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PubMedDate not supplied

[Values of wide-range option of 3D CT in the evaluation of vertebral foramen].

In the material of 32 patients with various pathologic conditions of vertebral foramina the value was analysed of spatial option 3D CT in correlation to biplanar sections and CT multiplanar reconstructions. A significant value was found in the comparative assessment of dimensions and the degree of narrowing of the openings at different levels, localisation of osteophytes and lateral hernias. Three-dimensional reconstruction of the internal surface and vertebral foramen volume was obtained.

Adult↗
PubMed2000

Unusual association: Streptococcus bovis tricuspid endocarditis with atrial-septal aneurysm and patent foramen ovale.

Streptococcus bovis endocarditis is a frequent cause of streptococcal endocarditis and is associated with colonic tumours. The tricuspid valve is very rarely affected and its involvement is a complication which can lead to a less favourable outcome. We report the seventh case of tricuspid valve endocarditis due to S. bovis, and the first, to our knowledge, to be associated with an atrial-septal aneurysm and a patent foramen ovale. The underlying medical conditions and predisposing factors for development of tricuspid valve endocarditis are described and interesting new echocardiographic data are presented. The current guidelines on antibiotic therapy for S. bovis tricuspid valve endocarditis are reviewed.

Drug Therapy, Combination↗
PubMed2000

Cleft sternum and sternal foramen.

Cleft sternum is a rare congenital defect of the anterior chest wall and is the result of a failed midline fusion of the sternum. Depending on the degree of separation, there are complete and incomplete forms. Its clinical significance is that it leaves the heart and great vessels unprotected. Association with craniofacial hemangiomas and omphalocele is common. Prenatal diagnosis by ultrasonography is possible. Surgical correction should be performed during the neonatal period when the direct suturing of the sternal halves is possible and the thorax can accommodate the thoracic viscera. At an older age, surgical repair is feasible, but it may require additional measures, such as sliding chondrotomies of the adjacent costal cartilages and notching of the sternal bars, to facilitate the approximation. Lung herniation at the base of the neck should be corrected by uniting the cervical muscles. The first postoperative day is the most critical because of acute reduction of the mediastinal space. Long-term results are satisfactory. Sternal foramen is a congenital oval defect at the lower third of the sternum that is asymptomatic and could be detected by CT scanning. The awareness of the anomaly is important in acupuncture practice because of the danger of heart damage.

Abnormalities, Multiple↗
PubMed2000

[The foramen rotundum. Anatomy and radiological explorations. Pathology].

The foramen rotundum is a small canal deeply situated in the base of the skull which represents the way of exit of the maxillary nerve, second branch of the trigeminal nerve. Its precise individualization and analyse is difficult and necessitates a precise and adapted technique as well as a precise knowledge of its anatomical relationships. Its represents a frontier area between the endo- and exocranial spaces. Its involvement which is preferentially related with tumoral pathologies (and particularly with retrograde perineural invasion) profoundly modifies the prognosis of the disease and so should allow soon a multidisciplinary therapeutic discussion.

Bone Diseases↗
PubMed2000

Foramen of Morgagni hernia: surgical consideration.

We have recently encountered two patients with foramen of Morgagni hernias both of whom were symptomatic and required repair. Both patients did well following repair. Symptomatic Morgagni hernias should be repaired to reduce complications in later life.

Adolescent↗
PubMed2000

[Retrogastric colon mimicking foramen of Winslow hernia or left paraduodenal hernia: case report].

We report the case of a 54-year-old woman who developed epigastralgia and vomit. Because of the abnormal gas in the epigastrium on abdominal X-ray, ileus due to foramen of Winslow hernia or left paraduodenal hernia was suspected. However, abdominal CT and barium study revealed the gas in the epigastrium to be the air in the transverse colon interposed between the stomach and pancreatic body. This anomalous interposition of the transverse colon is called retrogastric colon. The ileus was due to non-specific inflammatory duodenal stenosis. It is important to prevent misdiagnosis of retrogastric colon as lesser sac pathologic condition such as abscess, bowel perforation and internal hernia.

Barium↗
PubMed2000

[Ebstein's anomaly with patent foramen ovale and supraventricular paroxysmal tachycardia].

A case of asymptomatic 36 years old men with Ebstein anomaly of tricuspid valve, patent foramen ovale and paroxismal supraventricular tachycardia is presented in this paper. A routine physical examination revealed a heart systolic murmur along left and right side of sternum, with right bundle branch block on ECG. It led to the detailed non-invasive cardiologic examination (transthoracic, transeophageal and stress echocardiography, ambulatory ECG), what disclosed above mentioned Ebstein anomaly. Also he was operated on upon superior lip fissure at the first year of life. Regarding his very mild symptoms (NYHA g. 1), he was treated only medicamentosly.

Adult↗
PubMedDate not supplied

[Transcatheter closure of patent foramen ovale in patients after cryptogenic stroke].

