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. 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

  20. 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

  1. 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

  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. 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

  11. [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

  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. 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

  17. 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

  18. 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

  19. 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

  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. 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

  12. 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

  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. 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.

  17. 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

  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. 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

  2. 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

  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. 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

  5. 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

  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. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  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. 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

  2. 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

  3. 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

  4. 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

  5. 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

  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. 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

  17. 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

  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. 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

  2. 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

  3. 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

  4. 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.

  5. 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

  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. 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

  12. 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

  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. 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

  18. [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

  19. 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

  20. [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

  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. 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

  13. 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

  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. 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

  19. 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

  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

    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

  4. 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

  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. 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

  5. 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

  6. 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

  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. 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

  11. 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.

  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. [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

  14. 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

  15. 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

  16. 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.

  17. 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

  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. 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

  5. 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

  6. 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

  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. 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

  13. 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

  14. 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

  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. 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

  4. 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

  5. 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

  6. 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

  7. 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 ...

  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. 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

  10. 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.

  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. 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

  7. 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

  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. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  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. 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

  19. 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. ...

  20. 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 ...

  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. 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

  5. [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

  6. 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

  7. 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

  8. 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

  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, ...

  11. Arterial Catheterization

    MedlinePlus

    ... rial line can provide valuable information to adjust oxygen therapy or mechanical ventilator (respirator; breathing machine) settings. The blood oxygen pres- sure measures from an arterial line give ...

  12. Celiac Artery Aneurysm

    PubMed Central

    McMullan, D. Michael; McBride, Michael; Livesay, James J.; Dougherty, Kathryn G.; Krajcer, Zvonimir

    2006-01-01

    Aneurysm of the celiac artery is an uncommon clinical problem; fewer than 180 cases have been reported in the world medical literature. Most patients are symptomatic at the time of diagnosis. However, occasionally such aneurysms are detected incidentally during diagnostic imaging for other diseases. We present the case of a 72-year-old man who had an asymptomatic celiac artery aneurysm detected by computed tomographic angiography after endoluminal exclusion of an infrarenal aortic aneurysm. The patient underwent successful resection of the aneurysm and revascularization of the aorta–common hepatic and splenic arteries with use of an autologous saphenous vein graft. PMID:16878636

  13. Basilar Artery Aneurysm at a Persistent Trigeminal Artery Junction

    PubMed Central

    Aguiar, G.B.; Conti, M.L.M.; Veiga, J.C.E.; Jory, M.; Souza, R.B.

    2011-01-01

    Summary The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  14. Ventral root re-implantation is better than peripheral nerve transplantation for motoneuron survival and regeneration after spinal root avulsion injury

    PubMed Central

    2013-01-01

    Background Peripheral nerve (PN) transplantation and ventral root implantation are the two common types of recovery operations to restore the connection between motoneurons and their target muscles after brachial plexus injury. Despite experience accumulated over the past decade, fundamental knowledge is still lacking concerning the efficacy of the two microsurgical interventions. Methods Thirty-eight adult female Sprague–Dawley rats were divided into 5 groups. Immediately following root avulsion, animals in the first group (n = 8) and the second group (n = 8) received PN graft and ventral root implantation respectively. The third group (n = 8) and the fourth group (n = 8) received PN graft and ventral root implantation respectively at one week after root avulsion. The fifth group received root avulsion only as control (n = 6). The survival and axonal regeneration of severed motoneurons were investigated at 6 weeks post-implantation. Results Re-implantation of ventral roots, both immediately after root avulsion and in delay, significantly increased the survival and regeneration of motoneurons in the avulsed segment of the spinal cord as compared with PN graft transplantation. Conclusions The ventral root re-implantation is a better surgical repairing procedure than PN graft transplantation for brachial plexus injury because of its easier manipulation for re-implanting avulsed ventral roots to the preferred site, less possibility of causing additional damage and better effects on motoneuron survival and axonal regeneration. PMID:23799915

  15. Digital subtraction angiography of a persistent trigeminal artery variant.

    PubMed

    Temizöz, Osman; Genchellac, Hakan; Unlü, Ercüment; Cağli, Bekir; Ozdemir, Hüseyin; Demir, M Kemal

    2010-09-01

    Persistent trigeminal artery variants are described as cerebellar arteries that directly originate from the precavernous segment of the internal carotid artery. This has been observed in 0.18% of cerebral catheter angiograms. On the other hand, a persistent trigeminal artery variant feeding both the anterior inferior cerebellar artery and the posterior inferior cerebellar artery territory is very rare. We present this uncommon anomalous artery along with digital subtraction angiography findings and discuss its clinical significance in light of the literature. PMID:19821254

  16. Sports‐related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis

    PubMed Central

    Vandervliet, Everhard J M; Vanhoenacker, Filip M; Snoeckx, Annemie; Gielen, Jan L; Van Dyck, Pieter; Parizel, Paul M

    2007-01-01

    Acute and chronic sports‐related muscle and tendon injuries are not infrequent in youngsters. In particular, the physis is prone to trauma as it constitutes the weakest part of the immature skeleton. The type of sports activity determines the location of the lesion. Most commonly, apophyses of the hip and pelvis are subject to avulsion. The purpose of this paper is to give a short overview of the pathogenesis, location, prevalence and imaging characteristics of acute and chronic avulsion injuries in the immature skeleton, with special emphasis on tennis‐related injuries. Tennis‐related injuries particularly involve apophyses of the ischial tuberosity, the anterior inferior or superior iliac spine and the iliac crest. PMID:17586583

  17. Dry Endoscopic-Assisted Mini-Open Approach With Neuromonitoring for Chronic Hamstring Avulsions and Ischial Tunnel Syndrome

    PubMed Central

    Gómez-Hoyos, Juan; Reddy, Manoj; Martin, Hal D.

    2015-01-01

    Chronic hamstring origin avulsions and ischial tunnel syndrome are common causes of posterior hip pain. Although physical therapy has shown benefits in some cases, recent evidence has reported better outcomes with surgical treatment in appropriately selected patients. The full-open approach has been the classic procedure to address this problem. However, the complications related to extensive tissue exposure and the proximity of the incision to the perianal zone have led to the description of full-endoscopic techniques. Achieving an accurate hamstring repair could be technically demanding with a full-endoscopic procedure. Accurate reattachment is crucial in hamstring repair because of the functional demand of the muscles crossing of 2 major joints (hip and knee). This surgical note describes a mixed technique including a mini-open approach, neuromonitoring, and dry endoscopic-assisted repair of the hamstring origin as an alternative for treating patients with chronic hamstring avulsions and ischial tunnel syndrome that remain symptomatic despite nonoperative treatment. PMID:26258031

  18. Angioplasty and stent placement -- peripheral arteries

    MedlinePlus

    Percutaneous transluminal angioplasty - peripheral artery; PTA - peripheral artery; Angioplasty - peripheral arteries; Iliac artery -angioplasty; Femoral artery - angioplasty; Popliteal artery - angioplasty; Tibial artery - angioplasty; Peroneal artery - ...

  19. Mesenteric artery ischemia

    MedlinePlus

    ... Dead bowel - mesenteric; Dead gut - mesenteric; Atherosclerosis - mesenteric artery; Hardening of the arteries - mesenteric artery ... The arteries that supply blood to the intestines run directly from the aorta, the main artery from the heart. ...

  20. Peripheral Artery Disease

    MedlinePlus

    ... Physician Resources Professions Site Index A-Z Peripheral Artery Disease (PAD) Peripheral artery disease (PAD) refers to ... is peripheral artery disease treated? What is peripheral artery disease (PAD)? Peripheral artery disease, or PAD, refers ...

  1. Evaluation of Avulsion-Induced Neuropathology in Rat Spinal Cords with 18F-FDG Micro-PET/CT.

    PubMed

    Ling, Ze-Min; Tang, Ying; Li, Ying-Qin; Luo, Hao-Xuan; Liu, Lin-Lin; Tu, Qing-Qiang; Zhou, Li-Hua

    2015-01-01

    Brachial plexus root avulsion (BPRA) leads to dramatic motoneuron death and glial reactions in the corresponding spinal segments at the late stage of injury. To protect spinal motoneurons, assessment of the affected spinal segments should be done at an earlier stage of the injury. In this study, we employed 18F-FDG small-animal PET/CT to assess the severity of BPRA-induced cervical spinal cord injuries. Adult Sprague-Dawley rats were randomly treated and divided into three groups: Av+NS (brachial plexus root avulsion (Av) treated with normal saline), Av+GM1 (treated with monosialoganglioside), and control. At time points of 3 day (d), 1 week (w), 2 w, 4 w and 8 w post-injury, 18F-FDG micro-PET/CT scans and neuropathology assessments of the injured spinal roots, as well as the spinal cord, were performed. The outcomes of the different treatments were compared. The results showed that BPRA induced local bleeding and typical Wallerian degeneration of the avulsed roots accompanied by 18F-FDG accumulations at the ipsilateral cervical intervertebral foramen. BPRA-induced astrocyte reactions and overexpression of neuronal nitric oxide synthase in the motoneurons correlated with higher 18F-FDG uptake in the ipsilateral cervical spinal cord during the first 2 w post-injury. The GM1 treatment reduced BPRA-induced astrocyte reactions and inhibited the de novo nNOS expressions in spinal motoneurons. The GM1 treatment also protected spinal motoneurons from avulsion within the first 4 w post-injury. The data from this study suggest that 18F-FDG PET/CT could be used to assess the severity of BPRA-induced primary and secondary injuries in the spinal cord. Furthermore, GM1 is an effective drug for reducing primary and secondary spinal cord injuries following BPRA. PMID:26010770

  2. Evaluation of Avulsion-Induced Neuropathology in Rat Spinal Cords with 18F-FDG Micro-PET/CT

    PubMed Central

    Li, Ying-Qin; Luo, Hao-Xuan; Liu, Lin-Lin; Tu, Qing-Qiang; Zhou, Li-Hua

    2015-01-01

    Brachial plexus root avulsion (BPRA) leads to dramatic motoneuron death and glial reactions in the corresponding spinal segments at the late stage of injury. To protect spinal motoneurons, assessment of the affected spinal segments should be done at an earlier stage of the injury. In this study, we employed 18F-FDG small-animal PET/CT to assess the severity of BPRA-induced cervical spinal cord injuries. Adult Sprague-Dawley rats were randomly treated and divided into three groups: Av+NS (brachial plexus root avulsion (Av) treated with normal saline), Av+GM1 (treated with monosialoganglioside), and control. At time points of 3 day (d), 1 week (w), 2 w, 4 w and 8 w post-injury, 18F-FDG micro-PET/CT scans and neuropathology assessments of the injured spinal roots, as well as the spinal cord, were performed. The outcomes of the different treatments were compared. The results showed that BPRA induced local bleeding and typical Wallerian degeneration of the avulsed roots accompanied by 18F-FDG accumulations at the ipsilateral cervical intervertebral foramen. BPRA-induced astrocyte reactions and overexpression of neuronal nitric oxide synthase in the motoneurons correlated with higher 18F-FDG uptake in the ipsilateral cervical spinal cord during the first 2 w post-injury. The GM1 treatment reduced BPRA-induced astrocyte reactions and inhibited the de novo nNOS expressions in spinal motoneurons. The GM1 treatment also protected spinal motoneurons from avulsion within the first 4 w post-injury. The data from this study suggest that 18F-FDG PET/CT could be used to assess the severity of BPRA-induced primary and secondary injuries in the spinal cord. Furthermore, GM1 is an effective drug for reducing primary and secondary spinal cord injuries following BPRA. PMID:26010770

  3. Lithium accelerates functional motor recovery by improving remyelination of regenerating axons following ventral root avulsion and reimplantation.

    PubMed

    Fang, Xin-Yu; Zhang, Wen-Ming; Zhang, Chao-Fan; Wong, Wai-Man; Li, Wen; Wu, Wutian; Lin, Jian-Hua

    2016-08-01

    Brachial plexus injury (BPI) often involves the complete or partial avulsion of one or more of the cervical nerve roots, which leads to permanent paralysis of the innervated muscles. Reimplantation surgery has been attempted as a clinical treatment for brachial plexus root avulsion but has failed to achieve complete functional recovery. Lithium is a mood stabilizer drug that is used to treat bipolar disorder; however, its effects on spinal cord or peripheral nerve injuries have also been reported. The purpose of this study was to investigate whether lithium can improve functional motor recovery after ventral root avulsion and reimplantation in a rat model of BPI. The results showed that systemic treatment with a clinical dose of lithium promoted motor neuron outgrowth and increased the efficiency of motor unit regeneration through enhanced remyelination. An analysis of myelin-associated genes showed that the effects of lithium started during the early phase of remyelination and persisted through the late stage of the process. Efficient remyelination of the regenerated axons in the lithium-treated rats led to an earlier functional recovery. Therefore, we demonstrated that lithium might be a potential clinical treatment for BPI in combination with reimplantation surgery. PMID:27185485

  4. [Staged reconstruction of brachiocephalic arteries and coronary artery bypass grafting].

    PubMed

    Lysenko, A V; Belov, Iu V; Stonogin, A V

    2015-01-01

    It is presented the results of staged treatment of 28 patients with lesion of brachiocephalic arteries and ischemic heart disease. Patients underwent reconstructive surgery on brachiocephalic arteries (n=34) and coronary artery bypass grafting (n=28). Diagnostic and surgical features are described and indications for this technique are defined. The authors studied Russian and international experience, described postoperative complications and suggested ways to improve the results of simultaneous interventions. PMID:26081182

  5. Coronary Arteries

    MedlinePlus

    ... side of the heart is smaller because it pumps blood only to the lungs. The left coronary artery, ... heart is larger and more muscular because it pumps blood to the rest of the body. Updated August ...

  6. Arterial Stiffness

    PubMed Central

    Avolio, Alberto

    2013-01-01

    Stiffness of large arteries has been long recognized as a significant determinant of pulse pressure. However, it is only in recent decades, with the accumulation of longitudinal data from large and varied epidemiological studies of morbidity and mortality associated with cardiovascular disease, that it has emerged as an independent predictor of cardiovascular risk. This has generated substantial interest in investigations related to intrinsic causative and associated factors responsible for the alteration of mechanical properties of the arterial wall, with the aim to uncover specific pathways that could be interrogated to prevent or reverse arterial stiffening. Much has been written on the haemodynamic relevance of arterial stiffness in terms of the quantification of pulsatile relationships of blood pressure and flow in conduit arteries. Indeed, much of this early work regarded blood vessels as passive elastic conduits, with the endothelial layer considered as an inactive lining of the lumen and as an interface to flowing blood. However, recent advances in molecular biology and increased technological sophistication for the detection of low concentrations of biochemical compounds have elucidated the highly important regulatory role of the endothelial cell affecting vascular function. These techniques have enabled research into the interaction of the underlying passive mechanical properties of the arterial wall with the active cellular and molecular processes that regulate the local environment of the load-bearing components. This review addresses these emerging concepts. PMID:26587425

  7. Carotid artery surgery

    MedlinePlus

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  8. Avulsion of the auricle in an anticoagulated patient: is leeching contraindicated? A review and a case.

    PubMed

    Mommsen, Jens; Rodríguez-Fernández, Javier; Mateos-Micas, Mario; Vázquez-Bouso, Olga; Gumbao-Grau, Victor; Forteza-Gonzalez, Gabriel

    2011-06-01

    Amputation of the auricle is a periodic occurrence leading to disfigurement if not treated properly. Venous stasis is a common complication in reattachments and requires decongestant and anticoagulant treatment. Today, leech therapy is the treatment of choice. Common problems are that it is not available everywhere and that it is usually contraindicated in anticoagulated patients. The peculiarities of leech therapy and the various aspects of surgical management are reviewed. A case of a partial amputation of the auricle in a patient under concomitant anticoagulation therapy with warfarin is presented. The amputated part was reattached in another hospital without microvascular anastomosis. The patient presented to our department with early signs of venous congestion. Leech therapy was started 35 hours after trauma, and the patient continued his anticoagulation therapy. With this treatment, 90% of the amputated part was rescued. The anticoagulation therapy of the patient may have played an important role in the first hours after reattachment, preventing capillary thrombosis and in consequence facilitating the minimal oxygenation necessary. The claim that anticoagulation therapy is a contraindication to leeching should be questioned in cases of reattachments in well-controllable locations without arterial anastomosis. PMID:22655116

  9. Avulsion of the Auricle in an Anticoagulated Patient: Is Leeching Contraindicated? A Review and a Case

    PubMed Central

    Mommsen, Jens; Rodríguez-Fernández, Javier; Mateos-Micas, Mario; Vázquez-Bouso, Olga; Gumbao-Grau, Victor; Forteza-Gonzalez, Gabriel

    2011-01-01

    Amputation of the auricle is a periodic occurrence leading to disfigurement if not treated properly. Venous stasis is a common complication in reattachments and requires decongestant and anticoagulant treatment. Today, leech therapy is the treatment of choice. Common problems are that it is not available everywhere and that it is usually contraindicated in anticoagulated patients. The peculiarities of leech therapy and the various aspects of surgical management are reviewed. A case of a partial amputation of the auricle in a patient under concomitant anticoagulation therapy with warfarin is presented. The amputated part was reattached in another hospital without microvascular anastomosis. The patient presented to our department with early signs of venous congestion. Leech therapy was started 35 hours after trauma, and the patient continued his anticoagulation therapy. With this treatment, 90% of the amputated part was rescued. The anticoagulation therapy of the patient may have played an important role in the first hours after reattachment, preventing capillary thrombosis and in consequence facilitating the minimal oxygenation necessary. The claim that anticoagulation therapy is a contraindication to leeching should be questioned in cases of reattachments in well-controllable locations without arterial anastomosis. PMID:22655116

  10. Dual left anterior descending artery with anomalous origin of long LAD from pulmonary artery - rare coronary anomaly detected on computed tomography coronary angiography

    PubMed Central

    Vohra, Aditi; Narula, Harneet

    2016-01-01

    Dual left anterior descending artery is a rare coronary artery anomaly showing two left anterior descending arteries. Short anterior descending artery usually arises from the left coronary artery, while long anterior descending artery has anomalous origin and course. Dual left anterior descending artery with origin of long anterior descending artery from the pulmonary artery (ALCAPA) is a very rare coronary artery anomaly which has not been reported previously in the literature. We present the computed tomography coronary angiographic findings of this rare case in a young female patient who presented with atypical chest pain. PMID:27413266

  11. Comparative evaluation of four transport media for maintaining cell viability in transportation of an avulsed tooth – An in vitro study

    PubMed Central

    Bharath, Makonahalli Jaganath; Sahadev, Chickmagravalli Krishnegowda; Ramachandra, Praveen Kumar Makonahalli; Rudranaik, Sandeep; George, Jijo; Thomas, Ashna

    2015-01-01

    Objectives: The study was performed to compare and evaluate the efficacy of four experimental storage media (Hank's balanced salt solution, Ringer's lactate solution, tender coconut water, and green tea extract) for maintaining cell viability of human periodontal cells at different time intervals of 15 min 30 min, 60 min, and 90 min. Materials and Methods: Human periodontal cells were cultured and stored in the four media. After 15 min 30 min, 60 min, and 90 min, the different media were examined under optical microscope and viabilities analyzed using an optical calorimeter. Mean and standard deviation were estimated from the results that were statistically analyzed using one-way analysis of variance (ANOVA) to identify the significant groups. Results: The results indicated that there was no difference in cell viability between the four media up to a period of 60 min, whereas green tea extract showed a lower cell viability after 90 min. Conclusion: Within the limitations of the present study, it appears that due to superior osmolality, cost effectiveness, and easier availability, Ringer's lactate, tender coconut water, and green tea extract can be used as alternate storage media for avulsed tooth. PMID:25767771

  12. Persistent trigeminal artery arising from the arterial ring/fenestration of the cavernous segment of the internal carotid artery.

    PubMed

    Uchino, Akira; Saito, Naoko; Kurita, Hiroki; Ishihara, Shoichiro

    2012-09-01

    A persistent trigeminal artery (PTA) is the most common carotid-vertebrobasilar anastomosis, usually arising from the cavernous or precavernous segment of the internal carotid artery (ICA) and connecting to the distal basilar artery. There are two types of PTA, lateral and medial. We present the first case of a lateral-type PTA arising from the large arterial ring/fenestration of the cavernous segment of the left ICA with findings from both magnetic resonance angiography and selective catheter angiography. PMID:22215430

  13. Clinical Study of Endometrial Polyp and Role of Diagnostic Hysteroscopy and Blind Avulsion of Polyp

    PubMed Central

    Remadevi, Chithra; Sumathy, Sudha; Sharma, Deepti; Sreedhar, Sarala; Jose, Amrutha

    2016-01-01

    Introduction Endometrial polyp is one of the common causes of Abnormal Uterine Bleeding (AUB) in the reproductive age group as well as postmenopausal age group. Aim To study the clinical features of endometrial polyp and the safety and feasibility of blind polypectomy following diagnostic hysteroscopy. Materials and Methods Total of 256 women who were diagnosed to have endometrial polyp by transvaginal ultrasound and underwent diagnostic hysteroscopy and blind polypectomy by simple avulsion in the period of January 2008 to December 2014 were included in our study. Polyp was confirmed by the histopathology. Results The prevalence of polyp among women who underwent diagnostic hysteroscopy and blind polypectomy was more common in the age group of 40-49years. Polyps manifested as AUB in 45.6% of our study population. The mean size of the polyp was not significantly different between premenopausal and postmenopausal women and single and multiple polyps. Histopathological study of the polyp showed two malignant polyps in our study population. Premalignant lesions i.e., endometrial hyperplasia without atypia and with atypia was found in 33 women. There was one uterine perforation, one cervical tear; one false passage and one patient had mild bleeding after the procedure. In our study, in the mean follow-up period of 37.57±28.12 months, 3.9% (7 women) had recurrence. In the follow-up period of 16.56±18.96 months, 78.9% women didn’t have recurrence. Conclusion Diagnostic hysteroscopy and blind polypectomy has low complication rate and recurrence rate and technically feasible for the practicing gynaecologists which don’t need much training and is cost-effective also. PMID:27504357

  14. Function of transected or avulsed rectus muscles following recovery using an anterior orbitotomy approach

    PubMed Central

    Pineles, Stacy L.; Laursen, Jessica; Goldberg, Robert A.; Demer, Joseph L.; Velez, Federico G.

    2013-01-01

    PURPOSE To assess the function of muscles retrieved from a retrobulbar location using an anterior orbitotomy approach and to identify the prognostic factors favoring a good outcome. METHODS The records of all patients undergoing anterior orbitotomy for the retrieval of a transected or avulsed muscle in a retrobulbar location were reviewed. Ocular motility, before and after retrieval (with ductions scaled from −4 to +4), was evaluated. RESULTS Record review identified 11 patients who had suffered trauma to 12 muscles (5 inferior, 6 medial, and 1 lateral rectus muscle). Ductions improved from −4 ± 0.4 preoperatively to −2.7 ± 0.9 postoperatively (P = 0.002); mean primary position deviation improved from 34Δ ± 14Δ-15Δ ± 9Δ (P < 0.001), and mean deviation in the field of action improved from 47Δ ± 20Δ-20Δ ± 22Δ (P = 0.02). Ductions improved by at least two units in three patients, all of whom had medial rectus trauma. Single binocular vision in primary gaze was achieved in 6 patients. Patients with medial rectus muscle injury and patients injured by sinus surgery had the lowest likelihood of recovering single binocular vision. CONCLUSIONS Our results are similar to historical series in which muscles were not retrieved and transpositions performed; however, muscle retrieval avoids risks associated with transposition surgeries such as anterior segment ischemia. Muscle recovery via the anterior orbitotomy approach may be reasonable to consider in those cases with a reasonable possibility of having active force generation postoperatively. PMID:22835914

  15. Hyperdensity of the Basilar Artery on Postmortem CT: A Potential Indicator for Basilar Artery Thrombosis.

    PubMed

    Garland, Jack; Tse, Rexson; Beh, Raymond J; Lyons, Timothy J; Cala, Allan D

    2016-06-01

    Basilar artery thrombosis constitutes 1% of all types of stroke, carries a mortality rate of up to 90%, and is one of the rarer causes of sudden death. It leads to brain stem ischemia and commonly presents with impaired consciousness, cranial nerve palsy, hemiplegia or quadriplegia, and sudden collapse. Clinically, the diagnosis of basilar artery thrombosis is made on clinical symptoms, along with a hyperdense basilar artery in antemortem computed tomography (CT) scan. To our knowledge, whether a hyperdense basilar artery indicates basilar artery thrombosis on postmortem CT scan is not documented in the literature. We present a case report of a 55-year-old man who on postmortem CT scan showed a hyperdense basilar artery and was subsequently confirmed to be a fatal basilar artery thrombosis. We suggest that a hyperdense basilar artery on postmortem CT should prompt the pathologist to consider basilar artery thrombosis. PMID:27049662

  16. Superficial Ulnar Artery Associated with Anomalous Origin of the Common Interosseous and Ulnar Recurrent Arteries

    PubMed Central

    Pamidi, Narendra; Nayak, Satheesha B; Jetti, Raghu; Thangarajan, Rajesh

    2016-01-01

    Occurrence of vascular variations in the upper limb is not uncommon and is well described in the medical literature. However, occurrence of superficial ulnar artery associated with unusual origin of the common interosseous and ulnar recurrent arteries is seldom reported in the literature. In the present case, we report the anomalous origin of common trunk of common interosseous, anterior and posterior ulnar recurrent arteries from the radial artery, in a male cadaver. Further, ulnar artery had presented superficial course. Knowledge of anomalous arterial pattern in the cubital fossa reported here is clinically important during the angiographic procedures and plastic surgeries. PMID:27437201

  17. Superficial Ulnar Artery Associated with Anomalous Origin of the Common Interosseous and Ulnar Recurrent Arteries.

    PubMed

    Sirasanagandla, Srinivasa Rao; Pamidi, Narendra; Nayak, Satheesha B; Jetti, Raghu; Thangarajan, Rajesh

    2016-05-01

    Occurrence of vascular variations in the upper limb is not uncommon and is well described in the medical literature. However, occurrence of superficial ulnar artery associated with unusual origin of the common interosseous and ulnar recurrent arteries is seldom reported in the literature. In the present case, we report the anomalous origin of common trunk of common interosseous, anterior and posterior ulnar recurrent arteries from the radial artery, in a male cadaver. Further, ulnar artery had presented superficial course. Knowledge of anomalous arterial pattern in the cubital fossa reported here is clinically important during the angiographic procedures and plastic surgeries. PMID:27437201

  18. Anatomically corrected malposed great arteries misdiagnosed as transposition of great arteries: Diagnosis on fetal echocardiography

    PubMed Central

    Kumar, Vivek; Shah, Sejal

    2016-01-01

    We present a diagnosis of isolated anatomically corrected malposed great arteries on fetal echocardiography at 31 weeks of gestation period. The patient was referred to our institute with a diagnosis of suspected transposition of great arteries.

