Science.gov

Sample records for arterial avulsion presenting

  1. Replantation of an avulsed ear, using a single arterial anastamosis.

    PubMed

    O'Toole, G; Bhatti, K; Masood, S

    2008-01-01

    Avulsion of the ear is relatively uncommon and replantation a technical challenge. A case in which an avulsed ear was successfully replanted using a single arterial anastamosis is described. The surgical difficulties encountered, the pharmaceutical approach to postoperative care and the problems which resulted from the lack of venous drainage are discussed. PMID:18061545

  2. First dorsal metacarpal artery adiposofascial flap for venous conduit and soft tissue cover in an avulsed thumb: case report.

    PubMed

    Dodakundi, Chaitanya; Hattori, Yasunori; Doi, Kazuteru

    2012-06-01

    Skin loss, need for vein grafts, and secondary surgeries are often encountered in avulsion injuries of the thumb. We report a case of successful salvage of an avulsion type of near total amputation of the thumb following a conveyor belt injury in which the first dorsal metacarpal artery adiposofascial flap was used for combined soft tissue cover and venous conduit. PMID:22517573

  3. Umbilical cord avulsion in waterbirth.

    PubMed

    Schafer, Robyn

    2014-01-01

    Umbilical cord avulsion (or "cord snapping") is often cited as a risk associated with waterbirth. This article discusses a case study in which a cord avulsed during a waterbirth and uses it as a basis to explore the incidence, etiology, and associated risk factors of umbilical cord avulsion. The diagnosis, clinical presentation, and management of cord avulsion in waterbirth is presented along with a thorough review of the literature and relevant professional standards. This article offers recommendations for clinical practice to minimize the risk of a cord avulsion and highlights the need for additional research and provider education to ensure optimal care of women and newborns. PMID:24588881

  4. Management of full-length complete ureteral avulsion

    PubMed Central

    Tang, Kaifa; Sun, Fa; Tian, Yuan; Zhao, Yili

    2016-01-01

    ABSTRACT Introduction Complete ureteral avulsion is one of the most serious complications of ureteroscopy. The aim of this report was to look for a good solution to full-length complete ureteral avulsion. Case presentation A 40-year-old man underwent ureteroscopic management. Full-length complete avulsion of ureter occurred during ureteroscopy. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis were performed 6 hours after ureteral avulsion. The patient was followed-up during 34 months. Double-J tube was removed at 3 months after operation. Twenty three months after the first operation, the patient developed hydronephrosis because of a new ureter upside stone, then rigid ureteroscopy and holmium laser lithotripsy were used successfully. Conclusion Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis may be a good choice for full-length complete ureteral avulsion. PMID:27136483

  5. Patterns in ritual tooth avulsion at Roonka.

    PubMed

    Durband, Arthur C; Littleton, Judith; Walshe, Keryn

    2014-08-01

    Tooth avulsion is the intentional removal of one or more teeth for ritual or aesthetic reasons, or to denote group affiliation. Typically the maxillary incisors are the teeth most often selected for removal. Previous authors have discussed the presence of tooth avulsions in several individuals recovered from Roonka, but those papers did not examine any patterns in those removals that might be present. Analysis of the tooth avulsions at Roonka reveals a change in the practice over time, with the older burials from phase II typically showing removal of both maxillary central incisors with a left side bias when only one tooth is removed, and the more recent phase III burials showing only one incisor avulsed and a right side bias for removal. Frequencies in the practice also changed over time, with avulsions being much more common in the older phase II burials. Historical evidence suggests that any particular regional or social group would have its own particular pattern of tooth avulsion, so these changes in tooth avulsions at Roonka suggest that the site was either used by multiple groups of people for burials, or that there was significant cultural change during the occupation of the site. PMID:24827419

  6. Anterior cerebral artery territory infarctions presenting with ascending tetraparesis.

    PubMed

    Okamoto, Kensho; Hamada, Eri; Okuda, Bungo

    2004-01-01

    We describe a patient with ascending tetraparesis following stroke. The patient presented initially with spastic paraparesis which acutely evolved to tetraparesis with abulia. Magnetic resonance imaging revealed acute infarctions in the bilateral medial frontal regions but not in the brainstem or spinal cord. Multiple infarctions in the anterior cerebral artery territory appeared to originate from artery to artery embolism. The present case provides distinct clinical features of anterior cerebral artery syndrome which mimic myelopathy or brainstem lesions. PMID:17903956

  7. Avulsion and storage media.

    PubMed

    Hiremath, Geeta; Kidiyoor, Krishnamurthy H

    2011-05-01

    Avulsion of a tooth caused by trauma, and its successful treatment is a challenging situation that a dentist encounters in clinical practice. There is a definitive treatment for the avulsed tooth, which depends on many factors. The immediate replacement and replantation of the avulsed tooth is necessary, but it cannot always be accomplished for a number of reasons. Thus, the tooth should be transported in a suitable medium to maintain the cell viability. The storage medium is one of the important factors that will help the dentist in rendering successful treatment for the avulsed tooth. There is a continuing search for an ideal storage medium. This review paper focuses on the various storage media, with special reference to coconut water. PMID:25426601

  8. Suture Bridge Fixation Technique for Posterior Cruciate Ligament Avulsion Fracture

    PubMed Central

    Lee, Kwang Won; Lee, Gyu Sang; Choy, Won Sik

    2015-01-01

    We presented a surgical technique including a suture bridge technique with relatively small incision for the reduction and fixation of posterior ligament avulsion fractures. A suture anchor was used to hold the avulsed fragment and a knotless anchor was used to continuously compress the bony fragment into the fracture site, thereby maintaining reduction during healing. PMID:26640635

  9. Anorectal avulsion: an exceptional rectal trauma.

    PubMed

    Ibn Majdoub Hassani, Karim; Ait Laalim, Said; Benjelloun, El Bachir; Toughrai, Imane; Mazaz, Khalid

    2013-01-01

    Anorectal avulsion is an exceptional rectal trauma in which the anus and sphincter no longer join the perineum and are pulled upward. As a result, they ventrally follow levator ani muscles. We present a rare case of a 29-years old patient who was admitted in a pelvic trauma context; presenting a complete complex anorectal avulsion. The treatment included a primary repair of the rectum and a diverting colostomy so as to prevent sepsis. Closure of the protective sigmoidostomy was performed seven months after the accident and the evolution was marked by an anal stenosis requiring iterative dilatations. PMID:24094142

  10. Isolated intermittent vertigo: A presenting feature of persistent trigeminal artery

    PubMed Central

    Parthasarathy, Rajsrinivas; Derksen, Carol; Saqqur, Maher; Khan, Khurshid

    2016-01-01

    Embryonic carotid – basilar anastomosis when persistent in adult life can present with a variety of neurological symptoms. We present a patient with isolated intermittent vertigo attributable to the embryonic anastomosis and describe the different types of persistent trigeminal artery. A 76-year-old Caucasian man presented with isolated intermittent vertigo and symptoms suggestive of anterior and posterior circulation strokes. Impaired vasomotor reactivity was demonstrated on insonation of the anterior and posterior cerebral arteries in this patient with a persistent left trigeminal artery and 75% stenosis of the left internal carotid artery (ICA). The symptom of intermittent vertigo resolved with carotid endarterectomy. Decreased flow across the stenotic segment of the ICA which subserved the posterior circulation resulted in basilar insufficiency. Hypoperfusion to the flocculonodular lobe supplied by the anterior inferior cerebellar artery is a likely cause for the intermittent vertigo. PMID:26933370

  11. Isolated intermittent vertigo: A presenting feature of persistent trigeminal artery.

    PubMed

    Parthasarathy, Rajsrinivas; Derksen, Carol; Saqqur, Maher; Khan, Khurshid

    2016-01-01

    Embryonic carotid - basilar anastomosis when persistent in adult life can present with a variety of neurological symptoms. We present a patient with isolated intermittent vertigo attributable to the embryonic anastomosis and describe the different types of persistent trigeminal artery. A 76-year-old Caucasian man presented with isolated intermittent vertigo and symptoms suggestive of anterior and posterior circulation strokes. Impaired vasomotor reactivity was demonstrated on insonation of the anterior and posterior cerebral arteries in this patient with a persistent left trigeminal artery and 75% stenosis of the left internal carotid artery (ICA). The symptom of intermittent vertigo resolved with carotid endarterectomy. Decreased flow across the stenotic segment of the ICA which subserved the posterior circulation resulted in basilar insufficiency. Hypoperfusion to the flocculonodular lobe supplied by the anterior inferior cerebellar artery is a likely cause for the intermittent vertigo. PMID:26933370

  12. Modeling coupled avulsion and earthquake timescale dynamics

    NASA Astrophysics Data System (ADS)

    Reitz, M. D.; Steckler, M. S.; Paola, C.; Seeber, L.

    2014-12-01

    River avulsions and earthquakes can be hazardous events, and many researchers work to better understand and predict their timescales. Improvements in the understanding of the intrinsic processes of deposition and strain accumulation that lead to these events have resulted in better constraints on the timescales of each process individually. There are however several mechanisms by which these two systems may plausibly become linked. River deposition and avulsion can affect the stress on underlying faults through differential loading by sediment or water. Conversely, earthquakes can affect river avulsion patterns through altering the topography. These interactions may alter the event recurrence timescales, but this dynamic has not yet been explored. We present results of a simple numerical model, in which two systems have intrinsic rates of approach to failure thresholds, but the state of one system contributes to the other's approach to failure through coupling functions. The model is first explored for the simplest case of two linear approaches to failure, and linearly proportional coupling terms. Intriguing coupling dynamics emerge: the system settles into cycles of repeating earthquake and avulsion timescales, which are approached at an exponential decay rate that depends on the coupling terms. The ratio of the number of events of each type and the timescale values also depend on the coupling coefficients and the threshold values. We then adapt the model to a more complex and realistic scenario, in which a river avulses between either side of a fault, with parameters corresponding to the Brahmaputra River / Dauki fault system in Bangladesh. Here the tectonic activity alters the topography by gradually subsiding during the interseismic time, and abruptly increasing during an earthquake. The river strengthens the fault by sediment loading when in one path, and weakens it when in the other. We show this coupling can significantly affect earthquake and avulsion

  13. Common iliac artery aneurysm presenting as acute sciatic nerve compression.

    PubMed Central

    Mohan, S. R.; Grimley, R. P.

    1987-01-01

    Aneurysms of the iliac arteries usually remain silent, but when they rupture the consequences can be dramatic. They produce few clinical signs suggestive of their presence. However, such aneurysms have been found to be the cause of non-vascular clinical situations. Often they present with features of compression on adjacent viscera. We present a case in which a large common iliac artery aneurysm was found to be causing symptoms of acute sciatic nerve compression. PMID:3447118

  14. Vertebral artery thrombosis: a rare presentation of primary polycythaemia

    PubMed Central

    Gul, H L; Lau, S Y M; Chan-Lam, D; Ng, J-P

    2014-01-01

    Primary polycythaemia, also known as polycythaemia vera (PV), is a myeloproliferative neoplasm (MPN) which is associated with arterial and venous thrombosis and which can contribute to significant morbidity and mortality if untreated. Arterial thrombosis accounts for a large proportion of PV-related thrombotic events which may manifest as stroke and myocardial infarction. There is an abundance of literature documenting thrombosis arising in the cerebral vasculature secondary to PV. However, vertebral artery thrombosis associated with PV has not been previously described. We present a case of vertebral artery thrombosis as the presenting manifestation of PV. This case demonstrates the importance of recognising MPNs as a cause of an unusual presentation of thrombosis. PMID:24862411

  15. Anterior Inferior Iliac Spine Avulsion Fracture

    PubMed Central

    Serbest, Sancar; Tosun, Hacı Bayram; Tiftikçi, Uğur; Oktas, Birhan; Kesgin, Engin

    2015-01-01

    Abstract Avulsion fractures of the pelvic apophyses rarely occur in adolescent athletes in the course of sudden strong contraction of muscle attached to growth cartilage. This injury may usually be misdiagnosed for tendon or muscle strain. Patient's history, physical examination, and radiologic studies are important for diagnosis. The literature includes only a few case reports but no case series as yet. The aim of this study was to present the results of 5 cases of anterior inferior iliac spine (AIIS) avulsion fractures treated conservatively. The study included 5 patients (4 male, 1 female, mean age 13.6 years) who underwent conservative treatment for AIIS avulsion fractures and had an adequate follow-up. All patients were admitted to the emergency department and misdiagnosed as muscle strain. Three of them were football player, 1 skier, and 1 fighter. Each patient was treated with immobilization and nonsteroidal anti-inflammatory drugs. At follow-up, all patients showed relief from their pain and mechanical symptoms and regained full range of motion and returned to their previous levels of activity. Diagnosis requires careful attention to the physical examination and imaging. In this series, all pelvic avulsion fractures (100%) were managed successfully with a conservative approach. Good results and return to previous levels of activity can be achieved with conservative treatment. PMID:25700329

  16. An unusual presentation of thoracoacromial artery pseudoaneurysm following shoulder arthroplasty

    PubMed Central

    Wright, Anna Elizabeth; Wall, Michael; Slaney, Penny; Downing, Richard

    2014-01-01

    Pseudoaneurysms of peripheral arteries are not an uncommon condition presenting to vascular surgeons. Perioperative injury and infection are two of the commonest causes. We describe a case of an 82-year-old lady, who presented 10 years following right shoulder joint replacement, with a sharply marginated erythematous cutaneous eruption over the right shoulder. Subsequent angiography revealed a pseudoaneurysm of the acromial branch of the thoracoacromial artery. Planned intervention was superseded by a further embolic episode, which prompted immediate percutaneous translumninal embolisation of the aneurysm. The aetiology of a pseudoaneurysm 10 years following shoulder arthroplasty is discussed. PMID:24973348

  17. Intimal pulmonary artery sarcoma presenting as dyspnea: case report

    PubMed Central

    Hsing, Jeff M; Thakkar, Snehal G; Borden, Ernest C; Budd, George T

    2007-01-01

    Background We report a case of pulmonary sarcoma which is a rare cause of the common symptom of dyspnea. Case presentation A fifty-one year old previously healthy male presented to the emergency room with complaints of dyspnea on exertion. A cardiac workup including an exercise stress test was negative but an echocardiography showed pulmonary stenosis. Cardiac MRI showed a large mass extending from the pulmonic valve to both the right and left pulmonary arteries suggestive of sarcoma. A complete resection and repair of the pulmonary artery was done and adjuvant chemotherapy with doxorubicin and ifosfamide was recommended. The patient is currently disease free after eighteen months. Conclusion Pulmonary artery sarcomas are a difficult diagnosis. The diagnosis may remain elusive for some time until the proper imaging techniques are utilized to make a diagnosis. Earlier and accurate diagnosis may lead to earlier interventions and improve survival. PMID:17603895

  18. APOPHYSEAL FRACTURE OR AVULSION OF THE GREATER TROCHANTER

    PubMed Central

    FREITAS, ANDERSON; MACEDO, SÍLVIO LEITE DE

    2016-01-01

    ABSTRACTS The apophyseal fracture or avulsion of the greater trochanter occurs in skeletally immature patients. It has at etiological factors indirect mechanisms (avulsion) and direct mechanisms (trauma on the trochanter), the latter being the most common. The clinical presentation is easily identified and a simple X- ray can confirm the diagnosis. Regardless of the treatment chosen, this pathology has a high correlation with osteonecrosis of the femoral head, even as a rare fact, however with innocent appearance, on this pathology. PMID:27217820

  19. Onyx embolization of an avulsed thalamoperforator following endoscopic colloid cyst and lamina terminalis fenestration

    PubMed Central

    Turner, Raymond D; Chaudry, Imran; Turk, Aquilla; Spiotta, Alejandro

    2014-01-01

    A patient presented with headaches and was found to have a colloid cyst in the third ventricle and ventriculomegaly. The patient underwent endoscopic colloid cyst resection and third ventriculostomy without incidence. Prior to emergence, a blown right pupil was acutely noted, and bright red blood emanated from the ventricular drain that was routinely placed in the endoscopy tract at the conclusion of the procedure. CTangiography demonstrated active extravasation from the pre-pontine cistern into the third ventricle and subarachnoid space. Emergency DSA confirmed active extravasation from an avulsed thalamoperforator arising from the proximal right P1 posterior cerebral artery, which was immediately embolized without incident. PMID:25053667

  20. Onyx embolization of an avulsed thalamoperforator following endoscopic colloid cyst and lamina terminalis fenestration.

    PubMed

    Turner, Raymond D; Chaudry, Imran; Turk, Aquilla; Spiotta, Alejandro

    2015-08-01

    A patient presented with headaches and was found to have a colloid cyst in the third ventricle and ventriculomegaly. The patient underwent endoscopic colloid cyst resection and third ventriculostomy without incidence. Prior to emergence, a blown right pupil was acutely noted, and bright red blood emanated from the ventricular drain that was routinely placed in the endoscopy tract at the conclusion of the procedure. CTangiography demonstrated active extravasation from the pre-pontine cistern into the third ventricle and subarachnoid space. Emergency DSA confirmed active extravasation from an avulsed thalamoperforator arising from the proximal right P1 posterior cerebral artery, which was immediately embolized without incident. PMID:25063695

  1. Microsurgical Replantation of a Two-Segment Total Scalp Avulsion.

    PubMed

    Hu, Weiguo; Henry, Anne-Sophie; Lucas, Camille; Ta, Pierre; Philandrianos, Cécile; Kerfant, Nathalie

    2016-06-01

    Total scalp avulsion is a rare and severe injury that may be life threatening and can result in devastating disfigurement and psychological trauma. Microsurgical hair-bearing scalp replantation is considered the procedure of choice and should be performed by a skilled surgical team. Replantation of a multifragmented scalp is even rarer and shows random results. Only 2 patients have been reported, resulting in partial or total necrosis of implanted fragments. The authors describe the successful replantation of a totally avulsed 2-segment scalp in a 63-year-old woman whose hair was entrapped in the propeller shaft of a ship. The avulsed scalp involved both eyebrows, the frontal region, the upper part of both ears, and most of the occipital portion. After initial management including correction of hemorrhagic shock, the patient underwent emergency scalp replantation by microsurgical anastomosis of 3 arteries and 4 veins and the use of 2 vein grafts.According to authors' experience, multifragmented scalp avulsion imposes emergency relocation using as many microsurgical sutures as possible and implementation of vein grafts to ensure optimal revascularization of the avulsed scalp. PMID:27171945

  2. Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

    PubMed Central

    Tayeb, Marawan El; Mellon, Matthew J.; Lingeman, James E.

    2015-01-01

    We present a case report of successful management of ureteropelvice junction avulsion during ureteroscopy successfully managed with simultaneous percutaneous nephrolithotomy and early endoscopic ureteral realignment. PMID:26834898

  3. Anomalous origin of the left coronary artery from the pulmonary artery presenting as dilated cardiomyopathy: a case report

    PubMed Central

    2014-01-01

    Introduction Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly and one of the causes of myocardial ischemia. The usual clinical course is severe left-sided heart failure and mitral valve insufficiency presenting during the first months of life. Case presentation We report the case of a 6-month-old Tunisian girl who presented with dilated cardiomyopathy. Echocardiography suspected anomalous origin of the left coronary artery. The definitive diagnosis of anomalous origin of the left coronary artery from the pulmonary artery was reached by multislice computed tomography and coronary angiography. Conclusion In cases of dilated cardiomyopathy, anomalous origin of the left coronary artery from the pulmonary artery syndrome has to be kept in mind as a surgically correctable cause. PMID:24885797

  4. Patient Presentation and Management of Labial Ulceration Following Uterine Artery Embolization

    SciTech Connect

    Gonsalves, Carin Franciosa, Stefan V.; Shah, Suken; Bonn, Joseph; Wu, Christine

    2007-11-15

    Uterine artery embolization is a safe and effective procedure for the treatment of symptomatic uterine fibroids. Nontarget embolization of adjacent internal iliac artery branches is a reported complication of uterine artery embolization. The following report describes the presentation and management of ulcerations of the labium minora due to nontarget embolization of the internal pudendal artery.

  5. High speed intravascular photoacoustic imaging of atherosclerotic arteries (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Piao, Zhonglie; Ma, Teng; Qu, Yueqiao; Li, Jiawen; Yu, Mingyue; He, Youmin; Shung, K. Kirk; Zhou, Qifa; Kim, Chang-Seok; Chen, Zhongping

    2016-02-01

    Cardiovascular disease is the leading cause of death in the industrialized nations. Accurate quantification of both the morphology and composition of lipid-rich vulnerable atherosclerotic plaque are essential for early detection and optimal treatment in clinics. In previous works, intravascular photoacoustic (IVPA) imaging for detection of lipid-rich plaque within coronary artery walls has been demonstrated in ex vivo, but the imaging speed is still limited. In order to increase the imaging speed, a high repetition rate laser is needed. In this work, we present a high speed integrated IVPA/US imaging system with a 500 Hz optical parametric oscillator laser at 1725 nm. A miniature catheter with 1.0 mm outer diameter was designed with a 200 μm multimode fiber and an ultrasound transducer with 45 MHz center frequency. The fiber was polished at 38 degree and enclosed in a glass capillary for total internal reflection. An optical/electrical rotary junction and pull-back mechanism was applied for rotating and linearly scanning the catheter to obtain three-dimensional imaging. Atherosclerotic rabbit abdominal aorta was imaged as two frame/second at 1725 nm. Furthermore, by wide tuning range of the laser wavelength from 1680 nm to 1770 nm, spectroscopic photoacoustic analysis of lipid-mimicking phantom and an human atherosclerotic artery was performed ex vivo. The results demonstrated that the developed IVPA/US imaging system is capable for high speed intravascular imaging for plaque detection.

  6. Posterior cerebral artery stroke presenting as alexia without agraphia.

    PubMed

    Sharma, Bhawna; Handa, Rahul; Prakash, Swayam; Nagpal, Kadam; Bhana, Indu; Gupta, Pankaj Kumar; Kumar, Sunil; Sisodiya, Mahendra Singh

    2014-12-01

    Alexia without agraphia (pure alexia) was the first of the disconnection syndromes to be described by Dejerine who reported a patient of alexia without agraphia secondary to an embolic occipital lobe infarct. We herein report a 55-year-old man who presented with alexia without agraphia with magnetic resonance imaging suggestive of left posterior cerebral artery infarct involving left occipital lobe and splenium of corpus callosum. Alexia without agraphia is a relatively uncommon clinical condition, which should always be thought in a patient presenting with difficulty in reading with normal visual acuity. Ophthalmologists should also be aware of this disconnection syndrome as many patients initially take their advice due to predominant visual complaints. Early diagnosis and treatment of this condition help in ensuring the patient and attendants about nonprogressive nature of the disease and may prevent further episodes of stroke. PMID:24935413

  7. Delayed Replantation of Avulsed Teeth: Two Case Reports

    PubMed Central

    Savas, Selcuk; Kucukyilmaz, Ebru; Akcay, Merve; Koseoglu, Serhat

    2015-01-01

    This case report presents two cases of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. Eight-year-old boy and 10-year-old boy presented with avulsed maxillary central incisors due to trauma occurring 27 and 7 hours earlier, respectively. Treatment guidelines for avulsed mature/immature permanent teeth with prolonged extra-oral time were carried out for the teeth and the extra-oral endodontic treatment was completed. After having been repositioned, the teeth were stabilized for 4 weeks and prophylactic antibiotic was prescribed. Clinical and radiographic controls were done after 18 months for Case I and 12 months for Case II. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position but revealed clinical initial replacement resorption and ankylosis. PMID:25810928

  8. Avulsion of permanent teeth: theory to practice.

    PubMed

    Trope, Martin

    2011-08-01

    This paper presents clinical protocols for the emergency, early and post treatment complications of the avulsed tooth. The biological basis for these protocols is presented so that the reader understands the clinical decisions that have been made. Most of the protocols described in this article, but not all, have been adopted in the official guidelines of the International Association of Dental Traumatology. Some experimental results are promising and they have therefore been included in the review to stimulate colleagues to further research. PMID:21635689

  9. Conditions Presenting with Symptoms of Peripheral Arterial Disease

    PubMed Central

    Sharma, Aditya M.; Norton, Patrick T.; Zhu, Daisy

    2014-01-01

    Peripheral artery disease (PAD) is estimated to affect more than 20% of people older than 65 years. The vast majority of patients with symptoms suggestive of PAD have atherosclerosis often associated with conventional vascular risk factors such as smoking, diabetes, dyslipidemia, and inflammation. A minority of people presenting with symptoms suggesting PAD have an alternative etiology. These groups of disorders are often underdiagnosed, and if diagnosed correctly the diagnosis may be delayed. Understanding these pathologies well is important, as they can be very debilitating and optimal treatment may vary significantly. Inappropriate treatment of these disorders can lead to worsening morbidity and mortality. This article discusses the underlying causes of nonatherosclerotic PAD, including the diagnosis and treatment of these disorders. PMID:25435652

  10. [Bony avulsions of the rotator cuff : Arthroscopic concepts].

    PubMed

    Greiner, S; Scheibel, M

    2011-01-01

    Bony avulsions of the rotator cuff and isolated greater or lesser tuberosity fractures are rare injuries and a clear consensus regarding classification and therapy does not yet exist. Conservative therapy is limited, especially in injuries with displaced fragments and in these cases surgical treatment is frequently indicated. The ongoing development of arthroscopic techniques has led to quite a number of reports about arthroscopically assisted or total arthroscopic techniques in the treatment of these injuries. The advantages and disadvantages of arthroscopic concepts for the treatment of bony avulsions of the rotator cuff are presented with reference to the current literature. PMID:21153534

  11. Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

    PubMed Central

    Tanweer, Omar; Thomas, Cheddhi; Engler, John; Shapiro, Maksim; Becske, Tibor

    2016-01-01

    Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature. PMID:27114966

  12. Bilateral anterior choroidal artery infarction presenting with progressive somnolence.

    PubMed

    van Son, Brechtje; Vandevenne, Jan; Viaene, Pieter

    2014-09-01

    A 55-year-old woman was admitted with a 3 days history of increasing lethargy with bradyphrenia and apathy. She progressively developed severe somnolence with marked abulia, right hemiparesis, right hemianopsia, and pseudobulbar palsy. Brain magnetic resonance imaging showed the rare image of bilateral acute anterior choroidal artery infarction. Pseudobulbar mutism and in rare cases abulia have been described in acute anterior choroidal artery infarction contralateral to an older lesion in mirror position. Although neurologic deterioration is not infrequent in anterior choroidal artery territory infarcts, the absence of focal neurologic signs on admission is rare and did not raise suspicion of acute stroke. PMID:25106836

  13. Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

    PubMed

    Bou, Steven; Day, Carly

    2014-11-01

    Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES. PMID:24880061

  14. The TRAP (twin reversed arterial perfusion) sequence - case presentation.

    PubMed

    Mărginean, Claudiu; Mărginean, Maria Oana; Mureşan, Daniel; Zahiu, LuminiŢa; Horváth, Emőke

    2016-01-01

    We present a particular case of TRAP (twin reversed arterial perfusion) syndrome, which has a very rarely association of the simultaneous existence of a rudimentary malformed heart and brain, and also other malformations like abdominal wall abnormality, absent bladder with present kidneys, and absence of the lungs, which appear only in a few cases on the receptor twin from this sequence, malformations incompatible with life. A Caucasian 26-year-old pregnant woman, at the first pregnancy, with a monochorionic-diamniotic pregnancy, 26 weeks of gestation was referred to our hospital, for polyhydramnios. The patient delivered a living female newborn, weighing 950 g, with an Apgar score of 2 at one minute - the donor fetus and a second female newborn with multiple malformations, no signs of life and who weighed 2300 g - the receptor fetus. The anatomopathological examination confirmed the TRAP sequence associated with severe facial dysmorphism, bilateral phocomelia and cardiac malformations (rudimentary hypoplastic, univentricular) and a vascular anastomosis between the two umbilical cords. Anemia and cardiac complications which can lead to cardiac failure, appear early during pregnancy and caused the death of the pumping twin. We emphasize that in our case of TRAP sequence, the ultrasound examination established the diagnosis of the syndrome with high accuracy. Therefore, we can conclude that the existence of a rudimentary heart and a vascular anastomosis between the two umbilical cords supports the apparition of TRAP sequence. The early diagnosis of this pathology, the observation of the pregnancy with the help of weekly ultrasounds and the intrauterine interventions can increase the survival chances of the donor fetus from the TRAP sequence. PMID:27151718

  15. Marfan syndrome presenting with headache and coincidental ophthalmic artery aneurysm.

    PubMed

    Vandersteen, Anthony Martin; Kenny, Joanna; Khan, Naheed L; Male, Alison

    2013-01-01

    A 24-year-old Ugandan woman was referred for a neurology opinion after complaining of a year long history of right-sided retro-orbital stabbing pain. Brain imaging revealed a coincidental 3 mm left ophthalmic artery aneurysm. Marfanoid habitus was noted; after further investigations she was diagnosed with mild aortic root dilatation, subtle lens dislocation and Marfan syndrome. Her symptoms were secondary to temporomandibular joint dysfunction, an under-recognised complication of Marfan syndrome. Her ophthalmic artery aneurysm is likely to be a coincidental finding. PMID:23505274

  16. A Case of Nonunion Avulsion Fracture of the Anterior Tibial Eminence

    PubMed Central

    Atsumi, Satoru; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2016-01-01

    Avulsion fracture of the anterior tibial eminence is an uncommon injury. If bone union does not occur, knee extension will be limited by impingement of the avulsed fragment and knee instability will be induced by dysfunction of the anterior cruciate ligament (ACL). This report describes a 55-year-old woman who experienced an avulsion fracture of the right anterior tibial eminence during recreational skiing. Sixteen months later, she presented at our hospital with limitation of right knee extension. Plain radiography showed nonunion of the avulsion fracture region, and arthroscopy showed that the avulsed fragment impinged the femoral intercondylar notch during knee extension. The anterior region of the bony fragment was debrided arthroscopically until the knee could be extended completely. There was no subsequent instability, and the patient was able to climb a mountain 6 months after surgery. These findings indicate that arthroscopic debridement of an avulsed fragment for nonunion of an avulsion fracture of the anterior tibial eminence is a minimally invasive and effective treatment for middle-aged and elderly patients with a low level of sports activity. PMID:27119035

  17. Avulsion fracture of the iliac crest in a child☆☆☆

    PubMed Central

    Mortati, Rafael Borghi; Borghi Mortati, Lucas; Silva Teixeira, Matheus; Itiro Takano, Marcelo; Armelin Borger, Richard

    2014-01-01

    Avulsion fractures of the apophysis of the iliac crest have rare incidence and are little known. In this article, we report the case of an 11-year-old female patient who presented this injury after indirect trauma. From careful radiographic analysis, an avulsion fracture of the iliac crest was identified. It was decided to use nonsurgical treatment comprising analgesia and load restriction. This case report emphasizes the importance of suspecting avulsion fractures in cases of low-energy trauma, and also guides the treatment, so as to prevent functional deficit and deformities. PMID:26229818

  18. Successful Nonoperative Treatment of Isolated Popliteus Tendon Avulsion Fractures in Two Adolescents

    PubMed Central

    McKay, Scott D.; Holt, Andrew; Stout, Thomas; Hysa, Viola Qafalijaj

    2014-01-01

    Isolated popliteal tendon avulsion fractures are relatively uncommon in the pediatric population as other posterolateral lateral structures are often involved. This report describes two skeletally immature male patients who presented with knee injuries without ligamentous instability and were subsequently diagnosed with isolated popliteus tendon avulsion fractures. Both of these patients were managed nonoperatively and had subjectively full recoveries. As the treatment for isolated popliteal tendon avulsion fractures is still unclear, the report here may contribute to strategies regarding conservative treatment of these injuries. PMID:25197598

  19. An unusual presentation of right coronary artery fistula.

    PubMed Central

    Rein, A J; Yatsiv, I; Simcha, A

    1988-01-01

    A four year old girl with infective endocarditis had unexplained facial swelling. Cross sectional echocardiography showed that a large right coronary artery fistula to the right atrium was obstructing the distal superior vena cava. The diagnosis was confirmed by cardiac catheterisation and at operation. The child was symptom free one year after operation. Images Fig 1 Fig 2 PMID:3382575

  20. Avulsion fracture of the straight and reflected heads of rectus femoris.

    PubMed

    Deehan, D J; Beattie, T F; Knight, D; Jongschaap, H

    1992-09-01

    We present a rare case of avulsion fracture of the reflected head of rectus femoris. This occurred in a 13-year-old male footballer. Diagnosis was made with pelvic radiology and treatment was bed rest and analgesia. PMID:1449579

  1. Tooth Avulsion in the School Setting

    ERIC Educational Resources Information Center

    Krause-Parello, Cheryl A.

