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At least 991 records · Page 55Linked to original sources
PubMed2004

Ileal herniation into a sigmoid colon epiploic fat foramen extrasigmoid hernia.

Internal abdominal hernia (IAH) is defined as protrusion of viscus through a peritoneal or mesenteric aperture, leading to its encapsulation within another compartment in the abdominal cavity. Herein we report a rare case of small bowel obstruction due to herniation with incarceration of a loop of ileum into a foramen formed by the epiploic fat of the sigmoid colon due to a non-specific inflammatory process; this may be defined as extrasigmoid hernia. To our knowledge, there has been no previous report of this type of IAH in the English literature. In summary, an acute intestinal obstruction with strangulation in the absence of an external hernia without previous operation suggests the possibility of internal hernia, especially if the patient has a history of intermittent abdominal distress.

Hernia↗
PubMed2005

High prevalence of patent foramen ovale in migraine with aura.

In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour-coded sonography (c-TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c-TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c-TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis.

Adult↗
PubMed2005

Prevalence of patent foramen ovale in a large series of patients with migraine with aura, migraine without aura and cluster headache, and relationship with clinical phenotype.

A relationship between migraine and patent foramen ovale (PFO) has been observed in relatively small series of patients so far. Furthermore, the exact mechanism underlying such an association remains unknown. In the present study we determined the prevalence of PFO by contrast-enhanced transcranial Doppler (TCD) in a group of 260 patients with migraine with aura (MA+), 74 patients with migraine without aura (MA-), and 38 patients with cluster headache (CH). One-hundred-sixty-one MA+subjects (61.9%), 12 MA-subjects (16.2%), and 14 CH-subjects (36.8%) were PFO-carriers. The association was independent on the frequency of migraine attacks and complexity of aura. Finally, among the 15 patients who had a history of at least one migraine attack occurring during a Valsalva maneuver only one subject turned out to be PFO-carrier. Our findings confirm previous observations of a link between MA+, CH, and PFO. They also suggest that such an association is independent on migraine clinical phenotype and is probably unrelated to the pathogenic mechanism of paradoxical embolism.

Adult↗
PubMed2005

Paradoxical embolism due to open foramen ovale with atrial septal aneurysm as a cause of myocardial infarction in a young male.

Paradoxical embolism is a rare cause of myocardial infarction. We present a case of a young man who was admitted to our hospital with an inferior myocardial infarction. Coronary arteriography showed a total distal occlusion of a posterolateral branch of the circumflex artery. Contrast-enhanced echocardiography showed a large atrial septal aneurysm with a patent foramen ovale and massive right-to-left shunting. No other sources of cardiac embolism could be identified. In this case, paradoxical embolism probably has resulted in myocardial infarction.

Adult↗
PubMed2005

Patent foramen ovale and stroke: prognosis and treatment in young adults.

A patent foramen ovale (PFO) is found with increased frequency in patients with stroke of undetermined origin but the significance and therapeutic implications of this observation remain unclear. Several lines of evidence suggest a role for the PFO in stroke pathophysiology for some cryptogenic stroke patients, such as those whose PFO is accompanied by a prothrombotic state, atrial septal aneurysm, or lower extremity/pelvic DVT. Diagnostic evaluation of the patient with cryptogenic stroke and PFO is directed at identifying these subgroups. Appropriate therapy for primary and secondary stroke prevention in a subject with a PFO remains unclear given current uncertainties as to the pathophysiological significance of PFO. Additional studies are needed, such as those focused on lower extremity veins or the cardiac interatrial septum, to guide therapy in specific stroke subpopulations.

Adolescent↗
PubMed2005

Which treatment for patent foramen ovale in cryptogenic stroke?

The management of a patient with a cryptogenic stroke and a patent foramen ovale (PFO) depends on the existence of identifiable causes of stroke, on the PFO characteristics, on the characteristics of the patient, on the contraindications to antithrombotic therapy, and on the preference of the patient. There is no consensus on the management of a patient with a cryptogenic stroke and a PFO, but the algorithm presented in this article seems reasonable to these authors.

