scholarly journals Delayed severe median nerve palsy due to undiagnosed brachial pseudoaneurysm

VASA ◽  
2020 ◽  
Vol 49 (5) ◽  
pp. 418-421
Author(s):  
Jean-Eudes Trihan ◽  
Iris Lebuhotel ◽  
Mathieu Desvergnes ◽  
Fabrice Schneider
Keyword(s):  
Median Nerve ◽  
Endovascular Procedures ◽  
Diagnostic Delay ◽  
Neurological Complications ◽  
Nerve Compression ◽  
Autologous Vein ◽  
Median Nerve Palsy ◽  
Vein Bypass ◽  
Neurological Prognosis

Summary. Post-catheterization pseudoaneurysms are a well-known complication of many endovascular procedures at the site of arterial puncture. However, long-term neurological complications due to undiagnosed compression are rare. A 60-year-old man presented to our unit for round, non-pulsatile, painless swelling in the inner side of his upper arm. Clinical examination showed finger paralysis, associated with amyotrophy of the forearm. Large brachial pseudoaneurysm with median nerve compression was diagnosed. The patient underwent autologous vein bypass, with poor 6-month neurological recovery. Early diagnosis of pseudoaneurysms is paramount because, when associated with nerve compression, the longer the diagnostic delay, the poorer the neurological prognosis.

scholarly journals The deep femoral artery as a inflow source for distal reconstruction

2019 ◽  
Vol 41 part 2 (2) ◽  
pp. 35-38
Author(s):  
V. I. Rusyn ◽  
V. V. Korsak ◽  
V. V. Rusyn ◽  
F. V. Horlenco ◽  
V. M. Dobosh
Keyword(s):  
Quality Of Life ◽  
Femoral Artery ◽  
Limb Ischemia ◽  
Deep Femoral Artery ◽  
Autologous Vein ◽  
Vein Bypass ◽  
Profunda Femoris ◽  
Chronic Limb Ischemia

of the study. To improve the treatment outcomes of patients with occlusion-stenotic lesions of the femoral-popliteal-tibial segment, long-term results of the profundafemorispopliteal autologous vein bypass surgery have been studied. Material and methods. In the surgical clinic of A. Novak Regional Clinical Hospital during the last 10 years has been performed 300 isolated profundoplasty at chronic limb ischemia. In 16 p atients w ith d eep femoral popliteal autologous vein bypass, a distal segment of arteria profunda femoris was used as the «tidal» artery, which varied from 0,51 to 0,63 in diameter (0,58 cm in average). Results. In the immediate and long-term follow-up period, no thrombosis of profunda femoris popliteal autologous vein shunt was observed in 5 years. The ankle-brachial pressure index after surgery increases almost twice and approaches 0,9 on posterior tabial artery. The mean profunda popliteal collateral index score decreased to 0,301 ± 0,099 in all patients after surgery. If we compare the quality of life after profunda femoris popliteal autologous vein reconstruction, it should be noted that the quality of life in our patients before the operation was 21,8 ± 4,9 points, after the operation − 45,6 ± 4,9 points. Conclusion.Profundafemorispopliteal autologous vein bypass by a length of up to 15 cm provides blood supply to the limb with stenoticocclusive lesions of the femoral-popliteal-tibial segment, with the passage of at least one artery of the leg and the arteries of the pedis. Keywords: chronic limb ischemia; deep femoral artery, prufundoplasty.

