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At least 973 records · Page 54Linked to original sources

PubMed1998

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

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

Adult↗

PubMed1997

[Open foramen ovale in patients with arterial vascular occlusions of the retina and optic nerve].

BACKGROUND: We examined the frequency and significance of persistent foramen ovale (PFO) in patients with ocular circulatory disturbance. PATIENTS AND METHODS: Forty patients with acute arterial occlusions of the posterior bulb segment were investigated by means of transthoracic and transesophageal echocardiography (TEE). The parallel presence of cerebral ischemia was clarified on the basis of existing CCT findings and by additional HMPAO-SPECT investigation. RESULTS: PFO was identified in nine of the patients investigated. The probability of paradoxical embolism arises from further findings: eight of those with PFO (89%) showed echocardiographic signs of right heart strain, indicating previous pulmonary embolism, compared with only three of those without PFO (10%). Five of those with PFO showed a potential source of embolism, two of them with phlebothromboses in their clinical history and three with additional atrial septal aneurysm. Cardiovascular risk factors were prevalent in the group without PFO. Both groups had a mean age of approximately 60 years. Signs of cerebral ischemia were present in the SPECT or CT findings for four of the patients with PFO and nine of those without. CONCLUSIONS: From our findings, it appears highly probable that ocular arterial occlusion is caused by paradoxical embolism. PFO should be taken into account in establishing a diagnosis, including diagnosis in elderly patients.

Adult↗

PubMed2002

[Occlusion by catheter intervention in patent foramen ovale via additional transseptal puncture].

In patients with a cryptogenic cerebral ischemia, the percutaneous closure of a patent foramen ovale (PFO) has gained increasing acceptance as an alternative strategy to prevent paradoxical embolism. Promising data with low recurrence rates have been reported for several self-expanding double disk devices. The implantation of the device is usually performed by passing the PFO. However, in one patient with a TIA (m, 43 years) transesophageal echocardiography (TEE) revealed an atrial septum abnormality with a hypermobile septum and a very small distance (approximately 12 mm) between the PFO channel and the anterior mitral valve leaflet, which was too short to accommodate the regular implantation procedure of the device via the PFO-channel itself. In this particular case the device (PFO-Star TSD) was advanced to the left atrium via an additional transseptal puncture--performed under TEE guidance--to allow for complete closure of the PFO without impairment of the mitral valve function. No periinterventional complications were observed. During the follow-up period of 9 months the patient was completely asymptomatic with no functional impairment of the mitral valve and no residual intracardiac shunt.

Adult↗

PubMed2002

[Interventional occlusion of foramen ovale and atrial septal defects after paradoxical embolism incidents].

Two hundred and fifty-one patients with a persistent foramen ovale (PFO), mean age 43.3 +/- 12.4 years, underwent catheter closure between 6/1995 and 6/2001. One hundred and forty-one had an ischemic stroke, 99 a transient ischemic attack (TIA) or prolonged reversible ischemic neurologic deficit, 5 peripheral arterial embolism, 4 suffered from decompression sickness after diving and 2 had transient global amnesia. Fifty-nine of them had multiple events in spite of antiplatelet or anticoagulant therapy. The patients received five different devices: 13 Rashkind Occluders, 20 Amplatzer septal Occluders, 109 Amplatzer PFO-Occluders, 73 CardioSEAL and 36 STAR-Flex devices. Time of fluoroscopy was 8.3 +/- 4.5 min. In three patients a device embolized and had to be removed from the groin vessels. We saw five inguinal or retroperitoneal venous hematomas with the need for operation in one patient. One early and one late perforation of the left atrium caused by a guide wire and a left-atrial disc, respectively, also needed surgery. Fourteen patients had documented late arrhythmias. Six patients with atrial fibrillation needed drugs or cardioversion while the other patients with runs of supraventricular tachycardia, atrial flutter and multiple extrasystoles needed no therapy. On transesophageal echocardiography (TEE) 6 months after implantation we found four significant residual leaks. These patients had the defect closed with a second device. In addition a secundum atrial septal defect (ASD) was closed in 17 patients (mean age 38 +/- 10.5 years) with Amplatzer septal Occluders (12) and CardioSEAL devices (5). These patients had experienced eight strokes and nine TIAs, 3 of them had had multiple events. Two of these patients had a significant residual defect and one had atrial flutter following the procedure. Two hundred and two PFO-patients and 12 ASD patients were followed for 6-62 (24.6 +/- 14.2) months; 2 died due to a traffic accident and a myocardial infarction, respectively. Four patients had another neurologic event following PFO-closure. We now overlook 210 patients with 348.6 symptom-free patient years and have a 1-year recurrence rate of neurologic events of 1.9%. Catheter closure of the PFO and atrial septal defect is a simple, effective and quick method which ensures a high closure rate, avoids life-long anticoagulation and has a low recurrence rate of neurologic events.

