ending of the present counseling relationship, many family counselors conceptualize closure as the start of a working relationship between counselor and family that may be summoned in future times of crisis or during a difficult life…

  16. [Angioscopy and angioplasty of the iliac and femoral arteries].

    Science.gov (United States)

    Baudrillard, J C; Cécile, J P; Foucart, H; Carlier, C; Baidj, Z

    1990-01-01

    Angioscopy is a technique of endoscopic investigation of the vascular lumen and its contents, which we have coupled with iliac and femoral angioplasty. The material comprises 3 main elements: the angioscope, the TV-monitoring assembly and the infusion system. No complication was recorded in a series of 94 angioscopies (47 iliac, 44 distal femoral and 3 grafts) performed over a period of 18 months. The technical quality of the images obtained was good in 90% of cases (85/94). Angioscopy revealed lesions that had either been nonvisualized or underrated by angiography, and played a determinant role in 16% of cases (15/94), whereby the therapeutical procedure could be modified accordingly.

  17. [Femoral head chondroblastoma and reconstruction with osteochondral allograft. Case report].

    Science.gov (United States)

    Orlando-Díaz, C; Guzmán-Vargas, R; Rincon-Cardozo, D F; Mantilla-León, N; Camacho-Casas, J A

    2014-01-01

    Femoral head chondroblastoma is an infrequent tumor, accounting for approximately 1-2% of benign bone tumors. It occurs more frequently in young male patients. It's most frequent locations include the proximal humerus, proximal femur, distal femur and proximal tibia. The femoral head is the third most frequent site of this tumor. There is no specific treatment for this entity; reported treatments range from acetabular osteotomies and osteochondral grafts, to vascularized fibular grafts, all of them with good results. However, this tumor is clinically unpredictable if left untreated. We report a case managed with osteochondral graft and followed-up for three years after the surgical procedure.

  18. Can femoral dialysis catheter insertion cause a life threatening complication?

    Directory of Open Access Journals (Sweden)

    Nurkay Katrancıoğlu

    2014-09-01

    Full Text Available Venous catheter (VC insertion may be necessary for the patients with renal failure facing vascular access problem. Femoral VCs are commonly used for their lower complication rates especially in emergency clinics. The incidence of bleeding associated with VC is reported 0.5-1.6%, however, life threatening hemorrhage and complications requiring surgical intervention are very rare. In this manuscript, we aimed to present a case with hemolytic uremic syndrome complicated with retroperitoneal hematoma after femoral VC insertion. J Clin Exp Invest 2014; 5 (3: 472-474

  19. Closure The Definitive Guide

    CERN Document Server

    Bolin, Michael

    2010-01-01

    If you're ready to use Closure to build rich web applications with JavaScript, this hands-on guide has precisely what you need to learn this suite of tools in depth. Closure makes it easy for experienced JavaScript developers to write and maintain large and complex codebases -- as Google has demonstrated by using Closure with Gmail, Google Docs, and Google Maps. Author and Closure contributor Michael Bolin has included numerous code examples and best practices, as well as valuable information not available publicly until now. You'll learn all about Closure's Library, Compiler, Templates, tes

  20. Estimation of pretraumatic femoral antetorsion in bilateral femoral shaft fractures

    Energy Technology Data Exchange (ETDEWEB)

    Citak, Musa; Jagodzinski, Michael; Krettek, Christian; Huefner, Tobias [Hannover Medical School, Trauma Department, Hannover (Germany); Citak, Mustafa [BG-University Hospital Bergmannsheil, Department of Surgery, Bochum (Germany); Kendoff, Daniel; O' Loughlin, Padhraig F. [Hospital for Special Surgery, Orthopaedic Department, New York, NY (United States); Tavassol, Frank [Hannover Medical School, Department of Oral and Maxillofacial Surgery, Hannover (Germany)

    2009-12-15

    To describe a system for measurement of the pretraumatic femoral antetorsion angle post-bilateral femoral shaft fracture with the use of new imaging software which allows segmentation and three dimensional (3D) reconstruction of DICOM (digital imaging and communications in medicine) images. This case involved a 20-year-old patient with bilateral femoral shaft fractures. Following initial clinical examination, CT scans of both femurs were performed. Subsequently, the DICOM datasets were uploaded to the new software tool. Following segmentation and 3D reconstruction, pretraumatic femoral antetorsion angles were determined. Femoral antetorsion was described and assessed in two ways by referring to the intersection of the posterior condylar plane and (1) a line drawn between the center of the femoral head and femoral neck, (2) a line drawn between the centers of the femoral head and greater trochanter. Using these definitions, values for femoral antetorsion were found to be, respectively, 20 at the right fracture site and 19 on the left site, and 33 bilaterally. The investigators describe in this current technical report the use of new imaging software which enables the calculation of femoral AV following reduction of virtual fracture fragments which are created from standard DICOM images. We believe that this 3D reconstruction method of measuring the antetorsion angle can be integrated into a regular treatment algorithm and may potentially optimize clinical outcomes. (orig.)

  1. 血管生成素对糖尿病大鼠股骨头血管新生及渗漏的影响%The effects of Ang- 1 on the angiogenesis and vascular leakage of diabetic rats' femoral head

    Institute of Scientific and Technical Information of China (English)

    陈海英; 王秀国; 陈少强; 刘文革; 唐军民

    2011-01-01

    目的 探讨血管生成素1 (angi.Poietin-1,Ang-1)对糖尿病大鼠股骨头微血管新生及渗漏的影响.方法 建立速发型链脲佐菌素(streptozotocin,STZ)糖尿病大鼠模型,随机分为正常5周组(CON1)、10周组(CON2)及15周组(CON3),糖尿病5周组(DM1)、10周组(DM2)及15周组(DM3),每组10只.墨汁灌注观测股骨头微血管密度;摘取模型动物股骨头组织,免疫组化分析凝血因子Ⅷ(FⅧ)表达;原位杂交分析血管内皮生长因子(VEGFmRNA)表达强度;RT-PCR分析Ang-l的mRNA表达. 结果 糖尿病大鼠股骨头随病程发展,Ang-l、FⅧ因子表达上升,与正常组相比有显著性差异(P<0.01).VEGFmRNA表达量均高于正常组(P<0.01);微血管密度加大,显示血管增生、渗漏.结论 糖尿病股骨头Ang-1与VEGFmRNA相互协同或拮抗分别促进微血管增生、抗血管渗漏.表达于血管内皮细胞的FⅧ及VEGFmRNA与微血管密度(MVD)变化存在正相关.%Objective To probe into the effects of Ang-1 on the angiogenesis and microvascular leakage of diabetic rats' femoral head. Methods By establishing models of the rats with STZ diabetes, and randomly dividing them into the normal groups (C0N1, CON2 and CON3) and the diabetic groups (DM1, DM2 and DM3) with 10 rats each group, the microvascular density through infusion with ink, the expression of blood coagulation factor VHI with immunohistochemistry, and the expression of the mRNA of both VEGF by hybridization in situ and Ang-1 by RT-PCR, were performed. Results The diabetic rats'femoral head varied in the course of illness. Their expression of Ang-1, blood coagulation factorVlD, and VEGF mRNA significantly rose, as compared with those of rats in the normal groups (P<0.01). The microvascular density enlarged with vascular proliferation and leakage. Conclusions The interaction and antagonism between Ang-1 and VEGF mRNA of diabetic rats' femoral head can promote microvascular proliferation and resist vascular leakage

  2. Hybrid closure of atrial septal defect: A modified approach

    Directory of Open Access Journals (Sweden)

    Kshitij Sheth

    2015-01-01

    Full Text Available A 3.5-year-old girl underwent transcatheter closure of patent ductus arteriosus in early infancy during which time her secundum atrial septal defect (ASD was left alone. When she came for elective closure of ASD, she was found to have bilaterally blocked femoral veins. The defect was successfully closed with an Amplatzer septal occluder (ASO; St. Jude Medical, Plymouth, MN, USA using a hybrid approach via a sub-mammary mini-thoracotomy incision without using cardiopulmonary bypass. At the end of 1-year follow-up, the child is asymptomatic with device in a stable position without any residual shunt.

  3. Radiation induced femoral palsy

    Energy Technology Data Exchange (ETDEWEB)

    Aranda, B.; Esnault, S.; Brunet, P. (Hopital de la Salpetriere, Paris (France))

    1982-01-01

    We report four cases of femoral palsy due to compressive fibrosis, after pelvic radiation therapy. Three patients had Hodgkin's disease, and one testicular seminoma. Prominent clinical features include major groin induration and underlying swelling. Unlike what is usually seen in tumoral relapse, little or no pain is associated with these neuropathies. The femoral post-radic palsy develops earlier and faster than brachial plexus palsy of same aetiology. In one case, progressive aggravation led to surgical neurolysis which resulted in dramatic and long lasting improvement. The principal preventive and therapeutic management methods are discussed: since compressive fibrosis is related to the use of isolated and massive electron beam therapy, various associations of cobalt and electron beam therapy are designed to best prevent the side effects of each of these methods. The early treatment of developing fibrosis by D. penicillamine is discussed.

  4. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    BACKGROUND: In hip fracture surgery, the exact choice of implant often remains somewhat unclear for the individual surgeon, but the growing literature consensus has enabled publication of evidence-based surgical treatment pathways. The aim of this article was to review author pathways and national...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  5. Proximal Focal Femoral Deficiency

    Directory of Open Access Journals (Sweden)

    Vishal Kalia, Vibhuti

    2008-01-01

    Full Text Available Proximal focal femoral deficiency (PFFD is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contrast arthrography orMagnetic Resonance Imaging is indicated when radiological features are questionable and to disclose thepresence and location of the femoral head and any cartilagenous anlage. The disorder is more commonlyunilateral and is apparent at birth. However, bilateral involvement is rarely seen. Therapy of the disorder isdirected towards satisfactory ambulation and specific treatment depending on the severity of dysplasia.

  6. Vascular Cures

    Science.gov (United States)

    ... Contact Us Vascular Disease What is Vascular Disease? Education and Awareness Vascular Diseases Abdominal Aortic Aneurysm Aortic Dissection Arteriovenous Malformation Atherosclerosis Buerger's Disease Carotid Artery Disease ...

  7. Efficacy and safety of percutaneous treatment of iatrogenic femoral artery pseudoaneurysm by biodegradable collagen injection.

    Science.gov (United States)

    Hamraoui, Karim; Ernst, Sjef M P G; van Dessel, Pascal F H M; Kelder, Johannes C; ten Berg, Jurriën M; Suttorp, Maarten Jan; Jaarsma, Wybren; Plokker, Thijs H W

    2002-04-17

    OBJECTIVES; The goal of this study was to assess the safety and efficacy of femoral artery pseudoaneurysm (FAP) closure by collagen injection. BACKGROUND; The FAP is an infrequent but troublesome complication after percutaneous transfemoral catheter procedures. If ultrasound-guided compression repair (UGCR) fails, vascular surgery is indicated. We have developed a less invasive method to close FAPs percutaneously by injecting collagen and, thus, inducing clotting within the aneurysm. Via a 9F needle or 11F sheath, a biodegradable adhesive bovine collagen is injected percutaneously into the FAP, guided by angiography from the contralateral site. From 1993 to 2000, compression and UGCR had failed to obliterate 110 FAPs. These patients have been treated by collagen injection. Mean age of the patients was 65.6 +/- 10.2 years (range: 32 to 85 years), and 50% were women. Immediate closure of the FAP was achieved in 107/110 patients (97.3%) without any complication or adverse effect. In one patient the collagen could not be applied due to unfavorable anatomy. One patient needed a second session of collagen injection. In one patient too much collagen was inserted, which resulted in external compression of the artery, and surgical intervention was required. The overall success rate was 108/110 (98%, 95% confidence interval: 93.5% to 99.8%). Among the patients with successful procedures, there were no recurrences during six months follow-up. The percutaneous treatment of iatrogenic FAP, by injection with collagen, is an effective and safe strategy. This method provides an excellent therapeutic alternative to the traditional surgical management.

  8. Proximal Focal Femoral Deficiency

    OpenAIRE

    Vishal Kalia, Vibhuti

    2008-01-01

    Proximal focal femoral deficiency (PFFD) is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contra...

  9. Transhepatic approach to closure of patent foramen ovale: report of 2 cases in adults.

    Science.gov (United States)

    Hussain, Jamal; Strumpf, Robert; Ghandforoush, Aslan; Jamal, Ayman; Diethrich, Edward

    2010-01-01

    Patent foramen ovale is increasingly diagnosed in patients who are undergoing clinical study for cryptogenic stroke or migraine. In addition, patent foramen ovale is often suspected as a cause of paradoxical embolism in patients who present with arterial thromboembolism. The femoral venous approach to closure has been the mainstay. When the femoral approach is not feasible, septal occluder devices have been deployed via a transjugular approach.Herein, we describe 2 cases of patent foramen ovale in which the transhepatic approach was used for closure. To our knowledge, this is the 1st report of a transhepatic approach to patent foramen ovale closure in an adult patient. Moreover, no previous case of patent foramen ovale closure has been reported in a patient with interrupted inferior vena cava.

  10. Ultrasound -- Vascular

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Ultrasound - Vascular Vascular ultrasound uses sound waves to evaluate ... the limitations of Vascular Ultrasound? What is Vascular Ultrasound? Ultrasound is safe and painless, and produces pictures ...

  11. Ultrasound -- Vascular

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Ultrasound - Vascular Vascular ultrasound uses sound waves to evaluate the ... are the limitations of Vascular Ultrasound? What is Vascular Ultrasound? Ultrasound is safe and painless, and produces ...

  12. Closure Operators and Closure Systems on Quantaloid-Enriched Categories

    Institute of Scientific and Technical Information of China (English)

    Min LIU; Bin ZHAO

    2013-01-01

    In this paper,we introduce the fundamental notions of closure operator and closure system in the framework of quantaloid-enriched category.We mainly discuss the relationship between closure operators and adjunctions and establish the one-to-one correspondence between closure operators and closure systems on quantaloid-enriched categories.

  13. Treatment of osteonecrosis of the femoral head by transplantation of vascular pedicled iliac bone combined with osteochondral autologous%带旋髂深血管蒂髂骨与骨软骨联合移植治疗股骨头坏死

    Institute of Scientific and Technical Information of China (English)

    咸宝山; 姜文学; 刘富; 咸如良

    2010-01-01

    Objective To discuss the results and clinical application of the treatment in osteonecro-sis of the femoral head (ONFH) by transplantation of vascular pedicled iliac bone combined with cylindrical osteochondral autologous.Methods Thirteen hips have been treated by transplantation of vascular pedicled iliac bone combined with cylindrical osteochondral autologous from November 2001 to May 2007.All pa-tients were male,aging from 26 to 43 years with all average of 34.3 years.Seven cases were in left hip,6 in right.According to Association Research Circulation Osseous stage,2 cases were in stage ⅢA,4 in ⅡB and 7 in ⅢC.The anterior-posterior and axial X-ray of bilateral hip joints were taken at 3 months,6 months,and every year postoperatively.The CT or MRI was taken as well if necessary.The function of hip joint was e-valuated by Harris hip score.Results All patients were well followed up from 1.5 to 6 years,with the mean time of 2.4 years.The contour of the transplanted iliac bone and cylindrical osteochondral was found in the femoral head by X-ray and CT but the edge around the transplanted bone was blurry 3 months post-operatively.The bone density in the femoral head was uneven and the shape of the femoral head was irregular.One to 2 years postoperatively,the transplanted iliac bone and cylindrical osteochondral healed,the height of the collapse were restored from 2 to 5 mm (mean,3.1±1.6 mm),and osteolysis diminished or disappeared.One year postoperatively,the percentage of better results was 100%in X-ray,CT or MRI performance.No patients received the total hip replacement due to collapse or pain.The Harris hip score was increased from 54.7±7.6 pre-operation to 81.8±13.5 one year post-operation with statistically significant difference.Conclu-sion Transplantation of vascular pedicled iliac bone combined with osteochondral autologous is an effective method to treat moderate and advanced ONFH,but long-term effect need to be observed further.%目的 探讨带

  14. Simultaneous proximal femoral rotational and distal femoral varus osteotomies for femoral retroversion and genu valgum.

    Science.gov (United States)

    Wagner, Russell; Barcak, Eric A

    2012-04-01

    Whereas excess femoral anteversion and its related symptoms have been described many times, excess femoral retroversion is less well documented. We report the case of a 30-year-old woman who had a history of chronic bilateral hip and knee pain and evidence of excess femoral retroversion, genu valgum, early-onset lateral and patellofemoral compartment osteoarthritis of both knees, and hip arthritis. She experienced symptomatic relief after undergoing staged bilateral simultaneous proximal femoral rotational and distal femoral lateral opening wedge osteotomies. Although this combination of alignment problems is not an infrequent clinical occurrence, we have found no literature on this condition or treatment. The patient provided written informed consent for print and electronic publication of this case report.

  15. Frequency and Effect of Access-Related Vascular Injury and Subsequent Vascular Intervention After Transcatheter Aortic Valve Replacement

    DEFF Research Database (Denmark)

    Dencker, Ditte; Taudorf, Mikkel; Luk, N H Vincent;

    2016-01-01

    Vascular access and closure remain a challenge in transcatheter aortic valve replacement (TAVR). This single-center study aimed to report the incidence, predictive factors, and clinical outcomes of access-related vascular injury and subsequent vascular intervention. During a 30-month period, 365...

  16. Focal femoral condyle resurfacing.

    LENUS (Irish Health Repository)

    Brennan, S A

    2013-03-01

    Focal femoral inlay resurfacing has been developed for the treatment of full-thickness chondral defects of the knee. This technique involves implanting a defect-sized metallic or ceramic cap that is anchored to the subchondral bone through a screw or pin. The use of these experimental caps has been advocated in middle-aged patients who have failed non-operative methods or biological repair techniques and are deemed unsuitable for conventional arthroplasty because of their age. This paper outlines the implant design, surgical technique and biomechanical principles underlying their use. Outcomes following implantation in both animal and human studies are also reviewed. Cite this article: Bone Joint J 2013;95-B:301-4.

  17. Vascular Cures

    Science.gov (United States)

    ... is Possible EVERY DOLLAR SAVES LIVES. Donate Now Vascular Cures innovates patient-centered research, catalyzes breakthrough collaborations and empowers people in their vascular health journey. what is vascular disease PATIENTS see ...

  18. Vascular ring

    Science.gov (United States)

    ... subclavian and left ligamentum ateriosus; Congenital heart defect - vascular ring; Birth defect heart - vascular ring ... Vascular ring is rare. It accounts for less than 1% of all congenital heart problems. The condition ...

  19. Fluoroscopically-guided micropuncture femoral artery access for large-caliber sheath insertion.

    Science.gov (United States)

    Cilingiroglu, Mehmet; Feldman, Ted; Salinger, Michael H; Levisay, Justin; Turi, Zoltan G

    2011-04-01

    Over the last decade, significant developments have been made in the treatment of structural heart disease. Some of these techniques require placement of large arterial sheaths for device delivery. Optimal vascular access is essential for successful large-vessel sheath insertion as well as to avoid vascular complications. The critical step for ideal percutaneous vessel entry is single anterior wall-only puncture of the common femoral artery in a location above the femoral bifurcation and below the inguinal ligament. We describe a fluoroscopically-guided micropuncture technique for accurate placement of large-caliber arterial sheaths.

  20. Eyelid closure at death

    Directory of Open Access Journals (Sweden)

    A D Macleod

    2009-01-01

    Full Text Available Aim: To observe the incidence of full or partial eyelid closure at death. Materials and Methods: The presence of ptosis was recorded in 100 consecutive hospice patient deaths. Results: Majority (63% of the patients died with their eyes fully closed, however, 37% had bilateral ptosis at death, with incomplete eye closure. In this study, central nervous system tumor involvement and/or acute hepatic encephalopathy appeared to be pre-mortem risk factors of bilateral ptosis at death. Conclusion: Organicity and not psychogenicity is, therefore, the likely etiology of failure of full eyelid closure at death.

  1. Anastomotic femoral aneurysms

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Schroeder, T V

    1996-01-01

    OBJECTIVE: Anastomotic pseudoaneurysms continue to be a late complication of vascular surgery, particularly following prosthetic graft procedures. The purpose of this study was to investigate if a previously reported increase in interval between the original operation and the development of pseud...

  2. Management of iatrogenic RV injury - RV packing and CPB through PTFE graft attached to femoral artery.

    Science.gov (United States)

    Mangukia, Chirantan V; Agarwal, Saket; Satyarthy, Subodh; Aggarwal, Satish Kumar; Datt, Vishnu; Satsangi, Deepak Kumar

    2015-01-01

    Cardiac injuries during repeat sternotomy are rare. While undergoing debridement for chronic osteomyelitis (post arterial septal defect closure), a 4-year-old girl sustained significant right ventricular (RV) injury. Bleeding from the RV was controlled by packing the injury site, which helped in maintaining stable hemodynamics till arrangements were made for instituting cardiopulmonary bypass (CPB). Since the femoral artery was very small and unsuitable for direct cannulation, a polytetrafluoroethylene (PTFE) graft sutured end-to-side to the femoral artery was used for establishing CPB. The injury was successfully repaired.

  3. Femoralni trikotnik: The femoral triangle:

    OpenAIRE

    Mlakar, Boštjan; Ravnik, Dean

    1999-01-01

    The topography and structures of the femoral triangle are presented. The femorai triangle lies between the inguinal ligament at the base, the sartoriusmuscle at the lateral border and the long adductor muscle at the medial border. The apex of the femoral triangle is situated at the meeting point of the medial borders of the sartorius and long adductor muscles. The subinguinal space, which is divided into the lacuna musculorum and lacuna vasorum, provides a passageway for the lateral cutaneous...

  4. Long-term effects of vascularized fibular graft transplantation for avascular necrosis of femoral head%吻合血管游离腓骨移植治疗股骨头坏死的中期及远期疗效评估

    Institute of Scientific and Technical Information of China (English)

    田雷; 王坤正; 党晓谦; 王春生

    2012-01-01

    Objective To evaluate the long-term efficacy of vascularized fibular graft transplantation for avascular necrosis of the femoral head in FicatⅡ -Ⅲ . Methods From June 1985 to June 2005 , 361 cases( 385 hips) of femoral head necrosis were treated by vascularized fibular graft-based method,of which the effective follow-up were 257 cases (281 hips). There were 144 male and 113 female patients, aged from 23 to 56 years, (39. 2 ± 15. 3) years in average. According to Ficat staging of femoral head necrosis: 187 hips were in stage Ⅱ and 94 hips were in stage Ⅲ The follow-up assessments mainly included harris scores of pain, clinical function of hip joint and radiographic evaluation (X-ray film) . Results The follow-up rate was 71. 19% ; the follow-up time was five to 20 years, (10. 7 ±4.4) years in average. The results of pain assessments showed: in stage Ⅱ group, the excellent rates of preoperative evaluation and last postoperative follow-up were 13. 4% and 86. 6% respectively with pain scores of ( 15. 16 ± 3. 41 ) and ( 32. 99 ± 6.50) respectively; in stage IH group, the excellent rates of preoperation period and last postoperative follow-up were 3. 19% and 54.3% , with pain scores of (8.47 ±2. 15) and (30.70 ±4.25) respectively. The differences of pain assessments between the preoperation period and last postoperative follow-up were statistically significant ( t = 8. 472, 13. 625; P < 0. 001 ). The results of clinical hip function assessments showed the excellent rates of preoperation period and last postoperative follow-up in stage Ⅱ group, were 15. 5% and 72. 2% , with integrated scores of (53.08 ±9.91) and (88.46 ±10.02) respectively; in stage Ⅱ group, the excellent rates of preoperation period and last postoperative follow-up were 4. 92% and 34. 4% , with integrated scores of (40. 32 ± 8. 37) and (82. 78 ± 12. 16) respectively. The difference of clinical hip function assessments between the preoperation period and last postoperative follow

  5. 'Femoral head necrosis' in metabolic and hormonal osteopathies

    Energy Technology Data Exchange (ETDEWEB)

    Heuck, F.H.W.; Treugut, H.

    1984-07-01

    The pathogenesis of bone necrosis is discussed with special attention and with respect to metabolic, hormonal, and vascular factors. The influence of statics and dynamics of the hip joint bones for the development of aseptic necrosis are discussed. 45 patients with ''idiopathic femoral head necroses'' were observed, including 6 cases of renal osteopathy following renal transplantation and immune suppression therapy, 14 cases of long term corticoid therapy, and 11 cases of liver diseases of different genesis. The femoral head necrosis understood as complication of an osteopathy. In our patients there were 31 males and 14 females - which means higher involvement of males. Plain radiological findings and CT-findings of changes of the femoral heat structure in different stages of the disease are described. Early diagnosis of metabolic and hormonal osteopathies is demanded for a joint keeping therapy of the beginning femoral head necrosis. 90 refs.

  6. 活骨Ⅱ方加不同引经药对股骨头坏死兔股骨头内血管内皮生长因子表达的影响%Effect of Huogu Ⅱ Formula Combined with Different Meridian-guiding Herb on the Expression of Vascular Endothelial Growth Factor in Femoral Head Necrosis

    Institute of Scientific and Technical Information of China (English)

    孔祥英; 田能; 王荣田; 林娜; 李莉; 陈卫衡

    2012-01-01

    Objective;To investigate the effect of Huogu II formula and its combination with different meridian-guiding herb on the expression of vascular endothelial growth factor (VEGF) in the femoral head of rabbits with osteonecrosis of the femoral head ( ONFH) , as well as to explore the mechanism of prevention and treatment for ONFH. Method; The animal mode! Of ONFH was established by liquid nitrogen frozen in the rabbit left hind leg. Ninety-eight. Japanese white rabbits were randomized to sham-operated group, model group, Huogu II group and Huogu D plus achyranthes root, Pubescent angelica, asarum and Balloonflower respectively, evenly 14 in each group. During the course of ONFH animal model establishment, al! The rabbits were subcutaneously injected with recombinant human granulocyte colony-stimulating factor (rhG-CSF) (30 jig · kg-1· d-1, for continuous 7 days). Meanwhile normal saline and decoction of the formulae were administrated by gavage respectively. Materials were drawn at the second and forth week after model establishment Histopathologica! Changes were observed by HE staining, vascular morphology was observed by ink perfusion, VEGF was measured by immunohistochemical assay in femoral heads of the left hind leg. Result; Compared with sham-operated group, the ratio of empty lacuna increased sharply, vessel area and VEGF levels decreased obviously in the model group. But in comparison with the model group, the empty lacuna ratio of Huogu II group decreased obviously, vessel area, VEGF increased significantly. Compared with Huogu II group, the empty lacuna ratio decreased and vessel area increased significantly at the forth week, and the expression of VEGF increased both at the second and forth week in the achyranthes root group. As for the balloonflower group, empty lacuna ratio showed the increase potention trend, and the number of VEGF-positive cells decreased obvious at the forth week. There were no significant changes in Asarum and Pubescent angelica

  7. The myth of closure.

    Science.gov (United States)

    Boss, Pauline; Carnes, Donna

    2012-12-01

    Therapies for grief and loss have traditionally focused on the work of grieving. The goal was to reach an endpoint, now popularly called closure. There are, however, many people who, through no fault of their own, find a loss so unclear that there can be no end to grief. They have not failed in the work of grieving, but rather have suffered ambiguous loss, a type of loss that is inherently open ended. Instead of closure, the therapeutic goal is to help people find meaning despite the lack of definitive information and finality. Hope lies in increasing a family's tolerance for ambiguity, but first, professionals must increase their own comfort with unanswered questions. In this article, the authors, one a poet, the other a family therapist and theorist, offer a unique blending of theory, reflection, and poetry to experientially deepen the process of self-reflection about a kind of loss that defies closure. © FPI, Inc.

  8. A Case of Femoral Fracture in Klippel Trenaunay Syndrome

    Directory of Open Access Journals (Sweden)

    Sam Nahas

    2014-01-01

    Full Text Available We present a case of Klippel Trenaunay syndrome (KTS who presented with severe bilateral knee osteoarthritis (OA. Preoperative planning was commenced for a total knee replacement (TKR. Whilst on the waiting list the patient suffered a fall and sustained a complete femoral diaphysis fracture. Conservative management in the form of skin traction was initially chosen as significant extra- and intramedullary vascular malformations posed an increased risk of perioperative bleeding. This failed to progress to union, and so open reduction and internal fixation was performed. This subsequently resulted in on-going delayed union, which was subsequently managed with low intensity pulsed ultrasound (LIPUS, otherwise known as Exogen (Bioventus. exogen. Secondary exogen, 2012. There are only two previous documented cases of femoral fracture in KTS. This is the first report of a patient with this rare syndrome receiving this treatment. We discuss the management of fracture in this challenging group of patients.

  9. Achieving closure at Fernald

    Energy Technology Data Exchange (ETDEWEB)

    Bradburne, John; Patton, Tisha C.

    2001-02-25

    When Fluor Fernald took over the management of the Fernald Environmental Management Project in 1992, the estimated closure date of the site was more than 25 years into the future. Fluor Fernald, in conjunction with DOE-Fernald, introduced the Accelerated Cleanup Plan, which was designed to substantially shorten that schedule and save taxpayers more than $3 billion. The management of Fluor Fernald believes there are three fundamental concerns that must be addressed by any contractor hoping to achieve closure of a site within the DOE complex. They are relationship management, resource management and contract management. Relationship management refers to the interaction between the site and local residents, regulators, union leadership, the workforce at large, the media, and any other interested stakeholder groups. Resource management is of course related to the effective administration of the site knowledge base and the skills of the workforce, the attraction and retention of qualified a nd competent technical personnel, and the best recognition and use of appropriate new technologies. Perhaps most importantly, resource management must also include a plan for survival in a flat-funding environment. Lastly, creative and disciplined contract management will be essential to effecting the closure of any DOE site. Fluor Fernald, together with DOE-Fernald, is breaking new ground in the closure arena, and ''business as usual'' has become a thing of the past. How Fluor Fernald has managed its work at the site over the last eight years, and how it will manage the new site closure contract in the future, will be an integral part of achieving successful closure at Fernald.

  10. GENU RECURVATUM AS A LATE COMPLICATION OF FEMORAL FRACTURE IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Vadim P. Kuzmin

    2017-03-01

    Full Text Available Genu recurvatum is an uncommon condition in children. Occasionally, it may occur as a late complication of femoral shaft fracture. There are studies that describe the possibility of genu recurvatum occurrence due to the tibial pin traction and without tibial tuberosity pinning. The primary traumatic reasons are Salter – Harris V-type fractures of the tibial tuberosity and tuberosity avulsion. Our case of genu recurvatum occurrence in an 8-year-old girl with femoral shaft fracture 3 years after trauma confirms the importance of this complication. We believe that the etiology of tibial physeal closure and genu recurvatum after femoral fracture in children is unclear. It seems that identifying one cause for this serious complication in all cases is not possible. However, for complete elimination of iatrogenic factors, we recommend not to put the wire through tibial tuberosity in cases where traction is necessary.

  11. Profunda Anchor Technique for Ipsilateral Antegrade Approach in Endovascular Treatment of Superficial Femoral Artery Ostial Occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2015-04-15

    Endovascular treatment of the superficial femoral artery (SFA) is challenging in the presence of flush ostial occlusion. One of the main challenges is the availability of access sites for intervention. Contralateral retrograde femoral access followed by cross-over and antegrade intervention while commonly used, may not be feasible in cases of altered iliac anatomy (e.g. kissing iliac stents). Ipsilateral antegrade intervention using common femoral artery (CFA) access in these instances while possible is typically challenging due to inadequate working length of the CFA for interrogation of the SFA ostium, compounded by the lack of sheath stability. The “profunda anchor” technique uses a buddy wire in the profunda femoris artery (PFA) to stabilize the sheath and allow catheter manipulation for antegrade intervention at the level of the SFA ostium. The PFA is further used as a conduit for deployment of closure device to avoid interference with the treated SFA.

  12. Tank closure reducing grout

    Energy Technology Data Exchange (ETDEWEB)

    Caldwell, T.B.

    1997-04-18

    A reducing grout has been developed for closing high level waste tanks at the Savannah River Site in Aiken, South Carolina. The grout has a low redox potential, which minimizes the mobility of Sr{sup 90}, the radionuclide with the highest dose potential after closure. The grout also has a high pH which reduces the solubility of the plutonium isotopes. The grout has a high compressive strength and low permeability, which enhances its ability to limit the migration of contaminants after closure. The grout was designed and tested by Construction Technology Laboratories, Inc. Placement methods were developed by the Savannah River Site personnel.

  13. THREE-DIMENSIONAL GAIT ANALYSIS OF PATIENTS WITH OSTEONECROSIS OF FEMORAL HEAD BEFORE AND AFTER TREATMENTS WITH VASCULARIZED GREATER TROCHANTER BONE FLAP%大转子骨瓣治疗股骨头缺血性坏死手术前后三维步态分析

    Institute of Scientific and Technical Information of China (English)

    崔大平; 赵德伟

    2011-01-01

    Objective To provide the objective basis for the evaluation of the operative results of vascularized greater trochanter bone flap in treating osteonecrosis of the femoral head (ONFH) by three-dimensional gait analysis.Methods Between March 2006 and March 2007, 35 patients with ONFH were treated with vascularized greater trochanter bone flap, and gait analysis was made by using three-dimensional gait analysis system before operation and at 1, 2 years after operation. There were 23 males and 12 females, aged 21-52 years (mean, 35.2 years), including 8 cases of steroid-induced, 7 cases of traumatic, 6 cases of alcoholic, and 14 cases of idiopathic ONFH. The left side was involved in 15 cases, and right side in 20 cases. According to Association Research Circulation Osseous (ARCO) classification, all patients were diagnosed as having femoral-head necrosis at stage Ⅲ. Preoperative Harris hip functional score (HHS) was 56.2 ± 5.6. The disease duration was 1.5-18.6 years (mean, 5.2 years). Results All incisions healed at stage Ⅰ without early postoperative complications of deep vein thrombosis and infections of incision. Thirty-five patients were followed up 2-3 years with an average of 2.5 years. At 2 years after operation, the HHS score was 85.8 ± 4.1, showing significant difference when compared with the preoperative score (t=23.200, P=0.000). Before operation, patients showed a hip muscles gait, short gait, reduce pain gait, and the pathological gaits significantly improved at 1 year after operation. At 1 year and 2 years after operation, step frequency, pace, step length and hip flexion, hip extension, knee flexion, ankle flexion were significantly improved (P < 0.01). Acceleration-time curves showed that negative wave and spinous wave at acceleration-stance phase of front feet and hind feet in affected limb were obviously reduced at 1 year and 2 years after operation. Postoperative petronas wave appeared at swing phase; the preoperative situation was three

  14. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research

    DEFF Research Database (Denmark)

    Shane, Elizabeth; Burr, David; Ebeling, Peter R

    2010-01-01

    atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present......, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association...

  15. Vascular Diseases

    Science.gov (United States)

    The vascular system is the body's network of blood vessels. It includes the arteries, veins and capillaries that carry ... to and from the heart. Problems of the vascular system are common and can be serious. Arteries ...

  16. Recurrent femoral hernia and associated ovarian pathology.

    Science.gov (United States)

    Gately, Ryan Patrick; Concannon, Elizabeth Sarah; Hogan, A; Ryan, R S; O'Leary, M; Barry, K

    2012-08-27

    The following case describes an ovarian tumour presenting in a highly unusual manner-in the form of a recurrent femoral hernia. Recurrent femoral herniae are unusual and should prompt awareness of underlying pathology causing increased intra-abdominal pressure.

  17. Vascular Vertigo

    OpenAIRE

    Mazyar Hashemilar; Masoud Nikanfar; Dariush Savadi Oskoui

    2017-01-01

    Vertigo is a common complaint in neurology and medicine. The most common causes of vertigo are benign paroxysmal positional vertigo, vestibular neuritis, Meniere’s disease, and vascular disorders. Vertigo of vascular origin is usually limited to migraine, transient ischemic attacks, and ischemic or hemorrhagic stroke. Vascular causes lead to various central or peripheral vestibular syndromes with vertigo. This review provides an overview of epidemiology and clinical syndromes of vascular vert...

  18. Mail Office annual closure

    CERN Multimedia

    2013-01-01

    On the occasion of the annual closure of CERN, there will be no mail distributed on Friday 20 December 2013 but mail will be collected in the morning. Nevertheless, you will still be able to bring your outgoing mail to Building 555-R-002 until 12 noon.  

  19. MNC Subsidiary Closure

    DEFF Research Database (Denmark)

    de Faria, Pedro; Preto, Miguel Torres; Sofka, Wolfgang

    2013-01-01

    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. We ask to what degree the foreign knowledge that they were exposed to is valued in their new job. We argue theoretically that this foreign knowledge is both valuable and not readily available in the host...

  20. MNC Subsidiary Closure

    DEFF Research Database (Denmark)

    de Faria, Pedro; Sofka, Wolfgang; Torres Preto, Miguel

    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. We ask to what degree the foreign knowledge that they were exposed to is valued in their new job. We argue theoretically that this foreign knowledge is both valuable and not readily available in the host...

  1. A new method to catheterize a femoral artery in mice using a nylon suture as a 'guide wire'.

    Science.gov (United States)

    Fukui, S; Nawshiro, H; Wada, K; Shima, K; Hallenbeck, J M

    2001-09-01

    Mice are commonly used in laboratory experiments. Their femoral arteries are so tiny that catheterization is quite difficult. We describe a new method to catheterize the femoral artery in mice. The key feature of this new method is the use of a nylon suture as a 'guide wire'. The full catheterization system consists of two sizes of polyethylene tubes (PE-10, PE-50) and a 4-0 nylon suture. We have been able to repeatedly catheterize mouse femoral arteries (n = 57) successfully and easily with this new system. We believe that this new method can facilitate vascular catheterization in small animals such as mice.

  2. Femoral hernia; Clinical significance of radiologic diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Bergenfeldt, M.; Lasson, A. (Lund University (Sweden). Department of Surgery Malmo General Hospital (Sweden)); Ekberg, O.; Kesek, P. (Lund University (Sweden). Department of Radiology Malmo General Hospital (Sweden))

    A retrospective study of 18 patients with femoral hernia assessed by herniography is presented. Although a palpable lump was present in 11 patients (61%), the diagnosis of a femoral hernia was not made before herniography. Surgical exploration was performed in 12 patients and a femoral hernia was found and repaired with beneficial outcome in 9 of them. In conclusion: herniography is of value for the diagnosis of a femoral hernia in patients with obscure groin pain. (author). 14 refs.; 2 figs.

  3. Ring closure in actin polymers

    Science.gov (United States)

    Sinha, Supurna; Chattopadhyay, Sebanti

    2017-03-01

    We present an analysis for the ring closure probability of semiflexible polymers within the pure bend Worm Like Chain (WLC) model. The ring closure probability predicted from our analysis can be tested against fluorescent actin cyclization experiments. We also discuss the effect of ring closure on bend angle fluctuations in actin polymers.

  4. Technique of temporary subcutaneous "Figure-of-Eight" sutures to achieve hemostasis after removal of large-caliber femoral venous sheaths.

    Science.gov (United States)

    Cilingiroglu, Mehmet; Salinger, Michael; Zhao, David; Feldman, Ted

    2011-07-01

    Over the last decade, significant advances have been made in percutaneous treatment of structural heart diseases. Many of these interventions require insertion of large caliber sheaths in the femoral veins. Manual compression, compression devices, and various closure devices have been used for removal of large-sized venous sheaths. Here, we describe the use of a temporary subcutaneous "Figure-of-Eight" suture technique for venous access site closure after removal of large-caliber sheaths.

  5. Femoral Reconstruction Using External Fixation

    Directory of Open Access Journals (Sweden)

    Yevgeniy Palatnik

    2011-01-01

    Full Text Available Background. The use of an external fixator for the purpose of distraction osteogenesis has been applied to a wide range of orthopedic problems caused by such diverse etiologies as congenital disease, metabolic conditions, infections, traumatic injuries, and congenital short stature. The purpose of this study was to analyze our experience of utilizing this method in patients undergoing a variety of orthopedic procedures of the femur. Methods. We retrospectively reviewed our experience of using external fixation for femoral reconstruction. Three subgroups were defined based on the primary reconstruction goal lengthening, deformity correction, and repair of nonunion/bone defect. Factors such as leg length discrepancy (LLD, limb alignment, and external fixation time and complications were evaluated for the entire group and the 3 subgroups. Results. There was substantial improvement in the overall LLD, femoral length discrepancy, and limb alignment as measured by mechanical axis deviation (MAD and lateral distal femoral angle (LDFA for the entire group as well as the subgroups. Conclusions. The Ilizarov external fixator allows for decreased surgical exposure and preservation of blood supply to bone, avoidance of bone grafting and internal fixation, and simultaneous lengthening and deformity correction, making it a very useful technique for femoral reconstruction.

  6. A case against closure

    Directory of Open Access Journals (Sweden)

    Olin, Doris

    2005-01-01

    Full Text Available Este artigo examina a objeção ao fechamento [dedutivo] que surge no contexto de certos paradoxos epistêmicos, paradoxos cuja conclusão é que a crença justificada pode ser inconsistente. É universalmente aceito que, se essa conclusão é correta, o fechamento deve ser rejeitado, para que se evite a crença justificada em enunciados contraditórios (P, ~P. Mas, mesmo que os argumentos desses paradoxos - o paradoxo da falibilidade (do prefácio e o paradoxo da loteria - seja mal sucedidos, eles, ainda assim, sugerem a existência de evidência independente para uma objeção mais direta contra o fechamento. O exame do argumento da falibilidade revela uma exigência de modéstia epistêmica que viola o fechamento a partir de múltiplas premissas. A reflexão sobre o paradoxo da loteria nos confronta com um dilema em que cada alternativa fornece um contra-exemplo ao fechamento a partir de uma única premissa. Seja ou não possível a inconsistência racional, há uma objeção contra o fechamento. This paper examines the case against closure that arises in the context of certain epistemic paradoxes, paradoxes whose conclusion is that it is possible for justified belief to be inconsistent. It is generally agreed that if this conclusion is correct, closure must be rejected in order to avoid justified belief in contradictory statements (P, ~P. But even if the arguments of these paradoxes – the fallibility (preface paradox and the lottery paradox – are unsuccessful, they nonetheless suggest independent grounds for a more direct case against closure. Examination of the fallibility argument reveals a requirement of epistemic modesty that violates multiple premise closure. Reflection on the lottery paradox presents us with a dilemma in which each alternative provides a counterexample to single premise closure. Whether or not rational inconsistency is possible, there is a case against closure.

