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At least 1,387 records · Page 77Linked to original sources
PubMed2003

Intrapelvic dislocation of the head of femur through the obturator foramen associated with ipsilateral fracture femur.

We describe a case of traumatic anterior dislocation of the hip in a 14-year-old boy with associated intrapelvic displacement of the femoral head and ipsilateral fractures of the shaft of the femur and greater trochanter. There was a delay in presentation of eight days. At operation the femoral head was reduced into the acetabulum after enlarging the obturator foramen by performing an osteotomy of the superior pubic ramus.

Accidents, Traffic↗
PubMed2003

The positions of the patients in the diagnosis of patent foramen ovale by transcranial Doppler.

BACKGROUND AND PURPOSE: There is no information about the optimal position of a patient for the performance of a transcranial Doppler (TCD) examination to detect patent foramen ovale (PFO). Such information is important to improving the sensitivity of the test in comparison to the gold standard of transesophageal echocardiography (TEE). METHODS: Thirty-four patients with TEE-proved PFO were examined by contrast TCD. Examinations were done in both the sitting and supine positions in random order. RESULTS: Eight hundred ninety-two microemboli were recorded. Patients' positions and the sequence of testing did not affect the number of microemboli detected. Yet for each individual, 1 of the 2 positions was more sensitive. CONCLUSIONS: To improve the sensitivity of TCD in the detection of PFO, it is recommended, in the case of a first negative test, to change the patient's position for a repeated TCD examination.

Contrast Media↗
PubMed2003

Complete arcuate foramen precluding C1 lateral mass screw fixation in a patient with rheumatoid arthritis: case report.

Case report of a complete arcuate foramen in a human atlas vertebra inhibiting the placement of lateral mass screw instrumentation at C1. Our objective is to report the presentation of the case, the operative considerations, and the management for this anatomic variation. The groove for the vertebral artery on the posterolateral surface of the atlas (C1) varies in size and depth from a slight impression to a clear sulcus. With anomalous ossification the sulcus can be bridged which results in a posterolateral tunnel within the posterior arch of the atlas. With increasing rates of screw fixation instrumentation that include the atlas, it is of paramount importance to know the location and course of the vertebral artery in relation to the planned route of instrumentation. The patient underwent a posterolateral fusion from C1 to C4 using autogenous iliac crest bone graft. Internal fixation from C2 to C4 was obtained using lateral mass screw instrumentation. After the vertebral artery was identified passing through the posterior arch of C1, sublaminar wires were utilized for fixation from C1 to C2. The patient responded well to surgical intervention without complications. Abnormal vertebral artery coursing through a posterolateral tunnel in the posterior arch of C1 has been described and its incidence has a range from 1.14% to 18%. When this variant is present, lateral mass screw fixation at C1 may be contra-indicated. We recommend close scrutiny of preoperative radiographs to avoid the possibility of endangering the vertebral artery when this situation exists.

Aged↗
PubMed2003

[Case report: Rhizomelic chondrodysplasia punctata and foramen magnum stenosis in a newborn].

Chondrodysplasia punctata is a peroxisomal disorder which is a form of multiple epiphyseal dysplasia. It is characterized by calcifications of unossified cartilaginous epiphyseal centers during the first year of life. Severe autosomal recessive rhisomelic form shows bilateral proximal shortening of the upper and lower limbs with punctate epiphyseal calcifications. We report radiological findings of a patient with rhisomelic chondrodysplasia punctata. Magnetic resonance imaging showed foramen magnum stenosis that caused spinal cord compression.

Chondrodysplasia Punctata, Rhizomelic↗
PubMed2003

Cases from the aerospace medicine residents' teaching file. Transient ischemic attack in an aviator with patent foramen ovale and Factor V Leiden.

A case report is presented of a naval aviator who suffered a transient ischemic attack (TIA) 1 mo after experiencing right leg pain and swelling following a 4-d drive. Although a venous thrombotic source was never discovered, the presence of both a patent foramen ovale and a thrombophilic condition supports paradoxical embolism (PDE) as the cause of this pilot's TIA. The presentation, diagnosis, treatment, and aeromedical disposition of TIA secondary to a PDE is discussed.

