Popliteal artery aneurysms: is endovascular reconstruction durable?

Purpose: To describe an endovascular method of performing femoropopliteal in situ saphenous vein (SV) bypass and popliteal artery aneurysm (PAA) embolization.

Methods: Twenty-two patients underwent PAA operations. Twelve patients had conventional SV bypasses with PAA proximal and distal ligation, whereas 10 underwent PAA embolization and an endovascular in situ SV bypass (EISB).

Biotech pharmaceuticals and biotherapy: an overview.

Broadly, the history of pharmaceutical biotechnology includes Alexander Fleming"s discovery of penicillin in a common mold, in 1928, and the subsequent development-prompted by World War II injuries-of large-scale manufacturing methods to grow the organism in tanks of broth. Pharmaceutical biotechnology has since changed enormously. Two breakthroughs of the late 1970s became the basis of the modern biotech industry: the interspecies transplantation of genetic material, and the fusion of tumor cells and certain leukocytes.

Achilles tendon rupture repair: biomechanical comparison of the triple bundle technique versus the Krakow locking loop technique.

This study was designed to compare the tensile strength of ruptured Achilles tendons repaired using either the triple bundle technique or the Krakow locking loop technique. Eight pairs of fresh frozen cadaveric Achilles tendons were harvested. A simulated "Achilles tendon rupture" was created 4 cm from the calcaneal insertion in all sixteen tendons by transversely cutting the tendon with a scalpel.

Endovascular-assisted versus conventional in situ saphenous vein bypass grafting: cumulative patency, limb salvage, and cost results in a 39-month multicenter study.

Objective: In this retrospective multicenter study, the results of a minimally invasive method of endovascular-assisted in situ bypass grafting (EISB) versus "open" conventional in situ bypass grafting (CISB) were evaluated with a comparison of primary and secondary patency, limb salvage, and cost.

Methods: Enrolled in this study were 273 patients: 117 underwent CISB (42 femoropopliteal, 75 femorocrural) and 156 underwent EISB (41 femoropopliteal, 115 femorocrural). EISB was performed with an angioscopic Side Branch Occlusion system and an angioscopically guided valvulotome.

Sesamoiditis of the index finger presenting as acute suppurative flexor tenosynovitis.

Sesamoiditis involving the hand is uncommon, usually reported in the thumb, and has not been reported in the index finger. As rare as this clinical entity remains, its presentation simulating an acute suppurative flexor tenosynovitis is even more rare. We report a patient who presented with Kanavel's 4 cardinal signs of acute suppurative tenosynovitis who was subsequently found to have an acute sesamoiditis of the index finger.

Comparison of laparoscopic and open ventral herniorrhaphy.

The repair of large and/or recurrent ventral hernias is associated with significant complications and a recurrence rate that can be more than 50 per cent. Laparoscopic ventral herniorrhaphy, a recent development, has been shown to be safe and effective in the repair of ventral hernias. This study retrospectively reviews all ventral hernia repairs over a 3-year period, November 1995 through December 1998, at a community-based teaching hospital.

Comparison between the transabdominal and retroperitoneal approaches for aortic reconstruction in patients at high risk.

Purpose: The purpose of this study was to compare the transabdominal approach with the retroperitoneal approach for elective aortic reconstruction in the patient who is at high risk.

Methods: From January 1992 through January 1997, 148 patients underwent aortic operations: 92 of the patients were classified as American Society of Anesthesia (ASA) class IV. Forty-four operations on the patients of ASA class IV were performed with the transabdominal approach (25 for abdominal aortic aneurysms and 19 for aortoiliac occlusive disease), and 48 operations were performed with the retroperitoneal approach (27 for abdominal aortic aneurysms and 21 for aortoiliac occlusive disease).

Minimally invasive in situ bypass.

Since the report of a successful femoropopliteal in situ saphenous vein bypass in 1962, surgeons have attempted to make this bypass a less invasive operation and simplify the two principal technical components of the operation: (1) rendering the saphenous vein valves incompetent and (2) occluding the venous side branches. To accomplish this bypass, however, a long incision that is the length of the leg over the course of the saphenous vein is often necessary, which can be fraught with hazard, especially in patients with diabetes in whom wound complications can be devastating. An angioscopically assisted technique that allows the surgeon to perform valvulotomy and occlude venous side branches from within the saphenous vein--a minimally invasive in situ vein bypass--has been developed.

Patellar ligament reconstruction using allograft patellar ligament: a case report.

This report describes a method of patellar ligament reconstruction. Our patient sustained a rupture of the patellar ligament and had reconstruction with allograft patellar ligament after failed primary repair. At the 2-year follow-up, his range of motion was 0 degrees to 110 degrees and he was able to return to unrestricted standing work.

Palmar (displaced) fracture of the proximal index metacarpal.

A patient sustained a fracture of the ulnar side of the proximal end of the second metacarpal. The fragment was completely displaced into the palmar soft tissues. Open reduction was necessary.

A biomechanical study of the ankle syndesmosis after fibular graft harvest.

Harvesting the fibula as corticocancellous bone graft is not without complications. Multiple clinical studies chronicled the morbidity at the donor site, both immediately after surgery and at long-term follow-up. To our knowledge, no cadaveric or biomechanical studies addressed the effect that fibular osteotomy has on the ankle syndesmosis.

Biomechanical comparison of hybrid external fixators.