  7. Summer season | Cafeteria closures

    CERN Multimedia

    2013-01-01

    Please note the following cafeteria closures over the summer season: Bldg. 54 closed from 29/07/2013 to 06/09/2013. Bldg. 13: closed from 13/07/2013 to 06/09/2013. Restaurant No. 2, table service (brasserie and restaurant): closed from 01/08/2013 to 06/09/2013. Bldg. 864: closed from 29/07/2013 to 06/09/2013. Bldg. 865: closed from 29/07/2013 to 06/09/2013.

  8. Summer season | Cafeteria closures

    CERN Multimedia

    2013-01-01

    Please note the following cafeteria closures over the summer season: Bldg. 54 closed from 29/07/2013 to 06/09/2013. Bldg. 13: closed from 13/07/2013 to 06/09/2013. Restaurant No. 2, table service (brasserie and restaurant): closed from 01/08/2013 to 06/09/2013. Bldg. 864: closed from 29/07/2013 to 06/09/2013. Bldg. 865: closed from 29/07/2013 to 06/09/2013.

  9. Arterial Ligation for Infected Femoral Psuedo-Aneurysm in Drug Injecting Abusers

    Directory of Open Access Journals (Sweden)

    Mohammadzade Mohammad Ali

    2009-10-01

    Full Text Available Pseudo-aneurysm of the femoral artery is the most common arterial complication in drug injecting abusers. Scholars in vascular surgery have published debating statements regarding techniques of successful surgical management during last two decades. We present the results of simple arterial ligation in a series of 32 patients presenting with infected femoral pseudo-aneurysm. Most of the patients were males (89%. Young persons in the age group of 15-44 years were mostly affected. Site of lesion included common femoral artery in 65% , superficial femoral artery 28% and at bifurcation 6.2%. celulitis in 14 (53%, abscess & "ncelulitis in 6 (19%, necrosing fasciitis in 2 (6.2% and vascular abscess in 7 (22% cases were the forms of associated local infection. There was no hemorrhage, vascular thrombosis, amputation, or mortality. Claudicating were the only complications identified in 2 patients with Tripe ligation. Ligation is the optimal management for infected pseudo-aneurysms because it is easy, cost-effective, and safe. Early reconstruction is not recommended, since there is an extended infection in the location of the pseudo-aneurysm.

  10. RELAP-7 Closure Correlations

    Energy Technology Data Exchange (ETDEWEB)

    Zou, Ling [Idaho National Lab. (INL), Idaho Falls, ID (United States); Berry, R. A. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Martineau, R. C. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Andrs, D. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Zhang, H. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Hansel, J. E. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Sharpe, J. P. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Johns, Russell C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-04-01

    The RELAP-7 code is the next generation nuclear reactor system safety analysis code being developed at the Idaho National Laboratory (INL). The code is based on the INL’s modern scientific software development framework, MOOSE (Multi-Physics Object Oriented Simulation Environment). The overall design goal of RELAP-7 is to take advantage of the previous thirty years of advancements in computer architecture, software design, numerical integration methods, and physical models. The end result will be a reactor systems analysis capability that retains and improves upon RELAP5’s and TRACE’s capabilities and extends their analysis capabilities for all reactor system simulation scenarios. The RELAP-7 code utilizes the well-posed 7-equation two-phase flow model for compressible two-phase flow. Closure models used in the TRACE code has been reviewed and selected to reflect the progress made during the past decades and provide a basis for the colure correlations implemented in the RELAP-7 code. This document provides a summary on the closure correlations that are currently implemented in the RELAP-7 code. The closure correlations include sub-grid models that describe interactions between the fluids and the flow channel, and interactions between the two phases.

  11. Osteonecrosis of the femoral head after bone marrow transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Mi; Jun, Jeong Su; Park, Chang Suk; Kim, Yong Sik; Kwon, Soon Yong; Kim, Yoo Jin; Kim, Chun Choo [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2003-07-01

    To retrospectively review findings of osteonecrosis of the femoral head after bone marrow transplantation. We reviewed the clinical and MR findings of osteonecrosis of the femoral head in 23 of 1112 patients who underwent marrow transplantation during a five-year follow-up period lasting from 1996 to 2000. Mean age at the time of diagnosis was 31 (range, 20-47) years, and the mean time from transplant to diagnosis was 17 months. All patients developed variable graft-versus-host disease and seventeen were treated with high-dose prednisolone and/or cysclosporin for severe acute or extensive chronic graft versus host disease. Osteonecrosis was diagnosed by magnetic resonance (MR) imaging, which allowed early detection of disease assessment of its stage. At the time of diagnosis, 15 hips were at stage I, 28 at stage II, two at stage III, and none at stage IV, according to the international ARCO classification system. Osteonecrosis of femoral diaphyses, the lower lumbar spine, or pelvic bones in the MR field was also found to have occurred in 11 patients. Initial treatment was conservative: 21 hips underwent surgery [core decompression (n=10), vascularized fibular bone graft (n=5), and joint replacement (n=6)]. In patients receiving high-dose steroids for the treatment of graft-versus-host disease, MR screening might help detect osteonecrosis at an early stage.

  12. Indications for the microvascular medial femoral condylar flap in craniomaxillofacial surgery.

    Science.gov (United States)

    Thiele, Oliver Christian; Kremer, Thomas; Kneser, Ulrich; Mischkowski, Robert Andreas

    2014-07-01

    The medial femoral condylar flap makes it possible to reconstruct bone, cartilage, and skin, but elongation of the pedicle is usually required to bridge the distances to the vascular connections in the neck. The indications in the maxillofacial area include reconstruction of the temporomandibular joint (TMJ), pseudarthrosis of the jaws, osteonecrosis of the jaws and skull, and augmentation of bone in irradiated or otherwise compromised tissue. If small bony defects require safe and reliable osseous, osteochondral, or osteocutaneous reconstruction, the medial femoral condylar flap can be used to fill the gap between small avascular, and larger microvascular, bone transplants.

  13. [Growth and deformity after in situ fixation of slipped capital femoral epiphysis].

    Science.gov (United States)

    Druschel, C; Placzek, R; Funk, J F

    2013-08-01

    For mild to moderate slipped capital femoral epiphysis (SCFE) in situ fixation is the current treatment standard. However, concerning the implant selection (screw versus k-wires) as well as the prophylactic stabilisation of the non-affected hip, controversies still exist. The aim of this study was to analyse femoral residual growth and femoral deformities after in situ fixation of SCFE either with k-wires or screws. We conducted a retrospective analysis of the radiographs of adolescents treated for SCFE in our department between 01/2003 and 02/2011. To evaluate femoral growth the articulo-trochanteric distance, centro-trochanteric distance, caput-collum-diaphyseal angle, pin-joint ratio and pin-physis ratio were determined. The femoral deformity was assessed by measuring the sphericity of the femoral head. Degenerative changes were evaluated in the final radiographs. Statistical analysis was performed concerning differences between therapeutically and prophylactically treated hips as well as stabilisations with k-wires and screws. A total of 22 patients (female : male = 14 : 8, mean age girls: 11 ± 1 years, boys: 13 ± 2 years) with 26 slipped capital femoral epiphyses was analysed. K-wires were used for fixation in 4 hips each therapeutically and prophylactically, 22 hips with SCFE and 14 non-affected hips were stabilised with screws. Treatment with screws did not lead to significantly earlier physeal closure than k-wire pinning. Regarding the femoral growth parameters a significant decrease in the articulo-trochanteric distance and CCD angle was detectable in all groups. The pin-joint ratio revealed an adequate residual growth in 58 % of the therapeutically and in 72 % of the prophylactically treated hips without significant difference between k-wires and screws. The pin-physis ratio demonstrated similar values. Regarding the femoral deformity the SCFE hips resulted in a significantly reduced sphericity, which remained unchanged during follow-up. The

  14. What Is Vascular Disease?

    Science.gov (United States)

    ... Donors Corporate Sponsors Donor Privacy Policy What Is Vascular Disease? What Is Vascular Disease? Vascular disease is any abnormal condition of ... steps to prevent vascular disease here. Understanding the Vascular System Your vascular system – the highways of the ...

  15. Complications Associated With Femoral Cannulation During Minimally Invasive Cardiac Surgery.

    Science.gov (United States)

    Lamelas, Joseph; Williams, Roy F; Mawad, Maurice; LaPietra, Angelo

    2017-06-01

    Different types of cannulation techniques are available for minimally invasive cardiac surgery. At our institution, we favor a femoral platform for most minimally invasive cardiac procedures. Here, we review our results utilizing this cannulation approach. We retrospectively reviewed all minimally invasive valve surgeries that were performed at our institution between January 2009 and January 2015. Operative times, lengths of stay, postoperative complications, and mortality were analyzed. We identified 2,645 consecutive patients. The mean age was 69.7 ± 12.77 years, and 1,412 patients (53.4%) were male. Three hundred fifty-eight patients (13.5%) had a history of cerebrovascular accident, 422 (16%) had previous heart surgery, and 276 (10.4%) had a history of peripheral vascular disease. The procedures performed were isolated aortic valve replacements (42.1%), isolated mitral valve operations (40.6%), tricuspid valve repairs (0.57%), double valve surgery (15%), triple valve surgery (0.3%), and ascending aortic aneurysm resection with and without circulatory arrest (5%). Femoral cannulation and central cannulation were utilized in 2,400 patients (90.7%) and 244 patients (9.3%), respectively. The median aortic cross-clamp time and cardiopulmonary bypass time were 81 minutes (interquartile range, 65 to 105) and 113 minutes (interquartile range, 92 to 142), respectively. The median postoperative hospital length of stay was 6 days (interquartile range, 5 to 9). There were 31 cerebrovascular accidents (1.17%), no aortic dissections, two compartment syndromes, two femoral arterial pseudoaneurysms, and 174 (6.65%) groin wound seromas. The overall 30-day mortality was 57 patients (2.15%). Minimally invasive cardiac surgical procedures utilizing femoral cannulation techniques have a low risk of complications. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Femoral head osteonecrosis: Volumetric MRI assessment and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Bassounas, Athanasios E. [Department of Medical Physics, School of Medicine, University of Ioannina, GR 451 10 Ioannina (Greece); Karantanas, Apostolos H. [Department of Radiology, School of Medicine, University of Crete, Heraklion, GR 711 10 (Greece); Fotiadis, Dimitrios I. [Unit of Medical Technology and Intelligent Information Systems, Department of Computer Science, University of Ioannina and Biomedical Research Institute-FORTH, GR 451 10 Ioannina (Greece); Malizos, Konstantinos N. [Orthopaedic Department, Medical School, University of Thessalia, GR 412 22 Larissa (Greece)]. E-mail: kmalizos@otenet.gr

    2007-07-15

    Effective treatment of femoral head osteonecrosis (FHON) requires early diagnosis and accurate assessment of the disease severity. The ability to predict in the early stages the risk of collapse is important for selecting a joint salvage procedure. The aim of the present study was to evaluate the outcome in patients treated with vascularized fibular grafts in relation to preoperative MR imaging volumetry. We studied 58 patients (87 hips) with FHON. A semi-automated octant-based lesion measurement method, previously described, was performed on the T1-w MR images. The mean time of postoperative follow-up was 7.8 years. Sixty-three hips were successful and 24 failed and converted to total hip arthroplasty within a period of 2-4 years after the initial operation. The rate of failures for hips of male patients was higher than in female patients. The mean lesion size was 28% of the sphere equivalent of the femoral head, 24 {+-} 12% for the successful hips and 37 {+-} 9% for the failed (p < 0.001). The most affected octants were antero-supero-medial (58 {+-} 26%) and postero-supero-medial (54 {+-} 31%). All but postero-infero-medial and postero-infero-lateral octants, showed statistically significant differences in the lesion size between patients with successful and failed hips. In conclusion, the volumetric analysis of preoperative MRI provides useful information with regard to a successful outcome in patients treated with vascularized fibular grafts.

  17. [Vascular dementia

    NARCIS (Netherlands)

    Leeuw, H.F. de; Gijn, J. van

    2004-01-01

    Vascular dementia is one of the most frequently occurring dementia syndromes. Its prevalence is about 5% among subjects above 85 years of age. Elevated blood pressure and atherosclerosis are the most important risk factors. According to international criteria, vascular dementia usually occurs within

  18. A comparison of the boomerang wire vascular access management system versus manual compression alone during percutaneous diagnostic and interventional cardiovascular procedures.

    Science.gov (United States)

    Echeverria, Angela; Krajcer, Zvonimir

    2016-01-01

    Vascular closure devices allow for early sheath removal, allowing for earlier patient mobilization The Boomerang vascular access management system does not alter arterial integrity for future interventions Access site complications provide significant morbidity in diagnostic and therapeutic interventions.

  19. Free vascularized fibula graft to treat chondroblastoma of the hip.

    Science.gov (United States)

    Riedel, Barth; Franklin, Corinna; Seal, Alex; Stevanovic, Milan

    2012-02-17

    Chondroblastomas are rare tumors that present in the epiphysis of the long bones. Bone grafting following aggressive surgical curettage has yielded the best results. When present in the femoral head, they pose a higher risk of recurrence due to the difficulty of achieving an adequate resection without destroying the structural integrity of the weight-bearing surface. This article describes a case of surgical treatment of a chondroblastoma of the femoral head with the use of a free vascularized fibula graft. A 26-year-old woman had several months of increasing left hip pain and decreased range of motion. Imaging studies confirmed a large bubbly lesion with sclerotic borders in the left femoral head consistent with chondroblastoma. After performing an aggressive and complete excisional biopsy, a large cavitary defect remained in the femoral head. Reconstruction of the defect and structural support was achieved using a free vascularized fibula. Nine years postoperatively, the patient had full hip motion, no pain, and no radiographic evidence of collapse. A free vascularized fibula graft is an excellent option for the reconstruction of a large femoral head defect after chondroblastoma resection.

  20. Risk of femoral hernia after inguinal herniorrhaphy

    DEFF Research Database (Denmark)

    Mikkelsen, T; Bay-Nielsen, M; Kehlet, H

    2002-01-01

    BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July...... 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database....... The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia...

  1. Risk of femoral hernia after inguinal herniorrhaphy

    DEFF Research Database (Denmark)

    Mikkelsen, T; Bay-Nielsen, M; Kehlet, H

    2002-01-01

    BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July...... 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database....... The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia...

  2. 40 CFR 265.280 - Closure and post-closure.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure and post-closure. 265.280 Section 265.280 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... location, topography, and surrounding land use, with respect to the potential effects of pollutant...

  3. FINAL CLOSURE PLAN SURFACE IMPOUNDMENTS CLOSURE, SITE 300

    Energy Technology Data Exchange (ETDEWEB)

    Lane, J E; Scott, J E; Mathews, S E

    2004-09-29

    Lawrence Livermore National Laboratory of the University of California (LLNL) operates two Class II surface impoundments that store wastewater that is discharged from a number of buildings located on the Site 300 Facility (Site 300). The wastewater is the by-product of explosives processing. Reduction in the volume of water discharged from these buildings over the past several years has significantly reduced the wastewater storage needs. In addition, the impoundments were constructed in 1984, and the high-density polyethylene (HDPE) geomembrane liners are nearing the end of their service life. The purpose of this project is to clean close the surface impoundments and provide new wastewater storage using portable, above ground storage tanks at six locations. The tanks will be installed prior to closure of the impoundments and will include heaters for allowing evaporation during relatively cool weather. Golder Associates (Golder) has prepared this Final Closure Plan (Closure Plan) on behalf of LLNL to address construction associated with the clean closure of the impoundments. This Closure Plan complies with State Water Resources Control Board (SWRCB) Section 21400 of the California Code of Regulations Title 27 (27 CCR {section}21400). As required by these regulations and guidance, this Plan provides the following information: (1) A site characterization, including the site location, history, current operations, and geology and hydrogeology; (2) The regulatory requirements relevant to clean closure of the impoundments; (3) The closure procedures; and, (4) The procedures for validation and documentation of clean closure.

  4. Preinguinal Splitting and Reunion of Femoral Nerve Entrapping the Fleshy Fibres of Iliacus Muscle - A Case Report.

    Science.gov (United States)

    Ashwini, L S; Somayaji, S Nagabhooshana; Rao, Mohandas; Marpalli, Sapna

    2017-04-01

    Division of nerves close to their origin and muscular entrapments by nerves in the limbs is not very common. Femoral nerve is the largest branch of the lumbar plexus and arises from dorsal divisions of ventral rami of L2 to L4 spinal nerves. During routine cadaveric dissection for first year medical students at Melaka Manipal Medical College (Manipal Campus), Karnataka, India, we observed a variation in the division and course of left femoral nerve in about 65-year-old male cadaver. The femoral nerve was split into two divisions above the inguinal ligament after its origin from the lumbar plexus. The lower division of the nerve passed deep to the iliopsoas muscle fibres and the upper division ran superficial to iliacus muscle deep to fascia iliaca. Both the divisions joined just above the inguinal ligament to form the trunk of the femoral nerve. Further course and distribution of the nerve was normal. The reports have shown that compression neuropathies of femoral nerve in the limbs are caused by neoplastic masses, vascular abnormalities and also by different anomalous muscles. Such neuropathies may also result from indirect compression of femoral nerve between the fibres of psoas major muscle and lateral pelvic wall. The potential clinical importance of above mentioned variations in the division of femoral nerve would emphasize the surgeons to diagnose the neuromuscular entrapments and consequent alterations of sensation in the anterior and medial aspects of the thigh.

  5. Vascular rings.

    Science.gov (United States)

    Backer, Carl L; Mongé, Michael C; Popescu, Andrada R; Eltayeb, Osama M; Rastatter, Jeffrey C; Rigsby, Cynthia K

    2016-06-01

    The term vascular ring refers to congenital vascular anomalies of the aortic arch system that compress the esophagus and trachea, causing symptoms related to those two structures. The most common vascular rings are double aortic arch and right aortic arch with left ligamentum. Pulmonary artery sling is rare and these patients need to be carefully evaluated for frequently associated tracheal stenosis. Another cause of tracheal compression occurring only in infants is the innominate artery compression syndrome. In the current era, the diagnosis of a vascular ring is best established by CT imaging that can accurately delineate the anatomy of the vascular ring and associated tracheal pathology. For patients with a right aortic arch there recently has been an increased recognition of a structure called a Kommerell diverticulum which may require resection and transfer of the left subclavian artery to the left carotid artery. A very rare vascular ring is the circumflex aorta that is now treated with the aortic uncrossing operation. Patients with vascular rings should all have an echocardiogram because of the incidence of associated congenital heart disease. We also recommend bronchoscopy to assess for additional tracheal pathology and provide an assessment of the degree of tracheomalacia and bronchomalacia. The outcomes of surgical intervention are excellent and most patients have complete resolution of symptoms over a period of time. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. The effect of patulin on femoral bone structure in male rabbits

    Directory of Open Access Journals (Sweden)

    Veronika Kováčová

    2015-05-01

    Full Text Available A lot of kinds of crops are susceptible to fungal attack, leading to considerable financial losses and damage the health of humans and animals. Patulin, a toxic fungal metabolite, can be found mainly in apple and apple products, with much less frequent contamination in other food products. Because of its high incidence and harmful health effects, patulin belongs to a class of mycotoxins, which are strictly monitored. However, its effect on bone structure is still unknown. This study was designed to investigate the impact of patulin on femoral bone structure in adult male rabbits. Four month-old male rabbits were randomly divided into two groups of three animals each. Rabbits from the experimental group (group A, n=3 were intramuscularly administered with patulin at dose 10 μg.kg-1 body weight (b.w. twice a week for 4 weeks. The second group without patulin administration served as a control (group B, n=3. At the end of the experiment, body weight, femoral weight and length, cortical bone thickness and histological structure of femoral bones from all rabbits were determined. The results did not show any significant differences in body weight, femoral weight and length between experimental and control groups of rabbits. On the other hand, intramuscular application of patulin induced a significant increase in cortical bone thickness (p <0.05 and considerable changes in qualitative histological characteristics of compact bone in adult male rabbits. In patulin-intoxicated males, the primary vascular longitudinal bone tissue was absent near endosteal border. On the other hand, this tissue occurred near periosteum and also in the middle part of the femoral bone in these rabbits. The values for the primary osteons' vascular canals were significantly lower (p <0.05 in males exposed to patulin as compared to the control group. Based on these findings we can conclude that intramuscular patulin administration demonstrably influences cortical bone thickness

  7. The modified Dunn procedure for slipped capital femoral epiphysis: the Bernese experience.

    Science.gov (United States)

    Tannast, M; Jost, L M; Lerch, T D; Schmaranzer, F; Ziebarth, K; Siebenrock, K A

    2017-04-01

    Based on previous investigations on the vascular blood supply to the femoral head, a technique for anatomical reduction after slipped capital femoral epiphysis was developed. This technique is a modification of the original technique by Dunn using a retinacular soft-tissue flap. This allows the visual control of the epiphyseal vascular blood supply. We report the experience at the inventor's institution with a critical discussion of the available literature. Using a trochanteric osteotomy for surgical dislocation of the hip, a retinacular soft tissue flap is created containing the deep branch of the medial femoral circumflex artery, the external rotators and the capsule. The femoral epiphysis can be mobilised safely and reduced on the femoral neck after resection of the almost constantly present reactive metaphyseal callus. In our institution, the rate of avascular necrosis with 2% is comparably low to Dunn's original results. It is only present in cases where no bleeding was already evident before reduction of the epiphysis. The ten-year long-term results are favorable in these cases with a good functional result and only little progression of osteoarthritis. However, other authors have reported higher rates of avascular necrosis up to 24% in their initial experience. In experienced hands using the correct meticulous surgical technique, the results are favorable regarding the rates of avascular necrosis, the functional outcome and the development of radiographic osteoarthritis - even in acute and severe cases. Avascular necrosis is rare but can be observed if there is no evidence of intra-operative femoral head perfusion before and after reduction of the epiphysis.

  8. Using tunneled femoral vein catheters for "urgent start" dialysis patients: a preliminary report.

    Science.gov (United States)

    Hingwala, Jay; Bhola, Cynthia; Lok, Charmaine E

    2014-01-01

    Multiple benefits of arteriovenous fistulas (AVF) and arteriovenous grafts (AVGs) exist over catheters. As part of a strategy to preserve thoracic venous sites and reduce internal jugular (IJ) vein catheter use, we inserted tunneled femoral vein catheters in incident "urgent start" dialysis patients while facilitating a more appropriate definitive dialysis access. "Urgent start" dialysis patients between January 15, 2013 and January 15, 2014 who required chronic dialysis, and did not have prior modality and vascular access plans, had tunneled femoral vein catheters inserted. We determined the femoral vein catheter associated infections rates, thrombosis, and subsequent dialysis access. Eligible patients were surveyed on their femoral vein catheter experience. Twenty-two femoral vein catheters were inserted without complications. Subsequently, one catheter required intraluminal thrombolytic locking, while all other catheters maintained blood flow greater than 300 ml/min. There were no catheter-related infections (exit site infection or bacteremia). Six patients continued to use their tunneled catheter at report end, one transitioned to peritoneal dialysis, thirteen to an arteriovenous graft, and two to a fistula. One patient received a tunneled IJ vein catheter. Of the patients who completed the vascular access survey, all indicated satisfaction with their access and that they had minimal complaints of bruising, bleeding, or swelling at their access sites. Pain/discomfort at the exit site was the primary complaint, but they did not find it interfered with activities of daily living. Femoral vein tunneled catheters appear to be a safe, well tolerated, and effective temporary access in urgent start dialysis patients while they await more appropriate long-term access.

  9. Location of femoral artery puncture site and the risk of postcatheterization pseudoaneurysm formation.

    Science.gov (United States)

    Gabriel, Marcin; Pawlaczyk, Katarzyna; Waliszewski, Krzysztof; Krasiński, Zbigniew; Majewski, Wacław

    2007-08-21

    Iatrogenic causes constitute increasingly frequent sources of pseudoaneurysms due to endovascular interventions. However, till now, all analyses focused on evaluating different risk factors contributing to the development of pseudoaneurysm, overlooking the issue of localization of femoral puncture. The aim of this study was to assess the influence of position of femoral artery puncture on the risk of pseudoaneurysm formation. 116 patients were evaluated for the site of catheter insertion into femoral arteries. Another group of 273 patients, suspected of vascular complications after endovascular procedures, were diagnosed with pseudoaneurysms which were analyzed for the location of arterial wall disruption. Puncture sites of groin arteries, i.e. EIA (2.7%), CFA (77.5%), SFA and DFA (19.8%), correlated with pseudoaneurysm location reaching 7.6% (EIA), 54.3% (CFA) and 38.1% (SFA, DFA). Type of procedure influenced these values. Duplex ultrasound mapping of CFA before the endovascular intervention eliminated discrepancies between the incidence of pseudoaneurysm formation and the frequency of arterial puncture in the selected vascular segments. Pseudoaneurysms formed in 4.5% of patients undergoing traditional palpation-guided vessel cannulation and in 2.6% of patients after ultrasound-guided puncture of the femoral artery. Upon further analysis, we concluded that the likelihood of the development of pseudoaneurysm depends on the artery punctured in the groin. This risk increases dramatically for external iliac artery, superficial and deep femoral arteries. A simple means of prevention of this dangerous complication of femoral artery puncture is duplex ultrasound mapping of the groin arteries.

  10. Femoral rotation unpredictably affects radiographic anatomical lateral distal femoral angle measurements

    DEFF Research Database (Denmark)

    Miles, James Edward

    2016-01-01

    Objective: To describe the effects of internal and external femoral rotation on radiographic measurements of the anatomical lateral distal femoral angle (a-LDFA) using two methods for defining the anatomical proximal femoral axis (a-PFA). Methods: Digital radiographs were obtained of 14 right fem...

  11. Imaging appearance of entrapped periosteum within a distal femoral Salter-Harris II fracture

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Johnathan [University of Virginia, Department of Radiology and Medical Imaging, 1218 Lee Street, Box 800170, Charlottesville, VA (United States); Children' s Hospital of Los Angeles, Department of Radiology, Los Angeles, CA (United States); Abel, Mark F. [University of Virginia, Department of Orthopedics, P.O. Box 801016, Charlottesville, VA (United States); Fox, Michael G. [University of Virginia, Department of Radiology and Medical Imaging, 1218 Lee Street, Box 800170, Charlottesville, VA (United States)

    2015-10-15

    Salter Harris II fractures of the distal femur are associated with a high incidence of complications, especially premature physeal closure. Many risk factors for this high rate of premature physeal closure have been proposed. More recently, entrapment of periosteum within the physis has been suggested as an additional predisposing factor for premature physeal closure. The radiographic diagnosis of entrapped soft tissues, including periosteum, can be suggested in the setting of a Salter-Harris II fracture when the fracture does not reduce and physeal widening >3 mm remains. We report a patient who sustained a distal femoral Salter-Harris II fracture following a valgus injury. The patient had persistent distal medial physeal widening >5 mm following attempted reduction. A subsequent MRI revealed a torn periosteum entrapped within the distal femoral physis. Following removal of the periosteum, the patient developed a leg length discrepancy which required physiodesis of the contralateral distal femur. We present this case to raise awareness of the importance of having a high index of suspicion of periosteal entrapment in the setting of Salter-Harris II fractures since most consider entrapped periosteum an indication for surgery. (orig.)

  12. Imaging appearance of entrapped periosteum within a distal femoral Salter-Harris II fracture.

    Science.gov (United States)

    Chen, Johnathan; Abel, Mark F; Fox, Michael G

    2015-10-01

    Salter Harris II fractures of the distal femur are associated with a high incidence of complications, especially premature physeal closure. Many risk factors for this high rate of premature physeal closure have been proposed. More recently, entrapment of periosteum within the physis has been suggested as an additional predisposing factor for premature physeal closure. The radiographic diagnosis of entrapped soft tissues, including periosteum, can be suggested in the setting of a Salter-Harris II fracture when the fracture does not reduce and physeal widening >3 mm remains. We report a patient who sustained a distal femoral Salter-Harris II fracture following a valgus injury. The patient had persistent distal medial physeal widening >5 mm following attempted reduction. A subsequent MRI revealed a torn periosteum entrapped within the distal femoral physis. Following removal of the periosteum, the patient developed a leg length discrepancy which required physiodesis of the contralateral distal femur. We present this case to raise awareness of the importance of having a high index of suspicion of periosteal entrapment in the setting of Salter-Harris II fractures since most consider entrapped periosteum an indication for surgery.

  13. Planning for integrated mine closure

    Energy Technology Data Exchange (ETDEWEB)

    Linda Starke (ed.)

    2008-07-01

    This document presents an Integrated Mine Closure Planning Toolkit for the mining and metals sector. The toolkit is intended to be used to promote a more disciplined approach to integrated closure planning and to increase the uniformity of good practices across the sector. The concepts apply equally well to both large and small companies. The document is not intended to be prescriptive; it provides a suite of tools that can be brought to bear in formulating well-considered decisions when planning for closure. It uses a risk and opportunity based process to guide the practitioner through the iterative process of preparing for planned closure. The first section, with head office and mine management personnel as the primary audience, describes the participants of effective closure planning. Sections 2 and 3 provide the frameworks for a conceptual closure plan and a detailed plan. The key audiences for these two sections are mine management and head office personnel, financial modellers and estimators, governments, academics and non-governmental organizations. The forth section addresses decommissioning and post closure planning, and Section 5 draws together the conclusions and outlines several unresolved issues. The five narrative sections are followed by Section 6 which outlines 13 tools, some of which are already available in earlier ICMM publications, member practices and other sector-affiliated publications. Others have been developed to cover identified gaps. These tools provide the practitioner with practical work processes, examples and contexts within which to apply closure planning discipline.

  14. Pseudoaneurisma de artéria poplítea secundário a osteocondroma femoral: relato de caso

    Directory of Open Access Journals (Sweden)

    Fabricio Mascarenhas de Oliveira

    Full Text Available Osteochondromas are the most common benign tumor of the bone. They are sometimes responsible for vascular complications involving either veins or arteries, principally around the knee. Pseudoaneurysms are considered a rare condition. The authors describe the occurrence of a pseudoaneurysm of the popliteal artery in association with a femoral osteochondroma in a 30-years-old man.

  15. Hemostatic efficacy and safety of a novel mechnical compression device for femoral arteriotomy

    Energy Technology Data Exchange (ETDEWEB)

    Hwangbo, Lee; Kwak, Min Kyu; Lee, Seung Chan; KIm, Chang Won [Dept. of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of)

    2015-05-15

    To evaluate the hemostatic efficacy and safety of a novel mechanical compression device for femoral arteriotomy. We identified 290 patients who underwent vascular intervention with a novel mechanical compression device applied for femoral arteriotomy hemostasis without additional manual compression or other closing devices from October 2013 to January 2014. Among them, 251 patients with complete medical records were enrolled in the study. The immediate technical success and the delayed (4 hour) complication-free hemostasis rates were evaluated. All available clinically relevant information, including major and minor complications, was gathered. The clinical factors associated with the development of complications were analyzed. The immediate and delayed complication-free hemostasis rates were 99.6% (250/251) and 94.0% (236/251). The femoral arteriotomy of one patient with immediate hemostatic failure was compressed manually. No major complications were observed among the immediately successful patients. Fifteen patients developed minor complications. When patients who developed complications were compared to those without complications, the complication group was younger, received a larger vascular sheath, and had a shorter device application time. This novel hemostatic compression device exhibited good hemostasis and low complication rates during femoral arteriotomy.

  16. A Huge Capital Drop with Compression of Femoral Vessels Associated with Hip Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Tomoya Takasago

    2015-01-01

    Full Text Available A capital drop is a type of osteophyte at the inferomedial portion of the femoral head commonly observed in hip osteoarthritis (OA, secondary to developmental dysplasia. Capital drop itself is typically asymptomatic; however, symptoms can appear secondary to impinge against the acetabulum or to irritation of the surrounding tissues, such as nerves, vessels, and tendons. We present here a case of unilateral leg edema in a patient with hip OA, caused by a huge bone mass occurring at the inferomedial portion of the femoral head that compressed the femoral vessels. We diagnosed this bone mass as a capital drop secondary to hip OA after confirming that the mass occurred at least after the age of 63 years based on a previous X-ray. We performed early resection and total hip arthroplasty since the patient’s hip pain was due to both advanced hip OA and compression of the femoral vessels; moreover, we aimed to prevent venous thrombosis secondary to vascular compression considering the advanced age and the potent risk of thrombosis in the patient. A large capital drop should be considered as a cause of vascular compression in cases of unilateral leg edema in OA patients.

  17. VASCULAR SURGERY

    African Journals Online (AJOL)

    Thromboses can result from venous stasis, vascular injury or hypercoagulability, and those involving the deep veins proximal to the knee are linked to an increased risk of PE.2 .... tool for DVT in hospitalised patients, where higher scores.

  18. Vascular Dementia

    Science.gov (United States)

    ... that includes enjoyable activities well within the comfort zone of the person with vascular dementia. New situations, ... your cholesterol in check. A healthy, low-fat diet and cholesterol-lowering medications if you need them ...

  19. vascular hemiplegia

    OpenAIRE

    Voto Bernales, Jorge; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú

    2014-01-01

    The vascular hemiplegia is the functional disorder of a lateral half of the body produced by alterations of cerebral vessels. Should review the concepts of this common condition, with the dual aim of expanding its nosographic value and considering the hemiplegic patient as worthy of the highest professional care La hemiplejia vascular, es el trastorno funcional de una mitad lateral del cuerpo producido por alteraciones de los vasos cerebrales. Conviene revisar los conceptos sobre esta frec...

  20. vascular hemiplegia

    OpenAIRE

    Voto Bernales, Jorge; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú

    2014-01-01

    The vascular hemiplegia is the functional disorder of a lateral half of the body produced by alterations of cerebral vessels. Should review the concepts of this common condition, with the dual aim of expanding its nosographic value and considering the hemiplegic patient as worthy of the highest professional care La hemiplejia vascular, es el trastorno funcional de una mitad lateral del cuerpo producido por alteraciones de los vasos cerebrales. Conviene revisar los conceptos sobre esta frec...

  1. A method to quantify and visualize femoral head intraosseous arteries by micro-CT.

    Science.gov (United States)

    Qiu, Xing; Shi, Xiaotian; Ouyang, Jun; Xu, Dachuan; Zhao, Dewei

    2016-08-01

    We describe a technique for perfusing a barium sulphate suspension into the intraosseous artery. Following the perfusion of abarium sulphate suspension into 14 fresh lower limbs of Chinese cadavers, micro-CT scanning was applied to digitize, quantify and visualize the intraosseous arteries in the human femoral heads. Then, the femoral heads were removed and subjected to micro-CT scanning. The data were imported into the amira and mimics programs to reconstruct and quantify the intraosseous arteries. The femoral head intraosseous artery lengths, areas, volumes, and femoral head bone volumes were quantified. The artery densities and artery ratios were calculated and analysed with independent-samples t-tests. The intraosseous vasculature volume renderings were displayed as screenshots and videos made with amira. Many intraosseous artery study technologies were compared. The barium sulphate suspension was milky white in colour. The perfusion of the barium sulphate suspension followed by micro-CT scanning provided a good representation of the intraosseous artery. The femoral head intraosseous artery lengths, areas and volumes, and the femoral head bone volumes were displayed as the X¯±S . No differences were observed between the left and right femoral head intraosseous arteries in terms of the artery densities or artery ratios. The volume renderings and 3-D orthogonal projections displayed the overall distributions of the intraosseous arteries. The videos clearly demonstrated the entry sites of the nutrition-carrying arteries, their courses and branches, and the intraosseous arterial anastomoses. Our technique is the simplest and least time-consuming method of producing accurate vascular three-dimensional reconstructions. The perfusion of a barium sulphate suspension into intraosseous arteries combined with micro-CT scanning can deliver high-resolution 3-D digitized data and images of intraosseous arteries. This technique does not require bone decalcification or bone

  2. Percutaneous vascular plug for incomplete surgical left atrial appendage closure.

    Science.gov (United States)

    Levisay, Justin P; Sangodkar, Sandeep; Salinger, Michael H; Lampert, Mark; Feldman, Ted

    2014-04-01

    Surgical left atrial appendage (LAA) exclusion has a failure rate as high as 60% due to persistent residual flow in the LAA or large LAA remnants. We describe a novel technique for treatment of incomplete surgical LAA ligation, and define the mechanism that led to persistence of the remnant LAA without any thrombus formation.

  3. Ultrasound in evaluation of post-interventional femoral vein obstruction: a case report

    Directory of Open Access Journals (Sweden)

    Gerdts Eva

    2009-03-01

    Full Text Available Abstract Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention. In some cases, however, bleeding surrounding the femoral vessels, may severely distort the color Doppler images, making detection of venous complications especially difficult. This report refers to such a case where post-catheterization haematoma was suspected to cause an obstruction of the femoral vein. Spectral Doppler recordings of blood flow in the common femoral vein, up-stream, distal to the hemorrhagic area, confirmed the diagnosis of obstruction by demonstrating changes in the venous flow pattern in the common femoral vein, consistent with venous hypertension. Due to the poor quality of the ultrasound images, the exact cause of the obstruction had to be established by another imaging modality, not affected by haemorrhages. CT showed that the common femoral vein was compressed at the puncture site by surrounding haemorrhages. Thus, when bleeding due to cardiac catheterization is associated with possible venous obstruction and findings by color Doppler are equivocal due to degradation of the color-Doppler image, detection of venous hypertension by spectral Doppler, performed distal to the bleeding area, strongly supports the presence of venous obstruction where the exact cause may be established by CT.

  4. Fixation of intracapsular femoral neck fractures: Effect of trans-osseous capsular decompression

    Directory of Open Access Journals (Sweden)

    Elsayed Ibraheem Elsayed Massoud

    2010-06-01

    Full Text Available Objectives: Intracapsular femoral neck fractures have been found as associated with hemarthrosis. The fluid in the intact capsule elevates the intracapsular pressure to a level could tamponades the vascular supply of the femoralhead. Therefore, capsular decompression seems necessaryto salvage the femoral head circulation. Negative impact of the capsular incision also has been reported. Therefore, we hypothesize that creation of a trans-osseousportal can decompress the capsule as well as not threaten the capsular related blood vessels.Materials and methods: In present study, 27 patients with intracapsular femoral neck fractures were included. Coinciding with closed reduction and internal fixation we made a trans-osseous portal for capsular decompression. Patients were followed-up prospectively for a mean periodof 43.1 months.Results: All fractures united. However, one patient 17 years-old who was nursed preoperatively in skin traction developed osteonecrosis of the femoral head.Conclusion: Our results supported that the trans-osseous capsular decompression has evacuated the intracapsular haematoma and has not threatened the capsular integrity. Preoperative traction of the injured limb particularly in the young patient may play a role in development of osteonecrosisof the femoral head.

  5. Osteonecrosis of Femoral Head Occurred after Stent Placement of Femoral Artery

    Directory of Open Access Journals (Sweden)

    Akiyoshi Shimatani

    2014-01-01

    Full Text Available We present a case of osteonecrosis of femoral head (ONFH that occurred after stent angiography of femoral artery for the treatment of arteriosclerosis obliterans (ASO of left inferior limb in a 76-year-old woman. No case of late collapse of femoral head as a complication of endovascular procedure such as stent placement has been previously documented. We considered that ONFH occurred after detaining stent at a junction of left deep femoral artery for the treatment of the ischemia of left lateral and medial femoral circumflex artery.

  6. Vascular calcification of the lower extremities demonstrated by Tc-99m MDP bone scintigraphy in a patient with diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seok Tae; Sohn, Myung Hee [Chonbuk National University Medical School, Chonju, l (Korea, Republic of)

    2001-06-01

    The femoral vessels are sometimes visualized on bone scintigraphy. This is almost always caused by calcification of the femoral artery associated with atherosclerotic changes of the arterial wall. Vascular calcification is frequently seen in the elderly and in diabetics. A 78 year old woman was admitted for non-insulin dependent diabetes mellitus. In this patient with diabetes mellitus, tibial arteries as well as femoral arteries were visualized onTc-99m MDP bone scintigraphy in contrast with visualization of femoral artery alone observed in the elderly.

  7. Osteonecrosis of the femoral head: diagnosis and classification systems

    National Research Council Canada - National Science Library

    Choi, Ho-Rim; Steinberg, Marvin E; Y. Cheng, Edward

    2015-01-01

    Osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated...

  8. Is there already a place for endovascular treatment of the common femoral artery?

    Science.gov (United States)

    Geiger, M; Deloose, K; Callaert, J; Bosiers, M

    2015-02-01

    Surgical endarterectomy has been considered the prefered technique for treating the common femoral artery (CFA). Although favorable endovascular treatment results of the CFA have recently become available, losing the groin area as an important acess site is still the major concern for this technique to become the golden standart. Nevertheless, the endovascular approach has shown, through several studies, including our experience, the capacity to establish itself as a complementery treatment for the modern vascular surgeon.

  9. Significance of radiological diagnosis in complex investigation of necroses of femoral head ossification centers. Pt. 2

    Energy Technology Data Exchange (ETDEWEB)

    Siegling, C.W.; Endert, G.; Ritter, H.; Schumann, E.

    1984-07-01

    101 scintigraphic investigations and 42 angiograms show that the vascular tamponade is the decisive factor for the beginning of necrosis of the femoral head ossification center. Plain films, scintigraphy and angiography give information of the duration of the disease. Extent and localisation of the circulatory disturbance are important for the prognosis of the disease. From stage classification and prognostic factors the conclusions for therapy can be drawn.

  10. The femoral sulcus in total knee arthroplasty.

    Science.gov (United States)

    Lingaraj, Krishna; Bartlett, John

    2009-05-01

    The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native femoral sulcus. The location of the femoral sulcus was studied in 112 consecutive patients undergoing TKA. The mean sulcus position was 0.7 mm lateral to the midline of the distal femoral resection (SD 1.4, 95% CI, 0.5-1.0 mm). However, the variation in sulcus positions ranged from 4 mm medial to 4 mm lateral to the midline. The mean sulcus position in valgus knees was 1.0 mm lateral to the midline (SD 1.8), and that in varus knees was 0.7 mm lateral to the midline (SD 1.2) (P = 0.501). It appears prudent to centre the femoral component on the native sulcus rather than the midline of the distal femoral resection, so as to ensure accurate alignment of the prosthetic sulcus with the native sulcus and to encourage normal patella tracking.