Adolescent↗

PubMed2000

[Patent foramen ovale: conservative or surgical therapy?].

Notwithstanding the difficulties in definitely confirming paradoxical embolism, the association between patent foramen ovale (PFO) and cryptogenic stroke has repeatedly been demonstrated in clinical studies. Moreover, the recurrence rate of cerebral ischemia in patients with PFO and an unexplained stroke was found to be 3-4% per year in two recently published series. With the exception of right atrial pressure elevation in the setting of major pulmonary embolism, a reliable risk stratification of patients with PFO based on clinical or echocardiographic findings is not yet possible. The presence of atrial septal aneurysm, a wide opening of the defect during the cardiac cycle and a large atrial shunt have been implicated as risk factors by some investigators. Long-term prevention of paradoxical embolism with oral anticoagulants seems to be of questionable benefit. Besides, these agents are poorly tolerated and carry the risk of significant or fatal bleeding at a rate of 2-5% per year. Surgery of the atrial septum has been performed for many decades in patients with atrial septal defect and evidence accumulates that it is a safe and highly effective procedure in patients with PFO. At present, surgical closure of the PFO appears to be the treatment of choice for secondary prevention of paradoxical embolism. However, further studies are needed to define the appropriate candidates for surgical treatment. Devices for catheter-based sealing of PFO are also available and are currently being evaluated in clinical trials. However, experience with their use remains confined to specialized centers. Furthermore, further technical improvements of these systems are needed in order to optimize successful delivery and positioning, increase their long-term stability, and reduce periprocedural complications.

Cardiac Catheterization↗

PubMed1997

[Diagnosis and therapy of a fluttering thrombus in the open foramen ovale].

The finding of an extremely mobile thrombus in a patent foramen ovale (i.e., transit thrombus) without arterial embolism is rare. In our case-report diagnosis was made by routine-echocardiography. Clinically nonapparent deep vein thrombosis was documented by phleography and was thought to be the origin of the embolus. After implantation of a caval filter device cardiac surgery was performed and the embolus was removed without complications.

Heart Septal Defects, Atrial↗

PubMed1997

[Combined lytic and heart surgical therapy of in open foramen ovale incarcerated giant thrombus with pulmonary and cerebral embolization].

A case of phlebothrombosis with recurrent pulmonary and cerebral embolism is presented which occurred in a 42 year old patient two weeks after treatment of a traumatic crural fracture despite of prophylaxis with low molecular heparin. By means of transthoracic echocardiography a large intracardiac thrombus was detected, entrapped in an patent foramen ovale (PFO) and prolapsing through both atrioventricular valves into both ventricles. This was found after systemic thrombolysis with rtPA had been performed because of fulminant pulmonary embolism. Subsequently the intracardiac thrombus was surgically removed and the PFO closed. The importance of an PFO for paradoxical embolism is discussed as well as the various therapeutical paths to treat an "embolus-in-transit" (cardiac surgery, thrombolytic therapy or anti-coagulation).

Adult↗

PubMed2003

Reversible cochleo-vestibular deficits in two cases of jugular foramen tumor after surgery.

Primary jugular foramen (JF) tumor, such as glomus jugular tumor or JF schwannoma, may manifest as a lower cranial nerve deficit; in addition, it can be accompanied by deafness or vertigo if it affects the cranial nerve (CN) VIII. Recently, we encountered JF schwannoma 1 and glomus jugulare tumor 1. Both cases invaded the adjacent cerebellopontine angle, leading to cochleo-vestibular deficits prior to the operation. After surgery, recovery of the audiovestibular function, including hearing, auditory brainstem response and caloric response, was anticipated in both patients. Therefore, cochleo-vestibular deficits in JF tumors can be attributed to compression neuropathy, rather than tumor infiltration.