    2005-01-01

    Tooth avulsions occur when a tooth is displaced from its socket. Tooth avulsions are common dental injuries that may occur before, during, or after school. Therefore, it is essential that school nurses be well prepared to intervene when such a dental emergency arises. It is also imperative that school nurses and school personnel are fully equipped…

  2. First-Aid Algorithms in Dental Avulsion

    ERIC Educational Resources Information Center

    Baginska, Joanna; Wilczynska-Borawska, Magdalena

    2012-01-01

    Almost one fourth of traumatic dental injuries occur at schools or in their surroundings. Prevalence of tooth avulsion varies from 0.5% to 16% of all cases of dental trauma. Children with dental avulsion may seek help from school nurses so they should be able to provide first-aid treatment. However, many studies showed that the general level of…

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

    PubMed Central

    e Albuquerque, Rodrigo Pires; da Palma, Idemar Monteiro; Cobra, Hugo; de Paula Mozella, Alan; Vaques, Victor

    2015-01-01

    Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up. PMID:27218089

  4. SIMULTANEOUS BILATERAL AVULSION FRACTURE OF THE TIBIAL TUBEROSITY IN A TEENAGER: CASE REPORT AND THERAPY USED

    PubMed Central

    e Albuquerque, Rodrigo Pires; Giordano, Vincenzo; Carvalho, Antônio Carlos Pires; Puell, Thiago; e Albuquerque, Maria Isabel Pires; do Amaral, Ney Pecegueiro

    2015-01-01

    Simultaneous bilateral avulsion fracture of the tibial tuberosity in teenagers is a rare lesion. We describe the first case in the literature, in a teenage girl who sustained a fall while jumping during a volleyball match. No predisposing factors were iden tified. The lesions were treated with open surgical reduction and internal fixation. The aim of the present study was to present a case of simultaneous bilateral avulsion fracture of the tibial tuberosity in a teenage girl and the therapy used. PMID:27042651

  5. Echocardiographic presentation of anomalous origin of the left coronary artery from the pulmonary artery.

    PubMed

    Silverman, Norman H

    2015-12-01

    In the 1970s, diagnosing anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was often uncertain using imaging alone; however, with the advances in high-frequency transducers, advanced image processing, and other ultrasound modalities such as Doppler colour flow imaging, tissue Doppler imaging, and speckle tracking to asses regional wall motion abnormalities, modern echocardiography now permits accurate diagnosis of ALCAPA with greater certainty. Although many consider ultrasound to be the only imaging test necessary if there is a question as to the diagnosis, other imaging modalities such as MRI, CT, and cardiac catheterisation with angiography remain valuable complementary tests, especially in older patients. PMID:26675598

  6. Odontogenic Pain as the Principal Presentation of Vertebral Artery Pseudoaneurysm; a Case Report

    PubMed Central

    Zenteno, Marco; Alvis-Miranda, Hernando Raphael; Lee, Angel; Moscote-Salazar, Luis Rafael

    2015-01-01

    Dissection of the vertebral artery is an important but rare cause of cerebrovascular accidents. Here we report a 48-year-old man with toothache since 4 days before who presented to the emergency department with neck pain and final diagnosis of dissecting right vertebral artery pseudoaneurysm. To our knowledge, this maybe the first report of odontogenic pain as the first manifestation of vertebral artery pseudoaneurysm in the literatures. PMID:26495399

  7. Neonatal pulmonary artery thrombosis presenting as persistent pulmonary hypertension of the newborn.

    PubMed

    Sawyer, Taylor; Antle, Amanda; Studer, Matthew; Thompson, Mark; Perry, Stanton; Mahnke, C Becket

    2009-05-01

    Pulmonary artery thrombosis in neonates occurs rarely. This report describes the case of a term infant with a pulmonary artery thrombosis presenting as persistent pulmonary hypertension of the newborn. The risk factors identified in the case included maternal diabetes and heterozygous factor V Leiden deficiency. The pulmonary thrombus was successfully treated with percutaneous catheter-based embolectomy. PMID:19052800

  8. Avulsion threshold in a large Himalayan river: the case of the Kosi, India and Nepal

    NASA Astrophysics Data System (ADS)

    Sinha, R.; Kommula, S.

    2010-12-01

    Avulsion, the relatively rapid shift of a river to a new course on a lower part of a floodplain, is considered as a major fluvial hazard in large population centers such as the north Bihar plains, eastern India and the adjoining areas of Nepal. This region witnessed one of the most recent avulsions of the Kosi River on 18 August, 2008 when the river shifted by ~120 km eastward. This was perhaps one of the greatest avulsions in a large river in recent years triggered by the breach of the eastern afflux bund at Kusaha in Nepal at a location 12 km upstream of the Kosi barrage and affecting more than 3 million people in Nepal and north Bihar. The trigger for an avulsion largely depends upon the regional channel-floodplain slope relationships and the lowest elevation available in the region. Most of the available assessments of avulsion threshold have therefore been based on the examination of channel slopes- longitudinal and cross-sectional. However, planform dynamics in a sediment-charged river such as the Kosi also plays an important role in pushing the river towards threshold for avulsion. The present study has made use of SRTM DEM, temporal satellite images and maps to compute the avulsion threshold for a ~50 km long reach of the Kosi river after incorporating planform dynamics in a GIS environment. Flow accumulation paths generated from the SRTM data match closely with the zones of high avulsion threshold. Not just that the Kusaha plots in a high avulsion threshold zone, we also identify several critical points where breach (avulsion) can occur in near future. This study assumes global significance keeping in view the most recent flooding in the Indus River in Pakistan. Like the Kusaha breach in Kosi in August 2008, the Indus flood trauma started with the breach of the eastern marginal embankment in the upstream of Taunsa barrage and was apparently triggered by rise of bed level due to excessive sediment load. The mega avulsion of the Kosi on 18th August 2008

  9. Coronary artery calcium scanning: past, present, and future.

    PubMed

    Hecht, Harvey S

    2015-05-01

    Coronary artery calcium scanning (CAC) has emerged as the most robust predictor of coronary events in the asymptomatic primary prevention population, particularly in the intermediate-risk cohort. Every study has demonstrated its superiority to risk factor-based paradigms, e.g., the Framingham Risk Score, with outcome-based net reclassification indexes ranging from 52.0% to 65.6% in the intermediate-risk, 34.0% to 35.8% in the high-risk, and 11.6% to 15.0% in the low-risk cohorts. CAC improves medication and lifestyle adherence and is cost-effective in specified populations, with the ability to effectively stratify the number needed to treat and scan for different therapeutic strategies and patient cohorts. Data have emerged clearly demonstrating the worse prognosis associated with increasing CAC on serial scans, suggesting a potential role for evaluating residual risk and treatment success or failure. CAC is also strongly associated with the development of stroke and congestive heart failure. PMID:25937196

  10. Late presentation of an anomalous origin of the left coronary artery from the pulmonary artery: case report and review.

    PubMed

    Ramana, Ravi K; Varga, Peter; Leya, Ferdinand

    2008-10-01

    Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare cause of ischemia, heart failure and/or sudden death. A premortem diagnosis beyond early childhood is exceedingly rare because over 90% of untreated infants die in the first 12 months of life. We present a case of an asymptomatic fourteen-year old male with ALCAPA diagnosed by multidetector computed tomography (MDCT) angiography, who was successfully treated by surgical coronary transfer of the ALCAPA with reimplantation of the LCA to the aortic root. PMID:18830005

  11. Tooth replantation after traumatic avulsion: a 27-year follow up.

    PubMed

    Martins, Wilson Denis; Westphalen, Vania Portela Ditzel; Westphalen, Fernando Henrique

    2004-04-01

    This report presents a case of replantation of a traumatically avulsed central incisor in a 32-year-old woman. The tooth was replanted after a 30-min extra-alveolar period. Emergency unconventional immobilization was performed, using 2-0 chromic gut, and a restorative composite made Gunning-type splint. The tooth is still in place 27 years after replantation (1976 to date) without marked resorption. PMID:15025692

  12. Atypical stress-avulsion fracture of the Lisfranc joint complex.

    PubMed

    O'Neill, Barry J; Sweeney, Laura A; Moroney, Paul J; Mulhall, Kevin J

    2014-04-01

    Antiphospholipid syndrome and systemic erythematosus have been associated with metatarsal stress fractures. Stress fractures of the Lisfranc joint complex are uncommon injuries but have been reported to occur most frequently in ballet dancers. We present a case of an avulsion fracture of the Lisfranc joint complex that occurred spontaneously. We have reviewed the association between systemic conditions and metatarsal fractures and proposed a series of hypothetical pathological events that may have contributed to this unusual injury. PMID:24521754

  13. Neglected lesser tuberosity avulsion in an adolescent elite gymnast

    PubMed Central

    Karavasili, Alexandra; Manolarakis, Manolis; Paxinos, Thrasivoulos; Papavasiliou, Athanasios

    2014-01-01

    We report the case of a 16-year-old elite gymnast who presented with recurring pain in the left shoulder after training. The athlete recalled an injury to the shoulder 2 years ago. Clinically a localized tenderness to the anterior shoulder and loss of strength and range of motion was noted. Imaging investigation suggested a neglected lesser tuberosity avulsion. The athlete was treated with open excision of the deformed tuberosity and direct repair of the subscapularis to the humeral head. Following a careful postoperative rehabilitation protocol the athlete was able to return to unrestricted gymnastics after 6 months. After surgery the athlete followed a intense rehabilitation program that allowed him to return to sports at 6 months. At 5-years follow-up, the athlete was asymptomatic and competing at an international level. Avulsion fractures of the lesser tuberosity are extremely rare injuries with significant shoulder disability if left untreated. Anatomic repair can yield excellent results, even in neglected cases.

  14. Isolated single coronary artery presenting as acute coronary syndrome: case report and review.

    PubMed

    Mahapatro, Anil K; Patro, A Sarat K; Sujatha, Vipperala; Sinha, Sudhir C

    2014-06-01

    Congenital single coronary artery is commonly associated with complex congenital heart diseases and manifests in infancy or childhood. But isolated single coronary artery is a rare congenital anomaly which can present as acute coronary syndrome in adults. The aim of the work is to discuss on isolated single coronary artery in two adults presenting as acute coronary syndrome. The first case underwent coronary angiography (CAG) through right radial route, but switched over to femoral for confirmation of diagnosis and due to radial spasm. An aortic root angiogram was done to rule out presence of any other coronary ostia. It revealed a single coronary artery originating from right sinus of valsalva. After giving rise to posterior descending artery branch at crux, it continued in the atrioventricular groove to the anterior basal surface of the heart and traversed as anterior descending artery. There was no atheromatous occlusive stenosis. This is R-I type single coronary artery as per Lipton classification. In the second case, angiography was completed through right radial route. It revealed a single coronary artery arising from right aortic sinus. Anterior descending and circumflex branch were originating from proximal common trunk of the single coronary artery and supplying the left side of the heart. The right coronary artery has diffuse atheromatous disease without significant stenosis in any major branch. This is R-III C type as per Lipton classification. A coronary anomaly of both origin and course is very rare. It may be encountered in adults evaluated for atherosclerotic coronary heart disease. Knowledge and understanding of anatomical types of this congenital anomaly will reduce time, anxiety, complications during CAG and cardiac surgery. PMID:25075168

  15. Pulmonary veno-occlusive disease presenting with thrombosis of pulmonary arteries.

    PubMed Central

    Katz, D. S.; Scalzetti, E. M.; Katzenstein, A. L.; Kohman, L. J.

    1995-01-01

    Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension. An unusual case presenting with thrombosis of the right pulmonary artery and serological evidence of autoimmunity is reported. Images PMID:7638821

  16. Management of a child with pulmonary arterial hypertension presenting with systemic hypertension.

    PubMed

    Flores, Saul; Daily, Joshua; Pratap, Jayant Nick; Cash, Michelle C; Hirsch, Russel

    2016-02-01

    We describe the course and management of a 12-year-old girl with severe pulmonary arterial hypertension who initially presented with severe systemic hypertension. Successful therapy included pulmonary vasodilators and an atrial septostomy, while ensuring adequate maintenance of her systemic vascular resistance to maintain cardiac output. Clear understanding of the physiology and judicious medical management in patients with severe pulmonary arterial hypertension using extreme compensatory mechanisms is vitally important. PMID:26082002

  17. Ruptured Left Gastric Artery Aneurysm: Unique Presentation with Hemothorax and Hemomediastinum

    SciTech Connect

    Lee, Michael K.S. Vrazas, John I.

    2006-06-15

    Although splanchnic artery aneurysms are uncommon and remain mostly asymptomatic, they are associated with a high mortality rate when they rupture. We discuss the case of a 66-year-old woman who had successful embolization of a left gastric artery aneurysm after presenting with acute chest pain and the unusual computed tomography findings of hemothorax and hemomediastinum. To our knowledge, only one other similar case has been published in the literature.

  18. Backwater controls of avulsion location on deltas

    NASA Astrophysics Data System (ADS)

    Chatanantavet, Phairot; Lamb, Michael P.; Nittrouer, Jeffrey A.

    2012-01-01

    River delta complexes are built in part through repeated river-channel avulsions, which often occur about a persistent spatial node creating delta lobes that form a fan-like morphology. Predicting the location of avulsions is poorly understood, but it is essential for wetland restoration, hazard mitigation, reservoir characterization, and delta morphodynamics. Following previous work, we show that the upstream distance from the river mouth where avulsions occur is coincident with the backwater length, i.e., the upstream extent of river flow that is affected by hydrodynamic processes in the receiving basin. To explain this observation we formulate a fluvial morphodynamic model that is coupled to an offshore spreading river plume and subject it to a range of river discharges. Results show that avulsion is less likely in the downstream portion of the backwater zone because, during high-flow events, the water surface is drawn down near the river mouth to match that of the offshore plume, resulting in river-bed scour and a reduced likelihood of overbank flow. Furthermore, during low-discharge events, flow deceleration near the upstream extent of backwater causes enhanced deposition locally and a reduced channel-fill timescale there. Both mechanisms favor preferential avulsion in the upstream part of the backwater zone. These dynamics are fundamentally due to variable river discharges and a coupled offshore river plume, with implications for predicting delta response to climate and sea level change, and fluvio-deltaic stratigraphy.

  19. Single coronary artery originating from the right sinus Valsalva presenting as typical angina pectoris.

    PubMed

    Lamberti, Monica; Ratti, Gennaro; Tedeschi, Carlo; Capogrosso, Cristina

    2016-01-01

    A single coronary artery (SCA) ostium is a rare finding. In the general population, the incidence of SCA is approximately 0.024%. We introduce a case of a warehouseman presenting with chest pain after a morning work. The exercise ECG showed ST segment depression in the V 1-4 leads. The coronary angiography procedure and the CT demonstrated an SCA dividing into the right coronary artery and left main coronary artery. We identified a borderline lesion in the distal left anterior descending artery with fractional flow reserve of 0.85. In our case, the coronary anomaly was considered at low risk of arrhythmia and sudden death, and the patient was, therefore, treated conservatively. PMID:26951439

  20. Partial salvage of avulsed tissue after dog bite.

    PubMed

    Øregaard, J S; Lang, C L; Venzo, A

    2016-02-01

    Injuries to the nose can be severe from both a functional and cosmetic perspective. After suffering a dog bite to the central part of the face, an 18-year old woman underwent replantation of the avulsed tissue with the help of microsurgical arterial anastomosis. A venous anastomosis was impossible and venous congestion was treated with leech therapy. Subsequent skin necrosis occurred after a few days and the replantation was revised, revealing healthy tissue immediately below. The defect was covered with a full-thickness skin graft. At follow-up review eight months later, the functional and cosmetic result was satisfactory. To our knowledge, this is one of few cases where an injury of this severity healed with a cosmetically acceptable result. PMID:26673050

  1. Avulsion fracture of the anterior inferior iliac spine with abundant reactive ossification in the soft tissue.

    PubMed

    Resnick, J M; Carrasco, C H; Edeiken, J; Yasko, A W; Ro, J Y; Ayala, A G

    1996-08-01

    Patients who have sustained an avulsion fracture and present clinically during the healing phase of the injury may manifest a mass that clinically and radiographically mimics a malignant neoplasm. A 15-year-old male soccer goalkeeper presented with a large ossified mass in the soft tissues overlying the right hip 6 months after experiencing a popping sensation in his hip joint during a game. Although an osteosarcoma was suspected clinically and radiographically, a Tru-Cut needle biopsy of the lesion revealed reactive bone formation. Correlation of the clinical, radiographic, and pathologic findings indicated an avulsion fracture of the anterior inferior iliac spine with abundant reactive ossification in the soft tissues. The healing phase of an avulsion fracture may clinically and radiographically be mistaken for neoplasia. In such cases, a Tru-Cut needle biopsy may reveal the reactive nature of the process. PMID:8865496

  2. Isolated avulsion of the vastus lateralis tendon insertion in a weightlifter: a case report

    PubMed Central

    Trikha, Paul S; Wood, David G

    2009-01-01

    Introduction We report a case of isolated, unilateral avulsion of the vastus lateralis tendon from its insertion at the patella. This was diagnosed by magnetic resonance imaging, and underwent successful surgical repair. Case presentation A healthy 32-year-old national level power lifter presented with an isolated avulsion of the vastus lateralis tendon. After a failed course of conservative therapy he underwent surgical repair and a graded physical therapy programme. One year later he returned to full training with no evidence of re-rupture. Conclusion This is the first reported case of an isolated vastus lateralis avulsion. Our experience suggests that magnetic resonance imaging is invaluable in the diagnosis of this condition and that surgical repair provides a good outcome in high demand patients. PMID:19918436

  3. A tuber calcanei avulsion fracture developed on the basis of idiopathic osteoporosis in a young male: a case report.

    PubMed

    Terzi, R; Özer, T

    2015-09-01

    Calcaneus fractures constitute 1.2 % of all fractures. Tuber calcanei avulsion fractures constitute 1.3-2.7 % of calcaneus fractures. Osteoporosis, osteomalacia, and diabetes mellitus have been reported to increase the risk of development of these fractures. It has been reported that tuber calcanei avulsion fractures in elderly females might develop due to osteoporosis. As far as we know, no tuber calcanei avulsion fracture developing on the basis of osteoporosis without presence of a trauma has been reported in young males in the literature. In the current case report, a 41-year-old male patient who was admitted with complaints of pain in the left heel and diagnosed with calcaneal avulsion fracture that developed on the basis of idiopathic osteoporosis and who was treated with conservative methods was presented. PMID:25851698

  4. Avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica: a case report.

    PubMed

    Hayashi, Shinya; Nishiyama, Takayuki; Fujishiro, Takaaki; Kanzaki, Noriyuki; Kurosaka, Masahiro

    2011-12-01

    We present a rare case of avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica in a 16-year-old male basketball player. He had sensory disturbance affecting his left lateral thigh 10 days after the injury. Tinel's sign was elicited on percussing the avulsed bony fragment of the anterior superior iliac spine. He underwent open reduction and internal fixation. The lateral femoral cutaneous nerve was noted to be entrapped by one third of the avulsed bony fragment. That fragment was removed, and the remaining portion was reduced and fixed with 2 screws. At week 6, the patient had returned to basketball playing without pain. At week 8, sensory distribution in the left lateral thigh had returned to normal. PMID:22184178

  5. Spontaneous coronary artery dissection as the first presentation of systemic lupus erythematosus.

    PubMed

    Reddy, Sravan; Vaid, Tejasvini; Ganiga Sanjeeva, Naveen Chandra; Shetty, Ranjan K

    2016-01-01

    A 33-year-old woman with no premorbidities presented to us with chest pain and worsening dyspnoea since 1 week. Systemic examination was suggestive of acute pulmonary oedema and preliminary investigations revealed evolved anterior wall myocardial infarction (MI). The patient was stabilised and taken up for angiography which revealed spontaneous coronary artery dissection (SCAD) of the left anterior descending (LAD) artery. She underwent percutaneous coronary intervention (PCI) for the same. Further investigation into the cause for the SCAD came strongly positive for systemic lupus erythematosus (SLE). She had no prior symptoms suggestive of SLE and the SCAD was its very first clinical manifestation. PMID:27558190

  6. Diagnosing adductor muscle avulsion at the symphysis pubis with ultrasound.

    PubMed

    Chen, David J; Caldera, Franklin E; Kim, Woojin

    2014-04-01

    A 58-yr-old woman presented after experiencing left hip and groin pain for 1 mo. She denies any history of trauma, falls or any bruising, or history of sports injury or extreme physical exertion before her symptoms. On ultrasonography, she was found to have an avulsion tear at the origin of the adductor muscles, predominantly involving the adductor longus and brevis muscles. The treatment course was conservative: nonsteroidal anti-inflammatory drugs for pain control and physical therapy for muscle strengthening and balance improvement. Upon follow-up, she demonstrated significant improvement and resolution of her pain. PMID:24196970

  7. Avulsion of the brachial plexus in a great horned owl (Bubo virginaus)

    USGS Publications Warehouse

    Moore, M.P.; Stauber, E.; Thomas, N.J.

    1989-01-01

    Avulsion of the brachial plexus was documented in a Great Horned Owl (Bubo virginianus). A fractured scapula was also present. Cause of these injuries was not known but was thought to be due to trauma. Differentiation of musculoskeletal injury from peripheral nerve damage can be difficult in raptors. Use of electromyography and motor nerve conduction velocity was helpful in demonstrating peripheral nerve involvement. A brachial plexus avulsion was suspected on the basis of clinical signs, presence of electromyographic abnormalities in all muscles supplied by the nerves of the brachial plexus and absence of median-ulnar motor nerve conduction velocities.

  8. A pain in the neck: carotid artery dissection presenting as vasculitis.

    PubMed

    Collamer, Angelique N; Battafarano, Daniel

    2013-07-01

    Spontaneous cervical artery dissection is increasingly recognized as a common cause of ischemic stroke in the young and middle-aged. Noninvasive imaging techniques such as magnetic resonance imaging and magnetic resonance angiography have widely replaced conventional angiography as the initial diagnostic study of extracranial dissections, allowing greater numbers of patients to be screened and thus leading to increased frequency of the diagnosis. We present a case of spontaneous carotid artery dissection in a previously healthy 48-year-old woman who presented with neck pain and elevated inflammatory markers. Marked gadolinium enhancement of the right extracranial internal carotid artery on magnetic resonance imaging led to an initial diagnosis of vasculitis. This case shows that the vessel injury associated with spontaneous carotid artery dissection is associated with an inflammatory response that can mimic vasculitis on highly sensitive imaging techniques, a phenomenon not well described previously. In this report, we review the nonvasculitic conditions that can mimic vasculitis and present clinicians complex diagnostic challenges. Recognition of these pseudovasculitic syndromes is important to avoid overdiagnosis resulting in unnecessary and potentially harmful immunosuppressive and cytotoxic treatments. PMID:23820364

  9. Otorrhagia as the initial presentation of an internal carotid artery aneurysm in the middle ear. Case presentation

    PubMed Central

    PETRI, MARIA; DINESCU, VERONICA; NECULA, VIOLETA; COSGAREA, MARCEL

    2016-01-01

    Middle ear aneurysms are rare and difficult to treat. The case of a 50-year-old female who presented with left otorrhagia caused by an internal carotid aneurysm is reported. She had no medical history of tinnitus, vertigo, otalgia or otorrhea. Middle ear surgery was effective in resolving bleeding and did not cause any permanent neurological deficit. High resolution computed tomography angiography is the technique of choice and, in some cases, can be complemented with a magnetic resonance angiography. Misdiagnosis of the internal carotid artery aneurysm may lead to serious morbidity because of bleeding or vascular occlusion. The use of modern imaging techniques explain the current relative increase in frequency. PMID:27152084

  10. Primary adenocarcinoma of the small intestine presenting as superior mesenteric artery syndrome: A case report

    PubMed Central

    SUN, KE-KANG; WU, XIAOYANG; LIU, GANG; QIAN, HAIXIN; SHEN, XIAOJUN

    2016-01-01

    Superior mesenteric artery syndrome (SMAS) is an uncommon cause of vomiting and weight loss due to compression of the third part of the duodenum by the superior mesenteric artery. Small bowel adenocarcinoma is an uncommon tumor, which is frequently delayed in diagnosis as its symptoms and signs are non-specific. The present study describes a case of SMAS occurring in a 51-year-old man, caused by intestinal obstruction secondary to a primary adenocarcinoma of the duodenal-jejunal junction. To the best of our knowledge, the present case is the first report of small bowel adenocarcinoma masquerading as SMAS. The present case highlights the importance of considering the possibility of SMAS in patients with upper bowel obstruction caused by intestinal carcinoma. PMID:26998097

  11. Triceps tendon avulsion and associated injuries of the elbow

    PubMed Central

    Canbora, Kerem; Ozyurek, Selahattin; Gumussuyu, Gurkan; Kose, Ozkan

    2013-01-01

    A rupture or avulsion of the triceps tendon is very rare but concomitant elbow injuries with avulsion of the triceps tendon are even rarer. In this study, an extraordinary and unusual injury combination (radial head and trochlear fracture associated with triceps tendon avulsion), which happened during a fall onto the elbow with outstretched hand, was identified and has been discussed in the literature. PMID:23667221

  12. Parental behavior regarding traumatically avulsed teeth: case reports.

    PubMed

    Barreira, Alice Kelly; Gotze, Gabriela da Rosa; Primo, Laura Salignac de Souza Guimaraes; Maia, Lucianne Cople

    2008-01-01

    The prognosis for an avulsed tooth depends primarily on appropriate emergency management, which usually must be provided by lay people prior to the child's initial dental contact. As immediate replantation is considered the best therapy for an avulsed tooth in permanent dentition, parents should be made aware of first aid procedures for this situation. This article describes three cases involving avulsed teeth in children and discusses the parents' approaches concerning emergency procedures. PMID:18348377

  13. Avulsion fracture of the straight and reflected heads of rectus femoris.

    PubMed Central

    Deehan, D J; Beattie, T F; Knight, D; Jongschaap, H

    1992-01-01

    We present a rare case of avulsion fracture of the reflected head of rectus femoris. This occurred in a 13-year-old male footballer. Diagnosis was made with pelvic radiology and treatment was bed rest and analgesia. Images Fig. 1 Fig. 2 PMID:1449579

  14. Unruptured anterior communicating artery aneurysm presenting as depression: A case report and review of literature

    PubMed Central

    Bunevicius, Adomas; Cikotas, Paulius; Steibliene, Vesta; Deltuva, Vytenis P.; Tamsauskas, Arimantas

    2016-01-01

    Background: Intracranial aneurysms most commonly present following rupture causing subarachnoid hemorrhage. Mental disorders are common among patients with unruptured intracranial aneurysms and in aneurysmal subarachnoid hemorrhage survivors. However, to the best of our knowledge, there is no published report of unruptured intracranial aneurysm presenting as a mental disorder. Case Description: A 69-year-old male without a past history of mental disorders and neurological symptoms presented with a 2-month history of anxiety, sadness, lack of pleasure in usual activities, fatigue, difficulties falling asleep and waking up early in the morning, reduced appetite, and weight loss. The patient was diagnosed with major depressive disorder and antidepressant treatment was initiated. Subsequent non-contrast computed tomography (CT) of the head demonstrated hypointense oval-shaped lesion within the projection of the anterior communicating artery. CT angiography confirmed the diagnosis of a 0.8 × 0.6 cm saccular aneurysm originating from the anterior communicating artery and anterior cerebral artery. The patient underwent microsurgical clipping of the aneurysm. On psychiatric assessment 1 month after the surgery, there were no signs of depressive disorder and antidepressive treatment was discontinued. On follow-up visit 1 year after the surgery, the patient did not have any mood symptoms. Conclusions: The case indicates that organic brain lesions, including intracranial aneurysms, should be suspected in elderly patients presenting with their first episode of mental disorder. PMID:27583172

  15. Progressive Intracranial Vertebral Artery Dissection Presenting with Isolated Trigeminal Neuralgia-Like Facial Pain

    PubMed Central

    Nakamizo, Tomoki; Koide, Takashi; Miyazaki, Hiromichi

    2015-01-01

    Intracranial vertebral artery dissection (IVAD) is a potentially life-threatening disease, which usually presents with ischemic stroke or subarachnoid hemorrhage. IVAD presenting with isolated facial pain is rare, and no case with isolated trigeminal neuralgia- (TN-) like facial pain has been reported. Here, we report the case of a 57-year-old male with IVAD who presented with acute isolated TN-like facial pain that extended from his left cheek to his left forehead and auricle. He felt a brief stabbing pain when his face was touched in the territory of the first and second divisions of the left trigeminal nerve. There were no other neurological signs. Magnetic resonance imaging (MRI) of the brain 7 days after onset revealed dissection of the left intracranial vertebral artery without brain infarction. The pain gradually disappeared in approximately 6 weeks, and the patient remained asymptomatic thereafter, except for a brief episode of vertigo. Follow-up MRI revealed progressive narrowing of the artery without brain infarction. This case indicates that IVAD can present with isolated facial pain that mimics TN. IVAD should be considered in the differential diagnosis of acute facial pain or TN. PMID:26146576

  16. Giant cavernous carotid artery aneurysm mimicking a fungal granuloma and presenting with massive epistaxis

    PubMed Central

    Roopesh Kumar, V R; Madhugiri, Venkatesh S; Sasidharan, Gopalakrishnan M; Gundamaneni, Sudheer K

    2012-01-01

    A 42-year-old man presented with frequent minor nasal bleeds since 1 month. He was undergoing chemotherapy for pulmonary tuberculosis. MRI brain revealed a space occupying lesion in the right cavernous sinus extending to sphenoid sinus, with T2 inversion. An initial diagnosis of fungal granuloma was made and endoscopic trans-nasal biopsy was attempted. During surgery, a pink pulsating mass was seen in the sphenoid sinus and the procedure was abandoned. A cerebral CT-angiography done subsequently revealed a giant right cavernous segment internal carotid artery (ICA) aneurysm. He was then referred to our centre and upon admission he collapsed secondary to a major bout of epistaxis. An emergency cervical carotid artery ligation resulted in transient control of epistaxis. Owing to recurrence of bleed, trapping of the aneurysm was done resulting in cure. The present case shows that a giant cavernous ICA aneurysm can occasionally be erroneously diagnosed as fungal granuloma. PMID:23010464

  17. Coronary Artery Fistula Presenting as Unstable Angina Pectoris in Patients with Antiphospholipid Syndrome

    PubMed Central

    Demir, Şerafettin; Yucel, Ceyhun; Tufenk, Mucahit; Tosu, Aydin Rodi; Selcuk, Murat; Bozkurt, Abdi

    2013-01-01

    The cardiovascular system is one of the primary targets in patients with antiphospholipid syndrome. The valves are the most frequently affected. Atherosclerosis and coronary thrombosis are also seen. The risk of acute coronary syndrome is 10 times higher in patients with APS. We present an APS patient case who was hospitalized with acute coronary syndrome and who was later found to have coronary artery fistula. PMID:24023543