  11. Femoral revision surgery with impaction bone grafting

    NARCIS (Netherlands)

    B.L.E.F. ten Have (Bas); R.W. Brouwer (Reinoud); F.C. van Biezen (Frans); J.A.N. Verhaar (Jan)

    2012-01-01

    textabstractThe purpose of this prospective study was to evaluate the long-term clinical and radiological outcomes of revision of the femoral component of a total hip replacement using impaction bone grafting. Femoral revision with an impacted allograft was performed on 29 patients (31 hips). In all

  12. Classification of subtrochanteric femoral fractures.

    Science.gov (United States)

    Loizou, C L; McNamara, I; Ahmed, K; Pryor, G A; Parker, M J

    2010-07-01

    A review of the literature identified 15 different classification methods for subtrochanteric femoral fractures. Only eight of those classifications defined the area of bone, which constituted a subtrochanteric fracture. The actual length of femur defined as the subtrochanteric zone varied from 3 cm up to the level of the femoral isthmus. There was no agreement between the different classifications regarding the proximal and distal border or for those fractures, which traverse anatomical boundaries. In the various classifications, fractures were subdivided into 2-15 subgroups. The majority of the identified studies were unable to find the classifications useful in either determining treatment or predicting the outcome after treatment. We subdivided subtrochanteric fractures into three types based on the degree of fracture comminution. We examined the inter- and intra-observer agreement of our recommended classification. One orthopaedic consultant, one specialist hip fracture surgeon, two trainee registrar orthopaedic surgeons and one specialty trainee in orthopaedics, on two different occasions, 8 weeks apart, independently classified the radiographs of 20 patients with a subtrochanteric fracture. The mean kappa value for inter- and intra-observer variation was 0.71 and 0.79, respectively, with both showing substantial agreement and, therefore, this simpler classification is recommended. Based on the review of previous classification methods, we also recommend that the subtrochanteric zone be defined as the one in which the fracture line crossing the femur is predominantly within the area of bone extending 5 cm below the lower border of the lesser trochanter.

  13. Relaxation response in femoral angiography.

    Science.gov (United States)

    Mandle, C L; Domar, A D; Harrington, D P; Leserman, J; Bozadjian, E M; Friedman, R; Benson, H

    1990-03-01

    Immediately before they underwent femoral angiography, 45 patients were given one of three types of audiotapes: a relaxation response tape recorded for this study, a tape of contemporary instrumental music, or a blank tape. All patients were instructed to listen to their audiotape during the entire angiographic procedure. Each audiotape was played through earphones. Radiologists were not told the group assignment or tape contents. The patients given the audiotape with instructions to elicit the relaxation response (n = 15) experienced significantly less anxiety (P less than .05) and pain (P less than .001) during the procedure, were observed by radiology nurses to exhibit significantly less pain (P less than .001) and anxiety (P less than .001), and requested significantly less fentanyl citrate (P less than .01) and diazepam (P less than .01) than patients given either the music (n = 14) or the blank (n = 16) control audiotapes. Elicitation of the relaxation response is a simple, inexpensive, efficacious, and practical method to reduce pain, anxiety, and medication during femoral angiography and may be useful in other invasive procedures.

  14. Incarcerated Femoral Hernia Containing Ipsilateral Fallopian Tube

    Directory of Open Access Journals (Sweden)

    Stefanos Atmatzidis

    2010-01-01

    Full Text Available Femoral hernias are more common in women and lead to a substantial higher rate for an emergency operation, due to strangulation. Incarcerated femoral hernia with fallopian tube as a content is an extremely rare condition. A 20-year-old woman presented to the emergency department complaining of a 6-day right groin swelling, which became painful and tender to palpation during the last 48 hours. Preoperative ultrasonography detected an oedematous hernia sac, above the femoral vessels, suggesting the presence of an incarcerated femoral hernia. The patient eventually underwent emergency surgery and the diagnosis of a strangulated femoral hernia sac, containing fallopian tube, was established. No resection of the uterine tube was performed and the hernia was repaired with polypropylene plug. The postoperative period was uneventful and the woman was discharged on the second postoperative day.

  15. Closure report for N Reactor

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule.

  16. Femoral artery thrombosis after internal fixation of a transverse acetabular fracture in a patient with osteogenesis imperfecta type I

    Directory of Open Access Journals (Sweden)

    Morgan Steven J

    2008-01-01

    Full Text Available Abstract Osteogenesis imperfecta is a genetic disorder characterized by increased susceptibility to fractures and vascular injuries due to connective tissue fragility. In this case report, we present a patient with osteogenesis imperfecta type I who sustained a transverse fracture of the right acetabulum while transferring from bed to chair. The fracture was repaired through an ilioinguinal approach. During the surgery, an iatrogenic injury to the femoral artery and vein occurred. This intraoperative complication was salvaged by immediate vascular repair. We discuss the possible causes of iatrogenic vascular injuries in patients with osteogenesis imperfecta. Orthopaedic surgeons should be aware of this potentially devastating complication in this particular patient cohort.

  17. Variations of femoral condyle shape.

    Science.gov (United States)

    Biscević, Mirza; Hebibović, Mujo; Smrke, Dragica

    2005-12-01

    The aim of this study is to mathematically approximate the shape of the femoral articulating line and compare radiuses of condylar curves within and between males and females. Ten male and ten female participants were included in the study. Radiuses of medial and lateral condylar curves were calculated from the side view knee X-ray by original mathematical equation. Average radiuses of condylar curves were between 4.5 and 1.7 cm medially, and between 3.2 and 1.8 cm laterally, for 0 degrees and 90 degrees flexion contact point respectively. Males had longer curve radiuses of both condyles (p knee geometry, and other ellipsoidal structures in human body, like wrist, scull segments, dental arches, etc.

  18. Closure and Sealing Design Calculation

    Energy Technology Data Exchange (ETDEWEB)

    T. Lahnalampi; J. Case

    2005-08-26

    The purpose of the ''Closure and Sealing Design Calculation'' is to illustrate closure and sealing methods for sealing shafts, ramps, and identify boreholes that require sealing in order to limit the potential of water infiltration. In addition, this calculation will provide a description of the magma that can reduce the consequences of an igneous event intersecting the repository. This calculation will also include a listing of the project requirements related to closure and sealing. The scope of this calculation is to: summarize applicable project requirements and codes relating to backfilling nonemplacement openings, removal of uncommitted materials from the subsurface, installation of drip shields, and erecting monuments; compile an inventory of boreholes that are found in the area of the subsurface repository; describe the magma bulkhead feature and location; and include figures for the proposed shaft and ramp seals. The objective of this calculation is to: categorize the boreholes for sealing by depth and proximity to the subsurface repository; develop drawing figures which show the location and geometry for the magma bulkhead; include the shaft seal figures and a proposed construction sequence; and include the ramp seal figure and a proposed construction sequence. The intent of this closure and sealing calculation is to support the License Application by providing a description of the closure and sealing methods for the Safety Analysis Report. The closure and sealing calculation will also provide input for Post Closure Activities by describing the location of the magma bulkhead. This calculation is limited to describing the final configuration of the sealing and backfill systems for the underground area. The methods and procedures used to place the backfill and remove uncommitted materials (such as concrete) from the repository and detailed design of the magma bulkhead will be the subject of separate analyses or calculations. Post-closure

  19. Vascular emergencies.

    Science.gov (United States)

    Semashko, D C

    1997-01-01

    This article reviews the initial assessment and emergent management of several common as well as uncommon vascular emergencies. Aortic dissection, aneurysms, and arterial occlusive disease are familiar but challenging clinical entities. Less frequently encountered conditions are also discussed including an aortic enteric fistula, mesenteric venous thrombosis, phlegmasia alba dolens, and subclavian vein thrombosis.

  20. Vascular Disease Foundation

    Science.gov (United States)

    ... Contact Us Vascular Disease What is Vascular Disease? Education and Awareness Vascular Diseases Abdominal Aortic Aneurysm Aortic Dissection Arteriovenous Malformation Atherosclerosis Buerger's Disease Carotid Artery Disease ...

  1. What Is Vascular Disease?

    Science.gov (United States)

    ... Contact Us Vascular Disease What is Vascular Disease? Education and Awareness Vascular Diseases Abdominal Aortic Aneurysm Aortic Dissection Arteriovenous Malformation Atherosclerosis Buerger's Disease Carotid Artery Disease ...

  2. Percutaneous closure of catheter enterotomy: feasibility determination in vivo.

    Science.gov (United States)

    Roy, Sumit; Hol, Per Kristian

    2014-01-01

    To determine whether a catheter enterotomy can be percutaneously sealed with a commercially available vascular closure implant. The study was performed using a porcine model of small intestinal obstruction. Preliminary experiments were performed to allow an informed choice between two of the most promising commercially available alternatives: A multipronged metal clip (StarClose®) and a resorbable anchored polymer plate (FemoSeal®). Thereafter closure of seven enterotomies was attempted with the most suitable implant. The deployment procedure was subjectively analyzed. The sealed enterotomies were visually evaluated and hydrostatically tested. StarClose was rejected for formal assessment because it was both difficult to deploy and could not ensure a watertight seal. The conventional method for deploying FemoSeal was found to be inappropriate for percutaneously closing enterotomies. However an improvised accessory allowed all seven enterotomies to be successfully sealed with the implant using a modified procedure that involved only one additional step. After closure, six of the seven enterotomies tolerated intraluminal pressure up to 65 mm Hg. FemoSeal has the potential to serve as an implant for percutaneous closure of catheter enterotomies if the deployment tool can be appropriately modified.

  3. Femoral hernia sac laparoscopy: a case report.

    Science.gov (United States)

    Ramirez Valderrama, Alexander; Ruiz, Dan; Malik, Manmeet; Tiszenkel, Howard

    2014-01-01

    We present the case of a 64-year-old female with an incarcerated right femoral hernia, associated with a small bowel obstruction that was successfully treated with an open femoral hernia repair with plug. At the same time we performed a hernia sac laparoscopy to evaluate the viability of the previously reduced small bowel. The hernioscopy was performed with a 0° 5 mm scope with reliable evaluation of the peritoneal cavity. We confirm that hernioscopy is a safe and feasible procedure and provides useful information for the appropriate management of acute incarcerated femoral/inguinal hernias.

  4. Experimental fixation of femoral osteotomies by cerclage with nylon straps.

    Science.gov (United States)

    Rhinelander, F W; Stewart, C L

    1983-10-01

    Following the successful experience of Partridge in the fixation of human femoral fractures by nylon-strap cerclage, this research in 23 mature dogs was performed to compare nylon-strap with wire-loop cerclage for healing periods of up to 12 weeks. Supplemented by intramedullary fixation with Steinmann pins, long oblique femoral osteotomies were fixed in one femur of each dog by nylon straps and in the other femur by wire loops, at separate operations. The nylon straps were all secured at the same tension by a special "gun." The wire loops were all secured at the same tension by the Rhinelander tightener-twister. Half of the nylon straps had "bumps" along the inner surface, which were added by Partridge in an effort to circumvent the microvascular disturbance reported with Parham bands. On examination by microangiography and correlated histology, all of the osteotomies, regardless of the type of fixation, showed good progress toward osseous union. After fixation by wire cerclage no loss of position or disturbance of blood supply was noted. After fixation by nylon straps slight (clinically insignificant) longitudinal displacement, attributed to slight lengthening of the straps, with consequent loosening was noted in all cases. This loosening was considered advantageous because it appeared to be responsible for the unexpected lack of impairment of the vascularization of the underlying cortical bone by any of the straps. The bumps on the undersurface of some of the straps were, thus, of no vascular advantage, and their presence made accurate fixation of the ostectomy fragments more difficult on the small bones. These studies support the value of fixation by plain nylon straps and show their advantage over straps with bumps for fixation of long oblique single osteotomies of bones the size of the canine femur.

  5. RCRA closure of mixed waste impoundments

    Energy Technology Data Exchange (ETDEWEB)

    Blaha, F.J. [Doty and Associates (United States); Greengard, T.C.; Arndt, M.B. [Rockwell International (United States)

    1989-11-01

    A case study of a RCRA closure action at the Rocky Flats Plant is presented. Closure of the solar evaporation ponds involves removal and immobilization of a mixed hazardous/radioactive sludge, treatment of impounded water, groundwater monitoring, plume delineation, and collection and treatment of contaminated groundwater. The site closure is described within the context of regulatory negotiations, project schedules, risk assessment, clean versus dirty closure, cleanup levels, and approval of closure plans and reports. Lessons learned at Rocky Flats are summarized.

  6. A case of acute bilateral femur fracture with vascular injury

    Institute of Scientific and Technical Information of China (English)

    Slavisa Zagorac; Aleksandar Lesic; Marko Bumbasirevic

    2016-01-01

    The femoral fractures remain the great challenge for orthopedic surgeons regarding time of fixation and appropriate fixation techniques. There is a bimodal distribution of fractures occurring most frequently in young males after high-energy trauma (motor vehicle accidents) and in elderly females after falls from standing. Young patients with femoral fracture are under the great risk of multiple injuries. Hence, the great significance is optimal time of fixation. We present a case of unusual pattern of injury and fixation technique of bilateral proximal femur fracture associated with vascular injury, with very satisfied outcome.

  7. A case of acute bilateral femur fracture with vascular injury

    Directory of Open Access Journals (Sweden)

    Slavisa Zagorac

    2016-01-01

    Full Text Available The femoral fractures remain the great challenge for orthopedic surgeons regarding time of fixation and appropriate fixation techniques. There is a bimodal distribution of fractures occurring most frequently in young males after high-energy trauma (motor vehicle accidents and in elderly females after falls from standing. Young patients with femoral fracture are under the great risk of multiple injuries. Hence, the great significance is optimal time of fixation. We present a case of unusual pattern of injury and fixation technique of bilateral proximal femur fracture associated with vascular injury, with very satisfied outcome.

  8. Training effect of using Touch Surgery for intramedullary femoral nailing.

    Science.gov (United States)

    Sugand, Kapil; Mawkin, Mala; Gupte, Chinmay

    2016-02-01

    Simulation in orthopaedic training is becoming increasingly popular and has been widely used in formal curricula. However, these resources are expensive and not easily accessible to every trainee. Other means of disseminating surgical education through virtual reality (VR) multimedia can act as useful adjunct to traditional methods of teaching. One validated VR platform is Touch Surgery, a cognitive task simulation and rehearsal app. The primary objective of this study was to identify the training effect of Touch Surgery intramedullary femoral nailing (IFN) modules using objective performance metrics over six consecutive attempts. Secondary objectives consisted of validated multiple choice questions (MCQ) testing before the first (pre) and after the sixth (post) attempts. 27 medical undergraduates were recruited to complete the decision-making process six consecutive times for four modules on the procedural steps of IFN. The modules consisted of (i) preparing the patient and equipment, (ii) femoral canal preparation, (iii) nail insertion and proximal locking, and (iv) distal locking and closure. Real-time objective performance metrics were obtained, stored electronically and analysed using the median and Bonett-Price 95% confidence intervals from the participants' attempts to assess training effect. Significance was calculated using the Mann-Whitney U test for independent data whilst the Wilcoxon signed ranked test was used for paired data. Significance was set as 2-tailed p-value training effect with practice. Novices demonstrated cognitive competencies to ensure patient safety prior to operating. The app is an effective adjunct to traditional learning methods and has the potential for curricular implementation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Promising results after vacuum-assisted wound closure and mesh-mediated fascial traction

    DEFF Research Database (Denmark)

    Kleif, Jakob; Fabricius, Rasmus; Bertelsen, Claus Anders

    2012-01-01

    -mediated fascial traction (VAWCM) is a novel technique recently introduced for late fascial closure of the OA. In previous studies, the disease aetiologies were mainly vascular and visceral surgical disease and trauma. We report our results using VAWCM in a non-trauma patient population treated with an OA due...

  10. Is spontaneous closure of a patent arterial duct common?

    Science.gov (United States)

    Hoffman, Julien I E

    2017-01-01

    As closing a patent arterial duct is relatively simple, safe, and successful, most children with a patent arterial duct have it closed soon after diagnosis. The larger ducts are closed to prevent congestive heart failure, pulmonary vascular disease, or aneurysmal dilatation of the ductus, and smaller ducts are closed to prevent infective endocarditis. Consequently, there is no opportunity to determine whether spontaneous closure or diminution in size of the patent arterial duct is common. If the duct does become smaller, flow through it may be so low that no murmur is produced - the silent ductus. The frequency and best management of the silent patent arterial duct are unknown, and we do not know whether these tiny ducts are the last stage before spontaneous closure.

  11. Meralgia paresthetica and femoral acetabular impingement: a possible association.

    Science.gov (United States)

    Ahmed, Aiesha

    2010-12-11

    Meralgia paresthetica consists of pain and dysesthesia in the anterolateral thigh. Etiology is divided into spontaneous and iatrogenic causes. To my knowledge this has never been attributed to femoral acetabular impingement. This case highlights the presence of lateral femoral cutaneous neuropathy in the setting of femoral acetabular impingement syndrome thus raising the possibility of an association. Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies.

  12. Mini-mesh repair for femoral hernia

    National Research Council Canada - National Science Library

    Kulacoglu, Hakan

    2014-01-01

    Femoral hernia consists only 4% of all primary groin hernias. It is described as "the Bête Noire of Hernias" because of its nature and anatomy which is difficult to understand for the surgeons and tendency to recurrence...

  13. Radiation-induced femoral head necrosis

    African Journals Online (AJOL)

    2011-03-25

    Mar 25, 2011 ... osteonecrosis of the femoral head, following radiotherapy for a squamous cell .... therapy, alcoholism, gout/hyperuricemia, and idiopathic osteonecrosis. ... 15 pediatric patients treated for cancer in a major pediatric oncology ...

  14. Hydrocoele of a femoral hernia sac.

    Science.gov (United States)

    Mote, D G; Chakravarty, K B

    2009-12-01

    Hydrocoele of a femoral hernia sac is an extremely rare entity. Extensive literature review and Internet searching revealed only a few authentically reported cases. It mostly occurs in females during the fourth to sixth decades of life. The most common clinical presentation is groin swelling. It is diagnosed as an irreducible or incarcerated femoral hernia or subcutaneous lipoma. In almost all of the reported cases, the diagnosis of hydrocoele of a femoral hernia sac has been made only after surgical exploration. The present case is a 40-year-old lady who presented with a painless lump in the right groin and was diagnosed as a case of hydrocoele of a femoral hernia sac only after exploration.

  15. Herniography off femoral, obturator and perineal hernias

    Energy Technology Data Exchange (ETDEWEB)

    Ekberg, O.; Nordblom, I.; Fork, F.T.; Gullmo, A.

    1985-08-01

    Positive contrast herniography was used in the workup of 550 patients with unclear groin pain. The majority of these patients had rather characteristic hernias of indirect, direct or femoral type. However, now and then diagnostic problems arose. A femoral hernia may look like a direct or even obturator hernia. There is also a variety of multilocular femoral hernias and other types. A femoral hernia may be present together with other hernias in the ipsilateral or contralateral groin. Obturator hernias are usually small but are always confined to the obturator canal laterally in the obturator foramen. Abnormalities in the pouch of Douglas may include a deep rectogenital pouch, diverticula and true herniations. These uncommon herniographic findings are described and discussed.

  16. Acute appendicitis in a femoral hernia

    Directory of Open Access Journals (Sweden)

    Zdravković Darko

    2007-01-01

    Full Text Available INTRODUCTION Acute appendicitis in a femoral hernia is an uncommon condition that can be serious. Complications are more frequent if the diagnosis is delayed and surgery is not performed on time. CASE REPORT We present a 71-year-old man with a painful swollen mass. The patient presented with fatigue and loss of appetite, while body temperature was normal. The abdomen was not painful, and peristaltic was normal. All laboratory findings were normal. After anamnesis and physical examination, the presumed diagnosis was incarcerated femoral hernia and the patient was sent to the operating room. Intraoperative findings revealed an incarcerated femoral hernia within a phlegmonous inflammated appendix. Appendectomy and McVay hernioplastics were done. The postoperative course was without complications. CONCLUSION It is very important to bear in mind that right femoral hernia with signs of incarceration and inflammation may contain an acutely inflamed appendix. Delayed diagnosis and misdiagnosis cause greater morbidity and mortality.

  17. Femoral nerve entrapment: a new insight.

    Science.gov (United States)

    Vázquez, M T; Murillo, J; Maranillo, E; Parkin, I G; Sanudo, J

    2007-03-01

    Compression of the femoral nerve in the iliac fossa has been reported as a consequence of several pathologies, but never as a result of muscular compression. Aberrant slips of iliacus, however, have occasionally been reported to cover or split the femoral nerve. This study aimed to assess such variations as potential factors in femoral nerve compression. A large and homogeneous sample of 121 embalmed cadavers (242 specimens) was studied. Statistical comparisons were made using the chi-squared test. Muscular slips from iliacus and psoas, piercing or covering the femoral nerve, were found in 19 specimens (7.9%). No significant differences by sex or side were found. The more frequent variation was piercing of the femoral nerve by a muscular slip (17 specimens, 7.0%). The nerve then entered the thigh as one or more branches. The less frequent variation found was a muscular slip or sheet covering the femoral nerve as it lay on iliacus (2 specimens, 0.8%). Each disposition may be a potential risk for nerve entrapment.

  18. Missed vascular injuries: presentation and outcome.

    Science.gov (United States)

    Siddique, Muhammad Khalid; Majeed, Shahid; Irfan, Muhammad; Ahmad, Nisar

    2014-06-01

    To describe the different presentation, diagnostic evaluation, management and outcome of complications of missed vascular injuries. A case series. Combined Military Hospital, Rawalpindi and Combined Military Hospital, Kharian Cantt, from June 2009 to June 2012. All the patients with vascular injuries missed at the time of causative trauma who reported during this study period were included. Patients presented with acute vascular injuries and iatrogenic aneurysm at the vascular anastomosis site were excluded. All cases were evaluated with either CT or conventional angiography and managed with various open vascular surgical techniques and their results were assessed. Twenty eight patients with missed vascular injury underwent various vascular repairs. Age of patients ranged from 16 to 78 years (mean = 33.7 ± 15.4 years). Male to female ratio was 6:1. Twelve (42.8%) patients presented with pseudoaneurysm alone, 10 (35.7%) with traumatic arteriovenous fistulae, 4 (14.3%) with post-traumatic thrombosis and occlusion and 2 (7.1%) with pseudoaneurysm and hemorrhage. Penetrating injuries were the commonest cause in 19 (67.8%). The time interval between injury and presentation in hospital ranged from 2 to 1300 weeks (mean 228 weeks). Lower limb vessels were affected in 20 (71.4%), the upper limb in 5 (17.8%) and neck vessels in 3 (10.7%). Superficial femoral artery was the most frequently involved artery in 9 (32.1%) cases. Interposition reverse autogenous saphenous vein graft was most common type of repair in all types of missed vascular injuries. One (3.5%) patient had amputation after secondary hemorrhage. Low velocity penetrating trauma was the common cause of missed vascular injury. Pseudoaneurysm was the most common presentation.

  19. [Percutaneous transluminal angioplasty in vascular by-passes].

    Science.gov (United States)

    Rodríguez, J E; Fernández Guinea, O; López, V; Suárez Pereiro, M J; Reimunde, E; Cosío, J M; Barreiro, A

    1993-01-01

    Results from 21 cases of percutaneous transluminal angioplasties as a treatment of stenosed vascular by-pass from 16 patients, are presented. The technique took place in 10 cases at the aorto-femoral area, in others 10 cases at the popliteal-femoral area and, in the last one, at the carotid-subclavian area. Preliminary results were successful in all cases (100%). Follow-up showed a better long-term results at the aorto-femoral level. Considering the satisfactory results and also considering that, in case of negative results or re-stenosis, other surgical techniques could be performed, we conclude that the percutaneous transluminal angioplasty should be the first treatment for such of injuries.

  20. [Laparotomy closure in advanced peritonitis].

    Science.gov (United States)

    Bensman, V M; Savchenko, Yu P; Shcherba, S N; Golikov, I V; Triandafilov, K V; Chaykin, V V; Pyatakov, S N; Saakyan, A S; Saakyan, E A

    to improve the results of advanced peritonitis management. 743 patients with advanced peritonitis were studied. Patients were divided into 2 groups depending on treatment strategy. Programmed relaparotomy combined with removable draining musculoaponeurotic seams during laparotomy closure decreased mortality from 47.8±2.7% to 24.1±2.3% (pperitonitis management. Laparotomy closure with only cutaneous seams is indicated in case of persistent abdominal hypertension. Large eventration always requires abdominal wall repair. APACHE-III scale scores have significant prognostic value in patients with advanced peritonitis.

  1. Closure phase and lucky imaging.

    Science.gov (United States)

    Rhodes, William T

    2009-01-01

    Since its introduction by Jennison in 1958, the closure-phase method for removing the effects of electrical path-length errors in radio astronomy and of atmospheric turbulence in optical astronomy has been based on the non-redundant-spacing triple interferometer. It is shown that through application of lucky imaging concepts it is possible to relax this condition, making closure-phase methods possible with redundantly spaced interferometer configurations and thereby widening their range of application. In particular, a quadruple-interferometer can, under lucky imaging conditions, be treated as though it were a triple interferometer. The slit-annulus aperture is investigated as a special case.

  2. Homogeneous orbit closures and applications

    CERN Document Server

    Lindenstrauss, Elon

    2011-01-01

    We give new classes of examples of orbits of the diagonal group in the space of unit volume lattices in R^d for d > 2 with nice (homogeneous) orbit closures, as well as examples of orbits with explicitly computable but irregular orbit closures. We give Diophantine applications to the former, for instance we show that if x is the cubic root of 2 then for any y,z in R liminf |n|=0 (as |n| goes to infinity), where denotes the distance of a real number c to the integers.

  3. Aetiology of femoral hernias revisited: bilateral femoral hernia in a young male (two cases).

    Science.gov (United States)

    Kochupapy, R T; Ranganathan, G; Dias, S; Shanahan, D

    2013-01-01

    Bilateral femoral hernias are less common in men than in women and rare in young adults. Only one case of a bilateral femoral hernia in a young man has been reported in the literature before. Three main theories have been postulated for femoral hernias. The theory that they are an acquired disease is the most accepted due to the common occurrence of such hernias in multiparous women but the theory lacks enough evidence. We report two cases in young men. Anatomical variations in the femoral canal could be the primary aetiological factor in these patients. A unilateral femoral hernia in young men with acquired aetiological factors requires a clinical examination of the opposite side.

  4. Femoral head activity in Perthes' disease: clinical evaluation of a quantitative technique for estimating tracer uptake. [/sup 99m/Tc-polyphosphate or diphosphenate

    Energy Technology Data Exchange (ETDEWEB)

    Morley, T.R.; Short, M.D.; Dowsett, D.J.

    1978-08-01

    A method for quantifying the uptake of Tc-99m-labeled phosphate complexes in the femoral head has been clinically evaluated, being used specifically for studying the uptake of these bone-seeking agents in Perthes's disease. The analysis depends on the selection, by computer program, of a reliable reference area in the femoral shaft, which is then compared with the mean uptake from each femoral head. The femoral-head activity is then represented as an uptake ratio. These ratios, together with a fixed contour representing the uptake in the femoral-head regions, provide more clinical information than the radiograph or scintiphoto, particularly in the early stages of unilateral or bilateral femoral-head disease and during followup. No correlation has been found between these ratios and qualitative techniques for assessing Perthes' disease by radiograph. From the quantitative data so far obtained it is clear that osteotomy reduces the vascularity of the femoral head, and in certain cases this reduction persists for some years. Tc-99m-labeled diphosphonate compounds were used in more recent studies, and a significant increase in sensitivity was obtained, compared with earlier polyphosphate data.

  5. Evaluation of a pig femoral head osteonecrosis model

    Directory of Open Access Journals (Sweden)

    Kim Harry

    2010-03-01

    Full Text Available Abstract Background A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head. Methods Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging. Results An angiogram of the microfil casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis. Conclusion Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve

  6. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures.

    Science.gov (United States)

    Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo

    2011-03-01

    Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  7. Telephone switchboard closure | 19 December

    CERN Multimedia

    2014-01-01

    Exceptionally, the telephone switchboard will close at 4 p.m. on Friday, 19 December, instead of the usual time of 6 p.m., to allow time for closing all systems properly before the annual closure. Therefore, switchboard operator assistance to transfer calls from/to external lines will stop. All other phone services will run as usual.

  8. Abdominal wound closure: current perspectives

    Directory of Open Access Journals (Sweden)

    Williams ZF

    2015-12-01

    Full Text Available Zachary F Williams, William W Hope Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC, USA Abstract: This review examines both early and late wound complications following laparotomy closure, with particular emphasis on technical aspects that reduce hernia formation. Abdominal fascial closure is an area of considerable variation within the field of general surgery. The formation of hernias following abdominal wall incisions continues to be a challenging problem. Ventral hernia repairs are among the most common surgeries performed by general surgeons, and despite many technical advances in the field, incisional hernia rates remain high. Much attention and research has been directed to the surgical management of hernias. Less focus has been placed on prevention of hernia formation despite its obvious importance. This review examines the effects of factors such as the type of incision, suture type and size, closure method, patient risk factors, and the use of prophylactic mesh. Keywords: incisional, abdominal, hernia, prevention, wound closure techniques 

  9. Vacuum assisted closure in coloproctology

    NARCIS (Netherlands)

    Bemelman, W.A.

    2009-01-01

    Vacuum-assisted closure has earned its indications in coloproctology. It has been described with variable results in the treatment of large perineal defects after abdominoperineal excision, in the treatment of stoma dehiscence and perirectal abscesses. The most promising indication for

  10. Pseudoarthrosis in atypical femoral fracture: case report.

    Science.gov (United States)

    Giannotti, S; Bottai, V; Dell'Osso, G; De Paola, G; Ghilardi, M; Guido, G

    2013-11-01

    Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment; they have a high frequency of delayed healing. The authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy. Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment even if, in the literature, there is no clarity on the exact pathogenetic mechanism. The Task Force of the American Society for Bone and Mineral Research described the major and minor features to define atypical fractures and recommends that all the five major features must be present while minor features are not necessary. Another controversial aspect regarding the atypical femoral fractures is the higher frequency of the delayed healing that can be probably related to a suppressed bone turnover caused by a prolonged period of bisphosphonates treatment. This concept could be corroborated by the Spet Tc exam. In the case of a pseudoarthrosis, there is not a standardization of the treatment. In this report, the authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy; the patient was studied with clinical, bioumoral end SPECT-Tc exam of both femurs. Many studies show the relationship between bisphosphonates and the presence of atypical fractures. These fractures should be monitored more closely due to the risk of nonunion and they require considering an initial treatment with pharmacological augmentation to reduce the complications for the patient and the health care costs.

  11. Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure.

    Science.gov (United States)

    Klouche, Kada; Amigues, Laurent; Deleuze, Sebastien; Beraud, Jean-Jacques; Canaud, Bernard

    2007-01-01

    Availability of a functional vascular access is a mandatory prerequisite for extracorporeal renal replacement therapy in patients with acute renal failure. The femoral site of insertion commonly is chosen because it is an easy and convenient access. However, an array of complications may substantially alter the quality of treatment, and it appears that catheter-related morbidity and dysfunction are more frequent with the femoral than internal jugular site. This study is designed to evaluate the potential benefits of using soft silicone tunneled catheters ((ST)Caths) at the femoral site. Thirty patients with acute renal failure treated by intermittent hemodialysis (IHD) and/or continuous venovenous hemodiafiltration (CVVHDF) were assigned to either twin (ST)Caths or twin polyurethane nontunneled femoral catheters. Time necessary for catheter insertion, catheter-related complications, and catheter lifespan were monitored. Catheter performance during IHD and the effect of catheter type on dialysis dose were evaluated. The time necessary for (ST)Cath insertion was significantly longer. The incidence of vein thrombosis and catheter-related infection was lower, and the ratio of venous return pressure to catheter blood flow was better with an (ST)Cath. Recirculation rates were similar for both types of catheters. Whether treated by using IHD or CVVHDF, patients with an (ST)Cath benefited from a greater delivered dialysis dose. Multivariate analysis confirmed that (ST)Cath use was a determinant factor to optimize dialysis dose delivery. (ST)Cath patency was significantly longer. In patients with acute renal failure, use of an (ST)Cath minimizes catheter-related morbidity and improves dialysis efficiency compared with conventional femoral catheters.

  12. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    Directory of Open Access Journals (Sweden)

    Sampat S Dumbre Patil

    2016-01-01

    Full Text Available Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN or surface implants like Dynamic Condylar Screw (DCS are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years and mean followup period was 52.1 months (range 27-72 months. Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

  13. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    Science.gov (United States)

    Dumbre Patil, Sampat S; Karkamkar, Sachin S; Patil, Vaishali S Dumbre; Patil, Shailesh S; Ranaware, Abhijeet S

    2016-01-01

    Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion. PMID:27512218

  14. Femoral hernia: a review of 83 cases.

    Science.gov (United States)

    Alimoglu, O; Kaya, B; Okan, I; Dasiran, F; Guzey, D; Bas, G; Sahin, M

    2006-03-01

    We evaluate the factors that affect morbidity and mortality in patients who underwent surgery due to femoral hernia. The medical records of 83 patients who underwent femoral hernia repair between January 1996 and June 2004 were retrospectively analyzed. The femoral hernias were repaired either with McVay or mesh plug hernioplasty. Sex, age, surgical repair technique, presence of incarceration/strangulation, incarcerated/strangulated organs, postoperative complications, duration of hospitalization, recurrence rate, and factors that affect mortality and morbidity were studied. There were 83 patients with femoral hernia in our study. Patients' age ranged from 10 to 75 years (mean age was 46.84) with a predominance of female (71%). Thirty-six patients (40%) underwent emergency surgery with the diagnosis of strangulation or incarceration of femoral hernia. Seventeen patients had strangulation and underwent resection; eleven of these patients had omentum in the hernial sac, whereas six patients had intestines. Four of these patients underwent laparotomy. The remaining 19 patients had incarceration and underwent simple reduction of hernial sac content without resection. Forty-seven (60%) patients underwent elective surgery. McVay technique was used for 79 patients, while the other four patients were treated with mesh-plug. Twelve patients (15%) developed a variety of complications (nine patients (25%) in emergency, three patients (6%) in elective group). There was one mortality. Recurrences occurred in two patients. Femoral hernia is an important surgical pathology with high rates of incarceration/strangulation and intestinal resection. Emergency surgery can increase morbidity and mortality especially in the elderly. Early elective surgery may reduce complication.

  15. 40 CFR 265.112 - Closure plan; amendment of plan.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure plan; amendment of plan. 265... DISPOSAL FACILITIES Closure and Post-Closure § 265.112 Closure plan; amendment of plan. (a) Written plan... have a written closure plan. Until final closure is completed and certified in accordance with §...

  16. Catecholamines in plasma from artery, cubital vein, and femoral vein in patients with cirrhosis. Significance of sampling site

    DEFF Research Database (Denmark)

    Henriksen, J H; Ring-Larsen, H; Christensen, N J

    1986-01-01

    The concentration of noradrenaline (NA) and adrenaline (A) was measured in arterial, cubital venous and femoral venous plasma in order to determine possible differences in different vascular beds in the peripheral circulation. In patients with cirrhosis, arterial plasma NA (median 2.54 nmol/l, n ...... the skin of forearm and hand). To assess circulating levels of catecholamines, the importance of arterial sampling is stressed as peripheral venous samples may also reflect local factors....

  17. Impact of pharyngeal closure technique on fistula after salvage laryngectomy.

    Science.gov (United States)

    Patel, Urjeet A; Moore, Brian A; Wax, Mark; Rosenthal, Eben; Sweeny, Larissa; Militsakh, Oleg N; Califano, Joseph A; Lin, Alice C; Hasney, Christian P; Butcher, R Brent; Flohr, Jamie; Arnaoutakis, Demetri; Huddle, Matthew; Richmon, Jeremy D

    2013-11-01

    No consensus exists as to the best technique, or techniques, to optimize wound healing, decrease pharyngocutaneous fistula formation, and shorten both hospital length of stay and time to initiation of oral intake after salvage laryngectomy. We sought to combine the recent experience of multiple high-volume institutions, with different reconstructive preferences, in the management of pharyngeal closure technique for post-radiation therapy salvage total laryngectomy in an effort to bring clarity to this clinical challenge. To determine if the use of vascularized flaps in either an onlay or interposed fashion reduces the incidence or duration of pharyngocutaneous fistula after salvage laryngectomy compared with simple primary closure of the pharynx. Multi-institutional retrospective review of all patients undergoing total laryngectomy after having received definitive radiation therapy with or without chemotherapy between January 2005 and January 2012, conducted at 7 academic medical centers. Academic, tertiary referral centers. The study population comprised 359 patients from 8 institutions. All patients had a history of laryngeal irradiation and underwent laryngectomy between 2005 and 2012. They were grouped as primary closure, pectoralis myofascial onlay flap, or interposed free tissue. All patients had a minimum of 4 months follow-up. Fistula incidence, severity, and predictors of fistula. Of the 359 patients, fistula occurred in 94 (27%). For patients with fistula, hospital stay increased from 8.9 to 12.1 days (P fistula with primary closure was 34%. For the interposed free flap group, the fistula rate was lower at 25% (P = .07). Incidence of fistula was the lowest for the pectoralis onlay group at 15% (P = .02). Multivariate analysis confirmed a significantly lower fistula rate with either flap technique. For patients who developed fistula, mean duration of fistula was significantly prolonged with primary closure (14.0 weeks) compared with pectoralis flap (9

  18. COMPARATIVE STUDY OF LAPAROSCOPIC CLOSURE OPEN PEPTIC PERFORATION CLOSURE

    Directory of Open Access Journals (Sweden)

    Vivek

    2015-10-01

    Full Text Available Laparoscopic closure of perforated duodenal ulcer was first performed in the year 1990 . Due to its advantage of better view of the peritoneal cavity an opportunity for thorough lavage and avoidance of upper abdominal incision, with its related complication, especially in high – ri sk patients, this procedure has gained popularity all over the world. Approximately 10 - 20% of patients suffering from peptic ulcer develop perforation of stomach or duodenum in which, chemical peritonitis develop initially from gastric secretion and duoden al secretion the condition is life threatening. Early diagnosis and treatment is extremely important. Mortality will increase up if perforation exists more than 24 to 48 hours. Usually surgical intervention of simple closure with omental patch of the perforation is required. this study aims at evaluating efficacy , safety and outcome of laparoscopic surgery for perforated duodenal ulcer patients admitted during period Jan 2009 to Dec 2012 at tertiary hospital in north Karnataka A total of 61cases diagnosed as peritonitis secondary to duodenal ulcer perforation were involved in the study 30underwent open perforation closure and 31 cases underwent lap closure. Peptic ulcers are focal defects in the gastric or duodenal mucosa which extend into the sub mucosa or deeper. they may be acute or chronic and ultimately are caused by on imbalance between the action of peptic acid and mucosal defenses peptic ulcer remains a common outpatient diagnosis, but the number of elective operations for peptic ul cer disease have decreased dramatically over the past 30 decades due to the advent of H2 blockers However the incidence of emergency surgeries, and death rate associated with peptic ulcer are same

  19. Femoral component loosening after hip resurfacing arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Zustin, Jozef; Sauter, Guido [University Medical Centre Hamburg-Eppendorf, Institute of Pathology, Hamburg (Germany); Hahn, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); Morlock, Michael M. [TUHH Hamburg University of Technology, Biomechanics Section, Hamburg (Germany); Ruether, Wolfgang [University Medical Centre Hamburg-Eppendorf, Department of Orthopaedics, Hamburg (Germany); Amling, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); University Medical Centre Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany)

    2010-08-15

    Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral

  20. Generalized Convective Quasi-Equilibrium Closure

    Science.gov (United States)

    Yano, Jun-Ichi; Plant, Robert

    2016-04-01

    Arakawa and Schubert proposed convective quasi-equilibrium as a basic principle for closing their spectrum mass-flux convection parameterization. In deriving this principle, they show that the cloud work function is a key variable that controls the growth of convection. Thus, this closure hypothesis imposes a steadiness of the cloud work function tendency. This presentation shows how this principle can be generalized so that it can also encompasses both the CAPE and the moisture-convergence closures. Note that the majority of the current mass-flux convection parameterization invokes a CAPE closure, whereas the moisture-convergence closure was extremely popular historically. This generalization, in turn, includes both closures as special cases of convective quasi-equilibrium. This generalization further suggests wide range of alternative possibilities for convective closure. In general, a vertical integral of any function depending on both large-scale and convective-scale variables can be adopted as an alternative closure variables, leading to an analogous formulation as Arakawa and Schubert's convective quasi-equilibrium formulation. Among those, probably the most fascinating possibility is to take a vertical integral of the convective-scale moisture for the closure. Use of a convective-scale variable for closure has a particular appeal by not suffering from a loss of predictability of any large-scale variables. That is a main problem with any of the current convective closures, not only for the moisture-convergence based closure as often asserted.

  1. Safety and efficacy of the Perclose suture-mediated closure device following carotid artery stenting under clopidogrel platelet blockade

    Energy Technology Data Exchange (ETDEWEB)

    Zorger, Niels; Finkenzeller, Thomas; Lenhart, Markus; Hamer, Okka; Paetzel, Christian; Borisch, Inghita; Toepel, Ingolf; Feuerbach, Stefan; Link, Johann [University of Regensburg Klinikum, Franz-Josef-Strauss-Allee 11, 93042, Regensburg (Germany)

    2004-04-01

    The aim of this study was evaluation of a closure device (Perclose, Menlo Park, Calif.) for closure of the femoral artery access site in patients undergoing aggressive anticoagulation and platelet blockade after carotid stenting. Fifty-five patients who received clopidogrel in addition to aspirin and heparin as medication for carotid stenting were included for suture of the femoral access site after using 7- or 8-F guide catheters. The technical success, the time for suture, the clotting parameters, and complications were examined. Follow-up investigations, including ultrasound and clinical examinations, were performed. The groin was checked for possible hematoma, pseudoaneurysm, arteriovenous fistula, and local infection. Technical success was obtained in 51 of 54 patients (94%) after a mean procedure time of 6 min (range 5-10 min). The suture device was not used in one patient (2%) for anatomical reasons and failed to obtain hemostasis in 3 of 54 (6%) patients. In 4 of 54 patients (7%) bleeding was observed at the punctured site 4-6 h after intervention which was treated by a compression bandage. The mean dedicated activated clotting time was 137 s (range 29-287 s) before intervention and 349 s (150-958 s) just before deploying the Perclose device. During follow-up after 2 days (range 2-6 days) and 6 months no further complications of the puncture site were observed except for two large groin hematomas. No major complications occurred. Closure of the femoral access site after carotid stenting using a Perclose closure device is safe and effective even in patients receiving an aggressive anticoagulation and antiplatelet therapy. (orig.)

  2. [Use of autologous superficial femoral artery in surgery for aortic prosthesis infection].

    Science.gov (United States)

    da Gama, A Dinis; Rosa, António; Soares, Mário; Moura, Carlos

    2003-01-01

    The surgical management of the aortic prosthesis infection still remains an enormous challenge for the vascular surgeon and a critical issue for the patient's integrity and life. Several techniques for its management have been devised and employed, along the years, but none of them revealed itself as totally satisfactory. This stimulates the creation of new alternatives. We present the clinical case of an infected aortic prosthesis in a 41 year old man, complicated by duodenal and ureteral erosion, in whom the autologous superficial femoral artery was employed successfully in the treatment of this most demanding situation.