Adult↗
PubMedDate not supplied

[Voltage sources analysis in studies with foramen ovale electrodes].

INTRODUCTION: Paroxysmal activity in medial temporal lobe epilepsy is originated in either hippocampal or parahippocampal regions. This activity can be directly recorded by foramen ovale electrodes. That paroxysmal activity will start from irritative or ictal areas. However, anatomo-functional relations between both regions are still debated. OBJECTIVE: We describe a new physical very simple model which allows to directly analysis the anatomo-physiological relations between sources for interictal and ictal areas. RESULTS: 1) The mathematical model allows to fit with minimum error and great precision the voltage sources originated from monopoles. 2) We can obtain this degree of precision with a matrix using an internodal distance of 0.1 mm (300x200 nodes) 3) Triplets of potentials with double sources with equal or specially with inverse charges have bigger error than monopolar charges. 4) Fitting real data obtained from a patient shows an error of 0.29 +/- 0.17% for interictal and 0.54 +/- 1.22% and 2.84 +/- 3.00% for two seizures (mean +/- SD). CONCLUSIONS: This model allows directly to know the relative anatomo-physiological relations between interictal and ictal sources in MTLE, which have a very important implications so for patho-physiological as therapeutics and outcome implications.

Action Potentials↗
PubMed2003

[Percutaneous closure of patent foramen ovale: prevention of recurrent strokes. Immediate results and one year follow-up].

UNLABELLED: Patent foramen ovale (PFO) is a risk factor for transient ischemic attack (TIA) or ischemic stroke. In this study we investigated short and long-term safety and efficacy of percutaneous closure of PFO in secondary stroke prevention. METHODS AND RESULTS: We implanted PFO-closure devices in 8 patients (3 men and 5 women) after TIA or ischemic stroke (mean age 38 +/- 15.2). The implantation procedures were performed in general anesthesia, under transoesophageal echocardiography and fluoroscopy. No periprocedural complications were observed. Post-procedural shunts were not observed either. All patients did not experience any TIA or stroke during follow-up (5 patients completed a 1-year period). Only in one patient transient ventricular extrasystolia was observed 1 month after device implantation. CONCLUSIONS: Percutaneous PFO closure seems to be a safe and effective technique in prevention of recurrent stroke.

Adult↗
PubMed1992

Paradoxical air embolism in pigs with a patent foramen ovale.

Recent studies have indicated that divers with a patent foramen ovale (PFO) are at risk of developing some forms of decompression sickness. Thus, the objective of the present study was to investigate if the occurrence of paradoxical air embolism (PAE) was enhanced in pigs with a PFO compared to the occurrence in pigs without such a defect. Out of 54 pigs, 18 had a PFO (group PFO), and the other 36 composed the controls (group C). The pigs were anesthetized, mechanically ventilated, and received venous air infusion at four different rates (0.050, 0.075, 0.100, and 0.200 ml.kg-1.min-1). PAE was monitored by use of a transesophageal echocardiographic probe to detect if any arterial air bubbles were present in the left atrium or the aorta. We found that PAE appeared at a lower infusion rate in group PFO than in group C. When PAE occurred, the mean pulmonary arterial pressure and the mean arterial pressure were significantly higher in pigs with a PFO than in the control pigs. Finally, the infused air volume per kilogram of body weight in group PFO was significantly lower than that observed in group C. The results demonstrated that the risk of PAE occurring in mechanically ventilated pigs with a PFO was greater compared to the risk observed in pigs without a PFO.

