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A 89 year-old female was admitted with the complaint of right hypochondralgia. And also she complained of right thigh pain after admission. On hospital day 4, she underwent CT examination in order to evaluate right thigh with severe pain. The preoperative diagnosis of obturator foramen hernia was performed.
Over a six months' period we prospectively studied the prevalence of patent foramen ovale (PFO) in patients under 50 years of age admitted for cerebral infarction as assessed by cerebral computed tomography. The study recruited 16 patients (9 male, 7 female, mean age 39 +/- 10 years). Before the contrast study, 5 patients had other identifiable sources of stroke after neurologic investigations and 2-D echocardiography with color-Doppler, whereas 11 had no precise origin. The overall prevalence was 50% with 8 PFO demonstrated, 6 during normal breathing and two during a coughing test. All were in the sub-group of 11 patients without a predetermined source of stroke (prevalence 73%) and in 83% of patients aged under 40. In accordance with the literature, we found a high prevalence of PFO in the ischemic cerebral infarction population aged under 50 years and without another possible source of stroke; this prevalence is higher in patients under 40 years old. This observation confirms the suspicion of paradoxical embolism in these cases.
The position of the mental foramen of the local Malays and Indians in Singapore was determined from a series of orthopantomograms. The most frequent location does not conform to the position cited in many anatomy, surgery, and dental anesthesia texts as being below and between the apices of the lower premolars. This data has implications in the teaching and practice of dental anesthesia. In both these races, the median location is just below the second premolar.
We compared the prevalence of patent foramen ovale (PFO), detected by two-dimensional contrast echocardiography, in a group of 60 adults aged under 55 who had experienced a cerebral ischaemic accident and had normal standard examination of the heart, and in a control group of 100 patients. The prevalence of PFO was significantly higher in neurological patients (40 p. 100) than in controls (10 p. 100; p less than 0.001). Within the neurological group, the prevalence of PFO determined blindly, i.e. without any knowledge of the aetiological diagnosis, increased with the uncertainty of diagnosis: 21 p. 100 when a cause could be determined (n = 19), 40 p. 100 when a facilitating factor of cerebral accident, such as mitral valve prolapse, migraine or consumption of oral contraceptives, could be identified (n = 15), and 54 p. 100 when neither cause nor facilitating factor could be found (n = 26; p less than 0.10). In view of the very high prevalence of clinically silent venous thrombosis, these results suggest that paradoxical embolism through a PFO might be responsible for cerebral ischaemic accidents more frequently than is generally believed.
For the purpose of observing the biomechanical relationship among intervertebral disk (D), intervertebral foramen (F) and vertebral canal (C), 11 sets of functional unit of lumbar spine from fresh cadavers were used as specimens in this experiment. The data showed that the DFC were closely related in dimensional changes with different loadings, a phenomenon we call it DFC variation reaction. It was shown that the loading axes in the disk and in the inter-articular joints worked together biomechanically as an isosceles triangle to accommodate the stresses applied. The mechanism of the relapsed symptoms of protruded intervertebral disk after diskectomy, and of that of spinal canal stenosis was discussed. A reasonable operation for treatment of these maladies has been suggested.
A case of infantile obstructive jaundice caused by a right-sided foramen of Bochdalek's diaphragmatic hernia is reported. This association has not previously been reported in an infant. At operation, extrahepatic biliary obstruction was relieved by reduction of the contents of the hernia. This unusual presentation of a right-sided congenital diaphragmatic hernia underscores the usual diagnostic delay seen with such lesions.
Air embolism may occur during neurosurgery if performed in the seated position. Paradoxical systemic air embolism represents a potentially severe complication in case of patent foramen ovale. Contrast echocardiography detected such a malformation in 10/100 patients, which contra-indicated the sitting position in these 10 patients. No episode of paradoxical air embolism was observed in the 90 remaining patients, although 16 cases of pulmonary air embolism were detected during surgery.
Intrapetrous ceruminomas are rate tumors; only four cases have been reported in the literature. These had characteristics of cerebellopontine angle tumors. Our case had the characteristics of a tumor of the jugular foramen.
An anatomical pecularity was observed in the form of a bony bridge connecting the palatal spines in front of the greater palatine foramen in 17.1% of edenticulus human skulls, while in the cadavers, these spines were seen connected by a tough fibrous band.