  3. Closure constraints for hyperbolic tetrahedra

    CERN Document Server

    Charles, Christoph

    2015-01-01

    We investigate the generalization of loop gravity's twisted geometries to a q-deformed gauge group. In the standard undeformed case, loop gravity is a formulation of general relativity as a diffeomorphism-invariant SU(2) gauge theory. Its classical states are graphs provided with algebraic data. In particular closure constraints at every node of the graph ensure their interpretation as twisted geometries. Dual to each node, one has a polyhedron embedded in flat space R^3. One then glues them allowing for both curvature and torsion. It was recently conjectured that q-deforming the gauge group SU(2) would allow to account for a non-vanishing cosmological constant Lambda, and in particular that deforming the loop gravity phase space with real parameter q>0 would lead to a generalization of twisted geometries to a hyperbolic curvature. Following this insight, we look for generalization of the closure constraints to the hyperbolic case. In particular, we introduce two new closure constraints for hyperbolic tetrahe...

  4. [Femoral venous catheter: an unusual complication].

    Science.gov (United States)

    Garcia, P; Mora, A; Trambert, P; Maler, E; Courant, P

    2000-08-01

    We report an erratic course of a venous femoral catheter which was in the abdominal cavity in a patient with an haemoperitoneum and an hepatic injury. This complication led to an inefficiency of the transfusion and a worsening of the haemoperitoneum.

  5. Femoral Prosthesis Infection by Rhodotorula mucilaginosa▿

    Science.gov (United States)

    Savini, Vincenzo; Sozio, Federica; Catavitello, Chiara; Talia, Marzia; Manna, Assunta; Febbo, Fabio; Balbinot, Andrea; Di Bonaventura, Giovanni; Piccolomini, Raffaele; Parruti, Giustino; D'Antonio, Domenico

    2008-01-01

    This case report is a case history of a femoral prosthesis infection caused by Rhodotorula mucilaginosa in a human immunodeficiency virus patient. Though the pathogenicity of this organism for bone tissue has been previously reported, this is the first reported case of an orthopedic prosthesis infection by this species of the genus Rhodotorula. PMID:18753353

  6. Postmortem Femoral Blood Concentrations of Risperidone

    DEFF Research Database (Denmark)

    Linnet, Kristian; Johansen, Sys Stybe

    2014-01-01

    Postmortem femoral blood concentrations of the antipsychotic drug risperidone and the active metabolite 9-hydroxyrisperidone were determined by an achiral LC-MS/MS method in 38 cases. The cause of death was classified as unrelated to risperidone in 30 cases, in which the sum of the concentration ...

  7. Inadvertent femoral artery "stripping": surgical management.

    Science.gov (United States)

    Liddicoat, J E; Bekassy, S M; Daniell, M B; De Bakey, M E

    1975-02-01

    Following "vein stripping" for varicosities, two patients were referred to our service for evaluation of arterial insufficiency of the lower extremities. Both patients had had surgical interruption of the femoral arterial system which required reconstruction. This paper emphasizes the importance of understanding surgical anatomy and presents the techniques of successful surgical management of both cases.

  8. Intraoperative arteriography during femoral-popliteal bypass.

    Science.gov (United States)

    Liddicoat, J E; Bekassy, S M; DeBakey, M E

    1975-07-01

    Minor technical errors may jeopardize the patency of femoral-popliteal bypass grafts. In an attempt to detect such errors, intraoperative arteriography has been routinely employed. It allows immediate recognition and correction of the most common abnormal findings: intraluminal debris, intimal dissection, distal thrombosis, arterial spasm, and kinking of the graft.

  9. Prophylactic Nailing of Incomplete Atypical Femoral Fractures

    Directory of Open Access Journals (Sweden)

    Chang-Wug Oh

    2013-01-01

    Full Text Available Introduction. Recent reports have described the occurrence of low-energy subtrochanteric and femoral shaft fractures associated with long-term bisphosphonate use. Although information regarding the surgical treatment of these atypical femoral fractures is increasing, it is unclear if the preventive operation is useful in incomplete fractures. This study examined the results of preventive intramedullary nailing for incomplete atypical femoral fractures. Material and Methods. A retrospective search was conducted for patients older than 50 years receiving bisphosphonate therapy, with incomplete, nondisplaced fractures in either the subtrochanteric or diaphyseal area of the femur. Seventeen patients with a total of 20 incomplete, non-displaced lesions were included. The mean duration of bisphosphonate use was 50.5 months. Eleven of the 17 (64.7% patients had complete or incomplete fractures on the contralateral femur. All were treated with prophylactic fixation of an intramedullary (IM nail. The minimum followup was 12 months. Results. All cases healed with a mean period of 14.3 weeks. Nineteen of the 20 cases healed with the dissolution of incomplete fractures of the lateral aspect. A complete fracture developed at the time of nailing in one patient, but it healed with callus bridging. Conclusion. IM nailing appears to be a reliable way of preventing the progress of incomplete atypical femoral fractures.

  10. Tension free femoral hernia repair with plug

    Directory of Open Access Journals (Sweden)

    Milivoje Vuković

    2013-01-01

    Conclusions: The technique of closing the femoral canal with plug a simple. The plug is made from monofilament material and is easily formed. This technique allows the reduction of recurrence and can be used safely, quickly and easily in elective and emergency situations.

  11. Differential effects of relaxin deficiency on vascular aging in arteries of male mice.

    Science.gov (United States)

    Jelinic, Maria; Tare, Marianne; Conrad, Kirk P; Parry, Laura J

    2015-08-01

    Exogenous treatment with the naturally occurring peptide relaxin increases arterial compliance and reduces vascular stiffness. In contrast, relaxin deficiency reduces the passive compliance of small renal arteries through geometric and compositional vascular remodeling. The role of endogenous relaxin on passive mechanical wall properties in other vascular beds is unknown. Importantly, no studies have investigated the effects of aging in arteries of relaxin-deficient mice. Therefore, we tested the hypothesis that mesenteric and femoral arteries stiffen with aging, and this is exacerbated with relaxin deficiency. Male wild-type (Rln (+/+)) and relaxin knockout (Rln (-/-)) mice were aged to 3, 6, 12, 18, and 23 months. Passive mechanical wall properties were assessed by pressure myography. In both genotypes, there was a significant increase in circumferential stiffening in mesenteric arteries with aging, whereas in the femoral artery, aging reduced volume compliance. This was associated with a reduced ability of the artery to lengthen with aging. The predominant phenotype observed in Rln (-/-) mice was reduced volume compliance in young mice in both mesenteric and femoral arteries. In summary, aging induces circumferential stiffening in mesenteric arteries and axial stiffening in femoral arteries. Passive mechanical wall properties of Rln (-/-) mouse arteries predominantly differ at younger ages compared with Rln (+/+) mice, suggesting that a lack of endogenous relaxin only has a minor effect on vascular aging.

  12. Demonstration by radionuclide imaging of possible vascular steal from a renal transplant. [I-131, Tc-99

    Energy Technology Data Exchange (ETDEWEB)

    Bloss, R.S.; McConnell, R.W.; McConnell, B.G.; Floyd, M.; Conner, W.T.; Henry, R.G.; Kahan, B.D.

    1979-10-01

    Radionuclide studies in a renal-transplant patient with congestive heart failure suggested vascular steal from the renal allograft by a contralateral femoral arteriovenous fistula. These reliable, noninvasive diagnostic procedures have potential use in similar settings to evaluate allograft perfusion and function. Correction by removal of the fistula was demonstrated.

  13. Ipsilateral Acetabular and Femoral Neck and Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Hideto Irifune

    2015-01-01

    Full Text Available Floating hip injuries and ipsilateral femoral neck and shaft fractures are rare. Additionally, the simultaneous occurrence of these injuries is extremely rare, and only one case report of the simultaneous occurrence of these injuries has been published. Here, we report the case of a patient with ipsilateral acetabular and femoral neck and shaft fractures following a suicide attempt. The patient experienced nonunion of the femoral neck and shaft after the initial operation and therefore underwent reconstruction using a femoral head prosthesis with a long stem and interlocking screws. Our procedure may be used in primary and/or secondary reconstruction for ipsilateral acetabular and femoral neck and shaft fractures.

  14. Computerized tomography analysis of aceptic necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Ichioka, Yoshiaki; Masuda, Takeshi; Matsuno, Takeo; Hasegawa, Isao; Sugano, Hiroki; Konno, Takushi.

    1988-03-01

    Computerized tomography (CT) findings of the normal femoral head in 14 patients with unilateral aceptic necrosis of the femoral head (ANF) and in healthy adults were analyzed for early diagnostic significance. CT appearance of the bone trabeculae fell into normal finding, diffuse sclerosis, and mottled sclerosis. The development of necrosis during the process was accompanied by diffuse sclerosis, suggesting that diffuse sclerosis is an early CT appearance in the case of ANF. In a three-dimensional quantification of the necrotic area for 20 patients before rotational osteotomy of the femoral head, deformation of the femoral head after the surgery was found to frequently result from 50 % or more of the necrotic area in the femoral head, irrespective of the size of necrosis on the surface of the femoral head. This suggested the influence of the three-dimensional spread of necrosis on the intensity of the femoral head. (Namekawa, K.).

  15. The distal femoral and proximal tibial growth plates: MR imaging, three-dimensional modeling and estimation of area and volume

    Energy Technology Data Exchange (ETDEWEB)

    Craig, Joseph G.; Holsbeeck, Marnix van [Department of Radiology, Henry Ford Hospital, Detroit, MI (United States); Cody, Dianna D. [Department of Imaging Physics, University of Texas, M.D. Anderson Hospital, Houston, TX (United States)

    2004-06-01

    To explore how the size of the growth plate changes with age using three-dimensional (3D) models of the distal femoral and proximal tibial growth plates in pediatric patients. We retrospectively created 3D models of the normal unaffected distal femoral (n=20) and proximal tibial (n=10) growth plates in 14 patients (9 males, 5 females) age range 3.8-15.6 years who were referred for evaluation of premature partial closure of the growth plate or hyaline cartilage abnormality. All patients had one or more 3D fat-suppressed spoiled GRASS sequence from which models were made of normal growth plates. Total projected area was estimated from standardized maximum intensity projection (MIP) views, and volume was computed from the entire model. We also included the total projected area of the distal femur (n=7) or proximal tibia (n=8) in 11 patients (8 males, 3 females, 5-13 years) who had previously been evaluated for bone bridging. The 3D femoral and tibial growth plate anatomy was displayed. Femoral growth plate area varied from 804 mm{sup 2} to 3,463 mm{sup 2}. Femoral physeal cartilage volume varied from 2.1 cm{sup 3} to 12.6 cm{sup 3}. Tibial growth plate area varied from 736 mm{sup 2} to 3,026 mm{sup 2}. Tibial physeal cartilage volume varied from 1.9 cm{sup 3} to 13.2 cm{sup 3}. The growth plate area values appear to increase linearly with increasing age. (orig.)

  16. An uncommon Salter-Harris I fracture of the distal femoral physis with marked epiphyseal dislocation.

    Science.gov (United States)

    Hale, Christopher; Forstater, Alan; O'Malley, Gerald

    2013-02-01

    This is a report of an uncommon Salter-Harris I fracture of the distal femoral physis with complete dislocation of the distal epiphysis. These fractures are most frequently sustained during sports injuries, with motor vehicle accidents as another leading cause. They are at high risk of nonanatomic healing with subsequent varus or valgus deformity or premature growth arrest of the physis with subsequent leg length difference. Although certain fractures of the distal femoral physis may be very rarely encountered in the emergency department, the unavailability of appropriate consult service or risk of vascular compromise may necessitate reduction by the emergency physician. This fracture-dislocation was reduced with intravenous opioid analgesia, gentle traction along the axis of the lower extremity, and firm but gentle manual reduction of the proximal femoral fragment. External casts alone have a high rate of failure in sustaining anatomic alignment, so percutaneous pinning is recommended as the definitive treatment. After reduction, this patient was transferred to a pediatric hospital capable of performing the necessary operative fixation.

  17. Arterial Misplacement of a Femoral Central Venous Catheter Complicated with Acute Arterial Occlusion

    Directory of Open Access Journals (Sweden)

    Hung-Lung Hung

    2005-03-01

    Full Text Available Femoral vein catheterization is often carried out during resuscitation and in critical care units. It is usually achieved via a blind, external landmark-guided technique, through manual localization of the femoral artery. However, this approach can be challenging in patients with severe shock because of absence or ambiguity of the arterial pulse. We report a case of inadvertent cannulation, with a large-bore catheter, of the right femoral artery, which was mistaken as a venous route for medication and massive transfusion. The large cannula caused direct mechanical obstruction, while intra-arterial medications induced vascular injury and vasospasm. Both factors led to thrombosis and occlusion of the right external iliac artery, thus jeopardizing the distal blood supply, and ultimately resulting in muscle necrosis of the involved limb, and the need for thrombectomy and extensive fasciotomy to salvage the extremity. This case highlights that correct placement of a central venous catheter should be clearly ascertained before the catheter is used for medical treatment, especially when catheterization is performed in shock status.

  18. Femoral nerve compression secondary to a ganglion cyst arising from a hip joint: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Kalacı Aydıner

    2009-01-01

    Full Text Available Abstract Introduction Femoral nerve compression due to a cystic lesion around the hip joint is rare and only a few cases have been described in the literature. Among these, true ganglion cysts are even more rare. Case presentation We report the case of a 57-year-old woman with femoral nerve compression caused by a true ganglion cyst of the hip joint. Conclusion A high index of suspicion is required to predict a non-palpable cystic lesion around the hip joint as it may mimic different disorders and should be kept in mind in the differential diagnosis of unusual groin pain, radicular pain and peripheral vascular disorders.

  19. [Intraluminal Aspect of Femoro-femoral Cross-over Bypass Graft Mimics Bladder Stone].

    Science.gov (United States)

    Sonak, I; Wiedemann, A; Heppner, H J

    2016-04-01

    Iatrogenic bladder perforation with delayed diagnosis and treatment in the context of the placement of a vascular prosthesis, e.g. a femoro-femoral cross-over bypass graft, is extremely rare. This is emphasised by the present publication, which is the second published case study worldwide. To identify such a situation is very important because there is a risk of inappropriate treatment if such a bypass complication remains undetected, and the potential complications of an improperly intended "treatment of a bladder stone" may be deleterious or even lethal. Therefore, the involved disciplines should be aware of this possibility in order to initiate relevant diagnostic measures, especially diagnostic cystoscopy, without any delay if symptoms such as voiding disorders or alguria coincide with vascular bypass grafting.

  20. The Association of Femoral Neck Stress Fractures with Femoral Acetabular Impingement

    Science.gov (United States)

    Safran, Marc R.; Goldin, Michael; Anderson, Christian; Fredericson, Michael; Stevens, Kathryn J.

    2013-01-01

    Objectives: To determine if there is an increased incidence of femoral acetabular impingement (FAI) in patients presenting with stress fractures of the femoral neck. Methods: After IRB approval, the imaging studies of 25 athletes (22 females, 3 males, mean age 26, range 19 - 39 years) with femoral neck stress injuries were assessed for the presence of features suggesting FAI, including acetabular retroversion, coxa profunda, abnormal femoral head-neck junction, fibrocystic change, os acetabulae, labral tear and chondral injury. All subjects had to have an adequate AP Pelvis radiograph, a lateral radiograph of the affected hip, and an MRI of the affected hip. The alpha angle, anterior offset ratio, and center to edge (CE) angle were measured on radiographs. The grade of stress injury was determined on MR images. All images and measurements were made by a musculoskeletal fellowship trained radiologist, a fellowship trained orthopaedic surgeon, an orthopaedic sports medicine fellow and a physical medicine and rehabilitation resident. Charts were reviewed to determine treatment of the stress fracture, outcome and final follow up, as well as to determine if the patient had any further treatment for their hip. Results: Of the 25 hips (18 right, 7 left) with femoral neck stress reactions, 9 were grade 2 (bone marrow edema), 5 were grade 3 (high T2 and low T1 marrow signal), and 11 were grade 4 (stress fracture). Twenty patients (80%) had coxa profunda - where the floor of the cotyloid fossa touches or extends beyond the ilioischial line (incidence in general population is 15.2% of males, and 19.4% of females). Coxa profunda, defined by the floor of the cotyloid fossa touching or extending beyond the ilioischial line and a center edge angle of more than 35o, was present in 28% of subjects. Acetabular retroversion as assessed by the crossover sign was present in 42% (normal incidence is 5% of population). Center edge angle was greater than 35o in 20% and greater than 40 o

  1. Vascular development in Arabidopsis.

    Science.gov (United States)

    Ye, Zheng-Hua; Freshour, Glenn; Hahn, Michael G; Burk, David H; Zhong, Ruiqin

    2002-01-01

    Vascular tissues, xylem and phloem, form a continuous network throughout the plant body for transport of water, minerals, and food. Characterization of Arabidopsis mutants defective in various aspects of vascular formation has demonstrated that Arabidopsis is an ideal system for investigating the molecular mechanisms controlling vascular development. The processes affected in these mutants include initiation or division of procambium or vascular cambium, formation of continuous vascular cell files, differentiation of procambium or vascular cambium into vascular tissues, cell elongation, patterned secondary wall thickening, and biosynthesis of secondary walls. Identification of the genes affected by some of these mutations has revealed essential roles in vascular development for a cytokinin receptor and several factors mediating auxin transport or signaling. Mutational studies have also identified a number of Arabidopsis mutants defective in leaf venation pattern or vascular tissue organization in stems. Genetic evidence suggests that the vascular tissue organization is regulated by the same positional information that determines organ polarity.

  2. Closure constraints for hyperbolic tetrahedra

    Science.gov (United States)

    Charles, Christoph; Livine, Etera R.

    2015-07-01

    We investigate the generalization of loop gravity's twisted geometries to a q-deformed gauge group. In the standard undeformed case, loop gravity is a formulation of general relativity as a diffeomorphism-invariant SU(2) gauge theory. Its classical states are graphs provided with algebraic data. In particular, closure constraints at every node of the graph ensure their interpretation as twisted geometries. Dual to each node, one has a polyhedron embedded in flat space {{{R}}3}. One then glues them, allowing for both curvature and torsion. It was recently conjectured that q-deforming the gauge group SU(2) would allow us to account for a non-vanishing cosmological constant Λ \

  3. S-nitrosothiols dilate the mesenteric artery more potently than the femoral artery by a cGMP and L-type calcium channel-dependent mechanism.

    Science.gov (United States)

    Liu, Taiming; Schroeder, Hobe J; Zhang, Meijuan; Wilson, Sean M; Terry, Michael H; Longo, Lawrence D; Power, Gordon G; Blood, Arlin B

    2016-08-31

    S-nitrosothiols (SNOs) are metabolites of NO with potent vasodilatory activity. Our previous studies in sheep indicated that intra-arterially infused SNOs dilate the mesenteric vasculature more than the femoral vasculature. We hypothesized that the mesenteric artery is more responsive to SNO-mediated vasodilation, and investigated various steps along the NO/cGMP pathway to determine the mechanism for this difference. In anesthetized adult sheep, we monitored the conductance of mesenteric and femoral arteries during infusion of S-nitroso-l-cysteine (L-cysNO), and found mesenteric vascular conductance increased (137 ± 3%) significantly more than femoral conductance (26 ± 25%). Similar results were found in wire myography studies of isolated sheep mesenteric and femoral arteries. Vasodilation by SNOs was attenuated in both vessel types by the presence of ODQ (sGC inhibitor), and both YC-1 (sGC agonist) and 8-Br-cGMP (cGMP analog) mediated more potent relaxation in mesenteric arteries than femoral arteries. The vasodilatory difference between mesenteric and femoral arteries was eliminated by antagonists of either protein kinase G or L-type Ca(2+) channels. Western immunoblots showed a larger L-type Ca(2+)/sGC abundance ratio in mesenteric arteries than in femoral arteries. Fetal sheep mesenteric arteries were more responsive to SNOs than adult mesenteric arteries, and had a greater L-Ca(2+)/sGC ratio (p = 0.047 and r = -0.906 for correlation between Emax and L-Ca(2+)/sGC). These results suggest that mesenteric arteries, especially those in fetus, are more responsive to SNO-mediated vasodilation than femoral arteries due to a greater role of the L-type calcium channel in the NO/cGMP pathway.

  4. Transcatheter closure of aortopulmonary window in children: Case reports and literature review

    Institute of Scientific and Technical Information of China (English)

    XIE Zhao-feng; ZHANG Zhi-wei; XIE Yu-mei; LI Jun-jie

    2011-01-01

    @@ INTRODUCTION Aortopulmonary (AP) window is an uncommon congenital anomaly, accounting for approximately 0.2 %of all congenital heart abnormalities 1.It is usually nonrestrictive and is conventionally treated surgically at an early age to prevent the development of pulmonary vascular obstructive disease.In 10 %of this lesion, it is restrictive and case reports of its percutaneous closure are mostly limited to these patients.

  5. 100-D Ponds closure plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Petersen, S.W.

    1997-09-01

    The 100-D Ponds is a Treatment, Storage, and Disposal (TSD) unit on the Hanford Facility that received both dangerous and nonregulated waste. This Closure Plan (Rev. 1) for the 100-D Ponds TSD unit consists of a RCRA Part A Dangerous Waste Permit Application (Rev. 3), a RCRA Closure Plan, and supporting information contained in the appendices to the plan. The closure plan consists of eight chapters containing facility description, process information, waste characteristics, and groundwater monitoring data. There are also chapters containing the closure strategy and performance standards. The strategy for the closure of the 100-D Ponds TSD unit is clean closure. Appendices A and B of the closure plan demonstrate that soil and groundwater beneath 100-D Ponds are below cleanup limits. All dangerous wastes or dangerous waste constituents or residues associated with the operation of the ponds have been removed, therefore, human health and the environment are protected. Discharges to the 100-D Ponds, which are located in the 100-DR-1 operable unit, were discontinued in June 1994. Contaminated sediment was removed from the ponds in August 1996. Subsequent sampling and analysis demonstrated that there is no contamination remaining in the ponds, therefore, this closure plan is a demonstration of clean closure.

  6. 40 CFR 264.112 - Closure plan; amendment of plan.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure plan; amendment of plan. 264... Closure and Post-Closure § 264.112 Closure plan; amendment of plan. (a) Written plan. (1) The owner or operator of a hazardous waste management facility must have a written closure plan. In addition,...

  7. Free fibular strut graft in neglected femoral neck fractures in adult

    Directory of Open Access Journals (Sweden)

    Azam Md Quamar

    2009-01-01

    Full Text Available Background: Neglected femoral neck fracture in adults still poses a formidable challenge. Existing treatment options varies from osteotomy (with or without graft to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula. The aim of this study was to assess outcome of nonvascularized fibular strut graft and cancellous screw fixation in neglected femoral neck fractures in the younger age group. Materials and Methods: Medical records of 32 patients of neglected femoral neck fracture, in the age group of 22-45 years (mean 37.8 years, operated between May 1994 to December 2001, were retrospectively reviewed. After the application of inclusion and exclusion criteria, 28 patients having three years minimum follow-up (mean 4.6 years were included. Delay between injury and operation varied from four weeks to 42 weeks (mean 16.4 weeks. Closed reduction was achieved in 17 patients; open reduction through Watson-Jones anterolateral approach was performed in the remaining 15 patients in whom closed reduction failed. The fracture was transfixed with three parallel guide wires. Appropriate sized cannulated lag screw (7 mm was then inserted in two of the wires. Selection of the third guide wire for fibula depended on the space available in both anteroposterior and lateral view. Results: Satisfactory bony union was obtained in 25 patients, of whom in four cases, the union occurred in 10-20° (mean 15° of varus. Nonunion occurred in three patients (9.37%, and aseptic necrosis occurred in another six patients (18.75%. Of the 25 patients where union was achieved, five patients showed excellent results; 14 good and six had poor functional result, as evaluated using modified Anglen criteria. Conclusion: Nonvascularized fibular strut graft along with cancellous screws provides a dependable and technically less-demanding alternative procedure for neglected femoral neck fractures in young adults. Fibula

  8. Efficacy of Core Decompression of Femoral Head to Treat Avascular Necrosis in Intravenous Drug Users

    Directory of Open Access Journals (Sweden)

    Hossein Soleimani

    2013-04-01

    Full Text Available Core decompression (CD of the femoral head is one of the effective treatments of avascular necrosis (AVN, especially in the early stages of the disease. To investigate further the value of CD in treating the AVN, this study was performed on patients with symptomatic AVN with different etiologies who were treated with CD. This study was carried out on 25 patients (with the total number of 37 femoral head who were diagnosed AVN using X-Ray and MRI. The CD treatments for these patients were started soon after the diagnosis. The results were considered as a success if there was no progression of disease confirmed by X Ray or no subsequent operation was required. Modified Ficat staging was used to record changes before and 2 years after CD treatment. Twenty five patients were participated in this study in which 68% (n=17 were female, 32% (n=8 were male, and the average of the age of the patients were 29.58±4.58. Eight of these patients had systemic lupus erythematous (SLE (32%, 4 rheumatoid arthritis (RA (16%, 3 with kidney transplant (12%, 1 Takayasu’s vasculitis (4% and 1 Wegner vasculitis (4%. Eight of patients had a history of intravenous injection of Temgesic (32%. In patients using Temgesic the changes in Modified Ficat staging were significantly different before and after CD treatment (P=0.03 in comparison with other groups. And in all 8 Temgesic users AVN progressed to the stage 3 and 4 after CD treatment. This study demonstrated that CD treatment to prevent the changes in the femoral head has been more effective in patients with collagen vascular diseases and kidney transplant than patients using intravenous Temgesic. These patients, in spite of early operation, showed no benefit of CD to prevent the changes in the femoral head.

  9. Femoral bifurcation disease: balloon or knife.

    Science.gov (United States)

    Bosiers, Marc; Deloose, Koen

    2009-10-01

    Arterial occlusive disease at the level of the femoral bifurcation mostly occurs in combination with inflow and/or outflow lesions. Surgical endarterectomy of the femoral bifurcation is a well-proven low-risk and easy surgical intervention with known durable success, while, although proven to be safe, evidence is lacking about the durability of the endovascular approach. Based on the evidence at hand, the surgical approach should be recommended for the vast majority of patients and the endovascular approach should only be indicated as the first strategy in selected cases presenting with factors that might compromise the outcome of surgery in the groin. If feasible, the hybrid approach with endarterectomy at the level of the bifurcation and endovascular repair of the inflow and outflow lesions is preferred in patients with multilevel disease.

  10. Femoral head fracture without hip dislocation

    Institute of Scientific and Technical Information of China (English)

    Aditya K Aggarwal; Ashwani Soni; Daljeet Singh

    2013-01-01

    Femoral head fractures without dislocation or subluxation are extremely rare injuries.We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high energy trauma due to road traffic accident.He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39.He received cementless total hip replacement.At latest follow-up of 2.3 years,functional outcome was excellent with Harris hip score of 95.Such isolated injuries have been described only once in the literature and have not been classified till now.The purpose of this report is to highlight the extreme rarity,possible mechanism involved and a novel classification system to classify such injuries.

  11. Distinct Differences on Neointima Formation in Immunodeficient and Humanized Mice after Carotid or Femoral Arterial Injury

    Science.gov (United States)

    Moser, Jill; van Ark, Joris; van Dijk, Marcory C.; Greiner, Dale L.; Shultz, Leonard D.; van Goor, Harry; Hillebrands, Jan-Luuk

    2016-01-01

    Percutaneous coronary intervention is widely adopted to treat patients with coronary artery disease. However, restenosis remains an unsolved clinical problem after vascular interventions. The role of the systemic and local immune response in the development of restenosis is not fully understood. Hence, the aim of the current study was to investigate the role of the human immune system on subsequent neointima formation elicited by vascular injury in a humanized mouse model. Immunodeficient NOD.Cg-PrkdcscidIL2rgtm1Wjl(NSG) mice were reconstituted with human (h)PBMCs immediately after both carotid wire and femoral cuff injury were induced in order to identify how differences in the severity of injury influenced endothelial regeneration, neointima formation, and homing of human inflammatory and progenitor cells. In contrast to non-reconstituted mice, hPBMC reconstitution reduced neointima formation after femoral cuff injury whereas hPBMCs promoted neointima formation after carotid wire injury 4 weeks after induction of injury. Neointimal endothelium and smooth muscle cells in the injured arteries were of mouse origin. Our results indicate that the immune system may differentially respond to arterial injury depending on the severity of injury, which may also be influenced by the intrinsic properties of the arteries themselves, resulting in either minimal or aggravated neointima formation. PMID:27759053

  12. Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation

    Institute of Scientific and Technical Information of China (English)

    WANG Wen-yue; YANG Tian-fu; FANG Yue; LEI Ming-ming; WANG Guang-lin; LIU Lei

    2010-01-01

    Objective:Subtrochanteric femoral fractures are severe injuries.Although many treatment methods have been developed,controversy exists regarding the optimal management of these fractures.This study evaluated the clinical outcome of subtrochanteric femoral fractures fixed with long proximal femoral nail antirotation(PFNA-long).Methods:Between October 2006 and February 2008,25 patients with traumatic subtrochanteric fractures of the femur were treated with PFNA-long.Closed reduction and fixation were performed in 20 cases.In the remaining 5 cases,closed reduction was difficult,so limited open reduction was performed,with bone grafting in 4 cases and circumferential wiring in 4 cases.Results:The average follow-up time was 16.1 months.All subtrochanteric femoral fractures healed uneventfully except one case of delayed union.The mean union time was 26.2 weeks.Technical difficulties with nail insertion were encountered in 3 cases.No implant failure was observed.Conclusion:PFNA-long is effective in treatment of subtrochanteric femoral fractures,with a high rate of bone union,minor soft tissue damage,early return to functional exercise and few implant-related complications.

  13. Structural determinants of hospital closure.

    Science.gov (United States)

    Longo, D R; Chase, G A

    1984-05-01

    In a retrospective case-control study, structural characteristics of hospitals that closed during the years 1976-1980 were contrasted with three comparison groups: hospitals that were acquired in a merger; hospitals that joined a multihospital system; and hospitals that remained autonomously opened, to investigate these characteristics as predictors of closure. Characteristics investigated included environmental, structural, and process variables. The independent variables were measured 5 years prior to outcome. Findings indicate that closed hospitals resemble hospitals acquired in a merger ("failure"), and likewise autonomous hospitals resemble hospitals that join a multihospital system ("success"). The most important predictors of hospital failure were the physician-to-population ratio, the East North Central and West North Central census regions, the level of diversification, low occupancy rate, location in a standard metropolitan statistical area, the chief executive officer's lack of affiliation in the American College of Hospital Administrators, profit status, bed size of less than 50, and presence in a state with a rate-setting agency. Surprisingly, this study shows the bed-to-population ratio to be unrelated to closure. In addition, the findings strongly support the open-system perspective, which, unlike the closed-system perspective, is concerned with the vulnerability of the organization to the uncontrollable and often unpredictable influences of the environment.

  14. [Avascular necrosis of the femoral head].

    Science.gov (United States)

    Porubský, Peter; Trč, Tomáš; Havlas, Vojtěch; Smetana, Pavel

    Avascular necrosis of the femoral head in adults is not common, but not too rare diseases. In orthopedic practice, it is one of the diseases that are causing implantation of hip replacement at a relatively early age. In the early detection and initiation of therapy can delay the implantation of prosthesis for several years, which is certainly more convenient for the patient and beneficial. This article is intended to acquaint the reader with the basic diagnostic procedures and therapy.

  15. Current concepts in total femoral replacement

    OpenAIRE

    Ramanathan, Deepak; Siqueira, Marcelo BP; Klika, Alison K.; Higuera, Carlos A.; Barsoum, Wael K.; Joyce, Michael J

    2015-01-01

    Total femoral replacement (TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20th century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing li...

  16. Proximal femoral reconstruction with custom mega prosthesis

    OpenAIRE

    2003-01-01

    Seventy-seven patients with proximal femoral tumours underwent limb salvage surgery with custom mega prostheses between July 1989 and January 2002. We describe 44 cases with a mean follow-up of 57.8 months. Forty-one patients presented with malignant neoplasms of which 11 were malignant giant cell tumours, eight were chondrosarcoma and five were metastases. Wide margins were achieved for all malignant tumours, and marginal resection was done for all benign and metastatic lesions. Six patients...

  17. Radiofrequency ablation of two femoral head chondroblastomas

    Energy Technology Data Exchange (ETDEWEB)

    Petsas, Theodore [Department of Radiology, University of Patras (Greece); Megas, Panagiotis [Department of Orthopaedic Surgery, University of Patras (Greece)]. E-mail: panmegas@med.upatras.gr; Papathanassiou, Zafiria [Department of Radiology, University of Patras (Greece)

    2007-07-15

    Chondroblastoma is a rare benign cartilaginous bone tumor. Surgical resection is the treatment of choice for pain relief and prevention of further growth. Open surgical techniques are associated with complications, particularly when the tumors are located in deep anatomical sites. The authors performed RF ablation in two cases of subarticular femoral head chondroblastomas and emphasize its positive impact. The clinical course, the radiological findings and the post treatment results are discussed.

  18. Bisphosphonate-induced atypical subtrochanteric femoral fracture

    OpenAIRE

    2013-01-01

    The use of bisphosphonates (BPs) is universally accepted in the management of osteoporosis. However, a small percentage of patients have been recognised to develop atypical subtrochanteric fractures of the femur with the prolonged use of BPs. We report a rare case of bilateral insufficiency lesions in the proximal femora, where a major subtrochanteric fracture developed with a minor fall. This was successfully treated with internal fixation using proximal femoral nail.

  19. Ipsilateral femoral neck and trochanter fracture

    Directory of Open Access Journals (Sweden)

    Devdatta S Neogi

    2011-01-01

    Full Text Available Ipsilateral fractures in the neck and trochanteric region of the femur are very rare and seen in elderly osteoporotic patients. We present a case of a young man who presented with ipsilateral fracture of the femoral neck and a reverse oblique fracture in the trochanteric region following a motor vehicle accident. A possible mechanism, diagnostic challenge, and awareness required for identifying this injury are discussed.

  20. Branding of vascular surgery.

    Science.gov (United States)

    Perler, Bruce A

    2008-03-01

    The Society for Vascular Surgery surveyed primary care physicians (PCPs) to understand how PCPs make referral decisions for their patients with peripheral vascular disease. Responses were received from 250 PCPs in 44 states. More than 80% of the respondents characterized their experiences with vascular surgeons as positive or very positive. PCPs perceive that vascular surgeons perform "invasive" procedures and refer patients with the most severe vascular disease to vascular surgeons but were more than twice as likely to refer patients to cardiologists, believing they are better able to perform minimally invasive procedures. Nevertheless, PCPs are receptive to the notion of increasing referrals to vascular surgeons. A successful branding campaign will require considerable education of referring physicians about the totality of traditional vascular and endovascular care increasingly provided by the contemporary vascular surgical practice and will be most effective at the local grassroots level.

  1. Effect of cholesterol lowering on stiffness of aortic and femoral arterial walls in rabbits on a high fat diet

    Institute of Scientific and Technical Information of China (English)

    XUE Li; XU Wan-hai; XU Jin-zhi; ZHANG Tong; BI Hong-yuan; SHEN Bao-zhong

    2009-01-01

    Background Researches in arterial elasticity have increased over the past few years. We investigated the effects of simvastatin on vascular stiffness in fat fed rabbits by ultrasonography.Methods Thirty rabbits were assigned randomly to 3 groups: normal control group (A), the cholesterol group (B), simvastatin group (C: high fat diet for 4 weeks and high fat diet + simvastatin for further 4 weeks). Stiffness coefficient, pressure strain elastic modulus and velocity of pulse waves in abdominal aorta and femoral artery were measured by ultrasonographic echo tracking at the end of the 4th and the 8th weeks.Results At the end of the 4th week, stiffness coefficient, pressure strain elastic modulus and pulse wave velocity of femoral artery were significantly increased in group B compared with those in group A. Similarly, at the end of the 8th week, the same parameters of abdominal aorta were significantly increased in group B compared with those in group A. In contrast, stiffness coefficient, pressure strain elastic modulus and pulse wave velocity of femoral artery were significantly decreased in group C compared with those in group B, however, there was no significant difference in parameters of abdominal aorta between groups B and C.Conclusion Short term administration of simvastatin can improve the elasticity of femoral artery but not abdominal aorta.

  2. Biomechanical considerations in slipped capital femoral epiphysis and insights into prophylactic fixation.

    Science.gov (United States)

    Leblanc, E; Bellemore, J M; Cheng, T; Little, D G; Birke, O

    2017-04-01

    Slipped capital femoral epiphysis (SCFE) is a deformity of the proximal femur secondary to widened and unstable physis. In stabilising the slip, gold standard treatments stop growth and involve premature physeal closure, which prevents the remodelling of the acquired deformity and creates a leg length discrepancy that may be significant in younger patients. We measured the impact of placing threaded screws across the proximal femoral physis by measuring the centre-trochanteric distance (CTD) and articulo-trochanteric distance (ATD) in participants with or without prophylactic fixation. We then compared the mechanical performance of static (stainless and titanium cannulated Synthes screws) and potentially growing implants (Synthes SCFE screw and Pega Medical Free Gliding screw) in a validated synthetic bone model. In the review of 30 non-fixed and 60 fixated hips over a mean follow-up of 1.9 years, we have noted a significant difference in pre/post CTD and ATD, as well as the change in CTD and ATD over time. In the biomechanical study, the newer implants allowing growth (Synthes SCFE screw and Pega Medical Free Gliding screw) were both shown to be at least non-inferior. The primary deformity of a SCFE in itself alters hip mechanics. Also, as confirmed in this study, there is a secondary deformity that is created by static fixation and relative trochanteric overgrowth. To help remodel mild deformities and prevent secondary trochanteric overgrowth, growing implants seem to be non-inferior to the more standard means of fixation in static testing.

  3. The use of a surgical incision management system on vascular surgery incisions: a pilot study.

    Science.gov (United States)

    Weir, Gregory

    2014-06-01

    Health care-associated infections in hospitals, including surgical site infections, contribute significantly to morbidity as well as mortality. Surgical incision management (SIM) using negative pressure wound therapy (Prevena™ Incision Management System, Kinetic Concepts, Inc., San Antonio, TX, USA) is designed to cover and protect closed surgical incisions from external factors including infectious sources and local trauma, while negative pressure removes fluid and infectious material from the surgical incision. A prospective case-control study assessed wound complications in patients undergoing vascular bypass procedures, where both femoral areas were incised to gain access to the femoral arteries. SIM was placed on one femoral area while a standard postoperative wound dressing was placed on the contralateral femoral area. Eight patients were included in this pilot study. All of them required bilateral femoral artery access. During the follow-up period patients were monitored for wound complications. All wound complications requiring surgical intervention were considered significant. No significant wound complications occurred in wounds treated with SIM, compared with three significant complications in control wounds. These preliminary data would suggest a potential reduction in wound complications and no observed increase in haemorrhage in high-risk patients with severe co-morbidities undergoing vascular surgery.

  4. Contribution of perfusion pressure to vascular resistance response during head-up tilt

    Science.gov (United States)

    Imadojemu, V. A.; Lott, M. E.; Gleeson, K.; Hogeman, C. S.; Ray, C. A.; Sinoway, L. I.

    2001-01-01

    We measured brachial and femoral artery flow velocity in eight subjects and peroneal and median muscle sympathetic nerve activity (MSNA) in five subjects during tilt testing to 40 degrees. Tilt caused similar increases in MSNA in the peroneal and median nerves. Tilt caused a fall in femoral artery flow velocity, whereas no changes in flow velocity were seen in the brachial artery. Moreover, with tilt, the increase in the vascular resistance employed (blood pressure/flow velocity) was greater and more sustained in the leg than in the arm. The ratio of the percent increase in vascular resistance in leg to arm was 2.5:1. We suggest that the greater vascular resistance effects in the leg were due to an interaction between sympathetic nerve activity and the myogenic response.

  5. Femoral Head Growth Plate Dysplasia and Fracture in Juvenile Rabbits Induced by Off-target Antiangiogenic Treatment.

    Science.gov (United States)

    Hall, A Peter; Mitchard, T; Rolf, M G; Stewart, J; Duffy, P

    2016-08-01

    Epiphyseal growth plate dysplasia (chondrodysplasia) might be considered as the pathognomonic feature of antiangiogenic treatment in preclinical species as it is reliably and dose-responsively induced in rodents and monkeys with vascular endothelial growth factor receptor (VEGFR) inhibitors, fibroblast growth factor (FGF) receptor inhibitors, matrix metalloproteinase inhibitors, and vascular targeting agents. Here we report epiphyseal growth plate dysplasia in juvenile rabbits treated with an oral spleen tyrosine kinase inhibitor induced by off-target antiangiogenic inhibition of VEGF and FGF family kinase receptors. Epiphyseal growth plate dysplasia resulted in weakening and fracturing of the femoral head physis in 6 of 10 male and 1 of 10 female animals as well as microfracturing and dysplasia of the distal femoral articular cartilage in 1 male animal. Fracture lines ran through the zone of hypertrophic cartilage (as well as adjacent zones), were orientated parallel to the physeal plane, and often involved displacement of the femoral head. We would suggest that the high prevalence of growth plate fracture in the rabbit may represent a potential additional adverse risk to those already established for children treated with antiangiogenic therapy.

  6. Prophylactic pinning for slipped capital femoral epiphysis: does it affect proximal femoral morphology?

    Science.gov (United States)

    Cousins, Gerard R; Campbell, Donald M; Wilson, Neil I L; Maclean, Jamie G B

    2016-05-01

    This study was designed to determine whether prophylactic pinning of the unaffected hip in unilateral slipped capital femoral epiphysis affects the proximal femoral morphology. Twenty-four hips prophylactically pinned were compared with 26 cases observed. The articulotrochanteric distance (ATD) and the trochanteric-trochanteric distance (TTD) were measured. Postoperative radiographs were compared with final follow-up radiographs. The final TTD : ATD ratio was higher (P=0.048) in the pinned group, suggesting relative coxa vara/breva. There was a smaller difference between the two hips in the prophylactically pinned group (0.7) as opposed to those observed (1.47). Prophylactic pinning does not cause growth to stop immediately but alters the proximal femoral morphology.

  7. 40 CFR 264.178 - Closure.

    Science.gov (United States)

    2010-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Use and Management of Containers § 264.178 Closure. At closure, all hazardous waste and hazardous waste residues must be removed...

  8. 40 CFR 264.351 - Closure.

    Science.gov (United States)

    2010-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Incinerators § 264.351 Closure. At closure the owner or operator must remove all hazardous waste and hazardous waste...