Journal Article↗
PubMed2005

The management of patients with patent foramen ovale and stroke.

The management of patients with patent foramen ovale (PFO) and stroke remains uncertain. What is known is that PFO is a very common finding in the general population. The risk of initial and recurrent stroke in individuals with PFO is relatively low. With the advent of transesophageal echocardiography, PFO is more commonly being diagnosed. There are insufficient data to support a benefit of warfarin over aspirin in preventing recurrent stroke in most patients with PFO. In those with PFO and a history of a procoagulant state or deep venous thrombosis, anticoagulation may be indicated after weighing the risks of anticoagulation against potential benefits in preventing recurrent stroke. PFO closure does not guarantee the prevention of future stroke and should be addressed case by case, with consideration of patients for entry into ongoing clinical trials of safety, efficacy, and durability.

Journal Article↗
PubMed1994

Comparison of transesophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale.

We directly compared the utility of agitated saline solution contrast echocardiography and color flow Doppler with both transthoracic and transesophageal echocardiography in the detection of patient foramen ovale (PFO). Forty-three patients referred for contrast echocardiography and transesophageal echocardiography were prospectively studied. Three were excluded because of technically inadequate contrast, and two were excluded because of hemodynamically significant atrial septal defect. The remaining 38 patients, who ranged in age from 19 to 73 years, were referred for cerebrovascular events (31), peripheral embolus (5), atrial septal aneurysm (1), and suspected atrial septal defect (1). With either contrast or color flow Doppler, PFO was detected by transthoracic imaging in 9 (24%) of 38 patients compared with 20 (53%) of 38 with transesophageal echo. PFO was present in 1 (3%) of 38 by TTE color flow, 9 (24%) of 38 by TTE contrast, 17 (45%) of 38 by TEE color flow, and 14 (37%) of 38 by TEE contrast. Discordant findings with TEE were the result of contrast-positive, color-negative results in 3 patients and color-positive, contrast-negative results in 6. With TEE contrast used as a diagnostic gold standard, other techniques detected PFO with the following sensitivities, specificities, and positive and negative predictive values: TEE color flow 79%, 75%, 65%, 86%, respectively; TTE contrast 50%, 92%, 78%, 76%, respectively; and TTE color flow 7%, 100%, 50%, 65%, respectively. Thus PFO is detected more frequently with TEE. TEE contrast and color flow Doppler yielded discordant findings in a minority of patients, probably as a result of intrinsic limitations in each technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Hypoplasia of the eustachian valve and abnormal orientation of the limbus of the foramen ovale in hypoplastic left heart syndrome.

We examined the eustachian valve and the limbus of the foramen ovale in 42 hearts with hypoplastic left heart syndrome (HLHS) and in 16 normal hearts. In HLHS, only 4.8% of the eustachian valves were moderately to well developed, whereas the remaining 95.2% were abnormal (p < 0.001): 92.9% of the eustachian valves were absent or markedly hypoplastic, and 2.4% had an abnormally redundant and enlarged eustachian valve. The eustachian valve was well developed in 87.5% of normal hearts. In addition, the lesser development of the eustachian valve seemed to correlate with lesser development of the left side of the heart. The limbus was well developed in 100% of the normal hearts and moderately to well developed in only 33.3% of the HLHS group (p < 0.001). Most hearts in the HLHS group had marked hypoplasia of the limbus, which was rotated and deviated so as to be close to the superior vena caval entrance.

Aortic Valve↗
PubMed1979

Prenatal closure of the foramen ovale in complete transposition of great vessels. Observations in a case with intact ventricular septum and normally developed left heart chambers.