  18. Biomechanical analysis of the splenic avulsion mechanism.

    PubMed

    Chebil, Omar; Behr, Michel; Auriault, Florent; Arnoux, Pierre-Jean

    2014-08-01

    The spleen is a frequently injured abdominal organ in road accidents, with an injury frequency close to 30%. The splenic avulsion exhibit a significant ratio of morbidity. It is clinically described as the complete failure of the pancreatico-splenic ligament (PSL) which is composed of splenic vessels and connective tissues. What are the biomechanical mechanisms involved with spleen avulsion? Is it possible to quantify tolerance levels of PSL structure? The current work combines both experimental and finite element (FE) investigations to determine the splenic avulsion process. Tensile tests on 13 PSL samples were performed up to failure. The experimental results provide reference data for model validation and showed a failure process starting at a peak force of 70±34 N combined with a peak strain of 105±26%. In an attempt to identify possible vessel ruptures within the PSL, a FE model of the PSL was developed including both vessels and connective tissues. The vessel wall behaviour up to failure was reproduced using an Ogden law and calibrated by inverse analysis according to literature data. The connective tissues function was modelled by a cohesion-loss interface. Once model correlation to experimental results was achieved, numerical simulation revealed that haemorrhage could occur even before the maximum peak is reached. Indeed, the first vessel ruptures were recorded at a strain of 92% at the upper lobe vein. PMID:24944004

  19. Traumatic avulsion of the tricuspid valve after gas bottle explosion

    PubMed Central

    Krisper, Maximilian; Köhncke, Clemens; Pieske, Burkert

    2016-01-01

    Summary We present a very rare example of chronic right heart failure caused by torrent tricuspid regurgitation. Massive right heart dilatation and severe tricuspid regurgitation due to avulsion of the tricuspid valve apparatus occurred as a result of a blunt chest trauma following the explosion of a gas bottle 20 years before admission, when the patient was a young man in Vietnam. After this incident, the patient went through a phase of severe illness, which can retrospectively be identified as an acute right heart decompensation with malaise, ankle edema, and dyspnea. Blunt chest trauma caused by explosives leading to valvular dysfunction has not been reported in the literature so far. It is remarkable that the patient not only survived this trauma, but had been managing his chronic heart failure well without medication for over 20 years. Learning points Thorough clinical and physical examination remains the key to identifying patients with relevant valvulopathies.With good acoustic windows, TTE is superior to TEE in visualizing the right heart.Traumatic avulsion of valve apparatus is a rare but potentially life-threatening complication of blunt chest trauma and must be actively sought for. Transthoracic echocardiography remains the method of choice in these patients. PMID:27249554

  20. Novel variant of dual left anterior descending artery arising from single right coronary artery anomaly presenting with angina inversa

    PubMed Central

    Arslan, Gokhan; Iyisoy, Atilla; Bingol, Hakan

    2015-01-01

    A 55-year-old female without a history of coronary artery disease, hypertensive for the past 17 years, was admitted with resting chest pain. Electrocardiography revealed a negative T-wave in anterior chest leads. Coronary angiography visualised anomalous coronary anatomy, with a common origin of the right coronary artery and the left main coronary artery in the right sinus of Valsalva serving as a common coronary trunk. It should be emphasised that T-wave abnormalities and chest angina may be related to this congenital coronary anomaly. PMID:26702282

  1. All-arthroscopic repair of arcuate avulsion fracture with suture anchor.

    PubMed

    Zhang, Hui; Hong, Lei; Wang, Xue-Song; Zhang, Jin; Liu, Xin; Feng, Hua

    2011-05-01

    Arcuate avulsion fractures are very rare but present pathologic posterolateral rotation instability. Untreated instability may lead to overload of the reconstructed posterior cruciate ligament (PCL) graft. Surgical treatment and clinical results have not yet been reported to our knowledge. This study presents the case of a 45-year-old man with PCL injury and an arcuate avulsion fracture of the fibular head. The dial test was positive preoperatively, and magnetic resonance imaging showed an "arcuate" sign. The avulsed bone fragment was reduced and fixed with a suture anchor by an all-arthroscopic technique. At the 1-year follow-up, the patient had resumed all his normal activities, including sports. He scored 1+ on the posterior drawer test, and external rotation was 1° less than that in his contralateral normal knee. Compared with the values in the contralateral normal knee, the posterior tibial translation was reduced from 15.5 mm preoperatively to 6.3 mm postoperatively. The postoperative magnetic resonance imaging and computed tomography scans showed that the reconstructed PCL graft and the osseous fragment of the styloid process of the fibular head attached to the popliteofibular ligament were reduced. This technical note describes an all-arthroscopic reduction and fixation technique of arcuate avulsed fracture of the fibular head. PMID:21398077

  2. Possible complications of ureteroscopy in modern endourological era: two-point or "scabbard" avulsion.

    PubMed

    Gaizauskas, Andrius; Markevicius, Marius; Gaizauskas, Sergejus; Zelvys, Arunas

    2014-01-01

    Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple types of complications. Severe complications are possible including ureteral perforation or avulsion. Ureteral avulsion has been described as an upper urinary tract injury related to the action of blunt trauma, especially from traffic accidents, being the mechanism of injury, the result of an acute deceleration/acceleration movement. With the advent of endourology, that term is also applied to the extensive degloving injury resulting from a mechanism of stretching of the ureter that eventually breaks at the most weakened site, or ureteral avulsion is referred to as a discontinuation of the full thickness of the ureter. The paper presents a case report and literature review of the two-point or "scabbard" avulsion. The loss of long segment of the upper ureter, when end-to-end anastomosis is not technically feasible, presents a challenge to the urological surgeon. In the era of small calibre ureteroscopes these complications, due to growing incidence of renal stones will become more and more actual. Our message to other urologists is to know such a complication, to know the ways of treatment, and to analyse ureteroscopic signs, when to stop or pay attention. PMID:25610699

  3. Phrenic Arterial Injury Presenting as Delayed Hemothorax Complicating Simple Rib Fracture

    PubMed Central

    2016-01-01

    Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means. PMID:27051252

  4. Refractory Hypotension as an Initial Presentation of Bilateral Subclavian Artery Stenosis

    PubMed Central

    Wylie, John V.; Carrozza, Joseph P.

    2016-01-01

    Bilateral subclavian stenosis is a rare clinical condition. An interbrachial pressure difference of 15 mm Hg can raise suspicion for unilateral subclavian artery stenosis, but the diagnosis of bilateral subclavian artery stenosis can be challenging. We present a case of a 75-year-old woman who presented with refractory hypotension after surgery. Initial vitals revealed blood pressure in the 60s/50s mm Hg in both arms. Cardiopulmonary examination was remarkable for diminished pulses in all 4 extremities and audible carotid bruits. She continued to be hypotensive despite aggressive fluid resuscitation. Troponin T peaked at 0.24 ng/mL (reference < 0.04), and an echocardiogram revealed a reduction in ejection fraction (37% from 50%). Left and right heart catheterization demonstrated normal filling pressures and cardiac output. During the procedure, however, it was noted that the patient's central blood pressure was 70–80 mm Hg higher than cuff pressures obtained in either arm. Selective angiography revealed 90% left subclavian ostial stenosis as well as 70% stenosis of the right subclavian artery. PMID:27547473

  5. Refractory Hypotension as an Initial Presentation of Bilateral Subclavian Artery Stenosis.

    PubMed

    Afari, Maxwell Eyram; Wylie, John V; Carrozza, Joseph P

    2016-01-01

    Bilateral subclavian stenosis is a rare clinical condition. An interbrachial pressure difference of 15 mm Hg can raise suspicion for unilateral subclavian artery stenosis, but the diagnosis of bilateral subclavian artery stenosis can be challenging. We present a case of a 75-year-old woman who presented with refractory hypotension after surgery. Initial vitals revealed blood pressure in the 60s/50s mm Hg in both arms. Cardiopulmonary examination was remarkable for diminished pulses in all 4 extremities and audible carotid bruits. She continued to be hypotensive despite aggressive fluid resuscitation. Troponin T peaked at 0.24 ng/mL (reference < 0.04), and an echocardiogram revealed a reduction in ejection fraction (37% from 50%). Left and right heart catheterization demonstrated normal filling pressures and cardiac output. During the procedure, however, it was noted that the patient's central blood pressure was 70-80 mm Hg higher than cuff pressures obtained in either arm. Selective angiography revealed 90% left subclavian ostial stenosis as well as 70% stenosis of the right subclavian artery. PMID:27547473

  6. Reduction and fixation of the avulsion fracture of the tibial eminence using mini-open technique.

    PubMed

    Lu, Xiong-Wei; Hu, Xiao-Peng; Jin, Chen; Zhu, Tong; Ding, Yong; Dai, Li-Yang

    2010-11-01

    The purpose of this prospective study is to present and evaluate a new technique using suture anchors for the treatment of the avulsion fractures of the tibial eminence. Twenty-three consecutive patients with the displaced avulsion fracture of the tibial attachment of anterior cruciate ligament were treated using mini-open technique with suture anchors between 2005 and 2008. According to the classification of Meyers and McKeever, there were 5 type II, 13 type III, and 5 type IV fractures. The median follow-up period was 18 months (range, 12-32 months). The patient assessment included Lysholm score, Tegner score, IKDC score, and radiographic evaluation. The median Lysholm score improved from 32 (range, 28-48) preoperatively to 98 (range, 85-100) postoperatively. The median preoperative Tegner score was 3 (range, 2-5), and the median postoperative Tegner score was 7 (range, 5-9). The global IKDC objective score was normal (A) in 21 knees and nearly normal (B) in 2 knees. At final follow-up, the Lachman test and anterior drawer test were negative. The results showed that mini-open reduction and fixation of avulsion fracture of the tibial eminence with suture anchors have achieved satisfactory results. We suggest the use of this technique for treating avulsion fractures of the tibial eminence. PMID:20127313

  7. Evaluation of sixth grade primary schoolchildren's knowledge about avulsion and dental reimplantation.

    PubMed

    Castilho, Lithiene Ribeiro; Sundefeld, Maria Lucia Marçal Mazza; de Andrade, Dalton Francisco; Panzarini, Sônia Regina; Poi, Wilson Roberto

    2009-08-01

    Dental trauma, particularly tooth avulsion, is a frequent cause of tooth loss in children, adolescents, and young adults. The avulsed tooth should be immediately reimplanted in its alveolus. This procedure can be performed by anyone at the accident site and not only by dental surgeons. Therefore, the purpose of this study is to evaluate the knowledge of sixth graders of the city of Araçatuba, SP, about dental avulsion and tooth reimplantation through a structured and standardized survey. Our sample consisted of 778 students. The data collected was processed using the program EPIINFO 2000. Most students were around 12 years of age and 94.5% related to practice some kind of sports. Results demonstrated that the possibility of tooth reimplantation after dental avulsion is not acknowledged among these students and dental traumatism was associated to caries, toothache, and use of orthodontic appliances. Only 18.9% of the students associated dental traumatism to an impact trauma; 3.6% would store the tooth in milk, and 3.1% believed the tooth could be reimplanted by anyone present at the accident site. In summary, the results show an overall the lack of knowledge about dental traumatism and highlight the need of special programs designed to educate school-aged students about emergency procedures to handle cases of dental traumatisms. PMID:19459922

  8. Spontaneous Coronary Artery Dissection: One Disease, Variable Presentations, and Different Management Approaches.

    PubMed

    Al Emam, Abdel Rahman A; Almomani, Ahmed; Gilani, Syed A; Khalife, Wissam I

    2016-09-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. It occurs predominantly among younger females, typically in the absence of atherosclerotic coronary artery disease. Presentations vary greatly and this condition can be fatal. Given its rarity, there are no management guidelines. We present six patients with SCAD with different presentations and treatment approaches as examples in our literature review. Two patients presented with ST elevation myocardial infarction (STEMI), two with non-STEMI (NSTEMI), and two with cardiac arrest. Patients were treated according to the presentation, clinical stability, and extension and distribution of the dissection. Four patients underwent emergent percutaneous coronary intervention (PCI) and one was clinically stable and treated medically initially and underwent an elective PCI after 4 weeks when coronary angiogram showed persistent dissection. Another patient was treated medically as he was hemodynamically stable and the dissection affected a small branch. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was used for diagnosis confirmation as well as during and after PCI to assure good stent apposition. All patients had excellent outcome. SCAD is a rare cause of acute coronary syndrome and a high index of suspicion is crucial for early diagnosis. In patients with early presentation, limited disease, and ongoing symptoms, emergent cardiac catheterization with PCI has excellent outcome. However, in stable patients, medical management and elective PCI in few weeks if the dissection persists is a more reasonable approach. IVUS and OCT are invaluable especially in ambiguous cases. PMID:27574379

  9. All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament

    PubMed Central

    Gwinner, Clemens; Hoburg, Arnd; Wilde, Sophie; Schatka, Imke; Krapohl, Björn Dirk; Jung, Tobias M.

    2016-01-01

    Background: The posterior cruciate ligament (PCL) avulsion fracture from its tibial insertion is a rare condition. Despite the further technical advent in refixation of avulsion fractures, the reported failure rate of current approaches remains high and the optimal surgical technique has not been elucidated yet. The purpose of the current study is to present an all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the PCL and initial clinical outcomes. Methods: Patients underwent a thorough clinical and radiological examination of both knees at 3, 6, 12, 18, and if possible also at 24 months. Clinical evaluation included subjective and objective IKDC 2000, Lysholm score, and KOOS score. Radiographic imaging studies included CT scans for assessment of osseous integration and anatomic reduction of the bony avulsion. In addition to that posterior stress radiographs of both knees using the Telos device (Arthrex, Naples, USA) were conducted to measure posterior tibial translation. Results: A total of four patients (1 female, 3 male; ø 38 (± 18) years), who underwent arthroscopic refixation of a PCL avulsion fracture using the Tight Rope device were enrolled in this study. Mean follow up was 22 [18–24] months. The mean subjective IKDC was 72.6% (± 9.9%). Regarding the objective IKDC three patients accounted for grade A, one patient for grade C. The Lysholm score yielded 82 (± 6.9) points. The KOOS score reached 75% (± 13%; symptoms 76%, pain 81%, function 76%, sports 66%, QoL 64%). All patients showed complete osseous integration and anatomic reduction of the bony avulsion. The mean posterior tibial translation at final follow up was 2.8 [0–7] mm. Conclusions: All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament provides satisfactory clinical results in a preliminary patient cohort. It is a reproducible technique, which minimizes soft tissue damage and obviates a second surgery for hardware

  10. Blunt traumatic superior gluteal artery pseudoaneurysm presenting as gluteal hematoma without bony injury: A rare case report.

    PubMed

    Babu, Annu; Gupta, Amit; Sharma, Pawan; Ranjan, Piyush; Kumar, Atin

    2016-08-01

    Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment. PMID:27578385

  11. The Geomorphic Role of Large Woody Debris in River Avulsions

    NASA Astrophysics Data System (ADS)

    Stout, J. C.; Grove, J. R.; Rutherfurd, I.; Marren, P.

    2014-12-01

    The avulsion or abandonment of a river channel in favor of a new course on the floodplain is integral to the development and maintenance of anabranching planforms. Avulsions tend to occur on rivers where the rate of vertical aggradation outpaces lateral migration. In fine cohesive floodplain sediments, avulsions evolve through five stages dependent on the amount of flow and sediment being captured by the new channel. There is limited data available to allow the prediction of autogenic and allogenic controls on: the time over which an avulsion is active; its likely location; the frequency of occurrence; and the length of the interavulsion period. The delivery of wood to the river channel is an autogenic process which has received much attention over the last three decades. Surprisingly it has not previously been considered in anabranch avulsions, apart from where log-jams entirely block channels. The presence of large woody debris in the channel acts as a roughness element, trapping, and impeding the movement of sediments and deflecting flow onto the floodplain. We hypothesize that the delivery rates of wood to the channel, and its subsequent configuration (i.e. dimension, amount, volume, spatial arrangement and blockage ratio), alters flow and sediment routing through the channel. These changes directly influence the stages of avulsion development. To test this conceptual model we have used eleven floodplain cores to reconstruct the timing of a Holocene avulsion. The morphology of the channel in each evolutionary stage was used to estimate the relative role of wood as a roughness element. This was done by coupling a mass balance wood delivery model, run in a Monte Carlo simulation, to the geomorphic processes of each evolutionary stage of the avulsion. Our results allow us to quantify the importance of in-channel wood during each stage of the avulsion. These data highlight that there are critical points in the evolution of anabranching channels when large wood

  12. Perinatal/Neonatal case presentation: pulmonary artery sling associated with respiratory distress.

    PubMed

    Healey, David; Ron, Nitin; Hromada, Andrew; Chhabra, Manoj

    2016-01-01

    Pulmonary artery sling is a very rare cause of pediatric respiratory distress. The estimated prevalence of the disease was first determined by Yu et al. in 2008 as 59 per million school-aged children. Associated symptoms are cough, wheezing, and feeding difficulty, all of which are common in routine outpatient pediatric clinical encounters. We report a case of a premature male neonate twin who was admitted to the neonatal intensive care unit with respiratory distress and pneumothorax. His presentation, as well as the etiology of his pulmonary disease, was felt to be consistent with those of numerous other premature infants. Akin to this was his delayed discharge on account of his slow progress with oral feeding. Parents gave a history of tachypnea and feeding difficulty to his doctors. He presented twice to the emergency room in respiratory distress. At 4 months of age, while in hospital for a pulmonary infection, he had an echocardiogram that revealed a pulmonary artery sling. We review the literature on this vascular anomaly, discuss its diagnosis and management, and critique the clinical thinking that determined this child's course from the perspective of availability heuristics. PMID:26788443

  13. Temporal Artery Calciphylaxis Presenting as Temporal Arteritis in a Case of Rhinoorbitocerebral Mucormycosis.

    PubMed

    Chi, Mijung; Kim, H Jane; Basham, Ryan; Yoon, Michael K; Vagefi, Reza; Kersten, Robert C

    2015-01-01

    Mucormycosis is a rare often fatal opportunistic fungal infection. It is typically described in patients with diabetes in ketoacidotic status and is rare in renal transplant recipients. Calciphylaxis is a rare and highly morbid disease of vascular calcification affecting patients with end-stage renal disease (ESRD). The first case of a renal transplant recipient who was inflicted with both rhinoorbitocerebral mucormycosis and calciphylaxis is reported. A 45-year-old man presented with 2-day history of left upper blepharoptosis, periorbital pain, left-sided headache, binocular diplopia, and left V2 numbness. He had undergone renal transplant for ESRD 7 months earlier with resultant immunosuppressive therapy. MRI and nasal biopsy confirmed rhinoorbitocerebral mucormycosis. Immunosuppressive therapy was stopped and antifungal therapy begun. He had orbital exenteration for progressive rhinoorbitocerebral mucormycosis. Two months later, the patient reported new-onset intermittent bitemporal headache and bilateral swollen, tender temporal arteries. Temporal artery biopsy revealed features consistent with calciphylaxis. Clinical presentation, treatment course, and follow up are discussed. PMID:24853118

  14. Splenic artery aneurysm presenting as a submucosal gastric lesion: A case report

    PubMed Central

    Tannoury, Jenny; Honein, Khalil; Abboud, Bassam

    2016-01-01

    We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation. PMID:27499832

  15. Splenic artery aneurysm presenting as a submucosal gastric lesion: A case report.

    PubMed

    Tannoury, Jenny; Honein, Khalil; Abboud, Bassam

    2016-07-25

    We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation. PMID:27499832

  16. Percutaneous Closure of a Coronary Artery-to-Vein Graft Anastomotic Pseudoaneurysm Presenting as Acute Coronary Syndrome after Recent Coronary Artery Bypass Grafting

    PubMed Central

    Sharma, Suresh; Gupta, Kamal; Wiley, Mark; Parashara, Deepak

    2015-01-01

    Pseudoaneurysm formation has been reported in degenerated coronary artery saphenous vein bypass grafts, as well as in native coronary arteries after interventional procedures or blunt trauma. In contrast, pseudoaneurysm formation arising from the anastomotic site of native coronary vessels soon after coronary artery bypass grafting is rare, and neither the clinical presentation of this phenomenon nor its treatment is well described. We present the case of a 63-year-old man, a recent coronary artery bypass grafting patient, who presented with acute coronary syndrome due to a large and expanding pseudoaneurysm of the saphenous vein-to-ramus intermedius artery graft anastomosis. After several attempts, we successfully treated the pseudoaneurysm by means of percutaneous coil embolization. To our knowledge, this is the first report of acute coronary syndrome secondary to a pseudoaneurysm at the coronary artery–saphenous vein graft anastomosis. In addition, this appears to be the first report of the percutaneous treatment of such a pseudoaneurysm by means of coil embolization. PMID:26175645

  17. Atypical presentation of a hepatic artery pseudoaneurysm: A case report and review of the literature

    PubMed Central

    Luckhurst, Casey M; Perez, Chelsey; Collinsworth, Amy L; Trevino, Jose G

    2016-01-01

    Classically, hepatic artery pseudoaneurysms (HAPs) arise secondary to trauma or iatrogenic causes. With an increasing prevalence of laparoscopic procedures of the hepatobiliary system the risk of inadvertent injury to arterial vessels is increased. Pseudoaneurysm formation post injury can lead to serious consequences of rupture and subsequent hemorrhage, therefore intervention in all identified visceral pseudoaneurysms has been advocated. A variety of interventional methods have been proposed, with surgical management becoming the last step intervention when minimally invasive therapies have failed. The authors present a case of a HAP in a 56-year-old female presenting with jaundice and pruritis suggestive of a Klatskin’s tumor. This presentation of HAP in a patient without any significant past medical or surgical intervention is atypical when considering that the majority of HAP cases present secondary to iatrogenic causes or trauma. Multiple minimally invasive approaches were employed in an attempt to alleviate the symptomology which included jaundice and associated inflammatory changes. Ultimately, a right hepatic trisegmentectomy was required to adequately relieve the mass effect on biliary outflow obstruction and definitively address the HAP. The presentation of a HAP masquerading as a malignancy with jaundice and pruritis, rather than the classic symptoms of abdominal pain, anemia, and melena, is unique. This presentation is only further complicated by the absent history of either trauma or instrumentation. It is important to be aware of HAPs as a potential cause of jaundice in addition to the more commonly thought of etiologies. Furthermore, given the morbidity and mortality associated with pseudoaneurysm rupture, intervention in identifiable cases, either by minimally invasive or surgical interventions, is recommended. PMID:27366305

  18. Stent-assisted coil embolization for anterior cerebral artery dissection presented with cerebral infarction

    PubMed Central

    Iwasaki, Mitsuhiro; Hattori, Itaro; Sasaki, Makoto; Ishimori, Hisatsugu; Nemoto, Akihiro; Hikita, Chiyoe; Sato, Junko; Fukuta, Shinya; Morimoto, Masafumi

    2015-01-01

    Background: Compared to those found in the vertebrobasilar system, intracranial dissection in the anterior circulation is relatively rare, especially in the anterior cerebral artery (ACA). Moreover, only several cases of ACA dissection that underwent endovascular treatment have been reported. Here we present a rare case of gradually developing ACA dissecting aneurysm causing cerebral infarction, successfully treated by stent-assisted coil embolization. Case Description: A 36-year-old man was admitted with sudden right hemiparesis. Diffusion-weighted magnetic resonance (MR) imaging showed cerebral infarction in the left ACA territory, and MR angiography showed segmental stenosis at the A2 portion of the left ACA. Three-dimensional digital subtraction angiogram showed segmental dilatation and stenosis at the left A2 portion. We diagnosed ACA dissection causing acute cerebral infarction and treated the patient conservatively. Five months after the onset, the dissecting artery at the left A2 portion formed a gradually dilating aneurysm, suggesting increased risk for aneurysmal rupture. We attempted endovascular treatment entailing coil embolization of an aneurysm while preserving the left A2 with stent assistance. The patient remained neurologically stable 6 months after the procedure. Conclusions: Although there are few reported cases of ACA dissection where endovascular treatment was attempted, we consider stent-assisted embolization for gradually developing ACA dissecting aneurysm as an alternative method to prevent bleeding and recurrent infarction. PMID:26677416

  19. Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage.

    PubMed

    Cohen, José E; Moscovici, Samuel; Rajz, Gustavo; Vargas, Andres; Itshayek, Eyal

    2016-08-01

    Basilar artery dissection (BAD) is a rare condition with a worse prognosis than a dissection limited to the vertebral artery. We report a rare case of chronic BAD with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage (SAH) in a 54-year-old woman. The diagnosis of acute BAD could only be made retrospectively, based on clinical and neuroradiological studies from a hospital admission 10months earlier. Angiography performed after her SAH showed unequivocal signs of imperfect healing; she was either post-recanalization of a complete occlusion or post-dissection. Residual multi-channel intraluminal defects led to the development of a small aneurysm, which was responsible for the massive hemorrhage. The occurrence of an associated aneurysm, and wall disease, but not an intraluminal process, reinforces the diagnosis of dissection. The patient was fully recovered at 90day follow-up. This case reinforces the need for long-term neuroradiological surveillance after non-hemorrhagic intracranial dissections to detect the development of de novo aneurysms. PMID:26960262

  20. Q Fever Endocarditis Presenting with Superior Mesenteric Artery Embolism and Renal Infarction.

    PubMed

    Raizada, Amol; Apte, Nachiket; Pham, Scott

    2016-02-01

    Q fever is a zoonotic disease with a reservoir in mammals, birds, and ticks. Acute cases in human beings can be asymptomatic, or they can present with a flu-like illness, pneumonia, or hepatitis. Approximately 5% of cases progress to chronic Q fever. Endocarditis, the most typical manifestation of chronic Q fever, is usually associated with small vegetations that occur in patients who have had prior valvular damage or who are immunocompromised. We present what we think is the first reported case of superior mesenteric artery embolism from Q fever endocarditis of the aortic valve, in a 39-year-old woman who needed surgical embolectomy and subsequent aortic valve replacement. PMID:27047296

  1. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation

    PubMed Central

    Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP), and typically present with ipsilateral acromioclavicular joint (ACJ) dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL) attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT) reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia. PMID:27493819

  2. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation.

    PubMed

    Onada, Yoshihiro; Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP), and typically present with ipsilateral acromioclavicular joint (ACJ) dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL) attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT) reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia. PMID:27493819

  3. Newly diagnosed hyperthyroidism in the 25th gestational week of pregnancy presenting with systolic arterial hypertension only.

    PubMed

    Zaveljcina, Janez; Legan, Mateja; Gaberšček, Simona

    2016-05-01

    We present a case of a 30-year-old woman diagnosed with arterial hypertension in the 25th week of pregnancy. Our search for secondary causes of arterial hypertension revealed hyperthyroid Hashimoto's thyroiditis (HT), which was treated with propilthiouracil. Three weeks after delivery, she was normotensive without medication. In the next four months, she developed hypothyroidism and treatment with L-thyroxine was started. In conclusion, in the second half of pregnancy, a hyperthyroid HT can occur - in spite of the well-known amelioration of autoimmune thyroid disorders in that period, and can be the only cause of arterial hypertension. PMID:26979941

  4. Combined Tibial Tubercle Avulsion Fracture and Patellar Avulsion Fracture: An Unusual Variant in an Adolescent Patient.

    PubMed

    Stepanovich, Matthew T; Slakey, Joseph B

    2016-01-01

    Traumatic extensor dysfunction of the knee in children is a rare injury, with the majority resulting from tibial tubercle avulsion fracture or patellar sleeve fracture. We report a rare case of combined patellar avulsion fracture and tibial tubercle fracture. With open anatomic reduction, both injuries were successfully treated. While many variations of tibial tubercle fracture have been reported, the authors believe this to be the first report in the English-language literature of this particular combined injury to the knee extensor mechanism in an adolescent. Advanced imaging with computed tomography provided vital information to aid with operative planning, especially since the majority of the unossified tubercle was not seen on plain radiographs, and all fracture fragments were originally believed to be from the tibial tubercle. Computed tomography distinguished the patellar fracture from the tibial tubercle fragments, verifying preoperatively the complexity of the injury. PMID:26761925

  5. An Unusual Aneurysm of the Main Pulmonary Artery Presenting as Acute Coronary Syndrome

    SciTech Connect

    Kholeif, Mona A.; El Tahir, Mohamed Kholeif, Yasser A.; El Watidy, Ahmed

    2006-10-15

    A 70-year old man presented with retrosternal chest pain. His electrocardiogram showed nonspecific T wave changes. Cardiac-specific troponin I (cTnI) was elevated. His condition was managed as acute coronary syndrome, following which he had two minor episodes of hemoptysis. A CT pulmonary angiogram showed no evidence of pulmonary embolism, but a large mass lesion was seen in the mediastinum. Echocardiography and cardiac MRI demonstrated a large solid mass, arising from the right ventricular outflow tract and causing compression of the main pulmonary artery (MPA). The differential diagnosis included pericardial and myocardial tumors and clotted aneurysm of the MPA. At surgery, a clotted aneurysmal sac was identified originating from the MPA and the defect was healed. Aneurysms of the MPA are rare. They most commonly present with dyspnea and chest pain. Compression of surrounding structures produces protean manifestations. A high index of suspicion coupled with imaging modalities establishes the diagnosis. Blunt trauma to the chest, at the time of an accident 4 years previously, may explain this aneurysm. The patient's presentation with chest pain was probably due to compression and/or stretching of surrounding structures. Coronary artery compression simulating acute coronary syndrome has been documented in the literature. The rise in cTnI may have been due to right ventricular strain, as a result of right ventricular outflow obstruction by the aneurysm. This has not been reported previously in the literature. The saccular morphology and narrow neck of the aneurysm predisposed to stagnation leading to clotting of the lumen and healing of the tear, which caused the diagnostic difficulty.