  19. Anatomically corrected malposed great arteries misdiagnosed as transposition of great arteries: Diagnosis on fetal echocardiography.

    PubMed

    Kumar, Vivek; Shah, Sejal

    2016-01-01

    We present a diagnosis of isolated anatomically corrected malposed great arteries on fetal echocardiography at 31 weeks of gestation period. The patient was referred to our institute with a diagnosis of suspected transposition of great arteries. PMID:27625528

  20. [Simultaneous brachiocephalic arteries reconstruction and coronary artery bypass grafting].

    PubMed

    Lysenko, A V; Belov, Iu V; Stonogin, A V

    2015-01-01

    It is presented the results of simultaneous surgical treatment of 55 patients with brachiocephalic arteries lesion and ischemic heart disease. All patients underwent reconstructive operations on brachiocephalic arteries and CABG. The features of diagnosis and surgical stage are described. The indications for this method are defined. The authors studied russian and world experience; complications of simultaneous operations are presented. It is suggested ways for improvement of results of simultaneous reconstructions. PMID:26031945

  1. Aberrant ovarian collateral originating from external iliac artery during uterine artery embolization.

    PubMed

    Kwon, Joon Ho; Kim, Man Deuk; Lee, Kwang-Hun; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Park, Sung Il; Lee, Do Yun

    2013-02-01

    We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE. PMID:22565531

  2. Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

    SciTech Connect

    Kwon, Joon Ho; Kim, Man Deuk Lee, Kwang-hun; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Park, Sung Il; Lee, Do Yun

    2013-02-15

    We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.

  3. [Atherosclerotic renal artery stenosis].

    PubMed

    Sauguet, A; Honton, B

    2014-12-01

    Atherosclerotic renal artery stenosis can cause ischaemic nephropathy and arterial hypertension. Renal artery stenosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Many patients with RAS may be managed effectively with medical therapy for several years without endovascular stenting, as demonstrated by randomized, prospective trials including the cardiovascular outcomes in Renal Atherosclerotic Lesions (CORAL) trial, the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial. These trials share the limitation of excluding subsets of patients with high-risk clinical presentations, including episodic pulmonary edema and rapidly progressing renal failure and hypertension. Blood pressure control and medication adjustment may become more difficult with declining renal function and may prevent the use of angiotensin receptor blocker and angiotensin-converting enzyme inhibitors. The objective of this review is to evaluate the current management of RAS for cardiologists in the context of recent randomized clinical trials. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary edema, rapidly declining renal function and severe resistant hypertension. PMID:25450992

  4. Morphological and sedimentological evidences of repeated avulsions of Someşu Mic River (Romania), associated to salt tectonics

    NASA Astrophysics Data System (ADS)

    Persoiu, I.; Radoane, M.

    2009-04-01

    . Four palaeochannels are visible on the floodplain's surface, these being also evident in the sedimentary structure of the valley infill, as revealed by the electrical imaging and drilling. Former channel infills consist mainly of massive and sandy clays (low electrical resistivity - 5.8 ohm.m), whereas the sectors between them are filled by pebbles and sands interpreted to be channel deposits (high values of the electrical resistivity - 80 ohm.m).The absence of coarse gravels from the bottom, direct disposal of fine sediments on marls and the presence of massive clay suggests 3 stages in the channels evolution. The first one is a long period of stability, supposed to be associated to a low sinuous course, when river incised the sedimentary complex of the floodplain, until it was intersected the valley bottom. The second stage is an abrupt avulsion to the right, produced probably during an important flood, and the third stage corresponds to the period of complete abandonment of it and the evolution as oxbow lake. If we take in consideration the presence of the diapiric syncline on the right side of the valley, and the disposal of parallel channels with it (including the present-day one), we conclude that this behavior is caused by a lateral tilting of the floodplain trough the right.

  5. Novel, congenital iliac arterial anatomy: Absent common iliac arteries and left internal iliac artery

    PubMed Central

    Green, Christopher S.; Helmy, Mohammed A.

    2015-01-01

    Congenital anomalies of the iliac arterial system are rare and can be associated with ischemia. With an increase in vascular imaging and interventions, such anomalies are likely to be encountered with greater frequency. We present the case of a 25-year-old female who was incidentally found to have absence of the common iliac arteries bilaterally and the left internal iliac artery, a constellation not previously reported in the literature. We present relevant imaging findings, review embryonic vascular development, and discuss potential clinical implications.

  6. Artery phantoms for intravascular optical coherence tomography: healthy arteries.

    PubMed

    Bisaillon, Charles-Étienne; Dufour, Marc L; Lamouche, Guy

    2011-09-01

    We present a method to make phantoms of coronary arteries for intravascular optical coherence tomography (IV-OCT). The phantoms provide a calibrated OCT response similar to the layered structure of arteries. The optical properties of each layer are achieved with specific concentrations of alumina and carbon black in a silicone matrix. This composition insures high durability and also approximates the elastic properties of arteries. The phantoms are fabricated in a tubular shape by the successive deposition and curing of liquid silicone mixtures on a lathe setup. PMID:21991552

  7. Location of foot arteries using infrared images

    NASA Astrophysics Data System (ADS)

    Villasenor-Mora, Carlos; González-Vega, Arturo; Martín Osmany Falcón, Antonio; Benítez Ferro, Jesús Francisco Guillemo; Córdova Fraga, Teodoro

    2014-11-01

    In this work are presented the results of localization of foot arteries, in a young group of participants by using infrared thermal images, these are the dorsal, posterior tibial and anterior tibial arteries. No inclusion criteria were considered, that causes that no strong statistical data about the influence of the age in the arterial localization. It was achieved to solve the confusion when veins present a heat distribution similar to the artery and in the position of this. it contributes to enhance the rate of location of arteries. In general it is possible to say that the use of infrared thermal images is a good technique to find the foot arteries and can be applied in its characterization in a future. The procedure proposed is a non-invasive technique, and in certain fashion does not requires specialized personnel to achieve locate the arteries. It is portable, safe, and relatively economical.

  8. Persistent primitive trigeminal artery associated with monocular blindness and external carotid-vertebral artery anastomosis

    PubMed Central

    Yin, Suo; Zhang, Hong T.; Zhang, Dao P.; Zhang, Shu L.

    2015-01-01

    In this paper, we present 2 rare cases of persistent embryonic anastomoses. In one case, the patient presented with persistent trigeminal artery along with multiple foci of cerebral infarction as well as central retinal artery thrombosis. In the other case, the patient had direct anastomosis of the vertebral artery with ipsilateral external carotid artery as well as pontine infarction, aneurysm, and unilateral hypoplasia of the vertebral artery. The findings in these cases may shed light on the clinical presentation of such persistent anastomoses and aid their detection in clinical settings. PMID:25935186

  9. Persistent primitive trigeminal artery associated with monocular blindness and external carotid-vertebral artery anastomosis.

    PubMed

    Yin, Suo; Zhang, Hong T; Zhang, Dao P; Zhang, Shu L

    2015-05-01

    In this paper, we present 2 rare cases of persistent embryonic anastomoses. In one case, the patient presented with persistent trigeminal artery along with multiple foci of cerebral infarction as well as central retinal artery thrombosis. In the other case, the patient had direct anastomosis of the vertebral artery with ipsilateral external carotid artery as well as pontine infarction, aneurysm, and unilateral hypoplasia of the vertebral artery. The findings in these cases may shed light on the clinical presentation of such persistent anastomoses and aid their detection in clinical settings. PMID:25935186

  10. The artery blood supply variant of the upper limb

    PubMed Central

    MASLARSKI, IVAN

    2015-01-01

    Variations of arterial patterns in the upper limb have represented the most common subject of vascular anatomy. Different types of artery branching pattern of the upper limb are very important for orthopedists in angiographic and microvascular surgical practice. The brachial artery (BA) is the most important vessel in the normal vascular anatomy of the upper limb. The classical pattern of the palmar hand region distribution shows the superficial palmar arch. Normally this arch is formed by the superficial branch of the ulnar artery and completed on the lateral side by one of these arteries: the superficial palmar branch of the radial artery, the princeps pollicis artery, the superficial palmar branch of the radial artery or the median artery. After the routine dissection of the right upper limb of an adult male cadaver, we found a very rare variant of the superficial arch artery – a division in a higher level brachial artery. We found this division at 10.4 cm from the beginning of the brachial artery. This superficial brachial artery became a radial artery and was not involved in the formation of the palm arch. In the forearm region, the artery variant was present with the median artery and the ulnar artery, which form the superficial palm arch. PMID:26733754

  11. Hardening of the arteries

    MedlinePlus

    Atherosclerosis; Arteriosclerosis; Plaque buildup - arteries; Hyperlipidemia - atherosclerosis; Cholesterol - atherosclerosis ... Hardening of the arteries often occurs with aging. As you grow older, ... narrows your arteries and makes them stiffer. These changes ...

  12. Mesenteric artery ischemia

    MedlinePlus

    ... ischemia is often seen in people who have hardening of the arteries in other parts of the ... long-term (chronic) mesenteric artery ischemia caused by hardening of the arteries ( atherosclerosis ): Abdominal pain after eating ...

  13. Carotid Artery Disease

    MedlinePlus

    ... brain with blood. If you have carotid artery disease, the arteries become narrow, usually because of atherosclerosis. ... one of the causes of stroke. Carotid artery disease often does not cause symptoms, but there are ...

  14. Coronary artery disease

    MedlinePlus Videos and Cool Tools

    The coronary arteries supply blood to the heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, a ...

  15. Carotid Artery Disease

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Carotid Artery Disease? Carotid artery disease is a disease in ... blood to your face, scalp, and neck. Carotid Arteries Figure A shows the location of the right ...

  16. Left Main Coronary Artery Aneurysm

    PubMed Central

    Doustkami, Hossein; Maleki, Nasrollah; Tavosi, Zahra

    2016-01-01

    Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic. PMID:27403190

  17. Pulmonary Artery Intimal Sarcoma: A Case Report

    PubMed Central

    Kriz, Joseph P.; Munfakh, Nabil A.; King, Gregory S.; Carden, Juan O.

    2016-01-01

    Pulmonary artery intimal sarcomas are rare and lethal malignant tumors that typically affect larger vessels: the aorta, inferior vena cava, and pulmonary arteries. Since symptoms and imaging of pulmonary arterial intimal sarcomas mimic pulmonary thromboembolism, the differential diagnosis of a patient presenting with chest pain, dyspnea, and filling defect within the pulmonary arteries should include intimal sarcoma. Often right ventricular failure is observed due to pulmonary hypertension caused by the obstructive effect of the tumor and concomitant chronic thromboembolism. We report the case of a 72-year-old African-American male with arterial intimal sarcoma of the left and right pulmonary artery with extension through the right artery into the bronchus and right lung. PMID:27239183

  18. Physiologic assessment of coronary artery fistula

    SciTech Connect

    Gupta, N.C.; Beauvais, J. )

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  19. Geomorphology, facies architecture, and high-resolution, non-marine sequence stratigraphy in avulsion deposits, Cumberland Marshes, Saskatchewan

    USGS Publications Warehouse

    Farrell, K.M.

    2001-01-01

    This paper demonstrates field relationships between landforms, facies, and high-resolution sequences in avulsion deposits. It defines the building blocks of a prograding avulsion sequence from a high-resolution sequence stratigraphy perspective, proposes concepts in non-marine sequence stratigraphy and flood basin evolution, and defines the continental equivalent to a parasequence. The geomorphic features investigated include a distributary channel and its levee, the Stage I crevasse splay of Smith et al. (Sedimentology, vol. 36 (1989) 1), and the local backswamp. Levees and splays have been poorly studied in the past, and three-dimensional (3D) studies are rare. In this study, stratigraphy is defined from the finest scale upward and facies are mapped in 3D. Genetically related successions are identified by defining a hierarchy of bounding surfaces. The genesis, architecture, geometry, and connectivity of facies are explored in 3D. The approach used here reveals that avulsion deposits are comparable in process, landform, facies, bounding surfaces, and scale to interdistributary bayfill, i.e. delta lobe deposits. Even a simple Stage I splay is a complex landform, composed of several geomorphic components, several facies and many depositional events. As in bayfill, an alluvial ridge forms as the feeder crevasse and its levees advance basinward through their own distributary mouth bar deposits to form a Stage I splay. This produces a shoestring-shaped concentration of disconnected sandbodies that is flanked by wings of heterolithic strata, that join beneath the terminal mouth bar. The proposed results challenge current paradigms. Defining a crevasse splay as a discrete sandbody potentially ignores 70% of the landform's volume. An individual sandbody is likely only a small part of a crevasse splay complex. The thickest sandbody is a terminal, channel associated feature, not a sheet that thins in the direction of propagation. The three stage model of splay evolution

  20. Left Subclavian Artery Occlusion: Femoro-Axillary Artery Retrograde Bypass

    PubMed Central

    Nakashima, Masaya; Kobayashi, Hideaki; Kobayashi, Masayoshi

    2016-01-01

    The treatment tactics for subclavian artery occlusion include the more commonly used endovascular therapy rather than surgical intervention. We present a case of a 61-year-old woman with dialysis-dependent chronic renal failure who experienced left finger necrosis in the left upper extremity. To salvage the limb, we performed femoro-axillary (fem-ax) artery bypass using an autologous saphenous vein graft. However, 10 months later, she experienced coldness in the left forearm. Angiography revealed chronic total occlusion of the venous bypass. Despite emergent thrombectomy, redo fem-ax artery bypass operation was performed using a prosthetic graft. Upper limb salvage can be achieved by fem-ax artery retrograde bypass. PMID:27386454

  1. Legacy Morphologies: Channel Avulsions and Historical Engineering Structures Drive Form and Process in the Lower Yuba and Feather Rivers, California

    NASA Astrophysics Data System (ADS)

    James, L. A.; Singer, M. B.; Aalto, R.

    2008-12-01

    Geomorphic changes in the lower Yuba and Feather Rivers due to hydraulic mining provide a chance to study centennial-scale processes. Channel changes over 150 years were determined using channel-bank stratigraphy, geochemical signatures (total Hg, grain-size distributions, bulk geochemistry, fallout radionuclides, and Sr/Nd isotopes), and spatial analyses of high-resolution topographic data, historical maps, and aerial photos. Repeated avulsions and broad erosion/deposition patterns are shown, including a downstream shift in activity through time. In the 20th century, both rivers experienced deep main-channel incision and floodplain alluviation of natural levees and abandoned channels. Buried trees rooted in pre- mining soils indicate the Feather has not returned to pre-mining base levels below the Yuba confluence. Early engineering works controlled channel responses and recovery. For example, the Feather River avulsed into a channel dredged through Shanghai Bend (c.1907) so it now crosses resistant Quaternary alluvium over a 3-m knickpoint bench that could soon be breached. Moreover, levees and channelization near the Yuba-Feather confluence at Marysville (c.1905) narrowed and deepened flows, encouraging the bed incision noted by Gilbert. Effects of legacy sediment on channel processes are well known. Here, channel recovery was also constrained by channel morphologies engineered with boulder wing dams and revetment in the Yuba and channelization and levees in the Feather. The resulting bed incision reduces lateral connectivity between channels and floodplains and increases sediment conveyance. Historical and anthropogenic perspectives are essential to explaining channel dynamics at these scales. Unless models of channel and floodplain evolution recognize historical changes and engineering works, they may miss crucial components of geomorphic change and potential impacts downstream. In such systems, the historical dimension is essential to river management, water

  2. An unusual course of the radial artery.

    PubMed

    Pelin, C; Zagyapan, R; Mas, N; Karabay, G

    2006-11-01

    Radial artery variations are of importance for clinicians, whether in angiographic examinations or surgical approaches. The high origin radial artery is the most frequent arterial variation observed in the upper limb, showing an incidence of 14.27% in dissection material and 9.75% in angiographic examination. In the present study an unusual course of the radial artery and its relation with the median nerve has been evaluated. During embryological development the radial artery sprouts from two arterial buds arising from the lateral side of the brachial artery and coalescing with each other. The artery lies in the forearm and is overlapped by the brachioradial muscle. In this particular case the radial artery originated from the medial side of the brachial artery and crossed the median nerve twice in an unusual manner 8 cm below the point at which the deep brachial artery arose and 12 cm above the intercondylar line. These results will enhance anatomical knowledge of the region and reduce complication in surgical approaches. PMID:17171625

  3. Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy.

    PubMed

    Pohl, Yango; Filippi, Andreas; Kirschner, Horst

    2005-04-01

    The status of the periodontal ligament (PDL) and of the pulp are decisive for the healing of avulsed and replanted teeth. A tooth rescue box was developed and distributed to offer optimal storage conditions for avulsed teeth. The therapy comprised extraoral endodontic treatment and applications of medicaments to enhance periodontal healing. In this long-term clinical study the healing results following avulsion and replantation were investigated. Twenty-eight permanent teeth in 24 patients were evaluated. The extraoral storage media and periods varied considerably. Soon after avulsion six teeth were stored in a cell culture medium (tooth rescue box Dentosafe) for 1-53 h; the PDL was defined as not compromised. Sixteen teeth were stored in a non-physiologic situation temporarily, the PDL was considered as compromised. Six teeth were stored in non-physiologic conditions for longer periods; the condition of the PDL was defined as hopeless. On 14 teeth antiresorptive-regenerative therapy (ART) with the local application of glucocorticoids and enamel matrix derivative and the systemic administration of doxycyclin was used. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. The mean observation period was 31.2 months (+/-24.1; 5.1-100.2; median: 23.8). All six teeth rescued physiologically healed with a functional PDL (functional healing, FH) irrespective of the storage period. Of eight teeth with a compromised PDL on which ART was used, three teeth healed with a functional PDL. All other teeth showed replacement resorption, in three teeth additionally infection-related resorption was recorded. The predominant influence on the healing results was the immediate physiologic rescue of avulsed teeth (chi-square, P = 0.0001). The use of ART seemed to support FH (chi-square, P = 0.0547) in teeth with a compromised PDL. No other factors (maturity of roots, crown fractures, gender, age, antibiotics) were related to healing. In a linear

  4. Brachial artery pseudoaneurysm

    PubMed Central

    Kemp, Katie; Radwan, Rami; Shingler, Guy; Davies, Chris

    2014-01-01

    We describe a case of an elderly man who presented with an upper arm swelling that had developed following a humeral fracture 8 months previously. The swelling was painless but associated with significantly diminished motor function of his right hand and concurrent paraesthaesia. On examination, a large pulsatile mass was identified and CT angiography confirmed the presence of an 11×7 cm brachial artery pseudoaneurysm. The patient underwent surgical repair in which a fragment of the humerus was found to have punctured the brachial artery resulting in a pseudoaneurysm. The patient had an uncomplicated postoperative period and was discharged 2 days later having regained some motor function in his right hand. PMID:24859555

  5. Coronary artery fistulas

    PubMed Central

    Said, S.A.M.; Thiadens, A.A.H.J.; Fieren, M.J.C.H.; Meijboom, E.J.; van der Werf, T.; Bennink, G.B.W.E.

    2002-01-01

    The aetiology of congenital coronary artery fistulas remains a challenging issue. Coronary arteries with an anatomically normal origin may, for obscure reasons, terminate abnormally and communicate with different single or multiple cardiac chambers or great vessels. When this occurs, the angiographic morphological appearance may vary greatly from discrete channels to plexiform network of vessels. Coronary arteriovenous fistulas (CAVFs) have neither specific signs nor pathognomonic symptoms; the spectrum of clinical features varies considerably. The clinical presentation of symptomatic cases can include angina pectoris, myocardial infarction, fatigue, dyspnoea, CHF, SBE, ventricular and supraventricular tachyarrhythmias or even sudden cardiac death. CAVFs may, however, be a coincidental finding during diagnostic coronary angiography (CAG). CAG is considered the gold standard for diagnosing and delineating the morphological anatomy and pathway of CAVFs. There are various tailored therapeutic modalities for the wide spectrum of clinical manifestations of CAVFs, including conservative pharmacological strategy, percutaneous transluminal embolisation and surgical ligation. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696067

  6. Anomalous Origin of Left Circumflex Artery

    PubMed Central

    Çitaku, Hajdin; Kamberi, Lulzim; Gorani, Daut; Koçinaj, Dardan; Krasniqi, Xhevdet

    2015-01-01

    Introduction: The coronary anatomic variation of the left circumflex artery (LCx) is considered as the most common anatomic variation with a separate ostium from the right sinus, and very unusual variation as a proximal branch of right coronary artery (RCA). Case report: We report two cases, the first case is a 64-year-old man with chest pain and with history of hypertension, obesity, dyslipidemia and current smoker, and the second case is a 67-year-old who presented to the emergency department with chest pain and with a past medical history of arterial hypertension and type 2 diabetes mellitus. In the coronarography of the first case is detected an ectopic left circumflex coronary artery from the right coronary sinus with stenotic changes in RCA and LCx. The second case in the coronary angiography revealed an ectopic left circumflex coronary artery from the proximal part of the right coronary artery with stenotic changes in LAD, RCA and LCx. Based on guidelines for revascularization our patients successfully underwent treatment procedures. We present two cases that because of the atherosclerotic coronary artery disease leads to the need of coronarography find out the presence of coronary artery anomalies. Conclusion: During the coronarography we should think about coronary artery anomaly or missing artery knowing that type of these anomalies, considering that may be a contributing factor in the development of the atherosclerosis determines the method of the treatment. PMID:26843740

  7. Carotid artery anatomy (image)

    MedlinePlus

    There are four carotid arteries, two on each side of the neck: right and left internal carotid arteries, and right and left external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to the head and brain.

  8. Permanent Cortical Blindness After Bronchial Artery Embolization

    SciTech Connect

    Doorn, Colette S. van De Boo, Diederick W.; Weersink, Els J. M.; Delden, Otto M. van Reekers, Jim A. Lienden, Krijn P. van

    2013-12-15

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  9. Vapor resistant arteries

    NASA Technical Reports Server (NTRS)

    Shaubach, Robert M. (Inventor); Dussinger, Peter M. (Inventor); Buchko, Matthew T. (Inventor)

    1989-01-01

    A vapor block resistant liquid artery structure for heat pipes. A solid tube artery with openings is encased in the sintered material of a heat pipe wick. The openings are limited to that side of the artery which is most remote from the heat source. The liquid in the artery can thus exit the artery through the openings and wet the sintered sheath, but vapor generated at the heat source is unlikely to move around the solid wall of the artery and reverse its direction in order to penetrate the artery through the openings. An alternate embodiment uses finer pore size wick material to resist vapor entry.