Paradoxical embolism through a patent foramen (PFO) is a possible mechanism of ischaemic stroke in patients with cryptogenic stroke. Occlusion of PFO in such patients is considered by some authors as most effective in stroke prevention. We present our initial experience with transcatheter closure of PFO with the new self-expanding device--the Amplatzer PFO occluder in three young patients (age < 50 years). Each of them experienced at least one ischaemic stroke episode, without a left heart or carotid source and each had an interatrial communication with right-to-left shunting during Valsalva manoeuvre on echocardiography. The PFO's were closed completely without complications, under transoesophageal echo guidance in general anaesthesia. Complete closure was confirmed at one-month follow-up echocardiogram in each patient. No repeat cerebral accidents occurred at that time. The procedures were relatively easy and the clear presentation of the implant on TEE and fluoroscopy, made implantation fully controlled. The unique feature of the device is, that until release it can easily be retrieved, repositioned or removed. Transcatheter closure of PFO with the Amplatzer PFO occluder may become the new therapeutic option for patients with cryptogenic stroke and presumed paradoxical embolism.

Adult↗
PubMed2001

Transcatheter closure of patent foramen ovale in patients with cryptogenic stroke.

BACKGROUND: About 50% of patients with cryptogenic stroke have a patent foramen ovale (PFO). The recurrence rate of paradoxical embolism is higher if a PFO is detected. METHODS: Thirty-five patients with PFO and > or = 1 thromboembolic event due to paradoxical embolism were included in the study (23 males, 12 females, mean age 47.8 +/- 14 years, mean weight 75 +/- 15 kg). Twenty-three patients had a transient ischemic attack whereas 12 experienced an ischemic stroke. Twenty-nine patients had one thromboembolic event, 4 patients had two thromboembolic events, and 2 patients had three thromboembolic events. The implantation procedure was performed, as previously reported, under general anesthesia, fluoroscopic guidance and during transesophageal echocardiography. RESULTS: The implantation procedure was successful in all patients. There were no complications related to the procedure. Four different devices were implanted (Amplatzer 3 patients; Cardioseal 12 patients; Starflex 12 patients, PFO Star 8 patients). The procedure time and fluoroscopic time were 50 +/- 21.8 and 12.2 +/- 8.3 min respectively. At transesophageal echocardiography performed after the procedure, 11 patients had a trivial shunt. None of the patients had a residual shunt at 1 month of follow-up. The mean follow-up was 12.3 +/- 8 months (median 11.0 months, range 3-37 months). In no patient did recurrence of a thromboembolic event occur during follow-up. CONCLUSIONS: Percutaneous PFO closure is a feasible and safe technique for the prevention of recurrent paradoxical embolism.

Adult↗
PubMed2001

[Treatment for recurrent paradoxical brain embolism through the patent foramen ovale].

We report here two patients with recurrent paradoxical brain embolism through the patent foramen ovale(PFO). The TIAs, which occurred frequently under antiplatelet therapy, resolved soon after commencing the anticoagulation therapy. Case 1, a 57-year-old woman, was diagnosed as having lacunar brain infarction and was treated with ticlopidine hydrochloride. Eleven months later, she suffered from frequent TIAs. Anticoagulation therapy was started after the presence of PFO was documented on transesophageal echocardiography(TEE). Thereafter, her TIA disappeared. Case 2 was a 67-year-old man with a history of lacunar brain infarction. Although he was treated with aspirin for 9 months, he showed transient monoplegia in his right leg. His TEE study also revealed the presence of PFO. After the anticoagulation therapy reached the proper level(PT-NR = 2), he never experienced the recurrence of TIA. If the antiplatelet therapy failed to prevent the recurrence of TIA, it is recommended to find out the presence of PFO which is a potential source of paradoxical brain embolism. In such a case, anticoagulation therapy should be instituted.

Aged↗
PubMed2001

Embolic distribution through patent foramen ovale demonstrated by (99m)Tc-MAA brain SPECT after Valsalva radionuclide venography.