Objectives: To determine the stiffness characteristics of the hybrid ring fixator in the treatment of (OTA 41-C) proximal metaphyseal and shaft tibial fractures.

Design: Five identical composite tibiae were fixed with a Synthes, ACE Fischer, Howmedica Monticelli-Spinelli, or Smith & Nephew Trauma Ilizarov hybrid external fixator or with the conventional Ilizarov wire fixator. The Synthes and Monticelli-Spinelli fixators were tested twice, the first time with the connectors on the outside of the ring and the second time with the connectors on the inside of the ring.

Transposed basilic vein versus polytetrafluorethylene for brachial-axillary arteriovenous fistulas.

Background: Both transposed basilic vein (BV) and polytetrafluorethylene (PTFE) upper arm arteriovenous fistulas (AVF) are common angioaccess operations. To evaluate the patency and complication rates after AVF, a concurrent series of patients was reviewed.

Methods: Ninety-eight patients underwent brachial artery to axillary vein AVF: 30 BV and 68 PTFE.

Acute compartmental syndrome from hematogenous osteomyelitis of the ulna.

Compartmental syndrome of the forearm in children is usually caused by fractures, soft-tissue damage, burns, or arterial injury. This report presents the case of a child who had compartmental syndrome of the forearm resulting from acute hematogenous osteomyelitis of the ulna.

A method to locate the radial digital nerve of the index finger.

The radial digital nerve of the index finger is susceptible to injury during penetrating trauma or elective release of the A1 pulley. The intersection of a line drawn down the midline of the index finger and the proximal palmar crease identifies the location of the radial digital nerve. This method of identifying the topography of the nerve should assist the surgeon in determining the likelihood of injury after penetrating trauma, and preventing injury during elective procedures.

Pathologic morphology of the dislocated proximal femur in children with cerebral palsy.

We describe the gross and microscopic anatomic changes in the hip that result from the deforming forces in children with neuromuscular imbalance. Twelve dislocated proximal femora that had been resected from children with spastic diplegia or tetraplegia were evaluated with respect to their gross, microscopic, and radiographic structure. The epiphyses were wedge shaped with deformation of the femoral head apparent in all cases.

Biomechanical study of lumbar pedicle screws: does convergence affect axial pullout strength?

We tested the hypothesis that two pedicle screws placed in convergence offer more resistance to axial pullout than do two pedicle screws placed in parallel. Eight fresh cadaveric lumbar spines, L2-L5, were harvested. Individual vertebra were then paired for testing.

Two open forearm fractures after airbag deployment during low speed accidents.

Automotive airbags effectively mitigate the impact of vehicular collision by absorbing and distributing a force that otherwise would be sustained by the occupants. To be effective, inflation must be instantaneous and sufficient to provide restraint to a moving body. Deployment of automotive airbags is a violent event that may cause injury to the occupants of the vehicle.

Iliofemoral venous thrombosis caused by compression of an internal iliac artery aneurysm: a minimally invasive treatment.

Purpose: To report the success of a minimally invasive treatment for phlegmasia cerulea dolens without gangrene caused by compression from an internal iliac artery aneurysm.

Methods And Results: An 81-year-old male with a 1-month history of paralysis owing to a hemorrhagic stroke presented with massive edema and skin mottling of the right lower extremity. Imaging confirmed right iliofemoral deep vein thrombosis caused by compression from a 4-cm internal iliac artery aneurysm.

Guidelines to decortication in posterolateral spine fusion.

Despite the development of innovative approaches and the general success that has been achieved with spinal fusion, the rate of nonunion in some studies has been reported as high as 35%. Decortication has been shown to promote the fusion process and provides not only a rich source of vascular supply from the underlying cancellous bone, but also access to pluripotent stem cells within the marrow. Although the blood supply to the lumbar spine has been described, little attention has been paid to relevant areas of the spine most affected by decortication during the posterolateral fusion process.

Complications of plantar fascia rupture associated with corticosteroid injection.

From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures.

Popliteal artery aneurysm treated with a minimally invasive endovascular approach: an initial report.

Purpose: To report a minimally invasive approach to popliteal artery aneurysm (PAA) treatment.

Methods And Results: A 48-year-old male with a 3-cm PAA was treated electively with an endovascular in situ saphenous vein bypass and transluminal antegrade coil embolization of the PAA prior to completion of the proximal anastomosis. Two short incisions at the anastomosis sites resulted in no wound complications, and the patient was discharged after 2 days.

Diagnosis of aortocaval fistula by computed tomography.

A case of an aortocaval fistula documented by contrast-enhancement computed tomography is reported. In the presence of a large abdominal aortic aneurysm, the computed tomography (CT) triad findings of: (1) vena caval effacement, (2) loss of the fat plane between the aorta and vena cava, and (3) rapid flow of contrast from the aorta into a dilated inferior vena cava is characteristic of an aortocaval fistula.

Traumatic carotid artery dissection and pseudoaneurysm treated with endovascular coils and stent.

Purpose: To report a case of post-traumatic internal carotid artery dissection and pseudoaneurysm formation at the C-1 level successfully treated by a percutaneous endovascular technique.

Methods And Results: A 20-year-old female presented 72 hours after a motor vehicle accident with incomplete occulosympathetic paresis (Horner's syndrome), carotidynia, and leftsided 1.5-cm x 2.