  10. Can the Anesthesiologist Use the Radial Artery for Monitoring After Transradial Artery Catheterization?

    PubMed

    Awad, Hamdy; Quevedo, Eduardo; Abas, Motaz; Brown, Michelle; Satiani, Bhagwan; Capers, Quinn; Starr, Jean E

    2015-06-15

    The use of transradial coronary angiography and intervention is growing because of its advantages over the femoral approach. However, the small size of the radial artery can contribute to complications. We present a case of an in situ access complication of transradial coronary artery catheterization. It is important for the anesthesiologist to know about the short-term and long-term consequences of this intervention, which could lead to narrowing of the artery even beyond the site of puncture. Understanding these changes could help anesthesiologists make better decisions about using the radial artery for monitoring after transradial coronary artery catheterization procedures. PMID:26050247

  11. Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

    PubMed Central

    Shin, Young-Soo; Hwang, Yeok-Gu; Savale, Abhijit Prakash

    2014-01-01

    An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty. PMID:24944978

  12. Peripheral arterial disease

    PubMed Central

    2009-01-01

    Introduction Up to 20% of adults aged over 55 years have detectable peripheral arterial disease of the legs, but this may cause symptoms of intermittent claudication in only a small proportion of affected people. The main risk factors are smoking and diabetes mellitus, but other risk factors for cardiovascular disease are also associated with peripheral arterial disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for people with chronic peripheral arterial disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2009. (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 59 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antiplatelet agents; bypass surgery; cilostazol; exercise; pentoxifylline; percutaneous transluminal angioplasty (PTA); prostaglandins; smoking cessation; and statins. PMID:19454099

  13. Peripheral arterial disease

    PubMed Central

    2011-01-01

    Introduction Up to 20% of adults aged over 55 years have detectable peripheral arterial disease of the legs, but this may cause symptoms of intermittent claudication in only a small proportion of affected people. The main risk factors are smoking and diabetes mellitus, but other risk factors for cardiovascular disease are also associated with peripheral arterial disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for people with chronic peripheral arterial disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010. Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review. We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 70 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antiplatelet agents, bypass surgery, cilostazol, exercise, pentoxifylline, percutaneous transluminal angioplasty (PTA), prostaglandins, smoking cessation, and statins. PMID:21477401

  14. True Aneurysm of the Proximal Brachial Artery

    PubMed Central

    Ramakrishna, Pinjala; Mahapatra, Sandeep; Rajesh, Ratna

    2013-01-01

    A 35-year-old farmer presented with complaints of pain in the right upper limb for 1 month and bluish discoloration of the right-hand finger tips with tingling and numbness. He sustained injury to the right upper limb while lifting a heavy object 1 mo previously. There was an ovoid swelling of 4 × 2 cm on the medial aspect of the right arm, 12 cm above the medial epicondyle at the level of the armpit with visible pulsations. There was distal neurovascular deficit. Duplex scan of the right upper limb arterial system revealed a pseudoaneurysm of the proximal right brachial artery, with dampened monophasic flow in the ulnar artery and no flow in the radial artery. Spiral computed tomography angiogram showed the presence of an echogenic periarterial lesion in the proximal brachial artery suggestive of pseudoaneurysm or an extrinsic compression by hematoma. Distal brachial artery was found to have filled with thrombus, with non-opacification of the radial and the distal ulnar artery. The patient was posted for excision of the aneurysmal arterial segment. A 5-cm-long reversed segment of vein graft was interposed in between the cut ends of the brachial artery. Histopathology: Specimen shows a part of the vessel wall composed of intimal, medial, and adventitial layers with intraluminal thrombus showing evidence of recanalization suggestive of true aneurysm of the brachial artery. PMID:26798692

  15. The clinical anatomy of the conal artery.

    PubMed

    Loukas, Marios; Patel, Swetal; Cesmebasi, Alper; Muresian, Horia; Tubbs, R Shane; Spicer, Diane; Dabrowski, Marek

    2016-04-01

    Coronary arteries have been extensively described and recognized by gross anatomic studies. However, in the clinical setting, the recognition of the conal artery is essential during coronary angiography, as well as certain congenital heart conditions such as tetralogy of Fallot. In order to provide a complete anatomic and physiologic correlation of the actual incidence and distribution of the conal artery we examined 300 formalin fixed hearts with gross dissections and 300 coronary angiograms. The conal artery was identified in all hearts examined and five main patterns were recognized. In Type A (193, 32.1%), the conal artery arose as a branch of the right coronary artery (RCA); in Type B (96, 16%), the conal artery arose from the common coronary ostium with the RCA; in Type C (242, 40.3%), the conal artery took origin from the right aortic sinus as an independent artery; in Type D (48, 8%), multiple conal arteries were present and arose from the RCA as separate branches (32, 66.6%), from a common ostium with the RCA (8, 16.6%) or from the aortic sinus (8, 16.6%); in Type E (22, 3.6%), the conal artery arose as a branch of the right ventricular branch (17, 2.8%) or acute marginal artery (5, 0.8%). The relative prevalence of the five patterns as well as the morphology and the topography of the conal artery varied significantly with the degree of coronary luminal stenosis (as observed during angiography) and also with the degree of hypertrophied ventricular wall (as observed during gross dissections). Clin. Anat. 29:371-379, 2016. © 2014 Wiley Periodicals, Inc. PMID:25255889

  16. Coronary Artery Manifestations of Fibromuscular Dysplasia

    PubMed Central

    Michelis, Katherine C.; Olin, Jeffrey W.; Kadian-Dodov, Daniella; d’Escamard, Valentina; Kovacic, Jason C.

    2015-01-01

    Fibromuscular dysplasia (FMD) involving the coronary arteries is an uncommon but important condition that can present as acute coronary syndrome, left ventricular dysfunction, or potentially sudden cardiac death. Although the classic angiographic “string of beads” that may be observed in renal artery FMD does not occur in coronary arteries, potential manifestations include spontaneous coronary artery dissection, distal tapering or long, smooth narrowing that may represent dissection, intramural hematoma, spasm, or tortuosity. Importantly, FMD must be identified in at least one other noncoronary arterial territory to attribute any coronary findings to FMD. Although there is limited evidence to guide treatment, many lesions heal spontaneously; thus, a conservative approach is generally preferred. The etiology is poorly understood, but there are ongoing efforts to better characterize FMD and define its genetic and molecular basis. This report reviews the clinical course of FMD involving the coronary arteries and provides guidance for diagnosis and treatment strategies. PMID:25190240

  17. Aberrant Radial Artery Causing Carpal Tunnel Syndrome

    PubMed Central

    Kokkalis, Zinon T.; Tolis, Konstantinos E.; Megaloikonomos, Panayiotis D.; Panagopoulos, Georgios N.; Igoumenou, Vasilios G.; Mavrogenis, Andreas F.

    2016-01-01

    Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic. PMID:27517078

  18. Aberrant Radial Artery Causing Carpal Tunnel Syndrome.

    PubMed

    Kokkalis, Zinon T; Tolis, Konstantinos E; Megaloikonomos, Panayiotis D; Panagopoulos, Georgios N; Igoumenou, Vasilios G; Mavrogenis, Andreas F

    2016-06-01

    Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic. PMID:27517078

  19. The symptomatology of megadolicho basilar artery.

    PubMed

    Herpers, M; Lodder, J; Janevski, B; van der Lugt, P J

    1983-01-01

    Cranial nerve dysfunction, obstruction hydrocephalus, signs of brain stem dysfunction, and signs of a space-occupying lesion in the posterior fossa are presumed to be related to a megadolicho basilar artery, if present. Since there are no large series of patients with such vascular anomaly, a bias in relating symptoms with the presence of a megadolicho basilar artery is not excluded. We therefore studied retrospectively the incidence of megadolicho and dolicho basilar artery on cranial CT-scan of 3332 patients of 50 years and older. Patient records were reviewed for the above mentioned symptoms. 12 out of 22 patients with a megadolicho basilar artery and 2 patients out of 40 with a dolicho basilar artery had one or two of these symptoms. It is concluded that a megadolicho basilar artery can cause cranial nerve dysfunction, obstruction hydrocephalus, signs of brain stem dysfunction, and signs of a space-occupying lesion in the posterior fossa. PMID:6317247

  20. Fusiform aneurysm of a persistent trigeminal artery associated with rare intracranial arterial variations and subarachnoid hemorrhage.

    PubMed

    Kimball, David; Ples, Horia; Kimball, Heather; Miclaus, Gratian D; Matusz, Petru; Loukas, Marios

    2015-01-01

    The trigeminal artery is one of four primitive anastomoses between the internal carotid artery and vertebrobasilar system that regresses in the sixth week of fetal development. A persistent trigeminal artery (PTA) is generally an incidental finding but may also be associated with intracranial vascular pathologies such as aneurysms, arteriovenous malformations, and cranial nerve compression syndromes. We present an extremely rare case of a right PTA with an associated bleeding fusiform aneurysm located in the carotidian (lateral) part of the PTA. In addition, this rare anatomic variation was associated with bilateral absence of the posterior communicating arteries, a left posterior cerebral artery originating from the left internal carotid artery, and agenesis of the A1 segment of the left anterior cerebral artery. PMID:25053265

  1. Basilar artery aneurysm at a persistent trigeminal artery junction. A case report and literature review.

    PubMed

    Aguiar, G B; Conti, M L M; Veiga, J C E; Jory, M; Souza, R B

    2011-09-01

    The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  2. Celiac artery disease and fatal rupture of a hepatic artery aneurysm in the Ehlers-Danlos syndrome.

    PubMed

    Nat, Amritpal; George, Tanya; Mak, Gregory; Sharma, Amit; Nat, Amitpal; Lebel, Robert

    2014-04-01

    Isolated visceral arteriopathies of the celiac and hepatic artery are rare. We present a case of a Caucasian man who presented with abdominal pain and was found to have a spontaneous celiac artery dissection. Genetic analysis revealed a mutation consistent with Ehlers-Danlos syndrome type IV. The patient died 2 months later from a spontaneous rupture of his hepatic artery. PMID:24688192

  3. Cooled artery extension

    NASA Technical Reports Server (NTRS)

    Gernert, Nelson J. (Inventor)

    1990-01-01

    An artery vapor trap. A heat pipe artery is constructed with an extension protruding from the evaporator end of the heat pipe beyond the active area of the evaporator. The vapor migrates into the artery extension because of gravity or liquid displacement, and cooling the extension condenses the vapor to liquid, thus preventing vapor lock in the working portion of the artery by removing vapor from within the active artery. The condensed liquid is then transported back to the evaporator by the capillary action of the artery extension itself or by wick located within the extension.

  4. Variant PTA Terminating in Cerebellar Artery, Associated with Multiple Aneurysms

    PubMed Central

    Hwang, Yeong Uk

    2016-01-01

    Persistent trigeminal artery (PTA) is one of the remnant fetal anastomoses between the carotid artery and basilar artery. PTAs are classified according to angiographic appearance and various connection. Among them, those directly terminating in the cerebellar arteries are rare subtype. In addition, aneurysms of the PTA are unusual in the literature and have not previously accompanied this subtype of PTA connecting cerebellar artery. We present the first case of an aneurysm of the PTA which is directly terminating in the cerebellar arteries and combined with multiple aneurysms. PMID:27446623

  5. Variant PTA Terminating in Cerebellar Artery, Associated with Multiple Aneurysms.

    PubMed

    Hwang, Yeong Uk; Kim, Jin Woo

    2016-01-01

    Persistent trigeminal artery (PTA) is one of the remnant fetal anastomoses between the carotid artery and basilar artery. PTAs are classified according to angiographic appearance and various connection. Among them, those directly terminating in the cerebellar arteries are rare subtype. In addition, aneurysms of the PTA are unusual in the literature and have not previously accompanied this subtype of PTA connecting cerebellar artery. We present the first case of an aneurysm of the PTA which is directly terminating in the cerebellar arteries and combined with multiple aneurysms. PMID:27446623

  6. Successful case of pancreaticoduodenectomy with resection of the hepatic arteries preserving a single aberrant hepatic artery for a pancreatic neuroendocrine tumor: report of a case.

    PubMed

    Ichida, Akihiko; Sakamoto, Yoshihiro; Akahane, Masaaki; Ishizawa, Takeaki; Kaneko, Junichi; Aoki, Taku; Hasegawa, Kiyoshi; Sugawara, Yasuhiko; Kokudo, Norihiro

    2015-03-01

    A 65-year-old male with a pancreatic neuroendocrine tumor presenting with a duodenal ulcer was referred to our department. The tumor involved the common hepatic artery, gastroduodenal artery, left hepatic artery and the right posterior hepatic artery, but not the right anterior hepatic artery originating from the superior mesenteric artery. The hepatic arteries, except the aberrant right anterior hepatic artery, were embolized using coils 18 days before the surgery. The patient underwent pancreaticoduodenectomy with resection of the tumor-encased hepatic arteries, while preserving the aberrant artery. The patient was discharged uneventfully on postoperative day 13 with no ischemic complications. A histopathological examination revealed a grade 2 pancreatic neuroendocrine tumor according to the classification of the World Health Organization, and the surgical margin was negative. The patient developed hepatic metastases 16 months after surgery; hence, hepatic resection was performed. The present surgical strategy is applicable in patients with relatively low-grade pancreatic malignancies involving major hepatic arteries. PMID:24477525

  7. PULMONARY ARTERY ACCELERATED FLOW REVEALING HODGKIN'S LYMPHOMA.

    PubMed

    Ibrahim, Tony; Chehab, Ghassan; Saliba, Zakhia; Smayra, Tarek; Baz, Maria; Abdo, Lynn; Haddad, Fady; Abdel-Massih, Tony

    2016-01-01

    We present a case in which transthoracic echocardiography was the first diagnostic tool to suspect mediastinal Hodgkin's lymphoma by revealing a change in the hemodynamic of left pulmonary artery flow, and it was used as a follow-up method for monitoring treatment efficacy by demonstrating a normalization of pulmonary artery hemodynamics. PMID:27169170

  8. Megadolicho vascular malformation of the intracranial arteries.

    PubMed

    Lodder, J; Janevski, B; van der Lugt, P J

    1981-01-01

    A patient is presented suffering a hemiparesis. Megadolicho-vascular malformation of the intracranial part of the internal carotid arteries and some of its branches and of the basilar artery was suggested by CT and confirmed by angiography. The value of CT compared with angiography in relation to intracranial megadolicho vascular malformations is discussed. PMID:6273040

  9. Coronary Artery Disease

    MedlinePlus

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened ...

  10. Occlusive Peripheral Arterial Disease

    MedlinePlus

    ... artery. Such people should seek medical care immediately. Did You Know... When people suddenly develop a painful, ... In This Article Animation 1 Peripheral Arterial Disease Did You Know 1 Did You Know... Figure 1 ...

  11. Retinal artery occlusion

    MedlinePlus

    ... These blockages are more likely if there is hardening of the arteries ( atherosclerosis ) in the eye. Clots ... Blindness and vision loss Blood clots Diabetes Glaucoma Hardening of the arteries High blood cholesterol levels High ...

  12. Coronary Artery Disease

    MedlinePlus

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women. CAD happens when the arteries that supply blood to ...

  13. Carotid artery surgery - discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000238.htm Carotid artery surgery - discharge To use the sharing features on this page, please enable JavaScript. You had carotid artery surgery to restore proper blood flow to your ...

  14. Coronary artery fistula

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/007315.htm Coronary artery fistula To use the sharing features on this page, please enable JavaScript. Coronary artery fistula is an abnormal connection between one of ...

  15. Peripheral Artery Disease (PAD)

    MedlinePlus

    ... changes and medication . View an animation of atherosclerosis Atherosclerosis and PAD Atherosclerosis is a disease in which plaque builds up ... of an artery. PAD is usually caused by atherosclerosis in the peripheral arteries (or outer regions away ...

  16. Coronary artery disease

    MedlinePlus Videos and Cool Tools

    ... heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, a process called atherosclerosis ...

  17. Continuous blood gas monitoring in femoral arteries

    NASA Astrophysics Data System (ADS)

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

    1995-05-01

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

  18. A Biomechanical Model of Artery Buckling

    PubMed Central

    Han, Hai-Chao

    2010-01-01

    The stability of arteries under blood pressure load is essential to the maintenance of normal arterial function and the loss of stability can lead to tortuosity and kinking that are associated with significant clinical complications. However, mechanical analysis of arterial bent buckling is lacking. To address this issue, this paper presents a biomechanical model of arterial buckling. Using a linear elastic cylindrical arterial model, the mechanical equations for arterial buckling were developed and the critical buckling pressure was found to be a function of the wall stiffness (Young’s modulus), arterial radius, length, wall thickness, and the axial strain. Both the model equations and experimental results demonstrated that the critical pressure is related to the axial strain. Arteries may buckle and become tortuous due to reduced (sub-physiological) axial strain, hypertensive pressure, and a weakened wall. These results are in accordance with, and provide a possible explanation to the clinical observations that these changes are the risk factors for arterial tortuosity and kinking. The current model is also applicable to veins and ureters. PMID:17689541

  19. The slow Wallerian degeneration gene in vivo protects motor axons but not their cell bodies after avulsion and neonatal axotomy.

    PubMed

    Adalbert, Robert; Nógrádi, Antal; Szabó, András; Coleman, Michael P

    2006-10-01

    The slow Wallerian degeneration gene (Wld(S)) delays Wallerian degeneration and axon pathology for several weeks in mice and rats. Interestingly, neuronal cell death is also delayed in some in vivo models, most strikingly in the progressive motoneuronopathy mouse. Here, we tested the hypothesis that Wld(S) has a direct protective effect on motoneurone cell bodies in vivo. Cell death was induced in rat L4 motoneurones by intravertebral avulsion of the corresponding ventral roots. This simultaneously removed most of the motor axon, minimizing the possibility that the protective effect toward axons could rescue cell bodies secondarily. There was no significant difference between the survival of motoneurones in control and Wld(S) rats, suggesting that the Wld(S) gene has no direct protective effect on cell bodies. We also tested for any delay in apoptotic motoneurone death following neonatal nerve injury in Wld(S) rats and found that, unlike Wld(S) mice, Wld(S) rats show no delay in cell death. However, the corresponding distal axons were preserved, confirming that motoneurone cell bodies and motor axons die by different mechanisms. Thus, Wld(S) does not directly prevent death of motoneurone cell bodies. It follows that the protection of neuronal cell bodies observed in several disease and injury models where axons or significant axonal stumps remain is most probably secondary to axonal protection. PMID:17074042

  20. Combination of Rare Right Arterial Variation with Anomalous Origins of the Vertebral Artery, Aberrant Subclavian Artery and Persistent Trigeminal Artery

    PubMed Central

    Ishihara, H.; San Millán Ruíz, D.; Abdo, G.; Asakura, F.; Yilmaz, H.; Lovblad, K.O.; Rüfenacht, D.A.

    2011-01-01

    Summary A 32-year-old woman hospitalized for subarachnoid hemorrhage showed rare arterial variation on the right side with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. Angiography showed the right vertebral artery to originate from the right common carotid artery, the right subclavian artery to arise separately from the descending aorta, and persistent trigeminal artery on the right side. The possible embryonic mechanism of this previously unreported variant combination is discussed. PMID:22005696

  1. Carotid Artery Disease

    MedlinePlus

    ... and efficacy continues to be studied in several medical centers. This procedure involves the placement of a small flexible tube (catheter) into an artery from the groin. The catheter is then directed to the neck to reach the carotid artery blockage. A balloon pushes open the artery wall and a stent ( ...

  2. Superficial ulnar artery perforator flap.

    PubMed

    Schonauer, Fabrizio; Marlino, Sergio; Turrà, Francesco; Graziano, Pasquale; Dell'Aversana Orabona, Giovanni

    2014-09-01

    Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions. PMID:25102397

  3. Goldenhar Syndrome Associated with Extensive Arterial Malformations

    PubMed Central

    Modica, Renee Frances; Barbeau, L. Daphna Yasova; Co-Vu, Jennifer; Beegle, Richard D.; Williams, Charles A.

    2015-01-01

    Goldenhar Syndrome is characterized by craniofacial, ocular and vertebral defects secondary to abnormal development of the 1st and 2nd branchial arches and vertebrae. Other findings include cardiac and vascular abnormalities. Though these associations are known, the specific anomalies are not well defined. We present a 7-month-old infant with intermittent respiratory distress that did not improve with respiratory interventions. Echocardiogram suggested a double aortic arch. Cardiac CT angiogram confirmed a right arch and aberrant, stenotic left subclavian artery, dilation of the main pulmonary artery, and agenesis of the left thyroid lobe. Repeat echocardiograms were concerning for severely dilated coronary arteries. Given dilation, a rheumatologic workup ensued, only identifying few weakly positive autoantibodies. Further imaging demonstrated narrowing of the aorta below the renal arteries and extending into the common iliac arteries and proximal femoral arteries. Given a physical exam devoid of rheumatologic findings, only weakly positive autoantibodies, normal inflammatory markers, and presence of the coronary artery dilation, the peripheral artery narrowings were not thought to be vasculitic. This case illustrates the need to identify definitive anomalies related to Goldenhar Syndrome. Although this infant's presentation is rare, recognition of specific vascular findings will help differentiate Goldenhar Syndrome from other disease processes. PMID:26688769

  4. Jet pump assisted artery

    NASA Technical Reports Server (NTRS)

    1975-01-01

    A procedure for priming an arterial heat pump is reported; the procedure also has a means for maintaining the pump in a primed state. This concept utilizes a capillary driven jet pump to create the necessary suction to fill the artery. Basically, the jet pump consists of a venturi or nozzle-diffuser type constriction in the vapor passage. The throat of this venturi is connected to the artery. Thus vapor, gas, liquid, or a combination of the above is pumped continuously out of the artery. As a result, the artery is always filled with liquid and an adequate supply of working fluid is provided to the evaporator of the heat pipe.

  5. External artery heat pipe

    NASA Technical Reports Server (NTRS)

    Gernert, Nelson J. (Inventor); Ernst, Donald M. (Inventor); Shaubach, Robert M. (Inventor)

    1989-01-01

    An improved heat pipe with an external artery. The longitudinal slot in the heat pipe wall which interconnects the heat pipe vapor space with the external artery is completely filled with sintered wick material and the wall of the external artery is also covered with sintered wick material. This added wick structure assures that the external artery will continue to feed liquid to the heat pipe evaporator even if a vapor bubble forms within and would otherwise block the liquid transport function of the external artery.

  6. Acute Arterial Emergencies

    PubMed Central

    Dagnone, L. E.; Brown, P. M.

    1983-01-01

    The response of the primary care physician in the initial assessment and management of acute arterial injuries will often be the deciding factor in survival of life, limb or organ system. Most arterial emergencies occur as a result of trauma, disruption of vessel wall and/or occlusion of flow. The common clinical syndromes of acute arterial emergencies are injuries to and beyond the aorta, acute aortic dissection, ruptured aortic aneurysm, and thromboembolic occlusive arterial disease. The role of arteriography and the urgency of definitive surgical repair in acute arterial emergencies is summarized. PMID:21283323

  7. Persistent trigeminal artery feeding a hemispheric branch of the posterior inferior cerebellar artery: a rare anatomic variant.

    PubMed

    Perot, G; Clarençon, F; Di Maria, F; Sourour, N; Biondi, A; Cornu, P; Chiras, J

    2011-10-01

    Persistent trigeminal artery is a rare persistent carotid-basilar anastomosis that usually connect the infracavernous segment of the ICA with the basilar artery. Rarely, PTA may feed cerebellar artery. We describe an exceptional case of PTA terminating in postero-inferior cerebellar artery (PICA) hemispheric branch. Angiographic and CTA features are presented and hypotheses regarding developmental origin of this variation are discussed. PMID:21492937

  8. A Large Posttraumatic Subclavian Artery Aneurysm Complicated by Artery Occlusion and Arteriobronchial Fistula Successfully Treated Using a Covered Stent

    SciTech Connect

    Stefanczyk, Ludomir; Czeczotka, Jaroslaw; Elgalal, Marcin; Sapieha, Michal; Rowinski, Olgierd

    2011-02-15

    The treatment of posttraumatic aneurysms of peripheral arteries using covered stents is increasingly commonplace. We present the case of a 10-year-old girl with a pseudoaneurysm of the subclavian artery complicated by an arteriobronchial fistula with hemorrhaging into the bronchial tree and distal subclavian artery occlusion. Despite the lack of artery patency, endovascular stent graft implantation was successful. Pseudoaneurysm exclusion and involution was achieved, together with a patent implant and maintained collateral circulation patency.

  9. Brachiomedian artery (arteria brachiomediana) revisited: a comprehensive review

    PubMed Central

    Kachlik, David; Konarik, Marek; Riedlova, Jitka; Baca, Vaclav

    2016-01-01

    This article reviews in detail the superficial brachiomedian artery (arteria brachiomediana superficialis), a very rare variant of the main arterial trunks of the upper limb. It branches either from the axillary artery or the brachial artery, descends superficially in the arm (similar to the course of the superficial brachial artery) and continues across the cubital fossa, runs superficially in the forearm, approaches the median nerve and enters the carpal canal to reach the hand. It usually terminates in the superficial palmar arch. The first drawing was published, in 1830, and the first description was published, in 1844. Altogether, to our knowledge, only 31 cases of a true, superficial brachiomedian artery have been reported (Some cases are incorrectly reported as superficial brachioradiomedian artery or superficial brachioulnomedian artery). Based on a meta-analysis of known, available studies, the incidence is 0.23% in Caucasians and 1.48% in Mongolians. Knowing whether or not this arterial variant is present is important in clinical medicine and relevant for: The catheterization via the radial or ulnar artery; harvesting the vascular pedicle for a forearm flap based on the radial, ulnar or superficial brachiomedian arteries; the possible collateral circulation in cases of the arterial closure; and the surgical management of carpal tunnel syndrome. Its presence can elevate the danger of an injury to the superficially located variant artery or of an accidental injection. PMID:27131025

  10. Right hepatic artery from splenic artery: the four-leaf clover of hepatic surgery.

    PubMed

    Caruso, Francesco; Dondossola, Daniele; Fornoni, Gianluca; Caccamo, Lucio; Rossi, Giorgio

    2016-09-01

    The anatomy of hepatic arteries is one of the most variable. Accurate awareness of all the possible anatomic variations is crucial in the upper GI surgery and especially in liver and pancreas transplantation. The most frequent anatomical variants are: a replaced or accessory right hepatic artery (RHA) from the superior mesenteric artery (6.3-21 %), a replaced or accessory left hepatic artery (LHA) from the left gastric artery (LGA) (3-18 %) or a combination of these two variants (up to 7.4 %). Herein, we describe the case of a 67-year-old cadaveric organ donor who presented a RHA originating from the splenic artery (SA) associated with both a CHA originating from the celiac trunk (CT) and a LHA originating from the LGA. PMID:26769020

  11. Systemic Artery to Pulmonary Artery Fistula Associated with Mitral Regurgitation: Successful Treatment with Endovascular Embolization

    SciTech Connect

    Iwazawa, Jin; Nakamura, Kenji; Hamuro, Masao; Nango, Mineyoshi; Sakai, Yukimasa; Nishida, Norifumi

    2008-07-15

    We present the case of a 60-year-old woman with symptomatic mitral regurgitation caused by a left-to-right shunt via anastomoses consisting of microfistulae, most likely of inflammatory origin, between the right subclavian artery and the right pulmonary artery. The three arteries responsible for fistulous formation, including the internal mammary, thyrocervical, and lateral thoracic arteries, were successfully occluded by transcatheter embolization using superabsorbent polymer microsphere (SAP-MS) particles combined with metallic coils. No complications have been identified following treatment with SAP-MS particles. This approach significantly reduced the patient's mitral regurgitation and she has remained asymptomatic for more than 4 years.