UNLABELLED: Cryptogenic stroke might relate to paradoxical embolism stemming from right-to-left shunt caused by patent foramen ovale (PFO). We performed radionuclide venography using the Valsalva maneuver, followed by (99m)Tc-macroaggregated albumin (MAA) brain SPECT to investigate the fate of emboli originating from the lower extremities. METHODS: Ten patients (9 men, 1 woman; mean age, 61 +/- 17 y) with PFO underwent radionuclide venography with and without the Valsalva maneuver on the whole-body image, followed by brain SPECT with (99m)Tc-MAA to determine the cortical uptake that would detect right-to-left shunt. After counts in each region of interest (ROI) were normalized by comparison with the averaged count, the distribution of MAA was compared with that of (99m)Tc-hexamethyl-propyleneamine oxime (HMPAO) brain SPECT by drawing ROIs on frontal, temporoparietal (anterior circulation territory), occipital, and cerebellar areas (posterior circulation territory). RESULTS: The thyroid on the whole-body scan was visualized after the Valsalva maneuver in 2 of the 10 patients. In 7 of 10 patients, 56 ROIs in the visualized cortical uptake showed that the distribution of MAA correlated well with that of HMPAO according to the equation: HMPAO = -71.21 + 1.71 x MAA, (r = 0.575, P < 0.01). The excess difference in the relative counts in the posterior over anterior circulation territory was 5.6% and 16.1% of the HMPAO and MAA values, respectively. CONCLUSION: Brain SPECT with (99m)Tc-MAA was more sensitive than thyroid visualization in detecting right-to-left shunt. The excess flow in the posterior cerebral circulation indicated an increased likelihood of cerebral emboli originating from the lower extremities and indicated that the flow difference between HMPAO and MAA probably resulted from poor linearization of HMPAO in the high-flow area.

Adult↗
PubMed2000

Clinical evaluation of inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen.

The conventional inferior alveolar nerve block (conventional technique) has potential risks of neural and vascular injuries. We studied a method of inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space anterior to the mandibular foramen (anterior technique) with the purpose of avoiding such complications. The insertion angle of the anterior technique and the estimation of anesthesia in the anterior technique were examined. The predicted insertion angle measured on computed tomographic images was 60.1 +/- 7.1 degrees from the median, with the syringe end lying on the contralateral mandibular first molar, and the insertion depth was approximately 10 mm. We applied the anterior technique to 100 patients for mandibular molar extraction and assessed the anesthetic effects. A success rate of 74% was obtained. This is similar to that reported for the conventional technique but without the accompanying risks for inferior alveolar neural and vascular complications.

Anesthesia, Dental↗
PubMed2001

Secondary prevention of cerebral ischemia in patent foramen ovale: systematic review and meta-analysis.

BACKGROUND: Therapy for patent foramen ovale (PFO), found with increased frequency in the setting of stroke in the young, is controversial. We compiled a synthesis of the literature on therapeutic options for PFO and stroke. METHODS: Searching MEDLINE (1966 to 1999), published abstracts, and bibliographies of primary and review articles, we identified five retrospective cohort studies that compared at least two different treatment options (antiplatelet therapy, warfarin, or surgery). Outcomes data on mode of therapy and recurrent stroke were abstracted, and pooled analysis was done using a random effects model. RESULTS: Warfarin was superior to antiplatelet therapy in preventing recurrent ischemic events (odds ratio [OR] 0.37; 95% confidence interval [CI], 0.23 to 0.60). Surgical PFO closure was comparable to warfarin treatment (OR 1.19; 95% CI, 0.62 to 2.27). CONCLUSION: Available data suggest that warfarin is superior to antiplatelet therapy and comparable to surgical PFO closure for the prevention of recurrent cerebral ischemic events from paradoxical embolism.

Adult↗
PubMed2001

[Arterial anatomy of the facial nerve at the stylo-mastoid foramen].

OBJECTIVE: To provide specific informations about the arterial related anatomy of the trunk of the facial nerve from the stylomastoid foramen to its bifurcation. METHODS: Dissection of 30 facial nerves in fresh cadavers after arterial casting with red-colored latex. RESULTS: A great anatomic variability does exist. The facial nerve is most often in relation to the stylomastoid artery which arises from the posterior auricular artery. The stylomastoid artery originates sometimes from the occipital artery or from the external carotid artery. In 19 cases of 30 the stylomastoid artery passes medially to the nerve, and 11 cases laterally. CONCLUSION: During parotid surgery, the main trunk of the facial nerve may be difficult to identify because of a large-caliber stylomastoid artery which can mask it. Therefore it is preferable to dissect this artery with caution, remaining at distance from the dangerous.

Arteries↗
PubMed2001

A review of the relationship between patent foramen ovale and type II decompression sickness.

The significance of patent foramen ovale (PFO) in the pathophysiology of Type II decompression sickness (DCS) remains controversial. PFOs are common, occurring in approximately one quarter of the normal population, thus making right-to-left shunting of venous gas emboli (VGE) a theoretical concern in both hyper- and hypobaric situations. Despite this high prevalence of PFO in the general population, and the relatively common occurrence of venous gas bubbles in diving and altitude exposures, the incidence of Type II DCS in diving or with altitude is remarkably low. Although the literature supports a relationship between the presence and size of PFO and cryptogenic stroke, and an increased relative risk of Type II DCS with a PFO in divers, the absolute increase in risk accrued is small. Hence, the value of screening is also controversial. This paper presents a summary of the literature on PFOs and DCS in animals, and in human altitude and diving, focusing on the latter; as well the analogous literature on cryptogenic stroke. The results of an examination of the literature on detection of, screening for, and treatment of PFOs is also presented.

Altitude↗