A poor long-term neurological prognosis is associated with abnormal cord insertion in severe growth-restricted fetuses

2018 ◽  
Vol 46 (9) ◽  
pp. 1040-1047 ◽  
Author(s):  
Masamitsu Nakamura ◽  
Nagayoshi Umehara ◽  
Keisuke Ishii ◽  
Jun Sasahara ◽  
Kenji Kiyoshi ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Birth Weight ◽  
Confidence Intervals ◽  
Developmental Disorders ◽  
Neurological Complications ◽  
Impaired Hearing ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome ◽  
Neurological Prognosis

Abstract Objective: To clarify and compare if the neurological outcomes of fetal growth restriction (FGR) cases with abnormal cord insertion (CI) are associated with a higher risk of a poor neurological outcome in subjects aged 3 years or less versus those with normal CI. Methods: A multicenter retrospective cohort study was conducted among patients with a birth weight lower than the 3rd percentile, based on the standard reference values for Japanese subjects after 22 weeks’ gestation, who were treated at a consortium of nine perinatal centers in Japan between June 2005 and March 2011. Patients whose birth weights were less than the 3rd percentile and whose neurological outcomes from birth to 3 years of age could be checked from their medical records were analyzed. The relationship between abnormal CI and neurological outcomes was analyzed. Univariate and multivariate models of multivariate logistic regression were employed to estimate the raw and odds ratio (OR) with 95% confidence intervals comparing marginal (MCI) and velamentous cord insertion (VCI) to normal CI. Results: Among 365 neonates, 63 cases of MCI and 14 cases of VCI were observed. After excluding 24 cases with neonatal or infant death from the total FGR population, the assessment of the outcomes of the infants aged 3 years or younger showed the following rates of neurological complications: 7.3% (n=25) for cerebral palsy, 8.8% (n=30) for developmental disorders, 16.7% (n=57) for small-for-gestational-age short stature (SGA), 0.6% (n=2) for impaired hearing, 0.9% (n=3) for epilepsy, 1.2% (n=4). The ORs (95% confidence intervals) based on multivariate analysis were as follows: cerebral palsy=10.1 (2.4–41.5) in the VCI group and 4.3 (1.6–11.9) in the MCI group, developmental disorders=6.7 (1.7–26) in the VCI group and 3.9 (1.1–14.2) in the single umbilical artery (SUA) group, 5.1 (1.4–18.7) for birth weight <1000 g and 2.8 (1.2–6.7) for placental weight <200 g. Conclusions: The present results indicate that growth-restricted fetuses diagnosed with a birth weight below the 3rd percentile exhibiting abnormal umbilical CI are at a high risk for poor neurological outcomes, including cerebral palsy and/or developmental disorders.

Median Nerve Function After Tendon Transfer For Ulnar Paralysis

1985 ◽  
Vol 10 (1) ◽  
pp. 30-32 ◽  
Author(s):  
J. W. BRANDSMA ◽  
P. W. BRAND
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Follow Up Study ◽  
Median Nerve Palsy ◽  
The Status ◽  
Leprosy Patients ◽  
Long Term Follow Up ◽  
Tendon Grafts

This is a long term follow-up study of the median nerves of 128 leprosy patients who originally had pure ulnar palsy for which they had tendon transfers to correct claw hand. Of the thirty-one cases in which the carpal tunnel was not used as a pathway for tendon grafts, 16% developed median palsy in the subsequent years. Of the ninety-seven cases in which tendon grafts were passed through the carpal tunnel, 7% developed a transient median nerve palsy and 11% developed permanent median palsy. None of the median nerve palsies developed during the weeks or months of post-operative re-education or observation, but were noted at follow-up visits months or years later. It is concluded that the use of the carpal tunnel did not significantly affect the status of those high-risk median nerves in cases of leprosy.

Very distal vein bypass in patients with thromboangiitis obliterans

VASA ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 304-309 ◽  
Author(s):  
Achim Neufang ◽  
Carolina Vargas-Gomez ◽  
Patrick Ewald ◽  
Nicolaos Vitolianos ◽  
Tolga Coskun ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Vein Graft ◽  
Duplex Ultrasound ◽  
Critical Limb Ischaemia ◽  
Thromboangiitis Obliterans ◽  
Surgical Revascularization ◽  
Autologous Vein ◽  
Therapeutic Concept ◽  
Autologous Vein Graft ◽  
Vein Bypass

Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.

scholarly journals Which triggers could support timely identification of primary antibody deficiency? A qualitative study using the patient perspective