  6. Looped and Tortuous Ulnar Artery – An Erratic Unilateral Vascular Presentation in the Proximal Forearm

    PubMed Central

    Rodrigues, Vincent; Rao, Mohandas KG; Nayak, Shivananda

    2016-01-01

    Precise and detailed knowledge of possible anatomical variations of the arterial pattern in the upper extremity is vital during reparative surgery in this region. Scientific literatures witnessed several reports on variant origin and branching pattern of ulnar artery. But report on looped and tortuous ulnar artery is lacking in the literature. We report here a unique case of ulnar artery having double loop at its commencement giving it an appearance of sigmoid shape and its undue tortuous course in the forearm. Such an unusual and unpredictable variation of ulnar artery is vulnerable for life threatening hemorrhage during clinical approaches. It could also lead to misinterpretation of CT scans as presence of tumours. Awareness on such exceptional anatomical discrepancy of ulnar artery is important to clinicians, neuroradiologists and radiologists in general. PMID:27504273

  7. Looped and Tortuous Ulnar Artery - An Erratic Unilateral Vascular Presentation in the Proximal Forearm.

    PubMed

    Rodrigues, Vincent; Rao, Mohandas Kg; Nayak, Shivananda; Kumar, Naveen

    2016-06-01

    Precise and detailed knowledge of possible anatomical variations of the arterial pattern in the upper extremity is vital during reparative surgery in this region. Scientific literatures witnessed several reports on variant origin and branching pattern of ulnar artery. But report on looped and tortuous ulnar artery is lacking in the literature. We report here a unique case of ulnar artery having double loop at its commencement giving it an appearance of sigmoid shape and its undue tortuous course in the forearm. Such an unusual and unpredictable variation of ulnar artery is vulnerable for life threatening hemorrhage during clinical approaches. It could also lead to misinterpretation of CT scans as presence of tumours. Awareness on such exceptional anatomical discrepancy of ulnar artery is important to clinicians, neuroradiologists and radiologists in general. PMID:27504273

  8. Vascular Ehlers-Danlos syndrome presenting as rapidly progressive multiple arterial aneurysms and dissections.

    PubMed

    Mortani Barbosa, Eduardo J; Pyeritz, Reed E; Litt, Harold; Desjardins, Benoit

    2011-12-01

    Life expectancy in vascular Ehlers-Danlos syndrome (EDS) is shortened due to spontaneous rupture of arteries, the colon and the gravid uterus. Two adolescent males with vascular EDS illustrate rapid progression of arterial aneurysms, dissections, and rupture. Radiologic imaging played an important role in initially diagnosing and monitoring the evolution of arterial involvement. Both prophylactic and emergency management remain largely ineffective in this connective tissue disorder; however, noninvasive imaging may provide important prognostic information. PMID:22065459

  9. Isolation of Left Common Carotid Artery with Its Origin Proximal to Patent Ductus Arteriosus Presenting in Adult Age

    PubMed Central

    Joshi, Anagha R.; Joshi, Saurabh; Kale, Kiran; Jain, Rahul; Bava, Jernail Singh

    2016-01-01

    Anomalies of aortic arch are a common occurrence. Such anomalies of right sided aortic arch with its various branching patterns are of clinical importance. Rarer anomalies include isolation (deficient connection) of either left subclavian artery or left common carotid artery; that is, they do not have their origin from aorta or its major branches. We present a case of an 18-year-old male who presented with gradual onset pulsatile swelling with bruit in neck on left side and was evaluated by CT brain and neck angiography. CT angiography revealed right sided aortic arch with aberrant left subclavian artery and isolated left common carotid artery. Very few cases of such an anomaly have been documented in the literature but none in an adult. PMID:27213071

  10. Left Internal Mammary Artery Injury Requiring Resuscitative Thoracotomy: A Case Presentation and Review of the Literature

    PubMed Central

    Al Hassani, Ammar; Abdul Rahman, Yassir; Kanbar, Ahad; El-Menyar, Ayman; Al-Aieb, Abubaker; Asim, Mohammad; Latifi, Rifat

    2012-01-01

    Background. Penetrating injuries to the chest and in particular to the heart that results in pericardial tamponade and cardiac arrest requires immediate resuscitative thoracotomy as the only lifesaving technique and should be performed without delay. Objective. To describe an external cardiac tamponade caused by massive tension hemothorax from penetrating injury of the left internal mammary artery (LIMA). Method. A case presentation treated at the Level I trauma center at Hamad General Hospital, in Doha, Qatar and review of the literature on LIMA injuries reported cases. Results. LIMA injury as a cause of hemothorax is not uncommon, but to our knowledge our case is the first massive tension hemothorax with witnessed cardiac arrest reported in the literature requiring emergency thoracotomy, performed in trauma room, with full recovery. Conclusion. Injury to the LIMA with massive tension hemothorax requires immediate resuscitative thoracotomy. PMID:23326745

  11. Concomitant Vesicouterine Rupture with Avulsion of Ureter: A Rare Complication of Vaginal Birth after Cesarean Section

    PubMed Central

    Thiek, J Lalnunnem; Sialo, Stephen; Ahanthem, Santa Singh

    2016-01-01

    Uterine rupture is the most serious and life threatening complication and occurs in 0.7-0.9% of vaginal birth after lower segment caesarean section. Cases of bladder rupture along with uterine rupture have been rarely reported and avulsion of ureter, required ureteric implantation is even rarer. This case report describe a very rare case of vesicouterine rupture with avulsion of ureter following vacuum assisted delivery in a grandmulti with previous lower segment cesarean section (LSCS). Haematuria is the most common presentation of bladder rupture. Antenatal counseling regarding this entity is recommended if woman opted for vaginal birth after cesarean section. Intrapartum and postpartum high index of suspicion are important in clinching the diagnosis. PMID:27134952

  12. Full-thickness skin avulsion of right leg following car accident trauma.

    PubMed

    Hosseinzadeh, Ahmad Zaghi

    2008-05-15

    The report presents a 24 year-old man who admitted at the orthopedic center with full-thickness skin avulsion of the right leg, due to his leg being caught under the wheel of a truck and subsequently traumatized. The day after injury, plastic and reconstructive surgery consult was done. After thoroughly irrigation, the 20 cm laceration was repaired above the knee. There was full-thickness skin necrosis below the knee down to the dorsal surface of the right leg (atypical form of skin avulsion). Debridment and graft was performed for the first stage. During the second stage, re-grafting was performed and the gasterocnemious flap was transposed to cover the Tibia bone. This study confirms early Plastic and reconstructive surgery consult from the trauma of lower extremities associated with skin lesion. PMID:18817278

  13. Dorsoradial avulsion of the triangular fibrocartilage complex with an avulsion fracture of the sigmoid notch of the radius.

    PubMed

    Morisawa, Y; Nakamura, T; Tazaki, K

    2007-12-01

    We report two extremely rare cases of dorsal radial avulsion injury of the triangular fibrocartilage complex accompanied by an avulsion fracture of the sigmoid notch of the radius. Anatomical reduction of the bone fragment in conjunction with reattachment of the dorsal portion of the radioulnar ligament to the radial sigmoid notch were necessary to restore stability of the distal radioulnar joint and tension of the triangular fibrocartilage proper. PMID:17993436

  14. Human pulmonary artery endothelial cells in the model of mucopolysaccharidosis VI present a prohypertensive phenotype

    PubMed Central

    Golda, Adam; Jurecka, Agnieszka; Gajda, Karolina; Tylki-Szymańska, Anna; Lalik, Anna

    2015-01-01

    Background Mucopolysaccharidosis type VI (MPS VI) is an autosomal recessive lysosomal disorder caused by a deficient activity of N-acetylgalactosamine-4-sulfatase (ARSB). Pulmonary hypertension (PH) occurs in MPS VI patients and is a marker of bad prognosis. Malfunction of endothelium, which regulates vascular tonus and stimulates angiogenesis, can contribute to the occurrence of PH in MPS VI. Aim The aim of the study was to establish a human MPS VI cellular model of pulmonary artery endothelial cells (HPAECs) and evaluate how it affects factors that may trigger PH such as proliferation, apoptosis, expression of endothelial nitric oxide synthase (eNOS), natriuretic peptide type C (NPPC), and vascular endothelial growth factor A (VEGFA). Results Increasing concentrations of dermatan sulfate (DS) reduce the viability of the cells in both ARSB deficiency and controls, but hardly influence apoptosis. The expression of eNOS in HPAECs is reduced up to two thirds in the presence of DS. NPPC shows a biphasic expression reaction with an increase at 50 μg/mL DS and reduction at 0 and 100 μg/mL DS. The expression of VEGFA decreases with increasing DS concentrations and absence of elastin, and increases with increasing DS in the presence of elastin. Conclusion Our data suggest that MPS VI endothelium presents a prohypertensive phenotype due to the reduction of endothelium's proliferation ability and expression of vasorelaxing factors. PMID:26937388

  15. What is the Best Root Surface Treatment for Avulsed Teeth?

    PubMed Central

    Tuna, Elif B; Yaman, Duygu; Yamamato, Seiko

    2014-01-01

    Dental avulsion is the most severe type of traumatic tooth injuries since it causes damage to several structures and results in avulsion of the tooth from its socket. Management protocols for avulsed teeth should include management of the pulp and periodontal ligament (PDL) cells in order to improve the long-term prognosis and survival of these teeth. The prognosis of the treatment as well as the survival of an avulsed tooth depends on intrinsic and extrinsic factors, such as the duration of the tooth’s extra-alveolar period, replantation time, the type of storage medium, PDL status and duration of splinting. Recent research has led to the development of storage media. However, there is not yet a single solution that fulfills all requirements to be considered as the ideal medium for temporary storage of avulsed teeth, and research on this field should carry on. On the other hand in case of delayed replantation, due to the great risk of tooth loss after avulsion, different root surface treatments have been proposed to prevent and delay root resorption before replantation. For this purpose, researchers have applied some different root surface treatment modalities in delayed replantation of avulsed teeth. Several protocols have been used to maintain PDL viability; some involve fluorides, steroids, sodium alendronate, enamel matrix derivatives (EMD) and basic fibroblast growth factor (bFGF, FGF-2). Among these applications, bFGF shows promising results in the regeneration of natural tooth structures and tissues. Better understanding of mechanism of bFGF may help to improve new technologies of regeneration of tooth structures. PMID:25317212

  16. Simultaneous Bilateral Tibial Tubercle Avulsion Fracture in a case of Pre-Existing Osgood-Schlatter Disease (OSD)

    PubMed Central

    Narayana Gowda, BS; Mohan Kumar, J

    2012-01-01

    Introduction: Osgood-Schlatter disease (OSD) is a well known condition, characterized by pain over the tibial tubercle with subsequent tubercle prominence. Avulsion fracture following OSD is a rare complication. We report an unusual case of simultaneous bilateral tibial tubercle avulsion fracture in a 16 year old boy who was a known case of OSD. Case presentation: A 16 year old boy a known case of OSD presented to the outpatient department with history of jumping from the school compound wall (two feet height) while playing, followed by severe pain around anterior aspect of both knees and difficulty in walking. Radiographs showed bilateral tibial tubercle avulsion fracture. He was treated successfully with open reduction and internal fixation with tension band wiring. At the end of 22 months the patient was symptomatically relieved and both the tuberosities were united with the main bone. Conclusion: Even though bilateral Osgood-Schlatter disease (OSD) is a well known condition, one should always keep in mind the risk of tibial tubercle avulsion fractures while treating a case of OSD. Patient should be advised not to involve in strenuous activities till the disease subsides radiologically or till skeletal maturity.

  17. [Aspects of expert opinions of avulsion fractures].

    PubMed

    Schröter, F

    2016-03-01

    The apophyses as secondary ossification centers are connected with the bone by cartilage. During the growth phase of puberty, the apophyseal plate is a mechanical weak spot. Especially, apophyses in the hip and pelvic area are exposed to considerable tensile and sheer stresses due to the strong muscles which are inserted here. The frequency of injuries to the apophyses correlates with the extent of sporting activities. For athletes participating in "Youth Train for the Olympics", this is the most common injury of all. Most often, the apophysis of the rectus femoris muscle is affected at the anterior inferior iliac spine. In adults, after complete ossification of the apophyseal plate such injuries are rare. However, in a very unusual mechanism of injury with maximum forced hip flexion and simultaneous maximum knee extension, avulsions of the ischial tuberosity are observed in adults. During the causality test-especially in the legal area of statutory accident insurance-the question is always whether the alleged course of events has to be regarded as a legally significant (partial) cause or if a longer period of time has been involved, so that the resulting morbid apophysis detachment was predominately due to fate, in which the alleged event must be interpreted as legally immaterial. PMID:26924516

  18. Complete occlusion of the proximal subclavian artery post-CABG: Presentation and treatment

    PubMed Central

    Sadek, Mouhannad M; Ravindran, Aravindhan; Marcuzzi, Daniel W; Chisholm, Robert J

    2008-01-01

    Atherosclerotic disease of the proximal left subclavian artery is an uncommon cause of angina in the post-coronary artery bypass graft patient, and is termed coronary-subclavian steal syndrome. Typical manifestations include cardiac symptoms of angina and noncardiac symptoms of lightheadedness, left arm numbness or weakness, and a difference in blood pressure of more than 20 mmHg between both arms. A case of complete proximal occlusion of the subclavian artery is reported. The clinical picture, investigations and treatment are described. Historical treatments of occlusive disease include surgical bypass graft and, more recently, percutaneous transluminal angioplasty. The patient underwent percutaneous transluminal angioplasty with stenting by a retrograde approach, with an excellent short-term response, but ultimately required a carotid subclavian bypass due to restenosis. PMID:18612504

  19. [A Case of Vertebral Artery Stenosis Presenting with Progressing Stroke and Treated by Percutaneous Transluminal Angioplasty].

    PubMed

    Hayashi, Kentaro; Matsuo, Yoshitaka; Toyoda, Keisuke; Hayashi, Yukishige; Shirakawa, Kiyoshi; Kaminogo, Makio

    2016-05-01

    A 75-year-old man with a history of diabetes mellitus and hypertension was suffered from dizziness and vomiting and brought to the near-by hospital. MRI showed cerebellar infarction due to right vertebral artery stenosis. Despite best medical treatment, the infarction progressed day by day and he was transferred to our hospital five days later. Neurological examination showed mild disturbance of consciousness and right hemiparesis. Right vertebral angiography revealed high-grade stenosis accompanied with atherosclerosis at the V3-V4 portion. Percutaneous transluminal angioplasty(PTA)was performed with 2.5mm×14mm balloon with 6 atm dilation. Postoperative course was uneventful and no further stroke occurred after the treatment. PTA was effective for vertebral artery stenosis manifested with progressing stroke. The indication of stent placement for the cerebral artery should be prudent. PMID:27166843

  20. Pancreatitis-associated pseudoaneurysm of the splenic artery presenting as lower gastrointestinal bleeding: treatment with transcatheter embolisation

    PubMed Central

    Taslakian, Bedros; Khalife, Mohammad; Faraj, Walid; Mukherji, Deborah; Haydar, Ali

    2012-01-01

    Pancreatitis is a known cause of pseudoaneurysms of the peripancreatic arteries, which can rarely rupture into various adjacent structures and become a source of life-threatening bleeding. The management is challenging and requires an individualised approach and multidisciplinary care. Herein, we present the case of a 24-year-old man in whom a splenic pseudoaneurysm ruptured into the adjacent infected pseudocyst, communicating with the colon by a fistulous tract, causing massive lower gastrointestinal bleeding. This was successfully managed by transcatheter arterial embolisation (TAE). PMID:23208811

  1. A Case of Superior Mesenteric Artery Aneurysm Mimicking an Abdominal Aortic Aneurysm and Presenting as a Pulsating Abdominal Mass

    PubMed Central

    Choi, Sang Tae; Kim, Keon Kuk; Kang, Jin Mo

    2016-01-01

    A 62-year-old male with a smoking history of 30 pack-years presented with a 1-year history of a periumbilical pulsating mass. He had been treated for hypertension for 2 years. Physical examination revealed a huge pulsating mass in the periumbilical abdomen. Femoral and popliteal arterial pulses were palpable. Computed tomography showed arterial dissection in the proximal segment of the superior mesenteric artery, a huge aneurysm (52×50 mm) with mural thrombus and two smaller aneurysms (20×20 mm) in the right ileocolic and ileal branches, along with atherosclerotic changes. Interposition using the great saphenous vein was performed after aneurysmal isolation and ligation of jejunal branches in the sac. Distal flow was reestablished by end-to-end and end-to-side anastomoses of the right ileocolic and ileal branches, respectively. No complications were observed at 1-year follow-up. PMID:27051659

  2. Human impact and avulsion: a long-standing relationship

    NASA Astrophysics Data System (ADS)

    Heyvaert, Vanessa M. A.; Walstra, Jan

    2015-04-01

    This study demonstrates that avulsions in Upper and Lower Khuzestan (Iran) are the result of interplay between human-induced and natural causes. The importance of human interference during all stages of river avulsion and the long-term consequences for alluvial fan development is proven. Avulsion can be defined as the diversion of flow from an existing channel onto the floodplain (or the fan surface), eventually resulting in a new channel belt (Allen, 1965). It represents the response of a river system to a wide range of autogenic factors, such as river meandering and vertical accretion, and allogenic controls, such as tectonics, climate change and sea-level change (Jones & Schumm, 1999). The framework used in this study is based on concepts introduced by Slingerland & Smith (2004), regarding avulsion style (i.e. through annexation, progradation or incision), and Makaske (2012), regarding the different phases in the process leading to avulsion (i.e. preconditioning, triggering and post-triggering)on megafans. This study primarily focusses on actions that directly affect river hydraulics, such as the construction and maintenance of dams, embankments, irrigation and diversion canals, the destruction of dams, channel modifications, etc. For several avulsion events, style and controlling factors are examined, and the ways by which human activities have interfered with the natural processes are highlighted. All case-studies are based on an integrated analysis of historical, archaeological, geomorphological and geological datasets. References: Allen, J.R.L., 1965. A review of the origin and characteristics of recent alluvial sediments. Sedimentology, 5, 89-91. Jones, L.S. & Schumm, S.A., 1999. Causes of avulsion: an overview, In: Smith, N.D. & Rogers, J. (Eds.), Fluvial Sedimentology VI, Blackwell Science, Oxford, UK, 171-178. Makaske, B., Maathuis, B.H.P., Padovani, C.R., Stolker, C., Mosselman, E. & Jongman, R.H.G., 2012. Upstream and downstream controls of recent

  3. BONY AVULSION INJURY OF THE PECTORALIS MAJOR IN A 19 YEAR-OLD MALE JUDO ATHLETE: A CASE REPORT

    PubMed Central

    Westrick, Richard B.; Owens, Brett D.; Johnson, Michael R.

    2013-01-01

    Background and Purpose: Bony avulsion of the pectoralis major muscle is a rare but potentially devastating injury for athletes. Pectoralis major rupture typically occurs in 20 to 39 year‐old males. The shoulder region is one of the most frequently injured areas in Judo athletes. The purpose of this case report is to describe diagnosis and treatment following a pectoralis major bony avulsion due to an atypical mechanism of injury in a young Judo athlete. Case Description: A 19‐year‐old military cadet and competitive judo athlete reported to a direct‐access sports physical therapy clinic 7 weeks after incurring a shoulder injury during a judo match. He complained of shoulder pain and weakness with the inability to perform pushups. He presented with horizontal adduction weakness and visible discontinuity of the pectoralis muscle with resisted adduction. Outcomes: Radiographs demonstrated a bony avulsion of the pectoralis major from its humeral attachment. The patient underwent surgical repair of the lesion the next week and was able to resume most military cadet activities within 5 months post‐operation. Discussion: Bony avulsions are exceptionally rare injuries, and are even more uncommon in athletes under the age of 20. It is important for clinicians to perform a thorough history and physical examination in order to avoid missing this diagnosis. Surgery is likely the best option for a young athletic population; while conservative management may be optimal for the older, inactive population. Level of Evidence: 4 PMID:24377072

  4. Presentation and therapy of spontaneous coronary artery dissection and comparisons of postpartum versus nonpostpartum cases.

    PubMed

    Ito, Hiroki; Taylor, Lee; Bowman, Martha; Fry, Edward T A; Hermiller, James B; Van Tassel, James W

    2011-06-01

    Predisposing risk factors, clinical course, and prognosis of spontaneous coronary artery dissection (SCAD) remain poorly understood. We reviewed medical records and coronary angiograms of patients admitted to our institution with the diagnosis of SCAD from 1999 through 2010. A definite diagnosis of SCAD required the agreement of 2 blinded board-certified interventional cardiologists who reviewed all images separately. Baseline characteristics of patients (n = 23) included mean age 45 ± 11 years, female gender in all (100%), history of hypertension in 13 (57%), and postpartum in 7 (30%). Eleven (48%) had ST-segment elevation on initial electrocardiogram. SCAD involved the left main in 5 patients (21.7%), left anterior descending coronary artery in 16 (70%), left circumflex coronary artery in 8 (35%), and right coronary artery in 6 (26%). Four patients (17%) underwent coronary stenting and 6 (26%) required urgent bypass surgery. Comparison between postpartum and nonpostpartum patients revealed significant differences in mean peak troponin levels: 50 ± 34 ng/ml vs 21 ± 23, p = 0.04, mean left ventricular ejection fraction: 34 ± 6% vs 49 ± 9, p <0.01, proximal coronary segment distribution: 6 (86%) vs 3 (19%), p = 0.004, and left anterior descending coronary artery distribution: 7 (100%) vs 9 (56%), p = 0.04, respectively. Repeat coronary angiographies were performed in 11 patients (46%) during a mean follow-up of 39 ± 38 months and 10 (91%) were found to have healed SCAD, including those who had undergone bypass surgery. In conclusion, our patients with SCAD were characterized by female gender, absence of coronary risk factors, and a high rate of vascular healing without residual stenosis. Larger infarct was found in postpartum patients. PMID:21439531

  5. Iliac Crest Avulsion Fracture in a Young Sprinter

    PubMed Central

    Casabianca, L.; Rousseau, R.; Loriaut, P.; Massein, A.; Mirouse, G.; Gerometta, A.; Khiami, F.

    2015-01-01

    Avulsion fracture of the iliac crest is an uncommon pathology. It usually occurs in teenagers during sport activities, more common in boys. We report a case of 16-year-old male competitive sprinter, who had an avulsion of a part of the iliac crest and the anterior-superior iliac spine during a competition. The traumatism occurred during the period of acceleration phase out of the blocks which corresponds to the maximum traction phase on the tendons. Then a total loss of function of the lower limb appears forcing him to stop the run. X-ray and CT scan confirmed the rare diagnosis of avulsion of the quasitotality of the iliac crest apophysis, corresponding to Salter 2 fracture. We performed an open reduction and internal fixation with two screws, allowing a return to sport after 3 months and his personal best record in the 100 meters at the 6th postoperative month. PMID:26421205

  6. New Treatments for Spinal Nerve Root Avulsion Injury

    PubMed Central

    Carlstedt, Thomas

    2016-01-01

    Further progress in the treatment of the longitudinal spinal cord injury has been made. In an inverted translational study, it has been demonstrated that return of sensory function can be achieved by bypassing the avulsed dorsal root ganglion neurons. Dendritic growth from spinal cord sensory neurons could replace dorsal root ganglion axons and re-establish a reflex arch. Another research avenue has led to the development of adjuvant therapy for regeneration following dorsal root to spinal cord implantation in root avulsion injury. A small, lipophilic molecule that can be given orally acts on the retinoic acid receptor system as an agonist. Upregulation of dorsal root ganglion regenerative ability and organization of glia reaction to injury were demonstrated in treated animals. The dual effect of this substance may open new avenues for the treatment of root avulsion and spinal cord injuries. PMID:27602018

  7. Subtle Radiological Features of Splenic Avulsion following Abdominal Trauma

    PubMed Central

    Rehim, S. A.; Dagash, H.; Godbole, P. P.; Raghavan, A.; Murthi, G. V.

    2010-01-01

    Splenic trauma in children following blunt abdominal injury is usually treated by nonoperative management (NOM). Splenectomy following abdominal trauma is rare in children. NOM is successful as in the majority of instances the injury to the spleen is contained within its capsule or a localised haematoma. Rarely, the spleen may suffer from an avulsion injury that causes severe uncontrollable bleeding and necessitates an emergency laparotomy and splenectomy. We report two cases of children requiring splenectomy following severe blunt abdominal injury. In both instances emergency laparotomy was undertaken for uncontrollable bleeding despite resuscitation. The operating team was unaware of the precise source of bleeding preoperatively. Retrospective review of the computed tomography (CT) scans revealed subtle radiological features that indicate splenic avulsion. We wish to highlight these radiological features of splenic avulsion as they can help to focus management decisions regarding the need/timing for a laparotomy following blunt abdominal trauma in children. PMID:21209813

  8. New Treatments for Spinal Nerve Root Avulsion Injury.

    PubMed

    Carlstedt, Thomas

    2016-01-01

    Further progress in the treatment of the longitudinal spinal cord injury has been made. In an inverted translational study, it has been demonstrated that return of sensory function can be achieved by bypassing the avulsed dorsal root ganglion neurons. Dendritic growth from spinal cord sensory neurons could replace dorsal root ganglion axons and re-establish a reflex arch. Another research avenue has led to the development of adjuvant therapy for regeneration following dorsal root to spinal cord implantation in root avulsion injury. A small, lipophilic molecule that can be given orally acts on the retinoic acid receptor system as an agonist. Upregulation of dorsal root ganglion regenerative ability and organization of glia reaction to injury were demonstrated in treated animals. The dual effect of this substance may open new avenues for the treatment of root avulsion and spinal cord injuries. PMID:27602018

  9. Simultaneous bilateral patellar tendon avulsion in an adolescent.

    PubMed

    Yee, P K; Poon, K C; Chiu, S Y

    2012-12-01

    A 13-year-old boy sustained an injury to both knees upon landing after a forceful jump in a soccer game. Plain radiography and magnetic resonance imaging demonstrated bilateral distal patellar tendon avulsions without fracture of the tibial tuberosities and the physes. To our knowledge, this particular injury has not been previously described in the literature. Open surgeries and internal fixation were performed with excellent functional outcome. This type of injury was similar to the well-recognised acute tibial tuberosity avulsion fracture in terms of the pathogenesis and treatment. We propose a further subtype of this injury pattern. PMID:23223656

  10. [Case of cerebellar and spinal cord infarction presenting with acute brachial diplegia due to right vertebral artery occlusion].

    PubMed

    Fujii, Takayuki; Santa, Yo; Akutagawa, Noriko; Nagano, Sukehisa; Yoshimura, Takeo

    2012-01-01

    A 73-year-old man was admitted for evaluation of sudden onset of dizziness, bilateral shoulder pain, and brachial diplegia. Neurological examination revealed severe bilateral weakness of the triceps brachii, wrist flexor, and wrist extensor muscles. There was no paresis of the lower limbs. His gait was ataxic. Pinprick and temperature sensations were diminished at the bilateral C6-C8 dermatomes. Vibration and position senses were intact. An MRI of the head revealed a right cerebellar infarction and occlusion of the right vertebral artery. An MRI of the cervical spine on T₂ weighted imaging (T₂WI) showed cord compression at the C3/4-C5/6 level secondary to spondylotic degeneration without any intramedullary signal changes of the cord. On the following day, however, high-signal lesions on T₂WI appeared in the C5-C6 spinal cord, suggesting cord infarction. Unilateral vertebral artery occlusion does not usually result in cervical cord infarction because of anastomosis of arteries. Because of the long-term mechanical compression in our case, it was likely that cervical cord ischemia was present before the onset of symptoms. On the basis of chronic cord compression, our case suggests that occlusion of a unilateral vertebral artery could cause cervical cord infarction. PMID:22790805

  11. Renal Artery Stump to Inferior Vena Cava Fistula: Unusual Clinical Presentation and Transcatheter Embolization with the Amplatzer Vascular Plug

    SciTech Connect

    Taneja, Manish; Lath, Narayan Soo, Tan Bien; Hiong, Tay Kiang; Htoo, Maung Myint; Richard, Lo; Fui, Alexander Chung Yaw

    2008-07-15

    Fistulous communication between the renal artery stump and inferior vena cava following nephrectomy is rare. We describe the case of a 52-year-old man with a fistula detected on investigation for hemolytic anemia in the postoperative period. The patient had had a nephrectomy performed 2 weeks prior to presentation for blunt abdominal trauma. The fistula was successfully occluded percutaneously using an Amplatzer vascular plug. The patient recovered completely and was discharged 2 weeks later.

  12. Bilateral atraumatic tibial tubercle avulsion fractures: case report and review of the literature.

    PubMed

    Khoriati, Al-Achraf; Guo, Shigong; Thakrar, Raj; Deol, Rupinderbir S; Shah, Khalil Y

    2015-04-01

    An avulsion fracture of the tibial tubercle is an uncommon injury, comprising less than 1% of all physeal injuries. The occurrence of such injuries bilaterally is even rarer. We report a case of bilateral atraumatic tibial tubercle avulsion fractures and its presentation, mechanism of injury, surgical management, post-operative rehabilitation and implications for clinical practice. A 17-year-old healthy male presented to the emergency department with severe pain on the anterior aspect of both knees and was unable to walk, having been brought in by ambulance after hearing a crack whilst jogging. On examination, there was significant swelling of both knees which were held in extension. On both sides there was a prominent deformity on the region of the tibial tubercle with a palpable gap, although no open skin wound. He was unable to actively move either knee joint. No neurovascular deficit was present. Plain radiographs revealed bilateral tibial tubercle avulsion fractures. Gentle manipulation was performed in the emergency department to the fragments in order to remove the tension from the skin. The fragments were reduced and fixed surgically with 4mm cannulated screws in an anterior to posterior direction. Both limbs were placed in temporary casts in 20 degrees of flexion. Postoperatively, the patient was kept non-weight bearing for four weeks then placed into a range of motion brace and movement commenced. Full weight bearing was permitted at the one month stage and he was advised to avoid any sporting activity until the 8 week stage and contact sports until the 10 week stage. Full movement of both joints was regained and the patient returned to full sporting activity in the absence of symptoms. This case emphasises the need for a high degree of vigilance when faced with such a presentation and a low threshold for further investigation and surgical intervention. PMID:25638599

  13. Coronary Artery Bypass Graft Surgery: The Past, Present, and Future of Myocardial Revascularisation

    PubMed Central

    Chedrawy, Edgar G.

    2014-01-01

    The development of the heart-lung machine ushered in the era of modern cardiac surgery. Coronary artery bypass graft surgery (CABG) remains the most common operation performed by cardiac surgeons today. From its infancy in the 1950s till today, CABG has undergone many developments both technically and clinically. Improvements in intraoperative technique and perioperative care have led to CABG being offered to a more broad patient profile with less complications and adverse events. Our review outlines the rich history and promising future of myocardial revascularization. PMID:25374960

  14. Right coronary artery dissection and aneurysm presented as acute inferior myocardial infarction from an automobile airbag trauma.

    PubMed

    Zeng, Chunlai; Hu, Wuming; Zhu, Ning; Zhao, Xuyong; Xu, Jian; Ye, Shiyong; Xiang, Yijia; Lv, Linchun

    2015-10-01

    Coronary artery dissection and aneurysm culminating in acute myocardial infarction are rare after blunt chest trauma. We are reporting a case of a previously healthy 52-year-old man who presented with right inferior lobe contusion, pleural effusion, right interlobar fissure effusion, bone fracture of right fourth rib, and acute inferior wall myocardial infarction and who experienced blunt trauma in his right chest wall by an airbag deployment in a car accident. Coronary angiography showed an aneurysm in the middle of right coronary artery with 70% afferent narrowing just distal to the aneurysm with no visible atherosclerotic lesion. A 4.0×20 mm TEXUS Liberté stent in the lesion was deployed, and a good coronary flow was obtained without residual stenosis and the aneurysm vanished. PMID:26319191

  15. Complete Cervical Avulsion with Intravaginal Misoprostol for Second Trimester Pregnancy Termination

    PubMed Central

    Sajjan, G. R.; Patil, Neelamma; Kaur, Manpreet; Shirgur, Shobha; Nandi, Suvarna; Ashwini, V.