  12. Endovascular Treatment of a Coronary Artery Bypass Graft to Pulmonary Artery Fistula with Coil Embolization

    SciTech Connect

    Nielson, Jeffery L. Kang, Preet S.

    2006-04-15

    Fistula formation between a coronary artery bypass graft (CABG)and the pulmonary arterial circulation represents a rare cause of recurrent angina in patients following bypass grafting. Therapy has traditionally involved surgical ligation by open thoracotomy. We describe a case of left internal mammary artery-left upper lobe pulmonary artery fistula presenting as early recurrent angina following CABG. The fistula was embolized using platinum coils, resulting in symptomatic relief and improvement in myocardial perfusion on cardiac perfusion scintigraphy. Coil embolization should be considered a therapeutic option in patients with coronary-pulmonary steal syndrome.

  13. Coronary artery stenosis.

    PubMed

    Weir, Ian

    2006-05-01

    The near exponential rise in percutaneous coronary intervention(PCI) in the treatment of patients with coronary artery disease and the consequent decline in referral of patients for coronary artery bypass grafting (CABG) has lead to a crisis in cardiac surgery. Is CABG, one of the most successful and widely applied surgical procedures, about to follow surgery for peptic ulcer disease into obsolescence? The question has serious implications for service provision and training as well as for informed patient consent. Keith Dawkins puts the case for PCI and gives a very clear and concise account of its inexorable rise to pre-eminence. David Taggart has taken on the Goliath of interventional cardiology and its associated industry by persuasively marshalling the data from the evidence base which strongly favours surgery in triple vessel and left main coronary disease. He points to the lack of long-term results and also to the weaknesses of many of the comparative studies so far published. His arguments have been positively received on both sides of the Atlantic but it is by no means certain that they will bring about the multidisciplinary approach to providing patients with treatment options which he and others advocate. It also remains to be seen whether the evidence base when it is eventually acquired will vindicate the present increasing dominance of PCI over CABG. PMID:16719994

  14. Variable scale channel avulsion history using fan architecture and stratigraphy, and sediment provenance of Sutlej-Yamuna fans in northwest Gangetic plains during Late Quaternary

    NASA Astrophysics Data System (ADS)

    Singh, Ajit; Gupta, Sanjeev; Sinha, Rajiv; Densmore, Alexander; Buylaert, Jan-Pieter; Carter, Andrew; Van-Dijk, Wout M.; Joshi, Suneel; Nayak, Nibedita; Mason, Philippa J.; Kumar, Dewashish; Mondal, Setbandhu; Murray, Andrew; Rai, Shiv P.; Shekhar, Shashank

    2016-04-01

    Channel avulsion during fan development controls distribution and deposition of channel sandbodies and hence alluvial architecture of a fan system. Variable scale spatio-temporal information of fluvial responses to past climate changes is stored in these channel sandbodies. Further these channel sandbodies form fluvial aquifers in alluvial fans and therefore understanding of alluvial architecture and stratigraphy of a fan is crucial for development of groundwater management strategies. In this study we used multiple approaches to map subsurface fluvial aquifer architecture and alluvial stratigraphy, and to estimate sediment provenance using U-Pb dating of detrital zircon grains of Sutlej-Yamuna fan system in northwest India. Satellite imagery based geomorphic mapping shows two large fan system with interfan area. The fan surfaces show presence of major and minor paleochannels. 2D resistivity tomography along several transects across fan surfaces shows distinct layers with contrasting resistivity values. These geo-electric facies corresponds to presence of channel sandbodies beneath surface signature of paleochannels and finer floodplain deposits useful to demarcate lateral extent of subsurface channel sandbodies. A more detailed subsurface stratigraphy using ~50m deep sediment cores and their luminescence ages from across fan surface shows presence of multi-storey sandbodies (MSB) separated by floodplain fines. Within the MSB, individual channel deposits are identified by presence of channel scour surfaces located at coarse sand overlying fine sand layer. Depositional ages of MSB's ranges from ~81 ka (late MIS5) to ~15 ka (MIS2) with major depositional break during MIS3 in parts of the fans. Sediment aggradation rate varies laterally across fan surface as well as vertically down the depth with an average rate of 0.54 mm/year. Fluvial channel persistence for studied time interval (about last 81 ka BP) shows major depositional breaks (and possible incision) at ~41 ka

  15. Pulse Wave Propagation in the Arterial Tree

    NASA Astrophysics Data System (ADS)

    van de Vosse, Frans N.; Stergiopulos, Nikos

    2011-01-01

    The beating heart creates blood pressure and flow pulsations that propagate as waves through the arterial tree that are reflected at transitions in arterial geometry and elasticity. Waves carry information about the matter in which they propagate. Therefore, modeling of arterial wave propagation extends our knowledge about the functioning of the cardiovascular system and provides a means to diagnose disorders and predict the outcome of medical interventions. In this review we focus on the physical and mathematical modeling of pulse wave propagation, based on general fluid dynamical principles. In addition we present potential applications in cardiovascular research and clinical practice. Models of short- and long-term adaptation of the arterial system and methods that deal with uncertainties in personalized model parameters and boundary conditions are briefly discussed, as they are believed to be major topics for further study and will boost the significance of arterial pulse wave modeling even more.

  16. Numerical modelling of fracture in human arteries.

    PubMed

    Ferrara, A; Pandolfi, A

    2008-10-01

    We present 3D finite element models of atherosclerotic arteries, used to investigate the influence of the geometry and tissue properties on the plaque rupture caused by overexpansion. We adopted a geometry reconstructed from a contiguous set of in vitro magnetic resonance images of a damaged artery. The artery wall is divided in three layers (adventitia, media and intima) and is discretized into tetrahedral finite elements. The artery material is described with a hyperelastic two-fiber anisotropic model proposed by Holzapfel et al. 2000. A new constitutive framework for arterial wall mechanics and a comparative study of material models. J Elasticity 61(1):1-48, while the plaque is assumed to be transversely isotropic. Cracks induced by mechanical actions are represented through cohesive surfaces, and are allowed to develop along solid elements boundaries only. Fractures are explicitly introduced in the discretized model at the locations where the tensile strength of the material is reached. PMID:19230149

  17. [Popliteal artery entrampment: report of one case].

    PubMed

    Parra, Juan; Corvalán, Felipe; Ibáñez, Fernando; Bianchi, Víctor; Bastías, Waldo; Salas, Cristian; Cam, Alfredo; Lamarca, Andrés

    2006-02-01

    Popliteal artery entrampment is a rare condition, occurring in young subjects, that causes ischemia of the extremity. The anatomical background is the compression or occlussion of the popliteal artery caused by forced plantar or dorsal flexion. We report a 32 year-old sportsman who presented with gangrene of the right first toe and a history of three months of progressive claudication. The Ankle-Brachial index and pulse volume curve registries showed a severe ischemia below the knee. Angiography showed a medial deviation of the popliteal artery associated to stenosis and aneurysm formation. A CT scan of the contralateral artery was normal. The patient was operated using a posterior approach, performing a reverse saphenous vein bypass graft and excising the popliteal artery. The postoperative period was uneventful. PMID:16554929

  18. Bilateral mechanical rotational vertebral artery occlusion.

    PubMed

    Dargon, Phong T; Liang, Conrad W; Kohal, Anmol; Dogan, Aclan; Barnwell, Stanley L; Landry, Gregory J

    2013-10-01

    Rotational vertebral artery occlusion, or bow hunter's stroke, is reversible, positional symptomatic vertebrobasilar ischemia. The typical mechanism of action is obstruction of a dominant vertebral artery with contralateral head rotation in the setting of baseline ipsilateral vertebral artery stenosis or occlusion. Here we present a rare case of mechanical occlusion of bilateral patent vertebral arteries manifesting as near syncope with rightward head rotation. Diagnostic cerebral angiography showed dynamic right C5 vertebral occlusion and left C2 vertebral occlusion. The patient underwent right C4/5 transverse process decompression. Postoperative angiogram showed patent flow through the right vertebral artery in neutral position and with head turn with resultant resolution of symptoms. PMID:23465174

  19. Anterior communicating artery aneurysm associated with an infraoptic course of anterior cerebral artery and rare variant of the persistent trigeminal artery: a case report and literature review.

    PubMed

    Turkoglu, Erhan; Arat, Anıl; Patel, Nirav; Kertmen, Hayri; Başkaya, Mustafa K

    2011-05-01

    Infraoptic course of the precommunicating segment of the anterior cerebral artery (A1) is a rare anomaly. Furthermore, the presence of this anomaly associated with persistent trigeminal artery variant has been reported in the literature only once. We present a patient who had infraoptic course of A1 associated with an ipsilateral persistent trigeminal artery variant arising from the right internal carotid artery with no apparent connection to the basilar artery. The persistent trigeminal artery variant supplied to the right posteroinferior cerebellar artery territory. The patient also had hypoplastic left vertebral artery, superior cerebellar arteries originating from posterior cerebellar arteries bilaterally, and a bilobed aneurysm of the anterior communicating artery. The aneurysm was clipped and the infraoptic course was verified during the surgery. The post-operative course was uneventful and a follow-up arteriogram on the 7th postoperative day revealed successful obliteration of the aneurysm. We reviewed the literature with respect to presentation, associated vascular anomalies, imaging, associated cerebral aneurysms and other cerebral abnormalities, and treatment of the associated aneurysms. A discussion of the embryogenesis of this rare anomaly is also provided. PMID:21269759

  20. Computerized tomography myelography with coronal and oblique coronal view for diagnosis of nerve root avulsion in brachial plexus injury

    PubMed Central

    2007-01-01

    Background The authors describe a new computerized tomography (CT) myelography technique with coronal and oblique coronal view to demonstrate the status of the cervical nerve rootlets involved in brachial plexus injury. They discuss the value of this technique for diagnosis of nerve root avulsion compared with CT myelography with axial view. Methods CT myelography was performed with penetration of the cervical subarachnoid space by the contrast medium. Then the coronal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified with presence of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve rootlets. The diagnosis was by extraspinal surgical exploration with or without spinal evoked potential measurements and choline acetyl transferase activity measurement in 25 patients and recovery by a natural course in 3 patients. Its diagnostic accuracy was compared with that of CT myelography with axial view, correlated with surgical findings or a natural course in 57 cervical roots in 28 patients. Results Coronal and oblique coronal views were superior to axial views in visualization of the rootlets and orientation of the exact level of the root. Sensitivity and specificity for coronal and oblique coronal views of unrecognition of intradural ventral and dorsal nerve root shadow without pseudomeningocele in determining pre-ganglionic injury were 100% and 96%, respectively. There was no statistically significant difference between coronal and oblique coronal views and axial views. Conclusion The information by the coronal and oblique coronal slice CT myelography enabled the authors to assess the rootlets of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction. PMID:17651476

  1. Late Endovascular Pulmonary Artery Band Migration.

    PubMed

    Luciani, Giovanni Battista; Lucchese, Gianluca; Hoxha, Stiljan; Torre, Salvatore; Treviso, Oscar; Faggian, Giuseppe

    2016-01-01

    Here reported is an unusual case of pulmonary artery band migration with serendipitous clinical presentation late after neonatal palliation of single ventricle with aortic arch hypoplasia. The diagnostic and therapeutic implications are discussed. PMID:26694278

  2. Concurrence of the tortuosity of bilateral common and left internal carotid arteries in a case with common origin of the innominate trunk and left common carotid artery.

    PubMed

    Yildiz, Sema; Cece, Hasan; Karayol, Sibel; Ziylan, Zeki

    2010-10-01

    Anatomical variations of carotid arterial system, which are not infrequently encountered, have great impact on the surgical approaches of the neck. Although few reports on common carotid artery tortuosity have been published, no case of symptomatic concurrent common carotid and internal carotid artery tortuosity has been reported. Herein, we report the first case with concurrent common origin of the innominate trunk and left common carotid artery and common and internal carotid artery tortuosity presenting with an oropharyngeal mass. PMID:20407773

  3. Giant Cavernous Aneurysm Associated with a Persistent Trigeminal Artery and Persistent Otic Artery

    PubMed Central

    Zhang, Chang-wei; Yang, Zhi-gang; Wang, Chao-hua; You, Chao; Mao, Bo-yong; He, Min; Sun, Hong

    2009-01-01

    Primitive trigeminal artery (PTA) and primitive otic artery (POA) is a very rare entity in adult life. We present a case of PTA and POA associated with a giant unruptured cavernous aneurysm in a 54-year-old woman. The PTA and the POA arose from the sac of the aneurysm directly, which greatly complicated endovascular therapy management. PMID:19721839

  4. Hepatic artery reinforcement after post pancreatectomy haemorrhage caused by pancreatitis.

    PubMed

    Merdrignac, Aude; Bergeat, Damien; Levi Sandri, Giovanni Battista; Agus, Marina; Boudjema, Karim; Sulpice, Laurent; Meunier, Bernard

    2016-08-01

    Post-pancreatectomy hemorrhage (PPH) is a major complication occurring in 6-8% of patients after pancreaticoduodenectomy (PD). Arterial bleeding is the most frequent cause. Mortality rate could reach 30% after grade C PPH according to ISGPS classification. Complete interruption of hepatic arterial flow has to be a salvage procedure because of the high risk of intrahepatic abscess following the procedure. We report a technique to perform an artery reinforcement after PPH caused by pancreatitis. A PD according to Whipple's procedure with child's reconstruction was performed in a 68-year-old man. At postoperative day 12, the patient presented a sudden violent abdominal pain with arterial hypotension and tachycardia. Computed tomography (CT) with intravenous contrast injection was performed. Arterial and venous phases showed a contrast extravasation on the hepatic artery. Origin of PPH was found as an erosion of hepatic artery caused by pancreatic leak. A peritoneal patch was placed around hepatic artery to reinforce damaged arterial wall. The peritoneal patch was harvested from right hypochondrium with a thin preperitoneal fat layer. The patch was sutured around hepatic artery with musculoaponeurotic face placed on the arterial wall. A CT was performed and hepatic artery was permeable with normal caliber in the portion of peritoneal patch reinforcement. The technique described in the present case consists in reinforcing directly arterial wall after occurrence of PPH. The use of a peritoneal patch during pancreatic surgery has first been described to replace a portion of portal vein after venous resection with the peritoneal layer placed on the intraluminal side of the vein. The present case describes a salvage technique to reinforce damaged artery after PPH in context of pancreatic leak. This simple technique could be useful to avoid complex arterial reconstruction and recurrent bleeding in septic context. PMID:27563565

  5. Hepatic artery reinforcement after post pancreatectomy haemorrhage caused by pancreatitis

    PubMed Central

    Merdrignac, Aude; Bergeat, Damien; Levi Sandri, Giovanni Battista; Agus, Marina; Boudjema, Karim; Sulpice, Laurent

    2016-01-01

    Post-pancreatectomy hemorrhage (PPH) is a major complication occurring in 6–8% of patients after pancreaticoduodenectomy (PD). Arterial bleeding is the most frequent cause. Mortality rate could reach 30% after grade C PPH according to ISGPS classification. Complete interruption of hepatic arterial flow has to be a salvage procedure because of the high risk of intrahepatic abscess following the procedure. We report a technique to perform an artery reinforcement after PPH caused by pancreatitis. A PD according to Whipple’s procedure with child’s reconstruction was performed in a 68-year-old man. At postoperative day 12, the patient presented a sudden violent abdominal pain with arterial hypotension and tachycardia. Computed tomography (CT) with intravenous contrast injection was performed. Arterial and venous phases showed a contrast extravasation on the hepatic artery. Origin of PPH was found as an erosion of hepatic artery caused by pancreatic leak. A peritoneal patch was placed around hepatic artery to reinforce damaged arterial wall. The peritoneal patch was harvested from right hypochondrium with a thin preperitoneal fat layer. The patch was sutured around hepatic artery with musculoaponeurotic face placed on the arterial wall. A CT was performed and hepatic artery was permeable with normal caliber in the portion of peritoneal patch reinforcement. The technique described in the present case consists in reinforcing directly arterial wall after occurrence of PPH. The use of a peritoneal patch during pancreatic surgery has first been described to replace a portion of portal vein after venous resection with the peritoneal layer placed on the intraluminal side of the vein. The present case describes a salvage technique to reinforce damaged artery after PPH in context of pancreatic leak. This simple technique could be useful to avoid complex arterial reconstruction and recurrent bleeding in septic context. PMID:27563565

  6. Branches and arterial supply of the recurrent artery of Heubner.

    PubMed

    Maga, Paweł; Tomaszewski, Krzysztof A; Krzyżewski, Roger M; Golec, Joanna; Depukat, Paweł; Gregorczyk-Maga, Iwona; Skrzat, Janusz

    2013-09-01

    The aim of this study was to describe the branches and arterial supply of the recurrent artery of Heubner (RAH) in order to provide detailed information to neurosurgeons operating in this area of the brain. A total of 70 human brains (39 male and 31 female) obtained from cadavers (aged 31-75 years) during routine autopsies were examined; brains from individuals who died due to neurological disorders were not included in the study. Immediately after dissection the arteries were perfused with acrylic paint emulsion through the circle of Willis or electively through the RAH. Brains were fixed in a 10 % solution of formaldehyde and sectioned; the sections were analyzed under a stereoscopic light microscope (magnification 2-40×). The RAH was present in 138 hemispheres with a mean of 1.99 per hemisphere. Mean RAH length was 25.2 mm and the mean diameter, in its place of origin, was 1 mm. Between two and 30 (mean 9.4) branches originated from the stem of the RAH. Each branch then divided into 2-40 smaller branches (mean 19). Primary branches were divided and named in accordance with their course and arterial supply. Primary RAH branches include the anterior perforating substance, sylvian fissure, olfactory, frontal, hypothalamic, optic tract and connecting branches. Left and right hemispheres were asymmetrically supplied by RAH branches, but none of these discrepancies were of statistical significance. PMID:23860669

  7. Endovascular Treatment of Lower Limb Penetrating Arterial Traumas

    SciTech Connect

    Mavili, Ertugrul Donmez, Halil; Ozcan, Nevzat; Akcali, Yigit

    2007-11-15

    Purpose: The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma. Materials and Methods: Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients. Results: On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient. Conclusions: We conclude that embolization-particularly n-butyl cyanoacrylate embolization-is technically feasible in patients with penetrating peripheral arterial trauma.

  8. Effects of pressure on arterial failure.

    PubMed

    Khamdaengyodtai, Pannathai; Vafai, Kambiz; Sakulchangsatjatai, Phrut; Terdtoon, Pradit

    2012-10-11

    A three-dimensional multilayer model of mechanical response for analyzing the effect of pressure on arterial failure is presented in this work. The multilayer arterial wall is considered to be composed of five different layers. The three-dimensional effects are incorporated within the five-concentric axisymmetric layers while incorporating the nonlinear elastic characteristics under combined extension and inflation. Constitutive equations for fiber-reinforced material are employed for three of the major layers, i.e., intima, media and adventitia and an isotropic material model is employed for the other two layers, i.e., endothelium and internal elastic lamina. Our own developed three-dimensional five-layer model has been utilized to model propagated rupture area of the arterial wall. Required parameters for each layer are obtained by using a nonlinear least square method fitted to in vivo non-invasive experimental data of human artery and the effects of pressure on arterial failure are examined. The solutions from our computational model are compared with previous studies and good agreements are observed. Local stresses and strain distributions across the deformed arterial wall are illustrated and consequently the rupture area is predicted by varying luminal pressure in the physiological range and beyond. The effects of pressure on the arterial failure have been interpreted based on this comprehensive three-dimensional five-layer arterial wall model. This is the first study which employs two constitutive equations and incorporates a five-layer arterial wall model in three-dimensions based on in vivo non-invasive experimental data for a human artery. PMID:22980577

  9. Spontaneous Coronary Artery Dissection with Cardiac Tamponade.

    PubMed

    Goh, Anne C H; Lundstrom, Robert J

    2015-10-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome. PMID:26504447

  10. Spontaneous Coronary Artery Dissection with Cardiac Tamponade

    PubMed Central

    Lundstrom, Robert J.

    2015-01-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome. PMID:26504447

  11. Management of nonocclusive hepatic artery complications after liver transplantation.

    PubMed

    Saad, Wael E A

    2007-09-01

    Nonocclusive arterial disease represents less than 5% of posttransplant arterial complications. Nonocclusive arterial complications are classified into (1) nonocclusive diminished flow in the hepatic artery, (2) arteriovenous fistulae, (3) pseudoaneurysms, and (4) arterial rupture. Due to the rarity of these complications, particularly when considering them individually, many of the opinions and managements of these complications are anecdotal. Transcatheter embolization is the main mode of minimal invasive management of these uncommon complications. Other minimal invasive methods have been described such as stent placement or direct percutaneous embolization/thrombosis. The article discusses the presentation, etiology, types, treatment indications, and various modes of minimal invasive therapy used to manage these complications. PMID:18086427

  12. Pulmonary artery agenesis associated with coronary collaterals among adults.

    PubMed

    Darwazah, Ahmad K; Alhaddad, Imad A

    2016-01-01

    Unilateral agenesis of the pulmonary artery is a rare congenital anomaly, which commonly involves the right side. Cases are associated with systemic collaterals, that may also rarely arise from the coronary arteries.Two adult patients are presented with a right pulmonary artery agenesis associated with collaterals from the right coronary artery. The implications of such an anomaly on pulmonary artery pressure and lung pathology differs among both cases. The association of coronary collaterals is rare and its implication is variable among various patients. PMID:27422770

  13. Double steal phenomenon secondary to innominate artery occlusion.

    PubMed

    Esen, Kaan; Yilmaz, Cengiz; Kaya, Omer; Soker, Gokhan; Gulek, Bozkurt; Sahin, Durmus Yildiray

    2016-07-01

    Innominate artery steno-occlusive disease is a relatively rare clinical entity and may cause cerebrovascular symptoms. Herein, we report a 50-year-old male patient who presented with recurrent syncopal episodes and cerebrovascular ischemia. Color Doppler sonography revealed a distinctive flow pattern with partial and total flow reversal in the right internal carotid artery and vertebral artery, respectively. Further angiographic evaluation revealed complete occlusion of the innominate artery. Endovascular stenting was successful and enabled normal antegrade flow in the right common carotid and vertebral artery. PMID:27107766

  14. Peripheral artery disease - legs

    MedlinePlus

    ... if they have a history of: Abnormal cholesterol Diabetes Heart disease (coronary artery disease) High blood pressure ( hypertension ) Kidney disease involving hemodialysis Smoking Stroke ( cerebrovascular disease )

  15. Infective endocarditis related to a coronary artery fistula with an unusual localization and ectatic coronary arteries.

