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At least 1,189 records · Page 66Linked to original sources
PubMed1994

Unmasking a patent foramen ovale during recurrent paradoxical cerebral embolism.

A patient with an acute ischemic stroke had an interatrial septal aneurysm shown by transesophageal echocardiography. Interatrial shunting, compatible with a patent foramen ovale, was observed on a follow-up study after a second stroke. This was seen in association with a right atrial thrombus. This case illustrates that an interatrial septal aneurysm serves as a marker for potential interatrial shunting, which can lead to paradoxical cerebral embolism.

Cerebral Infarction↗
PubMed1983

Percutaneous radiofrequency foramenal rhizotomies.

Thirty quadriplegic and paraplegic patients with intractable spasticity underwent percutaneous radiofrequency foramenal rhizotomies. This produced improvement in 94% of the patients, with excellent results in 73%. The complication rate was 3%. The major disadvantage of the procedure was recurrent spasticity, which was dealt with by simple repetition of the procedure. Rehabilitative goals were facilitated; needless painful disability was avoided; a need for intense nursing was reduced; the prevention and treatment of decubitus ulcer formation was enhanced. The study suggests that this procedure is effective, inexpensive, and at low risk to the patient.

Aged↗
PubMed1994

The role of distraction in improving the space available in the lumbar stenotic canal and foramen.

STUDY DESIGN: The terminal event in disc space narrowing and facet subluxation of the lumbar spine can produce clinical symptoms of spinal stenosis. Reversal of this process via distraction was performed on ten cadaveric motion segments with documented stenosis. METHODS: Computerized tomography and caliperic methods for the measurement of canal and foraminal areas were calculated in each segment after 5 and 10 mm of symmetrical distraction. Measurements were done in a blinded manner verified with orthographic software and statistical analysis. RESULTS: Decompression of foraminal space was statistically significant in 7 of 10 cadaveric specimens after 5 mm of distraction and 9 of 10 specimens after 10 mm of distraction. Minimal yet insignificant improvement in stenotic canal area was evident with distraction. CONCLUSION: The presence of posterior vertebral osteophytes was associated uniformly with poor improvement of space available in both stenotic canal and foramen.

Cadaver↗
PubMed2001

Patent foramen ovale and brain microembolization during scoliosis surgery in adolescents.

STUDY DESIGN: A case series is reported. OBJECTIVE: To improve understanding of the potential mechanisms associated with cerebral microemboli during scoliosis surgery in adolescents. SUMMARY OF BACKGROUND DATA: Paradoxical cerebral fat microembolization during scoliosis surgery has been associated with right-to-left shunting through an undetected patent foramen ovale. The prevalence of this cardiac defect in the adult population may be as high as 15% to 25%. Although the clinical relevance of this embolic phenomenon during scoliosis surgery has not been investigated, a few reports have documented its fatal consequences. It has been suspected in some patients with postoperative reduced visual function, particularly after complex instrumented fusions. METHODS: Bilateral transcranial Doppler (2 MHz) was used to monitor cerebral microemboli in the right and left middle cerebral arteries during spinal instrumentation and fusion in four patients. Additionally, transthoracic or transesophageal echocardiography incorporating pulse and color Doppler (3.5-5 MHz) and a contrast test was used in these patients to detect atrial shunts. RESULTS: Intraoperative transcranial Doppler monitoring detected high rates of cerebral microemboli associated with the presence of an atrial communication in two adolescents. In two additional patients with no detected brain microembolization, echocardiographic examination indicated the absence of an atrial shunt. CONCLUSION: The study findings suggest that unrecognized atrial communications in adolescents undergoing scoliosis surgery contribute to higher rates of Doppler-detected cerebral microemboli than those found in adolescents without this congenital defect.

Adolescent↗
PubMed2006

Transsciatic foramen pedicle VRAM coverage of gluteal defects.

Tumors of the gluteal region are rare. Defects from resection often can be closed primarily. Some patients require local flaps such as a gluteus maximus V-Y advancement flap. Such flaps typically result in some muscle dysfunction. In addition, the use of local irradiated tissue may lead to wound complications and prolonged hospitalization. Avoiding local radiated tissue, such as the gluteal muscles, can be beneficial. We report our experience using a novel route by passage through the transsciatic foramen to transpose a pedicle vertical rectus abdominis myocutaneous flap. This regional option avoids gluteal muscle dysfunction and potential wound complication from irradiated tissue.

Adult↗
PubMed2005

Controversies in the medical clearance of recreational scuba divers: updates on asthma, diabetes mellitus, coronary artery disease, and patent foramen ovale.