Animals↗
PubMed1992

[Effect of anhydrous glycerol injection into the mental foramen of rabbit on inferior nerve:An experimental study]

In this experiment anhydrous glycerol was injected into the mental foramen of rabbits to determine neurolytic effects on the peripheral trigeminal nerve by electrohysiologic and morphologic methods.The rabbits underwent unilateral injection of anhydrous glycerol and the control side was injected with normal saline.The results show that partial fibers are effected (myelinated and unmyelinated fibers at random).Glycerol injection increased the average latencies and reduced the average amplitudes of compound action potentials.Morphologic examination disclosed myelin swelling,disintergrationan d axonal shrinking,axonolysis.One week after the injection,eletrophysiologic and morphologic changes were most severe and signs of regeneration were noted in the fifth week,By 16 weeks after injection,the nerve fibers appeared almost normal.

Journal Article↗
PubMed2004

[Stroke recurrence in patients with brain embolism and patent foramen ovale--association with deep vein thrombosis detected by ultrasonography].

Paradoxical embolism through a patent foramen ovale (PFO) is a recognized cause of stroke, but its prognosis is not well known. The aim of our study is to evaluate differences in risk factors, recurrent stroke subtypes and effects of various preventive therapies between PFO associated stroke patients with and without deep vein thrombosis (DVT). A total of 63 patients who had an embolic stroke with a PFO within 3 months from stroke onset were enrolled. Venous ultrasonography, which was performed in all the patients, revealed DVT in 26 patients (41%). Venous thrombosis was confined to the isolated calf veins in 24 of 26 cases (92%). For prevention of stroke recurrence, warfarin was administrated in 32 patients, antiplatelet therapy was given in 21 patients, and combination of warfarin and antiplatelet therapy was chosen in 10 patients. Three patients with DVT and three other patients without DVT had recurrent ischemic events during a mean follow-up period of 14.6 months. In all the 3 patients without DVT, complicated aortic arch lesions were also observed, and 2 of them had lacunar infarcts. In all the three patients with DVT recurrent embolic stroke or TIA occurred in spite of anticoagulant therapy. Their INR values at the time of recurrence were all below 1.7, and 2 of them were associated with atrial septal aneurysm (ASA). Association with PFO, ASA, and DVT may be a substantial risk factor for recurrent stroke. Higher INR value in anticoagulation may be recommended for such patients to prevent stroke recurrence.

Aged↗
PubMed2004

Transcatheter device occlusion of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance.

BACKGROUND: Transcatheter device occlusion of atrial septal defects is becoming an effective alternative to surgery. In order to avoid the discomfort of transesophageal echocardiography and the need for general anesthesia we started using intracardiac ultrasound (ICUS) to guide device implantation in adult patients. OBJECTIVE: To assess the efficacy and safety of transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO) assisted by ICUS. METHODS: Between April 2001 and November 2002, 27 patients with ASD and four patients with PFO were selected for transcatheter device occlusion. Patient selection was based on previous transesophageal echocardiogram and clinical data. All patients were treated without anesthesia or sedation. The percutaneous occlusion technique was assisted by ICUS and fluoroscopy. Morphological aspects of the defect and measurement of its largest diameter were used to select device diameter. RESULTS: Thirty-one patients were treated (27 with ASD, four with PFO); 21 (68%) were female, mean age was 40.1+/-13.5 years, and mean ASD diameter was 20.1+/-6.4 mm. We implanted ASD Amplatzer occluding devices in all ASD patients, the size being selected by adding 4 to 6 mm to the maximum ASD diameter. The patients with PFO had an Amplatzer PFO occluder. Mean total procedure time was 50.1+/-18.9 minutes and mean fluoroscopy time was 11.7+/-5.9 minutes. All devices were successfully deployed. We had neither complications nor mortality. Follow-up evaluation was performed by transthoracic echocardiography at 24 hours, one, six and 12 months after occlusion. During a mean follow-up period of 8.5+/-7.1 months, all patients were free of symptoms and on transthoracic echocardiographic evaluation at 24 hours all but three patients had complete occlusion (three ASD patients had insignificant residual shunt), with 100% occlusion rate at six months. CONCLUSIONS: Transcatheter occlusion of atrial septal defects can be effectively and safely performed using ICUS to guide device implantation in selected adult patients.