    PubMed

    Gerede, Demet Menekse; Acibuca, Aynur; Uzun, Caglar; Goksuluk, Huseyin; Ongun, Aydan; Kilickap, Mustafa; Erol, Cetin

    2015-04-01

    Coronary artery fistulas (CAF) are a rare cardiac anomaly that can be either congenital or acquired. CAFs have clinical significance because of complications such as dyspnea on exertion, congestive heart failure, and cardiac tamponade. The literature also contains case reports of CAF presenting as bacterial endocarditis. We describe a 31-year-old man who presented with native valve infective endocarditis related to an unusual form of a CAF between the circumflex coronary artery and left ventricle. He also had giant coronary arteries, which were imaged with computed tomography angiography and transesophageal echocardiography. The diameter of the circumflex coronary artery and left main coronary artery was measured as 19 mm. Surgical intervention for heart valves was performed because of vegetations resistant to continued antibiotic treatment. At the same time, the CAF was treated with surgery. PMID:25362867

  16. Vascular Leiomyoma of the Pulmonary Artery.

    PubMed

    Klotz, Laura V; Morresi-Hauf, Alicia; Hatz, Rudolf A; Lindner, Michael

    2016-01-01

    Leiomyoma of the pulmonary artery represents a curiosity in the literature. We describe a case of a 54-year-old female patient who presented with recurrent cough of a few weeks' duration. Computed tomography of the thorax located a smooth, limited tumor in the left thorax near the interlobar space. Thoracoscopic exploration showed a tumor mass, fused with the pulmonary artery. After anterolateral thoracotomy, a complete resection of the tumor was performed. The histopathologic examination showed the presence of a vascular leiomyoma of the tunica media of the pulmonary artery. PMID:26694272

  17. Spontaneous coronary artery dissection in puerperium.

    PubMed

    Refaie, Medhat; Alshehri, Mohammed; Gallo, Ricardo

    2016-06-01

    Spontaneous coronary artery dissection in puerperium is uncommon and most often occurs in the third trimester of pregnancy and in the early postpartum period. Two weeks after delivery, a 41-year-old woman presented with typical retrosternal chest pain and inverted T-waves in leads II, V5 and V6, and Q-waves in aVR. Her peak troponin I level was 16.39 µgċL(-1) Coronary angiography showed left main spiral dissection extending to the mid left anterior descending artery and involving the first diagonal branch. Urgent coronary artery bypass grafting was performed successfully. The mechanism and approach are discussed. PMID:25746424

  18. Quaternary evolution of the rivers of northeast Hainan Island, China: Tracking the history of avulsion from mineralogy and geochemistry of river and delta sands

    NASA Astrophysics Data System (ADS)

    Pe-Piper, Georgia; Piper, David J. W.; Wang, Ying; Zhang, Yongzhan; Trottier, Corwin; Ge, Chendong; Yin, Yong

    2016-03-01

    The mineralogy and geochemistry of sands were investigated in the Nandu and Wanquan rivers, Hainan Island, China, to determine the history of avulsion in the lower reaches of the Nandu River. The study also provided the opportunity to assess the utility of geochemical analysis of sands as a provenance tool. Much of the heavy mineral fraction in the rivers consists of subangular Fe-Ti oxide and Fe-(hydr)oxide minerals, and less stable minerals such as amphibole, epidote, and andalusite, whereas rounded resistant ilmenite, rutile, tourmaline and zircon predominate on the deltaic coast. Mineral assemblage and chemical composition of individual samples are related to specific source areas and river tributaries. The results demonstrate northwestwards flow of the Nandu River during the mid-Holocene and earlier avulsion of the river to the northeast coast, probably during a Late Pleistocene marine highstand. Minor basement tilting, producing little relief, was sufficient to divert the lower reaches of rivers, and this effect was enhanced where basalt flows dammed former river courses. Bulk sample REE geochemistry is largely controlled by the relative abundance of monazite, allanite, titanite, zircon and epidote, derived principally from granites. Detrital geochemistry alone shows too much variability to interpret provenance. However, a smaller number of heavy mineral analyses provide an understanding of the mineralogical origins of geochemical variation, thus enabling interpretations of provenance.

  19. A Middle to Late Holocene avulsion history of the Euphrates river: a case study from Tell ed-Dēr, Iraq, Lower Mesopotamia

    NASA Astrophysics Data System (ADS)

    An Heyvaert, Vanessa Mary; Baeteman, Cecile

    2008-12-01

    Geoarchaeological research was performed to reconstruct the floodplain history in the surroundings of two ancient Mesopotamian cities: Tell ed-Dēr and Sippar. The mapping of the floodplain is based on facies analyses of the sedimentary succession of 225 hand-operated boreholes. The archaeological sites Tell ed-Dēr and Sippar are closely linked to a palaeochannelbelt of the Euphrates, located in the western part of the study area. Channel activity started at least in ca 3100 BC/5050 cal BP, until ca 1400-1000 BC/3350-2950 cal BP. The channel belt was part of an avulsion driven multiple Euphrates channel network that gradually became abandoned from the second half of the 2nd millennium BC. A second mapped Euphrates, Tigris or Joint Euphrates -Tigris palaeochannel belt became abandoned well before 3100 BC. Examples of natural processes as well as human interactions triggering avulsion are given. Moreover, textual, archaeological and geological data show clearly that flood-control techniques and the construction of large-scale dikes seemed to be a common practice.

  20. Unusual Transalveolar and Transmuco-Gingival Root Avulsion of a Fractured Primary Central Incisor: A Case with an 8-Year Follow-Up

    PubMed Central

    Ferrés-Amat, E.; Díaz-Martínez, C.; Herrera-Martínez, S.; Maura-Solivellas, I.; Ferrés-Padró, E.

    2015-01-01

    The purpose of this unique case report is to describe a very unusual dentoalveolar fracture associated with avulsion of the near-complete root. A 3-year-old male patient came for consultation after a dentoalveolar trauma with a “fragment that looks like canine” found in his mouth by his mother. This boy suffered root fracture of the upper primary central right incisor, accompanied by transalveolar and transmuco-gingival avulsion of the tooth root fragment, leaving the crown in its position in the dental arch. Clinical and radiological examinations were performed in order to follow up the case: 15 days, one month, and three months after trauma, the crown had a slight mobility without other clinical or radiological signs. After six months, the upper primary central right incisor's crown was exfoliated. Open bite due to the persistence of the pacifier habit favored the crown retention in the mouth. This case emphasizes the importance of primary diagnosis and follow-up of trauma cases. To the best of our knowledge, this kind of dental injury has not been previously described in the literature nor in the current Dental Trauma guidelines for the management of traumatic dental injuries in the primary dentition. PMID:25793129

  1. Rehabilitation Considerations of a Brachial Plexus Injury with Complete Avulsion of C5 and C6 Nerve Roots in a College Football Player

    PubMed Central

    Saliba, Susan; Saliba, Ethan N.; Pugh, Kelli F.; Chhabra, Abhinav; Diduch, David

    2009-01-01

    Severe brachial plexus injuries are rare in sports, but they have catastrophic results with a significant loss of function in the involved upper extremity. Nerve root avulsions must be timely managed with prompt evaluation, accurate diagnosis, and surgical treatment to optimize the potential for a functional outcome. This case report describes the mechanism of injury, diagnostic evolution, surgical management, and rehabilitation of a college football player who sustained a traumatic complete nerve root avulsion of C5 and C6 (upper trunk of the brachial plexus). Diagnostics included clinical evaluation, magnetic resonance imaging, computed tomography myelogram, and electromyogram. Surgical planning included nerve grafting and neurotization (nerve transfer). Rehabilitation goals were to bring the hand to the face (active biceps function), to stabilize the shoulder for abduction and flexion, and to reduce neuropathic pain. Direct current stimulation, bracing, therapeutic exercise, and biofeedback were used to maximize the use of the athlete’s upper extremity. Although the athlete could not return to sport or normal function by most standards, his results were satisfactory in that he regained an ability to perform many activities of daily living. PMID:23015895

  2. Subclavian Steal Syndrome with or without Arterial Stenosis: A Review.

    PubMed

    Kargiotis, Odysseas; Siahos, Simos; Safouris, Apostolos; Feleskouras, Agisilaos; Magoufis, Georgios; Tsivgoulis, Georgios

    2016-09-01

    The subclavian-vertebral artery steal syndrome (SSS) is the hemodynamic phenomenon of blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal subclavian artery or the innominate artery. Occasionally, SSS is diagnosed in patients not harboring arterial stenosis. With the exception of arterial congenital malformations, the limited case reports of SSS with intact subclavian artery are attributed to dialysis arteriovenous fistulas (AVFs). Interestingly, these cases are more frequently symptomatic than those with the classical atherosclerotic SSS forms. On the other hand, the disclosure of SSS due to subclavian/innominate artery atherosclerotic stenosis, even in the absence of accompanying symptoms, should prompt a thorough cardiovascular work-up for the early detection of coexisting coronary, carotid, or peripheral artery disease. Herein, we review the incidence, clinical presentation, sonographic findings, and therapeutic interventions related to SSS with and without subclavian/innominate artery stenosis. We also review the currently available data in the literature regarding the association of SSS and dialysis AVF. In addition, we present a patient with bilateral symptomatic SSS as the result of an arteriovenous graft (AVG) that was introduced after the preexisting AVF in the contralateral arm became nonfunctional. SSS due to subclavian or innominate artery stenosis/occlusion is rarely symptomatic warranting interventional treatment. In contrast, when it is attributed to AVF, surgical correction is frequently necessary. PMID:27301069

  3. Measuring How Elastic Arteries Function.

    ERIC Educational Resources Information Center

    DeMont, M. Edwin; MacGillivray, Patrick S.; Davison, Ian G.; McConnell, Colin J.

    1997-01-01

    Describes a procedure used to measure force and pressure in elastic arteries. Discusses the physics of the procedure and recommends the use of bovine arteries. Explains the preparation of the arteries for the procedure. (DDR)

  4. Screening for Carotid Artery Stenosis

    MedlinePlus

    ... Task Force learned about the potential benefits and harms of screening for carotid artery stenosis: Health professionals ... blood flow through the arteries. Potential Benefits and Harms of Carotid Artery Stenosis Screening and Treatment The ...

  5. Living with Carotid Artery Disease

    MedlinePlus

    ... from the NHLBI on Twitter. Living With Carotid Artery Disease If you have carotid artery disease, you can take steps to manage the ... treatment plan, and getting ongoing care. Having carotid artery disease raises your risk of having a stroke . ...

  6. Coronary artery stent (image)

    MedlinePlus

    ... with a balloon catheter and expands when the balloon is inflated. The stent is then left there to help keep the artery open. ... with a balloon catheter and expands when the balloon is inflated. The stent is then left there to help keep the artery open.

  7. Carotid Artery Disease

    MedlinePlus

    ... small balloon on its tip. They inflate the balloon at the blockage site in the carotid artery to flatten or compress the plaque against the artery wall. Carotid angioplasty is often combined with the placement of a small, metal, mesh-like device called a stent. When a stent is placed inside of a ...

  8. Arterial Pressure Analog.

    ERIC Educational Resources Information Center

    Heusner, A. A.; Tracy, M. L.

    1980-01-01

    Describes a simple hydraulic analog which allows students to explore some physical aspects of the cardiovascular system and provides them with a means to visualize and conceptualize these basic principles. Simulates the behavior of arterial pressure in response to changes in heart rate, stroke volume, arterial compliance, and peripheral…

  9. Blood Tracer Kinetics in the Arterial Tree

    PubMed Central

    Kellner, Elias; Gall, Peter; Günther, Matthias; Reisert, Marco; Mader, Irina; Fleysher, Roman; Kiselev, Valerij G.

    2014-01-01

    Evaluation of blood supply of different organs relies on labeling blood with a suitable tracer. The tracer kinetics is linear: Tracer concentration at an observation site is a linear response to an input somewhere upstream the arterial flow. The corresponding impulse response functions are currently treated empirically without incorporating the relation to the vascular morphology of an organ. In this work we address this relation for the first time. We demonstrate that the form of the response function in the entire arterial tree is reduced to that of individual vessel segments under approximation of good blood mixing at vessel bifurcations. The resulting expression simplifies significantly when the geometric scaling of the vascular tree is taken into account. This suggests a new way to access the vascular morphology in vivo using experimentally determined response functions. However, it is an ill-posed inverse problem as demonstrated by an example using measured arterial spin labeling in large brain arteries. We further analyze transport in individual vessel segments and demonstrate that experimentally accessible tracer concentration in vessel segments depends on the measurement principle. Explicit expressions for the response functions are obtained for the major middle part of the arterial tree in which the blood flow in individual vessel segments can be treated as laminar. When applied to the analysis of regional cerebral blood flow measurements for which the necessary arterial input is evaluated in the carotid arteries, present theory predicts about 20% underestimation, which is in agreement with recent experimental data. PMID:25299048

  10. Hypertension and arterial stiffness in heart transplantation patients

    PubMed Central

    de Souza-Neto, João David; de Oliveira, Ítalo Martins; Lima-Rocha, Hermano Alexandre; Oliveira-Lima, José Wellington; Bacal, Fernando

    2016-01-01

    OBJECTIVES: Post-transplantation hypertension is prevalent and is associated with increased cardiovascular morbidity and subsequent graft dysfunction. The present study aimed to identify the factors associated with arterial stiffness as measured by the ambulatory arterial stiffness index. METHODS: The current study used a prospective, observational, analytical design to evaluate a group of adult heart transplantation patients. Arterial stiffness was obtained by monitoring ambulatory blood pressure and using the ambulatory arterial stiffness index as the surrogate outcome. Multivariate logistic regression analyses were performed to control confounding. RESULTS: In a group of 85 adult heart transplantation patients, hypertension was independently associated with arterial stiffness (OR 4.98, CI 95% 1.06-23.4) as well as systolic and diastolic blood pressure averages and nighttime descent. CONCLUSIONS: Measurement of ambulatory arterial stiffness index is a new, non-invasive method that is easy to perform, may contribute to better defining arterial stiffness prognosis and is associated with hypertension.

  11. Damage control management of innominate artery injury with tracheostomy.

    PubMed

    Okada, Yohei; Narumiya, Hiromichi; Ishii, Wataru; Ryoji, Iiduka

    2016-12-01

    Innominate artery injury is a rare, but catastrophic complication of tracheostomy. We present a case of severe hemorrhagic shock in a 79-year-old male with innominate artery injury that occurred during tracheostomy. Despite temporary innominate artery isolation, the regional forehead saturation was 60 % without laterality. Because adequate cerebral blood flow was apparently maintained through collateral flow, we ligated the innominate, right carotid, and subclavian arteries. We confirmed adequate blood flow to the brain and the right subclavian artery through collateral circulation after ligation using computed tomographic angiography. A damage control management, which involves ligating the injured innominate artery to arrest hemorrhage and monitoring regional forehead saturation for brain ischemia, can be a considerable procedure for the treatment of severe hemorrhagic shock due to innominate artery injury. PMID:26943693

  12. Evaluation of Arterial Stiffness by Echocardiography: Methodological Aspects

    PubMed Central

    Cho, Jae Yeong

    2016-01-01

    As humans age, degenerative changes in the arterial structure gradually progress and result in the stiffening of the arteries, which is called arteriosclerosis. Arterial stiffness is now an established risk factor of cardiovascular disease (CVD). This stiffening has adverse effects for both the general population as well as for patients with CVD. Measurements of pulse wave velocity and pulse wave analysis are the two most commonly used methods in the evaluation of arterial stiffness, but these methods just allow indirect measures of arterial stiffness. Echocardiography is the most widely used imaging modality in the evaluation of cardiac structure and function and with recent technical advances, it has become possible to evaluate the structure, function and blood flow hemodynamics of the arteries using echocardiography. In the present review, we will discuss the current status of echocardiography in the evaluation of arterial stiffness, especially focusing on the methodological aspects. PMID:27231673

  13. [Single coronary artery and right aortic arch].

    PubMed

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Coronary anomalies are mostly asymptomatic and diagnosed incidentally during coronary angiography or echocardiography. However, they must be taken into account in the differential diagnosis of angina, dyspnea, syncope, acute myocardial infarction or sudden death in young patients. The case is presented of two rare anomalies, single coronary artery originating from right sinus of Valsalva and right aortic arch, in a 65 year-old patient with atherosclerotic coronary artery disease treated percutaneously. PMID:25304052

  14. Stenting in Acute Lower Limb Arterial Occlusions

    SciTech Connect

    Raja, Jowad; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria

    2008-07-15

    Management of critical limb ischemia of acute onset includes surgical embolectomy, bypass grafting, aspiration thrombectomy, thrombolysis, and mechanical thrombectomy followed by treatment of the underlying cause. We present our experience with the use of stents to treat acute embolic/thrombotic occlusions in one iliac and three femoropopliteal arteries. Although this is a small case series, excellent immediate and midterm results suggest that stenting of acute occlusions of the iliac, superficial femoral, and popliteal arteries is a safe and effective treatment option.

  15. Endovascular Exclusion of Renal Artery Aneurysm

    SciTech Connect

    Andersen, Poul Erik Rohr, Nils

    2005-06-15

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90{sup o}, but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable.

  16. [Cerebral artery thrombosis in pregnancy].

    PubMed

    Charco Roca, L M; Ortiz Sanchez, V E; Hernandez Gutierrez-Manchon, O; Quesada Villar, J; Bonmatí García, L; Rubio Postigo, G

    2015-11-01

    A 28 year old woman, ASA I, who, in the final stages of her pregnancy presented with signs of neural deficit that consisted of distortion of the oral commissure, dysphagia, dysarthria, and weakness on the left side of the body. She was diagnosed with thrombosis in a segment of the right middle cerebral artery which led to an ischemic area in the right frontal lobe. Termination of pregnancy and conservative treatment was decided, with good resolution of the symptoms. PMID:25698610

  17. Bilateral posterior cerebral artery infarction.

    PubMed

    Ryan, Davinia; Murphy, Sinead M; Hennessey, Michael J

    2010-01-01

    We report the case of a 70-year-old man who presented with short-term memory impairment and a homonymous left inferior quadrantanopia secondary to simultaneous bilateral posterior cerebral artery (PCA) territory infarction. As in more than a quarter of cases of PCA infarction, no aetiological cause was identified. Unlike the transient nature of symptoms in some cases following unilateral infarction, his deficits persisted on 2-month follow-up. PMID:22798298

  18. Successful Reconstruction of Asymptomatic Bilateral External Carotid Artery Aneurysms.

    PubMed

    Loja, Melissa N; Pevec, William C

    2016-04-01

    True aneurysms of the external carotid artery (ECA) are extremely rare with an unknown incidence and natural history. We present the successful operative management of an asymptomatic 65-year-old man found to have bilateral internal carotid artery stenosis and bilateral ECA aneurysms. His bilateral carotid arteries were reconstructed with bifurcated interposition grafts in a staged fashion. The patient recovered without sequelae and continues to be asymptomatic 1 year after reconstruction. We present the operative management of this rare case. PMID:26802292

  19. Left main coronary artery stenting in a 3.6 kg infant after arterial switch operation for transposition of the great arteries

    PubMed Central

    El-Said, Howaida G; Ebrahim, Mohammad; Moore, John W

    2015-01-01

    The patient presented with flash pulmonary edema related to severe left ventricular diastolic dysfunction several weeks after arterial switch operation (ASO) for D-transposition of the great arteries. Long segment, critical left main coronary artery stenosis in this 3.6 kilogram infant was successfully stented and resulted in resolution of the clinical findings. At 15-month follow-up, the patient remains asymptomatic and thriving. PMID:26085768

  20. The arteries of brain base in species of Bovini tribe.

    PubMed

    Zdun, Maciej; Frąckowiak, Hieronim; Kiełtyka-Kurc, Agata; Kowalczyk, Karolina; Nabzdyk, Maria; Timm, Anita

    2013-11-01

    Studies were conducted on 78 preparations of head and brain arteries in four species of Bos genus, that is in domestic cattle (N = 59), including 22 foetuses (CRL 36.5-78.5 cm), in banteng (Bos javanicus, N = 3), yak (Bos mutus f. grunniens, N = 2), American bison (Bison bison, N = 4), and European bison (Bison bonasus, N = 10). The comparative analysis permitted to demonstrate a similar pattern of brain base arteries in the studied animals. In the studied species, blood vessels of the arterial circle of the brain were found to form by bifurcation of intracranial segments of inner carotid arteries, which protruded from the paired rostral epidural rete mirabile. In Bovidae arterial circle of the brain was supplied with blood mainly by maxillary artery through the blood vessels of the paired rostral epidural rete mirabile. The unpaired caudal epidural rete mirabile was participating in blood supply to the arterial circle of the brain from vertebral and occipital arteries. It manifested character of a taxonomic trait for species of Bos and Bison genera. Basilar artery in all the examined animals manifested a variable diameter, with preliminary portion markedly narrowed, which prevented its participation in blood supply to the arterial circle of the brain. The results and taxonomic position of the species made the authors to suggest a hypothesis that a similar arterial pattern on the brain base might be present also in other species, not included in this analysis. PMID:24106047

  1. Ectopic Origin of Coronary Arteries Diagnozed by Coronary Angiography

    PubMed Central

    Krasniqi, Xhevdet; Gorani, Daut; Sejdiu, Basri; Citaku, Hajdin

    2016-01-01

    Introduction: Anomalous origin of coronary arteries from opposite sinus of Valsalva is rare finding. The incidence of anomalous origination of the left coronary artery from right sinus is 0.15% and the right coronary artery from the left sinus is 0.92%. The ectopic origin of left coronary artery or right coronary artery from opposite sinus depending on pathways and considering atherosclerotic changes are manifested with different clinical significance. Case report: We report two cases, the first case the coronary angiography showed the left coronary artery arising from the right coronary sinus, presenting with proximally and distally stenosed left anterior descending artery (LAD), associated with medial and distal stenosed right coronary artery (RCA). The second case the coronary angiography revealed the right coronary artery arising from the left coronary sinus, associated with tortuous medial and distal segments of left anterior descending artery (LAD), without atherosclerotic changes. The first case successfully underwent treatment procedures based on guidelines for revascularization. Conclusion: The coronary angiography of patients with coronary ischemia determines atherosclerotic disease with possibility of the presence of coronary artery anomalies that in cases with ectopic origin from opposite sinus continues to exist as a challenge during treatment in interventional cardiology. PMID:27482140

  2. Transcatheter Splenic Artery Occlusion for Treatment of Splenic Artery Steal Syndrome After Orthotopic Liver Transplantation

    SciTech Connect

    Uflacker, Renan; Selby, J. Bayne; Chavin, Kenneth; Rogers, Jeffrey; Baliga, Prabhakar

    2002-08-15

    Purpose: To review some aspects of the problem of splenic artery steal syndrome as cause of ischemia in transplanted livers and treatment by selective splenic artery occlusion. Materials and Methods: Eleven liver transplant patients from a group of 350 patients, nine men and two women,ranging in age from 40 years to 61 years (mean 52 years), presented with biochemical evidences of liver ischemia and failure, ranging from one to 60 days following orthotopic liver transplantation. Diagnosis of splenic artery steal syndrome was suspected by elevated enzymes, Doppler ultrasound and confirmed by celiac angiogram. Patients with confirmed hepatic artery thrombosis before angiography were excluded from the study. Embolization with Gianturco coils was performed. Results: All patients were treated by splenic artery embolization with Gianturco coils. The 11 patients improved clinically within 24 hours of the procedure with significant change in the biochemical and clinical parameters. Followup ranged from one month to two years. One of the 11 patient initially improved, but developed hepatic artery thrombosis within 24 hours of the embolic treatment,requiring surgical repair. Conclusion: Splenicartery steal syndrome following liver transplantation surgery can be diagnosed by celiac angiography, and effectively treated by splenic artery embolization with coils. Embolization is one of the treatments available, it is minimally invasive, and leads to immediate clinical improvement. Hepatic artery thrombosis is a possible complication of the procedure.

  3. [Ruptured Internal Carotid Artery Aneurysm Coiling in a Patient with Ipsilateral Internal Carotid Artery Occlusion via the Posterior Communicating Artery].

    PubMed

    Ashida, Noriaki; Saitoh, Minoru; Fujita, Atsushi; Kohmura, Eiji

    2016-09-01

    Background:De novo aneurysms after internal carotid artery(ICA)occlusion occur in the contralateral ICA or anterior communicating artery. Hemodynamic changes with increased blood flow to the contralateral carotid circulation were considered the main factor for the formation of these aneurysms. We report a rare case of ruptured ICA aneurysm associated with ipsilateral ICA occlusion treated with coil embolization via the vertebrobasilar and posterior communicating arteries. Case Presentation:An 82-year-old woman presented with sudden-onset disturbance of consciousness at our outpatient clinic and went into cardiopulmonary arrest. Computed tomography(CT)performed after cardiopulmonary resuscitation revealed diffuse subarachnoid hemorrhage. Three-dimensional CT angiography revealed a right ICA aneurysm associated with the ipsilateral ICA occlusion. Considering that the patient showed clinical improvement with the critical care for neurogenic pulmonary edema, the aneurysm was treated with endovascular coil embolization via the posterior communicating artery. With this technique, complete obliteration was attained without perioperative complication. Conclusion:Endovascular coil embolization via the posterior communicating artery was proven effective as a treatment method for ruptured ICA aneurysms with ipsilateral ICA occlusion. Hemodynamic stress due to increased blood flow in the posterior communicating artery may play an important role in the growth and rupture of ICA aneurysms. PMID:27605482

  4. Atherosclerosis and the internal mammary arteries

    SciTech Connect

    Singh, R.N.

    1983-06-01

    One hundred and fifty patients with coronary artery disease (CAD), 14 (9.3%) of whom had coexisting peripheral vascular disease, underwent bilateral internal mammary arteriography to study the incidence and extent of atherosclerosis in these vessels. Significant atherosclerosis of the internal mammary arteries (IMAs) was present in three patients (2%), of whom one had coexisting peripheral vascular disease. Lesions in the IMAs were found either proximally, close to the origin or distally, around the terminal bifurcation. Six of the 14 patients with peripheral vascular disease (4% of total subjects) had significant atherosclerosis of the brachiocephalic arteries. Atherosclerotic involvement of the IMA is very unusual and rarely interferes with the use of these vessels for coronary bypass. More common, however, is atherosclerosis of the subclavian arteries, a contraindication for IMA grafting if the lesion is proximal to the IMA origin.

  5. Diagnosis and Management of Pulmonary Arterial Hypertension

    PubMed Central

    Houtchens, Jeanne; Martin, Douglas; Klinger, James R.