Primary care and sports medicine physicians are frequently consulted on medical clearance for prospective recreational divers. We discuss four common and controversial medical conditions--asthma, diabetes mellitus, coronary artery disease, and patent foramen ovale--as they relate to fitness to dive. For each condition we review the relevant anatomy and physiology, current recommendations, and the pertinent medical literature. Finally, we offer evidence-based recommendations regarding fitness to dive for potential divers with these conditions.

Asthma↗
PubMed2006

Pterygopalatine fossa infiltration through the greater palatine foramen: where to bend the needle.

OBJECTIVE: In the literature, there has been controversy regarding the length of the greater palatine canal. If the pterygopalatine fossa is infiltrated in an attempt to reduce bleeding during sinus surgery, this information is important to be able to place local anesthetic with maximal effect and the least likelihood of complications. STUDY DESIGN: The authors conducted a prospective cadaver-based study using high-definition computed tomography (CT) scans. METHODS: Twenty-two cadaver heads were CT scanned and the greater palatine canal length, pterygopalatine fossa height, and thickness of the soft tissue in the roof of the mouth were measured on parasagittal images using the CT scanner workstation. RESULTS: The mean length of the greater palatine canal was 18.5 mm (95% confidence interval [CI]=17.9-19.1) and the mean height of the pterygopalatine fossa was 21.6 mm (95% CI=20.7-22.5). The mean thickness of the soft tissue in the roof of the mouth overlying the foramen of the greater palatine canal was 6.9 mm (95% CI=6.2-7.6). CONCLUSION: To perform an effective infiltration of the pterygopalatine fossa, the needle should be bent at 25 mm from the tip at an angle of 45 degrees.

Aged, 80 and over↗
PubMed2004

Harmonic imaging improves sensitivity at the expense of specificity in the detection of patent foramen ovale.

UNLABELLED: Contrast echocardiography using agitated saline is widely employed to detect right to left shunt in patients with suspected patent foramen ovale (PFO). The sensitivity of fundamental transthoracic echocardiography (FTTE) is often limited by poor far-field resolution. The purpose of this study was to evaluate the test characteristics of harmonic imaging during transthoracic echocardiography (HTTE) for the detection of PFO. METHODS: Sixty-four patients referred for transesophageal echo (TEE) for clinical indications underwent FTTE and HTTE during saline contrast injections. RESULTS: TEE identified nine PFOs. For FTTE, the sensitivity was 78% and the specificity was 100%. For HTTE, the sensitivity was 100% and the specificity was 82%. All ten false positives with HTTE occurred after five cardiac cycles, suggesting transpulmonary transit of the bubbles. CONCLUSION: In the detection of PFO, HTTE improves sensitivity at the expense of specificity, particularly if the timing of contrast appearance in the left heart is ignored.

Adult↗
PubMed2005

Paradoxical embolism through a patent foramen ovale: an unexpected complication of tracheal extubation.

A 41-year-old male with insulin-dependent diabetes mellitus was admitted for an elective arthroscopic release of adhesive capsulitis of his left shoulder. At the end of the surgical procedure, he appeared to regain consciousness but then became unresponsive at the time of tracheal extubation after a violent bout of coughing, developing bilateral up-going plantar responses, decorticate posturing and abnormal pupillary reflexes. He was transferred to the intensive care unit. The following day, the patient made a full neurological recovery. Contrast echocardiography, performed using agitated saline delivered through a femoral venous line, revealed a large patent foramen ovale with evidence of right to left shunting. In the absence of risk factors for air embolism, the clinical diagnosis was one of paradoxical embolism of venous thrombus resulting in brain stem ischaemia. The patient was commenced on life-long aspirin to minimise future embolic risk.

Adult↗
PubMed1994

Intracranial chondromyxoid fibroma extending into the jugular foramen.

A case is reported of an intracranial chondromyxoid fibroma (CMF) in a 67 year old man. The tumor originated in the petrous part of the temporal bone and extended into the jugular foramen. Microscopically, the tumor showed a lobular appearance, and was composed of spindle or stellate cells in an abundant myxoid, chondroid stroma. Immunohistochemically, S-100 protein was positive in the tumor cells and myxoid stroma. Intracranial CMF, especially in an elderly person, is exceedingly rare. Clinical and pathological findings are presented with reference to the previously reported articles.

Aged↗
PubMed1976

Hernia through the foramen of Winslow.

This is a report of a hernia through the foramen of Winslow in which the right half of the colon was herniated. It was gangrenous and perforated. Following hemicolectomy the patient recovered.

Aged↗
PubMed1979

Caecal herniation through the foramen of Winslow.

The 28th reported case of caecal herniation through the foramen of Winslow is presented. A review of the literature reveals a mortality of 49% in lesser-sac herniae due to late diagnosis and operative difficulties. The comparative ease of hernial reduction after deflating trapped bowel by small-bore needle aspiration is discussed.