Adult↗

PubMed2004

Cerebral microembolism during transcatheter closure of patent foramen ovale.

BACKGROUND: Although transcatheter closure of patent foramen ovale (PFO) and atrial septal defect (ASD) has become a commonly performed intervention, the incidence of cerebral embolism with or without neurological deficits during such procedures has not been studied. METHODS: We monitored the middle cerebral artery in two different depths (48 mm and 53 mm) by continuous transcranial Doppler ultrasound during transcatheter PFO closure in 35 consecutive patients (F/M 20/15, mean age 47 +/- 11 years) and during ASD closure in 8 patients (F/M 7/1, mean age 45 +/- 5 years). All automatically detected high intensity transient signals (HITS) were manually reviewed to eliminate artifacts. RESULTS: HITS were detected in 33 of 35 patients (96%) with a median rate of 8 (interquartile range 4-19, range 2-29) HITS. The highest rates were observed when the septum was crossed with the guide wire (median 2; IQR 0-12; range 0-25) and when the left atrial disc was deployed (median 2; IQR 1-4; range 0-13). Despite this high rate of cerebral microembolism no clinically apparent neurological or neuropsychological deficit was observed. CONCLUSIONS: Silent cerebral embolism frequently occurs during transcatheter PFO and ASD closure. The peak of HITS at the time of crossing the septum with the guide wire may support the hypothesis that cerebral emboli in patients with PFO may originate from the septum itself. This may represent an alternative mechanism to the generally assumed paradoxical embolism.

Adult↗

PubMed2001

Cecal herniation through the foramen of Winslow after laparoscopic Nissen fundoplication.

Laparoscopic Nissen fundoplication is the treatment of choice for medically refractive gastroesophageal reflux disease. Cecal herniation is an exceedingly rare complication of this procedure. We report the case of a 51-year-old woman who presented 2 months after a successful laparoscopic Nissen fundoplication with heartburn and epigastric pain that radiated to her back. Abdominal films showed an air-filled loop in the left upper quadrant. At surgery, the patient had a redundant loop of cecum, which had herniated through the foramen of Winslow over the stomach and was positioned beneath the left hemidiaphragm. The cecum was not ischemic. A right hemicolectomy was performed to prevent recurrence. The patient recovered fully and has had no further problems. This is the first report of such a case.

Cecal Diseases↗

PubMed1997

Laparoscopic repair of a diaphragmatic hernia through the foramen of morgagni.

A 78-year-old woman is described who presented with a diaphragmatic hernia through the foramen of Morgagni. A definitive diagnosis was confirmed by a sagittal view on magnetic resonance imaging prior to surgery. The hernia was repaired laparoscopically under an abdominal wall lifting technique without pneumoperitoneum, and her symptoms completely resolved postoperatively with no evidence of recurrence. The laparoscopic repair was considered a suitable and safe procedure for the treatment of a Morgagni hernia.

Aged↗

PubMed2005

Isolated glossopharyngeal and vagus nerves palsy due to fracture involving the left jugular foramen.

This report describes a case of delayed post-traumatic glossopharyngeal and vagus nerves palsy (i.e. dysphonia and swallowing dysfunction). A high resolution CT study of the cranial base detected a fracture rim encroaching on the left jugular foramen. Treatment consisted in supportive measures with incomplete recovery during a one-year follow-up period. Lower cranial nerves palsies after head trauma are rare and, should they occur, a thorough investigation in search of posterior cranial base and cranio-cervical lesions is warranted. The presumptive mechanism in our case is a fracture-related oedema and ischemic damage to the nerves leading to the delayed occurrence of the palsy.

Adolescent↗

PubMed2000

Surgical resection of jugulare foramen tumors by juxtacondylar approach without facial nerve transposition.