    2012-01-01

    Intravaginal misoprostol, a synthetic PGE1 analogue, has largely replaced all other techniques for pregnancy termination in II trimester, because of its successful results. Incidence of II trimester pregnancy termination has also increased in the present days, because of prenatal diagnosis of pregnancies with serious fetal abnormalities like cardiovascular and skeletal malformations. But there are serious and life threatening complications reported with the use of intravaginal misoprostol. Here we are reporting a case of complete avulsion of cervix from lower part of the uterus, with the use of intravaginal misoprostol, for II trimester termination of pregnancy. So, clinicians dealing with II trimester termination of pregnancy should be aware of such complications. PMID:22919526

  16. A giant spinal arterial aneurysm in a child presenting as quadriparesis.

    PubMed

    Santana-Ramírez, Adrian; Farias-Serratos, Felipe; Garzon-Muvdi, Tomas; Quiñones-Hinojosa, Alfredo

    2013-01-01

    A giant spinal aneurysm from anterior spinal artery not associated with arteriovenous (AV) malformations is unusual and no such cases have been reported in children. Few cases have been described as part of AV malformation complex and coarctation of the aorta. We report a case of anterior spinal aneurysm in a 1-year-old girl causing a subarachnoid haemorrhage and a cervical cord lesion. The diagnosis was confirmed with a multislice CT angiography. A microsurgical decompression was performed and excision of aneurysm was unsuccessful but neurological deficits were improved. No further approach was accepted by the parents. The mechanism for the development of spinal isolated aneurysms is not clear; it can be related to congenital vessel abnormalities and genetic origin. The multislice CT angiography is a very useful method to demonstrate the features of this entity. Previous reports of isolated spinal aneurysm are reviewed. PMID:23964047

  17. A giant spinal arterial aneurysm in a child presenting as quadriparesis

    PubMed Central

    Santana-Ramírez, Adrian; Farias-Serratos, Felipe; Garzon-Muvdi, Tomas; Quiñones-Hinojosa, Alfredo

    2013-01-01

    A giant spinal aneurysm from anterior spinal artery not associated with arteriovenous (AV) malformations is unusual and no such cases have been reported in children. Few cases have been described as part of AV malformation complex and coarctation of the aorta. We report a case of anterior spinal aneurysm in a 1-year-old girl causing a subarachnoid haemorrhage and a cervical cord lesion. The diagnosis was confirmed with a multislice CT angiography. A microsurgical decompression was performed and excision of aneurysm was unsuccessful but neurological deficits were improved. No further approach was accepted by the parents. The mechanism for the development of spinal isolated aneurysms is not clear; it can be related to congenital vessel abnormalities and genetic origin. The multislice CT angiography is a very useful method to demonstrate the features of this entity. Previous reports of isolated spinal aneurysm are reviewed. PMID:23964047

  18. Propolis as storage media for avulsed teeth: microscopic and morphometric analysis in rats.

    PubMed

    Mori, Graziela Garrido; Nunes, Daniele Clapes; Castilho, Lithiene Ribeiro; de Moraes, Ivaldo Gomes; Poi, Wilson Roberto

    2010-02-01

    The maintenance of the avulsed teeth in appropriate media for preserving the cellular viability has been important for repairing the periodontal ligament and preventing the root resorption after tooth reimplantation. Propolis is a substance capable of preserving cellular viability. This study aimed to analyze the propolis substance as a storage media for maintaining the avulsed teeth, besides to determine the ideal time period for keeping the tooth inside it. Thus, 60 maxillary right central incisors of rats were extracted and divided into five groups. In groups I and II, teeth were kept in propolis for 60 min and 6 h, respectively; in group III, teeth were kept in milk for 6 h; in group IV, teeth were kept dry for 60 min; and in group V, they were immediately reimplanted. All teeth had their root canals filled with calcium hydroxide paste. Following, teeth were reimplanted in their sockets. After 15 and 60 days, animals were killed and the obtained samples were processed in laboratory for microscopic and morphometric analyzing. The results showed that the occurrence of inflammatory resorption, dental ankylosis and the formation of the connective tissue parallel to the root surface were similar among groups. It could be verified a greater occurrence of replacement resorption in group IV when comparing to other groups. In groups I and IV, the presence of periodontal ligament-like connective tissue was substantially smaller than the other groups. Regarding to the cementum amount over the root, it could be observed that this was present in smaller amount in groups I and IV. Group II was similar to groups III and IV. Therefore, according to the results of this study, the use of propolis as a storage media for maintaining avulsed teeth could be highlighted, and the 6-h period was more appropriate than the 60-min period. PMID:20089064

  19. Avulsion of the direct head of rectus femoris following arthroscopic subspine impingement resection: a case report.

    PubMed

    Devitt, Brian M; Smith, Bjorn; Stapf, Robert; O'Donnell, John M

    2016-04-01

    Arthroscopic resection of the anterior inferior iliac spine (AIIS) for subspine impingement has become a relatively common procedure. The AIIS is the origin of the direct head of rectus femoris (dhRF). Previous studies have reported that removal of the contributing portion of the AIIS causing impingement is unlikely to weaken the attachment of the dhRF. The purpose of this article is to report a case of avulsion of the dhRF, following revision hip arthroscopy for the treatment of subspine impingement. A 23-year-old professional footballer underwent revision left hip arthroscopy for the treatment of subspine impingement. 5-mm of bone was resected inferior to the AIIS. Two-weeks post-operatively, he presented with sudden onset, severe left anterior thigh pain following a fall and hyperextension of his left hip. The patient felt a pop over the anterior aspect of his hip. He noticed immediate swelling, severe pain and stiffness. Examination revealed diffuse swelling, 4/5-power on straight-leg-raise, focal tenderness over the AIIS but no palpable gap. MRI confirmed the clinical suspicion of a dhRF avulsion. Given the minimal loss of power and the lack of significant retraction, the patient was treated conservatively. He was instructed to avoid excessive hip extension. He returned to full participation at 3-months. This article highlights a case of avulsion of the dhRF due to a hyperextension injury of the hip following arthroscopic resection of subspinal impingement, a previously unreported complication. Resection of soft and bone from the AIIS may weaken the insertion of the dhRF. Care should be taken during post-operative rehabilitation to avoid trauma and excessive forces on the dhRF tendon, which may lead to rupture. Rehabilitation should be focused on range of motion of the hip. PMID:27026819

  20. Traumatic avulsion of tibialis anterior following an industrial accident: A case report

    PubMed Central

    Rajeev, Aysha; McDonald, Mhiari; Newby, Mike; Patterson, Paul

    2015-01-01

    Introduction Rupture of the tibialis anterior tendon is uncommon and can occur spontaneously or following trauma. If suspected, it should be diagnosed promptly, enabling early surgical management and good restoration of function. Presentation of case A 48 year old male sustained a crush injury to his right foot when it became stuck in a vertical industrial fan at work. He attended A & E complaining of swelling of the dorsum of foot. On examination, there was tenderness at the base of the first metatarsal. X-ray revealed an avulsion fracture of the first metatarsal, and MRI showed rupture of tibialis anterior. The patient underwent surgical repair 10 days later, with post-operative management in a non-weight bearing, then weight bearing cast. X-ray at 8 weeks showed that the fracture had healed. The patient had a course of physiotherapy and was followed up at 6 months to assess pain and function. Discussion Tibialis anterior rupture should be considered if the history is suggestive, and can be diagnosed clinically based on the triad of a ‘pseudotumour’ of the ruptured tendon, loss of tendon contour, and reduced dorsiflexion of the ankle. In our case, the avulsion fracture prompted further imaging to confirm the diagnosis and plan surgery. There are various operative technique described in the literature. We used a whip stitch with anchors to reattach the tendon to the base of first metatarsal. Conclusion A prompt and early diagnosis of surgical repair of tibialis anterior tendon avulsion is important to ensure that the patients return to work as an industrial worker. PMID:26263452

  1. Avulsion of the direct head of rectus femoris following arthroscopic subspine impingement resection: a case report

    PubMed Central

    Devitt, Brian M.; Smith, Bjorn; Stapf, Robert; O’Donnell, John M.

    2016-01-01

    Arthroscopic resection of the anterior inferior iliac spine (AIIS) for subspine impingement has become a relatively common procedure. The AIIS is the origin of the direct head of rectus femoris (dhRF). Previous studies have reported that removal of the contributing portion of the AIIS causing impingement is unlikely to weaken the attachment of the dhRF. The purpose of this article is to report a case of avulsion of the dhRF, following revision hip arthroscopy for the treatment of subspine impingement. A 23-year-old professional footballer underwent revision left hip arthroscopy for the treatment of subspine impingement. 5-mm of bone was resected inferior to the AIIS. Two-weeks post-operatively, he presented with sudden onset, severe left anterior thigh pain following a fall and hyperextension of his left hip. The patient felt a pop over the anterior aspect of his hip. He noticed immediate swelling, severe pain and stiffness. Examination revealed diffuse swelling, 4/5-power on straight-leg-raise, focal tenderness over the AIIS but no palpable gap. MRI confirmed the clinical suspicion of a dhRF avulsion. Given the minimal loss of power and the lack of significant retraction, the patient was treated conservatively. He was instructed to avoid excessive hip extension. He returned to full participation at 3-months. This article highlights a case of avulsion of the dhRF due to a hyperextension injury of the hip following arthroscopic resection of subspinal impingement, a previously unreported complication. Resection of soft and bone from the AIIS may weaken the insertion of the dhRF. Care should be taken during post-operative rehabilitation to avoid trauma and excessive forces on the dhRF tendon, which may lead to rupture. Rehabilitation should be focused on range of motion of the hip. PMID:27026819

  2. Superficial temporal artery pseudoaneurysm presenting as a growing, pulsatile, and tender mass

    PubMed Central

    Seferi, Arsen; Alimehmeti, Ridvan; Pajaj, Ermira; Vyshka, Gentian

    2016-01-01

    Background: Superficial temporal artery (STA) pseudoaneurysms have been reported in the literature since the mid of seventeenth century from Bartholin, however, there is an increasing number of cases, suggesting a diversity of etiological factors. Among these, traumatic events, even of an iatrogenic nature, have been identified as causative factors for nonspontaneous STA pseudoaneurysms. Regional pain and tenderness, troublesome pulsations of the mass, cosmetic concerns as well as the risk of bleeding warrant a thorough evaluation and a definite interventional approach to the condition. Case Description: A 21-year-old Caucasian male searched medical advice for a growing, tender, and pulsatile mass on his right temple, with isolated and short episodes of lancinating sensations, after sustaining a blunt trauma following a hit with a stick half a year before the admission. Enhanced cranial computed tomography and angiography confirmed the diagnosis of an STA pseudoaneurysm. A direct percutaneous aspiration, as well as ultrasonography, was performed prior to the neurosurgical intervention, with the complete removal of the mass. Conclusions: STA pseudoaneurysms require a careful evaluation and a conclusive approach in order to avoid the risk of a growing mass and other nonremote complications such as bone erosions and bleeding. Different treatment options are available, including endovascular obliteration and embolization, however, surgical removal after ligation of the afferent and efferent segments of the vessel seem to be highly effective. PMID:27413578

  3. Rehabilitation of Avulsed Teeth in Fractured Jaws via Bone Grafting and Implant Placement: Report of Two Cases

    PubMed Central

    Baliga, Shridhar

    2015-01-01

    The maxillofacial region is one of the most injury-prone areas during road traffic accidents, personal violence, falls and sports. Maxillofacial trauma can lead to breakage or avulsion of upper anterior teeth, which may cause significant aesthetic and functional problems. There are many treatment options available for rehabilitation including removable partial dentures, fixed partial dentures, crown and bridges and implant-supported prostheses. Herein, two cases are presented where implant placement was done for upper anterior teeth, which were traumatized or avulsed following maxillofacial trauma. Both patients demonstrated a history of maxillofacial trauma and had undergone open reduction and internal fixation. The first patient had a severe maxillary alveolar defect treated via autogenous bone grafting and a six-month period was given for proper integration of the bone graft. The second patient was a smoker with very poor oral hygiene and a deep bite. Thus, implant placement was not initially justified. PMID:26877745

  4. Rehabilitation of Avulsed Teeth in Fractured Jaws via Bone Grafting and Implant Placement: Report of Two Cases.

    PubMed

    Jain, Anshul; Baliga, Shridhar

    2015-07-01

    The maxillofacial region is one of the most injury-prone areas during road traffic accidents, personal violence, falls and sports. Maxillofacial trauma can lead to breakage or avulsion of upper anterior teeth, which may cause significant aesthetic and functional problems. There are many treatment options available for rehabilitation including removable partial dentures, fixed partial dentures, crown and bridges and implant-supported prostheses. Herein, two cases are presented where implant placement was done for upper anterior teeth, which were traumatized or avulsed following maxillofacial trauma. Both patients demonstrated a history of maxillofacial trauma and had undergone open reduction and internal fixation. The first patient had a severe maxillary alveolar defect treated via autogenous bone grafting and a six-month period was given for proper integration of the bone graft. The second patient was a smoker with very poor oral hygiene and a deep bite. Thus, implant placement was not initially justified. PMID:26877745

  5. Acute myocardial infarction due to left anterior descending coronary artery dissection after blunt chest trauma.

    PubMed

    Oghlakian, Gerard; Maldjian, Pierre; Kaluski, Edo; Saric, Muhamed

    2010-03-01

    Cardiac complications of chest trauma range from arrhythmias to valvular avulsions to myocardial contusion, rupture, and rarely myocardial infarction. We describe a case of a young patient with blunt chest trauma after a motor vehicle accident in whom the diagnosis of myocardial infarction was established a week later because no electrocardiogram or cardiac biomarkers were obtained on presentation. Retrospective review of contrast-enhanced computed tomography (CT) of the chest done on presentation demonstrated a perfusion defect in the distribution of the left anterior descending artery (LAD). Subsequent coronary angiography demonstrated dissection in the proximal LAD. Our case illustrates the importance of electrocardiography and contrast-enhanced chest CT in initial evaluation of patients with blunt chest trauma and suspected injury to the coronary arteries. PMID:19214607

  6. Direct Repair without Augmentation of Patellar Tendon Avulsion following TKA

    PubMed Central

    Kumar, Nishikant; Yadav, Chandrashekhar; Kumar, Ashok

    2015-01-01

    Complications involving the extensor mechanism after TKA are potentially disastrous. We are reporting a case of patellar tendon rupture from tibial tuberosity following total knee arthroplasty. We managed it by direct repair with fiberwire using Krackow suture technique without augmentation. Our long term result has been very encouraging. Our method is a safe and better method of management of patellar tendon avulsion following TKA when it happens without any tissue loss. PMID:25632362

  7. TIBIAL TUBERCLE AVULSION FRACTURE IN A MALE ADOLESCENT.

    PubMed

    Matoković, Damir; Šimić-Klarić, Andrea; Rajić, Marijana Tomić; Crnković, Helena Tesari; Jurinić, Mislav; Jovanović, Savo

    2015-06-01

    Tibial tuberosity fractures are rare in childhood, most frequently due to excessive quadriceps muscle contraction. On performing long jump, a 15-year-old boy sustained tibial tuberosity avulsion fracture type II according to Watson-Jones. The patient was treated operatively with fragment repositioning and screw fixation. Ten months after the injury and rehabilitation, he resumed his sports activities with full range knee motion. PMID:26415319

  8. Recurrent Arterial Thrombosis as a Presenting Feature of a Variant M3-Acute Promyelocytic Leukemia

    PubMed Central

    Chotai, Pranit N.; Kasangana, Kalenda; Chandra, Abhinav B.; Rao, Atul S.

    2016-01-01

    Acute limb ischemia (ALI) is a common vascular emergency. Hematologic malignancies are commonly associated with derangement of normal hemostasis and thrombo-hemorrhagic symptoms during the course of the disease are common. However, ALI as an initial presenting feature of acute leukemia is rare. Due to the rarity of this presentation, there is a scarcity of prospective randomized data to optimally guide the management of these patients. Current knowledge is mainly based on isolated cases. We report our experience managing a patient who presented with ALI and was found to have occult leukemia. A review of all cases with ALI as a presenting feature of acute leukemia is also presented. PMID:27386455

  9. Recurrent Arterial Thrombosis as a Presenting Feature of a Variant M3-Acute Promyelocytic Leukemia.

    PubMed

    Chotai, Pranit N; Kasangana, Kalenda; Chandra, Abhinav B; Rao, Atul S

    2016-06-01

    Acute limb ischemia (ALI) is a common vascular emergency. Hematologic malignancies are commonly associated with derangement of normal hemostasis and thrombo-hemorrhagic symptoms during the course of the disease are common. However, ALI as an initial presenting feature of acute leukemia is rare. Due to the rarity of this presentation, there is a scarcity of prospective randomized data to optimally guide the management of these patients. Current knowledge is mainly based on isolated cases. We report our experience managing a patient who presented with ALI and was found to have occult leukemia. A review of all cases with ALI as a presenting feature of acute leukemia is also presented. PMID:27386455

  10. The Effectiveness of Oral Rehydration Solution at Various Concentrations as a Storage Media for Avulsed Teeth

    PubMed Central

    Eskandarian, Tahereh; Badakhsh, Samaneh; Esmaeilpour, Tahereh

    2013-01-01

    Introduction Following avulsion, the periodontal ligament (PDL) cells are at risk of necrosis. To achieve a favorable survival prognosis, the PDL cells must be kept viability. Therefore, immediate replantation is considered as the treatment of choice and in case it is not possible, storing the tooth in an appropriate storage media should be considered. Oral Rehydration Solution (ORS) is a glucose-electrolyte solution which can keep the optimal osmolality as well as pH and can even provide nutrients which are necessary for cellular growth. The present study aimed to evaluate the effectiveness of different concentrations of ORS in maintaining the viability of the PDL cells at different time points. Materials and Methods PDL cells were obtained from healthy extracted human premolars. Then, 8×10³ cells were seeded in each well of 96-well plate. Afterwards, each well was treated with ORS in three different concentrations and DMEM for 1, 3, 6, and 9 hours. Cell viability was determined by using the MTT assay. One way-ANOVA and post hoc (LSD) test were used for comparing the study groups. Results According to the results, 25% and 50% concentrations of ORS were more effective in preserving the PDL cell viability and could maintain 79.98% and 68.34% of the PDL cells, respectively, at least for the last experimental time point (up to 9 hours). Conclusions Therefore, our findings indicate that ORS might be a suitable storage medium for avulsed teeth. PMID:23412137

  11. Neuroprotection and immunomodulation by xenografted human mesenchymal stem cells following spinal cord ventral root avulsion

    PubMed Central

    Ribeiro, Thiago B.; Duarte, Adriana S. S.; Longhini, Ana Leda F.; Pradella, Fernando; Farias, Alessandro S.; Luzo, Angela C. M.; Oliveira, Alexandre L. R.; Olalla Saad, Sara Teresinha

    2015-01-01

    The present study investigates the effects of xenotransplantation of Adipose Tissue Mesenchymal Stem Cells (AT-MSCs) in animals after ventral root avulsion. AT-MSC has similar characteristics to bone marrow mesenchymal stem cells (BM-MSCs), such as immunomodulatory properties and expression of neurotrophic factors. In this study, Lewis rats were submitted to surgery for unilateral avulsion of the lumbar ventral roots and received 5 × 105 AT-MSCs via the lateral funiculus. Two weeks after cell administration, the animals were sacrificed and the moto neurons, T lymphocytes and cell defense nervous system were analyzed. An increased neuronal survival and partial preservation of synaptophysin-positive nerve terminals, related to GDNF and BDNF expression of AT-MSCs, and reduction of pro-inflammatory reaction were observed. In conclusion, AT-MSCs prevent second phase neuronal injury, since they suppressed lymphocyte, astroglia and microglia effects, which finally contributed to rat motor-neuron survival and synaptic stability of the lesioned motor-neuron. Moreover, the survival of the injected AT- MSCs lasted for at least 14 days. These results indicate that neuronal survival after lesion, followed by mesenchymal stem cell (MSC) administration, might occur through cytokine release and immunomodulation, thus suggesting that AT-MSCs are promising cells for the therapy of neuronal lesions. PMID:26548646

  12. Neuroprotection and immunomodulation by xenografted human mesenchymal stem cells following spinal cord ventral root avulsion.

    PubMed

    Ribeiro, Thiago B; Duarte, Adriana S S; Longhini, Ana Leda F; Pradella, Fernando; Farias, Alessandro S; Luzo, Angela C M; Oliveira, Alexandre L R; Olalla Saad, Sara Teresinha

    2015-01-01

    The present study investigates the effects of xenotransplantation of Adipose Tissue Mesenchymal Stem Cells (AT-MSCs) in animals after ventral root avulsion. AT-MSC has similar characteristics to bone marrow mesenchymal stem cells (BM-MSCs), such as immunomodulatory properties and expression of neurotrophic factors. In this study, Lewis rats were submitted to surgery for unilateral avulsion of the lumbar ventral roots and received 5 × 10(5) AT-MSCs via the lateral funiculus. Two weeks after cell administration, the animals were sacrificed and the moto neurons, T lymphocytes and cell defense nervous system were analyzed. An increased neuronal survival and partial preservation of synaptophysin-positive nerve terminals, related to GDNF and BDNF expression of AT-MSCs, and reduction of pro-inflammatory reaction were observed. In conclusion, AT-MSCs prevent second phase neuronal injury, since they suppressed lymphocyte, astroglia and microglia effects, which finally contributed to rat motor-neuron survival and synaptic stability of the lesioned motor-neuron. Moreover, the survival of the injected AT- MSCs lasted for at least 14 days. These results indicate that neuronal survival after lesion, followed by mesenchymal stem cell (MSC) administration, might occur through cytokine release and immunomodulation, thus suggesting that AT-MSCs are promising cells for the therapy of neuronal lesions. PMID:26548646

  13. Storage media for avulsed teeth: a literature review.

    PubMed

    Poi, Wilson Roberto; Sonoda, Celso Koogi; Martins, Christine Men; Melo, Moriel Evangelista; Pellizzer, Eduardo Pizza; de Mendonça, Marcos Rogério; Panzarini, Sônia Regina

    2013-01-01

    Dental avulsion is the most severe type of traumatic tooth injuries because it causes damage to several structures and results in the complete displacement of the tooth from its socket in the alveolar bone. The ideal situation is to replant an exarticulated tooth immediately after avulsion because the extraoral time is a determinant factor for treatment success and for a good prognosis. However, it is not always possible. The success of replantation depends on a number of factors that may contribute to accelerate or minimize the occurrence of root resorption or ankylosis, among which is the type and characteristics of the medium used for temporary storage during the time elapsed between avulsion and replantation. Maintaining the tooth in an adequate wet medium that can preserve, as longer as possible, the vitality of the periodontal ligament cells that remain on root surface is the key to success of replantation. Recent research has led to the development of storage media that produce conditions that closely resemble the original socket environment, with adequate osmolality (cell pressure), pH, nutritional metabolites and glucose, and thus create the best possible conditions for storage. Although these storage media can now be purchased in the form of retail products, the most common scenario is that such a product will not be readily available at the moment of the accident This paper reviews the literature on the different storage media that have been investigated for avulsed teeth based on full-length papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words 'storage medium', 'transportation medium', 'avulsion', 'tooth avulsion', 'replantation', 'tooth replantation', 'milk' and 'propolis'. After application of inclusion and exclusion criteria, 39 papers were selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage medium. The review of the literature showed that a

  14. Unusual presentation of basilar artery stroke secondary to patent foramen ovale: a case report

    PubMed Central

    Salam, Abdul; Sanmuganathan, Phil; Pycock, Chris

    2008-01-01

    Introduction We report a case of a patient presenting with neuropsychiatric manifestations secondary to paradoxical embolism Case presentation Unexplained rapid onset of confusion with amnesia and minimal neurological deficits can be a manifestation of various systemic causes of which stroke, either ischemic or hemorrhagic, is one. Thorough and systematic evaluation of these patients can be highly rewarding in terms of optimizing patient outcome. We report the case of a 45-year-old woman whose initial presentation was with acute onset of confusion, memory loss with personality change and headaches. A differential diagnosis of systemic illness and cerebral pathology was entertained. She was empirically treated for neurological infection. Brain imaging revealed bilateral thalamic and cerebellar infarction. Further evaluation with an aim to define the etiology, revealed the diagnosis of Patent Foramen Ovale with paradoxical embolism. The differential diagnosis of unexplained rapid onset of confusion, amnesia with minimal motor neurological deficits and relevant appropriate investigations are discussed in this case report. Conclusion This case highlights the importance of recognising the atypical manifestations of posterior fossa stroke. In young patients presenting with non-focal neuropsychiatric manifestations, paradoxical embolism, secondary to patent foramen ovale is a possible cause. PMID:18328096

  15. Outcomes of Primary Percutaneous Coronary Intervention for Patients with Previous Coronary Artery Bypass Grafting Presenting with STsegment Elevation Myocardial Infarction

    PubMed Central

    Garg, Pankaj; Kamaruddin, Hazlyna; Iqbal, Javaid; Wheeldon, Nigel

    2015-01-01

    Background: There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting acutely as ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). Objectives: To compare outcomes in STEMI patients undergoing PPCI with or without previous CABG surgery. Methods: An all-comer single-centre observational registry from a cardiothoracic centre in UK. All consecutive patients presenting for PPCI between 2007 and 2012 were included. Electronic records were used to extract relevant information. Mortality data were obtained from the Office of National Statistics. Overall median follow-up period was 1.7 years (intraquartile range 0.9-2.5). Results: Complete data were available for 2133 (97%) patients. 47-patients had previous history of CABG. Out of these, the infarct related artery (IRA) was native vessel in 22 and graft in 25 patients. Post re-vascularization TIMI flow was inferior in CABG cohort (presenting with STEMI to PPCI service with history of CABG are less likely to achieve acute reperfusion and have worse angiographic outcomes. Post PPCI, the prior CABG patients do not seem to have worse shortterm and long-term prognosis. PMID:27006712

  16. An unusual presentation of foreign body in the common carotid artery.

    PubMed

    Lahiri, Somdatta; Ghosh, Shibajyoti; Sengupta, Goutam; Bakshi, Udayan

    2011-12-01

    Penetrating trauma to neck resulting in arteriovenous (AV) fistula and aneurysms involving the carotid system are uncommon injuries with life-threatening consequences. We report here a case of a young factory worker who developed a traumatic AV fistula with false aneurysm, with however, no other complications. He was successfully operated when he presented to us two months after the injury and is doing well in follow-up. PMID:23204711

  17. A high prevalence of carotid artery stenosis in male patients older than 65 years, irrespective of presenting clinical manifestation of atherosclerotic diseases.

    PubMed

    Kazemi-Bajestani, Seyyed Mohammad Reza; van der Vlugt, Maureen; de Leeuw, Frank-Erik; Blankensteijn, Jan D; Bredie, Sebastian J H

    2013-05-01

    This study investigated the prevalence of carotid artery stenosis (CS) and the association with various risk factors in male patients (>65 years) diagnosed with cardiovascular diseases. Duplex sonography of the carotid arteries was performed in 434 of 473 eligible patients of whom 118 (27.8%) patients had significant CS ≥50%. The prevalence and severity of CS did not differ between patients who presented with neurological symptoms or acute coronary syndrome/peripheral artery disease (30.8% vs 25.9%, respectively). Among patients with CS, a higher rate of current smoking, a higher systolic blood pressure, and a lower glomerular filtration rate were observed compared with patients without CS. A history of coronary artery bypass graft was a significant predictor of the presence of CS (P = .003, odds ratio [OR] = 2.70 [1.40-5.19]). The prevalence of CS in elderly males with manifest atherosclerotic disease is high, irrespective of presenting clinical manifestation. PMID:22584247

  18. Non-marfan idiopathic medionecrosis (cystic medial necrosis) presenting with multiple visceral artery aneurysms and diffuse connective tissue fragility: Two brothers

    SciTech Connect

    Kubota, Jun; Tsunemura, Mami; Amano, Shigeko; Tokizawa, Shigemi; Oowada, Susumu; Shinkai, Hiroko; Maehara, Yasunobu; Endo, Keigo

    1997-05-15

    Two brothers with multiple visceral artery aneurysms or dilatations and diffuse connective tissue fragility who did not have clinical features of Marfan syndrome are reported. One presented with retroperitoneal hemorrhage during angiography, and idiopathic medionecrosis was proved by resection of the aneurysms. These cases belong to the heterogeneous group of Marfan syndrome. The angiographical features (multiple dilation of visceral arteries) suggests fragility of connective tissue and is predictive of hazards during and after a catheterization and operation.

  19. Diagnosing pubovisceral avulsions: a systematic review of the clinical relevance of a prevalent anatomical defect.

    PubMed

    Lammers, Karin; Fütterer, Jurgen J; Prokop, Mathias; Vierhout, Mark E; Kluivers, Kirsten B

    2012-12-01

    The aims of this systematic literature review were to assess whether the detection of pubovisceral avulsions using magnetic resonance (MR) imaging or perineal ultrasonography was clinically relevant in women with pelvic floor dysfunction and to evaluate the relation with anatomy, symptoms, and recurrence after surgery. We performed a systematic literature review using three bibliographical databases (PubMed, Embase, and CINAHL) as data sources. Clinical studies were included in which pubovisceral avulsions were studied in relation to pelvic organ prolapse (POP) stage, pelvic floor symptoms, and/or recurrence of POP after surgery. Ultimately, 21 studies met the inclusion criteria. POP stage and recurrence of POP after surgery were strongly associated with pubovisceral avulsions. Contradictory results were found regarding the relation between pubovisceral avulsions and urinary symptoms and symptoms of anorectal dysfunction. Pubovisceral avulsions, as diagnosed by MR imaging or perineal ultrasonography, are associated with higher stages of POP and recurrence of POP after surgery. PMID:22581241

  20. Microsurgical replantation of partial avulsion of the scalp. Case report.

    PubMed

    Svensson, H; Njalsson, T

    1995-06-01

    An 8-year-old girl was bitten by a dog and, as well as minor wounds, had a complete avulsion of the central part of the scalp covering an area of 8 x 10 cm. By rotating the replant 180 degrees and by using 5 cm long vein grafts, two sleeve anastomoses, and two end-to-end anastomoses the blood supply was restored. The operation lasted nine hours, and she stayed in hospital for 12 days. Her clinical course was uneventful. At follow-up 23 months later the cosmetic and functional results were good. PMID:7569816

  1. Ischiofemoral impingement resulting from a chronic avulsion injury of the hamstrings

    PubMed Central

    Hayat, Zara; Konan, Sujith; Pollock, Rob

    2014-01-01

    Significantly reduced distance between the ischium and the femur can result in symptomatic hip pain as a result of impingement. We present the case of a 16-year-old boy who presented with groin pain which had been affecting him for a year and a half following an innocuous football injury. Plain radiograph revealed a chronic apophyseal avulsion fracture of the ischium with excessive callus formation. CT scan and MRI revealed that the bony protuberance was responsible for symptomatic ischiofemoral impingement. In this case, he was successfully treated with non-operative management involving slow re-introduction to exercise. An unusual example of acquired ischiofemoral impingement, unrelated to surgery or significant trauma, this case highlights the need to consider such a diagnosis in otherwise unexplained groin pain. PMID:24966262

  2. Invasive pulmonary mucormycosis with concomitant lung cancer presented with massive hemoptysis by huge pseudoaneurysm of pulmonary artery.

    PubMed

    Kim, Young Il; Kang, Hyo Cheol; Lee, Ho Sung; Choi, Jae Sung; Seo, Ki Hyun; Kim, Yong Hoon; Na, Juock

    2014-11-01

    Pulmonary mucormycosis is a rare opportunistic invasive fungal infection involving the pulmonary vasculature in immunocompromised patients. Pseudoaneurysm of pulmonary artery in mucormycosis is a rare fatal complication after invasion and rupture of a pulmonary artery. We report a patient with diabetes mellitus and incidental lung cancer who developed massive hemoptysis because of a huge pseudoaneurysm of the left pulmonary artery by mucormycosis. Although the patient had been managed by amphotericin B followed by left pneumonectomy for persistent hemoptysis, he died from septic shock and multiorgan failure after surgery. Histologic analysis of a surgical specimen revealed concomitant squamous cell lung cancer. PMID:25441799

  3. Brachial Plexopathy/Nerve Root Avulsion in a Football Player: The Role of Electrodiagnostics

    PubMed Central

    Radecki, Jeffrey; Wolfe, Scott W.; Strauss, Helene L.; Mintz, Douglas N.

    2008-01-01

    Electromyography (EMG) studies are a useful tool in anatomical localization of peripheral nerve and brachial plexus injuries. They are especially helpful in distinguishing between brachial plexopathy and nerve root injuries where surgical intervention may be indicated. EMG can also assist in providing prognostic information after nerve injury as well as after nerve repair. In this case report, a football player presented with weakness in his right upper limb after a traction/traumatic injury to the right brachial plexus. EMG studies revealed evidence of both pre- and postganglionic injury to multiple cervical roots. The injury was substantial enough to cause nerve root avulsions involving the C6 and C7 levels. Surgical referral led to nerve grafts targeted at regaining function in shoulder abduction and elbow flexion. After surgery, the patient’s progress was monitored utilizing EMG to assist in identifying true axonal regeneration. PMID:18751870

  4. Penile erectile dysfunction after brachial plexus root avulsion injury in rats

    PubMed Central

    Fu, Guo; Qin, Bengang; Jiang, Li; Huang, Xijun; Lu, Qinsen; Zhang, Dechun; Liu, Xiaolin; Zhu, Jiakai; Zheng, Jianwen; Li, Xuejia; Gu, Liqiang

    2014-01-01

    Our previous studies have demonstrated that some male patients suffering from brachial plexus injury, particularly brachial plexus root avulsion, show erectile dysfunction to varying degrees. However, the underlying mechanism remains poorly understood. In this study, we evaluated the erectile function after establishing brachial plexus root avulsion models with or without spinal cord injury in rats. After these models were established, we administered apomorphine (via a subcutaneous injection in the neck) to observe changes in erectile function. Rats subjected to simple brachial plexus root avulsion or those subjected to brachial plexus root avulsion combined with spinal cord injury had significantly fewer erections than those subjected to the sham operation. Expression of neuronal nitric oxide synthase did not change in brachial plexus root avulsion rats. However, neuronal nitric oxide synthase expression was significantly decreased in brachial plexus root avulsion + spinal cord injury rats. These findings suggest that a decrease in neuronal nitric oxide synthase expression in the penis may play a role in erectile dysfunction caused by the combination of brachial plexus root avulsion and spinal cord injury. PMID:25422647

  5. Clinical presentation and cardiovascular risk profiles in patients with left main coronary artery disease in a middle eastern country.