Cecum↗
PubMed1981

Strangulated hernia of the foramen of Morgagni: introducing a principle for the reduction of obstructed intraabdominal hernias.

Comments are made on diaphragmatic hernias in general, and hernia of the foramen of Morgagni in particular. A case history is recorded of strangulation of such a hernia in a man of 76 years. Reduction of the entrapped colon was effected by intraluminal suction-decompression across the neck of the hernia. Search of the literature suggests that this principle is an innovation, and that it is an important manoeuvre for the management of any obstructed intraabdominal hernia where there is technical difficulty in its reduction.

Aged↗
PubMed1987

Foramen of Winslow hernia.

Two cases of caecal herniation through the foramen of Winslow are presented. The diagnosis was made at laparotomy, but could have been suspected from the clinical features and plain abdominal X-rays. Early operative intervention is the key to avoiding strangulation and the high mortality associated with this uncommon internal hernia.

Adult↗
PubMed2005

Percutaneous closure of patent foramen ovale.

AIM: To review the safety and efficacy of percutaneous closure of patent foramen ovale (PFO) in symptomatic patients without the use of general anaesthesia or echocardiographic guidance. METHOD: All patients accepted for percutaneous PFO closure by our service from August 2002 to August 2004 were included. Patient demographics and clinical information were obtained from clinical records and by telephone interview. Follow-up outcomes recorded were recurrence of systemic thromboembolism, residual shunt, and change in pattern of migraines. RESULTS: Forty consecutive adult patients, of whom 19 (48%) had an atrial septal aneurysm (ASA), underwent PFO closure using the Amplatzer occluder device with fluoroscopic guidance alone. Their mean age was 45 +/- 10 years (range 23-63 years) and 24 (60%) were male. The indications for closure were ischaemic stroke (n = 26), transient ischaemic attack (TIA) (n = 8), both stroke and TIA (n = 2), refractory hypoxia (n = 2), platypnoea-orthodeoxia (n = 1) and severe migraine with seizures (n = 1). Twenty patients suffered a single neurological event and 16 suffered >1 event, including six with only radiographic evidence of >1 event. Mean procedure time was 17.7 +/- 9.6 min and fluoroscopy time was 6.7 +/- 7.3 min. Implanted device sizes were 18 mm (n = 1), 25 mm (n = 37) and 35 mm (n = 2). In 33 patients, the procedure was performed as a day-case. No complications were encountered. No further neurological events occurred in 39 patients at a mean follow-up time of 11 +/- 7 months (3-25 months) nor was a significant shunt detected in the 34 who underwent follow-up echocardiography. CONCLUSIONS: Percutaneous closure of PFO with or without ASA, under local anaesthesia and without echocardiographic guidance, is a safe and effective procedure which can be performed as a day-case. This has now become our standard clinical practice.

Adult↗
PubMed2006

Prevalence of patent foramen ovale in migraine patients with and without aura compared with stroke patients. A transcranial Doppler study.

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7% in migraine with aura (MA) patients, 33.7% in migraine without aura (MoA) patients, 33.8% in young stroke patients and 20.5% in elderly stroke patients (P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1% and 25% (P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.

Adolescent↗
PubMed1995

Saline contrast and colour Doppler transoesophageal echocardiography in detecting a patent foramen ovale and right-to-left shunts in stroke patients.

A paradoxical embolism due to right-to-left shunt through a patent foramen ovale (PFO) can be responsible for stroke and other ischaemic cerebral events. We studied the usefulness of saline contrast transoesophageal echocardiography after the Valsalva manoeuvre in detecting PFO and right-to-left shunts in 28 adult patients without known reason for a recent stroke. The results were compared with conventional transthoracic colour Doppler and with transoesophageal colour Doppler techniques. A PFO was found in 24 patients (86%) of our selected study population, whereas in four patients no PFO was found. A PFO with left-to-right shunt could be diagnosed by transthoracic colour Doppler echocardiography in only one case. A PFO with left-to-right shunt was found by transoesophageal colour Doppler echocardiography in 17 patients (61%), but in only three of them was a right-to-left shunt detected, even after the Valsalva manoeuvre. In contrast, a PFO with right-to-left shunt could be detected in 21 patients (75%) by using saline contrast transoesophageal echocardiography with the Valsalva manoeuvre. However, the method was unable to detect three cases of PFO with only left-to-right shunt, which were detected by colour Doppler transoesophageal echocardiography. In conclusion, our results show that saline contrast transoesophageal echocardiography with the Valsalva manoeuvre greatly improves the echocardiographic detection of PFO with right-to-left shunts in stroke patients.

Adult↗