  9. 50 CFR 665.666 - Closures.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Closures. 665.666 Section 665.666 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION... § 665.666 Closures. (a) If the Regional Administrator determines that the harvest quota for any...

  10. Key financial ratios can foretell hospital closures.

    Science.gov (United States)

    Lynn, M L; Wertheim, P

    1993-11-01

    An analysis of various financial ratios sampled from open and closed hospitals shows that certain leverage, liquidity, capital efficiency, and resource availability ratios can predict hospital closure up to two years in advance of the closure with an accuracy of nearly 75 percent.

  11. Spontaneous closure of traumatic tympanic membrane perforations

    DEFF Research Database (Denmark)

    Jellinge, Marlene Ersgaard; Kristensen, S.; Larsen, K

    2015-01-01

    BACKGROUND: The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy. MET...

  12. Acute angle closure glaucoma following ileostomy surgery

    Directory of Open Access Journals (Sweden)

    Mariana Meirelles Lopes

    2015-02-01

    Full Text Available Angle-closure glaucoma can be induced by drugs that may cause pupillary dilatation. We report a case of a patient that developed bilateral angle closure glaucoma after an ileostomy surgery because of systemic atropine injection. This case report highlights the importance of a fast ophthalmologic evaluation in diseases with ocular involvement in order to make accurate diagnoses and appropriate treatments.

  13. MR evaluation of femoral neck version and tibial torsion

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, James Karl; Dwek, Jerry R. [University of California, San Diego, Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Pring, Maya E. [Rady Children' s Hospital, Department of Pediatric Orthopedic Surgery, San Diego, CA (United States)

    2012-01-15

    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

  14. Ipsilateral femoral neck and shaft fractures: An overlooked association

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA)); Riemer, B.L.; Butterfield, S.L. (Dept. of Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA))

    1991-05-01

    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG).

  15. Femoral neuropathy and meralgia paresthetica secondary to an iliacus hematoma.

    Science.gov (United States)

    Yi, Tae Im; Yoon, Tae Hee; Kim, Joo Sup; Lee, Ga Eun; Kim, Bo Ra

    2012-04-01

    Compressive femoral and lateral femoral cutaneous neuropathies from an iliacus hematoma are unusual presentation. We report a case of a 16-year-old boy who developed right femoral and lateral femoral cutaneous neuropathies as a complication of traumatic ipsilateral iliacus hematoma formation. The patient complained of numbness in the right thigh and calf as well as right leg weakness, and pain in the right inguinal area. Nerve conduction study and needle electromyography identified the neuropathies. After the electrodiagnostic studies, the pelvic bone MRI revealed a large, 9×5×4.5 cm right iliacus hematoma. As a result, diagnosis of a right iliacus hematoma compressing the femoral and lateral femoral cutaneous nerves was made, and the patient underwent an operation to remove the hematoma. Symptoms and neurological signs showed notable improvement after surgical decompression. Subsequent follow-up electrodiagnostic studies after 11 weeks demonstrated regeneration evidence.

  16. Management of femoral artery pseudoaneurysm due to addictive drug injection

    Institute of Scientific and Technical Information of China (English)

    李建文; 王三明; 陈小东

    2004-01-01

    Objective: To study surgical management for patients with femoral pseudoaneurysm resulting from addictive druginjection.Methods: Clinical data of 34 patients with femoral pseudoaneurysm resulting from addictive drug injection were retrospectively reviewed.Results: Thirteen patients underwent bypass graft ( end to side) of external iliac artery and superficial femoral artery using expanded polytetrafluoroethylene (ePTFE).Three patients who had an autogenous saphenous vein graft in situs, one of whom was then performed an ePTFE graft when rupture and bleeding occurred at the anastomotic site. Color Doppler image showed patent grafted blood vessels in all the patients after operation. Eighteen patients had their femoral arteries ligated. Limbs of all the 34 patients were saved.Conclusions: Ligating femoral artery is an effective way to treat femoral artery pseudoaneurysm if autogenous saphenous vein graft or artificial vessel graft is notapplicable.

  17. Vascular complications with transcatheter aortic valve implantation using the 18 Fr Medtronic CoreValve System: the Rotterdam experience.

    Science.gov (United States)

    Van Mieghem, Nicolas M; Nuis, Rutger-Jan; Piazza, Nicolo; Apostolos, Tzikas; Ligthart, Jurgen; Schultz, Carl; de Jaegere, Peter P; Serruys, Patrick W

    2010-01-01

    Transcatheter aortic valve implantation (TAVI) requires large bore catheters. Access site complications, therefore, can be a concern. The aim of this study is to present the 30-day incidence of major and minor vascular complications in patients treated with the third generation 18 Fr Medtronic CoreValve System. We prospectively evaluated the vascular complications occurring in all patients treated with the 18 Fr Medtronic CoreValve System between October 2006 and October 2009 in the Thoraxcenter using various proposed definitions. Ninety-nine consecutive patients were treated with TAVI using the 18 Fr Medtronic CoreValve System. Vascular events were encountered in 13 patients (13%), seven of these cases (54%) were related to incomplete arteriotomy closure with the Prostar device which is the default access closure technique in our centre. Depending on how major vascular complications were defined, the incidence varied from 4 to 13%. Blood transfusions in combination with surgical or percutaneous intervention were required in eight cases. Transcatheter aortic valve implantation with the 18 Fr Medtronic CoreValve System(R) has a 4 to 13% vascular complications' rate. More than half of the vascular events were due to incomplete Prostar arteriotomy closure, despite its use by experienced operators. Current percutaneous closure devices for these large arteriotomies seems suboptimal. Uniformity in how to define TAVI related vascular complications is needed.

  18. Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated with Acute Repair

    Directory of Open Access Journals (Sweden)

    David Walmsley

    2014-01-01

    Full Text Available Acute compartment syndrome is a surgical emergency and its diagnosis is more difficult in obtunded or insensate patients. We present the case of a 34-year-old woman who sustained a Gustilo-Anderson grade III open midshaft femur fracture with an isolated femoral vein injury treated with direct repair. She developed lower leg compartment syndrome at 48 hours postoperatively, necessitating fasciotomies. She was subsequently found to have a DVT in her femoral vein at the level of the repair and was started on therapeutic anticoagulation. This case highlights the importance of recognition of isolated venous injuries in a trauma setting as a risk factor for developing compartment syndrome.

  19. 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.

  20. Intermittent acute angle closure glaucoma and chronic angle closure following topiramate use with plateau iris configuration

    Directory of Open Access Journals (Sweden)

    Rajjoub LZ

    2014-07-01

    Full Text Available Lamise Z Rajjoub, Nisha Chadha, David A Belyea Department of Ophthalmology, The George Washington University, Washington, DC, USA Abstract: This is a case report describing recurrent intermittent acute angle closure episodes in the setting of topiramate use in a female suffering from migraines. Despite laser peripheral iridotomy placement for the pupillary block component, and the discontinuation of topiramate, the acute angle closure did not resolve in the left eye with chronic angle closure and the patient required urgent trabeculectomy. The right eye responded to laser peripheral iridotomy immediately and further improved after the cessation of topiramate. While secondary angle closure glaucoma due to topiramate use has been widely reported, its effects in patients with underlying primary angle closure glaucoma have not been discussed. Our report highlights the importance of recognizing the often multifactorial etiology of angle closure glaucoma to help guide clinical management. Keywords: angle closure glaucoma, plateau iris, topiramate, secondary glaucoma, drug-induced glaucoma

  1. Closure of Microcosm for refurbishment

    CERN Multimedia

    2014-01-01

    Since 1994, the Microcosm exhibition has given the opportunity to visitors of all ages and backgrounds to have a first glimpse into the secrets of physics.   To ensure that Microcosm can continue fulfilling its educational aims at the same level of quality for many years to come, it is closing for renovation work on 8 December 2014 and is expected to reopen during Summer 2015. During the closure, the “Fun with Physics” workshop will not take place, but the Universe of Particles exhibition in the Globe and the Passport to the Big Bang circuit will remain accessible to the public, free of charge and with no need to book in advance.  Guided tours of CERN are also available (advance booking required via this page).

  2. Closure for milliliter scale bioreactor

    Science.gov (United States)

    Klein, David L.; Laidlaw, Robert D.; Andronaco, Gregory; Boyer, Stephen G.

    2010-12-14

    A closure for a microreactor includes a cap that is configured to be inserted into a well of the microreactor. The cap, or at least a portion of the cap, is compliant so as to form a seal with the well when the cap is inserted. The cap includes an aperture that provides an airway between the inside of the well to the external environment when the cap is inserted into the well. A porous plug is inserted in the aperture, e.g., either directly or in tube that extends through the aperture. The porous plug permits gas within the well to pass through the aperture while preventing liquids from passing through to reduce evaporation and preventing microbes from passing through to provide a sterile environment. A one-way valve may also be used to help control the environment in the well.

  3. Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair.

    Science.gov (United States)

    Putnis, Soni; Wong, April; Berney, Christophe

    2011-12-01

    During totally extraperitoneal (TEP) endoscopic repair of inguinal hernias, it is possible to see the internal opening of the femoral canal. The aim of our study was to determine the incidence of synchronous femoral hernias found in patients undergoing TEP endoscopic inguinal hernia repair. This was a retrospective review of prospectively collected data on 362 consecutive patients who underwent 484 TEP endoscopic inguinal hernia repairs during a 5-year period, May 2005 to May 2010. During surgery, both inguinal and femoral canal orifices were routinely inspected. The presence of unilateral or bilateral inguinal and femoral hernias was recorded and repaired accordingly. There were a total of 362 patients. More males (343, 95%) underwent a TEP hernia repair than females (19, 5%). There were more cases of unilateral (240/362, 66%) than bilateral (122/362, 34%) inguinal hernias. A total of 18 cases of synchronous femoral hernias were found during operation. There was a higher incidence of femoral hernia in females (7/19, 37%) compared to males (11/343, 3%) (P hernias were clinically detectable preoperatively. Females undergoing elective inguinal hernia repair are more likely to have a synchronous femoral hernia than males. We suggest that all women presenting with an inguinal hernia also have a formal assessment of the femoral canal. TEP endoscopic inguinal hernia repair is an ideal approach as both inguinal and femoral orifices can be assessed and hernias repaired simultaneously during surgery.

  4. Magnetic resonance imaging and histopathology in the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Takatori, Yoshio; Kamogawa, Morihide; Nakamura, Toshitaka; Ninomiya, Setsuo; Kokubo, Takashi

    1989-05-01

    To correlate the magnetic resonance (MR) images with the histopathological findings in the femoral head, the histopathology of 24 femoral heads, 15 with osteonecrosis, five with osteoarthritis and four with other hip disorders were subjected to preoperative MR imaging which demonstrated low intensity areas due to long T1 relaxation time in the femoral head. The MR signal was low where fibrovascular tissue, disintegrated fibrovascular tissue, amorphous necrotic material, bone, or cartilagenous tissue occupied the medullary space. From this study, it seems possible to predict the histopathologic changes in the femoral head using MR images. (author).

  5. A rare and frequently unrecognised pathology in children: femoral hernia.

    Science.gov (United States)

    Temiz, A; Akcora, B; Temiz, M; Canbolant, E

    2008-10-01

    A femoral hernia is the protrusion of the abdominal contents through the femoral canal. It accounts for less than 1% of all groin hernias in children and is often confused with inguinal hernia or other inguinal pathologies. Preoperative misdiagnosis has been reported to be between 40 and 75%. We believe that misdiagnosis and mistreatment usually occur due to insufficient physical examination, knowledge and experience about childhood femoral hernias. Here, we report and discuss the clinical appearance and treatment approach of three patients operated with the diagnosis of femoral hernias.

  6. Riscos e consequências do uso da técnica transportal na reconstrução do ligamento cruzado anterior: relação entre o túnel femoral, a artéria genicular lateral superior e o epicôndilo lateral do côndilo femoral Risks and consequences of using the transportal technique in reconstructing the anterior cruciate ligament: relationships between the femoral tunnel, lateral superior genicular artery and lateral epicondyle of the femoral condyle

    Directory of Open Access Journals (Sweden)

    Diego Costa Astur

    2012-10-01

    Full Text Available OBJETIVO: Definir zona de segurança para evitar possíveis complicações vasculares e ligamentares durante a reconstrução do ligamento cruzado anterior. MÉTODOS: Reconstrução artroscópica com uso de técnica transportal e transtibial em joelhos de cadáver foi realizada seguida de dissecção e mensuração da distância entre o túnel femoral e a inserção proximal do ligamento colateral lateral e o túnel femoral e a artéria genicular lateral superior. RESULTADOS: A mensuração das distâncias analisadas mostra uma aproximação maior do principal ramo da artéria genicular lateral superior e da inserção proximal do ligamento colateral lateral com o túnel femoral, realizado com a técnica transportal. CONCLUSÃO: Percebemos que o uso da técnica transportal para reconstrução artroscópica do LCA apresenta maior probabilidade de lesão da artéria genicular lateral e da inserção do ligamento colateral lateral, favorecendo complicações pós-cirúrgicas como instabilidade do joelho, osteonecrose do côndilo femoral lateral e ligamentização do enxerto.OBJECTIVE: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. METHODS: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. RESULTS: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. CONCLUSION: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and

  7. tion of vascular malformations

    African Journals Online (AJOL)

    classification of vascular anomalies outside of the central ... The current classification of CNS vascular ... tural proteins within the wall of caver- .... ing (or established) loss of function or a threat to ..... natural history of the strawberry nevus. Arch.

  8. Society for Vascular Medicine

    Science.gov (United States)

    ... Certification with this new online course from the Society for Vascular Medicine. Learn more. Looking for a ... jobs are listed right now. Copyright © 2016 The Society for Vascular Medicine. All Rights Reserved.

  9. Collagen vascular disease

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/001223.htm Collagen vascular disease To use the sharing features on this ... previously said to have "connective tissue" or "collagen vascular" disease. We now have names for many specific ...

  10. 青壮年股骨头缺血坏死的显微手术及康复治疗%Microsurgery and postsurgery rehabilitation in the treatment of avascular necrosis of the femoral head in the young adults

    Institute of Scientific and Technical Information of China (English)

    周谋望; 张京

    2002-01-01

    Objective To investigate a new method and its clinical results to treatment avascular necrosis of the femoral head in young adults. Methods The necrotic bone of the femoral head was removed and then iliac periosteum and bone with vascular pedicle were transplanted in 25 cases(28 hips),Rehabilitation technique was applied after surgery. Follow up time was 3~ 9.5 years postoperation.Results 16 cases were excellent, 7 cases were good, and 2 cases were fair. The rate of excellent and good was 92% . Conclusions Transplantation of iliac periosteum and bone with vascular pedicle has the effect on revascularization and new bone formation, which following with rehabilitation may promote the reconstruction of the necrotic femoral head and prevent it to collapse. Thus the pathogenesis process had been stopped.

  11. The effect of femoral neck osteotomy on femoral component position of a primary cementless total hip arthroplasty.

    Science.gov (United States)

    Dimitriou, Dimitris; Tsai, Tsung-Yuan; Kwon, Young-Min

    2015-12-01

    The aim of this study was to quantify the femoral canal diameter and version at different femoral neck osteotomy locations, and to investigate the effect of the osteotomy plane on femoral component position in total hip arthroplasty (THA). Preoperative and postoperative three-dimensional models were reconstructed in 15 patients (19 hips) who underwent primary cementless THA with tapered non-anatomical femoral stem. On the pre-operative models, the osteotomy plane was simulated at different levels (-5, 0, 5, and 10 mm from the femoral saddle [piriformis fossa]) and angles (30, 40, 50, and 60° from the femoral anatomical axis). Medullary canal version and mediolateral diameter were measured on the osteotomy surfaces. On the postoperative models, the femoral neck osteotomy plane, stem anteversion and alignment were measured. The average canal diameter ranged from 22.8 to 26.3 mm at different osteotomy levels and from 20.8 to 29.0 mm at different osteotomy angles. The average canal version ranged from 11.4 to 23.2° at different resection levels and from 12.8 to 21° at different resection angles. The femoral stem anteversion was correlated with neck osteotomy angle (R = 0.72), whereas stem alignment in frontal plane (varus/valgus) was correlated with neck osteotomy level (R = 0.87). The femoral neck osteotomy plane in THA affects the postoperative stem position due to the complex morphology of the proximal femoral medullary canal, suggesting that both femoral neck resection level and angle should be considered in optimizing femoral component alignment in THA patients.

  12. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures.

    Science.gov (United States)

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-11-01

    The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

  13. Vascular grading of angiogenesis

    DEFF Research Database (Denmark)

    Hansen, S; Grabau, D A; Sørensen, Flemming Brandt;

    2000-01-01

    was moderately reproduced (kappa = 0.59). Vascular grade was significantly associated with axillary node involvement, tumour size, malignancy grade, oestrogen receptor status and histological type. In univariate analyses vascular grade significantly predicted recurrence free survival and overall survival for all...... patients (P analysis showed that vascular grading contributed with independent prognostic value in all patients (P

  14. Immediate and mid-term clinical course after percutaneous closure of paravalvular leakage.

    Science.gov (United States)

    Sánchez-Recalde, Angel; Moreno, Raúl; Galeote, Guillermo; Jimenez-Valero, Santiago; Calvo, Luis; Sevillano, Joel Hernández; Arroyo-Ucar, Eduardo; López, Teresa; Mesa, José M; López-Sendón, José L

    2014-08-01

    Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  15. Persistent knee complaints after retrograde unreamed nailing of femoral shaft fractures

    NARCIS (Netherlands)

    El Moumni, Mostafa; Schraven, Pim; ten Duis, Henk Jan; Wendt, Klaus

    2010-01-01

    Retrograde nailing is an attractive method for stabilisation of femoral shaft fractures in cases of polytrauma, ipsilateral pelvic, acetabular, tibial and femoral neck fractures, bilateral femoral fractures, obese and pregnant patients. However, retrograde nailing may result in complaints about the

  16. The therapeutic effect of negative pressure in treating femoral head necrosis in rabbits.

    Science.gov (United States)

    Zhang, Yin-gang; Wang, Xuezhi; Yang, Zhi; Zhang, Hong; Liu, Miao; Qiu, Yushen; Guo, Xiong

    2013-01-01

    Because negative pressure can stimulate vascular proliferation, improve blood circulation and promote osteogenic differentiation of bone marrow stromal cells, we investigated the therapeutic effect of negative pressure on femoral head necrosis (FHN) in a rabbit model. Animals were divided into four groups (n = 60/group): [1] model control, [2] core decompression, [3] negative pressure and [4] normal control groups. Histological investigation revealed that at 4 and 8 weeks postoperatively, improvements were observed in trabecular bone shape, empty lacunae and numbers of bone marrow hematopoietic cells and fat cells in the negative pressure group compared to the core decompression group. At week 8, there were no significant differences between the negative pressure and normal control groups. Immunohistochemistry staining revealed higher expression of vascular endothelial growth factor (VEGF) and bone morphogenetic protein-2 (BMP-2) in the femoral heads in the negative pressure group compared with the core decompression group. Transmission electron microscopy revealed that cell organelles were further developed in the negative pressure group compared with the core decompression group. Microvascular ink staining revealed an increased number of bone marrow ink-stained blood vessels, a thicker vascular lumen and increased microvascular density in the negative pressure group relative to the core decompression group. Real-time polymerase chain reaction revealed that expression levels of both VEGF and BMP-2 were higher in the negative pressure group compared with the core decompression group. In summary, negative pressure has a therapeutic effect on FHN. This effect is superior to core decompression, indicating that negative pressure is a potentially valuable method for treating early FHN.

  17. Subsidence crack closure: rate, magnitude and sequence

    Energy Technology Data Exchange (ETDEWEB)

    De Graff, J.V.; Romesburg, H.C.

    1981-06-01

    Tension cracks are a major surface disturbance resulting from subsidence and differential settlement above underground coal mines. Recent engineering studies of subsidence indicate that cracks may close where tensile stresses causing the cracks are reduced or relaxed. This stress reduction occurs as mining in the area is completed. Crack closure was confirmed by a study in the Wasatch Plateau coal field of central Utah. Cracks occurred in both exposed bedrock and regolith in an area with maximum subsidence of 3 m. Mean closure rate was 0.3 cm per week with individual crack closure rates between 0.2 cm and 1.0 cm per week. The mean crack closure magnitude was 80% with closure magnitudes varying between 31% and 100%. Actual magnitude values ranged from 0.6 cm to 6.5 cm with a mean value of 3.8 cm. Statistical analysis compared width change status among cracks over time. It was found that: 1) a 41% probability existed that a crack would exhibit decreasing width per weekly measurement, 2) closure state sequences seem random over time, and 3) real differences in closure state sequence existed among different cracks. (6 refs.) (In English)

  18. Analytic closures for M1 neutrino transport

    Science.gov (United States)

    Murchikova, E. M.; Abdikamalov, E.; Urbatsch, T.

    2017-08-01

    Carefully accounting for neutrino transport is an essential component of many astrophysical studies. Solving the full transport equation is too expensive for most realistic applications, especially those involving multiple spatial dimensions. For such cases, resorting to approximations is often the only viable option for obtaining solutions. One such approximation, which recently became popular, is the M1 method. It utilizes the system of the lowest two moments of the transport equation and closes the system with an ad hoc closure relation. The accuracy of the M1 solution depends on the quality of the closure. Several closures have been proposed in the literature and have been used in various studies. We carry out an extensive study of these closures by comparing the results of M1 calculations with precise Monte Carlo calculations of the radiation field around spherically symmetric protoneutron star models. We find that no closure performs consistently better or worse than others in all cases. The level of accuracy that a given closure yields depends on the matter configuration, neutrino type and neutrino energy. Given this limitation, the maximum entropy closure by Minerbo on average yields relatively accurate results in the broadest set of cases considered in this work.

  19. Digital image processing of vascular angiograms

    Science.gov (United States)

    Selzer, R. H.; Beckenbach, E. S.; Blankenhorn, D. H.; Crawford, D. W.; Brooks, S. H.

    1975-01-01

    The paper discusses the estimation of the degree of atherosclerosis in the human femoral artery through the use of a digital image processing system for vascular angiograms. The film digitizer uses an electronic image dissector camera to scan the angiogram and convert the recorded optical density information into a numerical format. Another processing step involves locating the vessel edges from the digital image. The computer has been programmed to estimate vessel abnormality through a series of measurements, some derived primarily from the vessel edge information and others from optical density variations within the lumen shadow. These measurements are combined into an atherosclerosis index, which is found in a post-mortem study to correlate well with both visual and chemical estimates of atherosclerotic disease.

  20. Role of Sonography in Clinically Occult Femoral Hernias.

    Science.gov (United States)

    Brandel, David W; Girish, Gandikota; Brandon, Catherine J; Dong, Qian; Yablon, Corrie; Jamadar, David A

    2016-01-01

    The purpose of this article is to evaluate the diagnostic accuracy of sonography in clinically occult femoral hernias and to describe our sonographic technique. The clinical and imaging data for 93 outpatients referred by general surgeons, all of whom underwent sonographic evaluation and surgery, were reviewed retrospectively. Of these, 55 patients who underwent surgical exploration for groin hernias within 3 months of sonography and met all inclusion criteria were included in the study. The sonographic technique involves using the pubic tubercle as an osseous landmark to identify and appropriately visualize the femoral canal. The Valsalva maneuver is then used to differentiate the movement of normal fat (a potential pitfall) from true herniation in the femoral canal. Surgical findings were used as the reference standard by which sonographic results were judged. Two-by-two contingency tables were used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. In these 55 patients, surgery revealed 15 femoral hernias. Eight femoral hernias occurred in women, and 7 occurred in men. For diagnosing femoral hernias, sonography demonstrated sensitivity of 80%, specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 92%. True-positive cases of femoral hernias have a sonographic appearance of a hypoechoic sac with speckled internal echoes. When examining during the Valsalva maneuver, a femoral hernia passes deep to the inguinal ligament, expands the femoral canal, displacing the normal canal fat, and effaces the femoral vein. Sonography can exclude femoral hernias with high confidence in light of its exceptional negative predictive value. With attention to technique and imaging criteria, the diagnostic accuracy of sonography can be enhanced.

  1. Biogeometry of femoral neck for implant placement

    Directory of Open Access Journals (Sweden)

    Patwa J

    2006-01-01

    Full Text Available Background : Treatment of fracture neck femur with three cannulated cancellous screws in an apex proximal configuration is practised in many parts of the world. Methods : Dimensions of femoral neck at the middle of transcervical neck using CT scan (live neck and vernier caliper (dry cadeveric neck in 20 subjects respectively were measured. Results : Inferior half of the neck is narrower than superior half. Conclusion : Biogeometry of the neck of femur does not accomodate two inferior screws and thus fixation of fracture neck femur with three canulated cancellous screws in an apex distal configuration is recommended.

  2. Eosinophilic granuloma of the capital femoral epiphysis.

    Science.gov (United States)

    Goto, Takahiro; Nemoto, Tetsuo; Ogura, Koichi; Imanishi, Jungo; Hozumi, Takahiro; Funata, Nobuaki

    2011-05-01

    Eosinophilic granuloma occurs almost exclusively in the diaphysis or metaphysis, when tubular bones are affected. The investigators present an extremely rare case of eosinophilic granuloma arising at the epiphysis of the femoral head in an 8-year-old boy. Plain radiographs and computed tomography showed a well-circumscribed radiolucent lesion, suggesting chondroblastoma or Brodie's abscess. However, the findings on magnetic resonance images were different from typical features of chondroblastoma or Brodie's abscess. The lesion was curetted. Histological diagnosis was eosinophilic granuloma. Differential diagnoses of a radiolucent lesion at the epiphysis in a child should include, though quite rare, eosinophilic granuloma.

  3. Circulating Concentrations of Adipocytokines and Their Receptors in the Isolated Corpus Cavernosum and Femoral Artery from Trained Rats on a High-Fat Diet.

    Science.gov (United States)

    Sponton, Amanda C S; Silva, Fábio H; Araujo, Hygor N; Valgas da Silva, Carmem P; de Moraes, Camila; Antunes, Edson; Zanesco, Angelina; Delbin, Maria A

    2017-01-01

    The aim of the present study was to evaluate different signaling pathways by which exercise training would interfere in endothelial function in obesity. Therefore, we examined adipocytokine levels and their receptors in the corpus cavernosum and femoral artery from trained rats on a high-fat diet. Functional experiments were performed in control sedentary and trained rats, and sedentary (h-SD) and trained male Wistar rats on a high-fat diet (h-TR). Nitric oxide (NO) and reactive oxygen species (ROS) were evaluated in vascular tissue. Circulating adipocytokines and their receptors were analyzed. In the h-SD group, the maximal responses to acetylcholine (ACh) were reduced in the femoral artery and corpus cavernosum as well as the electrical field stimulation, accompanied by an increase in circulating insulin, leptin, TNF-α, MCP-1, and PAI-1. Downregulation of ObR protein expression in the femoral artery was observed without alterations in AdipoR1 and TNFR1 in both preparations. A positive effect was observed in the h-TR group regarding the relaxation response to ACh and circulating adipocytokines, resulting in increased NO production and reduced ROS generation. Exercise restored the ObR protein expression only in the femoral artery. Aerobic exercise training ameliorated the inflammatory adipocytokines and restored the relaxation responses in the corpus cavernosum and femoral artery in rats on a high-fat diet. © 2017 S. Karger AG, Basel.

  4. Peroneal tendons well vascularized: results from a cadaveric study.

    Science.gov (United States)

    van Dijk, Pim A D; Madirolas, F Xavier; Carrera, Ana; Kerkhoffs, Gino M M J; Reina, Francisco

    2016-04-01

    Peroneal tendon tears are relatively common injuries that seem to have a poor healing tendency. The discussion goes that peroneal tendons have avascular zones, contributing to the poor healing of those tears. The purpose of this study was to provide evidence on the vascularization pattern of the peroneal tendons. Ten adult fresh-frozen cadavers were obtained from a university-affiliated body donation programme. The femoral artery was injected with natural coloured latex at the level of the knee. Macroscopic and microscopic dissections were performed to visualize the vascularization towards the peroneal tendons. To expose intratendinous vascularity, the tendons were cleared using a modified Spälteholz technique. In all specimens, blood was mainly supplied by the peroneal artery through a posterolateral vincula connecting both tendons. Branches were bifurcated every 3.9 ± 1.8 cm, starting 24 ± 5.3 cm proximal to the tip of the fibula. Eight out of 10 (80%) specimens had poor vascularized zones in the peroneus longus tendon. No avascular zones were found in the peroneus brevis tendon. The peroneal tendons are well vascularized by the peroneal artery, via vessels running through a common vincula for both tendons. In the peroneus brevis, no avascular zones were found. To keep the tendons well vascularized and therefore improve tendon healing, surgeons should be careful leaving the vincula intact during surgical procedures.

  5. Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup

    Directory of Open Access Journals (Sweden)

    Nunzio Catena

    2014-01-01

    Full Text Available Background:In children less than 6 years, the treatment of femoral shaft fracture is often non surgical, using closed reduction and casting. The literature reports many experience about this type of trauma but none of these has a long term followup. We present a retrospective study on a group of femoral diaphyseal fractures treated nonsurgically in children up to 6 years of age, with a minimum of 10 year followup. Materials and Methods:48 cases (36 males/12 females with femoral diaphyseal fractures treated between January 1988 and December 1998 were reviewed. Patients with fractures due to obstetrical trauma and pathologic fractures were excluded. The mean age of the patients was 3.3 ± 1.1 years (range 5 months-6 years. Right side was involved in 21 cases (44%, and left side in 27 cases (56%. In 34 cases (71%, closed reduction was performed and hip spica was applied with the hip and knee flexed to 45΀. In 8 cases (17%, skeletal traction was applied to perform fracture reduction and the traction pin was embedded in plaster while in the remaining 6 cases (12%, the Delitala pressure apparatus was applied after casting. Results:All fractures healed in our study. There were no complications (infection or vascular nervous issues, axial deviations, consolidation delays, or pseudoarthrosis. In 13 cases (27%, followup examinations showed mean lengthening of 1.3 ± 0.75 (range 0.5-2.5 cm of the fractured lower limb. All these patients were treated with skin traction before treatment and presented with 2.08 ± 0.28 cm mean initial femoral shortening. In 1 case (2% with 2.5 cm lengthening, epiphysiodesis of the ipsilateral knee was performed. No patients showed prolonged difficulty with gait disorders. Conclusion:On the basis of our results conservative treatment of femoral shaft fractures in children can be considered less invasive and safe procedure.

  6. Femoral stiffness after osteosynthesis of a subcapital osteotomy in osteoporotic bone: an in-vitro comparison of nine fixation methods.

    Science.gov (United States)

    Hernefalk, L; Messner, K

    1995-01-01

    Restitution of normal bone mechanics after osteosynthesis of a proximal femoral fracture in the elderly is assumed to be a prerequisite for optimal healing. To find the most appropriate fixation device for this purpose, the stiffness of 79 cadaver femora from donors with a history of osteoporosis was measured during axial loading before and after a subcapital osteotomy stabilized with one of nine different osteosynthesis devices. Only an osteotomy stabilized with an experimental device consisting of 2 von Bahr screws (Ericsson AB, Göteborg, Sweden) supported by acrylic cement gave similar mean values as the intact femur. A femur stabilized with the Deyerle device (Biomet, Bridge End, Wales, U.K.), with cannulated screws type Uppsala (Olmed AB, Uppsala, Sweden), or with von Bahr screws had an approximately 20-30% lower stiffness than tested intact. However, these devices provided a higher femoral stiffness than the hook-pin technique type LiH (Söderström AB, Gothenburg, Sweden), cannulated screws (Smith & Nephew, Memphis, TN, U.S.A.), a sliding screw plate (Smith & Nephew), a compression screw with variable length (Biomet), or an experimental screw providing expansion and compression. Despite attempted compression of the osteotomy by some of the devices, all of the commercially available devices resulted in a decrease of femoral stiffness after fixation, which may adversely influence the healing of femoral neck fractures in the elderly. Only a combination of screws and bone cement resulted in normal femoral stiffness, probably because of better device anchorage in the osteoporotic cancellous bone. However, this combination might have the potential risk of vascular damage.

  7. Yucca Mountain Waste Package Closure System

    Energy Technology Data Exchange (ETDEWEB)

    shelton-davis; Colleen Shelton-Davis; Greg Housley

    2005-10-01

    The current disposal path for high-level waste is to place the material into secure waste packages that are inserted into a repository. The Idaho National Laboratory has been tasked with the development, design, and demonstration of the waste package closure system for the repository project. The closure system design includes welding three lids and a purge port cap, four methods of nondestructive examination, and evacuation and backfill of the waste package, all performed in a remote environment. A demonstration of the closure system will be performed with a full-scale waste package.

  8. Yucca Mountain Waste Package Closure System

    Energy Technology Data Exchange (ETDEWEB)

    Herschel Smartt; Arthur Watkins; David Pace; Rodney Bitsoi; Eric Larsen; Timothy McJunkin; Charles Tolle

    2006-04-01

    The current disposal path for high-level waste is to place the material into secure waste packages that are inserted into a repository. The Idaho National Laboratory has been tasked with the development, design, and demonstration of the waste package closure system for the repository project. The closure system design includes welding three lids and a purge port cap, four methods of nondestructive examination, and evacuation and backfill of the waste package, all performed in a remote environment. A demonstration of the closure system will be performed with a full-scale waste package.

  9. A mouse model of osteonecrotic femoral head induced by methylprednisolone and lipopolysaccharide

    Directory of Open Access Journals (Sweden)

    Ha Thi -Ngan Le

    2016-03-01

    Full Text Available Introduction: Osteonecrosis of the femoral head is caused by various factors, including prolonged use of steroid drugs, use of alcohol, vascular injuries and hemoglobinopathies. This study aims to develop a mouse model for glucocorticoid-induced avascular necrosis (AVN of the femoral head.Methods: Adult mice were randomly divided into two groups: experimental and control. Group A (the experimental group was given (via intramuscular injection 10 mg/kg of lipopolysaccharide (LPS and 30 mg/kg of methylprednisolone (MPS. Each mouse additionally received MPS in divided oral doses of 13 mg/kg for 10 consecutive days. Group B (the control group received normal saline at the same location and same volume as those in Group A. Histological changes of the femoral heads were observed by electron microscopy at 3, 5, and 7 weeks after the last chemical injection. The percentage of empty lacunae was measured randomly and the expression of fibrocartilage was evaluated using an image analyz and shy;ing system. The expression of CD31 and VEGF-R2 were observed by immunohistochemistry. The bone marrow-derived mononuclear cells were stained with propidium iodide and cell cycle was analyzed by flow cytometry. Results:The results showed that at weeks 3 and 5, mice in Group A showed an increase in body weight. From weeks 5 to 7, mouse body weight in both groups remained constant. No difference in bone morphology was observed at week 7. The percentage of empty lacunae was 5.87 2.49% at week 5 and 21.58 8.10% at week 7. After 7 weeks, chondrocyte degeneration and fibrocartilage expression were observed. Moreover, the density of CD31 and VEGF-R2 markers increased in the femoral head. The rate of apoptosis in the bone marrow increased at week 3 then decreased. Conclusion: The data show that MPS, combined with LPS, can induce in mice features typical of early AVN of the femoral head. [Biomed Res Ther 2016; 3(3.000: 548-556

  10. Risk factor analysis for early femoral failure in metal-on-metal hip resurfacing arthroplasty: the effect of bone density and body mass index

    Directory of Open Access Journals (Sweden)

    Gross Thomas P

    2012-01-01

    Full Text Available Abstract Background The importance of appropriately selecting patients based on factors such as bone mineral density, body mass index, age, gender, and femoral component size has been demonstrated in many studies as an aid in decreasing the rate of revisions and improving the outcomes for patients after hip resurfacing arthroplasty (HRA; however, there are few published studies quantitatively specifying the potential risk factors that affect early femoral component failures. Therefore, the purpose of this study was to investigate the specific causes of early femoral component failures in hip resurfacing separately and more carefully in order to develop strategies to prevent these failures, rather than excluding groups of patients from this surgical procedure. Methods This retrospective study included 373 metal-on-metal HRAs performed by a single surgeon using the vascular sparing posterior minimally invasive surgical approach. The average length of follow-up was 30 ± 6 months. In order to understand the causes of early femoral failure rate, a multivariable logistic regression model was generated in order to analyze the effects of bone mineral density (T-score, gender, diagnosis, body mass index, femoral implant fixation type, age, and femoral component size. Results The average post-operative Harris hip score was 92 ± 11 points and the average post-operative UCLA score was 7 ± 2 points. There were three revisions due to femoral neck fracture and two for femoral component loosening. These occurred in two female and three male patients. In the multi-variable regression model, only T-score and body mass index showed significant effects on the failure rate of femoral components. Patients with a lower T-score and a higher body mass index had a significantly increased risk of early femoral component failure. Conclusion We recommend that dual energy x-ray absorptiometry scan T-score tests should be routinely performed on all hip resurfacing patients

  11. The effects of local nitroglycerin on the surgical delay procedure in prefabricated flaps by vascular implant in rats Efeitos da nitroglicerina tópica na autonomização de retalhos pré-fabricados por implante vascular em ratos

    Directory of Open Access Journals (Sweden)

    Jairo Zacchê de Sá

    2012-12-01

    Full Text Available PURPOSE: To evaluate the effect of local nitroglycerin on the viable area of a prefabricated flap for vascular implant in rats, and to investigate the surgical delay procedure. METHODS: A femoral pedicle was implanted under the skin of the abdominal wall in forty Wistar rats. The animals were divided into four groups of ten: group 1 - without surgical delay procedure and local nitroglycerin; group 2 - with surgical delay procedure, but without local nitroglycerin; group 3 - without surgical delay procedure, but with local nitroglycerin; and group 4 - with simultaneous surgical delay procedure and local nitroglycerin. The percentages of the viable areas, in relation to the total flap, were calculated using AutoCAD R 14. RESULTS: The mean percentage value of the viable area was 8.9% in the group 1. 49.4% in the group 2; 8.4% in the group 3 and 1.1% in the group 4. There was significant difference between groups 1 and 2 (p=0.005, 1 and 4 (p=0.024, 2 and 3 (p=0.003, 2 and 4 (p=0.001. These results support the hypothesis that the closure of the arterial venous channels is responsible for the phenomenon of surgical delay procedure. CONCLUSION: Local nitroglycerin did not cause an increase in the prefabricated viable flap area by vascular implantation and decreased the viable flap area that underwent delay procedures.OBJETIVO: Avaliar o efeito da nitroglicerina tópica sobre a área viável de um modelo de retalho pré-fabricado por implante vascular em ratos e analisar o mecanismo de autonomização cirúrgica aplicada a retalhos pré-fabricados. MÉTODOS: Foram utilizados 40 ratos Wistar. No primeiro tempo cirúrgico - 20 ratos foram submetidos a implante do pedículo femoral na região subdérmica da parede abdominal, e 20 submetidos à autonomização cirúrgica de retalho cutâneo de parede abdominal e, simultaneamente, implante do pedículo femoral na região subdérmica deste retalho. No segundo tempo - após três semanas e em todos os animais

  12. fibular osteosynthesis of neglected femoral neck fracture in a young ...

    African Journals Online (AJOL)

    Where there are no facilities for microvascular surgery, non- ... fixation of a neglected femoral neck fracture associated with aseptic necrosis of femoral head in ... After a follow-up of two years, he had a Harris hip ... applied on the fifth postoperative day and patient was ... radiographic features that suggested aseptic necrosis.

  13. Femoral herniorrhaphy and its affect on fibrinogen levels

    African Journals Online (AJOL)

    STORAGESEVER

    2009-02-18

    Feb 18, 2009 ... The study consists of 10 patients with features suggestive of femoral hernia ... development of post-operative thrombo embolic complications. ... the blood amongst our patients for femoral herniorrhaphy ... plasma fibrinogen level occur during and after surgery ... spinal anaesthesia has not been studied.

  14. Normal neurodynamic responses of the femoral slump test.

    Science.gov (United States)

    Lai, Weng-Hang; Shih, Yi-Fen; Lin, Pei-Ling; Chen, Wen-Yin; Ma, Hsiao-Li

    2012-04-01

    Femoral slump test is a neurodynamic testing, which could be used to assess the mechanosensitivity of the femoral component of the nervous system. Although Trainor and Pinnington reported the diagnosis accuracy of the femoral slump test, the neurodynamic responses of the femoral slump test have never been studied. The purposes of this study were to evaluate whether maneuvers that changed the nerve tension altered the responses of the femoral slump test and if these responses were influenced by gender and leg dominance; and to identify the correlations between flexibility and measured hip extension angle. Thirty-two asymptomatic subjects (16 males, 16 females) were recruited. The femoral slump test was performed in trunk slump and neutral positions, and cervical extension was used as the structure differential technique. Hip extension angle and visual analog scale (VAS) of thigh pain was measured during the test. Our results showed the decrease of nerve tension significantly increased hip extension ROM (P  0.05). These findings indicated that femoral slump test resulted in normal neurodynamic responses in individuals free of lower extremity problems, and these responses were independent of the influence of muscle flexibility or gender. Future research should emphasize the use of femoral slump test in patient groups such as low back and anterior knee pain.

  15. Reference values for local arterial stiffness. Part B : femoral artery

    NARCIS (Netherlands)

    Bossuyt, Jelle; Engelen, Lian; Ferreira, Isabel; Stehouwer, Coen D; Boutouyrie, Pierre; Laurent, Stéphane; Segers, Patrick; Reesink, Koen; Van Bortel, Luc M

    2015-01-01

    OBJECTIVE: Carotid-femoral pulse wave velocity (PWV) is considered the gold standard measure of arterial stiffness, representing mainly aortic stiffness. As compared with the elastic carotid and aorta, the more muscular femoral artery may be differently associated with cardiovascular risk factors (C

  16. Femoral compressive neuropathy from iliopsoas haematoma complicating dengue hemorrhagic fever

    Institute of Scientific and Technical Information of China (English)

    Sneha Ganu; Yesha Mehta

    2013-01-01

    Dengue fever is a debilitating mosquito-borne disease caused by dengue virus. We reported a case of femoral compression neuropathy due to iliopsoas hematoma complicating dengue hemorrhagic fever. Iliopsoas muscle hematoma can cause femoral neuropathy with resultant pain and paralysis. Such manifestations are not well documented in the literature. The pathogenesis of hematoma and compressive neuropathy with its appropriate management is discussed.