    PubMed

    Gehani, A A; El-Menyar, Ayman; Elgendy, Islam; Abuzaid, Ahmed; Ahmed, Emad; Haque, Saiful

    2013-04-01

    We evaluated the prevalence and clinical profile of patients with left main coronary artery disease (LMCA) in Qatar between 2006 and 2010. Patients were divided into 2 groups: patients with LMCA and patients without LMCA but had severe 3-vessel disease (VeD) eligible for surgical revascularization. Among 7000 patients who underwent coronary angiography, 210 patients had significant LMCA and 200 patients with severe 3VeD were matched for age and sex. Diabetes mellitus and hypertension were comparable in the 2 groups. Presentations with myocardial infarction or heart failure were comparable in both groups. Isolated LMCA was 4-fold higher in women (P = .02). Dyslipidemia and smoking were more prevalent in patients with distal and proximal lesions, respectively. Renal failure was independent predictor of LMCA (adjusted odds ratio: 2.6; 95% confidence interval: 1.43-4.69). One-year mortality was higher in LMCA (P = .01). The LMCA carries high mortality. Certain cardiovascular risk factors were important predictors of stenosis site. PMID:22492251

  6. Ruptured pseudoaneurysm of the middle meningeal artery presenting with a temporal lobe hematoma and a contralateral subdural hematoma

    PubMed Central

    Marvin, Eric; Laws, Lindsay Hilken; Coppens, Jeroen Raymond

    2016-01-01

    Background: Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare, associated with skull fractures, and have a high mortality rate. When they rupture, MMA pseudoaneurysms frequently cause epidural hematomas and occasionally ipsilateral subdural or subarachnoid hemorrhage. Isolated intraparenchymal hemorrhage has also been reported. Case Description: A 54-year-old female who suffered a loss of consciousness resulting in a fall presented with a Glasgow Coma Scale of 7t. Imaging demonstrated a right subdural hematoma (SDH) with midline shift, left skull fracture overlying the left MMA, and left temporal lobe intraparenchymal hematoma extending to the surface. The patient underwent a right craniectomy with evacuation of the SDH, and the preoperative computed tomographic angiography revealed abnormal dilation of the left MMA consistent with a pseudoaneurysm. The pseudoaneurysm was treated with endovascular treatment, and the intraparenchymal hematoma was treated conservatively. Her recovery was uneventful, and she received a cranioplasty 3 months after the decompression. Conclusions: The presence of a fracture over the MMA and intraparenchymal hematoma should prompt suspicion for a traumatic pseudoaneurysm. Pseudoaneurysms of the MMA can cause catastrophic bleeding, and prompt treatment is necessary. Endovascular embolization is an effective method that decreases the hemorrhage risk of MMA pseudoaneurysms. PMID:26862457

  7. Avulsion Fracture and Myositis Ossificans in a Professional Teenage Dancer: A Case Report.

    PubMed

    Tosun, Ozgur; Koralp, Muhabbet D; Tosun, Aliye; Celebi, Levent; Bulakbaşi, Nail

    2015-06-01

    Fractures of the transverse processes in the lumbar vertebrae occur as the result of major forces such as direct blunt trauma, violent lateral flexion-extension forces, avulsion of the psoas muscle, or Malgaigne fractures of the pelvis. Dancers make repeated and forceful hyperextension and flexions of the spine, which may cause fractures of the transverse processes of the lumbar vertebrae. Repeated trauma of muscles in dancers may cause avulsion fractures and myositis ossificans. Herein, we report MRI and CT findings of an avulsion from the right transverse process of the L2 and L3 vertebrae in a 16-year-old professional teenage dancer, who responded to conservative treatment. PMID:26046617

  8. Iatrogenic pseudoaneurysm of the superior gluteal artery presenting as pelvic mass with foot drop and sciatica: case report and review of literature.

    PubMed

    Ge, Phillip S; Ng, Gladys; Ishaque, Brandon M; Gelabert, Hugh; de Virgilio, Christian

    2010-01-01

    We report an unusual case of a pseudoaneurysm of the superior gluteal artery as a complication of bone marrow biopsy. A 51-year-old man presented with sciatic pain and foot drop after undergoing bone marrow biopsy and was initially diagnosed as having degenerative disc disease based on his past medical history. Pelvic magnetic resonance imaging (MRI) revealed a large heterogeneous mass suggestive of a neurogenic tumor, but pulsatile blood was instead encountered during computed tomography (CT)-guided needle biopsy. Subsequent workup established the diagnosis of a superior gluteal artery pseudoaneurysm, which was treated with coil embolization, followed by surgical evacuation of the hematoma, which relieved his sciatic pain. However, the patient continues to have a persistent foot drop. Gluteal artery pseudoaneurysms are exceedingly uncommon but should be considered in the workup of a patient with gluteal pain or sciatic nerve palsy following trauma or medical procedures in the gluteal region. PMID:19917559

  9. Mycotic aneurysm of the left subclavian artery presented with hemoptysis in an immunosuppressed man: case report and review of literature.

    PubMed

    Saliou, C; Badia, P; Duteille, F; D'Attellis, N; Ricco, J B; Barbier, J

    1995-04-01

    We report the case of a 32-year-old man with a mycotic aneurysm of the left subclavian artery. This patient had immunosuppression caused by chemotherapy administered for treatment of leukemia. This aneurysm was revealed by two episodes of hemoptysis caused by a lung parenchyma fistulization. The patient was treated successfully by simple ligation and exclusion via a thoracotomy with partial lung resection. Histologic examination confirmed the presence of aspergilloma filaments in the false aneurysm. We suspect that aspergilloma could have been the cause of the mycotic aneurysm in this particular case. The literature on subclavian artery mycotic aneurysms is reviewed. PMID:7707574

  10. Delta distributary dynamics in the Skagit River Delta (Washington, USA): Extending, testing, and applying avulsion theory in a tidal system

    NASA Astrophysics Data System (ADS)

    Hood, W. Gregory

    2010-11-01

    Analysis of historical aerial photos shows that Skagit Delta (Washington, USA) distributary dynamics are consistent with the Slingerland and Smith model of avulsion dynamics where the ratio of the water surface slopes of the two branches of a bifurcation predicts avulsion stability. This model was extended to predict distributary inlet (upstream) width and bankfull cross-sectional area. The water surface gradient ratio for a bifurcation pair predicted distributary width well; the lowest R2 was 0.61 for the 1937 data points, but R2 ranged from 0.83 to 0.90 for other year-specific regression lines. Gradient ratios were not constant over the historical record; from 1937 to 1972 the mainstem river channel lengthened by 1250 m in the course of marsh progradation, while distributary lengthening was comparatively negligible. Consequently, the gradient advantage of the distributaries increased and their channels widened. After the mainstem river terminus stabilized from 1972 to the present, the distributaries continued to lengthen with marsh progradation, so that distributary gradient advantage steadily declined and the distributaries narrowed. While distributary cross sections were not available for the historical period, they were surveyed in 2007 near the distributary inlets. Gradient ratio was more closely related to distributary inlet bankfull cross-sectional area ( R2 = 0.95) than to minimum distributary width for any photo year examined. Applying this form of analysis to Skagit Delta distributaries that have been dammed in the course of agricultural development suggests that their restoration to stabilize eroding marshes at their outlets and recover salmon migration pathways would be feasible without significant risk of full river avulsion.

  11. Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw

    PubMed Central

    Chen, Wei; Luo, Wei; Chen, Zhiqing; Jiang, Yi

    2016-01-01

    INTRODUCTION To investigate the feasibility and clinical efficacy of using a toothed plate and hollow lag screw in the surgical treatment of posterior cruciate ligament (PCL) avulsion fractures of the tibia. METHODS A total of 21 patients were treated with open reduction and internal fixation using a toothed plate and hollow lag screw, through a posteromedial approach using an inverted L-shaped incision. The patients were allowed appropriate functional exercises, including knee flexion and extension, after removal of the plaster at postoperative weeks 3–6. The follow-up period was between six months and two years. RESULTS This was a retrospective study of patients with PCL avulsion fractures of the tibia caused by road traffic accidents (n = 9), sports-related injuries (n = 6), falls (n = 5) and machinery-related injuries (n = 1). 20 patients presented with fresh fractures and one with an old fracture. The patients (13 men, eight women) had a mean age of 41.5 (range 19–72) years. Anatomical reduction of the fracture and satisfactory fixation were achieved in all 21 patients. Bony union was achieved in all patients at 8–12 weeks after surgery. Six months after surgery, knee flexion was 121.9° ± 10.4° and extension was 0°. According to the Lysholm Knee Scoring Scale, 19 patients were rated as ‘excellent’ and two as ‘good’. CONCLUSION The use of a toothed plate and hollow lag screw could be a simple and reliable approach for PCL avulsion fractures of the tibia. Patients achieved good knee function after surgery. PMID:26831316

  12. Avulsion in action: Reconstruction and modelling sedimentation pace and upstream flood water levels following a Medieval tidal-river diversion catastrophe (Biesbosch, The Netherlands, 1421-1750 AD)

    NASA Astrophysics Data System (ADS)

    Kleinhans, Maarten G.; Weerts, Henk J. T.; Cohen, Kim M.

    2010-05-01

    for presently-planned lower-delta engineered diversions. Furthermore, they elucidate the differences between upstream fluvial avulsion and downstream tidal-river avulsion that are important to recognise if we want to understand how deltaic distributary-networks are maintained.

  13. Surgical management of a completely avulsed adductor longus muscle in a professional equestrian rider.

    PubMed

    Quah, Conal; Cottam, Andrew; Hutchinson, James

    2014-01-01

    Avulsion injuries of the adductor longus muscle tendon are rare and a challenge to manage especially in athletes. There has been little published literature on the outcome of conservative and operative treatment for these injuries. We report the first case of an acute adductor longus avulsion injury which was surgically repaired in a professional equestrian rider. Return to full preinjury function was achieved at 3 months with surgical repair using 3 suture anchors. PMID:24711943

  14. [Treatment of complete traumatic avulsion of an incisor tooth in adults].

    PubMed

    Benmansour, A

    2013-05-01

    It is possible to replant an incisor tooth completely avulsed after trauma in adults. These cases are relatively frequent among athletes. It is essential to conserve the tooth in saline solution. The time before replantation must be as short as possible. The simple technique described here, which requires a minimum of material and no dental chair, makes it possible to replant an avulsed incisor with a good success rate. PMID:23803559

  15. The Riverbed Evolution, Avulsions and Backwater Hydrodynamics on the Huanghe River Delta

    NASA Astrophysics Data System (ADS)

    Chu, Z.; Ganti, V.; Lamb, M. P.

    2013-12-01

    The Huanghe River is known for high suspended sediment concentration and resultant heavy sedimentation and frequent channel-shifting among major rivers in the world. This plain coastal river is the main contributor of terrestrial sediment to the Bohai Sea and the Yellow Sea. Since 1855, there have been 11 major avulsions (versus 4 avulsions on the Mississippi River during the Holocene) on the lower reach with an recurrence interval of ~10 years, developing individual lobes that build up the modern Huanghe River delta. We summarize the main features of riverbed evolution on the delta with a database of measured data. The observed avulsions on the delta often occurred along a persistent spatial node, whose distance from the shoreline scales with the computed backwater length. In order to explain the avulsion locations on the delta, and meanwhile to test the viewpoint of river backwater controls on avulsion locations on deltas, we simulate the long profile evolution of the riverbed on the delta considering river discharge, river plume spreading, land subsidence and sea level rise, with a 1D fluvial morphodynamic model. The main results from the numerical simulations provide insights into how the long profile of the river on the delta evolves at the time scales of flood events and avulsions.

  16. Sequential avulsions of the tibial tubercle in an adolescent basketball player.

    PubMed

    Huang, Ying Chieh; Chao, Ying-Hao; Lien, Fang-Chieh

    2010-05-01

    Tibial tubercle avulsion is an uncommon fracture in physically active adolescents. Sequential avulsion of tibial tubercles is extremely rare. We reported a healthy, active 15-year-old boy who suffered from left tibial tubercle avulsion fracture during a basketball game. He received open reduction and internal fixation with two smooth Kirschner wires and a cannulated screw, with every effort to reduce the plate injury. Long-leg splint was used for protection followed by programmed rehabilitation. He recovered uneventfully and returned to his previous level of activity soon. Another avulsion fracture happened at the right tibial tubercle 3.5 months later when he was playing the basketball. From the encouragement of previous successful treatment, we provided him open reduction and fixation with two small-caliber screws. He recovered uneventfully and returned to his previous level of activity soon. No genu recurvatum or other deformity was happening in our case at the end of 2-year follow-up. No evidence of Osgood-Schlatter disease or osteogenesis imperfecta was found. Sequential avulsion fractures of tibial tubercles are rare. Good functional recovery can often be obtained like our case if we treat it well. To a physically active adolescent, we should never overstate the risk of sequential avulsion of the other leg to postpone the return to an active, functional life. PMID:20093955

  17. A Rare Occurrence of Simultaneous Venous and Arterial Thromboembolic Events – Lower Limb Deep Venous Thrombosis and Pulmonary Thromboembolism as Initial Presentation in Acute Promyelocytic Leukemia

    PubMed Central

    Kutiyal, Aditya S.; Dharmshaktu, Pramila; Kataria, Babita; Garg, Abhilasha

    2016-01-01

    The development of acute myeloid leukemia has been attributed to various factors, including hereditary, radiation, drugs, and certain occupational exposures. The association between malignancy and venous thromboembolism events is well established. Here, we present a case of a 70-year-old Indian man who had presented with arterial and venous thrombosis, and the patient was later diagnosed with acute promyelocytic leukemia (APL). In our case, the patient presented with right lower limb deep venous thrombosis and pulmonary thromboembolism four months prior to the diagnosis of APL. Although thromboembolic event subsequent to the diagnosis of malignancy, and especially during the chemotherapy has been widely reported, this prior presentation with simultaneous occurrence of both venous and arterial thromboembolism has rarely been reported. We take this opportunity to state the significance of a complete medical evaluation in cases of recurrent or unusual thrombotic events. PMID:26949347

  18. Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease

    PubMed Central

    Lo, Ruby C.; Bensley, Rodney P.; Dahlberg, Suzanne E.; Matyal, Robina; Hamdan, Allen D.; Wyers, Mark; Chaikof, Elliot L.; Schermerhorn, Marc L.

    2013-01-01

    Objective Prior studies have suggested treatment and outcome disparities between men and women for lower extremity peripheral arterial disease after surgical bypass. Given the recent shift toward endovascular therapy, which has increasingly been used to treat claudication, we sought to analyze sex disparities in presentation, revascularization, amputation, and inpatient mortality. Methods We identified individuals with intermittent claudication and critical limb ischemia (CLI) using International Classification of Diseases, Ninth Revision codes in the Nationwide Inpatient Sample from 1998 to 2009. We compared presentation at time of intervention (intermittent claudication vs CLI), procedure (open surgery vs percutaneous transluminal angioplasty or stenting vs major amputation), and in-hospital mortality for men and women. Regional and ambulatory trends were evaluated by performing a separate analysis of the State Inpatient and Ambulatory Surgery Databases from four geographically diverse states: California, Florida, Maryland, and New Jersey. Results From the Nationwide Inpatient Sample, we identified 1,797,885 patients (56% male) with intermittent claudication (26%) and CLI (74%), who underwent 1,865,999 procedures (41% open surgery, 20% percutaneous transluminal angioplasty or stenting, and 24% amputation). Women were older at the time of intervention by 3.5 years on average and more likely to present with CLI (75.9% vs 72.3%; odds ratio [OR], 1.21; 95% confidence interval [CI], 1.21–1.23; P < .01). Women were more likely to undergo endovascular procedures for both intermittent claudication (47% vs 41%; OR, 1.27; 95% CI, 1.25–1.28; P < .01) and CLI (21% vs 19%; OR, 1.14; 95% CI, 1.13–1.15; P < .01). From 1998 to 2009, major amputations declined from 18 to 11 per 100,000 in men and 16 to 7 per 100,000 in women, predating an increase in total CLI revascularization procedures that was seen starting in 2005 for both men and women. In-hospital mortality was

  19. Bacteria Present in Carotid Arterial Plaques Are Found as Biofilm Deposits Which May Contribute to Enhanced Risk of Plaque Rupture

    PubMed Central

    Lanter, Bernard B.; Sauer, Karin

    2014-01-01

    ABSTRACT Atherosclerosis, a disease condition resulting from the buildup of fatty plaque deposits within arterial walls, is the major underlying cause of ischemia (restriction of the blood), leading to obstruction of peripheral arteries, congestive heart failure, heart attack, and stroke in humans. Emerging research indicates that factors including inflammation and infection may play a key role in the progression of atherosclerosis. In the current work, atherosclerotic carotid artery explants from 15 patients were all shown to test positive for the presence of eubacterial 16S rRNA genes. Density gradient gel electrophoresis of 5 of these samples revealed that each contained 10 or more distinct 16S rRNA gene sequences. Direct microscopic observation of transverse sections from 5 diseased carotid arteries analyzed with a eubacterium-specific peptide nucleic acid probe revealed these to have formed biofilm deposits, with from 1 to 6 deposits per thin section of plaque analyzed. A majority, 93%, of deposits was located proximal to the internal elastic lamina and associated with fibrous tissue. In 6 of the 15 plaques analyzed, 16S rRNA genes from Pseudomonas spp. were detected. Pseudomonas aeruginosa biofilms have been shown in our lab to undergo a dispersion response when challenged with free iron in vitro. Iron is known to be released into the blood by transferrin following interaction with catecholamine hormones, such as norepinephrine. Experiments performed in vitro showed that addition of physiologically relevant levels of norepinephrine induced dispersion of P. aeruginosa biofilms when grown under low iron conditions in the presence but not in the absence of physiological levels of transferrin. PMID:24917599

  20. Total ureteral avulsion leading to early nephrectomy as a rare complication of simple lumbar discectomy; a case report

    PubMed Central

    Omidi-Kashani, Farzad; Mousavi, Seyed Mahdi

    2015-01-01

    Introduction: Lumbar discectomy constitutes the most common and probably easiest spine surgery but it is not without complications. The aim of this work is to report a case with total ureteral avulsion during lumbar discectomy due to careless advancement of the pituitary rongeur. Methods: A 59-year-old male presented with refractory left L5-S1 lumbar disc herniation. During the surgery, left sided total ureteral avulsion occurred. Early postoperative progressive abdominal pain was the main clue for further investigation and diagnostic work-up. Results: Abdominal ultrasonography, intravenous pyelography, and abdominal contrast-enhanced computed tomography (CT) detected a left ureteral injury. Although the injury was detected early, ureteral repair or renal autotransplantation was not possible and nephrectomy was finally indicated, due to a significant ureteral loss. Discussion: Careful use of discectomy instruments, avoidance of excessive advancement of pituitary rongeurs (more than 3 cm), and thorough knowledge of the relevant anatomy are critical in preventing ureteral injury. PMID:27163085

  1. Hydraulic and sediment transport properties of autogenic avulsion cycles on submarine fans with supercritical distributaries

    NASA Astrophysics Data System (ADS)

    Hamilton, Paul B.; Strom, Kyle B.; Hoyal, David C. J. D.

    2015-07-01

    Submarine fans, like other distributive systems, are built by repeated avulsion cycles. However, relative to deltas and alluvial fans, much less is known about avulsions in subaqueous settings. In this study, we ran a set of subaqueous fan experiments to investigate the mechanics associated with autogenic avulsion cycles of self-formed channels and lobe deposits on steep slopes. The experiments used saline density currents with crushed plastic to emulate sustained turbidity currents and bed load transport. We collected detailed hydraulic and bathymetric measurements and made use of a 1-D laterally expanding density current model to better understand different aspects of the avulsion cycle. Our results reveal three major components of the avulsion cycles: (1) distributary channel incision, extension, and stagnation; (2) mouth bar aggradation and hydraulic jump initiation; and (3) hydraulic jump sedimentation and upstream retreat. Interestingly, in all but one experiment, the avulsion cycles led to fans that remained perched above the basin slope break. Experimental data and hydraulic theory were used to unravel actual mechanics associated with cycles. We found that channels stopped extending into the basin due to a decay in sediment transport capacity relative to sediment supply and that the reduction in capacity was primarily an outcome of expansion-driven velocity reduction; dilution played a secondary role. Once channel extension ceased, mouth bar deposits aggraded to a thickness approximately equal to the critical step height needed to create a choked flow condition. The choke then initiated a hydraulic jump on the upstream side of the bar. Once formed, the jump detained a majority of the incoming sediment and forced the channel-to-lobe transition upstream, filling the channel with steep backset bedding and capping the entire channel with a mounded lobate deposit. These intrinsic processes repeated through multiple avulsion cycles to build the fan.

  2. [A case of Rathke's cleft cyst in association with anterior communicating artery aneurysm presenting a rare visual field defect].

    PubMed

    Yuki, K; Katsuzo, K; Ikawa, F; Takeshita, S; Hamasaki, O; Tohru, U

    1996-05-01

    We report a case of Rathke's cleft cyst associated with anterior communicating artery aneurysm. The patient was 60-year-old woman who developed visual disturbance two months before admission to our hospital. Visual acuity on the right was 0.06 and on the left was 0.08. The visual fields showed a complete temporal hemianopsia on the left eye and an incomplete temporal hemianopsia of the right eye with a central defect of the temporal visual field. CT and MR imagings showed an intra- and suprasellar mass lesion with no enhancement. Angiography showed bilateral A1 elevations and anterior communicating artery aneurysm. The operation was performed through interhemispheric approach. Suprasellar cystic mass compressed upward the optic nerves and chiasm, and aneurysmal dome stuck in the central region of chiasm. This anatomical disorders affected to the optic chiasm resulted in a rare visual field defect. Neck clipping of aneurysm and opening of the cyst were performed. A diagnosis of Rathke's cleft cyst was made. Following surgery, her visual fields resolved but she suffered from diabetes insipidus. PMID:8672308

  3. Perfusion Assessment with the SPY System after Arterial Venous Reversal for Upper Extremity Ischemia

    PubMed Central

    2014-01-01

    Background: The timing and pattern of reperfusion following arterial- venous reversal (AVR) in patients with terminal ischemia of an upper extremity is not well understood. Methods: The current case series describes the timing and pattern of reperfusion observed in patients with terminal upper extremity ischemia who underwent AVR and repeated postoperative indocyanine green (ICG) angiography between 2004 and 2009. For all included patients, the SPY Near-Infrared Perfusion Assessment System permitted visualization of ICG-labeled blood flow for 60-second sampling periods at scheduled postoperative time points; outflow and rate and amplitude of inflow were objectively quantified with SPY-Q Analysis Toolkit image analysis software. Results: The series comprised 6 male patients (mean age, 46 years) who presented with upper extremity ischemia related to hypothenar hammer syndrome (n = 2), embolism with patent foramen ovale (n = 2), atherosclerosis (n = 1), and avulsion amputation of the thumb (n = 1); the patient with the avulsion amputation was diagnosed with thromboangiitis obliterans at the time of replantation. AVR was successful in all 6 patients. In 5 of 6 patients, ICG angiography and SPY-based visualization/quantification showed that venous outflow and arterial inflow gradually normalized (versus unaffected digits) between postoperative days (PODs) 0 and 3 and was maintained at long-term follow-up (≥3 months); for the patient who underwent thumb replantation, perfusion normalized between POD 3 and month 5 follow-up. Conclusions: AVR effectively reestablished blood flow in patients with terminal upper extremity ischemia. ICG angiography with SPY technology revealed that, in most cases, kinetic curves, timing, and patterns of perfusion gradually normalized over several PODs. PMID:25426368

  4. Avulsion fractures of the pelvis – a qualitative systematic review of the literature

    PubMed Central

    Porr, Jason; Lucaciu, Calin; Birkett, Sarah

    2011-01-01

    Objective To assess a causal relationship between physical activity or boney surgical intervention and the occurrence of avulsion fracture in the pelvis. Secondarily to assess the average age at which avulsion fracture occurs in cases associated with physical activity or boney surgery. Method A literature search was performed on a variety of databases using text words and MeSH terms. Results were limited to English language. Cases involving trauma or pathological disease were excluded. Causation Criteria scores were calculated for each paper to establish a link between the suspected mechanism of injury and avulsion fracture. Results 48 papers were retrieved encompassing 66 cases of avulsion fracture. 88% of cases were associated with physical activity while 12% were associated with a history of surgery. Average age in the physical activity cases was 16.8(range 13–43) and 56.4(range 31–74) in the surgery related cases. Causation Criteria scores were definite in 76% of activity related cases and probable in 60% of boney surgery related cases. Conclusions Avulsion fractures of the pelvis represent a highly prevalent pathology among the adolescent athletic population. A population of skeletally mature patients with history of boney surgical intervention are also at risk. PMID:22131561

  5. Dual Nerve Transfers for Restoration of Shoulder Function After Brachial Plexus Avulsion Injury.

    PubMed

    Chu, Bin; Wang, Huan; Chen, Liang; Gu, Yudong; Hu, Shaonan

    2016-06-01

    The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83° of shoulder abduction and 54.00° of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV. PMID:26835823

  6. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.

    PubMed

    Hein, Christopher N; Deperio, Jennifer Gurske; Ehrensberger, Mark T; Marzo, John M

    2011-06-01

    Medial meniscal posterior root avulsion (MMRA) leads to deleterious alteration of medial joint compartment loading profiles and increased risk of medial degenerative changes. Surgical repair restores more normal biomechanics to the knee. Our hypothesis is that MMRA will cause medial meniscal (MM) extrusion and gap formation between the root attachment site and MM. Meniscal root repair will restore the ability of the meniscus to resist extrusion, and reduce gap formation at the defect. Seven fresh frozen human cadaveric knees were dissected and mechanically loaded using a servo-hydraulic load frame (MTS ®) with 0 and 1800 N. The knees were tested under three conditions: native, avulsed, and repaired. Four measurements were obtained: meniscal displacement anteriorly, medially, posteriorly, and gap distance between the root attachment site and MM after transection and repair. The medial displacement of the avulsed MM (3.28 mm) was significantly greater (p < 0.001) than the native knee (1.60mm) and repaired knee (1.46 mm). Gap formation is significantly larger in the avulsed compared to repaired state at 0 (p < 0.02) and 1800N (p < 0.02) and also larger with loading in both avulsed (p < 0.05) and repaired (p < 0.02) conditions. Therefore, MMRA results in MM extrusion from the joint and gap formation between the MM root and the MM. Subsequent surgical repair reduces meniscal displacement and gap formation at the defect. PMID:20684881

  7. Integrating Delta Building Physics & Economics: Optimizing the Scale of Engineered Avulsions in the Mississippi River Delta

    NASA Astrophysics Data System (ADS)

    Kenney, M. A.; Mohrig, D.; Hobbs, B. F.; Parker, G.

    2011-12-01

    Land loss in the Mississippi River Delta caused by subsidence and erosion has resulted in habitat loss, interference with human activities, and increased exposure of New Orleans and other settled areas to storm surge risks. Prior to dam and levee building and oil and gas production in the 20th century, the long term rates of land building roughly balanced land loss through subsidence. Now, however, sediment is being deposited at dramatically lower rates in shallow areas in and adjacent to the Delta, with much of the remaining sediment borne by the Mississippi being lost to the deep areas of the Gulf of Mexico. A few projects have been built in order to divert sediment from the river to areas where land can be built, and many more are under consideration as part of State of Louisiana and Federal planning processes. Most are small scale, although there have been some proposals for large engineered avulsions that would divert a significant fraction of the remaining available sediment (W. Kim, et al. 2009, EOS). However, there is debate over whether small or large diversions are the economically optimally and socially most acceptable size of such land building projects. From an economic point of view, the optimal size involves tradeoffs between scale economies in civil work construction, the relationship between depth of diversion and sediment concentration in river water, effects on navigation, and possible diminishing returns to land building at a single location as the edge of built land progresses into deeper waters. Because land building efforts could potentially involve billions of dollars of investment, it is important to gain as much benefit as possible from those expenditures. We present the result of a general analysis of scale economies in land building from engineered avulsions. The analysis addresses the question: how many projects of what size should be built at what time in order to maximize the amount of land built by a particular time? The analysis

  8. [A Case of Aplastic or Twig-Like Middle Cerebral Artery Presenting with an Intracranial Hemorrhage Two Years after a Transient Ischemic Attack].

    PubMed

    Uchiyama, Taku; Okamoto, Hiroaki; Koguchi, Motofumi; Tajima, Yutaka; Suzuyama, Kenji

    2016-02-01

    Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare anatomical anomaly, which can be associated with intracranial hemorrhage and cerebral ischemia. A 52-year-old woman who presented with sudden headache was admitted to our hospital. Computed tomography (CT) and magnetic resonance imaging showed no abnormality; however, magnetic resonance angiogram revealed an occlusion or severe stenosis in the left middle cerebral artery. Three-dimensional CT angiography demonstrated severe stenosis in the left middle cerebral artery. The patient was discharged without any neurological deficit; however, she subsequently complained of temporary weakness in the right hand. It was possibly due to a transient ischemic attack; therefore, cilostazol 200 mg/day was administered for prevention of cerebral ischemia. Single photon emission computed tomography(with or without administration of acetazolamide)showed neither significant decrease in the cerebral blood flow nor cerebrovascular reactivity; hence, surgical revascularization was not performed. However, two years after the initial admission, she was urgently admitted to our hospital with sudden headache and nausea followed by aphasia and weakness of the right extremities. CT images showed diffuse subarachnoid hemorrhage and intracerebral hemorrhage in the left temporo-parietal lobe. Cerebral angiography revealed that the left middle cerebral artery was Ap/T-MCA without cerebral aneurysms. The patient was treated conservatively, and she eventually recovered without any neurological deficit except mild aphasia. Since Ap/T-MCA is associated with both hemorrhagic and ischemic stroke, antiplatelet therapy should be administered carefully. Moreover, it is necessary to consider extracranial-intracranial bypass to reduce hemodynamic stress on the abnormal vessels. PMID:26856268

  9. Infarct Artery Distribution and Clinical Outcomes in Occluded Artery Trial Subjects Presenting with Non ST elevation Myocardial Infarction (From the Long Term Follow-up of the Occluded Artery Trial)

    PubMed Central

    Menon, Venu; Ruzyllo, Witold; Carvalho, Antonio C.; Marconi, Jose; de Sousa, Almeida; Forman, Sandra A.; Jaworska, Krystyna; Lamas, Gervasio A.; Roik, Marek; Thuaire, Christophe; Turgeman, Yoav; Hochman, Judith S.