Adult↗
PubMedDate not supplied

[The prevalence of patent foramen ovale in patients with migraine].

BACKGROUND AND PURPOSE: Migraine is a common neurologic disorder whose etiology remains unknown. Migraine has been reported as a possible risk factor for ischemic stroke, especially in young women. The relationship between migraine and stroke is stronger in patients suffering from migraine with aura compared to those with common migraine. Coexistence of migraine and patent foramen ovale (PFO) should be also considered. The aim of our study was to evaluate the frequency of PFO in patients with migraine with aura (MA) and compare it with the prevalence of PFO in migraine patients without aura (M) and in a healthy age-matched control group. MATERIAL AND METHODS: We assessed 62 patients (48 females) suffering from migraine with aura, 60 without aura (53 females) and 65 normal controls (51 females). In order to detect PFO the contrast transcranial Doppler was performed during Valsalva maneuver. RESULTS: The presence of PFO was found in 33/62 (53%) patients with MA compared to 15/60 (25%) without aura, and in 16/65 (25%) control subjects. The difference in PFO prevalence between MA patients and M patients and the difference between MA patients and the control group was statistically significant (p<0.05). CONCLUSIONS: Our findings suggest that at least some attacks of migraine with aura may be associated with paradoxical embolism.

Adult↗
PubMed2004

[Jugular foramen schwannomas: a review of 17 cases].

OBJECTIVE: To analysis the clinical presentation, radiological findings, surgical techniques and outcomes of jugular foramen (JF) schwannomas. METHODS: We reviewed our 10-year experience in the surgical treatment of 17 patients suffered from JF schwannomas in Hua Shan Hospital, Shanghai. A total of 8 males and 9 females with a mean age of 42 years underwent surgical procedures. A relative long period of 53-month symptomatic history was shown before surgery. The main clinical presentation are vertigo and hearing difficulty in 10 cases, atrophy of unilateral muscles of tongue in 9 cases, involvement of lower cranial nerve in 8 cases. The classification of tumors was type A (at cerebellopontine angle with minimal enlargement of the JF) in five cases, type B (JF with intracranial extension) in 3 cases, type C (extracranial tumors with JF extension) in 2 cases and type D (dumbbell-shaped with both intra-and extracranial components) in 7 cases. RESULTS: Far lateral approaches were used in 10 cases, retrosigmoid suboccipital approaches were used in 5 cases. Submandibular approaches were selected in other 2 cases. Gross total removal was achieved in 12 cases, and subtotal removal in 5 cases. Follow-up revealed marked improvement from preoperative symptoms in 9 cases and no additional deficits in 3 cases. 5 cases suffered from additional neurological deficits. There were two cases of temporary hoarseness and gradually improved within follow-up. Two patients suffered from swallowing problems as a new deficit. One patient had facial palsy. CONCLUSIONS: JF schwannomas can be surgically treated with relative good outcomes. Surgical approaches should be tailored according to the tumor extension.

Accessory Nerve Diseases↗
PubMed2004

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

BACKGROUND: Paradoxical embolism due to the presence of patent foramen ovale (PFO) is a well-established possible mechanism of ischaemic stroke of unknown origin. Mechanical sealing of the interatrial septum seems to be the most effective method for the prevention of stroke recurrences. AIM: To assess prospectively the short- and mid-term results of transcatheter closure of PFO in consecutive patients with a history of cryptogenic ischaemic stroke. METHODS: Between March 1999 and December 2002, thirty two patients with PFO (15 males, age from 19 to 55 years, mean 41 years) with a history of documented ischaemic stroke of unknown origin underwent transcatheter closure of PFO using an Amplatzer occluder. All procedures were performed under general anaesthesia and with transesophageal echocardiographic guidance. RESULTS: In all patients the procedure was effective and no complications were observed. During the follow-up period of a mean of 25.9 months (>12 months in 22 patients), no new neurological events were recorded. Control transesophageal echocardiography was performed in 28 patients mean 22.3 months after the procedure and confirmed the correct positioning of the occluder. A significant (>30 bubbles of contrast) residual shunt was detected in two patients. One patient developed episodes of paroxysmal supraventricular tachycardia which were effectively cured by radiofrequency ablation. CONCLUSIONS: Transcatheter closure of PFO is safe, effective and devoid of side effects connected with extracorporeal circulation. This procedure may become the treatment of choice in patients with the highest risk of recurrent ischaemic stroke.