  17. STRANGULATED FEMORAL HERNIA IN A MALE PATIENT – DIAGNOSTIC DILEMMA

    Directory of Open Access Journals (Sweden)

    Sapna

    2014-01-01

    Full Text Available Strangulated femoral hernia in a male patient is a very rare clinical presentation. Here we report a case of right inguinal swelling mimicking that of lymphadenopathy , later developing perforation due to strangulation of femoral hernia. Laparotomy with ileostomy was done

  18. Current concepts in total femoral replacement.

    Science.gov (United States)

    Ramanathan, Deepak; Siqueira, Marcelo Bp; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K; Joyce, Michael J

    2015-12-18

    Total femoral replacement (TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20(th) century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.

  19. SEXUAL DIMORPHISM OF MAXIMUM FEMORAL LENGTH

    Directory of Open Access Journals (Sweden)

    Pandya A M

    2011-04-01

    Full Text Available Sexual identification from the skeletal parts has medico legal and anthropological importance. Present study aims to obtain values of maximum femoral length and to evaluate its possible usefulness in determining correct sexual identification. Study sample consisted of 184 dry, normal, adult, human femora (136 male & 48 female from skeletal collections of Anatomy department, M. P. Shah Medical College, Jamnagar, Gujarat. Maximum length of femur was considered as maximum vertical distance between upper end of head of femur and the lowest point on femoral condyle, measured with the osteometric board. Mean Values obtained were, 451.81 and 417.48 for right male and female, and 453.35 and 420.44 for left male and female respectively. Higher value in male was statistically highly significant (P< 0.001 on both sides. Demarking point (D.P. analysis of the data showed that right femora with maximum length more than 476.70 were definitely male and less than 379.99 were definitely female; while for left bones, femora with maximum length more than 484.49 were definitely male and less than 385.73 were definitely female. Maximum length identified 13.43% of right male femora, 4.35% of right female femora, 7.25% of left male femora and 8% of left female femora. [National J of Med Res 2011; 1(2.000: 67-70

  20. Continuous blood gas monitoring in femoral arteries

    Science.gov (United States)

    Schlain, Les A.; Spar, Steven M.; Dellinger, Bart

    1995-05-01

    Continuous intra-arterial blood gas monitoring is a potentially valuable tool in the surgical and intensive care arenas. Patient oxygenation and acid base status can change rapidly and without warning. The ability to monitor pHa, PaCO2 and PaO2 in arterial blood will be a major medical advance for the anesthesiologist and intensivist. Intra-arterial blood gas sensors are typically placed in radial arteries. In certain patient populations accurate monitoring is not possible in radial arteries due to arterial environmental factors such as hypotension, vasoconstriction and atherosclerotic disease. These same factors can make radial cannulation difficult resulting in traumatic catheter insertion, thereby further compromising flow conditions. In situations where radial artery flow is expected to be compromised, selecting a large vessel for sensor placement is desirable. We report an initial feasibility study of our blood gas monitoring system using the femoral artery as the sensing site. Clinical results are presented as well as potential advantages and disadvantages associated with monitoring in the femoral artery.

  1. 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.

  2. Percutaneous closure of secundum atrial septal defects: Experience of a tertiary referral center

    Directory of Open Access Journals (Sweden)

    Ali Hikmet Kırdök

    2012-03-01

    Full Text Available Objectives: This study was aimed to evaluate our clinical experiences and investigate results of percutaneous closure of secundum atrial septal defects (ASD in our clinic.Results: We retrospectively included 70 patients (19 male, 51 female undergoing percutaneous ASD closure procedure with mean age of 36±14.8 (17-75 in our clinic between March 2008 and January 2010. Defect diameter measured by transesophageal echocardiography was 19.7±6.3 mm (6-32 mm. Device size used for percutaneous closure of ASD was 23.7±6.2 (12-36. Devices used for percutaneous closure were nitinol-based devices including Amplatzer (64.7%, Cardiofix (26.7% and biodegredable BioStar (8.6%. The percutaneous closure procedure was successful at 68 of 70 (97% patients. In 2 patients procedure failed. Failure reason was device embolization in one patient and device strut fracture in other; so these 2 patients referred to surgery. During follow up 2 more patients also referred to surgery because of device embolization in first day control. In 3 patients (4.2% supraventricular arrythmias that are converted to sinus by cardioversion are observed. Mean follow up interval was 18.6±9.6 months (1-44 and during this period peripheral vascular complications, cerebrovascular accidents, thrombus on devices, device erosion or death is not observed.Conclusion: Percutaneous closure of secundum ASD which started to replace surgical treatment of ASD in last decades is safe and effective method in short to mid-term period. However because of potentially serious complication risks it should be performed in special centers by operators who are experienced in treating structural heart diseases.

  3. Distal femoral osteotomy using a novel deformity reduction device.

    Science.gov (United States)

    Panichi, Enrico; Cappellari, Fulvio; Olimpo, Matteo; Piras, Lisa A; Radasch, Robert; Ferretti, Antonio; Peirone, Bruno

    2016-09-20

    Distal femoral osteotomy is a surgical procedure used to correct patellar luxation, secondary to a femoral deformity. A distal femoral osteotomy using the tibial plateau levelling osteotomy-jig to temporarily provide stability of the distal femoral osteotomy, maintaining limb alignment in the frontal and axial planes prior to internal plate fixation of the osteotomy, has been described. This report describes a novel jig named Deformity Reduction Device (DRD). This device was developed with the specific aim of increasing precision and predictability during corrective osteotomy execution in order to be consistent with the preoperative planning. The distal femoral osteotomy DRD-assisted procedure is described in detail, discussing the theoretical and practical principles of the application.

  4. Extensively Coated Cementless Femoral Components in Revision Hip Arthroplasty.

    Science.gov (United States)

    Greidanus, Nelson; Antoniou, John; Paprosky, Wayne

    2000-10-01

    A septic loosening and osteolysis can compromise the available host bone in patients requiring revision hip arthroplasty. Secure fixation of revision femoral components may not be possible if reliant only on proximal femoral bone for biologic fixation or cement interdigitation. The challenge for the revision arthroplasty surgeon is to find the best method to secure the implant in a femur with deficient bone proximally that will provide stability for load bearing and motion. In addition to providing stability, the implant must be durable and maintain long-term fixation. With over 16 years of experience with fully porous coated femoral revision implants, we have found that maximizing prosthetic-bone fit in the proximal femoral diaphyseal bone provides reliable long-term fixation in the majority of femoral revision cases.

  5. Hemodynamic Instability after Low-Energy Thigh Contusion Caused by Injury to the Femoral Artery: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Juan Miguel Rodríguez-Roiz

    2016-01-01

    Full Text Available Acute vascular injuries have been described in relation to high-energy trauma accidents or in patients undergoing surgery in the femoral area. We describe a healthy patient who sustained a direct, low-energy contusion in the thigh and presented haemodynamic instability. Arteriography was used to locate the point of bleeding, and embolisation and vessel occlusion were carried out to stop the haemorrhage. The genetic study identified the COL3A1 gene mutation; accordingly, the patient was diagnosed with the Ehlers-Danlos syndrome type IV (vascular type.

  6. Systematization of a set of closure techniques.

    Science.gov (United States)

    Hausken, Kjell; Moxnes, John F

    2011-11-01

    Approximations in population dynamics are gaining popularity since stochastic models in large populations are time consuming even on a computer. Stochastic modeling causes an infinite set of ordinary differential equations for the moments. Closure models are useful since they recast this infinite set into a finite set of ordinary differential equations. This paper systematizes a set of closure approximations. We develop a system, which we call a power p closure of n moments, where 0≤p≤n. Keeling's (2000a,b) approximation with third order moments is shown to be an instantiation of this system which we call a power 3 closure of 3 moments. We present an epidemiological example and evaluate the system for third and fourth moments compared with Monte Carlo simulations.

  7. Entropy production and collisionless fluid closure

    Energy Technology Data Exchange (ETDEWEB)

    Sarazin, Y; Zarzoso, D; Garbet, X; Ghendrih, Ph; Grandgirard, V [CEA, IRFM, F-13108 Saint-Paul-lez-Durance (France); Dif-Pradalier, G, E-mail: yanick.sarazin@cea.f [Center for Astrophysics and Space Science, U.C.S.D., La Jolla, CA 92093 (United States)

    2009-11-15

    A novel method is proposed to construct collisionless fluid closures accounting for some kinetic properties. The idea consists in optimizing the agreement between the fluid and kinetic quasi-linear entropy production rates, so as to constrain the closure coefficients. This procedure is applied to the slab branch of the ion temperature gradient driven instability. Focusing on the kinetic regime characterized by slow waves, the closure proposed by Hammett and Perkins (Hammett and Perkins 1990 Phys. Rev. Lett. 64 3019) naturally emerges from the systematic identification of the kinetic and fluid entropy production rates. This closure is revealed to be extremely powerful well beyond the kinetic regime. Besides, it reconciles the fluid and kinetic linear stability diagrams in the two-dimensional space of the density and temperature gradient lengths. Such a method is systematic and generic. As such, it is applicable to other models and classes of instabilities.

  8. Entropy production and collisionless fluid closure

    Science.gov (United States)

    Sarazin, Y.; Dif-Pradalier, G.; Zarzoso, D.; Garbet, X.; Ghendrih, Ph; Grandgirard, V.

    2009-11-01

    A novel method is proposed to construct collisionless fluid closures accounting for some kinetic properties. The idea consists in optimizing the agreement between the fluid and kinetic quasi-linear entropy production rates, so as to constrain the closure coefficients. This procedure is applied to the slab branch of the ion temperature gradient driven instability. Focusing on the kinetic regime characterized by slow waves, the closure proposed by Hammett and Perkins (Hammett and Perkins 1990 Phys. Rev. Lett. 64 3019) naturally emerges from the systematic identification of the kinetic and fluid entropy production rates. This closure is revealed to be extremely powerful well beyond the kinetic regime. Besides, it reconciles the fluid and kinetic linear stability diagrams in the two-dimensional space of the density and temperature gradient lengths. Such a method is systematic and generic. As such, it is applicable to other models and classes of instabilities.

  9. Testing turbulent closure models with convection simulations

    CERN Document Server

    Snellman, J E; Mantere, M J; Rheinhardt, M; Dintrans, B

    2012-01-01

    Aims: To compare simple analytical closure models of turbulent Boussinesq convection for stellar applications with direct three-dimensional simulations both in homogeneous and inhomogeneous (bounded) setups. Methods: We use simple analytical closure models to compute the fluxes of angular momentum and heat as a function of rotation rate measured by the Taylor number. We also investigate cases with varying angles between the angular velocity and gravity vectors, corresponding to locating the computational domain at different latitudes ranging from the pole to the equator of the star. We perform three-dimensional numerical simulations in the same parameter regimes for comparison. The free parameters appearing in the closure models are calibrated by two fit methods using simulation data. Unique determination of the closure parameters is possible only in the non-rotating case and when the system is placed at the pole. In the other cases the fit procedures yield somewhat differing results. The quality of the closu...

  10. Reliability assessment of underground shaft closure

    Energy Technology Data Exchange (ETDEWEB)

    Fossum, A.F. [RE/SPEC, Inc., Rapid City, SD (United States); Munson, D.E. [Sandia National Labs., Albuquerque, NM (United States)

    1994-12-31

    The intent of the WIPP, being constructed in the bedded geologic salt deposits of Southeastern New Mexico, is to provide the technological basis for the safe disposal of radioactive Transuranic (TRU) wastes generated by the defense programs of the United States. In determining this technological basis, advanced reliability and structural analysis techniques are used to determine the probability of time-to-closure of a hypothetical underground shaft located in an argillaceous salt formation and filled with compacted crushed salt. Before being filled with crushed salt for sealing, the shaft provides access to an underground facility. Reliable closure of the shaft depends upon the sealing of the shaft through creep closure and recompaction of crushed backfill. Appropriate methods are demonstrated to calculate cumulative distribution functions of the closure based on laboratory determined random variable uncertainty in salt creep properties.

  11. Cyanoacrylate for Intraoral Wound Closure: A Possibility?

    Directory of Open Access Journals (Sweden)

    Parimala Sagar

    2015-01-01

    Full Text Available Wound closure is a part of any surgical procedure and the objective of laceration repair or incision closure is to approximate the edges of a wound so that natural healing process may occur. Over the years new biomaterials have been discovered as an alternate to conventional suture materials. Cyanoacrylate bioadhesives are one among them. They carry the advantages of rapid application, patient comfort, resistance to infection, hemostatic properties, and no suture removal anxiety. Hence this study was undertaken to study the effect of long chain cyanoacrylate as an adhesive for intraoral wound closure and also to explore its hemostatic and antibacterial effects. Isoamyl-2-cyanoacrylate (AMCRYLATE was used as the adhesive in the study. In conclusion isoamyl cyanoacrylate can be used for intraoral wound closure, as an alternative to sutures for gluing the mucoperiosteum to bone, for example, after impaction removal, periapical surgeries, and cleft repair. Its hemostatic and antibacterial activity has to be further evaluated.

  12. [Percutaneous closure of patent ductus arteriosus: results and costs compared to surgical closure].

    Science.gov (United States)

    Vieu, T; Beaurain, S; Angel, C; Leriche, H; Petit, J; Conso, J F; Planché, C; Losay, J

    1995-10-01

    The comparison of the clinical results and costs of the two methods of closure of patient ductus arteriosus was undertaken in two comparable groups of 40 patients treated in the same period in the same hospital. After transcatheter closure there was a 9% residual shunt rate at 3 years, the 2 patients with a residual continuous murmur being operated secondarily. The only complication was severe haemolysis which regressed after transcatheter ablation of the prosthesis. After surgical closure, there were no residual shunt. Some postoperative complications were observed in 20% of cases, usually benign (ventilatory problems, dysphonia or urinary infection), but occasionally more serious (peroperative lesion of the pulmonary artery). Morbidity, inherent to the technique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was much less with transcatheter closure 38,558 francs versus 11,240 francs. On the other hand, the direct cost of transcatheter closure was greater than that of surgery: 32,798 francs versus 20,903 francs, the difference being related to the actual price of the prosthesis. The authors conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alternative to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure for an increase in cost of the initial procedure which should decrease in relation to the types and prices of the prosthesis used.

  13. Primary closure for postoperative mediastinitis in children.

    Science.gov (United States)

    Ohye, Richard G; Maniker, Robert B; Graves, Holly L; Devaney, Eric J; Bove, Edward L

    2004-09-01

    Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children. From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated. One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients. Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.

  14. Exceptional closure of UNIQA office at CERN

    CERN Multimedia

    HR Department

    2009-01-01

    The UNIQA office at CERN will be closed from Wednesday 18 February to Friday 20 February due to painting work. During this closure, the Headquarters of UNIQA in Geneva will remain at the disposal of the members. See details https://cern.ch/chis/UNIQA_Offices.asp The CERN office will re-open on Monday 23 February according to the normal schedule. We apologise for any inconvenience caused by this closure.

  15. Falso Aneurisma Femoral Iatrogénico: Ainda uma indicação para a Cirurgia Convencional? Iatrogenic femoral pseudoaneurysm: still an indication for conventional surgery?

    Directory of Open Access Journals (Sweden)

    Nelson Oliveira

    2011-12-01

    Full Text Available Introdução: Os Falsos Aneurismas (FA são uma das complicações mais frequentemente associadas à punção femoral diagnóstica e de intervenção cardíaca. A sua abordagem terapêutica tem evoluído no sentido da preponderância das técnicas não invasivas sendo a Cirurgia Convencional cada vez menos frequentemente praticada. Objectivos: Os autores propõem a propósito de um caso clínico, e através de uma revisão da literatura discutir a abordagem terapêutica dos FA e as indicações da Cirurgia Convencional. Caso clínico: Doente de sessenta e um anos, sexo masculino, com antecedentes de hipertensão arterial, doença coronária com enfarte agudo do miocárdio prévio, miocardiopatia dilatada, fibrilhação auricular paroxística sendo portador de cardiodesfibrilhador. Foi submetido a cateterismo cardíaco por via femoral direita para ablação do Feixe de His, tendo sido referenciado ao Serviço de Angiologia e Cirurgia Vascular por desenvolvimento progressivo de massa pulsátil dolorosa acompanhada de hipostesia da face anterior da coxa. A Angiodinografia confirmou a presença de falso aneurisma da artéria femoral profunda direita com 3cm de maior diâmetro e a presença de uma fístula entre a artéria e a veia femorais superficiais direitas. Por abordagem cirúrgica aberta, foi realizada a exclusão do falso aneurisma e rafia da artéria e veia femorais superficiais. Conclusão: A abordagem de primeira linha dos falsos aneurismas iatrogénicos pós cateterismo cardíaco é não invasiva mas a Cirurgia Convencional detém ainda um lugar primordial para um grupo restrito de doentes.Introduction: Pseudoaneurysms (PAN are one of the most common complications of cardiac catheterization. Treatment has evolved towards a less invasive approach, reducing the number of Open repairs. Objectives: The authors propose to discuss the contemporary management of PAN and the remaining indications for Conventional Surgical Repair based upon a case

  16. Estimated carotid-femoral pulse wave velocity has similar predictive value as measured carotid-femoral pulse wave velocity

    DEFF Research Database (Denmark)

    Greve, Sara V; Blicher, Marie K; Kruger, Ruan;

    2016-01-01

    BACKGROUND: Carotid-femoral pulse wave velocity (cfPWV) adds significantly to traditional cardiovascular risk prediction, but is not widely available. Therefore, it would be helpful if cfPWV could be replaced by an estimated carotid-femoral pulse wave velocity (ePWV) using age and mean blood pres...

  17. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases

    Directory of Open Access Journals (Sweden)

    Korkmaz MF

    2014-04-01

    Full Text Available Mehmet Fatih Korkmaz,1 Mehmet Nuri Erdem,2 Zeliha Disli,3 Engin Burak Selcuk,4 Mustafa Karakaplan,1 Abdullah Gogus5 1Department of Orthopedics and Traumatology, Inonu University School of Medicine, Malatya, Turkey; 2Department of Orthopedics and Traumatology, Nisantasi University School of Medicine, Istanbul, Turkey; 3Department of Anesthesiology, Malatya Government Hospital, Malatya, Turkey; 4Department of Family Medicine, Inonu University School of Medicine, Malatya, Turkey; 5Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul, Turkey Purpose: In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. Materials and methods: One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF classification and the American Society of Anesthesiologists' (ASA physical status classification (ASA grade. Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. Results: The mean age of the patients was 77.66 years (range: 37–98 years, and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range

  18. Spontaneous fracture of the femoral neck in preexisting avascular necrosis of femoral head in sickle cell disease

    Institute of Scientific and Technical Information of China (English)

    Raju Vaishya

    2012-01-01

    Avascular necrosis of the femoral head is a known complication of femoral neck fracture but on the contrary,femoral neck fracture in a case of preexisting avascular necrosis is a very rare phenomenon.We present a case study of a 47 year old Iraqi male who developed spontaneous ipsilateral subcapital femoral neck fracture under the condition of preexisting sickle cell disease and avascular necrosis of the femoral head.The fracture was unnoticed for a few months.The patient was managed successfully by uncemented total hip arthroplasty.Postoperative recovery was uneventful and he was discharged 4 days after surgery.At 1 year's follow-up,the patient had normal gait and hip function,with no sign of loosening or any other complications on radiograph.

  19. Femoral artery neointimal hyperplasia is reduced after wire injury in Ref-1+/- mice.

    Science.gov (United States)

    Basi, David L; Adhikari, Neeta; Mariash, Ami; Li, Qinglu; Kao, Esther; Mullegama, Sureni V; Hall, Jennifer L

    2007-01-01

    Redox factor-1 (Ref-1) is a multifunctional protein that regulates redox, DNA repair, and the response to cell stress. We previously demonstrated that Ref-1(+/-) mice exhibit a significantly reduced Ref-1 mRNA and protein levels within the vasculature, which are associated with increased oxidative stress. The goal of this study was to test the hypothesis that partial loss of Ref-1 altered the cellular response to vascular injury. Fourteen days after femoral artery wire injury, we found that vessel intima-to-media ratio was significantly reduced in Ref-1(+/-) mice compared with that in wild-type mice (P Ref-1(+/-) mice. In vitro studies found no significant changes in either serum-induced proliferation or baseline apoptosis in Ref-1(+/-) vascular smooth muscle cells. Exposure to Fas ligand; however, did result in increased susceptibility of Ref-1(+/-) vascular smooth muscle cells to apoptosis (P Ref-1(+/-) mice exhibited an increase in circulating baseline levels of IL-10, IL-1alpha, and VEGF compared with those in wild-type mice but a marked impairment in these pathways in response to injury. In sum, loss of a single allele of Ref-1 is sufficient to reduce intimal lesion formation and to alter circulating cytokine and growth factor expression.

  20. 105-DR Large Sodium Fire Facility closure activities evaluation report

    Energy Technology Data Exchange (ETDEWEB)

    Adler, J.G.

    1996-04-22

    This report evaluates the closure activities at the 105-DR Large Sodium Fire Facility. The closure activities discussed include: the closure activities for the structures, equipment, soil, and gravel scrubber; decontamination methods; materials made available for recycling or reuse; and waste management. The evaluation compares these activities to the regulatory requirements and closure plan requirements. The report concludes that the areas identified in the closure plan can be clean closed.

  1. Aldosterone and vascular damage.

    Science.gov (United States)

    Duprez, D; De Buyzere, M; Rietzschel, E R; Clement, D L

    2000-06-01

    Although the aldosterone escape mechanism is well known, aldosterone has often been neglected in the pathophysiologic consequences of the activated renin-angiotensin-aldosterone system in arterial hypertension and chronic heart failure. There is now evidence for vascular synthesis of aldosterone aside from its secretion by the adrenal cortex. Moreover, aldosterone is involved in vascular smooth muscle cell hypertrophy and hyperplasia, as well as in vascular matrix impairment and endothelial dysfunction. The mechanisms of action of aldosterone may be either delayed (genomic) or rapid (nongenomic). Deleterious effects of aldosterone leading to vascular target-organ damage include (besides salt and water retention) decreased arterial and venous compliance, increased peripheral vascular resistance, and impaired autonomic vascular control due to baroreflex dysfunction.

  2. NPAR- products, applications and closure

    Energy Technology Data Exchange (ETDEWEB)

    Vora, J.P.

    1995-04-01

    Almost a decade ago the Office of Nuclear Regulatory Research (RES) developed and implemented a comprehensive research program (NUREG-1144) widely known as NPAR or Nuclear Plant Aging Research. The NPAR program is a structured research program specifically oriented to understanding significant age-related degradation mechanisms and their long term effects on properties and performance of important components and systems and ways to mitigate detrimental effects of aging. It provided a road map and a phased approach to research that is applicable to any structure, system, or component of interest. This hardware-oriented engineering research program led the industry worldwide and communicated a need to understand and manage age-related degradation effects in selected but important structures and components. At the conclusion (1995) of the NPAR program, 22 electrical and mechanical components, 13 safety-related systems, and 10 special topics will have been studied and results summarized in 160 technical reports. This reference library of information listed and summarized in NUREG-1377, Rev. No. 4 provides a foundation upon which individual programs can be built for the specific needs of a utility, a regulator, or equipment manufacturers. During the life of the NPAR program, it has provided technical bases and support for license renewal, codes and standards, resolution of generic safety issues, information notices, regulatory guides and the standard Review Plan, as well as the Office of Nuclear Reactor Regulation and The NRC Regions. All ongoing NPAR activities will either be completed or terminated by the end of 1995. No new initiative will be undertaken. This paper summarizes NPAR products and accomplishments, application of the research results, and its status and closure.

  3. Accelerating cleanup: Paths to closure

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-06-01

    This report describes the status of Environmental Management`s (EM`s) cleanup program and a direction forward to complete achievement of the 2006 vision. Achieving the 2006 vision results in significant benefits related to accomplishing EM program objectives. As DOE sites accelerate cleanup activities, risks to public health, the environment, and worker safety and health are all reduced. Finding more efficient ways to conduct work can result in making compliance with applicable environmental requirements easier to achieve. Finally, as cleanup activities at sites are completed, the EM program can focus attention and resources on the small number of sites with more complex cleanup challenges. Chapter 1 describes the process by which this report has been developed and what it hopes to accomplish, its relationship to the EM decision-making process, and a general background of the EM mission and program. Chapter 2 describes how the site-by-site projections were constructed, and summarizes, for each of DOE`s 11 Operations/Field Offices, the projected costs and schedules for completing the cleanup mission. Chapter 3 presents summaries of the detailed cleanup projections from three of the 11 Operations/Field Offices: Rocky Flats (Colorado), Richland (Washington), and Savannah River (South Carolina). The remaining eight Operations/Field Office summaries are in Appendix E. Chapter 4 reviews the cost drivers, budgetary constraints, and performance enhancements underlying the detailed analysis of the 353 projects that comprise EM`s accelerated cleanup and closure effort. Chapter 5 describes a management system to support the EM program. Chapter 6 provides responses to the general comments received on the February draft of this document.

  4. Bloqueio dos nervos femoral e isquiático guiados por ultrassom em paciente anticoagulado: case reports Bloqueo de los nervios femoral e isquiático guiados por ultrasonido en paciente anticoagulado Ultrasound-guided femoral and sciatic nerve blocks in an anticoagulated patient: relato de casos

    OpenAIRE

    Leonardo Henrique Cunha Ferraro; Maria Angela Tardelli; Américo Masafuni Yamashita; José Daniel Braz Cardone; Juliana Midori Kishi

    2010-01-01

    JUSTIFICATIVA E OBJETIVOS: O uso de ultrassom para guiar a punção em bloqueios de nervos periféricos tem-se tornado cada vez mais frequente. Com a menor probabilidade de promover lesões vasculares, o ultrassom torna-se uma ferramenta interessante na realização de bloqueios periféricos, especialmente nos pacientes em uso de anticoagulantes ou com distúrbios da coagulação. O objetivo foi relatar dois casos em que se realizaram os bloqueios isquiático e femoral guiados por ultrassom em pacientes...

  5. Drinking citrus fruit juice inhibits vascular remodeling in cuff-induced vascular injury mouse model.

    Science.gov (United States)

    Ohnishi, Arika; Asayama, Rie; Mogi, Masaki; Nakaoka, Hirotomo; Kan-No, Harumi; Tsukuda, Kana; Chisaka, Toshiyuki; Wang, Xiao-Li; Bai, Hui-Yu; Shan, Bao-Shuai; Kukida, Masayoshi; Iwanami, Jun; Horiuchi, Masatsugu

    2015-01-01

    Citrus fruits are thought to have inhibitory effects on oxidative stress, thereby attenuating the onset and progression of cancer and cardiovascular disease; however, there are few reports assessing their effect on vascular remodeling. Here, we investigated the effect of drinking the juice of two different citrus fruits on vascular neointima formation using a cuff-induced vascular injury mouse model. Male C57BL6 mice were divided into five groups as follows: 1) Control (water) (C), 2) 10% Citrus unshiu (CU) juice (CU10), 3) 40% CU juice (CU40), 4) 10% Citrus iyo (CI) juice (CI10), and 5) 40% CI juice (CI40). After drinking them for 2 weeks from 8 weeks of age, cuff injury was induced by polyethylene cuff placement around the femoral artery. Neointima formation was significantly attenuated in CU40, CI10 and CI40 compared with C; however, no remarkable preventive effect was observed in CU10. The increases in levels of various inflammatory markers including cytokines such as monocyte chemotactic protein-1, interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α in response to vascular injury did not differ significantly between C, CU10 and CI10. The increases in cell proliferation and superoxide anion production were markedly attenuated in CI10, but not in CU10 compared with C. The increase in phosphorylated ERK expression was markedly attenuated both in CU10 and CI10 without significant difference between CU10 and CI10. Accumulation of immune cells did not differ between CU10 and CI10. These results indicate that drinking citrus fruit juice attenuates vascular remodeling partly via a reduction of oxidative stress. Interestingly, the preventive efficacy on neointima formation was stronger in CI than in CU at least in part due to more prominent inhibitory effects on oxidative stress by CI.

  6. Nonunion of the femoral neck: Possibilities and limitations of the various treatment modalities

    Directory of Open Access Journals (Sweden)

    Raaymakers Ernst

    2008-01-01

    Full Text Available Nowadays in cases of nonunions of the femoral neck, the surgeon is tempted to perform prosthetic replacement of the hip, more so if there is also evidence of avascular necrosis of the head of femur. This provides rapid pain relief and allows early mobilization. However, long-term results of hip arthroplasties, especially in younger people and in the presence of osteopenia, are not always as expected; and a less radical approach is worth considering. The intertrochanteric valgization osteotomy, described by Pauwels, is an excellent alternative for healthy patients up to 65 years of age with a nonunion of the femoral neck. A union rate of 80-90% of the nonunion is described by most authors. Leg length inequallity, rotational and angular deformities can be corrected at the same time. During the period 1973-1995, we performed valgization osteotomy according to Pauwels in 66 patients of, 18-72 years old (mean 49.5 years. 24 (37% of our patients died 4 months to 24 years (mean: 9.5 years after the operation. Union of the femoral neck was achieved in 58 (88% of the 66 patients; union of the osteotomy in 65 patients (99%. A good or excellent result was achieved in 62% (23 uneventful and 13 with healed, necrosis/arthrosis without need for further treatment of our patients. However, the method has its limits. We feel if there is too little bone stock inside the femoral head, a valgization osteotomy does not give good result. The radiographic signs of avascular necrosis in patients over 30 years of age is considered a contraindication for an osteotomy. However our results show that it is worthwhile trying to save the joint of young patients even in case of a segmental collapse. In the race between revascularization and collapse, often revascularization is the winner. We deliberately give nature its chance and don′t rely on the result of bleeding from drill holes in the head, nuclear scans and other methods to estimate vascularity. A secondary total hip

  7. Contralateral reversed distal femoral locking plate for fixation of subtrochanteric femoral fractures

    Institute of Scientific and Technical Information of China (English)

    Paritosh Gogna; Reetadyuti Mukhopadhyay; Amanpreet Singh; Ashish Devgan; Sahil Arora; Amit Batra; Sushil Kumar Yadav

    2015-01-01

    Purpose:Subtrochanteric fractures of the femur are being managed successfully with various intramedullary and extramedulary implants with reasonable success.However,these implants require precise placement under image intensifier guidance,which exposes the surgeon to substantial amount of radiation.It also restricts the management of these fractures at peripheral centers where facility of image intensifiers is not available.Keeping this in mind we designed this study to identify if contralateral reversed distal femoral locking plate can be used successfully without the use of image intensifier.Methods:Twenty-four consecutive patients (18 men and 6 women) with a mean age of 28 years (range 19-47 years) suffering subtrochanteric fractures of the femur underwent open reduction and internal fixation with reversed contralateral distal femoral locking plate.The outcome was assessed at the mean follow-up period of 3.2 years (range 2-4.6 years) using the Harris hip score.Results:Twenty-one fractures united with the primary procedure,with a mean time of consolidation being 11 weeks (range,9-16 weeks).One patient developed superficial suture line infection,which resolved with oral antibiotics.Another patient had a fall 3 weeks after surgery and broke the plate.Repeat surgery with reversed distal femoral locking compression plate was performed along with bone grafting and the fracture united.Two cases had nonunion,which went in for union after bone grafting.The mean Harris hip score at the time of final follow-up was 90.63 (range 82-97).Conclusion:The reversed contralateral distal femoral plate is a biomechanically sound implant,which when used for fixation of the subtrochanteric fractures with minimal soft tissue stripping shows results comparable to those achieved by using other extramedullary implants as well as intramedullary devices.The added advantage of this implant is its usability in the absence of an image intensifier.

  8. Vascular Cognitive Impairment.

    Science.gov (United States)

    Dichgans, Martin; Leys, Didier

    2017-02-03

    Cerebrovascular disease typically manifests with stroke, cognitive impairment, or both. Vascular cognitive impairment refers to all forms of cognitive disorder associated with cerebrovascular disease, regardless of the specific mechanisms involved. It encompasses the full range of cognitive deficits from mild cognitive impairment to dementia. In principle, any of the multiple causes of clinical stroke can cause vascular cognitive impairment. Recent work further highlights a role of microinfarcts, microhemorrhages, strategic white matter tracts, loss of microstructural tissue integrity, and secondary neurodegeneration. Vascular brain injury results in loss of structural and functional connectivity and, hence, compromise of functional networks within the brain. Vascular cognitive impairment is common both after stroke and in stroke-free individuals presenting to dementia clinics, and vascular pathology frequently coexists with neurodegenerative pathology, resulting in mixed forms of mild cognitive impairment or dementia. Vascular dementia is now recognized as the second most common form of dementia after Alzheimer's disease, and there is increasing awareness that targeting vascular risk may help to prevent dementia, even of the Alzheimer type. Recent advances in neuroimaging, neuropathology, epidemiology, and genetics have led to a deeper understanding of how vascular disease affects cognition. These new findings provide an opportunity for the present reappraisal of vascular cognitive impairment. We further briefly address current therapeutic concepts.

  9. [Femoral angioplasty. Long-term results].

    Science.gov (United States)

    Foucart, H; Carlier, C; Baudrillard, J C; Joffre, F; Cécile, J P

    1990-01-01

    A study on the long-term efficacy of femoral-popliteal angioplasty was carried out on 185 angioplasty cases over a 5 year follow-up period. A classification of data according to the type of lesion treated, revealed that results were favorable in case of stenosis (87%), short obstruction (70%) and long obstruction (35%). A special study of the outcome of treatments for stage IV arteritis was carried out. After comparing results with those obtained by other teams, the authors list the complications encountered, hematomas, and thromboses, and show their current tendency for regression. Lastly, the authors stress the advantages of angioscopy, which permits to identify the nature of the treated lesions and to predict possible complications, which are usually underrated by angiography.

  10. Slipped capital femoral epiphysis in down syndrome.

    Science.gov (United States)

    Dietz, Frederick R; Albanese, Stephen A; Katz, Danielle A; Dobbs, Matthew B; Salamon, Peter B; Schoenecker, Perry L; Sussman, Michael D

    2004-01-01

    Slipped capital femoral epiphysis (SCFE) and Down syndrome are both uncommon in the population at large, and rarely are both conditions present in a single individual. Institutional records were searched for both Down syndrome and SCFE. At least 2 years of follow-up was required. Eight patients were identified. At presentation four patients could not walk due to pain and four could walk. Six of eight hips presented with grade III SCFE. Four hips were treated with internal fixation in situ and four were manipulatively reduced in the operating room at the time of fixation with percutaneous screws or pins. Three hips healed uneventfully. Five hips developed aseptic necrosis (three partial, two whole head). This small retrospective study suggests an extremely high rate of complications in adolescents with Down syndrome and SCFE.

  11. Slipped upper femoral epiphysis with hemophilia A

    Directory of Open Access Journals (Sweden)

    Iyer Deepa

    2007-01-01

    Full Text Available A 13-year-old boy who had hemophilia A was reported with pain in the left thigh and hip on walking. He had no history of trauma. Severe hemophilia A is diagnosed with a Factor VIII level of < 1 iu/dl. The presumptive diagnosis was that of a spontaneous bleed into the hip joint. Factor VIII mutational analysis revealed a C to G substitution at nucleotide 6683 which results in a cystine change at codon 2194. However, the symptoms persisted and an X-ray demonstrated the presence of an acute on chronic slip of the upper femoral epiphysis. The patient was transferred to the center treating his hemophilia where the hip was pinned in situ under cover with Factor VIII. This case demonstrates the need to be aware of a possible traumatic diagnosis of hip pain in a hemophiliac child with a longstanding history of spontaneous bleeding into joints.

  12. FEMORAL MONONEUROPATHY: COMPLICATING A DIFFICULT PELVIC URETEROLITHOTOMY

    Directory of Open Access Journals (Sweden)

    D. Mehraban

    1996-07-01

    Full Text Available Femoral mononeuropathy is a complication of gynecological and urological operations. Tlte objective of this citse report is to bring to the attention of fellow urologists the very existence of this complication and offer measures to prevent it. A 48 year old obese worman with a 2 year history of frequent left renal colics, anil a nonfunction left kidney on IVP underwent a retrograde ureterogram study anil a transvaginal ureterolithotomy, in an exaggerated lithotomy position. Postoperatively, a left leg paralysis required 3 weeks of care and encouragement to heal. To prevent this complication, avoid putting too long and too much pressure by retractors on the psoas muscles. During the abdomino-perineal procedures, frequent change of retractor site and monitoring of distal arterial pulses would he helpful. Also, do not use the exaggerated lithotomy position for an extended period of time.

  13. Atypical subtrochanteric and diaphyseal femoral fractures

    DEFF Research Database (Denmark)

    Shane, Elizabeth; Burr, David; Abrahamsen, Bo

    2014-01-01

    Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients...... with no exposure to these drugs. In this report, we review studies on the epidemiology, pathogenesis, and medical management of AFFs, published since 2010. This newer evidence suggests that AFFs are stress or insufficiency fractures. The original case definition was revised to highlight radiographic features...... that distinguish AFFs from ordinary osteoporotic femoral diaphyseal fractures and to provide guidance on the importance of their transverse orientation. The requirement that fractures be noncomminuted was relaxed to include minimal comminution. The periosteal stress reaction at the fracture site was changed from...

  14. Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry

    Directory of Open Access Journals (Sweden)

    Pedro Beraldo de Andrade

    2014-07-01

    Full Text Available Background: The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Objective: To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route. Methods: From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure. Results: The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used. Conclusions: The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques.

  15. A Rabbit Model of Hormone-induced Early Avascular Necrosis of the Femoral Head

    Institute of Scientific and Technical Information of China (English)

    QIAN WEN; LIMA; YAN-PING CHEN; LIN YANG; WEI LUO; XIAO-NING WANG

    2008-01-01

    Objective To establish an experimental model of early stage avascular necrosis of the femoral head (ANFH) caused by corticosteroid in adult rabbits and to observe the pathological changes with various imaging techniques. Methods ANFH was induced by a combination of hypersensitivity vasculitis caused by injection of horse serum and subsequent administration of a high dose of corticosteroid. The pathological changes were detected with digital radiography (DR), computed tomography (CT), magnetic resonance imaging (MRI), ink artery infusion angiography, hematoxylin--eosin staining, and mmunohistochemistry. Results The imageological and athological changes corresponded to the clinical characteristics of early stage ANFH. DR showed bilaterally increased bone density, an unclear epiphyseal line, and blurred texture of cancellous bone. CT showed spot-like low-density imaging of cancellous bone, thinner cortical bone, osteoporosis, and an unclear epiphyseal line. MRI showed bone marrow edema and spot-like high signals in T2-weighted imaging in cancellous bone. Ink artery infusion angiography showed fewer obstructed blood vessels in the femoral head. HE staining of pathological sections showed fewer trabeculae and thin bone, an increased proportion of empty osteocyte lacunae, decreased hematopoiesis, thrombosis, and fat cell hypertrophy. Lmmunohistochemistry showed attenuated expression of vascular endothelial growth factor in osteoblasts and chondrocytes, and on the inner membrane of blood vessels. Conclusion Experimental rabbit model of early stage ANFH caused by corticosteroid can be successfully established and provide the foundation for developing effective methods to treat early stage ANFH.

  16. Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry

    Science.gov (United States)

    de Andrade, Pedro Beraldo; de Andrade, Mônica Vieira Athanazio; Barbosa, Robson Alves; Labrunie, André; Hernandes, Mauro Esteves; Marino, Roberto Luiz; Precoma, Dalton Bertolim; de Sá, Francisco Carleial Feijó; Berwanger, Otávio; Mattos, Luiz Alberto Piva e

    2014-01-01

    Background The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Objective To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route. Methods From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure. Results The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used. Conclusions The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques. PMID:25004418

  17. Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry

    Energy Technology Data Exchange (ETDEWEB)

    Andrade, Pedro Beraldo de, E-mail: pedroberaldo@cardiol.br; Andrade, Mônica Vieira Athanazio de; Barbosa, Robson Alves; Labrunie, André [Santa Casa de Misericórdia de Marília, São Paulo -SP (Brazil); Hernandes, Mauro Esteves [Santa Casa de Votuporanga, São Paulo -SP (Brazil); Marino, Roberto Luiz [Hospital Madre Teresa, Belo Horizonte -MG (Brazil); Precoma, Dalton Bertolim [Sociedade Hospital Angelina Caron, Campina Grande do Sul -PR (Brazil); Sá, Francisco Carleial Feijó de [Hospital do Coração do Cariri, Barbalha -CE (Brazil); Berwanger, Otávio [Instituto de Ensino e Pesquisa do Hospital do Coração, São Paulo -SP (Brazil); Mattos, Luiz Alberto Piva e [Sociedade Brasileira de Cardiologia, São Paulo -SP (Brazil); Instituto Dante Pazzanese de Cardiologia, São Paulo -SP (Brazil); Unidades de Hemodinâmica e Intervenção Cardiovascular Rede D' Or / São Luiz, São Paulo, SP (Brazil)

    2014-06-15

    The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention. To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route. From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure. The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used. The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques.

  18. [Hematoma of the abdominal wall. A case report: pitfall of Seldinger method via femoral artery].

    Science.gov (United States)

    Hiramatsu, Hisaya; Sugiura, Yasushi; Takeda, Ririko; Nanba, Hiroki

    2009-02-01

    We reported a case of an abdominal wall hematoma which caused by Seldinger method via the femoral artery. A 48-year-old female, suffered from direct carotid cavernous fistula, was treated by transfemoral transvenous embolization (TVE). The whole procedure was completed without difficulty except minor resistance of guide wire manipulation during left femoral artery catheterization. Four hours later, the patient became hypotensive and showed the sign of impending shock without definitive causes. Nine hours after the embolization a huge hematoma of the abdominal wall was found. It required the total 1200 m/ of blood transfusion before her blood pressure returned to normal. She recovered fully from this event and discharged uneventfully. There is a speculation that a deep circumflex iliac artery (DCIA) was injured with an angle-shaped guide wire and bled into the abdominal wall. And subsequent systemic heparinization prevented the coagulation process, resulting a large hematoma. Anatomically, an angle-shaped guide wire is easily able to migrate into DCIA. To prevent a vascular injury, it is very important to manipulate a guide wire under fluoroscopic control and to select a J-shaped guide wire instead of an angle-shaped one.

  19. Treatment of postcatheterization femoral arteriovenous fistulas with simple prolonged bandaging

    Institute of Scientific and Technical Information of China (English)

    ZHOU Tao; LIU Zhen-jiang; ZHOU Sheng-hua; SHEN Xiang-qian; LIU Qi-ming; FANG Zhen-fei; HU Xin-qun; LI Jiang; L(U) Xiao-lin

    2007-01-01

    Background The methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF-s) - simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome.Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.Methods To treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization.Results All iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4-46 days (mean (15±10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6-24 months (mean (11.8±3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed.Conclusion The results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.

