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Patients who sustain an unexplained stroke or peripheral ischemic event should be examined for paradoxical embolism via right-to-left shunting. The confirmation of a patent foramen ovale by echocardiography is simple and noninvasive, and should suggest the possibility of a right-sided embolic source. Unrecognized right-to-left shunting that allows paradoxical embolism may be more frequent than generally recognized.
Here we describe an interesting course of the sciatic nerve. A part of the common peroneal nerve perforated the piriformis and the fibers from the ventral branch of the S3, which were leaving the infrapiriformal foramen joined to it.
BACKGROUND: The great diffusion of the surgical technics in oral implantology and the progress of the radiological imaging produces some interest for the clinical anatomy of the mental foramen (MF). The study, in addition to the measurements that define it, considers others anatomical features of practical utility and the variableness of them. METHODS: In the Anatomic Institute of the Bologna University, it has been made a morphometric revision of the MF on 100 dried mandibles of normal young adults (78 males, 32 females) random chosen with the complete integrity of the dental apparatus and of the mandibular bone criteria. The measurements have been made by anthropometric methods on the two sides of the same mandible (n = 200) and for everyone has been reported in the tables the medium, the maximum and the minimum values with their specific variation interval. The results are applicable to the common work conditions because they take in consideration among the specific characteristics of the MF in addition to the seat, the course of the mandibular canal, the thickness and the height of the mandibular bone. RESULTS: To the clinical and diagnostic imaging object the medium values of the anatomical measurements can be considered sufficent. To anthropometric, anesthesiologic and surgical aims it is also necessary the knowledge of the maximum and the minimum values and the variation interval. In the living man the anatomicomedical study of the MF is made by the diagnostic imaging, especially by computed tomography with specific algorithm, because it makes possible absolutely exact measurements. CONCLUSIONS: Finally, the specifications on the MF provided by the present study are important not only for an anatomical but also for a practical point of view because they are a datum point value in the patient clinical management.
AIM OF THE STUDY: After the abdomen and the thorax, the cardiac approach seems to be the logical next step in development of minimally invasive surgery. We report our initial experience in closure of patient foramen ovale (PFO) through a mini thoracotomy. METHOD: A cardio-pulmonary bypass is initiated through canulaes introduced into the external iliac artery and vein. A right anterior mini-thoractomy is performed in the fourth intercostal space and a video-endoscopic camera is introduced through a trocar placed more laterally. The pericardium is opened anteriorly to the phrenic nerve. A venous canula is introduced into the superior vena cava and connected to the extracorporeal circuit. A ventricular fibrillation is provoked and both vena cavaes are clamped before the right atrium is opened. The PFO is closed with a double running suture. DISCUSSION: From November 1996 to march 1997, 4 patients were operated that way. The mean operation time was 212 +/- 17 minutes, the mean CPB time was 73 +/- 32 minutes, and the mean fibrillation time was 32 +/- 15 minutes. Echocardiography was performed at the end of the operations and at day 7. No residual shunt was detected and the cardiac function was not changed compared to the preoperative examination. CONCLUSION: Closure of a PFO can be performed through a mini-thoracotomy, with good results. With growing experience, the "minimally invasive" approach shall rapidly become a standard technique for this indication.
The authors were led to operate for a severe ischemic syndrome complicating fracture of the pelvis, a patient who presented with curious mobilisation of the femoral vessels in the obturator foramen with arterial and venous compression and who benefitted from treatment by simple reduction.
Scuba divers with patent foramen ovale (PFO) may be at risk for paradoxical nitrogen gas emboli when performing maneuvers that cause a rebound blood loading to the right atrium. We measured the rise and fall in intrathoracic pressure (ITP) during various maneuvers in 15 divers. The tests were standard isometric exercises (control), forceful coughing, knee bend (with and without respiration blocked), and Valsalva maneuver (maximal, gradually increased to reach control ITP, and as performed by divers to equalize middle ear pressure). All the maneuvers, as well as the downward slope of ITP at the release phase, were related to the control value. ITP levels were significantly higher than the standard isometric effort during a breath-hold knee bend (172%, P < 0.001), cough (133%, P < 0.05), and maximal Valsalva (136%, P < 0.05) whereas "usual" Valsalva maneuvers produced ITPs significantly lower than the standard (28%, P < 0.001). The downward slope of the pressure release curve was not significantly different among the different maneuvers (P < 0.1447). We conclude that maneuvers other than the usual divers' Valsalva are more likely to cause post-release central blood shift, both by the levels of ITP reached and by the time during which these ITPs are sustained. Divers (especially with PFO) should be advised to refrain from strenuous leg, arm, or abdominal exercise after decompression dives.
Several reports have described populations of divers with decompression sickness (DCS) who have a patent foramen ovale (PFO). The presence of a PFO is known to occur in about 30% of the normal population, hence 30% of divers are likely to have a PFO. Although observations have been made on the presence of a PFO in divers with and without DCS, the risk of developing DCS when a diver has a PFO has not been determined. In this study, Logistic Regression and Bayes' theorem were used to calculate the risk of DCS from data of three studies that reported on echocardiographic analysis of PFO in a diving population, some of whom developed DCS. Overall incidence of DCS was obtained from the sport diving population, from the U.S. Navy diving population, and from a commercial population. The analysis indicates that the presence of a PFO produces a 2.5 time increase in the odds ratio for developing serious (type II) DCS in all three types of divers. Since the incidence of type II DCS in these three populations averages 2.28/10,000 dives, the risk of developing DCS in the presence of a PFO remains small, and does not warrant routine screening by echocardiography of sport, military, or commercial divers.
A new case report of laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni in a 11-year-old boy with Down's syndrome is described. The review of 11 other cases in the adult literature illustrated the various aspects of this laparoscopic approach.
This paper reports on a rare case of a so-called corrected d-transposition of the great vessels of a 62-year old woman with situs inversus. In addition the patient had a VSD, a patent foramen ovale, and a tricuspid-valve insufficiency. The topography of the ventricular cavities, the great vessels and the coronary arteries is described in detail. There is pointed to the surgical treatment of additional abnormalities to improve the prognosis.
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