Obturator foramen bypass has successfully been used to replace an infected groin graft in eight patients. Early replacement of an infected graft is recommended because of the poor results and risks associated with conservative management.
The thoracic discal hernia is a rare affection whose prognosis has been transformed by the present diagnostic means and the technical progress of surgery. A case history has been reported of a thoracic discal hernia, T9-T10, with Brown-Sequard Syndrome and vertebral CT Scanning showed a left lateral localization. A posterior access remains indicated in lateral localization of those hernias, and it confirms clinical and neuroradiological findings showing a direct compression of the Adamkiewicz artery in the intervertebral foramen.
The authors report 5 cases of an uncommon unilateral hydrocephalus due to non neoplastic obstruction of the foramen of Monro. Clinically, it is an early hydrocephalus, and usual absence of neurological deficit contrasts with large unilateral ventricular dilatation. CT Scan made diagnosis easier, confirming non neoplastic etiology. The authors compare their own 5 cases with 14 cases alike in the literature and emphasize the usual post shunting good prognosis of these hydrocephalus. Etiology remains uncertain.
A tumour was found in the left ventricle of a 25 year-old woman. Histology of this "ependymoma of Monro's foramen" shows characteristic structures of the subfornical organ. Whereas tumours of the pituitary or the pineal gland, which are also part of the circumventricular organs, are quite frequent, a tumour with differentiation characteristic of the subfornical organ is a rarity.
Discal L4 crural neuralgia is conventionally considered secondary to a hernia of the L3-L4 disc. Now, another source of discoradicular conflict exists on the path of the L4 root: hernia of the link canal of the L4-L5 canal through which the root leaves the rachidian canal. Of 27 discal neuralgias operated upon, 9 were linked to a hernia of the L3-L4 disc, while 18 were secondary to a hernia of the L4-L5 foramen, that is 2 foramina hernias for 1 "intrarachidian" hernia. The diagnostic difficulties resulting from foramina hernias probably reflect a rarity that is more apparent than real. The etiology of crural neuralgia is conventionally sought at the L3-L4 disc. This search is often unsuccessful: one speaks of "essential crural neuralgia". The scanner provides the only certain way of revealing foramina hernias, and will probably detect increasing numbers and thus reduce the number of "idiopathic crural neuralgias".
The analysis of asymmetry of the arm long bones and of the cranial jugular foramen has been used to suggest handedness in humans. However, because of the unavailability of documented skeletal material, neither criterion has been systematically tested. If both criteria are associated with handedness, they should also be intercorrelated within individuals. Data were collected from skeletal material of 125 males and 57 females to test whether this intercorrelation exists. According to Chi-square analysis, no statistically significant association was identified. After examining several hypotheses, it was concluded that until further substantiation, neither criterion is related to handedness to a degree appropriate for forensic science identification from skeletal remains.
A patient with typical Marfan's syndrome was monitored by echocardiography, which detected (in 1978) a prolapse of the mitral valve complicated by severe cardiac insufficiency, necessitating valve replacement. Seven years later an aneurysm of the ascending aorta (60 mm) was detected which caused prolapse of the aortic valve with valvular insufficiency, combined with prolapse of the tricuspid valve and a calcified foramen ovale the permeability of which was verified by peripheral injection of contrast medium. Echocardiography, notably two-dimensional, is an excellent examination for regular and atraumatic monitoring of Marfan's syndrome and detection of cardiovascular complications.
Schwannomas of the jugular foramen are relatively uncommon tumors. The growth and initial presentation of these tumors are variable and may not be associated with neuropathies of cranial nerves IX, X and XI. Seven patients with jugular fossa schwannomas are presented. Auditory brain stem response, electronystagmogram, computed cranial tomography, and carotid angiography are helpful in diagnosis and preoperative evaluation. The surgical approach should be individualized to the lesion and may include transmastoid with extended facial recess, translabyrinthine, retrolabyrinthine, and infratemporal/cervical approaches.
The authors analyse 46 cases of congenital diaphragmatic hernia through Bochdalek's foramen, discovered during the neonatal period. An autopsy study showed the various causes of postoperative mortality, and the authors studied pre, per and postoperative prognosis. A search for the causes and mechanisms of the complications suggested measures liable to improve survival. The authors tried from this data to determine the best management of this malformation.