    2013-01-01

    We hypothesized that the insensitivity of the electrocardiogram (ECG) in identifying acute circumflex occlusion would result in differences in the distribution of the infarct related artery (IRA) between patients with non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) enrolled in the Occluded Artery Trial. We also sought to evaluate the impact of percutaneous intervention to the IRA on clinical outcomes for patients with NSTEMI. Overall NSTEMI subjects comprised 13% (n=283) of the trial population. The circumflex IRA was overrepresented in the NSTEMI group compared to patients enrolled with STEMI (42.5 vs. 11.2%; p<0.0001). The 7 year clinical outcomes for NSTEMI patients randomized to percutaneous intervention and optimal medical therapy versus optimal medical therapy alone were similar for the primary composite of Death, MI and Class IV Congestive Heart Failure (CHF) (22.3 vs. 20.23%, p=0.51, HR 1.20; 0.59-2.43); as well as the individual endpoints of Death (13.8 vs. 17.0%, p=0.51, HR 0.81;0.36-1.85); MI (6.1 vs. 5.1%, p=0.84, HR=1.11; 0.28-4.41); Class IV CHF (6.7 vs. 6.0%, p=0.45, HR 1.50;0.37-6.02). There was no interaction between MI type by ECG and treatment effect (p= NS). In conclusion the occluded circumflex IRA is overrepresented in the NSTEMI population. Consistent with the overall trial results, stable patients with NSTEMI and a totally occluded IRA did not benefit from randomization to PCI. PMID:23351464

  10. A Rare Combination of Avulsion Fractures Around the Knee –A Case Report

    PubMed Central

    Reddy, Hanumantha; Thonse, Chirag; Chikkanna, Jayanth Kumar Bangalore

    2015-01-01

    Patella fractures, tibial spine avulsion and Segond fractures are mainly due to trauma to the knee which may be direct or indirect injuries. While each entity is well documented when occurring in isolation, but bilateral inferior pole patella fracture, tibial spine avulsion in the right knee and bilateral segond fracture in a same patient is a rare occurrence. We report a case of 24-year-old male with such an injury. The diagnosis was confirmed by X-ray, CT scan and MRI imaging of right knee. Then the patient was treated with arthroscopic anterior cruciate ligament (ACL) avulsion fixation with pull through technique and suture disc; bilateral inferior pole patella was treated conservatively with knee brace, segond fracture was treated conservatively similarly. To the best of our knowledge, this is the rare case in the medical literature with all these injuries occurring simultaneously. PMID:26500971

  11. Avulsed Immature Permanent Central Incisors Obturated With Mineral Trioxide Aggregate: A Case Report

    PubMed Central

    Al-Kahtani, Ahmed

    2013-01-01

    The endodontic management of immature permanent incisors in young children can be challenging. This case reported an avulsed immature maxillary central incisors that underwent complete endodontic obturation using mineral trioxide aggregate. A 10-year-old male who suffered a fall injury avulsed both his central incisors. The revascularization process was not possible due to patient compliance and geographic reasons. Mineral trioxide aggregate was utilized as a novel endodontic treatment. After one year post-injury, the teeth remained symptom-free, the clinical and radiographic follow-up showed evidence of healthy periodontium. How to cite this article: Al-Kahtani A. Avulsed Immature Permanent Central Incisors Obturated With Mineral Trioxide Aggregate: A Case Report. J Int Oral Health 2013; 5(3):88-96. PMID:24155609

  12. Tibial Tuberosity Avulsion Fracture and Open Proximal Tibial Fracture in an Adult

    PubMed Central

    Liu, Yu-Ping; Hao, Qing-Hai; Lin, Feng; Wang, Ming-Ming; Hao, Yue-Dong

    2015-01-01

    Abstract A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. This case report describes the successful management of such a fracture pattern in a 45-year old male using an open reduction and lag screw fixation of the tuberosity with a minimally invasive reduction and plate fixation of the proximal tibial diaphyseal fracture. A literature search was done to determine the expected clinical outcome of this fracture pattern. This is the first reported adult case of an avulsion fractures of the tibial tuberosity associated with an open proximal tibial diaphyseal fracture successfully treated by an anatomical reduction and fixation of the avulsion fracture of the tibial tuberosity combined with minimally invasive percutaneous plate osteosynthesis of the proximal tibial diaphyseal fractures. PMID:26426669

  13. Rehabilitation of avulsion fracture of the tibial tuberosity following Osgood-Schlatter disease.

    PubMed

    Baltaci, G; Ozer, H; Tunay, V B

    2004-03-01

    A sixteen-year-old boy suffered from sharp pain in the knee during a jump while playing basketball. He had a positive history of Osgood Schlatter disease. Radiographic evaluation demonstrated an avulsion fracture of the tibial tuberosity Type III according to the classification of Watson-Jones. Rehabilitation after avulsion fracture of the tibial tuberosity is an important consideration for this relatively uncommon adolescent injury. In such avulsion fractures, landing on the ground with the knee fully extended after a jump is the most likely cause. This case report reviews the rehabilitation program, and selected functional outcome measures after rehabilitation are reported. The patient returned to sporting activity after 12 months. PMID:12910334

  14. Enhanced regeneration and functional recovery after spinal root avulsion by manipulation of the proteoglycan receptor PTPσ

    PubMed Central

    Li, Heng; Wong, Connie; Li, Wen; Ruven, Carolin; He, Liumin; Wu, Xiaoli; Lang, Bradley T.; Silver, Jerry; Wu, Wutian

    2015-01-01

    Following root avulsion, spinal nerves are physically disconnected from the spinal cord. Severe motoneuron death and inefficient axon regeneration often result in devastating motor dysfunction. Newly formed axons need to extend through inhibitory scar tissue at the CNS-PNS transitional zone before entering into a pro-regenerative peripheral nerve trajectory. CSPGs are dominant suppressors in scar tissue and exert inhibition via neuronal receptors including PTPσ. Previously, a small peptide memetic of the PTPσ wedge region named ISP (Intracellular Sigma Peptide) was generated, and its capabilities to target PTPσ and relieve CSPG inhibition were validated. Here, we demonstrate that after ventral root avulsion and immediate re-implantation, modulation of PTPσ by systemic delivery of ISP remarkably enhanced regeneration. ISP treatment reduced motoneuron death, increased the number of axons regenerating across scar tissue, rebuilt healthy neuromuscular junctions and enhanced motor functional recovery. Our study shows that modulation of PTPσ is a potential therapeutic strategy for root avulsion. PMID:26464223

  15. Large-scale avulsion of the late Quaternary Sutlej river in the NW Indo-Gangetic foreland basin

    NASA Astrophysics Data System (ADS)

    Singh, Ajit; Gupta, Sanjeev; Sinha, Rajiv; Carter, Andrew; Thomsen, Kristina J.; Mark, Darren F.; Buylaert, Jan-Pieter; Mason, Philippa J.; Murray, Andrew S.; Jain, Mayank; Paul, Debajyoti

    2015-04-01

    River avulsions are important processes in the spatial evolution of river systems in tectonically active sedimentary basins as they govern large-scale patterns of sediment routing. However, the pattern and timing of avulsions in large river systems are poorly documented and not well understood. Here we document late Quaternary paleo-river channel changes in the Indo-Gangetic basin of northwest India. Using a combination of satellite remote sensing and detailed sediment coring, we analyse the large-scale planform geometry, and detailed sedimentary and stratigraphic nature of a major fluvial sedimentary deposit in the shallow subsurface. This sediment body records aggradation of multiple fluvial channel fills. Satellite remote sensing analysis indicates the trace of the buried channel complex and demonstrates that it exists in region of the Himalayan foreland where no major rivers are currently present. Thus it records the former drainage pathway of a major river, which has since been diverted. We use optically stimulated luminescence dating techniques to develop an age model for the stratigraphic succession and hence constrain the timing of river channel existence and diversion. Provenance analysis based on U-Pb dating of detrital zircons and detrital mica Ar-Ar ages indicate sediment sources in the Higher Himalayan Crystalline and Lesser Himalayan Crystalline Series indicating that this paleo-river channel system formed a major perennial river derived from the main body of the Himalaya. Specifically we are able to fingerprint bedrock sources in the catchment of the present-day Sutlej river indicating that the paleo-fluvial system represents the former course of the Sutlej river prior to a major nodal avulsion to its present day course. Our results indicate that on geologically relatively short time-scales, we observe dramatic along strike shifts in the location of major Himalayan rivers. Our sediment records when combined with high-resolution dating and

  16. Splinting rationale and contemporary treatment options for luxated and avulsed permanent teeth.

    PubMed

    Lambert, Douglas L

    2015-01-01

    The continued growth in athletic participation among children and adults has increased the potential incidence of sports-related dental injuries. Regardless of preventive measures, damage and injury to the oral cavity can occur during participation in sports. Luxations, root fractures, bony fractures, and avulsions involving 1 or more teeth are a possibility. Many of these injuries require specific protocols for splinting of the traumatized tooth or teeth to allow the best possible outcomes. This article identifies luxation and avulsion injuries, explains the rationale for splinting, reviews guidelines for splint duration, and discusses contemporary material options available to stabilize affected permanent dentition. PMID:26545276

  17. Lumbar nerve root avulsions with secondary ipsilateral hip dysplasia in a child.

    PubMed

    Polyzoidis, Konstandinos; Petropoulou, Calliope; Argyropoulou, Paraskevi I; Vranos, Georgios; Sarmas, Ioannis; Argyropoulou, Maria I

    2002-09-01

    We report on an 8-year-old child with avulsions of the left L3, L4 and L5 nerve roots and traumatic meningoceles that were not associated with lumbar spine or pelvic girdle fractures. The patient had a history of a road traffic accident. Plain radiographs of the pelvis revealed left hip dysplasia. The magnetic resonance imaging findings of the lumbar spine are illustrated. The pathogenesis of lumbar nerve root avulsions and their association with ipsilateral hip dysplasia are discussed. PMID:12221453

  18. Replantation of an avulsed tooth with an extended extra oral period.

    PubMed

    Kubasad, Girish; Ghivari, Sheetal; Garg, Khushboo

    2012-01-01

    In this study, we have reported a case of the replantation of a maxillary incisor with an extended extraoral period following a traumatic avulsion. After storage in normal saline, the root surface of the avulsed tooth was conditioned with citric acid and treated with a triple antibiotic solution. The tooth socket was filled with Emdogain before replantation. A 12 month, 18 month and a 5 year follow-up clinical examination revealed the patient to be asymptomatic, and the tooth was functional. The recall radiograph showed no evidence of renewed periradicular breakdown and apical root resorption. PMID:23649072

  19. Guyon's canal syndrome due to tortuous ulnar artery with DeQuervain stenosing tenosynovitis, ligamentous injuries and dorsal intercalated segmental instability syndrome, a rare presentation: a case report

    PubMed Central

    2009-01-01

    The Guyon's canal syndrome is a well known clinical entity and may have significant impact on patient's quality of life. We report a case of 43-year-old male who presented with complaints of pain and numbness in right hand and difficulty in writing for past one month. On imaging diagnosis of Guyon's canal syndrome because of tortuous ulnar artery was made with additional findings of DeQuervain's stenosing tenosynovitis and dorsal intercalated segmental instability syndrome with ligamentous injury and subsequently these were confirmed on surgery. Although it is a rare syndrome, early diagnosis and treatment prevents permanent neurological deficits and improve patient's quality of life. PMID:20076781

  20. Carotid artery surgery - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100124.htm Carotid artery surgery - series To use the sharing features on ... 4 Normal anatomy Overview There are four carotid arteries, with a pair located on each side of ...

  1. Avulsion threshold and planform dynamics of the Kosi River in north Bihar (India) and Nepal: A GIS framework

    NASA Astrophysics Data System (ADS)

    Sinha, R.; Sripriyanka, K.; Jain, Vikrant; Mukul, Malay

    2014-07-01

    Models for river avulsions have identified the ratio between down-valley and cross-valley slopes of channels as the triggering factors for the sudden channel shift but have remained untested in the field. The August 2008 avulsion of the Kosi River at Kusaha, 12 km upstream of the Kosi barrage in Nepal, provided an opportunity to study a large-scale avulsion (~ 120 km) for its causal factors and driving mechanisms. We used the SRTM-based digital elevation model and remotely sensed data coupled with field topographic mapping with a kinematic GPS and a Total Station to characterise a ~ 50-km-long stretch of the Kosi River. We have computed reach-scale avulsion threshold index (ATI) integrating SRTM-derived slopes and planform dynamics on a GIS platform. We show that several reaches along the Kosi River are avulsion-prone, including the Kusaha point that is consistent with the August 2008 avulsion. We suggest that apart from cross-valley and down-valley slopes, planform dynamics such as thalweg shift, sinuosity variation, and channel multiplicity significantly influence the avulsion threshold in alluvial reaches of the rivers such as the Kosi.

  2. Migration and Differentiation of Neural Progenitor Cells after Recurrent Laryngeal Nerve Avulsion in Rats

    PubMed Central

    Zhao, Wan; Xu, Wen

    2014-01-01

    To investigate migration and differentiation of neural progenitor cells (NPCs) from the ependymal layer to the nucleus ambiguus (NA) after recurrent laryngeal nerve (RLN) avulsion. All of the animals received a CM-DiI injection in the left lateral ventricle. Forty-five adult rats were subjected to a left RLN avulsion injury, and nine rats were used as controls. 5-Bromo-2-deoxyuridine (BrdU) was injected intraperitoneally. Immunohistochemical analyses were performed in the brain stems at different time points after RLN injury. After RLN avulsion, the CM-DiI+ NPCs from the ependymal layer migrated to the lesioned NA. CM-DiI+/GFAP+ astrocytes, CM-DiI+/DCX+ neuroblasts and CM-DiI+/NeuN+ neurons were observed in the migratory stream. However, the ipsilateral NA included only CM-DiI+ astrocytes, not newborn neurons. After RLN avulsion, the NPCs in the ependymal layer of the 4th ventricle or central canal attempt to restore the damaged NA. We first confirm that the migratory stream includes both neurons and glia differentiated from the NPCs. However, only differentiated astrocytes are successfully incorporated into the NA. The presence of both cell types in the migratory process may play a role in repairing RLN injuries. PMID:25202908

  3. Knowledge about tooth avulsion and its management among dental assistants in Riyadh, Saudi Arabia

    PubMed Central

    2014-01-01

    Background Studies evaluating dental assistants’ knowledge about tooth avulsion and its management are rare. The purpose of this study was to evaluate the level of knowledge about tooth avulsion and its management among dental assistants in Riyadh, Saudi Arabia and to assess its relationship with their educational background. Methods A convenience sampling methodology was employed for sample selection. Over a period of four months starting in February, 2013, 691 pretested 17-item questionnaires were distributed. A total of 498 questionnaires were returned for an overall response rate of 72.1%. Six questions were related to knowledge about permanent tooth avulsion and one question was related to knowledge about primary tooth avulsion. Correct answers to these questions were assigned one point each, and based on this scoring system, an overall knowledge score was calculated. An analysis of covariance was used to test the association between the level of knowledge (total score) and the educational qualifications of the respondents (dental degree and others). A P-value of 0.05 was considered the threshold for statistical significance. Results The majority of the respondents (n = 387; 77.7%) were non-Saudis (377 were from the Philippines), and 79.1% (n = 306) of the Filipinos had a dental degree. The question about recommendations for an avulsed tooth that is dirty elicited the highest number of correct responses (n = 444; 89.2%), whereas the question about the best storage media elicited the lowest number of correct responses (n = 192; 38.6%). The overall mean score for knowledge about tooth avulsion was 6.27 ± 1.74. The mean knowledge score among the respondents with a dental degree was 6.63 ± 1.37, whereas that among the respondents with other qualifications was 5.71 ± 2.08. Conclusions The educational qualifications of the surveyed dental assistants were strongly correlated with the level of knowledge about tooth avulsion and its

  4. Tectonics of Modhupur Tract, its Effects on the Cenozoic Sediments and Jamuna River Avulsion

    NASA Astrophysics Data System (ADS)

    Hosain, A.

    2014-12-01

    Bangladesh is a country characterized by numerous natural disasters. These natural hazards occur both on the surface (e.g., flooding due to river avulsions) and within the subsurface (e.g., earthquakes) (see figure), and both types have been related to regional tectonic activity. Bangladesh is also one of the most highly populated countries in the world with a capital city, Dhaka, host to 17 million people. This urban center is located only 40 km south east from the Madhupur Tract, a potentially tectonically hazardous region. In order to determine this region's tectonic hazard potential, recent studies have attempted to detect and identify significant neotectonic signatures of the tract, such as faults, lineaments, and weak zones within the region. Recent earthquake evidence along the Madhupur Fault strongly supports the fact that the area is tectonically unstable and quite vulnerable to further seismicity, placing the fast-growing and densely populated Dhaka city in potential danger (see figure). The Madhupur Tract is in central Bangladesh, and is surrounded by the Jamuna-Brahmaputra river floodplain. Previous research suggests the uplift of the Madhupur Tract may have exerted a significant control on the avulsion history of the Jamuna River. The Jamuna river avulsion history is cyclic, with a periodicity of about 2000 years. Within these cycles, the Jamuna's position has fluctuated from west to east and east to west, repeatedly (Pickering et al. 2013). As this avulsion history is thought to be, at least partly, related to seismicity in the region, future seismicity has the potential to cause future river avulsions and related flooding. The Madhupur Tract is an exposed Quaternary deposit. It is believed that 1885 Bengal earthquake may have been caused by the rupture of the Madhupur blind fault (see figure). However, there is no paleo-seismological evidence, since it is an intra-plate active fault. The principle aim of this research is to identify the location of

  5. Arterial embolism

    MedlinePlus

    ... the artery (arterial bypass) to create a second source of blood supply Clot removal through a balloon catheter placed into the affected artery or through open surgery on the artery (embolectomy) Opening of the ...

  6. Aortic dissection presenting as acute subtotal left main coronary artery occlusion: a case approach and review of the literature.

    PubMed

    Ruisi, Michael; Fallahi, Arzhang; Lala, Moinakhtar; Kanei, Yumiko

    2015-05-01

    Aortic dissection is the most common fatal condition of the aorta, yet it is often missed on initial clinical presentation. Aortic dissection associated with acute coronary syndrome (ACS) is relatively rare, but if it occurs, it can be diagnostically challenging, and the condition can be fatal. Here we describe a case of aortic dissection presenting as ST-segment elevation myocardial infarction (STEMI) managed via the transradial approach. We describe the current literature on the subject. PMID:25780485

  7. Aortic Dissection Presenting as Acute Subtotal Left Main Coronary Artery Occlusion: A Case Approach and Review of the Literature

    PubMed Central

    Ruisi, Michael; Fallahi, Arzhang; Lala, Moinakhtar; Kanei, Yumiko

    2015-01-01

    Aortic dissection is the most common fatal condition of the aorta, yet it is often missed on initial clinical presentation. Aortic dissection associated with acute coronary syndrome (ACS) is relatively rare, but if it occurs, it can be diagnostically challenging, and the condition can be fatal. Here we describe a case of aortic dissection presenting as ST-segment elevation myocardial infarction (STEMI) managed via the transradial approach. We describe the current literature on the subject. PMID:25780485

  8. Challenges in predicting the need for coronary artery bypass grafting at presentation in patients with non-ST-segment elevation acute coronary syndromes.

    PubMed

    Mehta, Rajendra H; Chen, Anita Y; Pollack, Charles V; Roe, Matthew T; Zalenski, Robert J; Clements, Elizabeth A; Gibler, W Brian; Ohman, E Magnus; Harrington, Robert A; Peterson, Eric D

    2006-09-01

    In the case of non-ST-segment elevation acute coronary syndromes (NSTE-ACSs), the acute use of certain antiplatelet agents is complicated by concerns about perioperative bleeding risks in patients requiring coronary artery bypass grafting (CABG) during the index hospitalization. As a result, clinicians often withhold potentially useful agents, such as clopidogrel, before determining patients' coronary anatomy. An accurate predictive model could allow for a better balance of this safety concern with the demonstrated benefits of agents such as clopidogrel. To create an accurate decision-making tool that would assess, at hospital presentation, the need for CABG in patients with NSTE-ACSs, we studied 61,974 high-risk patients with NSTE-ACS admitted to 311 CABG-capable hospitals participating in Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) from 2001 to 2003. A total of 8,395 patients (14%) underwent CABG during their initial hospital stay. A multivariate model was developed and identified 13 presenting clinical characteristics significantly associated with the likelihood of CABG (previous CABG, male gender, previous heart failure, diabetes, hyperlipidemia, renal insufficiency, ST depression and transient ST elevation, age > or = 75 years, previous percutaneous coronary intervention, family history of coronary artery disease, hypertension, trends in CABG rates, and previous stroke). This model had only modest predictive accuracy and calibration (c-index = 0.67). In conclusion, although certain presenting clinical features are associated with an increased likelihood of CABG in patients with NSTE-ACSs during the index hospitalization, it remains difficult to reliably identify, before diagnostic angiography, those who will subsequently undergo surgical revascularization. PMID:16923449

  9. Avulsion in Action: Reconstruction and Modelling Sedimentation Pace and Upstream Flood Water Levels Following a Medieval Tidal-River Diversion and Storm Surge Catastrophe, The Netherlands, 1421-1750 AD

    NASA Astrophysics Data System (ADS)

    Cohen, K.; Kleinhans, M. G.; Weerts, H.

    2010-12-01

    mitigation for presently-planned lower-delta engineered diversions. Furthermore, they elucidate the differences between upstream fluvial avulsion and downstream tidal-river avulsion that are important to recognise if we want to understand how deltaic distributary networks are maintained.

  10. Different Mid-Term Prognostic Predictors of Major Adverse Events in Diabetic and Nondiabetic Peripheral Artery Disease Presenting With Critical Limb Ischemia.

    PubMed

    Liang, Kae-Woei; Kuo, Hsun-Nan; Lee, Wen-Lieng; Liu, Tsun-Jui; Lin, Wei-Wen; Tsao, Chen-Rong; Ting, Chih-Tai; Wang, Kuo-Yang

    2016-03-01

    We compared midterm prognostic predictors of peripheral artery disease (PAD) with or without diabetes mellitus (DM) presenting with critical lower limb ischemia (CLI). A total of 172 patients with PAD (109 DM; 63 non-DM) were enrolled. The major adverse events (MAEs) were death or amputation. The diabetic group had a higher MAE rate (39% vs 22%, P = .042) with a mean follow-up duration of 30 ± 19 months. In a multivariate binary logistic regression analysis, revascularization (odds ratio = 0.289, P = .006) and higher serum cholesterol (odds ratio=0.988, P = .027) predicted a lower MAE rate in the DM group. In contrast, the presence of severe chronic kidney disease (stage 4 or 5, odds ratio = 5.238, P = .025) was a positive predictor of MAEs in the nondiabetic group. In conclusion, the prognostic predictors of MAE in diabetic and nondiabetic patients with PAD and CLI were different. PMID:23389094

  11. Delayed replantation of an avulsed maxillary premolar with open apex: a 24 months follow-up case report.

    PubMed

    Ravi, K S; Pinky, C; Kumar, Shikhar; Vanka, Amit

    2013-01-01

    Avulsion of permanent teeth is most serious of all dental injuries and accounts for 1-16% of all traumatic injuries, of which maxillary incisors are most commonly involved. However, in this report a rare case of isolated avulsed immature premolar has been described. The patient had reported more than 3 hours after the trauma with a tooth stored in dry condition and soil contamination. The prognosis depends on measures taken at the place of accident or the time immediately after avulsion. Replantation is the treatment of choice, but cannot always be performed immediately. An appropriate emergency management and treatment plan is important for good prognosis. In this report stepwise management of an avulsed immature maxillary premolar with extended period of dry storage has been described followed up for a period of 2 yrs. PMID:24021335

  12. Radiographic and Arthroscopic Assessment of DRUJ Instability Due to Foveal Avulsion of the Radioulnar Ligament in Distal Radius Fractures

    PubMed Central

    Nakamura, Toshiyasu; Iwamoto, Takuji; Matsumura, Noboru; Sato, Kazuki; Toyama, Yoshiaki

    2014-01-01

    Background As the triangular fibrocartilage complex (TFCC) anchors the distal radius to the ulna via the radioulnar ligament (RUL), a severely displaced distal fragment of the radius may be associated with a foveal avulsion of the TFCC. The purpose of this retrospective study was to assess, radiographically and arthroscopically, the relationship between displacement of the radius, the ulnar styloid, and avulsion of the RUL resulting in distal radioulnar joint (DRUJ) instability. Materials and Methods Twenty-nine wrists of 29 patients with intra- and extra-articular distal radius fractures/malunion who underwent reduction or a corrective osteotomy of the displaced/malunited fracture, and/or wrist arthroscopy, were assessed radiographically and arthroscopically. Radial translation, radial inclination, radial shortening, volar or dorsal tilt, and the presence of an ulnar styloid fracture with more than 4 mm of displacement were measured from the initial films. Radiocarpal arthroscopy was used to assess peripheral lesions of the TFCC, while DRUJ arthroscopy was used to assess the foveal attachment. The relationship between displacement of the distal radius or the ulnar styloid fracture and the TFCC injury, including avulsion of the RUL, was recorded. Results Univariate analysis revealed that increased radial translation, decreased radial inclination, increased radial shortening, and an ulnar styloid fragment radially displaced by more than 4 mm were significant predictors of RUL avulsion at the fovea. Volar or dorsal tilt of the radius and ulnar variance did not correlate with RUL avulsion or TFCC injuries. Multiple logistic regression analysis revealed that radial translation was an independent risk factor of foveal avulsion of the RUL. Conclusions Increased radial translation and radial shortening and decreased radial inclination of the distal fragment can be associated with a foveal avulsion of the RUL. Radial translation can be an independent risk

  13. Radiographic and Arthroscopic Assessment of DRUJ Instability Due to Foveal Avulsion of the Radioulnar Ligament in Distal Radius Fractures.

    PubMed

    Nakamura, Toshiyasu; Iwamoto, Takuji; Matsumura, Noboru; Sato, Kazuki; Toyama, Yoshiaki

    2014-02-01

    Background As the triangular fibrocartilage complex (TFCC) anchors the distal radius to the ulna via the radioulnar ligament (RUL), a severely displaced distal fragment of the radius may be associated with a foveal avulsion of the TFCC. The purpose of this retrospective study was to assess, radiographically and arthroscopically, the relationship between displacement of the radius, the ulnar styloid, and avulsion of the RUL resulting in distal radioulnar joint (DRUJ) instability. Materials and Methods Twenty-nine wrists of 29 patients with intra- and extra-articular distal radius fractures/malunion who underwent reduction or a corrective osteotomy of the displaced/malunited fracture, and/or wrist arthroscopy, were assessed radiographically and arthroscopically. Radial translation, radial inclination, radial shortening, volar or dorsal tilt, and the presence of an ulnar styloid fracture with more than 4 mm of displacement were measured from the initial films. Radiocarpal arthroscopy was used to assess peripheral lesions of the TFCC, while DRUJ arthroscopy was used to assess the foveal attachment. The relationship between displacement of the distal radius or the ulnar styloid fracture and the TFCC injury, including avulsion of the RUL, was recorded. Results Univariate analysis revealed that increased radial translation, decreased radial inclination, increased radial shortening, and an ulnar styloid fragment radially displaced by more than 4 mm were significant predictors of RUL avulsion at the fovea. Volar or dorsal tilt of the radius and ulnar variance did not correlate with RUL avulsion or TFCC injuries. Multiple logistic regression analysis revealed that radial translation was an independent risk factor of foveal avulsion of the RUL. Conclusions Increased radial translation and radial shortening and decreased radial inclination of the distal fragment can be associated with a foveal avulsion of the RUL. Radial translation can be an independent risk

  14. [Immediate and remote results of surgical treatment of patients presenting with pathological tortuosity of internal carotid arteries and accompanying ocular ischaemic syndrome].

    PubMed

    Gavrilenko, A V; Kuklin, A V; Kisileva, T N; Abramian, A V; Omarzhanova, I I

    2013-01-01

    The article deals with the data concerning the efficacy of reconstructive operations and conservative treatment in patients presenting with pathological tortuosity of internal carotid arteries. The study included a total of 63 patients. The diagnostic algorithm was as follows: studying the haemodynamics of the internal carotid arteries, assessing the neurological status, and the methods of examining the eye. The patients were subdivided into two groups: Group One consisted of operated on patients (n=37) and Group Two comprising patients treated conservatively (n=26). The patients according to the neurological status were subdivided as follows: an asymptomatic course in 25 (39.7%) patients, transitory ischaemic attacks in 18 (28.6%) patients, dyscirculatory encephalopathy in 12 (19 %) patients, and stroke in 8 (12.7%) patients. Ophthalmological symptomatology was predominantly manifested by fits of amaurosis fugax in 19 (30.2%) patients and processes of maculodystrophy in 49 (77.8 %) patients. We assessed the immediate (day 30) and remote (1 year) results of conservative and surgical treatment. Group One patients demonstrated cessation of the amaurosis fugax attacks, improvement of the acuity of vision by 0.1 and more, enlargement of the borders of the field of vision, disappearance of scotomas, as well as arrest of the processes of maculodystrophy. Patients with transitory ischaemic attacks and dyscirculatory encephalopathy changed to the category of asymptomatic patients. In Group Two patients the dynamics of the neurological status was negative and the patients continued to experience fits of amaurosis fugas. The dynamics of the opthalmological symptomatology was weakly pronounced. PMID:24429568

  15. Arthroscopic Suture Fixation in Femoral-Sided Avulsion Fracture of Anterior Cruciate Ligament

    PubMed Central

    Prasathaporn, Niti; Umprai, Vantawat; Laohathaimongkol, Thongchai; Kuptniratsaikul, Somsak; Kongrukgreatiyos, Kitiphong

    2015-01-01

    A femoral-sided avulsion fracture of the anterior cruciate ligament (ACL) is a rare and challenging condition. Most reported cases have occurred in childhood or adolescence. Many techniques of ACL repair have been reported, and in recent years, techniques in arthroscopic surgery have been developed and have become ever more popular with orthopaedic surgeons. We created a technique of arthroscopic ACL repair with suture anchor fixation for a femoral-sided ACL avulsion fracture. This technique saves the natural ACL stump. It is available for cases in which creation of a tibial tunnel is not allowed. Moreover, it does not require a skin incision for fixation on the far femoral cortex and, therefore, does not require a second operation to remove the fixation device. The arthroscopic technique also has a good cosmetic outcome. PMID:26258035

  16. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament: functional result☆

    PubMed Central

    Barros, Marcos Alexandre; Cervone, Gabriel Lopes de Faria; Costa, André Luis Serigatti

    2015-01-01

    Objective To objectively and subjectively evaluate the functional result from before to after surgery among patients with a diagnosis of an isolated avulsion fracture of the posterior cruciate ligament who were treated surgically. Method Five patients were evaluated by means of reviewing the medical files, applying the Lysholm questionnaire, physical examination and radiological examination. For the statistical analysis, a significance level of 0.10 and 95% confidence interval were used. Results According to the Lysholm criteria, all the patients were classified as poor (<64 points) before the operation and evolved to a mean of 96 points six months after the operation. We observed that 100% of the posterior drawer cases became negative, taking values less than 5 mm to be negative. Conclusion Surgical methods with stable fixation for treating avulsion fractures at the tibial insertion of the posterior cruciate ligament produce acceptable functional results from the surgical and radiological points of view, with a significance level of 0.042.

  17. Spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit - a counterpart to Osgood-Schlatter disease in humans?

    PubMed

    Nehrbass, D; Arens, D; Zeiter, S

    2015-02-01

    The first reported case describing a spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit is presented. So far in animals, this condition has been only described in dogs and horses. In humans, this condition is also called Osgood-Schlatter disease (OSD) or syndrome, traction apophysitis of the tibial tubercle (ATT) or patellar tendon enthesopathy of the tibial tuberosity respectively. It is mainly seen in young adolescents coinciding with periods of growth spurts. In humans, its pathogenesis is believed to be caused by repetitive tendon/muscle strain at the insertion of the patellar tendon to the immature tibial tuberosity, which has its own secondary ossification center. Morphologically this case is characterized by bilateral chronic avulsion with incomplete separation of the tuberositas tibae, and proximal dislocation of the patella (patella alta). Despite these marked pathological changes, the animal was clinically without findings. Nevertheless, this case emphasizes the need for thorough clinical and radiological examination of rabbits intended for preclinical research studies prior to study begin, especially in orthopedic research. PMID:25435475

  18. Arterial stick

    MedlinePlus

    ... venous blood) mainly in its content of dissolved gases . Testing arterial blood shows the makeup of the ... arteries. Blood samples are mainly taken to measure gases in the arteries. Abnormal results may point to ...