    2011-01-01

    Pulmonary arterial hypertension is a rare disease, which requires a high index of suspicion to diagnose when patients initially present. Initial symptoms can be nonspecific and include complaints such as fatigue and mild dyspnea. Once the disease is suspected, echocardiography is used to estimate the pulmonary arterial (PA) pressure and to exclude secondary causes of elevated PA pressures such as left heart disease. Right heart catheterization with vasodilator challenge is critical to the proper assessment of pulmonary hemodynamics and to determine whether patients are likely to benefit from vasodilator therapy. Pathologically, the disease is characterized by deleterious remodeling of the distal pulmonary arterial and arteriolar circulation, which results in increased pulmonary vascular resistance. In the last fifteen years, medications from three different classes have been approved for the treatment of pulmonary arterial hypertension. These include the prostanoids, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors. PMID:21941650

  6. Acute Arterial Thrombosis of the Hand.

    PubMed

    Iannuzzi, Nicholas P; Higgins, James P

    2015-10-01

    Arterial thrombosis of the hand occurs infrequently but may result in considerable morbidity and compromise of hand function. The hand surgeon may be called upon to direct management in cases of acute arterial thrombosis of the hand and should have an understanding of the available diagnostic tools and treatment modalities. This article discusses the vascular anatomy of the hand and clinical manifestations of arterial thrombosis. Differences between isolated thrombosis and diffuse intravascular injury are detailed, and treatment options for these conditions are described. Appropriate care often requires coordination with interventional radiologists or vascular surgeons. Outcomes after treatment of arterial thrombosis of the hand are variable, and prognosis may be related to whether isolated thrombosis or diffuse intravascular injury is present. PMID:26408378

  7. Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization

    PubMed Central

    Park, Hun-Soo; Nakagawa, Ichiro; Wada, Takeshi; Nakagawa, Hiroyuki; Hironaka, Yasuo; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2014-01-01

    Background: Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization. Case Description: A 7-year-old girl presented with tetraparesis, ataxia, dysphagia, and dysphonia. Cerebral angiography revealed intracranial giant aneurysm arising from the right vertebral artery. The patient underwent endovascular parent artery occlusion alone to facilitate aneurysmal thrombosis as an initial treatment. This was done to avoid a coil mass effect to the brainstem. However, incomplete thrombosis occurred in the vicinity of the vertebral artery union. Therefore, additional coil embolization for residual aneurysm was performed. Two additional coil embolization procedures were performed in response to recurrence. Mass effect and clinical symptoms gradually improved, and the patient had no associated morbidity or recurrence at 2 years after the last fourth coil embolization. Conclusion: Intracranial giant vertebral artery aneurysms are rare and challenging in pediatric patients. Staged endovascular strategy can be a safe and effective treatment option. PMID:25071937

  8. Mineralization (calcification) of coronary arteries.

    PubMed

    Pawlikowski, M; Pfitzner, R; Wachowiak, J

    1994-01-01

    Mineralogical investigations of calcifications located in coronary vessels were performed on the material obtained from the endarterectomized arteries of 18 patients (15 M, 3 F, aged 36-65) during surgical revascularization procedures consisting in coronary artery bypass grafting. The samples were tested using scanning microscopy, X-ray diffractometry, infrared spectroscopy, atomic absorption spectroscopy, electron microprobe and neutron activation spectroscopy. The results of analyses were calculated with the use of computer programmes. Two types of mineralization were determined: 1. secret mineralization identified as higher than normal content of elements in biological tissues, not demonstrating any mineral grains, and 2. apparent mineralization, appearing micro- and macroscopically as grains composed mainly of hydroxyapatite containing admixture of carbonate groups, i.e. a mineral identical with apatite present in bones, or as calcification of other tissues (heart valves, lungs etc.). The authors suggest that the phenomenon of mineralization should be taken into consideration in the preventive treatment of coronary atheriosclerosis. PMID:7808039

  9. Arterial endofibrosis in professional cyclists

    PubMed Central

    VERALDI, G.F.; MACRÌ, M.; CRISCENTI, P.; SCORSONE, L.; ZINGARETTI, C.C.; GNONI, M.; MEZZETTO, L.

    2015-01-01

    External Iliac Artery Endofibrosis (EIAE) is an uncommon disease usually affecting young, otherwise healthy, patients. It usually involves cyclists but cases have been reported in other groups of endurance athletes. The external iliac artery is the most affected anatomical site but other locations are described too. The precise pathophysiology and long-term evolution of the disease still remain unknown. The diagnosis may be challenging and delayed as the patients usually present symptoms only in extreme conditions and physical and instrumental examinations may be normal at rest. We present two cases of young professional cyclists who suffered of exercise-induced leg pain which led them to reduce running. Both patients were firstly treated with balloon angioplasty that rapidly failed to improve their symptoms. The successive open surgery with endofibrosectomy and autologous saphenous vein closure patch completely resolved physical limitations. EIAE is a rare disease that can induce arterial stenosis, thrombosis, dissection and secondary atheroma. After-exercise ankle-brachial index represents a useful diagnostic criterion. Careful observation of angio-CT may strengthen the suspect. Knowledge of the these features allows a better pre-operative assessment and an early effective treatment. Surgical revascularization remains the gold standard approach. PMID:26888703

  10. Morphology of atherosclerotic coronary arteries

    NASA Astrophysics Data System (ADS)

    Holme, Margaret N.; Schulz, Georg; Deyhle, Hans; Hieber, Simone Elke; Weitkamp, Timm; Beckmann, Felix; Herzen, Julia; Lobrinus, Johannes A.; Montecucco, Fabrizio; Mach, François; Zumbuehl, Andreas; Saxer, Till; Müller, Bert

    2012-10-01

    Atherosclerosis, the narrowing of vessel diameter and build-up of plaques in coronary arteries, leads to an increase in the shear stresses present, which can be used as a physics-based trigger for targeted drug delivery. In order to develop appropriate nanometer-size containers, one has to know the morphology of the critical stenoses with isotropic micrometer resolution. Micro computed tomography in absorption and phase contrast mode provides the necessary spatial resolution and contrast. The present communication describes the pros and cons of the conventional and synchrotron radiation-based approaches in the visualization of diseased human and murine arteries. Using registered datasets, it also demonstrates that multi-modal imaging, including established histology, is even more powerful. The tomography data were evaluated with respect to cross-section, vessel radius and maximal constriction. The average cross-section of the diseased human artery (2.31 mm2) was almost an order of magnitude larger than the murine one (0.27 mm2), whereas the minimal radius differs only by a factor of two (0.51 mm versus 0.24 mm). The maximal constriction, however, was much larger for the human specimen (85% versus 49%). We could also show that a plastic model used for recent experiments in targeted drug delivery represents a very similar morphology, which is, for example, characterized by a maximal constriction of 82%. The tomography data build a sound basis for flow simulations, which allows for conclusions on shear stress distributions in stenosed blood vessels.

  11. Inferior epigastric artery pseudoaneurysms

    PubMed Central

    Avula, SK

    2015-01-01

    Introduction Inferior epigastric artery (IEA) pseudoaneurysms are recognised complications of abdominal wall procedures, and a variety of approaches including surgical excision and ligation, percutaneous procedures and conservative management have been employed in treating this rare complication. Methods We describe a case of an IEA pseudoaneurysm diagnosed on computed tomography (CT) angiography, 14 days following a laparoscopic assisted low anterior resection, which was managed successfully with surgical excision and ligation. A review of the literature identified 32 reports of this complication since 1973 with 69% of cases occurring since 2000. Findings The main aetiology of IEA pseudoaneurysm was abdominal surgery (n=20); 65% of cases were attributable to abdominal wound closure or laparoscopic surgery. Two-thirds (66%) of patients presented between 11 and 63 days, and all except 1 case presented with discomfort, abdominal mass or haemodynamic instability. Colour Doppler ultrasonography was the imaging modality of choice (n=18), either alone or in combination with computed tomography and/or angiography. Surgical ligation and excision and percutaneous coil embolisation formed the mainstay of attempted treatments (69%), particularly following treatment failure using an alternative technique. Conclusions The incidence of iatrogenic IEA pseudoaneurysms appears to be increasing. Awareness of this rare complication is of clinical importance to avoid excessive morbidity for affected individuals. PMID:26263930

  12. Rupture of ectopic renal arterial pseudoaneurysm after percutaneous nephrolithotomy

    PubMed Central

    Wang, Mingshuai; Zhang, Junhui; Xing, Nianzeng

    2016-01-01

    ABSTRACT A 35-year-old female patient presented with swelling pain at left waist for 1 month. Left renal pelvis stones were found and standard percutaneous nephrolithotomy was successfully performed. Two weeks later, the patient suddenly suffered massive bleeding presented with gross hematuria. Rupture of ectopic renal artery pseudoaneurysm was identified by computed tomography and angiography of the renal artery. Emergency selective angioembolization of one branch of the artery was performed. To our knowledge, this is the first report of ruptured ectopic renal arterial pseudoaneurysm. PMID:27564300

  13. Rarefaction and blood pressure in systemic and pulmonary arteries.

    PubMed

    Olufsen, Mette S; Hill, N A; Vaughan, Gareth D A; Sainsbury, Christopher; Johnson, Martin

    2012-08-01

    The effects of vascular rarefaction (the loss of small arteries) on the circulation of blood are studied using a multiscale mathematical model that can predict blood flow and pressure in the systemic and pulmonary arteries. We augmented a model originally developed for the systemic arteries (Olufsen et al. 1998, 1999, 2000, 2004) to (a) predict flow and pressure in the pulmonary arteries, and (b) predict pressure propagation along the small arteries in the vascular beds. The systemic and pulmonary arteries are modelled as separate, bifurcating trees of compliant and tapering vessels. Each tree is divided into two parts representing the `large' and `small' arteries. Blood flow and pressure in the large arteries are predicted using a nonlinear cross-sectional area-averaged model for a Newtonian fluid in an elastic tube with inflow obtained from magnetic resonance measurements. Each terminal vessel within the network of the large arteries is coupled to a vascular bed of small `resistance' arteries, which are modelled as asymmetric structured trees with specified area and asymmetry ratios between the parent and daughter arteries. For the systemic circulation, each structured tree represents a specific vascular bed corresponding to major organs and limbs. For the pulmonary circulation, there are four vascular beds supplied by the interlobar arteries. This manuscript presents the first theoretical calculations of the propagation of the pressure and flow waves along systemic and pulmonary large and small arteries. Results for all networks were in agreement with published observations. Two studies were done with this model. First, we showed how rarefaction can be modelled by pruning the tree of arteries in the microvascular system. This was done by modulating parameters used for designing the structured trees. Results showed that rarefaction leads to increased mean and decreased pulse pressure in the large arteries. Second, we investigated the impact of decreasing vessel

  14. Complications after selective embolization in the bilateral internal iliac arteries and the median sacral artery with gelfoam particles in dogs

    PubMed Central

    Li, Yetian; Wang, Wei; Wang, Guangye; Yin, Zongsheng

    2014-01-01

    Objective: The study aimed to observe the complications after the bilateral internal iliac arteries and the median sacral artery embolization by different severity and combinations of gelfoam particles. Methods: Sixteen healthy adult dogs were randomly divided into five groups. Under the monitoring of digital subtraction angiography (DSA), gelfoam particles with diameter of 50-150 μm were applied. In group A, embolization was performed up to the trunk of bilateral internal iliac arteries and the median sacral artery; in group B, embolization was up to the trunk of bilateral internal iliac arteries; in group C, embolization was up to the first branch of bilateral internal iliac arteries and the median sacral artery; in group D, embolization was up to the trunk of unilateral internal iliac artery and the median sacral artery; in group E embolization was performed up to the trunk of unilateral internal iliac artery. Results: Seven dogs died within 48 hours after embolization. In the dead animals of groups A, C and D, there were rectum necrosis and lamellar obfuscation and hemorrhage edema in bladder. In the histological examination, there are rectum and bladder cell dissociation, inflammatory cell infiltration and epithelial cell ablating in the dead animals. The embolization mainly presented in arterioles with a diameter of 100-200 μm. Conclusion: When gelfoam particles of 50-150 μm in diameter were applied for embolization in the internal iliac artery and median sacral artery, at least unilateral internal iliac artery should be preserved when embolization is performed in the proximal artery and the trunk. PMID:25356191

  15. Buckling instability in arteries.

    PubMed

    Vandiver, Rebecca M

    2015-04-21

    Arteries can become tortuous in response to abnormal growth stimuli, genetic defects and aging. It is suggested that a buckling instability is a mechanism that might lead to artery tortuosity. Here, the buckling instability in arteries is studied by examining asymmetric modes of bifurcation of two-layer cylindrical structures that are residually stressed. These structures are loaded by an axial force, internal pressure and have nonlinear, anisotropic, hyperelastic responses to stresses. Strain-softening and reduced opening angle are shown to lower the critical internal pressure leading to buckling. In addition, the ratio of the media thickness to the adventitia thickness is shown to have a dramatic impact on arterial instability. PMID:25661070

  16. Peripheral Arterial Disease

    MedlinePlus

    ... the blood vessels outside of your heart. The cause of PAD is atherosclerosis. This happens when plaque ... substance made up of fat and cholesterol. It causes the arteries to narrow or become blocked. This ...

  17. Coronary Artery Disease

    MedlinePlus

    ... ve started to help the medicine work. Other Organizations American Heart Association Questions to Ask Your Doctor Am I at risk for coronary artery disease (CAD)? What lifestyle changes should I make to decrease my risk of ...

  18. Coronary artery spasm

    MedlinePlus

    ... blocker or a long-acting nitrate long-term. Beta-blockers are another type of medicine that is used with other coronary artery problems. However, beta-blockers may make this problem worse. They should be ...

  19. Peripheral Arterial Disease

    MedlinePlus

    Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of ... smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, ...

  20. Carotid artery disease

    MedlinePlus

    ... you have had a stroke or TIA, a nervous system (neurological) exam will show other problems. You may also have the following tests: Blood cholesterol and triglycerides test Blood sugar (glucose) test Ultrasound of the carotid arteries ( carotid ...

  1. Peripheral artery bypass - leg

    MedlinePlus

    ... P. Peripheral arterial diseases. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ... noncoronary obstructive vascular disease.In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ...

  2. Coronary Artery Bypass Surgery

    MedlinePlus

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  3. Peripheral Arterial Disease

    MedlinePlus

    ... Prevention Living With Clinical Trials Links Related Topics Atherosclerosis Coronary Heart Disease Heart Attack Smoking and Your ... in the body's arteries, the condition is called atherosclerosis . Over time, plaque can harden and narrow the ...

  4. Carotid artery surgery

    MedlinePlus

    ... Aspirin and heart disease Butter, margarine, and cooking oils Carotid artery surgery - discharge Cholesterol and ... by: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the ...

  5. Visualization of hepatic arteries with 3D ultrasound during intra-arterial therapies

    NASA Astrophysics Data System (ADS)

    Gérard, Maxime; Tang, An; Badoual, Anaïs.; Michaud, François; Bigot, Alexandre; Soulez, Gilles; Kadoury, Samuel

    2016-03-01

    Liver cancer represents the second most common cause of cancer-related mortality worldwide. The prognosis is poor with an overall mortality of 95%. Moreover, most hepatic tumors are unresectable due to their advanced stage at discovery or poor underlying liver function. Tumor embolization by intra-arterial approaches is the current standard of care for advanced cases of hepatocellular carcinoma. These therapies rely on the fact that the blood supply of primary hepatic tumors is predominantly arterial. Feedback on blood flow velocities in the hepatic arteries is crucial to ensure maximal treatment efficacy on the targeted masses. Based on these velocities, the intra-arterial injection rate is modulated for optimal infusion of the chemotherapeutic drugs into the tumorous tissue. While Doppler ultrasound is a well-documented technique for the assessment of blood flow, 3D visualization of vascular anatomy with ultrasound remains challenging. In this paper we present an image-guidance pipeline that enables the localization of the hepatic arterial branches within a 3D ultrasound image of the liver. A diagnostic Magnetic resonance angiography (MRA) is first processed to automatically segment the hepatic arteries. A non-rigid registration method is then applied on the portal phase of the MRA volume with a 3D ultrasound to enable the visualization of the 3D mesh of the hepatic arteries in the Doppler images. To evaluate the performance of the proposed workflow, we present initial results from porcine models and patient images.

  6. [Modern morpho-functional concepts in cephalic arterial distribution].

    PubMed

    Scutariu, M D; Ciupilan, Corina

    2005-01-01

    The present paper provides a general morphofunctional study of the oro-maxillary-facial cephalic arterial area that shows some particular hemodynamic characteristics. The internal maxillary artery supplies a very large territory, with numerous and wide anastomoses. In order to understand the hemodynamic characteristics of this artery, we analyzed some older theories, such as: Ludwig von Bertalanffy's General Systems Theory, Walter Zimmermann's Telome Theory, and some general rheological principles also. PMID:16607795

  7. Serum and urinary enzyme activities in renal artery embolism.

    PubMed

    Donadio, C; Auner, I; Giordani, R; Lucchetti, A; Pentimone, F

    1986-10-31

    Renal artery embolism is not a rare occurrence, especially in patients with valvular heart disease, but the early diagnosis of this condition is infrequently accomplished. We report the clinical and laboratory data of 2 patients with valvular heart disease who presented with unilateral renal artery embolization. The usefulness of the determination of serum and urinary enzymes and renal function tests is discussed. We propose that these parameters support an earlier and more accurate diagnosis of renal artery embolism. PMID:2877758

  8. Successful Embolization of an Ovarian Artery Pseudoaneurysm Complicating Obstetric Hysterectomy

    SciTech Connect

    Rathod, Krantikumar R Deshmukh, Hemant L; Asrani, Ashwin; Salvi, Vinita S; Prabhu, Santoshi

    2005-01-15

    Transcatheter arterial embolization is becoming the therapy of choice for controlling obstetric hemorrhage, affording the ability to control persistent bleeding from pelvic vessels while avoiding the morbidity of surgical exploration. The clinicians are left with little choice if pelvic hemorrhage continues after hysterectomy and ligation of anterior division of both internal iliac arteries. We present one such case of intractable post-obstetric hysterectomy hemorrhage in which an ovarian artery pseudoaneurysm was diagnosed angiographically and successfully embolized, highlighting the role of transcatheter embolization.

  9. [Bilateral popliteal artery complications of multiple hereditary exostosis].

    PubMed

    Chaouch, N; Alimi, F; Kortas, C; Limayem, F; Braham, A; Mlika, Sinan; Jerbi, S; Ennabli, K

    2011-04-01

    The osseous exostose is a rare benign tumor of the bone from which the vascular complications can be of venous or arterial order, are translated in various boards. We report the case of a young adult who presents a forgery aneurysm of the right popliteal artery with the popliteal artery booby-trapped to the left. The patient benefited from surgical treatment with good clinical and radiological evolution. PMID:21277562

  10. Successful Nonoperative Management of HAGL (Humeral Avulsion of Glenohumeral Ligament) Lesion With Concurrent Axillary Nerve Injury in an Active-Duty US Navy SEAL.

    PubMed

    Ernat, Justin J; Bottoni, Craig R; Rowles, Douglas J

    2016-01-01

    Humeral avulsion of the glenohumeral ligament (HAGL) is a lesion that has been recognized as a cause of recurrent shoulder instability. To our knowledge there are no reports of successful return to full function in young, competitive athletes or return to manual labor following nonoperative management of a HAGL lesion. A 26-year-old Navy SEAL was diagnosed with a HAGL injury, and associated traction injury of the axillary nerve as well as a partial tear of the rotator cuff. Operative intervention was recommended; however, due to issues with training and with inability to properly rehab with the axillary nerve injury, surgical plans were delayed. Interestingly, the patient demonstrated both clinical and radiographic magnetic resonance imaging healing of his lesion over an 18-month period. At 18 months the patient had returned to full active duty without pain or instability as a Navy SEAL. PMID:27552458

  11. The transclival artery: a variant persistent carotid-basilar arterial anastomosis not previously reported.

    PubMed

    Kirkland, Jared D; Dahlin, Brian C; O'Brien, William T

    2016-01-01

    During embryological development, primitive anastomoses exist between the carotid and vertebrobasilar arteries. These anastomoses typically regress or are incorporated into the developing vasculature. Persistence beyond fetal development, however, results in vascular anomalies that alter haemodynamic flow with a predisposition for aneurysm formation. The carotid-vertebrobasilar anastomoses mirror the primitive communications and include (from most to least common) the trigeminal, hypoglossal, proatlantal and otic arteries. The hypoglossal and proatlantal variants extend through the hypoglossal canal or foramen magnum, respectively. We present a previously undescribed variant of these persistent fetal anastomoses, the 'transclival artery', which courses through its own transclival skull base canal/foramen. PMID:27413022

  12. Dual-artery stenting of a type III single coronary artery from right aortic sinus.

    PubMed

    Patil, Shivanad; Kharge, Jayashree; Ramlingam, Rangaraj; Kasamsetty, Subramanyam

    2015-12-01

    A single coronary artery presenting with stenosis in two of the three vessels arising from a common ostium is a rare anomaly Lipton et al. proposed a classification, which was modified by Yamanaka and Hobbs. In our case, a single coronary artery was giving rise to the LAD, left circumflex (LCx), and the right coronary artery (RCA). There was 80% stenosis in the ostium of the LCx. The RCA in the mid and distal segment had stenosis of 80% and 70%, respectively. We were able to successfully stent the three stenotic segments. PMID:26995427

  13. Management of carotid artery stenosis

    PubMed Central

    Louridas, George; Junaid, Asad

    2005-01-01

    OBJECTIVE To clarify the definition of carotid artery diseases, the appropriateness of screening for disease, investigation and management of patients presenting with transient ischemic attacks, and management of asymptomatic carotid bruits. SOURCES OF INFORMATION MEDLINE was searched using the terms carotid endarterectomy, carotid disease, and carotid stenosis. Most studies offer level II or III evidence. Consensus statements and guidelines from various neurovascular societies were also consulted. MAIN MESSAGE Patients with symptoms of hemispheric transient ischemic attacks associated with >70% stenosis of the internal carotid artery are at highest risk of major stroke or death. Risk is greatest within 48 hours of symptom onset; patients should have urgent evaluation by a vascular surgeon for consideration of carotid endarterectomy (CEA). Patients with 50% to 69% stenosis might benefit from urgent surgical intervention depending on clinical features and associated comorbidity. Patients with <50% stenosis do not benefit from surgery. Asymptomatic patients with >60% stenosis should be considered for elective CEA. CONCLUSION Symptomatic carotid artery syndromes need urgent carotid duplex evaluation to determine the need for urgent surgery. Those with the greatest degree of stenosis derive the greatest benefit from timely CEA. PMID:16060177

  14. Idiopathic Arterial Calcification of Infancy: Case Report

    PubMed Central

    Attia, Tarek Hamed; Abd Alhamed, Mohamed Maisara; Selim, Mohamed Fouad; Haggag, Mohamed Salah; Fathalla, Diaa

    2015-01-01

    Idiopathic arterial calcification of infancy is a rare autosomal recessive disease, characterized by deposition of calcium along the internal elastic membrane of arteries, accompanied by fibrous thickening of the intima which causes luminal narrowing. Here we are reporting a case of idiopathic arterial calcification of infancy in a Saudi female newborn of non-consanguineous pregnant woman who had polyhydramnios. The newborn baby had severe respiratory distress, systemic hypertension and persistent pulmonary hypertension of newborn. She was admitted to Neonatal Intensive Care Unit, where she was ventilated and proper treatment was provided. Molecular genetic testing was positive for mutations of ectonucleotide pyrophosphatase/phosphodiesterase1 gene which is reported in 80% of cases of Idiopathic arterial calcification of infancy. The baby died at about 5 month of age because of myocardial ischemia and cardiorespiratory arrest. Idiopathic Arterial Calcification of Infancy should be considered in any newborn who presented with persistent pulmonary hypertension of newborn, severe systemic hypertension and echogenic vessels on any radiological study. Calcifications of large and medium-sized arteries are important diagnostic finding. PMID:27252793

  15. Idiopathic Arterial Calcification of Infancy: Case Report.

    PubMed

    Attia, Tarek Hamed; Abd Alhamed, Mohamed Maisara; Selim, Mohamed Fouad; Haggag, Mohamed Salah; Fathalla, Diaa

    2015-11-01

    Idiopathic arterial calcification of infancy is a rare autosomal recessive disease, characterized by deposition of calcium along the internal elastic membrane of arteries, accompanied by fibrous thickening of the intima which causes luminal narrowing. Here we are reporting a case of idiopathic arterial calcification of infancy in a Saudi female newborn of non-consanguineous pregnant woman who had polyhydramnios. The newborn baby had severe respiratory distress, systemic hypertension and persistent pulmonary hypertension of newborn. She was admitted to Neonatal Intensive Care Unit, where she was ventilated and proper treatment was provided. Molecular genetic testing was positive for mutations of ectonucleotide pyrophosphatase/phosphodiesterase1 gene which is reported in 80% of cases of Idiopathic arterial calcification of infancy. The baby died at about 5 month of age because of myocardial ischemia and cardiorespiratory arrest. Idiopathic Arterial Calcification of Infancy should be considered in any newborn who presented with persistent pulmonary hypertension of newborn, severe systemic hypertension and echogenic vessels on any radiological study. Calcifications of large and medium-sized arteries are important diagnostic finding. PMID:27252793

  16. Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial.