  20. Intestinal Obstruction due to Bilateral Strangulated Femoral Hernias

    Directory of Open Access Journals (Sweden)

    Ioannis Nikolopoulos

    2014-01-01

    Full Text Available Introduction. Femoral hernias are at high risk of strangulation due to the narrow femoral canal and femoral ring. This can lead to symptoms of obstruction or strangulation requiring emergency surgery and possible bowel resection. To our knowledge, there is only one previous published report of bilateral strangulated femoral hernia. We present our case of this phenomenon. Case Report. An 86-year-old woman presented with symptoms of small bowel obstruction. Examination revealed two tender lumps in the area of the femoral triangle. CT scan revealed bilateral femoral hernias. Both hernias were repaired and a small bowel resection on the right side was performed with side to side anastomosis. She made an uneventful recovery. Conclusion. Bilateral femoral hernias are a rare occurrence with only one reported case of bilateral strangulation. Our case highlights the importance of meticulous history taking and clinical examination as any delay in diagnosis will increase the risk of mortality and morbidity for the patient. Hernias should always be considered as a cause if one presents with symptoms of abdominal pain or obstruction.

  1. Role of blood and vascular smooth muscle in the vasoactivity of nitrite.

    Science.gov (United States)

    Liu, Taiming; Schroeder, Hobe J; Barcelo, Lisa; Bragg, Shannon L; Terry, Michael H; Wilson, Sean M; Power, Gordon G; Blood, Arlin B

    2014-10-01

    Recent evidence from humans and rats indicates that nitrite is a vasodilator under hypoxic conditions by reacting with metal-containing proteins to produce nitric oxide (NO). We tested the hypothesis that near-physiological concentrations of nitrite would produce vasodilation in a hypoxia- and concentration-dependent manner in the hind limb of sheep. Anesthetized sheep were instrumented to measure arterial blood pressure and femoral blood flows continuously in both hind limbs. Nitrite was infused into one femoral artery to raise the nitrite concentration in the femoral vein by 10 to 15-fold while the sheep breathed 50%, 14% or 12% oxygen in inspired air. In contrast to reports in humans and rats, the nitrite infusion had no measurable effect on mean femoral blood flows or vascular conductances, regardless of inspired O2 levels. In vitro experiments showed no significant difference in the release of NO from nitrite in sheep and human red blood cells. Further experiments demonstrated nitrite is converted to NO in rat artery homogenates faster than sheep arteries, and that this source of NO production is attenuated in the presence of a heme oxidizer. Finally, western blots indicate that concentrations of the heme-containing protein cytoglobin, but not myoglobin, are markedly lower in sheep arteries compared with rats. Overall, the results demonstrate that nitrite is not a physiological vasodilator in sheep. This is likely due to a lack of conversion of nitrite to NO within the vascular smooth muscle, perhaps due to deficient amounts of the heme-containing protein cytoglobin.

  2. Our Experience with Patello femoral joint replacement

    Science.gov (United States)

    Ramos, Pablo; Arteaga, Gonzalo; Vargas, Medardo; Naranjo, Juan

    2017-01-01

    Background: Ten to fifteen percent of knee arthritis is reported to be isolated patellofemoral arthritis. Total knee arthroplasty is not recommended for isolated patella femoral arthritis particularly in young patients. We present the retrospective review our series in 7 years. Objectives: The aim of this presentation is to describe our experience in the management of patellofemoral osteoarthritis with the use of the partial patellofemoral arthroplasty, as well as to delineate the pitfalls and causes of revision in our initial series of 153 cases. Methods: between 2009 and 2016, our group performed 157 patellofemoral arthroplasties (PFA) 74% being in women, and 26% in men, the mean age for women was 58 yrs. And 38 yrs. for men, our initial 13 cases were managed with the Avon prosthesis (Stryker Corporation Kalamazoo, Michigan), and then we switched to the Vanguard PF (Zimmer-Biomet Warsaw In), both systems are an On-Lay design that is more flexible for addressing dysplastic trochleas that are more common in our population. Results: We performed a Knee Osteoarthritis Outcome Score (KOOS) for the assessment of the success of the procedure and obtained 87% of patients with excellent results (95 to 100), 10% with fair results (70 to 90) and 3% with poor outcomes (50), we performed a total of 3 revisions due to pain or progress to global arthritis. Conclusion: The PFA is a successful, safe and reproducible surgery that can be used in the group of patients that have isolated patellofemoral osteoarthritis. It requires a thorough knowledge of the patello femoral joint biomechanics, and physiopathology.

  3. The Incidence of Infection After Early Closure of Evulsive Facial Wounds

    Directory of Open Access Journals (Sweden)

    Hosseini-e- Todashki H

    2000-06-01

    Full Text Available The aim of this study was to evaluate the incidence of postoperative wound dehiscence and"ninfection after early closure of evulsive facial wounds. This treatment was conducted on 28 male patients"nwith evulsive facial wounds. The formation of these evulsive wounds was due to the rupture of"ntemporary cavitation caused by high and extra high velocity messiles. All patients with average age of 18"nyears old were treated 24-48 hrs afire accidents at base hospitals (1988-1990."nPrimary healing was achieved in 24 subjects from 7 tO 15 days after the standard operation. Wound"ndehiscences and bacterial infections were observed in 4 subjects."nThe conclusion can be made from the results is that the early closure of evulsive facial wounds may"nreduce the rate of wound dehiscence and infection because of high vascularity in this area.

  4. An eddy closure for potential vorticity

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Todd D [Los Alamos National Laboratory

    2009-01-01

    The Gent-McWilliams (GM) parameterization is extended to include a direct influence in the momentum equation. The extension is carried out in two stages; an analysis of the inviscid system is followed by an analysis of the viscous system. In the inviscid analysis the momentum equation is modified such that potential vorticity is conserved along particle trajectories following a transport velocity that includes the Bolus velocity in a manner exactly analogous to the continuity and tracer equations. In addition (and in contrast to traditional GM closures), the new formulation of the inviscid momentum equation results in a conservative exchange between potential and kinetic forms of energy. The inviscid form of the eddy closure conserves total energy to within an error proportional to the time derivative of the Bolus velocity. The hypothesis that the viscous term in the momentum equation should give rise to potential vorticity being diffused along isopycnals in a manner analogous to other tracers is examined in detail. While the form of the momentum closure that follows from a strict adherence to this hypothesis is not immediately interpretable within the constructs of traditional momentum closures, three approximations to this hypothesis results in a form of dissipation that is consistent with traditional Laplacian diffusion. The first two approximations are that relative vorticity, not potential vorticity, is diffused along isopyncals and that the flow is in approximate geostrophic balance. An additional approximation to the Jacobian term is required when the dissipation coefficient varies in space. More importantly, the critique of this hypothesis results in the conclusion that the viscosity parameter in the momentum equation should be identical to the tradition GM closure parameter {Kappa}. Overall, we deem the viscous form of the eddy closure for potential vorticity as a viable closure for use in ocean circulation models.

  5. Extremity vascular trauma. A 7-year experience in Lahore, Pakistan.

    Science.gov (United States)

    Hussain, Muhammad I; Zahid, Muhammad; Khan, Abdul-Waheed; Askri, Hasan; Khan, AbulFazal A

    2009-01-01

    To determine the outcome of various techniques of vascular repair in terms of repair related complications and limb salavagibility. From January 1999 to December 2005, this retrospective study was conducted in the Department of General Surgery, Lahore General Hospital, Lahore, Pakistan. The patients, who underwent various surgical interventions for extremity vascular trauma, were included in this study. Those, who underwent primary amputation due to non-salvageable injuries or who presented with late complications of vascular injuries were excluded. Ninety-three patients underwent different surgical procedures for extremity vascular trauma. Majority of the patients were young, (mean, 29.4 years) male (91.3%). Penetrating trauma was the most common mode of injury (77.4%). The median time interval between injury and repair was 4.5 hours. Superficial femoral artery was the most frequently injured artery (26.8%). Graft repair was carried out in 41 patients (46.6%), while (34.1%) of the patients had end-to-end anastomosis. Wound infection was the most common complication (18.2%). Seven patients (7.5%) had secondary amputations and 3 (3.2%) died from other injuries. Vascular reconstruction was successful in 89.3% of the patients. Early revascularization by employing simple repair or interposition autogenous vein graft repair results in successful limb salvage with acceptable complication rate.

  6. Local Sympathetic Denervation of Femoral Artery in a Rabbit Model by Using 6-Hydroxydopamine In Situ

    Directory of Open Access Journals (Sweden)

    Yufei Jin

    2014-01-01

    Full Text Available Both artery bundle and sympathetic nerve were involved with the metabolism of bone tissues. Whether the enhancing effects of artery bundle result from its accompanying sympathetic nerve or blood supply is still unknown. There is no ideal sympathetic nerve-inhibited method for the in situ denervation of artery bundle. Therefore, we dipped the femoral artery in the 6-hydroxydopamine (6-OHDA locally and observed its effect. Compared with control group, the in situ treatment of 6-OHDA did not damage the normal structure of vascular bundle indicated by hematoxylin-eosin (HE staining. However, the functions of sympathetic nerve was completely inhibited for more than 2 weeks, and only a few function of sympathetic nerve resumed 4 weeks later, evidenced by glyoxylic acid staining and the expression of tyrosine hydroxylase (TH and nerve peptide Y (NPY. Thus, 6-OHDA is promising as an ideal reagent for the local denervation of sympathetic nerve from artery system.

  7. Histopathological approach for diagnosis of intravascular leiomyosarcoma of the femoral vein

    Directory of Open Access Journals (Sweden)

    Gaurav Singal

    2016-04-01

    Full Text Available Malignant tumors arising from venous walls in the lower extremities are uncommon and intravascular leiomyosarcoma represents only a small proportion and rare of soft tissue leiomyosarcoma. All publications in the literature are of small clinical series or case reports. We present a case of primary leiomyosarcoma of the femoral vein in a 40 year old man; which is a rare lesion with less than 40 cases reported. The patient presented with swelling and localized leg pain. The diagnosis was made histopathologically, the tumor was resected, vascular reconstruction was performed, and for postoperative radiation therapy and chemotherapy patient was referred to the oncologist. Primary leiomyosarcoma of a major peripheral artery is extremely rare, and this report share the clinical presentation, histopathological findings, treatment, and prognosis in these patients

  8. Transcatheter closure of patent foramen ovale with the Spider~(TM) patent foramen ovale occluder: a prospective, single-center trial

    Institute of Scientific and Technical Information of China (English)

    ZHANG Cao-jin; HUANG Yi-gao; HUANG Xin-sheng; HUANG Tao; HUANG Wen-hui; SHEN Jun-jun; XUN Zheng-rong

    2010-01-01

    Background Transcatheter closure of patent foramen ovale (PFO) is a promising alternative to surgical closure or anticoagulation therapy to prevent paradoxical embolic events in patients with PFO. Several different devices have been used for transcatheter PFO closure. The aim of the present study was to evaluate the safety and feasibility for closure of PFO with a new PFO occluder, the Spider~(TM) PFO occluder. Methods The device was implanted in the PFO patients under fluoroscopy and transthoracic echocardiography (TTE) using a 10 French delivery sheath employing a femoral vein approach. Aspirin was administered at 100 mg/d for six months after occlusion. The clinical and echocardiographic follow-up of patients were performed at the 24th hour, 1st month, 3rd month, 6th month, and 12th month after occlusion, and yearly thereafter. Results The device was implanted successfully in all 55 patients. No major complications occurred during the perioperative period, such as thromboembolism, occluder dislodgement, infection or myocardial infarction. No residual shunt of the atrial level was shown by transesophageal echocardiography, and no latent arrhythmia or cerebral vesselevents occurred in any cases during follow-up ((35±9) months, range 6-51 months).Conclusion Transcatheter closure of a PFO with the Spider~(TM) PFO occluder is a safe and effective therapeutic option for the secondary prevention of presumed paradoxical embolism. However, randomized trials comparing this device with other devices and therapies have to be performed.

  9. [Arterial vascular injuries in fractures and dislocations].

    Science.gov (United States)

    Piatek, S; Bürger, T; Halloul, Z; Westphal, T; Holmenschlager, F; Winckler, S

    2001-05-01

    We analyzed reasons, numbers and results of arterial lesions accompanying fractures (n = 21) and luxations (n = 6) in a 6-year-period (1993-1998) retrospectively. Traffic accidents were in nearly 50% responsible for the injuries. 8 patients had suffered multiple injuries. In 17 patients the lower, and in 10 patients the upper extremities were affected. The vascular wall was completely disrupted or severed in 74%. In 7 cases (26%), patients had suffered blunt or indirect arterial trauma with intima- and media-lacerations due to subcapital fracture of the humerus (n = 2), fractured femoral bone (n = 1), luxation of the knee joint (n = 3) or the elbow (n = 1). The mean preoperative time period was 6 hours and 20 minutes (2 to 16 hours) in patients with complete ischaemia. Vascular reconstruction was performed by interposition of an autologous vein graft or an autologous venous bypass (n = 20), by direct reconstruction and primary suturing (n = 2), by use of a venous patch plasty (n = 2) and, in a single case, by autologous bypass procedure. In one case, a crural artery was ligated, in another case with a Mangled Extremity Severity Score (MESS) of 7 points a primary amputation of the lower leg was necessary. In 5 patients (19%) secondary amputations were performed. No patient died. The final outcome is mostly influenced by the preoperative period of ischaemia.

  10. Lower Extremity Permanent Dialysis Vascular Access.

    Science.gov (United States)

    Parekh, Vishal B; Niyyar, Vandana D; Vachharajani, Tushar J

    2016-09-07

    Hemodialysis remains the most commonly used RRT option around the world. Technological advances, superior access to care, and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Frequently encountered difficulties in clinical practice include (1) a high incidence of central venous catheter-related central vein stenosis and (2) limited options for creating a functioning upper extremity permanent arteriovenous access. Lack of surgical skills, fear of complications, and limited involvement of the treating nephrologists in the decision-making process are some of the reasons why lower extremity permanent dialysis access remains an infrequently used option. Similar to upper extremity vascular access options, lower extremity arteriovenous fistula remains a preferred access over arteriovenous synthetic graft. The use of femoral tunneled catheter as a long-term access should be avoided as far as possible, especially with the availability of newer graft-catheter hybrid devices. Our review provides a summary of clinical evidence published in surgical, radiology, and nephrology literature highlighting the pros and cons of different types of lower extremity permanent dialysis access.

  11. Bilateral impacted femoral neck fracture in a renal disease patient

    Directory of Open Access Journals (Sweden)

    Pramod Devkota

    2013-01-01

    Full Text Available Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.

  12. Neurapraxia of the femoral nerve in a modern dancer.

    Science.gov (United States)

    Sammarco, G J; Stephens, M M

    1991-01-01

    We have presented a case of an acute onset femoral nerve neurapraxia in a pure modern dancer. Repeated mild stretching of the femoral nerve during an established dance routine over a period of several months is implicated as the etiology. The thigh muscles quickly weakened, but regained strength within 3 months. Electromyographic evidence of specific femoral nerve injury initially was negative, but was evident 6 weeks following injury. Overuse syndrome in dancers can cause rapid loss of strength. Other conditions such as herniated intervertebral disc, acute hemorrhage, trauma, iliopsoas rupture, and acute stretching must be ruled out. Complete recovery was the natural outcome.

  13. Bilateral nonunited femoral neck fracture in a child with osteopetrosis.

    Science.gov (United States)

    Steinwender, G; Hosny, G A; Koch, S; Grill, F

    1995-01-01

    We report a case of osteopetrosis with bilateral nonunited femoral neck and coxa vara in a 7-year-old boy. There was a history of traumatic transcervical left femoral neck fracture unsuccessfully treated by internal fixation. We performed a bilateral subtrochanteric valgus osteotomy. K-Wire fixation failed on the right side due to hardness of the bone. Finally, internal fixation with an angular plate after predrilling of the femoral neck offered stability. Bone union was achieved on both sides, resulting in full recovery of normal physical activity.

  14. Comparison of Ultrasound-Guided and Fluoroscopy-Assisted Antegrade Common Femoral Artery Puncture Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Slattery, Michael M.; Goh, Gerard S.; Power, Sarah; Given, Mark F.; McGrath, Frank P.; Lee, Michael J., E-mail: mlee@rcsi.ie [Beaumont Hospital, Department of Radiology (Ireland)

    2015-06-15

    PurposeTo prospectively compare the procedural time and complication rates of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery (CFA) puncture techniques.Materials and MethodsHundred consecutive patients, undergoing a vascular procedure for which an antegrade approach was deemed necessary/desirable, were randomly assigned to undergo either ultrasound-guided or fluoroscopy-assisted CFA puncture. Time taken from administration of local anaesthetic to vascular sheath insertion in the superficial femoral artery (SFA), patients’ age, body mass index (BMI), fluoroscopy radiation dose, haemostasis method and immediate complications were recorded. Mean and median values were calculated and statistically analysed with unpaired t tests.ResultsSixty-nine male and 31 female patients underwent antegrade puncture (mean age 66.7 years). The mean BMI was 25.7 for the ultrasound-guided (n = 53) and 25.3 for the fluoroscopy-assisted (n = 47) groups. The mean time taken for the ultrasound-guided puncture was 7 min 46 s and for the fluoroscopy-assisted technique was 9 min 41 s (p = 0.021). Mean fluoroscopy dose area product in the fluoroscopy group was 199 cGy cm{sup 2}. Complications included two groin haematomas in the ultrasound-guided group and two retroperitoneal haematomas and one direct SFA puncture in the fluoroscopy-assisted group.ConclusionUltrasound-guided technique is faster and safer for antegrade CFA puncture when compared to the fluoroscopic-assisted technique alone.

  15. Prefabrication of axial vascularized tissue engineering coral bone by an arteriovenous loop: A better model

    Energy Technology Data Exchange (ETDEWEB)

    Dong Qingshan [Department of Oral and Maxillofacial Surgery, Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070 (China); Shang Hongtao; Wu Wei [Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi' an 710032 (China); Chen Fulin [Lab of Tissue Engineering, Faculty of Life Science, Northwest University, Xi' an 710069 (China); Zhang Junrui [Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi' an 710032 (China); Guo Jiaping [Department of Oral and Maxillofacial Surgery, Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070 (China); Mao Tianqiu, E-mail: tianqiumao@126.com [Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi' an 710032 (China)

    2012-08-01

    The most important problem for the survival of thick 3-dimensional tissues is the lack of vascularization in the context of bone tissue engineering. In this study, a modified arteriovenous loop (AVL) was developed to prefabricate an axial vascularized tissue engineering coral bone in rabbit, with comparison of the arteriovenous bundle (AVB) model. An arteriovenous fistula between rabbit femoral artery and vein was anastomosed to form an AVL. It was placed in a circular side groove of the coral block. The complex was wrapped with an expanded-polytetrafluoroethylene membrane and implanted beneath inguinal skin. After 2, 4, 6 and 8 weeks, the degree of vascularization was evaluated by India ink perfusion, histological examination, vascular casts, and scanning electron microscopy images of vascular endangium. Newly formed fibrous tissues and vasculature extended over the surfaces and invaded the interspaces of entire coral block. The new blood vessels robustly sprouted from the AVL. Those invaginated cavities in the vascular endangium from scanning electron microscopy indicated vessel's sprouted pores. Above indexes in AVL model are all superior to that in AVB model, indicating that the modified AVL model could more effectively develop vascularization in larger tissue engineering bone. - Highlights: Black-Right-Pointing-Pointer A modified arteriovenous loop (AVL) model in rabbit was developed in this study. Black-Right-Pointing-Pointer Axial prevascularization was induced in a larger coral block by using the AVL. Black-Right-Pointing-Pointer The prefabrication of axial vascularized coral bone is superior as vascular carrier.

  16. PHASE CLOSURE NULLING: THEORY AND PRACTICE

    Directory of Open Access Journals (Sweden)

    A. Chelli

    2009-01-01

    Full Text Available We provide a complete theory of the phase closure of a binary system in which a small, feeble, and unresolved companion acts as a perturbing parameter on the spatial frequency spectrum of a dominant, bright, resolved source. We demonstrate that the in uence of the companion can be measured with precision by measuring the phase closure of the system near the nulls of the primary visibility function. In these regions of phase closure nulling, frequency intervals always exist where the phase closure signature of the companion is larger than any systematic error and can thus be measured. We show that this technique allows retrieval of many astrophysically relevant properties of faint and close companions such as ux, position, and in favorable cases, spectrum. As a proof of concept, using the AMBER/VLTI instrument with 3 auxiliary telescopes of 1.8 m and only 15 minutes of on-sky integration, we detected the ve magnitudes fainter companion of HD 59717 at only 3.5 stellar radii distance from the primary. This is one of the highest contrast detected by interferometry between a companion and its parent star. We conclude by a rapid study of the potentialities of phase closure nulling observations with current interferometers and explore the requirements for a new type of dedicated instrument.

  17. Space Station evolution study oxygen loop closure

    Science.gov (United States)

    Wood, M. G.; Delong, D.

    1993-01-01

    In the current Space Station Freedom (SSF) Permanently Manned Configuration (PMC), physical scars for closing the oxygen loop by the addition of oxygen generation and carbon dioxide reduction hardware are not included. During station restructuring, the capability for oxygen loop closure was deferred to the B-modules. As such, the ability to close the oxygen loop in the U.S. Laboratory module (LAB A) and the Habitation A module (HAB A) is contingent on the presence of the B modules. To base oxygen loop closure of SSF on the funding of the B-modules may not be desirable. Therefore, this study was requested to evaluate the necessary hooks and scars in the A-modules to facilitate closure of the oxygen loop at or subsequent to PMC. The study defines the scars for oxygen loop closure with impacts to cost, weight and volume and assesses the effects of byproduct venting. In addition, the recommended scenarios for closure with regard to topology and packaging are presented.

  18. Poikiloderma vasculare atrophicans

    Directory of Open Access Journals (Sweden)

    Padmavathy L

    1994-01-01

    Full Text Available A 65 year old lady presented with generalised pruritus and discolouration of skin and mucous membranes of 5 years duration. The histopathology from the cutaneous lesions revealed features suggestive of poikiloderma vasculare atrophicans (PVA. Investigations did not reveal any underlying connective tissue disease,lymphoma or systemic disease. A diagnosis of idiopathic poikiloderma vasculare atrophicans was made.

  19. Outcomes of Clinical Application of Boomerang Closure Wire System

    Institute of Scientific and Technical Information of China (English)

    Jian-sheng WU; Wen-bin WEI; Yu-jia WANG; Xin-xia ZHANG; Xue-song HU

    2009-01-01

    Objectives To evaluate the efficacy and safety of clinical application of a novel type of vascular closure device named Boomerang closure wire system (BCWS). Methods BCWSs were used in 288 patients (BCWSs group) for hemostasis after transfernoral coronary angiography (CAG) or percutaneous coronary intervention (PCI). Device suc-cess rate, hemostasis success rate, manual compression time, recumbent time, minor peripheral complication rate, se-vere peripheral complication rate and hospital staying time after procedure were analyzed. Results were compared to those from 300 patients (control group) who received manual compression in our hospital during the same period. Results In BCWS group, device success rate was 97.2 %, hemostasis success rate was 95.1%. Manual compression time in CAG subgroup and PCI subgroup was 7.8 min and 11.2 min, respectively. Recumbent time was 136. 3 min in CAG subgroup, 284.6 min in PCI subgroup. Minor peripheral complication rate was 4.5 %, severe peripheral compli-cation rate was 2.4 %. Hospital-staying time after procedure in CAG group and PCI group was 1.8 d and 6.6 d, re-spectively. Compared to control group, manual compression time, recumbent time and hospital-staying time of BCWSs group had statistical significance; hemostasis success rate, minor peripheral complication rate and severe peripheral complication rate of BCWSs group bad no statistical difference. Conclusions BCWS provides satisfied haemostatic effect. Compared to routine manual compression, BCWS shortens manual compression time, recumbent time and hos-pital staying time.

  20. [Vascular factors in glaucoma].

    Science.gov (United States)

    Mottet, B; Aptel, F; Geiser, M; Romanet, J P; Chiquet, C

    2015-12-01

    The exact pathophysiology of glaucoma is not fully understood. Understanding of the vascular pathophysiology of glaucoma requires: knowing the techniques for measuring ocular blood flow and characterizing the topography of vascular disease and the mechanisms involved in this neuropathy. A decreased mean ocular perfusion pressure and a loss of vascular autoregulation are implicated in glaucomatous disease. Early decrease in ocular blood flow has been identified in primary open-angle glaucoma and normal pressure glaucoma, contributing to the progression of optic neuropathy. The vascular damage associated with glaucoma is present in various vascular territories within the eye (from the ophthalmic artery to the retina) and is characterized by a decrease in basal blood flow associated with a dysfunction of vasoregulation.

  1. 单纯超声心动图引导下行动脉导管未闭封堵术的安全性和有效性%Safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance

    Institute of Scientific and Technical Information of China (English)

    潘湘斌; 欧阳文斌; 李守军; 郭改丽; 刘垚; 张大伟; 张凤文; 逄坤静; 方能新

    2015-01-01

    immediately after the procedure.All patients survived without peripheral vascular injury or complications such as cardiac perforation.Hospitalization time was (3.4 ± 0.7) days.At one-month follow-up,no complications such as residual shunt or pericardial effusion were observed.Conclusion Echocardiography guided percutaneous patent ductus arteriosus closure by femoral artery approach is safe and effective,and can avoid X-ray and the use of contrast agents.

  2. Application of a three-dimensional microsurgical video system for a rat femoral vessel anastomosis

    Institute of Scientific and Technical Information of China (English)

    Liu Jianfeng; Chen Bin; Ni Yong; Zhan Yongqiang; Gao Haibin

    2014-01-01

    Background The operating microscopes have been applied to modern surgery for nearly a century.However,generations of microsurgeons have to flex their necks and fix their eyes on the eyepieces of a microscope continually that leads to physical and mental fatigue during a long operation.Stereoscopic three-dimensional (3D) media provides more ergonomic working environment,subsequently,resulting better performance in tasks and more accurate judgment.In this study,an alternative method of magnification was analyzed using a three-dimensional microsurgical video system and compared with the traditional method under microscopy to evaluate the availability and feasibility of a 3D microsurgical video system for microvascular anastomosis.Methods Forty Sprague-Dawley rats were randomly divided into four groups with each of 10.In 20 rats,10 femoral artery anastomoses with a conventional microscope (arterial microscope group) were compared with that of 10 femoral artery anastomoses with a 3D microsurgical video system (arterial 3D group).For the other 20 rats,10 femoral vein anastomoses using a conventional microscope (venous microscope group) were compared with that of 10 femoral vein anastomoses using a 3D microsurgical video system (venous 3D group).The arterial and venous microscope groups were considered to be the control groups.The arterial and venous 3D groups were the experimental groups.The examined criteria were as follows:anastomotic time,patency right after the procedure and 10 days later,number of sutures,vessel caliber,and pathological features.Results There were no differences between the operating equipment with respect to vessel caliber,anastomotic time,patency rate,number of sutures,and pathological changes in either the small arteries or veins.The average arterial anastomotic time of the arterial microscope group and arterial 3D group was 34.21 and 33.87 minutes,respectively (P >0.05).The average venous anastomotic time of the venous microscope group and

  3. Salter-Harris type II fracture of the femoral bone in a 14-year-old boy - case report.

    Science.gov (United States)

    Kuleta-Bosak, Elżbieta; Bożek, Paweł; Kluczewska, Ewa; Tomaszewski, Ryszard; Machnik-Broncel, Joanna

    2010-01-01

    Distal femoral physis fractures with displacement are rare injuries seen in adolescents related with high incidence of complication. They may lead to premature physeal closure consequently, to growth arrest and bone deformity. The case of a 14-year-old boy with Salter-Harris type II displaced fracture underwent surgery with open reduction has been described. CT examination with multiplanar reconstruction was used in pre-operative assessment of distal femur growth plate fracture. Knowledge of classification, prognosis and methods of treatment is necessary in accurate pre- and postoperative assessment of physial fractures in adolescents. CT and multiplanar reconstruction improve the understanding of patterns of injury, relative prevalence and accuracy of pre-operative planning.

  4. Salter-Harris type II fracture of the femoral bone in a 14-year-old boy – case report

    Science.gov (United States)

    Kuleta-Bosak, Elżbieta; Bożek, Paweł; Kluczewska, Ewa; Tomaszewski, Ryszard; Machnik-Broncel, Joanna

    2010-01-01

    Summary Background: Distal femoral physis fractures with displacement are rare injuries seen in adolescents related with high incidence of complication. They may lead to premature physeal closure consequently, to growth arrest and bone deformity. Case Report: The case of a 14-year-old boy with Salter-Harris type II displaced fracture underwent surgery with open reduction has been described. CT examination with multiplanar reconstruction was used in pre-operative assessment of distal femur growth plate fracture. Conclusions: Knowledge of classification, prognosis and methods of treatment is necessary in accurate pre- and postoperative assessment of physial fractures in adolescents. CT and multiplanar reconstruction improve the understanding of patterns of injury, relative prevalence and accuracy of pre-operative planning. PMID:22802768

  5. Estudio radiológico de anteversión femoral

    OpenAIRE

    Oller Asensio, Antonio; Oller Arcas, Javier

    2005-01-01

    La deformidad torso rotacional de las extremidades inferiores es un desorden esquelético frecuente, de gran importancia y es causa de alteración de la marcha. La anteversión femoral corresponde a la inclinación anterior de la cabeza femoral con respecto al eje bicondíleo femoral. El cuello femoral está normalmente en anteversión con respecto al plano bicondilar femoral.

  6. Treatment of osteonecrosis of the femoral head using autologous cultured osteoblasts: a case report

    Directory of Open Access Journals (Sweden)

    Kim Seok-Jung

    2008-02-01

    Full Text Available Abstract Introduction Osteonecrosis of the femoral head is a progressive disease that leads to femoral head collapse and osteoarthritis. Our goal in treating osteonecrosis is to preserve, not to replace, the femoral head. Case presentation We present the case of a patient with bilateral osteonecrosis of the femoral head treated with autologous cultured osteoblast injection. Conclusion Although our experience is limited to one patient, autologous cultured osteoblast transplantation appears to be effective for treating the osteonecrosis of femoral head.

  7. Median sternotomy closure: review and update research

    Institute of Scientific and Technical Information of China (English)

    Hua Kun; Yang Xiubin

    2009-01-01

    Cardiac surgery is a very common operation nowadays all over the world. Median stemotomy is a routine procedure required for cardiac access during open heart surgery. The complications of this procedure after the cardiac surgery range from 0.7% to 1.5% of all cases, and bear a high mortality rate if they occur. Every individual surgeon must pay great attention on every detail during the sternal closure. This article shows the details as to conventional information and updated progress on median sternotomy closure. The update contents involve in biomechanics, number of wires twists, biomaterial and so on.According to our experience, we recommend four peristernal single/double steel wires for sternal closure as our optimal choice.

  8. Biological constraints do not entail cognitive closure.

    Science.gov (United States)

    Vlerick, Michael

    2014-12-01

    From the premise that our biology imposes cognitive constraints on our epistemic activities, a series of prominent authors--most notably Fodor, Chomsky and McGinn--have argued that we are cognitively closed to certain aspects and properties of the world. Cognitive constraints, they argue, entail cognitive closure. I argue that this is not the case. More precisely, I detect two unwarranted conflations at the core of arguments deriving closure from constraints. The first is a conflation of what I will refer to as 'representation' and 'object of representation'. The second confuses the cognitive scope of the assisted mind for that of the unassisted mind. Cognitive closure, I conclude, cannot be established from pointing out the (uncontroversial) existence of cognitive constraints.

  9. Hanford Patrol Academy demolition sites closure plan

    Energy Technology Data Exchange (ETDEWEB)

    1993-09-30

    The Hanford Site is owned by the U.S. Government and operated by the U.S. Department of Energy, Richland Operations Office. Westinghouse Hanford Company is a major contractor to the U.S. Department of Energy, Richland Operations Office and serves as co-operator of the Hanford Patrol Academy Demolition Sites, the unit addressed in this paper. This document consists of a Hanford Facility Dangerous Waste Part A Permit Application, Form 3 (Revision 4), and a closure plan for the site. An explanation of the Part A Form 3 submitted with this closure plan is provided at the beginning of the Part A section. This Hanford Patrol Academy Demolition Sites Closure Plan submittal contains information current as of December 15, 1994.

  10. Adapting MARSSIM for FUSRAP site closure.

    Science.gov (United States)

    Johnson, Robert; Durham, L; Rieman, C

    2003-06-01

    The Multi-Agency Radiation Survey and Site Investigation Manual (MARSSIM) provides a coherent, technically defensible process for establishing that exposed surfaces satisfy site cleanup requirements. Unfortunately, many sites have complications that challenge a direct application of MARSSIM. Example complications include Record of Decision (ROD) requirements that are not MARSSIM-friendly, the potential for subsurface contamination, and incomplete characterization information. These types of complications are typically the rule, rather than the exception, for sites undergoing radiologically-driven remediation and closure. One such site is the Formerly Utilized Sites Remedial Action Program (FUSRAP) Linde site in Tonawanda, New York. Cleanup of the site is currently underway. The Linde site presented a number of challenges to designing and implementing a closure strategy consistent with MARSSIM. This paper discusses some of the closure issues confronted by the U.S. Army Corps of Engineers Buffalo District at the Linde site and describes how MARSSIM protocols were adapted to address these issues.

  11. Hip Hemiarthroplasty for Femoral Neck Fractures Using the Modified ...

    African Journals Online (AJOL)

    The patients had good hip abduction postoperatively. In addition ... Key words: Femoral neck fractures, hip hemiarthroplasty, ... the overall blood loss at surgery and morbidity after surgery, ... Their clinical and demographic features were noted.

  12. Management of Bilateral Femoral Fractures in Pregnancy: A Case ...

    African Journals Online (AJOL)

    Management of Bilateral Femoral Fractures in Pregnancy: A Case Report. ... There was no history of loss of consciousness, abdominal pains or vaginal bleeding. ... and manage the pregnancy to the point where the baby is safe for delivery.

  13. Spontaneous Enterocutaneous Fistula: A Rare Presentation of Incarcerated Femoral Hernia

    National Research Council Canada - National Science Library

    Meriç Emre Bostanci; Ilker Özel; Birkan Bozkurt; Sinan Soylu; Mustafa Turan

    2015-01-01

      Although femoral hernias are less commonly seen compared with other types of hernias, they have an inversely proportional importance to its lower frequency because of its higher risk of strangulation...

  14. Cell therapy for avascular osteonecrosis of femoral head

    Directory of Open Access Journals (Sweden)

    Tomoki Aoyama

    2009-04-01

    Full Text Available Avascular osteonecrosis of femoral head causes severe musculoskeletal disability. There is not standard treatment to cure avascular osteonecrosis.? Recently, cell therapy using bone marrow stromal cells has begun for this disease.

  15. Outcome of Femoral Plate Osteosynthesis in a Teaching Hospital in ...

    African Journals Online (AJOL)

    Valued eMachines Customer

    The scope of femoral fracture is wide and generally high energy forces are involved with multi- system trauma in ... concentration and packed cell volumes. One hundred and .... Alternatives include traction with or without cast bracing, plate.

  16. Acute femoral neuropathy secondary to an iliacus muscle hematoma.

    Science.gov (United States)

    Seijo-Martínez, M; Castro del Río, M; Fontoira, E; Fontoira, M

    2003-05-15

    We present a patient with a spontaneous iliacus muscle hematoma, appearing immediately after a minor physical maneuver, presenting with pain and femoral neuropathy initially evidenced by massive quadriceps muscle fasciculations. A magnetic resonance imaging (MRI) study of the pelvic area confirmed the diagnosis, showing a hematoma secondary to a partial muscle tear. The patient was managed conservatively, and the continuous muscle activity ceased in 3 days, with progressive improvement of the pain and weakness. The recovery was complete. Femoral neuropathy is uncommon and usually due to compression from psoas muscle mass lesions of diverse nature, including hematomas. Usually subacute, femoral neuropathy may present acutely in cases of large or strategically placed compressive femoral nerve lesions, and may require surgical evacuation. The case presented herein is remarkable since the muscle hematoma appeared after a nonviolent maneuver, fasciculations were present at onset, and conservative management was sufficient for a full recovery.

  17. Cost of treatment of paediatric femoral shaft fractures: compression ...

    African Journals Online (AJOL)

    Cost of treatment of paediatric femoral shaft fractures: compression plating versus conservative treatment. ... Log in or Register to get access to full text downloads. ... Results: Thirty-one patients who had ORIF and 31 matched controls were ...

  18. The quadratus femoris graft in old transcervical femoral fractures.

    Directory of Open Access Journals (Sweden)

    Delima D

    1989-07-01

    Full Text Available Sixteen patients with an old transcervical femoral fracture were treated with the quadratus femoris muscle pedicle bone graft with supplementary autografting. The result was a good functional hip in 14 cases.

  19. Effectiveness of plate augmentation for femoral shaft nonunion after nailing

    Directory of Open Access Journals (Sweden)

    Chin-Jung Lin

    2012-08-01

    Conclusion: Plate augmentation with retention of the nail with autologous bone grafting may be an effective and reliable alternative in treating nonunion of the femoral shaft fracture after open reduction and internal fixation with intramedullary nail.

  20. Delayed appearance of hypaesthesia and paralysis after femoral nerve block

    Directory of Open Access Journals (Sweden)

    Stefan Landgraeber

    2012-03-01

    Full Text Available We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible.

  1. Effects of external gamma radiation on femoral artery reimplantation in rats: morphometrical analyzes

    Directory of Open Access Journals (Sweden)

    Costa Regina de Faria Bittencourt da

    2003-01-01

    Full Text Available PURPOSE: To investigate the effects of external gamma radiation on rat femoral artery reimplant. METHODS: Sixty-two male Wistar rats were distributed in two groups I (Control and II (Irradiated, both formed by three observation subgroups: 2 (10 animals, 7 (11 and 21(10 postoperative days (PO. The right femoral artery of each animal was split up and reimplanted (end-to-end anastomosis, through microsurgery technique. In the first PO day group II animals were irradiated with a single dose of 15Gy, external source. The histological analysis, qualitative and descriptive analysis, was accomplished through hematoxylin and eosin (HE, Verhoeff and Masson trichromium methodology. Morphometric analysis was realized in the same slides used to histological analysis stained by HE. Computer software was used to quantify morphological alterations of the vascular wall, by processing captured images from a microscope. It was analyzed the intimal layer (intimal hyperplasia and endothelium cells formation and the nuclei percentage of smooth muscular cell in the medium layer and in the intima hyperplasia. The data were treated applying the statistical tests: Fisher's exact, Chi-square, Mann-Whitney, Kruskal-Wallis and analysis of variance (p < .05. RESULTS: The patency graft was observed by microscope distal to the autograft in 93.5% (29/31. It was observed that the gamma-radiation reduced the degree of covering of the vascular wall for the neo-formed endothelium. The nuclei percentage of smooth muscular cells, in the media, was smaller compared to control animals, although it was no significant for the studied sample size. The irradiated group showed a significant lower luminal stenosis and the intimal hyperplasia occurrence. In this group the percentage of smooth muscular cells proliferation, in the media, were significantly lower for 7 and 21 days of observation. CONCLUSION: The external single dose of 15 Gy gamma-radiation delivered at first postoperative day

  2. Traumatismos vasculares revisão de 5 anos Vascular Trauma a five year review

    Directory of Open Access Journals (Sweden)

    Luís F. Antunes

    2011-06-01

    Full Text Available O presente trabalho pretende avaliar a casuística dos traumatismos vasculares agudos admitidos no Serviço de Cirurgia Vascular dos Hospitais da Universidade de Coimbra (HUC durante o período de 5 anos, compreendido entre Julho de 2004 e Junho de 2009. Foram avaliados 97 doentes, sendo a principal causa de traumatismo as lesões iatrogénicas, seguida dos acidentes de viação. No grupo de doentes não relacionados com procedimentos coronários percutâneos verificou-se que no membro superior as artérias umeral e radial foram as mais afectadas, enquanto no membro inferior foram as artérias femoral superficial e poplítea. A isquémia aguda foi a principal forma de apresentação. Relativamente ao tratamento deste grupo de doentes, a RATT (ressecção e anastomose topo-topo e o enxerto foram os mais utlizados no membro superior, enquanto a trombectomia e o bypass foram as técnicas mais aplicadas a nível do membro inferior. Não houve mortalidade mas a morbilidade foi elevada, predominando as lesões neurológicas nos traumatismos do membro superior, e a amputação nos do membro inferior. Os resultados deste trabalho foram concordantes com o que está publicado na literatura em que se demonstra um aumento progressivo dos traumatismos de origem iatrogénica.This review intended to evaluate the series of acute vascular trauma in the Vascular Surgery Service of the Coimbra University Hospital in the period between July 2004 and June 2009. A total of 97 patients were evaluated with iatrogenic lesions being the main cause of trauma injuries, followed by traffic accidents. In group of patients not related with percutaneous coronary angioplasty, it was found that brachial and radial arteries were the most affected in upper limb, while in the lower limb were the superficial femoral and popliteal arteries. The main clinical manifestation was acute ischemic limb. In this group, resection with end-to-end anastomosis and grafts were the main treatment

  3. 2401-W Waste storage building closure plan

    Energy Technology Data Exchange (ETDEWEB)

    LUKE, S.M.

    1999-07-15

    This plan describes the performance standards met and closure activities conducted to achieve clean closure of the 2401-W Waste Storage Building (2401-W) (Figure I). In August 1998, after the last waste container was removed from 2401-W, the U.S. Department of Energy, Richland Operations Office (DOE-RL) notified Washington State Department of Ecology (Ecology) in writing that the 2401-W would no longer receive waste and would be closed as a Resource Conservation and Recovery Act (RCRA) of 1976 treatment, storage, and/or disposal (TSD) unit (98-EAP-475). Pursuant to this notification, closure activities were conducted, as described in this plan, in accordance with Washington Administrative Code (WAC) 173-303-610 and completed on February 9, 1999. Ecology witnessed the closure activities. Consistent with clean closure, no postclosure activities will be necessary. Because 2401-W is a portion of the Central Waste Complex (CWC), these closure activities become the basis for removing this building from the CWC TSD unit boundary. The 2401-W is a pre-engineered steel building with a sealed concrete floor and a 15.2-centimeter concrete curb around the perimeter of the floor. This building operated from April 1988 until August 1998 storing non-liquid containerized mixed waste. All waste storage occurred indoors. No potential existed for 2401-W operations to have impacted soil. A review of operating records and interviews with cognizant operations personnel indicated that no waste spills occurred in this building (Appendix A). After all waste containers were removed, a radiation survey of the 2401-W floor for radiological release of the building was performed December 17, 1998, which identified no radiological contamination (Appendix B).

  4. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research.