  19. EGb761 protects motoneurons against avulsion-induced oxidative stress in rats

    PubMed Central

    2010-01-01

    Background Root avulsion of the brachial plexus causes an oxidative stress reaction in the spinal cord and induces dramatic spinal motoneuron death, while EGb761 is a natural free radical cleaning agent. This study was designed to investigate the protective effects of intraperitoneally injected EGb761 against neural damage following brachial root avulsion. Methods The effect of EGb761 on avulsion-induced motoneuron injury was studied in 26 total groups of (n) rats, treated as follows. Animals in singular number groups received EGb761(50 mg/kg.d) and those in complex number groups received normal saline solution (i.p.), serving as controls. Groups 1-8 were used for the determination of nitric oxide (NO) levels in the serum and injured spinal cord at the 5 d, 2 w, 4 w, and 6 w time points. Groups 9-16 were used for determination of constitutive nitric oxide synthase (cNOS) and inducible nitric oxide synthase (iNOS) levels in injured spinal cord at the 5 d, 2 w, 4 w, and 6 w time points. Groups 17-26 were used for determination of the number of neuronal nitric oxide synthase (nNOS)-positive and surviving motoneurons in injured C7 ventral horn at the 5 d, 2 w, 4 w, 6 w and 8 w time points. Results Compared to control groups, the EGb761 treatment group not only had significant decreased levels of NO in serum at 2 w and 6 w after avulsion, but also had reduced levels of NO specifically in the spinal cord at 2 w, 4 w and 6 w. The cNOS activity in the spinal cord was also significant decreased at 2 w and 4 w, while the iNOS activity in injured C6-T1 spinal segments was reduced at 2 w, 4 w and 6 w. All together, the percentages of NADPH-d positive motoneurons in an injured C7 segment were down-regulated and the number of surviving motoneurons in injured C7 ventral horn was increased at 2 w, 4 w, 6 w and 8 w in treated versus untreated animals. Conclusions Intraperitoneal administration of EGb761 after root avulsion of the brachial plexus exerted protective effects by

  20. Avulsion at a drift-dominated mesotidal estuary: The Chubut River outlet, Patagonia, Argentina

    NASA Astrophysics Data System (ADS)

    Isla, Federico; Espinosa, Marcela; Rubio, Belén; Escandell, Alejandra; Gerpe, Marcela; Miglioranza, Karina; Rey, Daniel; Vilas, Federico

    2015-10-01

    The Chubut River flows from the Andes to the Atlantic Ocean, and is interrupted by a single dam built at the middle valley. The lower valley is dominated by the aggradation of an alluvial plain induced by a complex of spits that enclosed the inlet in the last 5000 years. The river has reduced its flow because the blocking of the upper basin by terminal moraines during the Upper Pleistocene. At least the last two marine transgressions have flooded this estuary, and contributed to the aggradation during regressions. The area is of particular interest in regard to irrigation channels practiced since the XIX century. Today, the mean monthly flow is less than 10 m3/s although peaks of 95 m3/s have been recorded in Gaiman in July 2001. The dynamics of the estuary is dominated by waves (wave-dominated estuary) as tidal effects attenuate in less than 5 km. Three vibracores were collected within this floodplain: (a) at Gaiman, an area without any effect of the sea (35 km from the coast); (b) at Trelew, at the former avulsion plain of the river (18 km from the coast); and (c) at Playa Magagna, a saltmarsh located 0.4 km from the beach. At the Gaiman core (1.54 m long) fresh-water epiphytic diatoms dominate (Epithemia sorex, Cocconeis placentula, Ulnaria ulna) suggesting the aggradation of an alluvial plain. The Trelew core (2.19 m long) was collected from a deltaic plain. It was composed by fine sand with organic matter at the base that evolved into silty layers to the top. Several unconformities and laminae with heavy minerals were detected by their geochemical composition analysed by micro X-ray fluorescence (Itrax XRF core scanner). Fine-sand laminated layers were perfectly detected by their high content in S and Cl. On the other hand, mud layers presented lower content in Mg and Al with increments in Ca and V. The core from the marsh area (1.67 m long) was analysed in terms of the diatom evolution in order to detect Holocene sea-level and salinity effects. The sand flats

  1. Anomalous Origination of Right Coronary Artery from Left Sinus in Asymptomatic Young Male Presenting with Positive Ischemic Response on Treadmill Test

    PubMed Central

    Setianto, Budi Yuli; Hartopo, Anggoro Budi; Gharini, Putrika Prastuti Ratna; Taufiq, Nahar

    2016-01-01

    Anomalous origination of coronary artery from the opposite sinus (ACAOS) is a rare coronary artery anomaly. Right ACAOS with interarterial course is a type of ACAOS, which conveys a high risk for myocardial ischemia or sudden death. We reported a case of right ACAOS with interarterial course in otherwise healthy young male. He was asymptomatic, until an obligatory medical check-up with treadmill test showed a sign of positive ischemic response. Further work-up revealed that he had right ACAOS with interarterial course. Watchful observation was applied to him, while strenuous physical activity and competitive sport were absolutely prohibited. PMID:26885410

  2. Avulsion processes at the terminus of low-gradient semi-arid fluvial systems: Lessons from the Río Colorado, Altiplano endorheic basin, Bolivia

    NASA Astrophysics Data System (ADS)

    Donselaar, M. E.; Cuevas Gozalo, M. C.; Moyano, S.

    2013-01-01

    The Río Colorado dryland river system in the southeast of the endorheic Altiplano Basin (Bolivia) terminates on a very flat coastal plain at the edge of the Salar de Uyuni, the world's largest salt pan with an area of ca. 12,500 km2. Since the Pleistocene the basin has experienced several lake expansion and contraction cycles in response to wetter and drier climate periods, respectively. At present the basin is in a dry climate period which results in a lake level lowstand and progradation of fluvial systems such as the Río Colorado onto the former lake bottom. The present field study of the terminus of the Río Colorado shows that the river experiences a gradual downstream decrease of bankfull width and depth. This bankfull decrease is caused by the combined effects of: (1) extremely low gradient of the lake bottom and, hence, loss of flow energy, and (2) downstream transmission losses due to high evaporation potential and river water percolation through the channel floor. Peak water discharge in seasonal, short-duration rain periods causes massive overbank flooding and floodplain inundation. On satellite images the morphology of the river terminus has a divergent pattern and resembles a network of coeval sinuous distributary channels. However, field observations show that only one channel is active at low flow stage, and at high-flow stage an abandoned, partially infilled channel may be active as well. The active channel at its termination splits into narrow and shallow anastomosing streams before its demise on the lacustrine coastal plain. The rest of the channels which form the divergent network are older sediment-filled abandoned sinuous river courses with multiple random avulsion points. These channel deposits, together with extensive amalgamated crevasse-splay deposits, form an intricate network of fluvial sand deposits. Successive stages of progressively deeper crevasse-channel incision into the floodplain are the result of waning-stage return flow of

  3. Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon

    PubMed Central

    Oshima, Takeshi; Nakase, Junsuke; Numata, Hitoaki; Takata, Yasushi

    2015-01-01

    A multiple-ligament knee injury that includes posterolateral corner (PLC) disruption often causes palsy of the common peroneal nerve (CPN), which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury. PMID:26064740

  4. Coronary artery balloon angioplasty - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100160.htm Coronary artery balloon angioplasty - series To use the sharing features ... out of 9 Normal anatomy Overview The coronary arteries supply blood to the heart muscle. The right ...

  5. Penetrating head injury with bilateral eye avulsion due to Himalayan bear bite.

    PubMed

    Roka, Yam B; Roka, Narayani; Shrestha, Manzil; Puri, Puspa R; Adhikari, Hari B

    2012-12-01

    The Himalayan black bear (Ursus thibetanus or Selenarctos thibetanus), although an omnivore, is more carnivorous than its American counterpart. It is also more aggressive towards humans and is a threatened species because of the deforestation in the Himalayas. Furthermore, poverty, encroachment of the forest, extensive deforestation, lack of education and living near the forest are factors that increase the probability of such animal injuries. We report the case of a 35-year-old woman who suffered a severe penetrating head injury with scalp and bilateral eye avulsion, which was managed successfully. PMID:23216732

  6. Stress avulsion fracture of the tarsal navicular. An uncommon sports-related overuse injury.

    PubMed

    Orava, S; Karpakka, J; Hulkko, A; Takala, T

    1991-01-01

    We report nine cases of stress-related avulsion fracture of the tarsal navicular in athletes. This uncommon over-use injury is thought to occur following repetitive cyclic compressive loading secondary to an impingement of the tarsal navicular. The small dorsal triangular fragment is best seen in weightbearing lateral view radiographs and isotope scan and/or tomography help confirm the diagnosis. We feel that operative treatment is the method of choice in highly symptomatic cases and among top athletes because of the shorter recovery time. PMID:1897656

  7. An evidence-based appraisal of splinting luxated, avulsed and root-fractured teeth.

    PubMed

    Kahler, Bill; Heithersay, Geoffrey S

    2008-02-01

    The evidence-based methodology involves framing a well defined PICO (problem, intervention, comparison and outcome) question related to a clinical problem and then comprehensively searching for the evidence, which is evaluated to appraise the value of the treatment intervention. For this systematic review of splinting of teeth that have been luxated, avulsed or root-fractured, the clinical PICO question is (P) what are splinting intervention decisions for luxated, avulsed and root-fractured teeth (I) considering that the splinting intervention choice may include (i) no splinting, (ii) rigid or functional splinting for the different types of trauma and (iii) different durations of the splinting period (C) when comparing these splinting choices for the different types of trauma and their effect on (O) healing outcomes for the teeth. A keyword search of PubMed was used. Reference lists from identified articles and dental traumatology texts were also appraised. The inclusion criterion for this review was either a multivariate analysis or controlled stratified analyses as many variables have the potential to confound the assessment and evaluation of healing outcomes for teeth that have been luxated, avulsed or root-fractured. A positive statistical test is not proof of a causal conclusion, as a positive statistical relationship can arise by chance, and so this review also appraises animal studies that reportedly explain biological mechanisms that relate to healing outcomes of splinted teeth. The clinical studies were ranked using the 'Centre of Evidence-based Medicine' categorization (levels 1-5). All 12 clinical studies selected were ranked as level 4. The studies generally indicate that the prognosis is determined by the type of injury rather than factors associated with splinting. The results indicate that the types of splint and the fixation period are generally not significant variables when related to healing outcomes. This appraisal identified difficulties in the

  8. Nonoperative Damage Control: The Use of Extracorporeal Membrane Oxygenation in Traumatic Bronchial Avulsion as a Bridge to Definitive Operation.

    PubMed

    Schmoekel, Nathan H; O'Connor, James V; Scalea, Thomas M

    2016-06-01

    The conventional treatment for an avulsed bronchus is emergent thoracotomy and repair or lobectomy. The principles of damage control thoracic operations include initial hemorrhage control with delayed definite repair after physiologic resuscitation. We report a multiply injured patient with avulsion of the left lower lobe bronchus. Profound acidosis, hypercarbia, and hypoxia precluded an emergent operation, and venovenous extracorporeal membrane oxygenation (V-V ECMO) was used for organ support during physiologic resuscitation. After the achievement of physiologic repletion, a thoracotomy and lobectomy were performed while the patient was supported by V-V ECMO. PMID:27211954

  9. Weak Radial Artery Pulse

    PubMed Central

    Venugopalan, Poothirikovil; Sivakumar, Puthuval; Ardley, Robert G.; Oates, Crispian

    2012-01-01

    We present an 11year-old boy with a weak right radial pulse, and describe the successful application of vascular ultrasound to identify the ulnar artery dominance and a thin right radial artery with below normal Doppler flow velocity that could explain the discrepancy. The implications of identifying this anomaly are discussed. PMID:22375269

  10. Depression as a Risk Factor for the Initial Presentation of Twelve Cardiac, Cerebrovascular, and Peripheral Arterial Diseases: Data Linkage Study of 1.9 Million Women and Men

    PubMed Central

    George, Julie; Walters, Kate; Osborn, David P.; Batty, G. David; Stogiannis, Dimitris; Rapsomaniki, Eleni; Pujades-Rodriguez, Mar; Denaxas, Spiros; Udumyan, Ruzan; Kivimaki, Mika; Hemingway, Harry

    2016-01-01

    Background Depression is associated with coronary heart disease and stroke, but associations with a range of pathologically diverse cardiovascular diseases are not well understood. We examine the risk of 12 cardiovascular diseases according to depression status (history or new onset). Methods Cohort study of 1,937,360 adult men and women, free from cardiovascular disease at baseline, using linked UK electronic health records between 1997 and 2010. The exposures were new-onset depression (a new GP diagnosis of depression and/or prescription for antidepressants during a one-year baseline), and history of GP-diagnosed depression before baseline. The primary endpoint was initial presentation of 12 cardiovascular diseases after baseline. We used disease-specific Cox proportional hazards models with multiple imputation adjusting for cardiovascular risk factors (age, sex, socioeconomic status, smoking, blood pressure, diabetes, cholesterol). Results Over a median [IQR] 6.9 [2.1–10.5] years of follow-up, 18.9% had a history of depression and 94,432 incident cardiovascular events occurred. After adjustment for cardiovascular risk factors, history of depression was associated with: stable angina (Hazard Ratio = 1.38, 95%CI 1.32–1.45), unstable angina (1.70, 1.60–1.82), myocardial infarction (1.21, 1.16–1.27), unheralded coronary death (1.23, 1.14–1.32), heart failure (1.18, 1.13–1.24), cardiac arrest (1.14, 1.03–1.26), transient ischemic attack (1.31, 1.25–1.38), ischemic stroke (1.26, 1.18–1.34), subarachnoid haemorrhage (1.17, 1.01–1.35), intracerebral haemorrhage (1.30, 1.17–1.45), peripheral arterial disease (1.24, 1.18–1.30), and abdominal aortic aneurysm (1.12,1.01–1.24). New onset depression developed in 2.9% of people, among whom 63,761 cardiovascular events occurred. New onset depression was similarly associated with each of the 12 diseases, with no evidence of stronger associations compared to history of depression. The strength of

  11. Identification and management of chronic shoulder pain in the presence of an MRA-confirmed humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion

    PubMed Central

    Karmali, Arif; McLeod, Jennifer

    2016-01-01

    Objective: To present the assessment and conservative management of chronic shoulder pain in the presence of a humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion in an active individual. Clinical Features: A 47 year-old female office-worker with constant, deep, right shoulder pain with occasional clicking and catching claimed to have “tore something” in her right shoulder five years ago while performing reverse bicep curls. A physical exam led to differential diagnoses of a Superior Labrum Anterior to Posterior (SLAP) lesion, Bankart lesion, and bicipital tendinopathy. A Magnetic Resonance Arthrogram revealed a HAGL lesion. Intervention and Outcome: A conservative chiropractic treatment plan in addition to physical therapy was initiated. The patient reported 75% improvement in symptoms after 4 treatments over a four-week duration. Summary: This case demonstrates the successful implementation of a conservative plan of management suggesting that the treatment provided to this patient should be considered and attempted prior to arthroscopic surgery. PMID:27385837

  12. Case report: endodontic and surgical treatment of an upper central incisor with external root resorption and radicular cyst following a traumatic tooth avulsion.

    PubMed

    Lux, Hans-Christian; Goetz, Falko; Hellwig, Elmar

    2010-11-01

    In the age group between 6 and 12 years, trauma to the upper incisors happens frequently. In the case of avulsion, a replantation is the state-of-the-art treatment; however, it may lead to several complications, particularly if suitable posttraumatic management is not carried out. External cervical resorptions as well as apical granuloma and cysts due to microbial contamination of the root canal are common complications. In the presented trauma case, a conservative approach was chosen to treat a large cystic lesion combined with cervical and apical resorptions. After initial placement of Ledermix and calcium hydroxide into the root canal, a marsupialization with the temporary insertion of an obturator was performed. The gradual reduction led to a fast recovery of the bony defect and a root canal filling was placed. The 2-year follow-up showed an improved condition. All adjacent teeth remained vital during the course of the treatment. PMID:20692191

  13. Airbag-induced thumb avulsion: two case reports.

    PubMed

    Stoel, Anne-Marie C C; Vanhaecke, Jeroen; Dezillie, Marleen; Oosterlinck, Dirk; Stockmans, Filip

    2015-03-01

    Although airbags are designed to save lives and protect victims from serious injuries, airbag deployment can cause unwanted lesions. In this case report, two cases are presented of young women who sustained an important fracture dislocation of the first carpometacarpal joint (CMC I joint) caused by airbag deployment during a car collision. PMID:25762890

  14. Arterial Stiffness Alterations and Inflammatory Response Following Endovascular Aortic Repair: Based on a Presentation at the 2013 VEITH Symposium, November 19-23, 2013 (New York, NY, USA).

    PubMed

    Moulakakis, Konstantinos G; Mylonas, Spyridon N; Kakisis, John; Kadoglou, Nikolaos P E; Papadakis, Ioannis; Sfyroeras, George S; Antonopoulos, Constantine C N; Mantas, George; Ikonomidis, Ignatios; Liapis, Christos D

    2015-04-01

    Endovascular abdominal aortic aneurysm repair (EVAR) and thoracic aortic aneurysm repair (TEVAR) have been widely incorporated into clinical practice. However, changes in arterial stiffness and post-implantation syndrome after aortic endografting remain important issues under investigation. The aneurysm sac wall motion after successful EVAR and TEVAR reflects complex interactions between all the components of the excluded aneurysm, including true compliance of the aneurysm wall itself, intra-aneurysm sac pressure, remodeling of the thrombus, and mechanical characteristics of the endograft. Experimental and clinical studies have shown that aortic endografting results in increased arterial stiffness in animal models. It can be assumed that the alterations of aortic mechanical properties can have a direct impact on heart output. The long-term impact of these mechanical changes on cardiovascular outcomes and the potential effects of different endografts on hemodynamics are important issues under investigation. Post-implantation syndrome (PIS) is a systemic inflammatory response frequently observed after endovascular treatment of aortic pathologies. The main features of PIS include fever, leukocytosis, elevated C-reactive protein levels, and coagulation disturbances. Endograft design appears to influence this inflammatory response following aortic endografting; woven polyester endografts have been shown to be associated with greater inflammatory response compared to PTFE stent grafts. The purpose of this paper is to review the literature to elucidate arterial stiffness alterations and inflammatory response after EVAR and TEVAR and the impact of endograft design on aortic stiffness and the post-inflammatory response. PMID:26798761

  15. Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury

    PubMed Central

    Woo, Sung Jong; Jegal, Midum; Park, Min Jong

    2016-01-01

    Background: Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair. Materials and Methods: Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14–25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work. Results: Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain. Conclusions: Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability. PMID:27293286

  16. The Use of Aloe Vera Extract as a Novel Storage Media for the Avulsed Tooth

    PubMed Central

    Badakhsh, Samaneh; Eskandarian, Tahereh; Esmaeilpour, Tahereh

    2014-01-01

    Background: Tooth avulsion is one of the most severe dental traumas which most often occur in children. When immediate replantation is not possible, storage in a proper media may lead to a prolonged survival rate. Aloe Vera is a cactus like plant with green, tapered leaves that are filled with a transparent viscous gel. This medicinal plant has significant anti-inflammatory, antioxidant, antibacterial and antifungal effects. The purpose of this study was to assess the effectiveness of different concentrations of Aloe Vera extract compared to DMEM (cell culture medium) and egg white. Methods: The periodontal ligament (PDL) cells were cultured and certain number of cells were treated with Aloe Vera extract (in four different concentrations), egg white and culture media for 1, 3, 6, and 9 hours. Cell viability was determined by using the (3-[4, 5-dimethylthiazolyl-2]-2, 5-diphenyltetrazolium bromide) assay. Moreover, One-way ANOVA and post hoc (LSD) test were used for analyzing the study groups. Results: The results indicate that culture media and Aloe Vera extract (10, 30, and 50% concentration) were statistically similar and significantly preserved more PDL cells compared to other experimental storage media. Conclusion: Aloe Vera 10, 30, and 50% may be recommended as a suitable storage media for avulsed teeth. PMID:25031484

  17. Human Embryonic Stem Cell-Derived Progenitors Assist Functional Sensory Axon Regeneration after Dorsal Root Avulsion Injury

    PubMed Central

    Hoeber, Jan; Trolle, Carl; Konig, Niclas; Du, Zhongwei; Gallo, Alessandro; Hermans, Emmanuel; Aldskogius, Hakan; Shortland, Peter; Zhang, Su-Chun; Deumens, Ronald; Kozlova, Elena N.

    2015-01-01

    Dorsal root avulsion results in permanent impairment of sensory functions due to disconnection between the peripheral and central nervous system. Improved strategies are therefore needed to reconnect injured sensory neurons with their spinal cord targets in order to achieve functional repair after brachial and lumbosacral plexus avulsion injuries. Here, we show that sensory functions can be restored in the adult mouse if avulsed sensory fibers are bridged with the spinal cord by human neural progenitor (hNP) transplants. Responses to peripheral mechanical sensory stimulation were significantly improved in transplanted animals. Transganglionic tracing showed host sensory axons only in the spinal cord dorsal horn of treated animals. Immunohistochemical analysis confirmed that sensory fibers had grown through the bridge and showed robust survival and differentiation of the transplants. Section of the repaired dorsal roots distal to the transplant completely abolished the behavioral improvement. This demonstrates that hNP transplants promote recovery of sensorimotor functions after dorsal root avulsion, and that these effects are mediated by spinal ingrowth of host sensory axons. These results provide a rationale for the development of novel stem cell-based strategies for functionally useful bridging of the peripheral and central nervous system. PMID:26053681

  18. Acute arterial occlusion - kidney

    MedlinePlus

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidneys need a good blood supply. The main artery to the kidney is called the renal artery. ...

  19. Acute arterial occlusion - kidney

    MedlinePlus

    ... arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury ...

  20. Diagnostic Confidence of Run-Off CT-Angiography as the Primary Diagnostic Imaging Modality in Patients Presenting with Acute or Chronic Peripheral Arterial Disease

    PubMed Central

    Werncke, Thomas; Ringe, Kristina Imeen; von Falck, Christian; Kruschewski, Martin; Wacker, Frank; Meyer, Bernhard Christian

    2015-01-01

    Objectives To investigate the reliability of CT-angiography of the lower extremities (run-off CTA) to derive a treatment decision in patients with acute and chronic peripheral artery disease (PAD). Materials and Methods 314 patients referred for run-off CTA were includ-ed in this retrospective study. First, diagnostic confidence of run-off CTA to derive a treat-ment decision was assessed in an interdisciplinary vascular conference using a 2 point scale (sufficient or not sufficient diagnostic confidence) and compared with the image quality eval-uated by two readers in consensus in four different levels (abdominopelvic, thigh, calf, foot arteries). Second, reliability of treatment decision was verified in all patients undergoing re-vascularization therapy. Results Diagnostic confidence of run-off CTA to derive a treatment deci-sion was sufficient in all patients with acute and in 97% of patients (215/221) with chronic PAD, whereas the rate of run-off CTA with non-diagnostic image quality was considerably higher in the calf and foot level (acute vs. chronic; calf: 28% vs.17%; foot: 52% vs. 20%). Reliability of treatment decision was superior for patients with chronic (123/133 = 92%) than for patients with acute PAD (64/78 = 82%, P = 0.02). Conclusion Run-off CTA is a reliable imaging modality for primary diag-nostic work-up of patients with acute and chronic PAD. PMID:25835948

  1. Vertebrobasilar Artery Occlusion

    PubMed Central

    Schoen, Jessica C.; Boysen, Megan M.; Warren, Chase R.; Chakravarthy, Bharath; Lotfipour, Shahram

    2011-01-01

    The presentation of vertebrobasilar artery occlusion varies with the cause of occlusion and location of ischemia. This often results in delay in diagnosis. Areas of the brain supplied by the posterior circulation are difficult to visualize and usually require angiography or magnetic resonance imaging. Intravenous thrombolysis and local-intra arterial thrombolysis are the most common treatment approaches used. Recanalization of the occluded vessel significantly improves morbidity and mortality. Here we present a review of the literature and a case of a patient with altered mental status caused by vertebrobasilar artery occlusion. PMID:21691534

  2. Bilateral popliteal arterial dissection.

    PubMed

    Chen, Po-Liang; Ko, Shih-Yu; Tan, Ken-Hing

    2012-01-01

    A clinical feature of bilateral popliteal arterial dissection without involving the descending aorta, bilateral iliac, as well as femoral arteries has never been reported in the past literature. We report a 56-year-old man with hypertension and coronary artery disease who presented to our emergency department with complaints of bilateral knee pain after long-distance walking. Physical examination was notable for elevated blood pressure, but there was no palpable pulsation over dorsalis pedis arteries on his feet. Laboratory evaluation revealed a d-dimer level of 35.2 mg/L (FEU) on the day of the test and 1.2 mg/L one and a half months ago (normal level, <0.55). These findings were suggestive of a recent-onset peripheral arterial occlusive disorder. Computed tomography of the aorta showed bilateral popliteal arterial dissection with arterial intimal flap. Abdominal aorta, bilateral iliac, and femoral arteries remained intact with only arteriosclerotic change. Minimally invasive endovascular stent grafting was then performed. The patient had an uneventful recovery. PMID:21106320

  3. Giant Subclavian Artery Aneurysm.

    PubMed

    Counts, Sarah; Zeeshan, Ahmad; Elefteriades, John

    2016-06-01

    We report the case of a 37-year-old construction executive presenting with chest pain, shortness of breath, and dizziness on exertion secondary to a giant left subclavian artery aneurysm and aortic valvular disease. PMID:27231430

  4. PARTIAL ARTICULAR SUPRASPINATUS TENDON AVULSION (PASTA) LESION. CURRENT CONCEPTS IN REHABILITATION

    PubMed Central

    2016-01-01

    ABSTRACT Rotator cuff pathology can contribute to shoulder pain and may affect the performance of sport activities, work, and activities of daily living. The partial articular supraspinatus tendon avulsion (PASTA) lesion represents a very common type of rotator cuff pathology seen in rehabilitation. When conservative treatment fails, surgery is generally required. Success of recovery depends on several factors, including: repair techniques, healing process related to timing, rehabilitation programs, and patient compliance with home exercises. To date, most treatment modalities and rehabilitation programs are based on clinical experience rather than scientific evidence. Therefore, the purpose of this clinical commentary is to provide an overview on the PASTA lesion, discuss the common treatment approaches adopted to date and to propose a rehabilitation program based on the available scientific evidence. Level of Evidence 5 PMID:27274431

  5. Type IV FDP avulsion: lessons learned clinically and through review of the literature.

    PubMed

    Henry, Steven L; Katz, Mark A; Green, David P

    2009-12-01

    The type IV flexor digitorum profundus avulsion is a rare injury involving fracture of the volar base of the distal phalanx and separation of the tendon from the fracture fragment. Recommendations for management are sparse and are substantiated only by a few isolated case reports. We recently encountered two of these injuries, both of which proved challenging, particularly with regard to joint incongruity and tendon adhesions. In reviewing the literature, it is apparent that no consensus exists regarding surgical strategies. However, based on our experience and that of other authors, we can suggest the following: (1) high index of suspicion of this potentially deceptive injury, with use of magnetic resonance imaging or ultrasound if preoperative confirmation is needed; (2) rigid bony fixation that prevents dorsal subluxation of the distal phalanx; (3) tendon repair that is independent of the bony fixation; and (4) early range of motion therapy. PMID:19399559

  6. Deep circumflex iliac artery as a free arterial graft for myocardial revascularization.

    PubMed

    Yaginuma, G; Sakurai, M; Meguro, T; Ota, K; Abe, K

    2000-02-01

    When complete revascularization cannot be obtained with the internal thoracic artery and the other arterial grafts, the deep circumflex iliac artery (DCIA) may be an excellent alternative conduit. The deep circumflex iliac artery was used as a free graft for direct myocardial revascularization in 4 patients from January to July 1999. We describe our experience with this arterial conduit, review the anatomy of the artery, and present our harvesting technique. PMID:10735725

  7. Visual Deterioration and Herniation of the Anterior Cerebral Artery: Unusual Presentation of an Empty Sella Syndrome Complicating Decompression of a Rathke Cleft Cyst.

    PubMed

    Sivaraju, Laxminadh; Thakar, Sumit; Hegde, Alangar S

    2016-06-01

    Clinical manifestations of empty sella syndrome include hypopituitarism cerebrospinal fluid rhinorrhea, headache, and visual abnormalities. A 21-year-old woman reported a 6-month history of worsening vision 3 years after decompression of a sellar-suprasellar Rathke cleft cyst. Her magnetic resonance imaging (MRI) showed a well-defined recurrent cyst in the sellar-suprasellar region causing chiasmatic compression. She underwent an endonasal, endoscopic decompression of the cyst, with subsequent improvement in her vision. A postoperative computed tomography confirmed good decompression of the cyst. Ten days after surgery, she reported sudden loss of vision in both eyes. MRI revealed an empty sella with herniation of both anterior cerebral arteries and optic chiasm into the sella. She underwent transnasal packing of the sellar floor with fat graft and bone plaques, and experienced gradual improvement in vision in her right eye. PMID:26828843

  8. [Peripheral arterial disease and diabetes related lower limb amputations. Presentation of the epidemiological data and the analysis of potentialities in preventive strategy].

    PubMed

    Kolossváry, Endre; Járai, Zoltán; Farkas, Katalin

    2016-08-01

    Lower limb amputation as one of the most devastating consequences of peripheral arterial disease and diabetes mellitus needs peculiar attention. This review aims at comparing Hungarian and international amputation data. Realizing the great variability of the global amputation incidence and trends data, the main determinants of this variety are assessed. These factors involve methodological differences in reporting, demographic, epidemiological, economic, societal and cultural variation of the affected populations and differences in the health care service. The amputation hazard can be considered as an example of lifetime risk that can be characterized by complex interaction of contionuously changing risk factor pattern. In that sense an effective preventive strategy planning needs complex measure implementations that associate with multidisciplinary approach, timely complex preventive interventions and centralized vascular care. Research and development on amputation field shows clear priority that can contribute to the better understanding of this extremely complex scenario with significant public health consequences. Orv. Hetil., 2016, 157(32), 1266-1274. PMID:27499285

  9. Quaternary megafans, large rivers and other avulsive systems: a potential "who is who" in the geological record

    NASA Astrophysics Data System (ADS)

    Latrubesse, E. M.

    2012-12-01

    A fascinating discussion has been recently calling the attention of sedimentologists and geomorphologists regarding to the dominant fluvial styles preserved in the geological record. While some authors postulate that distributary (or distributive) patterns are the most important systems likely to dominate the alluvial rock record (Weissmann et al.2010, among others) others suggest that a variety of fluvial styles are remarkably preserved in the geological record, rejecting the importance of the distributary systems (such as megafans and other like fans coastal systems) (Fielding et al, 2012 among others). However, the Quaternary record of the largest depositional tracks on Earth has been not assessed in a comparative and detailed way. Here I present results from some of the most important Quaternary areas of sedimentation of the world such as the alluvial belts of the largest rivers, the largest megafans and other impressive fluvial dominated wetlands in active tectonic basins. My study is based on field work I carried out in many of the analyzed areas, a literature review and remote sensing products. Specific examples are discussed from several rivers of the Amazon basin, the Parana River, the Mississippi River, among others. Large depositional tracks in forelands, platforms and intracratonic basins such as the Chaco, the Orinoco Llanos, the Bananal and Pantanal basin, the Ucamara depression, and the Indo-Gangetic plain, which contain a variety of complex avulsive systems and megafans, are discussed. A main conclusion is that megafans and similar distributary systems, avulsive systems with a variety of channel patterns and linear fluvial belts of major rivers, have the potential for preservation in the geological record. The scarcity of purely braided systems in large rivers is noticeable and they are mainly constrained to small-medium size channels, short length piedmont courses or related to relatively small alluvial fans. Meandering and anabranching systems are

  10. Arterial stick

    MedlinePlus

    ... limit tissue damage. Alternative Names Blood sample - arterial ... by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, ...