    PubMed

    Berman, Jonathan S; Symonds, Catherine; Birch, Rolfe

    2004-12-01

    The objective was to investigate the effectiveness of cannabis-based medicines for treatment of chronic pain associated with brachial plexus root avulsion. This condition is an excellent human model of central neuropathic pain as it represents an unusually homogenous group in terms of anatomical location of injury, pain descriptions and patient demographics. Forty-eight patients with at least one avulsed root and baseline pain score of four or more on an 11-point ordinate scale participated in a randomised, double-blind, placebo-controlled, three period crossover study. All patients had intractable symptoms regardless of current analgesic therapy. Patients entered a baseline period of 2 weeks, followed by three, 2-week treatment periods during each of which they received one of three oromucosal spray preparations. These were placebo and two whole plant extracts of Cannabis sativa L.: GW-1000-02 (Sativex), containing Delta(9)tetrahydrocannabinol (THC):cannabidiol (CBD) in an approximate 1:1 ratio and GW-2000-02, containing primarily THC. The primary outcome measure was the mean pain severity score during the last 7 days of treatment. Secondary outcome measures included pain related quality of life assessments. The primary outcome measure failed to fall by the two points defined in our hypothesis. However, both this measure and measures of sleep showed statistically significant improvements. The study medications were generally well tolerated with the majority of adverse events, including intoxication type reactions, being mild to moderate in severity and resolving spontaneously. Studies of longer duration in neuropathic pain are required to confirm a clinically relevant, improvement in the treatment of this condition. PMID:15561385

  17. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: a modified technique in a series of 22 cases.

    PubMed

    Chen, L B; Wang, H; Tie, K; Mohammed, A; Qi, Y J

    2015-09-01

    A total of 22 patients with a tibial avulsion fracture involving the insertion of the posterior cruciate ligament (PCL) with grade II or III posterior laxity were reduced and fixed arthroscopically using routine anterior and double posteromedial portals. A double-strand Ethibond suture was inserted into the joint and wrapped around the PCL from anterior to posterior to secure the ligament above the avulsed bony fragment. Two tibial bone tunnels were created using the PCL reconstruction guide, aiming at the medial and lateral borders of the tibial bed. The ends of the suture were pulled out through the bone tunnels and tied over the tibial cortex between the openings of the tunnels to reduce and secure the bony fragment. Satisfactory reduction of the fracture was checked arthroscopically and radiographically. The patients were followed-up for a mean of 24.5 months (19 to 28). Bone union occurred six weeks post-operatively. At final follow-up, all patients had a negative posterior drawer test and a full range of movement. KT-1000 arthrometer examination showed that the mean post-operative side-to-side difference improved from 10.9 mm (standard deviation (sd) 0.7) pre-operatively to 1.5 mm (sd 0.6) (p = 0.001). The mean Tegner and the International Knee Documentation Committee scores improved significantly (p = 0.001). The mean Lysholm score at final follow-up was 92.0 (85 to 96). We conclude that this technique is convenient, reliable and minimally invasive and successfully restores the stability and function of the knee. PMID:26330588

  18. Extracellular Matrix and the Mechanics of Large Artery Development

    PubMed Central

    Cheng, Jeffrey K.; Wagenseil, Jessica E.

    2012-01-01

    The large, elastic arteries, as their name suggests, provide elastic distention and recoil during the cardiac cycle in vertebrate animals. The arteries are distended from the pressure of ejecting blood during active contraction of the left ventricle (LV) during systole, and recoil to their original dimensions during relaxation of the LV during diastole. The cyclic distension occurs with minimal energy loss, due to the elastic properties of one of the major structural extracellular matrix (ECM) components, elastin. The maximum distension is limited to prevent damage to the artery by another major ECM component, collagen. The mix of ECM components in the wall largely determines the passive mechanical behavior of the arteries and the subsequent load on the heart during systole. While much research has focused on initial artery formation, there has been less attention on the continuing development of the artery to produce the mature composite wall complete with endothelial cells (ECs), smooth muscle cells (SMCs), and the necessary mix of ECM components for proper cardiovascular function. This review focuses on the physiology of large artery development, including SMC differentiation and ECM production. The effects of hemodynamic forces and ECM deposition on the evolving arterial structure and function are discussed. Human diseases and mouse models with genetic mutations in ECM proteins that affect large artery development are summarized. A review of constitutive models and growth and remodeling theories is presented, along with future directions to improve understanding of ECM and the mechanics of large artery development. PMID:22584609

  19. Evolution of complete arterial grafting. For coronary artery disease.

    PubMed Central

    Buxton, B F; Fuller, J A; Tatoulis, J

    1998-01-01

    Arterial grafting for the correction of coronary artery disease preceded the use of saphenous vein grafts, but the overwhelming popularity of the saphenous vein from 1970 to 1985 left the development of arterial grafting dormant. Excellent graft patency results from pedicled internal thoracic artery grafting and continued saphenous vein graft failure prompted our unit to explore complete arterial grafting with internal thoracic artery and radial artery grafts. One thousand and fifty-three patients who received a combination of internal thoracic artery and radial artery grafts were compared with 1,156 patients who received internal thoracic artery and saphenous vein grafts. All patients underwent primary coronary artery bypass surgery between 1995 and 1998. The early mortality and morbidity and the probability of survival at 2 years were similar in both groups of patients. Early graft patency studies of 35 radial artery grafts showed 33 (94%) were patent at a mean of 12 months. Complete arterial grafting using internal thoracic and radial arteries is safe and may provide a long-term benefit. Images PMID:9566058

  20. Gastroduodenal artery steal syndrome during liver transplantation: intraoperative diagnosis with Doppler ultrasound and management.

    PubMed

    Nishida, Seigo; Kadono, Jun; DeFaria, Werviston; Levi, David M; Moon, Jang I; Tzakis, Andreas G; Madariaga, Juan R

    2005-03-01

    Arterial steal syndrome (ASS) after liver transplantation has been reported. ASS causes arterial hypo-perfusion of the graft liver and devastating consequences. However, the diagnosis tends to be delayed. We present the recognized case of a gastroduodenal artery (GDA) steal syndrome that was diagnosed with intraoperative Doppler ultrasound and treated with GDA ligation during the liver transplantation. The patient had variation of hepatic artery anatomy (low bifurcation of the hepatic artery). Graft liver had the common hepatic artery and aberrant left hepatic artery. Doppler ultrasound of the liver was performed after the arterial reconstruction between the donor common hepatic artery and recipient right hepatic artery. It showed low hepatic arterial flow. There is no backflow bleeding from the donor aberrant left hepatic artery stump. After ligating big GDA, hepatic arterial waveform inside the liver drastically improved and strong backflow bleeding was recognized from the donor left aberrant hepatic artery stump. The current case should show the efficacy of intraoperative Doppler ultrasound of the liver on ASS and alert clinician to ligate GDA to prevent ASS if hepatic arterial flows are suboptimal. PMID:15730497

  1. SGLT inhibitors attenuate NO-dependent vascular relaxation in the pulmonary artery but not in the coronary artery.

    PubMed

    Han, Ying; Cho, Young-Eun; Ayon, Ramon; Guo, Rui; Youssef, Katia D; Pan, Minglin; Dai, Anzhi; Yuan, Jason X-J; Makino, Ayako

    2015-11-01

    Inhibitors of sodium-glucose cotransporter (SGLT)2 are a new class of oral drugs for type 2 diabetic patients that reduce plasma glucose levels by inhibiting renal glucose reabsorption. There is increasing evidence showing the beneficial effect of SGLT2 inhibitors on glucose control; however, less information is available regarding the impact of SGLT2 inhibitors on cardiovascular outcomes. The present study was designed to determine whether SGLT inhibitors regulate vascular relaxation in mouse pulmonary and coronary arteries. Phlorizin (a nonspecific SGLT inhibitor) and canagliflozin (a SGLT2-specific inhibitor) relaxed pulmonary arteries in a dose-dependent manner, but they had little or no effect on coronary arteries. Pretreatment with phlorizin or canagliflozin significantly inhibited sodium nitroprusside (SNP; a nitric oxide donor)-induced vascular relaxation in pulmonary arteries but not in coronary arteries. Phlorizin had no effect on cGMP-dependent relaxation in pulmonary arteries. SNP induced membrane hyperpolarization in human pulmonary artery smooth muscle cells, and pretreatment of cells with phlorizin and canagliflozin attenuated SNP-induced membrane hyperpolarization by decreasing K(+) activities induced by SNP. Contrary to the result observed in ex vivo experiments with SGLT inhibitors, SNP-dependent relaxation in pulmonary arteries was not altered by chronic administration of canagliflozin. On the other hand, canagliflozin administration significantly enhanced SNP-dependent relaxation in coronary arteries in diabetic mice. These data suggest that SGLT inhibitors differentially regulate vascular relaxation depending on the type of arteries, duration of the treatment, and health condition, such as diabetes. PMID:26361875

  2. Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

    PubMed Central

    Brzost, Jacek; Waniewska, Martyna; Szczepanski, Miroslaw J.

    2015-01-01

    The extracranial internal carotid artery aneurysm (EICAA) is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring 63 × 55 × 88 mm, stretching from the skull base to the angle of the mandible. PMID:26124973

  3. Treatment of a Left Internal Mammary Artery to Pulmonary Artery Fistula with Polytetrafluoroethylene Covered Stents: A Case Report and Review of the Literature

    SciTech Connect

    Abbott, J. Dawn; Brennan, Joseph J.; Remetz, Michael S.

    2004-01-15

    Internal mammary artery (IMA) to pulmonary artery (PA) fistula is a rare complication of coronary artery bypass grafting (CABG) that may present as myocardial ischemia. We describe a case of left IMA-to-PA fistula treated with balloon expandable coronary polytetrafluoroethylene (PTFE) graft stents and review previously reported cases of this entity.

  4. Simultaneous thrombosis of multiple coronary arteries in a patient with rheumatoid arthritis

    PubMed Central

    Kalayci, Arzu; Arslan, Erol; Bakar, Salih Murat; Guneri, Mahmut; Dizman, Rafet; Kivanc, Eylem; Karabay, Can Yucel

    2016-01-01

    We present a case of simultaneous coronary thrombosis of the left main, the left anterior descending artery and the right coronary artery in a patient, recently diagnosed with rheumatoid arthritis. PMID:27489603

  5. Simultaneous thrombosis of multiple coronary arteries in a patient with rheumatoid arthritis.

    PubMed

    Kalayci, Arzu; Arslan, Erol; Bakar, Salih Murat; Guneri, Mahmut; Dizman, Rafet; Kivanc, Eylem; Karabay, Can Yucel

    2016-01-01

    We present a case of simultaneous coronary thrombosis of the left main, the left anterior descending artery and the right coronary artery in a patient, recently diagnosed with rheumatoid arthritis. PMID:27489603

  6. Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy.

    PubMed

    Saini, Ashish P; Cyran, Stephen E; Ettinger, Steven M; Pauliks, Linda B

    2016-08-16

    A 15-year-old boy with transposition of the great arteries (TGA) and neonatal arterial switch operation (ASO) presented with complete occlusion of the left main coronary artery (LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram (CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies. PMID:27574609

  7. The isolated artery: an intrahepatic arterial pathway that can bypass the lobular parenchyma in mammalian livers.

    PubMed

    Ekataksin, W

    2000-02-01

    Controversy persists concerning the distribution of intrahepatic arterial termination. Apart from nourishing structures in the portal tract, several authors have suggested arterial supply to some isolated vascular beds that bypass the parenchyma, but this was not verified morphologically. In the present study, the existence of an isolated hepatic artery unaccompanied by a portal vein or a bile duct was shown in livers of pigs and other mammals including the dog, seal, ox, horse, and man. After colored media injection, liver blocks were sampled near the hepatic capsule and hepatic vein and subject to histologic assessment. The hepatic artery dissociated from superficial portal tract, ramified, and anastomosed extensively, forming a capsular plexus that drained at places into peripheral sinusoids in which resistive structural elaborations were observed. The artery also dissociated and fed an intramural plexus (vasa vasorum) of hepatic veins. This was collected into a vessel that penetrated the intima into the vein's lumen. In smaller sublobular veins, the plexus emptied into adjacent sinusoids; in central veins, the plexus was poorly developed. In canine and phocine livers, which have a special throttling musculature in sublobular veins, the isolated arterioles were numerous; in bovine and equine livers, which have a thick fibrous investment, the capsular plexus was well-developed. Occurrence of the isolated artery also was confirmed in the human but not in the rodent liver. In conclusion, the isolated artery is responsible for isolated vascular beds, in which the transintimal pathway can bypass the lobular sinusoids. PMID:10655246

  8. Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy

    PubMed Central

    Saini, Ashish P; Cyran, Stephen E; Ettinger, Steven M; Pauliks, Linda B

    2016-01-01

    A 15-year-old boy with transposition of the great arteries (TGA) and neonatal arterial switch operation (ASO) presented with complete occlusion of the left main coronary artery (LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram (CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies. PMID:27574609

  9. A vertebral artery dissection with basilar artery occlusion in a child.

    PubMed

    Devue, Katleen; Van Ingelgem, Annemie; De Keukeleire, Katrien; De Leeuw, Marc

    2014-01-01

    This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services. PMID:25587466

  10. Robot-assisted laparoscopic renal artery aneurysm repair with selective arterial clamping.

    PubMed

    Samarasekera, Dinesh; Autorino, Riccardo; Khalifeh, Ali; Kaouk, Jihad H

    2014-01-01

    Renal artery aneurysms represent a rare clinical entity, and most are managed with endovascular techniques when treatment is indicated. Laparoscopic and robot-assisted repair of renal artery aneurysms has been described; however, few reports exist in the literature. We describe our experience with the surgical management of a 1.6-cm right-sided renal artery aneurysms in a 35-year-old man who presented with flank pain. Using the DaVinci Si surgical platform (Intuitive, Sunnyvale, CA, USA), the aneurysm was resected and the renal artery was reconstructed. Segmental branches of the renal artery were dissected and selectively clamped during resection, allowing for regional rather than global renal ischemia. Operative time was 240 min, with an estimated blood loss of 200 cc. Warm ischemia time was only regional, for a duration of 44 min. Follow-up functional analysis showed preserved renal function in the right kidney. We describe our technique and show the technical feasibility of robot-assisted renal artery aneurysm repair. Furthermore, use of the DaVinci Si system facilitates segmental artery dissection, and allows for selective clamping during reconstruction. This avoids global renal ischemia and optimizes functional preservation. PMID:23692543

  11. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm

    PubMed Central

    Vultaggio, Fabrice; Morère, Pierre-Henri; Constantin, Christophe; Christodoulou, Michel; Roulin, Didier

    2016-01-01

    Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment. PMID:27358680

  12. A Brief Journey into the History of the Arterial Pulse

    PubMed Central

    Ghasemzadeh, Nima; Zafari, A. Maziar

    2011-01-01

    Objective. This paper illustrates the evolution of our knowledge of the arterial pulse from ancient times to the present. Several techniques for arterial pulse evaluation throughout history are discussed. Methods. Using databases including Worldcat, Pubmed, and Emory University Libraries' Catalogue, the significance of the arterial pulse is discussed in three historical eras of medicine: ancient, medieval, and modern. Summary. Techniques used over time to analyze arterial pulse and its characteristics have advanced from simple evaluation by touch to complex methodologies such as ultrasonography and plethysmography. Today's understanding of the various characteristics of the arterial pulse relies on our ancestors' observations and experiments. The pursuit of science continues to lead to major advancements in our knowledge of the arterial pulse and its application in diagnosis of atherosclerotic disease. PMID:21811677

  13. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm.

    PubMed

    Vultaggio, Fabrice; Morère, Pierre-Henri; Constantin, Christophe; Christodoulou, Michel; Roulin, Didier

    2016-06-27

    Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment. PMID:27358680

  14. Multilocular True Ulnar Artery Aneurysm in a Pediatric Patient.

    PubMed

    Stalder, Mark W; Sanders, Christopher; Lago, Mary; Hilaire, Hugo St

    2016-01-01

    Ulnar artery aneurysms are an exceedingly rare entity in the pediatric population and have no consistent etiologic mechanism. We present the case of a 15-year-old male with a multilocular ulnar artery aneurysm in the setting of no antecedent history of trauma, no identifiable connective tissue disorders, and no other apparent etiological factors. Furthermore, the patient's arterial palmar arch system was absent. The aneurysm was resected, and arterial reconstruction was successfully performed via open surgical approach with cephalic vein interposition graft. We believe this treatment modality should be considered as the primary approach in all of these pediatric cases in consideration of the possible pitfalls of less comprehensive measures. PMID:27104094

  15. An unexpected pulmonary arterial aneurysm in a COPD patient.

    PubMed

    Karkoulias, K; Lykouras, D; Nanopoulou, M; Tsiamita, M; Iliopoulos, P; Spiropoulos, K

    2011-01-01

    We present a case of an idiopathic pulmonary artery aneurysm in an asymptomatic patient who was treated for an irrelevant medical condition. Pulmonary artery aneurysms (PAA) are quite rare and can either be congenital or acquired. Congenital aneurysms are usually associated with cardiac malformations leading to pulmonary hypertension. Acquired aneurysms can be idiopathic or associated with infections (tuberculosis, syphilis), trauma, pulmonary valvular stenosis, or collagen diseases. Pulmonary artery aneurysms are not common and an idiopathic pulmonary artery aneurysm is a rare finding that could be diagnosed incidentally. PMID:22145274

  16. Spontaneous renal artery thrombosis and common iliac artery dissection in a previously healthy young adult.

    PubMed

    Penn, D Eli; Gist, Amber; Axon, R Neal

    2008-12-01

    A previously healthy 20-year-old male with a history of easy bruising presented to the emergency department complaining of intermittent left lower quadrant abdominal pain for one week. He was diagnosed with vascular (type IV) Ehlers-Danlos syndrome (EDS) and attendant defects in type III collagen leading to spontaneous left renal artery thrombosis and common iliac artery dissection. Treatment was conservative. The types of EDS and their general management are discussed. PMID:19005424

  17. Development of a Hypertrophic Ovarian Artery After Uterine Artery Embolization with Polyvinyl Alcohol Particles

    SciTech Connect

    Kim, Hyun S. Paxton, Ben E.

    2007-09-15

    Uterine artery embolization (UAE) for the treatment of symptomatic leiomyomata has shown excellent short-term clinical efficacy and minimal complications, yet recurrences after successful treatments at mid- and long-term follow-up have been reported. Exact etiologies for such recurrences have not been fully understood. We present a case of symptom recurrence with the development of a hypertrophic ovarian artery after successful UAE with polyvinyl alcohol particles, successfully treated with ovarian and repeat UAEs.

  18. Pulmonary haemorrhage due to an aortopulmonary collateral artery after arterial switch.

    PubMed

    Sugimoto, Ai; Ota, Noritaka; Sakamoto, Kisaburo

    2016-03-01

    A neonate with transposition of the great arteries and intact ventricular septum presented without pulmonary over-circulation, and subsequently developed pulmonary haemorrhage after corrective surgery. Postoperative CT revealed an aortopulmonary collateral artery arising from the descending aorta, and we performed successful embolisation on postoperative day 9. Aggressive imaging modalities such as angiography and/or CT imaging with contrast can detect unexpected extra-pulmonary blood supply and guide further management. PMID:26144860

  19. Dorsalis Pedis Artery Aneurysm: A Case Report and Review of the Literature.

    PubMed

    Christoforou, Panagitsa; Asaloumidis, Nikolaos; Katseni, Konstantina; Kotsis, Thomas

    2016-07-01

    Aneurysms of the foot arteries are rare. A case of a true dorsalis pedis artery aneurysm in a 69-year-old man, with no history of local trauma or injury on his foot, is presented. Clinical examination and ultrasonic imaging confirmed the aneurysm. Dorsalis pedis artery aneurysm was resected and an end-to-end anastomosis was performed, without complications. Arterial duplex scan findings, operative procedure, and literature review are presented and discussed. PMID:27174346

  20. Tracheoinnominate artery fistula following tracheostomy.

    PubMed

    Keçeligil, H T; Erk, M K; Kolbakir, F; Yildirim, A; Yilman, M; Unal, R

    1995-10-01

    Tracheoinnominate artery fistula is a relatively rare but highly lethal complication occurring in patients with long-standing tracheostomies. Early evaluation of this problem and prompt aggressive therapy are necessary. When massive haemorrhage begins, immediate arterial compression, control of the airway and subsequent treatment of the injured artery may be lifesaving. Immediate surgical exploration through a median sternotomy is necessary to control the proximal and distal innominate artery. After the damaged artery has been excised, vascular reconstruction can be performed to preserve the connection between the proximal and distal ends of the innominate artery. A pedicled pericardial patch was successfully used for the tracheal reconstruction. PMID:8574535

  1. Aberrant Left Inferior Bronchial Artery Originating from the Left Gastric Artery in a Patient with Acute Massive Hemoptysis

    SciTech Connect

    Jiang, Sen Sun, Xi-Wen Yu, Dong Jie, Bing

    2013-10-15

    Massive hemoptysis is a life-threatening condition, and the major source of bleeding in this condition is the bronchial circulation. Bronchial artery embolization is a safe and effective treatment for controlling hemoptysis. However, the sites of origin of the bronchial arteries (BAs) have numerous anatomical variations, which can result in a technical challenge to identify a bleeding artery. We present a rare case of a left inferior BA that originated from the left gastric artery in a patient with recurrent massive hemoptysis caused by bronchiectasis. The aberrant BA was embolized, and hemoptysis has been controlled for 8 months.

  2. Hepatic arterial loop with accessory right hepatic artery aneurysm with celiac atresia: endovascular therapy with a stent and detachable coils.

    PubMed

    Ferro, Carlo; Rossi, Umberto G; Seitun, Sara; Bovio, Giulio; Castellan, Lucio; De Paolis, Marco; Castaneda-Zuniga, Wilfrido R

    2008-08-01

    The present report describes an unusual case of an aneurysm of a right hepatic artery (RHA) branching from the superior mesenteric artery; the accessory RHA was looped to the left hepatic artery arising from the celiac axis (CA) and was associated with congenital atresia of the CA. The accessory RHA aneurysm was treated with the placement of a bare stent and detachable coils through the mesh of the stent. Complete and prompt exclusion of the aneurysm was achieved with blood flow preservation in the parent artery at midterm follow-up. PMID:18656020

  3. Understanding Arteries | Coronary Artery Disease | NIH MedlinePlus the Magazine

    MedlinePlus

    ... this page please turn Javascript on. Feature: Coronary Artery Disease Understanding Arteries Past Issues / Fall 2010 Table of Contents Below: ... the arteries and veins are healthy. A Healthy Artery An artery is a muscular tube. It has ...

  4. Internal carotid artery agenesis with stenosed intercavernous anastomosis: a case report

    PubMed Central

    Duan, Hongzhou; Li, Liang; Zhao, Guiping; Zhang, Yang; Zhang, Jiayong

    2016-01-01

    Abstract We report a rare case of internal carotid artery agenesis with stenosed intercavernous anastomosis. A 59-year-old male patient presented with a new infarction in the left basal ganglia. Magnetic resonance angiography and cerebral angiography showed that the right internal carotid artery disappeared from the origin to the foramen lacerum segment, and there was an anastomotic artery with severe stenosis passed through the floor of the sella and in front of the cavernous sinus. The right A1 segment of the anterior cerebral artery was absent and A2 segment was supplied by the normal contralateral internal carotid artery via the anterior communicating artery. PMID:27231043

  5. Transcatheter Arterial Embolization for Spontaneous Rupture of the Omental Artery

    SciTech Connect

    Matsumoto, Tomohiro; Yamagami, Takuji; Morishita, Hiroyuki; Iida, Shigeharu; Tazoe, Jun; Asai, Shunsuke; Masui, Koji; Ikeda, Jun; Nagata, Akihiro; Sato, Osamu; Nishimura, Tsunehiko

    2011-02-15

    We encountered a rare case of spontaneous rupture of the omental artery. A 25-year-old man without any episode of abdominal trauma or bleeding disorders came to the emergency unit with left upper abdominal pain. Hematoma with extravasation of the greater omentum and a hemoperitoneum was confirmed on abdominal contrast-enhanced computed tomography. Bleeding from the omental artery was suspected based on these findings. Transcatheter arterial embolization was successfully performed after extravasation of the omental artery, which arises from the left gastroepiploic artery, was confirmed on arteriography. Partial ometectomy was performed 10 days after transcatheter arterial embolization, revealing that the hematoma measured 10 cm in diameter in the greater omentum. Pathological examination showed rupture of the branch of an omental artery without abnormal findings, such as an aneurysm or neoplasm. Thus, we diagnosed him with spontaneous rupture of the omental artery. The patient recovered and was discharged from the hospital 10 days after the surgery, with a favorable postoperative course.

  6. Molecular controls of arterial morphogenesis

    PubMed Central

    Simons, Michael; Eichmann, Anne

    2015-01-01

    Formation of arterial vasculature, here termed arteriogenesis, is a central process in embryonic vascular development as well as in adult tissues. While the process of capillary formation, angiogenesis, is relatively well understood, much remains to be learned about arteriogenesis. Recent discoveries point to the key role played by vascular endothelial growth factor receptor 2 (VEGFR2) in control of this process and to newly identified control circuits that dramatically influence its activity. The latter can present particularly attractive targets for a new class of therapeutic agents capable of activation of this signaling cascade in a ligand-independent manner, thereby promoting arteriogenesis in diseased tissues. PMID:25953926

  7. [Isolated spontaneous dissection of visceral arteries].