PRESENTATION: Jugulare foramen tumors (JFT) remain a difficult challenge especially in the forms extending extradurally and invading the petrous bone. In the standard technique, facial nerve function is placed at risks because of its transposition. We report on 31 extradural (N = 11) or intra-extra dural (N = 20) JFT resected surgically using the juxtacondylar approach alone or in combination with the infratemporal approach and without facial nerve transposition. RESULTS: The juxtacondylar approach permits the opening of the JF on its posteroinferior aspect and thus reduces the extent of petrous bone drilling. In tumors strictly located in the JF (N = 11), no petrous bone drilling is necessary and the facial nerve is never exposed. In tumors extending into the petrous bone (N = 20), the facial nerve was never transposed and moreover was kept in its bony canal in 15 cases. In only 5 cases, was the fallopian canal opened as the tumor was invading its bony wall. Similarly hearing function, when pre-operatively intact was always preserved and a better preservation of the lower cranial nerves could be achieved. Whatever the tumoral extent along the petrosal carotid artery, a radical resection could be realized in 30 cases. CONCLUSION: Therefore, we consider the juxtacondylar approach a useful adjunct to increase the possibilities of resection of JFT; it allows a better preservation of the neurovascular structures, especially the facial nerve which is kept in place and moreover kept in its bony canal when it is not invaded by the tumor.

Adolescent↗

PubMed1997

Screening for patent foramen ovale and prevention of paradoxical embolus.

Paradoxic embolus is uncommon. Definite diagnosis requires demonstration of thrombus astride a patent foramen ovale (PFO) in a patient presenting cerebral or peripheral arterial embolism. With current echocardiography techniques, it is now possible to identify subjects with a PFO at risk for paradoxal embolism, however, the possibility of screening rekindles debate on prophylaxis and treatment. In the present report, we describe a case involving a woman who presented acute ischemia of the lower extremities with all the pathophysiologic features of paradoxical arterial embolism.

Aged↗

PubMed2003

Pubomyoaponeurotic foramen and posterior groin plait for groin hernia.

Sir Astley Paston Cooper stated in 1804 that a sound knowledge of proper anatomy of hernia is vital. But even in the succeeding two centuries, the confusion has only multiplied by varied and overly enthusiastic descriptions, some speculative and others real, by different workers. An attempt has been made to highlight the size of the controversies surrounding the anatomical structures forming the inguinal canal and groin. The inguinal and femoral hernias should be viewed collectively as one entity and together be called groin hernias. Therefore, the passage for their superficial emergence through the anterior abdominal wall is redefined and is called pubomyoaponeurotic foramen. It is uniformly accepted that the strong posterior wall of the groin area is the only preventive factor towards the emergence of hernia; it has been renamed as posterior groin plait. Therefore, proper understanding of its structure towards effective repair and reinforcement is the only safe method, whether the procedure is carried out by anterior or posterior route or laparoscopically. Hence, an attempt has been made to elucidate its true structure. In spite of so many descriptions, the exact anatomy of hernia is yet to be resolved.

Groin↗

PubMed2005

Pregnancy, patent foramen ovale and stroke: a case of pseudoperipheral facial palsy.

The pathogenetic role of patent foramen ovale (PFO) in embolic stroke and its prognostic and therapeutic implications have not yet been clearly defined. Nonetheless, recent availability of non-invasive diagnostic techniques, such as the transcranial Doppler (TCD), has increased the frequency with which this anomaly is diagnosed. Here we present the case of a young woman affected by post-partum peripheral facial palsy: further exams disclosed not only its truncal-ischaemic origin, but also, significantly, the presence of PFO, as well as of anticardiolipin antibodies (acL). Given the increased embolic risk in labouring women, this study highlights the importance of searching for PFO in case of a stroke during pregnancy.

Adult↗

PubMed2001

Transcranial Doppler in the diagnosis of cardiac patent foramen ovale.

Right-to-left shunt due to patent foramen ovale is a well-established risk factor for ischemic stroke, especially in young subjects and in patients with cryptogenic stroke. We report a detailed method for the diagnosis of a right-to-left shunt by means of transcranial Doppler as established at a recent consensus conference, and review the literature on the indications for the test.

Brain Ischemia↗

PubMed2002

Factor V Leiden mutation and patent foramen ovale in ischemic stroke.

We report a 47-years-old male with ischemic stroke, whose arteriographic and echocardiographic investigations did not reveal any steno-occlusive arterial disease or embolic source from the left cardiac chambers. A transesophageal echocardiogram showed a patent foramen ovale (PFO), whilst laboratory screening for coagulation abnormalities showed heterozygosity for factor V Leiden mutation. The significance of the association of PFO with factor V Leiden mutation is discussed as a possible cause of ischemic stroke through paradoxical embolism from a venous source. The high prevalence of these two conditions in the general population is emphasized and the indication for anticoagulant therapy is discussed.

Activated Protein C Resistance↗