A rare case is reported of premature closure of the foramen ovale in d-transposition of the great vessels with intact ventricular septum and normal development of the left side of the heart. Asphyxia neoatorum and cardiac failure were the manifestations in the early neonatal period. Balloon atrial septostomy during cardiac catheterization would be unsuccessful in infants with this condition, and closed atrial septectomy (Blalock-Hanlon procedure) would be necessary for survival.

Asphyxia Neonatorum↗
PubMed1992

Diagnosis of patent foramen ovale by transesophageal echocardiography and association with cerebral and peripheral embolic events.

This study compares the value of transthoracic (TTE) and transesophageal (TEE) color Doppler and contrast echocardiography for detecting a patent foramen ovale (PFO). A total of 238 patients were studied: 74 patients with a history of otherwise unexplained ischemic stroke, transient cerebral ischemic attacks or peripheral embolic events (group A), 48 with a history of similar episodes explained by other cardiac abnormalities (group B), and 116 with no embolic events (group C). A PFO was detected by contrast TEE in 50 of 238 patients (21%) compared with 45 patients (19%) by color Doppler TTE. In a subgroup of 198 patients, TEE results could be compared with TTE findings. No patient had a PFO identified by color Doppler TTE. Contrast TTE detected a PFO in 15 patients (8%) compared with contrast TEE which demonstrated a PFO in 44 of 198 patients (22%) (p less than 0.001). Prevalence of PFO by TEE was 22, 21 and 22% in groups A, B and C, respectively. A PFO was present in 50% of patients aged less than 40 years and otherwise unexplained ischemic stroke; this percentage was higher (p less than 0.05) than corresponding values found in all other groups. Thus, contrast and color Doppler TEE are significantly superior to TTE for detecting PFO. The prevalence of PFO is significantly increased in young adults with otherwise unexplained ischemic stroke.

Brain Ischemia↗
PubMed1992

Risk of patent foramen ovale for thromboembolic events in all age groups.

The association between a patent foramen ovale (PFO) and thromboembolic events in young patients has been reported. Autopsy data suggest that a PFO may be present in 20 to 35% of the population. To further assess the role of a PFO in patients with possible thromboembolic events, precordial and transesophageal contrast echocardiography was performed in 104 consecutive patients (age range 16 to 84 years) presenting with a stroke, transient ischemic attack or peripheral artery embolus (group I). These patients were compared with 94 consecutive patients (age range 23 to 82 years) undergoing transesophageal echocardiography for other reasons (group II). A PFO was found in 22 patients; 9 of 35 (26%) with an event but no risk factor (group Ia), 10 of 69 (14%) with an event but a recognized risk factor (group Ib), and 3 of 94 control patients (3.2%) (group II) (group Ia vs II: relative odds 10:1, p less than 0.001; group Ib vs II: relative odds 5:1, p less than 0.01; and group Ia vs Ib: p = not significant). The detection of a PFO was not related to age. The relatively low prevalence of a PFO in this study may reflect patient selection, but other explanations include: (1) Transesophageal contrast echocardiography may be relatively insensitive for its detection; (2) the prevalence in the general population may have been overestimated; and (3) most PFOs are very small, clinically insignificant and undetectable with this technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Evidence that patent foramen ovale is not a risk factor for cerebral ischemia in the elderly.

Patent foramen ovale (PFO) may be a risk factor for ischemic stroke in young patients. The aim of this study was to assess the importance of PFO in subjects with a wider age range using patient-control methodology. Transesophageal contrast echocardiography and carotid imaging were performed in 220 consecutive patients with cerebral ischemia (mean age 66 +/- 13 years) and in 202 community-based control subjects (mean age 64 +/- 11 years). Of patients with stroke, 35 (16%) had PFO compared with 31 control subjects (15%) (p = 0.98). Analysis of PFO prevalence by age did not show a significant difference between patients and controls subjects in the age groups < 50 years (27% vs 11%; p = 0.33), 50 to 69 years (17% vs 15%; p = 0.78), and > or = 70 years (12% vs 17%; p = 0.43). However, the group aged < 50 years was relatively small (26 cases, 19 controls). No significant difference in PFO prevalence was detected between patients with cryptogenic stroke (20%), noncryptogenic stroke (14%), and control subjects (15%). These results suggest that PFO is not a risk factor for cerebral ischemia in subjects aged > 50 years, which would have major implications for the investigation and management of stroke patients in this age group. Longitudinal studies are now required to assess the incidence of stroke in symptom-free patients with PFO.