    Science.gov (United States)

    Shane, Elizabeth; Burr, David; Ebeling, Peter R; Abrahamsen, Bo; Adler, Robert A; Brown, Thomas D; Cheung, Angela M; Cosman, Felicia; Curtis, Jeffrey R; Dell, Richard; Dempster, David; Einhorn, Thomas A; Genant, Harry K; Geusens, Piet; Klaushofer, Klaus; Koval, Kenneth; Lane, Joseph M; McKiernan, Fergus; McKinney, Ross; Ng, Alvin; Nieves, Jeri; O'Keefe, Regis; Papapoulos, Socrates; Sen, Howe Tet; van der Meulen, Marjolein C H; Weinstein, Robert S; Whyte, Michael

    2010-11-01

    Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem. A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis. A case definition was developed so that subsequent studies report on the same condition. The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present to designate a femoral fracture as atypical. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including BPs, other antiresorptive agents, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association with long-term BP use. Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by BPs. Moreover, a causal association between BPs and atypical fractures has not been established. However, recent observations suggest that the risk rises with increasing duration of

  5. Transcatheter closure of a pulmonary arteriovenous malformation in a patient with hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Parker, Christopher; Rousan, Talla A; Abu-Fadel, Mazen

    2015-07-01

    Pulmonary arteriovenous malformations (PAVM) are rare pulmonary vascular anomalies. Over 50 % of the cases are associated with hereditary hemorrhagic telangiectasia or Osler-Weber-Rendu Syndrome. Untreated PAVMs progressively enlarge and can cause significant right-to-left shunting. Surgical- and catheter-based approaches have been used in the management of PAVM. We report a case of a 74-year-old man who presented with dyspnea and hypoxia and was found to have a large right-sided PAVM. He underwent percutaneous closure of the PAVM with an Amplatzer device with significant improvement of his symptoms.

  6. Final Clean Closure Report Site 300 Surface Impoundments Closure Lawrence Livermore National Laboratory Livermore, California

    Energy Technology Data Exchange (ETDEWEB)

    Haskell, K

    2006-02-14

    Lawrence Livermore National Laboratory operated two Class II surface impoundments that stored wastewater that was discharged from a number of buildings located on the Site 300 Facility (Site 300). The wastewater was the by-product of explosives processing. Reduction in the volume of water discharged from these buildings over the past several years significantly reduced the wastewater storage needs. In addition, the impoundments were constructed in 1984, and the high-density polyethylene (HDPE) geomembrane liners were nearing the end of their service life. The purpose of this project was to clean close the surface impoundments and provide new wastewater storage using above ground storage tanks at six locations. The tanks were installed and put into service prior to closure of the impoundments. This Clean Closure Report (Closure Report) complies with State Water Resources Control Board (SWRCB) Section 21400 of the California Code of Regulations Title 27 (27 CCR section 21400). As required by these regulations and guidance, this Closure Report provides the following information: (1) a brief site description; (2) the regulatory requirements relevant to clean closure of the impoundments; (3) the closure procedures; and (4) the findings and documentation of clean closure.

  7. Forum. Femoral neck surgery using a local anaesthetic technique.

    Science.gov (United States)

    Howard, C B; Mackie, I G; Fairclough, J; Austin, T R

    1983-10-01

    Thirty cases of femoral sub-capital fractures, Garden grades 1-4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents.

  8. Periprosthetic subtrochanteric femoral fracture in a megaprosthesis of the knee

    Directory of Open Access Journals (Sweden)

    Vaishya Raju

    2013-10-01

    Full Text Available 【Abstract】We report a rare case of periprosthetic posttraumatic fracture of subtrochanteric region of femur after a megaprosthesis of the knee, done for resistant nonunion of distal femur with secondary osteoarthrosis in a 51 years old man. Treatment with a locking femoral plate was able to achieve primary union with a good result. Key words: Periprosthetic fractures; Femur; Femoral fractures; Knee

  9. Proximal femoral replacement for the treatment of periprosthetic fractures.

    Science.gov (United States)

    Klein, Gregg R; Parvizi, Javad; Rapuri, Venkat; Wolf, Christopher F; Hozack, William J; Sharkey, Peter F; Purtill, James J

    2005-08-01

    A periprosthetic fracture around the femoral component is a rare but potentially problematic complication after total hip arthroplasty. Reconstruction can be challenging, especially when severe bone stock deficiency is encountered. Proximal femoral replacement is one method of treating the severely deficient proximal part of the femur. The present report describes the outcomes of revision total hip arthroplasty with use of a proximal femoral replacement in a cohort of patients who had a Vancouver type-B3 periprosthetic fracture. With use of a computerized institutional database, all patients in whom a Vancouver type-B3 fracture (characterized by severe proximal bone deficiency and a loose femoral stem) had been treated with a proximal femoral replacement were identified. A modular femoral replacement with proximal porous coating had been used in all cases. The twenty-one patients who were identified had had a mean age of 78.3 years (range, fifty-two to ninety years) at the time of the index operation. The clinical and radiographic records of these patients were reviewed. At the time of the latest follow-up (mean, 3.2 years), all but one of the patients were able to walk and had minimal to no pain. Complications included persistent wound drainage that was treated with incision and drainage (two hips), dislocation (two hips), refracture of the femur distal to the stem (one hip), and acetabular cage failure (one hip). Despite a relatively high complication rate, we believe that proximal femoral replacement is a viable option for the treatment of periprosthetic fractures in older patients with severe bone deficiency. If a proximal femoral replacement is used, the stability of the hip must be tested diligently intraoperatively and a constrained acetabular liner should be utilized if instability is encountered. In order to enhance the bone stock, the proximal part of the femur, however poor in quality, should be retained for reapproximation onto the implant.

  10. Brodie's abscess of the femoral neck simulating osteoid osteoma.

    Science.gov (United States)

    Gulati, Yash; Maheshwari, Aditya V

    2007-10-01

    Subacute osteomyelitis (Brodie's abscess) is essentially a problem of diagnosis, and there may be considerable difficulty in distinguishing it from other benign and malignant bone lesions. Though reported in the metaphyseal region of the femur, Brodie's abscess is rarer in the femoral neck. The authors present a case of Brodie's abscess in the femoral neck, which clinico-radiologically simulated an osteoid osteoma. Retrospectively, the presence of a cortical sinus tract should have aroused suspicion.

  11. Closure properties of Watson-Crick grammars

    Science.gov (United States)

    Zulkufli, Nurul Liyana binti Mohamad; Turaev, Sherzod; Tamrin, Mohd Izzuddin Mohd; Azeddine, Messikh

    2015-12-01

    In this paper, we define Watson-Crick context-free grammars, as an extension of Watson-Crick regular grammars and Watson-Crick linear grammars with context-free grammar rules. We show the relation of Watson-Crick (regular and linear) grammars to the sticker systems, and study some of the important closure properties of the Watson-Crick grammars. We establish that the Watson-Crick regular grammars are closed under almost all of the main closure operations, while the differences between other Watson-Crick grammars with their corresponding Chomsky grammars depend on the computational power of the Watson-Crick grammars which still need to be studied.

  12. The effect of plant closure on crime

    OpenAIRE

    Rege, Mari; Skarðhamar, Torbjørn; Telle, Kjetil; Votruba, Mark

    2009-01-01

    We estimate the effect of exposure to plant closure on crime using an individual-level panel data set containing criminal charges for all unmarried and employed Norwegian men below the age of 40. Men originally employed in plants that subsequently closed are 14 percent more likely to be charged of a crime than comparable men in stable plants. There is no difference in charge rates prior to closure, supporting a causal interpretation of our result. Within crime categories, we find no effect of...

  13. Straight line closure of congenital macrostomia

    Directory of Open Access Journals (Sweden)

    Schwarz Richard

    2004-01-01

    Full Text Available The results of patients operated on by Nepal Cleft Lip and Palate Association (NECLAPA surgeons for congenital macrostomia were prospectively studied between January 2000 and December 2002. There were four males and three females with a median age of 10 years. Three had an associated branchial arch syndrome. In all patients an overlapping repair of orbicularis oris was done. Six patients had a straight line closure with excellent cosmetic results and one a Z-plasty with a more obvious scar. All had a normal appearing commissure. Overlapping orbicularis repair with straight line skin closure for this rare congenital anomaly is recommended.

  14. A simple physiologic pulsatile perfusion system for the study of intact vascular tissue.

    Science.gov (United States)

    Conklin, B S; Surowiec, S M; Lin, P H; Chen, C

    2000-07-01

    Perfusion vascular culture models may provide a useful link between cell culture models and animal culture models by allowing a high level of control over important parameters while maintaining physiologic structure. The purpose of this study was to develop and test a new vascular culture system for pulsatile perfusion culture of intact vascular tissue. The system generates a pulsatile component of flow by means of a cam-driven syringe and a peristaltic pump and compliance chamber. Cams were designed, constructed and tested to simulate canine femoral and common carotid artery flows. The mean pressure was adjusted between 60 and 200 mmHg without significantly affecting flow rate, flow waveform, or the pressure waveform. Porcine common carotid artery segments were cultured in this pulsatile perfusion system. The viability of vascular segments was tested after various culture times with a functional assay that demonstrated both smooth muscle cell and endothelial cell response to vasomotor challenge.

  15. Femoral Neck Shaft Angle in Men with Fragility Fractures

    Directory of Open Access Journals (Sweden)

    S. P. Tuck

    2011-01-01

    Full Text Available Introduction. Femoral neck shaft angle (NSA has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric, symptomatic vertebral (91, and distal forearm (67 fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm2: lumbar spine, femoral neck, and total femur measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately, nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P=0.001, but larger in those with distal forearm fractures (129.8° versus 128.5°: P=0.01. Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

  16. Osteoid Osteoma of the Femoral Neck in Athletes: Two Case Reports Differentiating From Femoral Neck Stress Injuries.

    Science.gov (United States)

    Cordova, Christopher B; Dembowski, Scott C; Johnson, Michael R; Combs, John J; Svoboda, Steven J

    2016-01-01

    The diagnosis of an intra-articular osteoid osteoma can be a challenging and lengthy process, with reports of delayed diagnosis of greater than 2 years. In the young, athletic patient with an atraumatic onset of groin pain, an overuse injury or muscle strain is the most likely etiology. However, an overuse injury of femoral neck stress fracture must be identified because of the potentially disastrous outcome of fracture completion. The similar clinical presentation of a femoral neck stress fracture and intra-articular osteoid osteoma of the femoral neck can further delay the diagnosis of the osteoid osteoma. In a patient with these differential diagnoses that do not improve with a period of nonweightbearing activity, a more intensive workup must ensue. The purpose of this case report is to describe the initial presentations, subsequent follow-up, and imaging findings leading to the diagnosis of osteoid osteoma as well as to differentiate an osteoid osteoma from femoral neck stress injuries.

  17. Prevascular femoral hernia and its relation with inferior epigastric vessels: a rare presentation of the femoral hernia sac.

    Science.gov (United States)

    Boshnaq, Mohamed; Phan, Yih Chyn; Akhtar, Mansoor; Hamade, Ayman

    2016-04-18

    A 61-year-old man presented to the emergency department, with a 2-week history of a painful lump on his right groin. A diagnosis of an irreducible right femoral hernia was made. As such, an urgent operation was carried out on the same day, and the patient was found to have a rare prevascular femoral hernia in which the sac was lying over the femoral vessels and split by the inferior epigastric vessels into 2 components resembling 2 trouser limbs. The hernia sac presented in a different and challenging way that necessitated meticulous dissection and full orientation of the anatomy of the femoral triangle. Complete dissection and control of the inferior epigastric vessels, and complete reduction of the sac followed by repair with a prosthetic mesh plug were performed successfully. The patient was discharged home the next day.

  18. Gait abnormalities following slipped capital femoral epiphysis.

    Science.gov (United States)

    Song, Kit M; Halliday, Suzanne; Reilly, Chris; Keezel, William

    2004-01-01

    The authors evaluated 30 subjects with treated unilateral slipped capital femoral epiphysis and a range of severity from mild to severe to characterize gait and strength abnormalities using instrumented three-dimensional gait analysis and isokinetic muscle testing. For slip angles less than 30 degrees, kinematic, kinetic, and strength variables were not significantly different from age- and weight-matched controls. For moderate to severe slips, as slip angle increased, passive hip flexion, hip abduction, and internal rotation in the flexed and extended positions decreased significantly. Persistent pelvic obliquity, medial lateral trunk sway, and trunk obliquity in stance increased, as did extension, adduction, and external rotation during gait. Gait velocity and step length decreased with increased amount of time spent in double limb stance. Hip abductor moment, hip extension moment, knee flexion moment, and ankle dorsiflexion moment were all decreased on the involved side. Hip and knee strength also decreased with increasing slip severity. All of these changes were present on the affected and to a lesser degree the unaffected side. Body center of mass translation or pelvic obliquity in mid-stance greater than one standard deviation above normal correlated well with the impression of compensated or uncompensated Trendelenburg gait.

  19. THE ENDO-EXO-FEMORAL PROSTHESIS

    Directory of Open Access Journals (Sweden)

    H. Aschoff

    2011-01-01

    Full Text Available Patients with above knee amputation (AKA face many challenges to mobility including difficulty with socket fit and fatigue due to high energy consumption. The aim of the Endo-Exo-Femur Prosthesis (EEFP is to avoid problems at the interface between the sleeve of the socket-prosthesis and the soft tissue coat of the femur stump which often impedes an inconspicuous and harmonic gait. In 1999 we began using a transcutaneous, press-fit distal femoral intramedullary device whose most distal external aspect serves as a hard point for AKA prosthesis attachment. The bone guided prosthesis enables an advanced gait via osseoperception and leads to a decreased oxygen consumption of the patient. Thirty two patients underwent the procedure between 1999 and 2008. Their indication for surgery was persistent AKA prosthesis difficulties with a history of AKA for trauma. The paper presents the patient data regarding the design of the implant, the operative procedure, patient satisfaction, gait analysis and oxygen consumption.

  20. Reconstruction of femoral length from fragmentary femora

    Science.gov (United States)

    Offei, Eric Bekoe; Osabutey, Casmiel Kwabena

    2016-01-01

    The reconstruction of femoral length (FL) from fragmentary femora is an essential step in estimating stature from fragmentary skeletal remains in forensic investigations. While regression formulae for doing this have been suggested for several populations, such formulae have not been established for Ghanaian skeletal remains. This study, therefore, seeks to derive regression formulae for reconstruction of FL from fragmentary femora of skeletal samples obtained from Ghana. Six measurements (vertical head diameter, transverse head diameter, bicondylar breadth, epicondylar breadth, sub-trochanteric anterior-posterior diameter, and sub-trochanteric transverse diameter) were acquired from different anatomical portions of the femur and the relationship between each acquired measurement and FL was analyzed using linear regression. The results indicated significantly moderate-to-high correlations (r=0.580–0.818) between FL and each acquired measurement. The error estimates of the regression formulae were relatively low (i.e., standard error of estimate, 13.66–19.28 mm), suggesting that the discrepancies between actual and estimated stature were relatively low. Compared with other measurements, sub-trochanteric transverse diameter was the best estimate of FL. In the absence of a complete femur, the regression formulae based on the assessed measurements may be used to infer FL, from which stature can be estimated in forensic investigations. PMID:27722014

  1. Computer-assisted femoral head resurfacing.

    Science.gov (United States)

    Hodgson, Antony J; Inkpen, Kevin B; Shekhman, Mark; Anglin, Carolyn; Tonetti, Jerome; Masri, Bassam A; Duncan, Clive P; Garbuz, Donald S; Greidanus, Nelson V

    2005-01-01

    Femoral head resurfacing is re-emerging as a surgical option for younger patients who are not yet candidates for total hip replacement. However, this procedure is more difficult than total hip replacement, and the mechanical jigs typically used to align the implant produce significant variability in implant placement and take a significant amount of time to position properly. We propose that a computer-assisted surgical (CAS) technique could reduce implant variability with little or no increase in operative time. We describe a new CAS technique for this procedure and demonstrate in a cadaver study of five paired femurs that the CAS technique in the hands of a novice surgeon markedly reduced the varus/valgus variability of the implant relative to the pre-operative plan (2 degrees standard deviation for CAS versus 5 degrees for a mechanical jig operated by an expert surgeon). We also show that the mechanical jig resulted in significantly retroverted implant placement. There was no significant difference in operative time between the two techniques.

  2. Noncirrhotic Extrahepatic Portosystemic Shunt Causing Adult-Onset Encephalopathy Treated with Endovascular Closure

    Directory of Open Access Journals (Sweden)

    Eldad Elnekave

    2015-01-01

    Full Text Available A 54-year-old woman presented with a six-month history of episodic confusion and progressive ataxia. A comprehensive metabolic panel was notable for elevated values of alkaline phosphatase (161 U/L, total bilirubin (1.5 mg/dL, and serum ammonia of 300 umol/L (normal range 9–47. Hepatitis panel, relevant serological tests, tumor markers (CA-19-9, CEA, and urea cycle enzyme studies were unrevealing. Lactulose and rifaximin therapy failed to normalize serum ammonia levels. Imaging revealed a structural vascular abnormality communicating between an enlarged inferior mesenteric vein and the left renal vein, measuring 16 mm in greatest diameter. The diagnosis of congenital extrahepatic portosystemic shunt was made and endovascular shunt closure was performed using a 22 mm Amplatzer II vascular plug. Within a day, serum ammonia levels normalized. Lactulose and rifaximin were discontinued, and confusion and ataxia resolved.

  3. THE RESULTS OF THE CLINICAL USE OF A NEW METHOD OF OSTEOSYNTHESIS WITH NON-FREE BONE AUTOPLASTY AT THE MEDIAL FEMORAL NECK FRACTURES

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2013-01-01

    Full Text Available Objective - to improve treatment outcomes in patients with medial fractures of the femoral neck through the development and introduction into clinical practice a new method of fixation with non-free plastic by the autograft from the iliac crest on a permanent muscular-vascular pedicle. Materials and methods. A comparative analysis of short- and long-term results of surgical treatment of 57 patients with medial fractures of the femoral neck, which were divided into primary and control groups. The study group included 24 patients who have undergone an osteosynthesis with cannulated screws with additional autoplasty with vascularized graft from the iliac crest. The control group consisted of 33 patients who underwent fixation with cannulated screws for the traditional method. Results. The use of non-free bone autoplasty in the main group of patients provided the best short- and long-term outcomes: fracture healing occurred in all cases in a period of 6 to 8 months. The long-term results of treatment of 22 patients after 2-6 years after the operation showed comparatively better anatomical functional outcomes. Conclusions. The indications for the clinical use of the fixation with the non-free bone autotransplantation are prognostically unfavorable for the union medial fractures of the femoral neck (II-III types by Pauwels or III-IV types by Garden in patients aged under 60 years with no signs of deforming arthrosis II-III stages.

  4. 78 FR 20625 - Extension of Hearing Record Closure Date

    Science.gov (United States)

    2013-04-05

    ... From the Federal Register Online via the Government Publishing Office DEFENSE NUCLEAR FACILITIES SAFETY BOARD Extension of Hearing Record Closure Date AGENCY: Defense Nuclear Facilities Safety Board. ACTION: Extension of hearing record closure date. SUMMARY: The Defense Nuclear Facilities Safety...

  5. 77 FR 65871 - Extension of Hearing Record Closure Date

    Science.gov (United States)

    2012-10-31

    ... From the Federal Register Online via the Government Publishing Office DEFENSE NUCLEAR FACILITIES SAFETY BOARD Extension of Hearing Record Closure Date AGENCY: Defense Nuclear Facilities Safety Board. ACTION: Extension of hearing record closure date. SUMMARY: The Defense Nuclear Facilities Safety...

  6. Obturator or "lateral" bypass in the management of infected vascular prostheses at the groin

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2002-01-01

    Full Text Available The infection of the previously implanted vascular graft at the groin, is associated with great mortality and morbidity rate [1]. The authors present a retrospective study in which they analyzed management of infected vascular prostheses at the groin, using obturator bypass in 26 cases, and "lateral" bypass in 15 cases. The indications for obturator bypass reconstructions included: 20 infections of aorto-femoral grafts, two infected pse udoaneurysms in the groin after RTA of the superficial femoral artery, and 4 infections of iliac-femoral grafts. The indications for lateral bypass reconstructions were: infections after aorto-femoral reconstructions - 8 cases; infection after femora-popliteal reconstructions - 4 cases; infection after iliac-femoral reconstruction - 2 patients, and one infected pseudoaneurysm in the groin after RTA of the superficial femoral artery. In 3 subjects obturator bypass was performed using extraperitoneal approach while in other 23 patients transperitoneal approach was done by donor's artery. The obturator bypass was performed using a PTFE graft in 3 cases and Dacron graft in 23. The donor's artery used for obturator bypass was a noninfected proximal part of aortofemoral graft in 20 cases, and iliac artery in 6 patients. The superfical femoral artery was recipient artery for obturator bypass in 3 cases, deep femoral artery in one case, and above the knee popliteal artery in 22 cases (Figure 1. In two patients transperitoenal approach to donors artery for "lateral" bypass has been used, and in 13 cases extraperitoneal. The proximal noninfected part of aorto femoral graft was used as a donor's artery for lateral bypass in 8 patients, while common iliac artery in 7 subjects. In 5 cases recon structions were performed using PTFE grafts, in 3 using autologous saphenous vein grafts, and in 7 using Dacron grafts. The recipient artery for "lateral" bypass was deep femoral in 8 cases, superficial femoral in three patients and

  7. The role of arterial vascularity in pathogenesis of infected pseudoarthrosis of the lower leg; Rola zaburzen ukrwienia tetniczego w patogenezie zakazonych stawow rzekomych goleni

    Energy Technology Data Exchange (ETDEWEB)

    Konarski, K. [Szpital im. J. Jonstona, Lublin (Poland)

    1993-12-31

    A series of 250 femoral arteriographies performed in patients with leg pseudoarthrosis served to asses condition of arteries of the extremity. It was found that vascular injuries contribute significantly to pathogenesis of union disorders in lower leg fractures. (author). 14 refs, 11 figs.

  8. Aneurisma da veia femoral simulando uma hérnia inguinal Femoral vein aneurysm simulating an inguinal hernia

    Directory of Open Access Journals (Sweden)

    Victor Assad Buffara-Jr

    2009-12-01

    Full Text Available INTRODUÇÃO: Somente seis casos de aneurismas da veia femoral simulando hérnia inguinal foram descritos na literatura. RELATO DO CASO: Um caso de aneurisma da veia femoral comum direita que simulava uma hérnia inguinal é descrito em jovem de 19 anos de idade com uma massa dolorosa de consistência mole na região inguinal direita de seis meses de duração. Durante a consulta médica, o paciente morreu durante em episódio de convulsão generalizada. Na necropsia, tromboembolismo pulmonar maciço e um aneurisma da veia femoral comum de 8x8x7 cm com trombos foram diagnosticados.BACKGROUND: Only six cases of femoral vein aneurysm are related on medical literature. CASE REPORT: A case of a right common femoral vein aneurysm simulating an inguinal hernia in a 19 year-old male. He had a soft and painful mass in the right inguinal area of six months of duration. At medical consultation, the patient died during a generalized convulsive episode. At necropsy, massive pulmonary thromboembolism and an 8x8x7 cm common femoral vein aneurysm with thrombus were recognized.

  9. 33 CFR 154.520 - Closure devices.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Closure devices. 154.520 Section 154.520 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... devices. (a) Except as provided in paragraph (b) of this section, each facility to which this part...

  10. Rural Primary School Closures in England.

    Science.gov (United States)

    Whitfield, Richard C.

    A three-phase interdisciplinary effort between educators and environmental planners is focusing on the social effects of rural primary school reorganization now occuring in England as a result of a declining birth rate and the resulting need for school closure. A questionnaire mailed nationally to rural Local Education Authorities, cross-community…

  11. The Story of a Charter School Closure.

    Science.gov (United States)

    Flynn, Susan L.; Arguelles, Lourdes

    2001-01-01

    The story of a charter school closure is told from the perspectives of students, parents, teachers, and community members, who felt that the sponsoring district revoked the charter for political reasons despite broad local support. The experience underscores the necessity of publicly subjecting the relationship of the public school system and the…

  12. Parallel hierarchical evaluation of transitive closure queries

    NARCIS (Netherlands)

    Houtsma, M.A.W.; Cacace, F.; Ceri, S.

    1991-01-01

    Presents a new approach to parallel computation of transitive closure queries using a semantic data fragmentation. Tuples of a large base relation denote edges in a graph, which models a transportation network. A fragmentation algorithm is proposed which produces a partitioning of the base relation

  13. End-of-year closure - Mail Office

    CERN Multimedia

    GS Department

    2010-01-01

    On the occasion of the annual closure of CERN, there will be no mail distributed on Tuesday 21 December 2010, but mail will be collected in the morning. Nevertheless, it will be possible for you to bring your mail for the departure until 12:00 at building 555-R-002. Mail Office

  14. The Triangle Closure is a Polyhedron

    CERN Document Server

    Basu, Amitabh; Köppe, Matthias

    2011-01-01

    Recently, cutting planes derived from maximal lattice-free convex sets have been studied intensively by the integer programming community. An important question in this research area has been to decide whether the closures associated with certain families of lattice-free sets are polyhedra. For a long time, the only result known was the celebrated theorem of Cook, Kannan and Schrijver who showed that the split closure is a polyhedron. Although some fairly general results were obtained by Andersen, Louveaux and Weismantel [An analysis of mixed integer linear sets based on lattice point free convex sets, Math. Oper. Res. 35, (2010) pp. 233--256], some basic questions have remained unresolved. For example, maximal lattice-free triangles are the natural family to study beyond the family of splits and it has been a standing open problem to decide whether the triangle closure is a polyhedron. In this paper, we resolve this by showing that the triangle closure is indeed a polyhedron, and its number of facets can be ...

  15. 300 Area Process Trenches Closure Plan

    Energy Technology Data Exchange (ETDEWEB)

    Luke, S.N.

    1994-08-15

    Since 1987, Westinghouse Hanford Company has been a major contractor to the US Department of Energy, Richland Operations Office and has served as co-operator of the 300 Area Process Trenches, the waste management unit addressed in this closure plan. For the purposes of the Resource Conservation and Recovery Act, Westinghouse Hanford Company is identified as ``co-operator.`` The 300 Area Process Trenches Closure Plan (Revision 0) consists of a Resource Conservation and Recovery Act Part A Dangerous Waste Permit Application, Form 3 and a Resource Conservation and Recovery Act Closure Plan. An explanation of the Part A Permit Application, Form 3 submitted with this document is provided at the beginning of the Part A Section. The closure plan consists of nine chapters and six appendices. The 300 Area Process Trenches received dangerous waste discharges from research and development laboratories in the 300 Area and from fuels fabrication processes. This waste consisted of state-only toxic (WT02), corrosive (D002), chromium (D007), spent halogenated solvents (F001, F002, and F003), and spent nonhalogented solvent (F005). Accurate records are unavailable concerning the amount of dangerous waste discharged to the trenches. The estimated annual quantity of waste (item IV.B) reflects the total quantity of both regulated and nonregulated waste water that was discharged to the unit.

  16. Opening up closure. Semiotics across scales

    Science.gov (United States)

    Lemke

    2000-01-01

    The dynamic emergence of new levels of organization in complex systems is related to the semiotic reorganization of discrete/continuous variety at the level below as continuous/discrete meaning for the level above. In this view both the semiotic and the dynamic closure of system levels is reopened to allow the development and evolution of greater complexity.

  17. Individual Consequences of Plant Closures and Cutbacks

    DEFF Research Database (Denmark)

    Andersen, Steen

    1991-01-01

    This thesis describes the segment of unemployment which has its origin in major closures and cutbacks. The argument for this is to make it possible to describe and to analyse a flow into and a flow out of a population of unemployed. Given a major dismissal the following questions are to be answer...

  18. Primary closure of equine laryngotomy incisions

    DEFF Research Database (Denmark)

    Lindegaard, C.; Karlsson, L.; Ekstrøm, C. T.;

    2016-01-01

    The objective was to report healing characteristics and complications after primary closure of equine laryngotomies and analyse factors potentially associated with complications. This retrospective case series of the medical records of horses (n = 180) undergoing laryngoplasty and laryngotomy inc...

  19. Parallel hierarchical evaluation of transitive closure queries

    NARCIS (Netherlands)

    Houtsma, M.A.W.; Houtsma, M.A.W.; Cacace, F.; Ceri, S.

    1991-01-01

    Presents a new approach to parallel computation of transitive closure queries using a semantic data fragmentation. Tuples of a large base relation denote edges in a graph, which models a transportation network. A fragmentation algorithm is proposed which produces a partitioning of the base relation

  20. 50 CFR 648.141 - Closure.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Closure. 648.141 Section 648.141 Wildlife... inaction of one or more states will cause the applicable target exploitation rate specified in § 648.140(a... state has been remedied by that state without causing the applicable specified target exploitation...

  1. Synthesis of azaphenanthridines via anionic ring closure

    DEFF Research Database (Denmark)

    Hansen, Henriette Møller; Lysén, M.; Begtrup, M.;

    2005-01-01

    A new and convergent synthesis of azaphenanthridines via an anionic ring closure is reported. Ortho-lithiation/in situ borylation of cyanopyridines produces the corresponding cyanopyridylboronic esters, which undergo a Suzuki-Miyaura cross-coupling to give the key intermediates. Addition of lithium...

  2. 50 CFR 635.28 - Closures.

    Science.gov (United States)

    2010-10-01

    ... for the shark species or complexes specified in § 635.27(b)(1) will remain open. (2) When NMFS..., provided the harvesting vessel does no fishing after the closure in the Atlantic Ocean north of 5 N. lat., and reports positions with a vessel monitoring system, as specified in § 635.69. Additionally,...

  3. Congenital Vascular Malformation

    Science.gov (United States)

    ... also be effective for small, localized birthmarks (port wine stains). Patients with a rare venous malformation (Kleppel– ... 3) non-profit organization focused on providing public education and improving awareness about vascular diseases. For more ...

  4. Vascular Effects of Histamine

    African Journals Online (AJOL)

    olayemitoyin

    effects of histamine are mediated via H1 and H2 receptors and the actions are modulated by H3 receptor subtype ... Keywords: Histamine, Vascular smooth muscle, Endothelium .... responses to histamine, but not those to acetylcholine, were.

  5. Intracranial Vascular Treatments

    Science.gov (United States)

    ... full size with caption Related Articles and Media Gamma Knife Linear Accelerator Catheter Embolization Angioplasty and Vascular Stenting Proton Therapy Radiation Dose in X-Ray and CT Exams Stereotactic ...

  6. A CADAVERIC STUDY OF VARIATIONS IN THE ORIGIN OF LATERAL CIRCUMFLEX FEMORAL ARTERY

    Directory of Open Access Journals (Sweden)

    Apurva Pradipkumar Darji

    2015-12-01

    Full Text Available Introduction: The lateral circumflex femoral artery is a branch of the profunda femoris artery, which is the largest branch of femoral artery. The knowledge of origin and branching patterns of the lateral circumflex femoral artery is valuable for various surgeries and clinical procedures. Objectives: To determine mode of origin of lateral circumflex femoral artery and to determine the distance of origin of lateral circumflex femoral artery from the origin of profunda femoris artery and from mid-inguinal point. Materials and Method: 130 femoral triangles were studied and various measurements were noted and analysed from the department of anatomy of various Medical colleges of Gujarat. Result and conclusion: The lateral circumflex femoral artery originated from profunda femoris artery in 119 cases and from femoral artery in 11 cases. In most of the cases, the distance of origin of lateral circumflex femoral artery from the origin of profunda femoris artery was ranging from 11 to 40 mm on both the sides.

  7. Ageing and vascular ageing

    OpenAIRE

    2006-01-01

    There is an age related decline in various physiological processes. Vascular ageing is associated with changes in the mechanical and the structural properties of the vascular wall, which leads to the loss of arterial elasticity and reduced arterial compliance. Arterial compliance can be measured by different parameters like pulse wave velocity, augmentation index, and systemic arterial compliance. There is evidence that arterial compliance is reduced in disease states such as hypertension, di...

  8. [Complex vascular access].

    Science.gov (United States)

    Mangiarotti, G; Cesano, G; Thea, A; Hamido, D; Pacitti, A; Segoloni, G P

    1998-03-01

    Availability of a proper vascular access is a basic condition for a proper extracorporeal replacement in end-stage chronic renal failure. However, biological factors, management and other problems, may variously condition their middle-long term survival. Therefore, personal experience of over 25 years has been critically reviewed in order to obtain useful information. In particular "hard" situations necessitating complex procedures have been examined but, if possible, preserving the peripherical vascular features.

  9. Blood flow interplays with elastin: collagen and MMP: TIMP ratios to maintain healthy vascular structure and function

    Directory of Open Access Journals (Sweden)

    Poulami Basu

    2010-03-01

    Full Text Available Poulami Basu, Utpal Sen, Neetu Tyagi, Suresh C TyagiDepartment of Physiology and Biophysics, University of Louisville School of Medicine, Louisville, Kentucky, USAAbstract: Differential vascular remodeling is one of the major mechanisms of heterogeneity in atherosclerosis. The structural and functional heterogeneity between arteries and veins determines the degree of vascular remodeling. Matrix metalloproteases (MMPs and their tissue inhibitors (TIMPs play key roles in vascular structural and functional remodeling. We hypothesized that the level of blood flow in different arteries and veins caused structural and functional heterogeneity that ultimately determined potential vascular remodeling. To test this hypothesis, in vivo blood flow and blood pressure in the aorta, carotid, femoral artery, and femoral vein was measured in male Sprague-Dawley rats (weight 380–400 gm. Arterial and venous pressures were measured by PE-50 catheter cannulation. Blood flow was measured by a transonic ultrasound system. The aortic arch, femoral and carotid arteries, and abdominal vena cava were isolated to determine the expression of MMP-2, -9, -12, and -13 and TIMP-1, -3, and -4 by Western blot and in gelatin gel zymography. Masson trichrome and van Gieson stains were used to stain the histologic tissue sections. The results revealed that blood flow was higher in the aorta and carotid artery than the femoral artery and vein. MMP-9 and MMP-13 were higher in the carotid artery in comparison with the other blood vessels, while TIMP-3 showed higher expression in the aorta than the arteries. Further, the MMP-9 activity was significantly higher in the carotid artery than in the aorta and femoral artery. There was a higher degree of basement membrane collagen in the femoral artery and therefore a low elastin: collagen ratio, while in the carotid artery a higher level of elastin and, therefore, a high elastin: collagen ratio was found. The results suggested that medial

  10. Vascular disorder in a competitive cyclist: a case report.

    Science.gov (United States)

    Clifft, Judy K; Coleman, F Ann; Malone, Casey B

    2014-10-01

    The purpose of this case report was to alert the physical therapist (PT) to the possibility of vascular disorders in endurance athletes with apparent musculoskeletal symptoms. A 33-year-old female injured her knee in a fall and described a history of progressive unilateral lower extremity (LE) pain and weakness, especially with running and cycling. She received LE stretching and strengthening but her symptoms persisted, so she stopped all activity. When she became symptomatic with minimal exertion, she went to a neurologist, but electromyographic (EMG)/nerve conduction velocity (NCV) studies were normal. Eventually, she was referred for vascular studies, which confirmed a diagnosis of external iliac artery endofibrosis. The patient underwent a right common iliac to common femoral artery bypass graft approximately 3 years after onset of initial symptoms. She ran a 5K race 3 weeks after surgery and returned to cycling after 4 weeks. Endofibrosis of the external iliac artery is an uncommon disorder but is most frequently diagnosed in high-performance athletes, especially cyclists. Physical therapists who practice in orthopedic settings should be aware of vascular conditions that mimic musculoskeletal disorders in endurance athletes. Vascular consult or referral may be necessary if PT interventions are ineffective in treating athletes with exercise-induced LE pain and weakness.

  11. Surgical outcome of proximal femoral fractures using proximal femoral - locking compression plate

    Directory of Open Access Journals (Sweden)

    Prakash A. Sasnur

    2015-07-01

    Full Text Available Introduction: Proximal femoral fractures are complex fractures following devastating injuries in young and elderly population. Despite marked improvement in implant design, surgical technique and patient care these fractures are associated with high incidence of implant failure, refracture and varus collapse. Intramedullary nails are technically demanding and associated with high re-operation rates. The study was done to evaluate the outcome of proximal femoral fractures treated with proximal femur locking compression plate (PF-LCP. Methods: This study is conducted at Al Ameen Medical College and Hospital, Bijapur during the period Jan 2012 to March 2014.Pertrochanteric fractures especially unstable intertrochanteric & subtrochanteric fractures were included. Technical difficulties with the implant and operating time were quantified. Union of fracture site and implant related complications were followed up clinically and radiological. The Harris Hip Score was used to evaluate the functional outcome. Results: Thirty-two patients were available for final evaluation with average age of 55.4 years. The average operation time was 1 hour and 35 minutes with mean blood loss of 180ml. Union was achieved in all the cases with an average time of 17 weeks. Complications included one case of delayed union and three cases of varus collapse. Conclusion: PF-LCP achieves anatomical reduction and stable fixation with higher union rate and fewer complications.

  12. Multiplanar CT assessment of femoral head displacement in slipped capital femoral epiphysis

    Energy Technology Data Exchange (ETDEWEB)

    Monazzam, Shafagh [Rady Children' s Hospital and Health Center, Department of Orthopedics, San Diego, CA (United States); Dwek, Jerry R. [Rady Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Hosalkar, Harish S. [Center for Hip Preservation, Department of Orthopedic Surgery, TriCity Medical Center, Oceanside, CA (United States)

    2013-12-15

    With recent changing approaches to the management of slipped capital femoral epiphysis (SCFE), the accurate radiographic assessment of maximum extent of displacement is crucial for planning surgical treatment. To determine what plane best represents the maximum SCFE displacement as quantified by the head-neck angle difference (HNAD), whether HNAD can quantitatively differentiate the SCFE cohort from the normal cohort, based on CT, and how Southwick slip angle (SSA) compares to HNAD. We reviewed 19 children with SCFE (23 affected hips) with preoperative CT scans and 27 age- and sex-matched children undergoing abdominal CT for non-orthopedic problems. Head-neck angle (HNA), the angle between the femoral epiphysis and the neck axis, was measured in three planes on each hip and the HNAD (affected - unaffected hip) was determined. SSA was measured on radiographs. The coronal HNAD (mean 8.7 ) was less than both the axial-oblique (mean 30.7 ) and sagittal (mean 37.4 ) HNADs, which were also greater than the HNADs of the normal cohort. Grouping HNAD measurements by SSA severity classification did not consistently distinguish between SCFE severity levels. Axial-oblique and sagittal planes best represent the maximum SCFE displacement while biplanar radiograph may underestimate the extent of the displacement, thereby potentially altering the management between in situ pinning and capital realignment. (orig.)

  13. Vascular compression syndromes.

    Science.gov (United States)

    Czihal, Michael; Banafsche, Ramin; Hoffmann, Ulrich; Koeppel, Thomas

    2015-11-01

    Dealing with vascular compression syndromes is one of the most challenging tasks in Vascular Medicine practice. This heterogeneous group of disorders is characterised by external compression of primarily healthy arteries and/or veins as well as accompanying nerval structures, carrying the risk of subsequent structural vessel wall and nerve damage. Vascular compression syndromes may severely impair health-related quality of life in affected individuals who are typically young and otherwise healthy. The diagnostic approach has not been standardised for any of the vascular compression syndromes. Moreover, some degree of positional external compression of blood vessels such as the subclavian and popliteal vessels or the celiac trunk can be found in a significant proportion of healthy individuals. This implies important difficulties in differentiating physiological from pathological findings of clinical examination and diagnostic imaging with provocative manoeuvres. The level of evidence on which treatment decisions regarding surgical decompression with or without revascularisation can be relied on is generally poor, mostly coming from retrospective single centre studies. Proper patient selection is critical in order to avoid overtreatment in patients without a clear association between vascular compression and clinical symptoms. With a focus on the thoracic outlet-syndrome, the median arcuate ligament syndrome and the popliteal entrapment syndrome, the present article gives a selective literature review on compression syndromes from an interdisciplinary vascular point of view.

  14. Permanent Closure of the TAN-664 Underground Storage Tank

    Energy Technology Data Exchange (ETDEWEB)

    Bradley K. Griffith

    2011-12-01

    This closure package documents the site assessment and permanent closure of the TAN-664 gasoline underground storage tank in accordance with the regulatory requirements established in 40 CFR 280.71, 'Technical Standards and Corrective Action Requirements for Owners and Operators of Underground Storage Tanks: Out-of-Service UST Systems and Closure.'

  15. 25 CFR 573.6 - Order of temporary closure.

    Science.gov (United States)

    2010-04-01

    ... or a customer. (7) A management contractor operates for business without a contract that the Chairman... 25 Indians 2 2010-04-01 2010-04-01 false Order of temporary closure. 573.6 Section 573.6 Indians... ENFORCEMENT § 573.6 Order of temporary closure. (a) When an order of temporary closure may issue...

  16. Pulmonary edema following transcatheter closure of atrial septal defect

    Directory of Open Access Journals (Sweden)

    Singhi Anil

    2010-01-01

    Full Text Available Pulmonary edema after device closure of atrial septal defect (ASD is a rare complication. We present illustrative images of a case of pulmonary edema after device closure of ASD in a 53 year old adult. Older patients undergoing ASD closure can benefit from their left atrial and left ventricular end diastolic pressures measurement before and after temporary balloon occlusion of ASD.

  17. A Simple Method for Thoracotomy Closure Avoiding Intercostal Nerve Damage

    Directory of Open Access Journals (Sweden)

    Ufuk Cagirici

    2016-09-01

    Full Text Available It is well known that intercostal nerve damage during thoracotomy closure causes severe postoperative pain. A simple closure technique is proposed for intercostal nerve-sparing during thoracotomy opening and closure. We think that this maneuver may avoid intercostal nerve compression.

  18. 27 CFR 28.102 - Bottles to have closures affixed.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Bottles to have closures... Transportation to a Manufacturing Bonded Warehouse § 28.102 Bottles to have closures affixed. Every bottle containing distilled spirits to be withdrawn under the provisions of this subpart shall have a closure...

  19. 78 FR 1206 - Second Extension of Hearing Record Closure Date

    Science.gov (United States)

    2013-01-08

    ... SAFETY BOARD Second Extension of Hearing Record Closure Date AGENCY: Defense Nuclear Facilities Safety Board. ACTION: Second extension of hearing record closure date. SUMMARY: The Defense Nuclear Facilities... closure date to January 2, 2013 (77 FR 65871). Extension of Time: The Board now extends the period of...

  20. [What do general, abdominal and vascular surgeons need to know on plastic surgery - aspects of plastic surgery in the field of general, abdominal and vascular surgery].

    Science.gov (United States)

    Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F

    2015-02-01

    There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options.