    PubMed

    Corral, M A; Encinas, J; Fernández-Pérez, G C

    2014-01-01

    We present the cases of two men with isolated spontaneous dissection of visceral arteries diagnosed by multidetector CT. In the first patient, dissection of the celiac trunk was associated with periarterial changes. In the second patient, dissection of the superior mesenteric artery was associated with stenosis at the root of the celiac trunk. Both patients presented with acute pain, which was more intense and longer lasting in the first patient. Aortic dissection was suspected clinically in both patients. Both dissections were short and had patent saccular false lumens and reduced caliber of the true lumens. This morphological type is one of the most uncommon within this rare entity. However, in recent years, the number of cases published is rising. This suggests that this entity may have been underdiagnosed before the widespread use of multidetector CT. We discuss the two morphological classifications of dissection of the visceral arteries and the need to adapt therapeutic management to the particular circumstances of each case. PMID:21724211

  8. Deep Circumflex Iliac Artery Pseudoaneurysm as a Complication of Paracentesis

    PubMed Central

    Satija, Bhawna; Kumar, Sanyal; Duggal, Ramnik K.; Kohli, Supreethi

    2012-01-01

    We report a case of a pseudoaneurysm arising from the deep circumflex iliac artery, in an end-stage renal disease patient with gross ascitis, presenting with an anterior abdominal wall hematoma following paracentesis. Duplex Doppler sonography confirmed the presence of the pseudoaneurysm and multidetector computed tomography angiography delineated the detailed arterial anatomy. PMID:22779062

  9. Anomalous origin of left coronary artery from pulmonary artery in adults.

    PubMed

    Murala, John S K; Sankar, Madhu N; Agarwal, Ravi; Golla, Prasad N; Nayar, Pradeep G; Cherian, Kotturathu M

    2006-02-01

    Various techniques have been described for management of anomalous origin of the left coronary artery from the pulmonary artery presenting in adults. Three patients, 1 male and 2 females, aged 27-37 years, underwent transpulmonary pericardial patch closure with concomitant left internal thoracic artery anastomosis to the left anterior descending artery, under standard cardiopulmonary bypass, thus creating a two-coronary system. One patient had concomitant mitral valve repair. All 3 survived the operation. Postoperative angiography in 2 patients revealed good antegrade flow with decreased collaterals in one and competitive inhibition with increased collaterals in the other. This procedure is considered to be the safest and simplest in this subset of patients. PMID:16432117

  10. Neurofibromatosis Type 1: Transcatheter Arterial Embolization for Ruptured Occipital Arterial Aneurysms

    SciTech Connect

    Kanematsu, Masayuki; Kato, Hiroki; Kondo, Hiroshi; Goshima, Satoshi; Tsuge, Yusuke; Kojima, Toshiaki; Watanabe, Haruo

    2011-02-15

    Two cases of ruptured aneurysms in the posterior cervical regions associated with type-1 neurofibromatosis treated by transcatheter embolization are reported. Patients presented with acute onset of swelling and pain in the affected areas. Emergently performed contrast-enhanced CT demonstrated aneurysms and large hematomas widespread in the posterior cervical regions. Angiography revealed aneurysms and extravasations of the occipital artery. Patients were successfully treated by percutaneous transcatheter arterial microcoil embolization. Transcatheter arterial embolization therapy was found to be an effective method for treating aneurysmal rupture in the posterior cervical regions occurring in association with type-1 neurofibromatosis. A literature review revealed that rupture of an occipital arterial aneurysm, in the setting of neurofibromatosis type 1, has not been reported previously.

  11. Bilateral persistent primitive trigeminal arteries associated with trigeminal neuralgia.

    PubMed

    Son, B; Yang, S; Sung, J; Lee, S

    2013-03-01

    Persistent carotid-vertebrobasilar anastomoses (PCVBA) include the primitive trigeminal artery (PTA), the primitive otic artery (POA), the primitive hypoglossal artery and proatlantal arteries (ProAs). The PTA is the most commonly seen of these accounting for approximately 80-85% of PCVBAs. The PTA which connects the internal carotid artery (ICA) to the basilar artery (BA) may occasionally connect to the superior or posterior inferior cerebellar arteries without interposition to the BA. It is then referred to as a persistent trigeminal artery variant (PTAV), an anomalous carotid-cerebellar anastomosis. Bilateral occurrence of PTA is extremely rare. During vertebral artery (VA) development the anterior radicular artery of segment C1 from the proatlantal artery of Padget evolves into the intradural component of the VA (V4 segment) plus a short extradural segment (distal V3 segment). Agenesis of a single anterior radicular artery of ProA results in the absence of one distal VA associated with an unremarkable contralateral VA and the BA. Absence or hypoplasia of the terminal portion of one VA is a commonly observed anatomic variant. However, absence of the terminal portions of both VAs is exceptional. A rare case of bilateral PTAs is presented with unilateral PTA and a contralateral PTAV causing trigeminal neuralgia. Furthermore, the bilateral PTAs were associated with the absence of the proximal portion of the BA in addition to the bilateral lack of a distal VA. This finding comes as a logical consequence of the developmental anatomy of the vertebrobasilar junction and is consistent with the assumed congenital nature of the anatomic variant. PMID:22113402

  12. Pulmonary Artery Access Embolization in Patients with Massive Hemoptysis in Whom Bronchial and/or Nonbronchial Systemic Artery Embolization Is Contraindicated

    SciTech Connect

    Tamashiro, Alberto; Miceli, Marisa H.; Rando, Cristian; Tamashiro, Gustavo A.; Villegas, Miguel O.; Dini, Andres E.; Balestrin, Aristobulo E.; Diaz, Jose A.

    2008-05-15

    The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible.

  13. All about Peripheral Arterial Disease

    MedlinePlus

    ... angioplasty (AN-gee-oh-plas-tee), also called balloon angioplasty , a narrow tube with a balloon attached is inserted and threaded into an artery. Then the balloon is inflated, opening the narrowed artery. Awire tube, ...

  14. Peripheral Artery Disease and Diabetes

    MedlinePlus

    ... High Blood Pressure Tools & Resources Stroke More Peripheral Artery Disease & Diabetes Updated:Jan 26,2016 People with ... developing atherosclerosis, the most common cause of peripheral artery disease (PAD) . And individuals with PAD have a ...

  15. About Peripheral Artery Disease (PAD)

    MedlinePlus

    ... changes and medication . View an animation of atherosclerosis Atherosclerosis and PAD Atherosclerosis is a disease in which plaque builds up ... of an artery. PAD is usually caused by atherosclerosis in the peripheral arteries (or outer regions away ...

  16. Peripheral Arterial Disease and Claudication

    MedlinePlus

    ... of fatty deposits inside them. This is called atherosclerosis. If you have PAD, your arms, and more ... also more likely in people who already have atherosclerosis in other arteries, such as the arteries in ...

  17. Side predilections of offending arteries in hemifacial spasm.

    PubMed

    Chung, Moonyoung; Han, Inbo; Chung, Sang-Sup; Huh, Ryoong

    2016-07-01

    The side predilections of various offending arteries in hemifacial spasm (HFS) have not been well studied. The relationship between clinical and radiological features of HFS and offending arteries were investigated in the present study. A retrospective analysis of 370 patients who underwent microvascular decompression for HFS was performed. The patients were divided into four groups based on the offending arteries, namely anterior inferior cerebellar artery (AICA), posterior inferior cerebellar artery (PICA), vertebral artery, and multiple offending arteries. Affected side, age at onset, presence of hypertension, and sigmoid sinus area and dominance were compared between groups. The mean age of patients with a left HFS was significantly greater than that of patients with a right HFS (P=0.009). The AICA affected primarily the right side and PICA and multiple offending arteries the left side (P<0.001). Side of sigmoid sinus dominance was significantly different among groups (P<0.001). The offending arteries in HFS may be related to these differences. AICA was associated with right-sided symptoms, younger age at onset, and presence of left dominant sigmoid sinus, while PICA was associated with left-sided symptoms, older age at onset, and smaller right sigmoid sinus area. PMID:26898581

  18. Lumbar artery perforator (LAP) flap: a salvage tool for extended lumbo-sacral necrosis after bilateral internal iliac arteries embolization.

    PubMed

    di Summa, Pietro Giovanni; Schaffer, Clara; Zaugg, Patrice; Bauquis, Olivier; Raffoul, Wassim

    2016-01-01

    We report the case of a 52-year-old man presenting an extensive lumbosacral necrosis after bilateral internal iliac arteries embolization following unstable pelvic fracture. Coverage of the defect was performed using two extended lumbar artery perforator flaps in a propeller fashion. Good functional and esthetic result was achieved at one-year follow-up. PMID:27583264

  19. Lumbar artery perforator (LAP) flap: a salvage tool for extended lumbo-sacral necrosis after bilateral internal iliac arteries embolization

    PubMed Central

    di Summa, Pietro Giovanni; Schaffer, Clara; Zaugg, Patrice; Bauquis, Olivier; Raffoul, Wassim

    2016-01-01

    Abstract We report the case of a 52-year-old man presenting an extensive lumbosacral necrosis after bilateral internal iliac arteries embolization following unstable pelvic fracture. Coverage of the defect was performed using two extended lumbar artery perforator flaps in a propeller fashion. Good functional and esthetic result was achieved at one-year follow-up.

  20. Combination of rare right arterial variation with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. A case report.

    PubMed

    Ishihara, H; San Millán Ruíz, D; Abdo, G; Asakura, F; Yilmaz, H; Lovblad, K O; Rüfenacht, D A

    2011-09-01

    A 32-year-old woman hospitalized for subarachnoid hemorrhage showed rare arterial variation on the right side with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. Angiography showed the right vertebral artery to originate from the right common carotid artery, the right subclavian artery to arise separately from the descending aorta, and persistent trigeminal artery on the right side. The possible embryonic mechanism of this previously unreported variant combination is discussed. PMID:22005696

  1. Molecular Mechanisms of Arterial Stiffening

    PubMed Central

    Cecelja, Marina; Chowienczyk, Phil

    2016-01-01

    Stiffening of large arteries is a hallmark of vascular aging and one of the most important determinants of the age-related increase in blood pressure and cardiovascular disease events. Despite a substantial genetic component, the molecular mechanisms underlying phenotypic variability in arterial stiffness remain unknown. Previous genetic studies have identified several genetic variants that are associated with measures of arterial stiffness. Here, we review the relevant advances in the identification of pathways underlying arterial stiffness from genomic studies. PMID:27493903

  2. Chronic Total Artery Occlusions in Noninfarct-Related Coronary Arteries

    PubMed Central

    Ozeke, Ozcan; Gungor, Mutlu; Topaloglu, Serkan; Aras, Dursun; Ozer, Can

    2014-01-01

    It has been rarely encountered some patients in clinical practice with coronary artery chronic total occlusion (CTO) on angiography but no any clinical history or electrocardiographic, echocardiographic, or left ventriculographic evidence of previous myocardial infarction. These noninfarct-related artery CTO (non-IRA CTO) lesions may be used as a clinical role model of endogenous cardioprotective mechanisms in addition to continuing the process of atherosclerosis. The objective of this study was to characterize the clinical characteristics of patients with non-IRA CTO patients and compared them to those with infarct-related CTO (IRA-CTO). We reviewed our invasive cardiology database searching for the CTO of any major coronary arteries, and assessed whether or not they have the clinical history or electrocardiographic, echocardiographic, and left ventriculographic evidence of previous myocardial infarction. Interestingly, we detected that all these patients with non-IRA CTO had diabetes mellitus, and the clinical and demographic features of these non-IRA CTO patients were compared with age- and sex-matched diabetic IRA-CTO patients with regard to conventional coronary risk factors and the angiographic collateral grading system. There were total 99 CTO patients (49 patients with non-IRA CTO and 50 patients with IRA-CTO).All patients with non-IRA CTO had better collateral circulation (96 vs. 40% p < 0.001) compared with those having IRA-CTO. The only significant difference between the groups was the status of current smoking (4 vs. 88%; p < 0.001). The present study showed that the non-IRA CTOs were associated with diabetes mellitus and better collateral development compared with IRA-CTO. In diabetic patients, the concomitant smoking use may be harmful by preventing endogenous cardioprotective mechanisms. PMID:24627613

  3. Treatment of subclavian artery stenosis: A case series

    PubMed Central

    Salman, Reem; Hornsby, Jane; Wright, Lucie J.; Elsaid, Tarek; Timmons, Grace; Mudawi, Ahmed; Bhattacharya, Vish

    2015-01-01

    Introduction In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options. Presentation Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb. This was initially managed with a heparin infusion followed by stenting of the subclavian artery which relieved her symptoms. Case 2: A fifty-nine year-old male presented with chronic ischemia of the left arm secondary to an occlusion of the left subclavian artery. This was managed by transposition of the left subclavian artery onto the left common carotid artery. Case 3: A sixty-four year-old female presented with left subclavian steal syndrome secondary to subclavian artery stenosis. She underwent carotid subclavian artery bypass. Case 4: A fifty-six year-old female presented with acute left upper limb ischaemia secondary to acutely thrombosed subclavian artery on a CT-angiography. She underwent a carotid to axillary bypass. Discussion and conclusion This case series demonstrates the treatment options available to vascular surgeons when managing symptomatic subclavian artery disease. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. If it is not successful then open surgery should be considered. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities. PMID:26722712

  4. Uterine artery embolization

    MedlinePlus

    ... the procedure. UAE is less invasive than surgical treatments for uterine fibroids. Many women may return more quickly to activities ... SC, Spies JB, Worthington-Kirsch R, et al. Uterine artery embolization for ... from the FIBROID registry. Obstet Gynecol . 2008; 111:22-33. Munro ...

  5. [Subtotal avulsion of the lower limb after traumatic section in a 2 and a half-year-old child].

    PubMed

    Costecalde, M; Gaubert, J; Bourse, P; Hornus, D; Fries, F; Thillaye du Boullay, C; Bardier, M

    1989-01-01

    Reimplantation after subtotal section of the right lower limb under the Scarpa triangle was been attempted and was successful. Section and contusion of the femoral artery and vein required 2 end-to-end saphenous bypass grafts. The use of the lower limb is correct, after to a follow up of 4 years. The risks, inherent to all proximal section, with important muscular masses, in a small child, are described. Functional prognosis depends on three aspects: bone, vessels, and nerves. A tibial pseudarthrosis had to be operated secondarily with significant lengthening. A partial stenosis of the graft was demonstrated arteriographically. Pes equinus, a result of paralysis, has been fitted with an orthesis. This observation is almost an experimental one: what can be the future of a reimplanted lower limb in the child. PMID:2930140

  6. Fibromuscular Dysplasia-Related Renal Artery Stenosis Associated with Aneurysm: Successive Endovascular Therapy

    SciTech Connect

    Serter, Selim Oran, Ismail; Parildar, Mustafa; Memis, Ahmet

    2007-04-15

    Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease. FMD of the renal arteries is one of the leading causes of curable hypertension. The simultaneous occurrence of FMD and renal artery aneurysm has been described previously. In this case, we present a fibrodysplastic lesion and an aneurysm in a renal artery treated with a percutanous transluminal angioplasty and coil embolization.

  7. Persistent median artery in the carpal tunnel and anastomosis with superficial palmar arch.

    PubMed

    Bijannejad, Dariush; Azandeh, Saeed; Javadnia, Fatemeh; Gholami, Mohammad Reza; Gharravi, Anneh Mohammad; Zhaleh, Mohsen

    2016-01-01

    Persistent median artery (PMA) in present cadaver originated from the brachial artery and anastomosed with the superficial palmar arch (SPA). As the PMA may be the cause of carpal tunnel syndrome and SPA is the main source of arterial supply, knowledge of which are important for the hand surgical interventions. PMID:27583265

  8. Persistent median artery in the carpal tunnel and anastomosis with superficial palmar arch

    PubMed Central

    Bijannejad, Dariush; Azandeh, Saeed; Javadnia, Fatemeh; Gholami, Mohammad Reza; Gharravi, Anneh Mohammad; zhaleh, Mohsen

    2016-01-01

    Abstract Persistent median artery (PMA) in present cadaver originated from the brachial artery and anastomosed with the superficial palmar arch (SPA). As the PMA may be the cause of carpal tunnel syndrome and SPA is the main source of arterial supply, knowledge of which are important for the hand surgical interventions. PMID:27583265

  9. Obstructive jaundice as a complication of a right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy

    PubMed Central

    Hsiao, Chih-Yang; Kuo, Ting-Chun; Lai, Hong-Shiee; Yang, Ching-Yao; Tien, Yu-Wen

    2015-01-01

    A hepatic artery pseudoaneurysm is a rare, but a potentially life-threatening complication after laparoscopic cholecystectomy (LC). Obstructive jaundice owing to a hepatic artery pseudoaneurysm after LC has never been reported. We report a patient with a hepatic artery pseudoaneurysm after LC who presented with tarry stools, bloody drainage and obstructive jaundice. PMID:25883462

  10. A very unusual anatomical variation and complication of common iliac artery and ureter in retroperitonoscopic ureterolithotomy

    PubMed Central

    Huri, Emre; Akgül, Turgay; Karakan, Tolga; Sargon, Mustafa; Germiyanoğlu, Cankon

    2011-01-01

    Anatomical localization of theureter comes along psoas major muscle and crosses over common iliac artery bifurcation. Common iliac artery aneurysm and impacted atherosclerosis are a rare condition that should be differed from the impacted ureter stone to avoid from undesirable complication. In this case, we present a very unusual anatomical variation and complication of common iliac artery and ureter in retroperitonoscopic ureterolithotomy. PMID:21523238

  11. Pulmonary arterial hypertension in primary amyloidosis

    PubMed Central

    Emerson, Lyska L.; Bull, David A.; Hatton, Nathan; Nativi-Nicolai, Jose; Hildebrandt, Gerhard C.; Ryan, John J.

    2016-01-01

    Abstract Amyloidosis involves extravascular deposition of fibrillar proteins within tissues and organs. Primary light chain amyloidosis represents the most common form of systemic amyloidosis involving deposition of monoclonal immunoglobulin light chains. Although pulmonary amyloid deposition is common in primary amyloidosis, clinically significant pulmonary amyloidosis is uncommon, and elevated pulmonary artery pressures are rarely observed in the absence of other underlying etiologies for pulmonary hypertension, such as elevated filling pressures secondary to cardiac amyloid. In this case report, we present a patient with primary light chain amyloidosis and pulmonary arterial hypertension in the setting of pulmonary vascular and right ventricular myocardial amyloid deposition. PMID:27252852

  12. Pulmonary arterial hypertension in primary amyloidosis.

    PubMed

    Cirulis, Meghan M; Emerson, Lyska L; Bull, David A; Hatton, Nathan; Nativi-Nicolai, Jose; Hildebrandt, Gerhard C; Ryan, John J

    2016-06-01

    Amyloidosis involves extravascular deposition of fibrillar proteins within tissues and organs. Primary light chain amyloidosis represents the most common form of systemic amyloidosis involving deposition of monoclonal immunoglobulin light chains. Although pulmonary amyloid deposition is common in primary amyloidosis, clinically significant pulmonary amyloidosis is uncommon, and elevated pulmonary artery pressures are rarely observed in the absence of other underlying etiologies for pulmonary hypertension, such as elevated filling pressures secondary to cardiac amyloid. In this case report, we present a patient with primary light chain amyloidosis and pulmonary arterial hypertension in the setting of pulmonary vascular and right ventricular myocardial amyloid deposition. PMID:27252852

  13. Persistent trigeminal artery causing "double" neurovascular conflict.

    PubMed

    Clerici, Angelo Maurizio; Merlo, Paola; Rognone, Felice; Noce, Monica; Rognone, Elisa; Bono, Giorgio

    2009-03-01

    We report the case of a 73-year-old woman who presented with right VI nerve palsy and homolateral atypical trigeminal neuralgia; standard neuroradiological investigation of orbital/retroorbital regions and intracranial arteries excluded the most commonly demonstrable underlying causes while brain magnetic resonance (T1-weighted fat suppression; T2-weighted thin-section) and magnetic resonance angiography disclosed the evidence of "double" neurovascular conflict because of persistent trigeminal artery with aneurysmal dilation. A role of this almost rare vascular condition in causing painful ophthalmoplegia is discussed. PMID:19267790

  14. Markers of arterial stiffness in peripheral arterial disease.

    PubMed

    Husmann, Marc; Jacomella, Vincenzo; Thalhammer, Christoph; Amann-Vesti, Beatrice R

    2015-09-01

    Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD. PMID:26317253

  15. Coupled vibration analysis of large arterial vessels

    NASA Astrophysics Data System (ADS)

    Zhang, Xiaoming; Fatemi, Mostafa; Greenleaf, James F.

    2002-05-01

    A coupled vibration model, which takes into account the elastic arterial wall, the interior blood, and exterior tissue, is presented. The arterial wall is considered as a cylindrical elastic shell and is modeled with the thick shell theory due to the large thickness-to-radius ratios. Both the blood and the tissue are considered as ideal fluids and are modeled with acoustic wave theory. A newly developed method, the wave propagation approach, is extended for the coupled vibration of arterial walls. The theoretic model is evaluated against those available in the literature. The experiments were carried out on a silicone rubber tube in a water tank with an ultrasound stimulated system. This system uses the radiation force of ultrasound to vibrate the tube at low frequency and records the resulting response by a laser vibrometer. Both the excitation and measurement are remote and noncontact. The measured fundamental frequency is in good agreement with the theoretical prediction.

  16. Management of trachea--innominate artery fistula.

    PubMed

    Ramesh, M; Gazzaniga, A B

    1978-01-01

    The case histories of three patients with trachea-innominate artery fistula are presented. Low tracheostomy was the etiologic factor producing the fistula in two patients. In both cases, the neck was hyperextended by placing a large roll behind the patient's shoulders and thereby elevating the trachea out of the mediastinum. In one patient a balloon cuff eroded the innominate artery. Management of these patients includes control of hemorrhage by cuff overinflation and/or by endotracheal intubation and packing of the tracheostomy site. The best surgical approach is via a right anterior thoracotomy and a separate neck incision to isolate the blood vessels involved. Median sternotomy should be avoided to prevent mediastinal infection and sternal dehiscence. Carotid stump pressures are a useful guide to determine the efficacy of innominate artery ligation. One patient was saved and is a long-term survivor. PMID:339003

  17. Superficial Temporal Artery Pseudoaneurysm: A Case Report

    PubMed Central

    Younus, Syed Muneeb; Imran, Muhammad; Qazi, Rabia

    2015-01-01

    Pseudoaneurysms of the superficial temporal artery are an uncommon vascular lesion of the external carotid system and most often the result of blunt head trauma. The frequency of pseudoaneurysms of the superficial temporal artery developing after craniotomy is exceedingly low and only a few cases have been reported. We present a case of pseudoaneurysm of this type in a 45-year-old male who underwent craniotomy for excision of meningioma. One month postoperatively, the craniotomy flap exhibited an enormous diffuse pulsate swelling. The suspected diagnosis of pseudoaneurysm arising from superficial temporal artery was confirmed on angiography. Surgical excision was done and no recurrences of the tumor or aneurysm were noted on subsequent follow up. PMID:26501064

  18. Hepatic artery aneurysm developing after Billroth's operation.

    PubMed

    Fatic, Nikola; Music, Davor; Zornic, Nenad; Radojevic, Nemanja

    2014-05-01

    In this report we review the unusual case of a patient with a common hepatic artery aneurysm presenting 30 years after a Billroth's II resection. A 65-year-old man with epigastric pain and 10 kg of weight loss in the previous 6 months was referred to our clinic. Computed tomography revealed the presence of an aneurysm of the common hepatic artery (HAA) of 35 mm. This HAA was surgically excluded by aneurysmectomy and prosthetic bypass. Intraoperatively we observed extensive peritoneal adhesions and connective tissue formation in the region of the hepatoduodenal and hepatogastric ligaments, and the outer wall of the HAA was tightly affixed to the root of the transverse mesocolon by connective adhesions. Retraction of the adhesions slowly brought about a continued stretching and thinning of the arterial wall likely caused the HAA. PMID:24184460

  19. Coronary Artery Fistula: Two Rare Cases.

    PubMed

    Wehbe, Mahmoud Sleiman; Vondran, Maximilian; Sauer, Matthias; Mohr, Friedrich-Wilhelm; Schroeter, Thomas

    2015-11-01

    Coronary artery fistula (CAF) is an incidental finding in up to 0.2% of cardiac catheterization studies and is a rare pathologic condition affecting up to 1% of the general population. We report two cases of CAF diagnosed by coronary angiography and managed by surgical ligation, with excellent postoperative outcome. Anatomic location, clinical presentation, investigation, and treatment of CAF are discussed. PMID:26522575

  20. [Arterial and venous microanastomoses in the rat].

    PubMed

    Gianaroli, L; Bufferli, M; Livani, M F

    1980-11-15

    Arterial and venous microvascular surgery for diameters smaller than 2 mm are shown with particular care. Some technical devices are put in evidence. Besides their statistical data the Authors present immediate and long term post-operative controls which are usually applied. The most frequent causes of failure are discussed. PMID:7213480