Age Factors↗
PubMed1979

Obturator foramen bypass in the management of infected vascular prostheses.

Seven patients with infected vascular prostheses in the femoral region were treated by removal of the prosthesis and extraanatomic reconstruction by way of the obturator foramen. Because the operation avoided entry into the infected area, it was considered the best surgical treatment for these patients. Although catastrophic hemorrhage and systemic sepsis were averted, amputation was eventually necessary in five patients, usually because of severe arteriosclerotic disease in distal arteries. Short-term benefit was gained by only two patients. The prevention of infection demands intensive preoperative preparation using prophylactic antibiotics and meticulous operating room technic.

Amputation, Surgical↗
PubMed1982

Obturator foramen approach. I. A new technique for reconstruction of the vas deferens after extensive resections.

A new approach for restoring continuity of the vas deferens after long segment resection is presented. The technique was used in six patients. It consists of passing the pelvic segment of the vas through the obturator foramen for anastomosis with the scrotal vasal segment. No complications were encountered, and the results were excellent. The vasal length was studied in 37 cadavers of different ages. The portion of the vas that could be spared by the obturator approach was calculated and found to represent as much as one third of the total vasal length. The indications for the technique are outlined.

Adolescent↗
PubMed1985

The 'foramen ovale electrode': a new recording method for the preoperative evaluation of patients suffering from mesio-basal temporal lobe epilepsy.

A technique to record from the mesio-basal aspect of the temporal lobe by a subdural electrode inserted through the foramen ovale (FO) is described. For this purpose a special electrode was developed that, in addition, allowed epicortical DC recording. After having tested its value experimentally in dogs with penicillin-induced hippocampal seizure foci, this 'FO electrode' was subsequently applied to 10 patients. Nine of them suffered from drug-resistant complex partial seizures suspected to be of mesio-basal limbic origin. Seven patients had in addition to the FO electrode depth electrodes stereotactically implanted within the hippocampus and nucleus amygdalae, thus allowing an evaluation of this new FO recording technique by direct comparison with stereo-EEG. Our results indicate that interictal epileptiform potentials as well as ictal discharges are reliably picked up by the FO electrode whenever nucleus amygdalae, hippocampus and parahippocampal gyrus show synchronous epileptic activity. As a rule, these events are not reflected in conventional scalp EEG records. Epileptiform activity in subcompartments of the mesio-basal limbic structures is not reliably reflected by the FO electrode. Negative epicortical DC shifts recorded by the FO electrode are a sensitive indicator of epileptic activity within the underlying deeper structures. In conclusion, in certain patients with drug-resistant epilepsy of suspected mesio-basal limbic origin the use of FO recording in the presurgical evaluation might provide sufficient information to give an indication for resective surgery, either by anterior temporal lobectomy or by selective amygdalo-hippocampectomy.

Amygdala↗
PubMed1987

The 'foramen ovale electrode': a safe tool to study temporal lobe epilepsy.

Following the description by Wieser et al. (1985) of the use of a foramen ovale electrode to record from mesial temporal structures the authors describe an alternative electrode equipped with radial tines to make it self-retaining. A helical section provides flexibility along the electrode's longitudinal axis preventing displacement of the tip during jaw movements. Clinical and detailed neurophysiological examinations failed to demonstrate any evidence of motor or sensory trigeminal nerve dysfunction and no complications were encountered.

Electrodes, Implanted↗