Adult↗
PubMed2004

Jugular foramen schwannoma: surgical experience in six cases.

PURPOSE: Schwannomas of the lower cranial nerves are rare tumours. We have surgical experience in six patients. MATERIAL AND METHODS: We have retrospectively reviewed the files of the six patients with jugular foramen schwannomas that were treated in multidisciplinary collaboration in the departments of neurosurgery and ENT. RESULTS: From a clinical point of view, the most important finding was that these tumours usually mimic a vestibular schwannoma. The imaging findings however always allowed the differentiation. The surgical technique included in all cases a suboccipital approach for the intracranial part. When large, the extracranial extension had to be removed through a lateral cervical or transfacial approach. There was no mortality and minor morbidity, with good functional outcome. In subtotally removed tumours, recurrence occurred. CONCLUSION: A combined neurosurgical and ENT approach allows for safe removal of these often large skull base tumours.

Adult↗
PubMed2004

Current management of patients with patent foramen ovale and cryptogenic stroke: our experience and review of the literature.

BACKGROUND: Patent Foramen Ovale (PFO) occurs in approximately 25% of the population and has been implicated in the etiology of cryptogenic stroke. Although the exact mechanism of PFO's role in stroke has not been defined, there is a growing body of evidence that supports both the safety and therapeutic benefit of PFO closure in cryptogenic stroke. Current methods of therapy include anticoagulation, surgical closure, and percutaneous closure. METHODS: We completed a retrospective analysis of data from the first 20 PFO closures at our institution and evaluated the current literature on PFO treatment. RESULTS: Percutaneous closure had a 100% technical success rate. There were no procedural complications and only 1 episode of supraventricular arrhythmia requiring therapy. CONCLUSION: Percutaneous closure is associated with a high technical success rate, decreased morbidity compared to surgery, and equal benefits after endothelialization of the device. As the mechanisms involved in PFO are better delineated, clear guidelines can be established for the percutaneous closure and follow-up of PFO.

Adult↗
PubMed2004

Incidence of abnormal cerebral findings in the MRI of clinically healthy divers: role of a patent foramen ovale.

BACKGROUND: To investigate incidence and number of abnormal cerebral hyperintensities (ACFs) in Magnet Resonance Imaging (MRI) and its relation to a patent foramen ovale (PFO) in divers with no history of decompression illness. METHODS: Cohort study on 50 divers (21-5500 dives). MAIN OUTCOME MEASURES: Incidence and number of ACFs visualized by cranial MRI and presence and size of a PFO as documented by echocardiography and transcranial Doppler ultrasound (TCD) with echocontrast. RESULTS: A total of 137 ACFs was found in the 50 subjects, with a significant correlation between the number of dives and number of ACFs (r = 0.28; p < 0.05); but after correction for age, the remaining correlation (r = 0.15) did not reach significance. In 18 divers, a PFO was present by either the application of echocardiography or TCD; in 12 divers, the PFO was of high hemodynamic relevance. Ten of 18 divers with a PFO had at least one ACF, while in the remaining 32 divers, only 14 had at least one ACF (56% versus 44%, p = NS). Seven of 14 divers (50%) with 4 ACFs had a PFO, compared to 11 of 36 (31%) with less than 4 ACFs (p = NS). CONCLUSION: In this cohort of healthy divers, in contrast to an earlier report, no significant association was found between PFO presence and incidence or number of ACFs.

Adult↗