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lisanne M. A. Janssen ◽  
Kim van den Akker ◽  
Mohamed A. Boussihmad ◽  
Esther de Vries
Keyword(s):  
Respiratory Infections ◽  
Diagnostic Delay ◽  
Signs And Symptoms ◽  
Negative Influence ◽  
Primary Antibody ◽  
Emotional Impact ◽  
Structured Interviews ◽  
Timely Treatment ◽  
The Way

Abstract Background Patients with predominantly (primary) antibody deficiencies (PADs) commonly develop recurrent respiratory infections which can lead to bronchiectasis, long-term morbidity and increased mortality. Recognizing symptoms and making a diagnosis is vital to enable timely treatment. Studies on disease presentation have mainly been conducted using medical files rather than direct contact with PAD patients. Our study aims to analyze how patients appraised their symptoms and which factors were involved in a decision to seek medical care. Methods 14 PAD-patients (11 women; median 44, range 16-68 years) were analyzed using semi-structured interviews until saturation of key emergent themes was achieved. Results Being always ill featured in all participant stories. Often from childhood onwards periods of illness were felt to be too numerous, too bad, too long-lasting, or antibiotics were always needed to get better. Recurrent or persistent respiratory infections were the main triggers for patients to seek care. All participants developed an extreme fatigue, described as a feeling of physical and mental exhaustion and thus an extreme burden on daily life that was not solved by taking rest. Despite this, participants tended to normalize their symptoms and carry on with usual activities. Non-immunologists, as well as patients, misattributed the presenting signs and symptoms to common, self-limiting illnesses or other ‘innocent’ explanations. Participants in a way understood the long diagnostic delay. They know that the disease is rare and that doctors have to cover a broad medical area. But they were more critical about the way the doctors communicate with them. They feel that doctors often don’t listen very well to their patients. The participants’ symptoms as well as the interpretation of these symptoms by their social environment and doctors had a major emotional impact on the participants and a negative influence on their future perspectives. Conclusions To timely identify PAD, ‘pattern recognition’ should not only focus on the medical ‘red flags’, but also on less differentiating symptoms, such as ‘being always ill’ and ‘worn out’ and the way patients cope with these problems. And, most important, making time to really listen to the patient remains the key.

scholarly journals Median Nerve Palsy following Elastic Stable Intramedullary Nailing of a Monteggia Fracture: An Unusual Case and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Surjit Lidder ◽  
Nima Heidari ◽  
Florian Amerstorfer ◽  
Stephan Grechenig ◽  
Annelie M. Weinberg
Keyword(s):  
Median Nerve ◽  
Intramedullary Nailing ◽  
Radial Head ◽  
Nerve Palsy ◽  
Unusual Case ◽  
Elastic Stable Intramedullary Nailing ◽  
Monteggia Fracture ◽  
Type I ◽  
Monteggia Lesion ◽  
Median Nerve Palsy

Monteggia fractures are rare in children, and subtle radial head dislocations, with minor plastic deformation of the ulna, may be missed in up to a third of cases. Complications of Monteggia fractures-dislocations include persistent radial head dislocation, forearm deformity, elbow stiffness, and nerve palsies at the time of presentation. An unusual case of median nerve palsy following elastic stable intramedullary nailing of a type I Monteggia lesion in a 6-year-old girl is presented, and we highlight that, although most nerve palsies associated with a Monteggia fracture-dislocations are treated expectantly in children, early intervention here probably provided the best outcome.

The Long-Term Follow-Up of Patients Undergoing Saphenous Vein Bypass Surgery

Circulation ◽  
1974 ◽  
Vol 49 (1) ◽  
pp. 77-85 ◽  
Author(s):  
DAVID S. CANNOM ◽  
D. CRAIG MILLER ◽  
NORMAN E. SHUMWAY ◽  
THOMAS J. FOGARTY ◽  
PAT O. DAILY ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Bypass Surgery ◽  
Saphenous Vein Bypass ◽  
Long Term Follow Up ◽  
Vein Bypass

Pseudogout of the Wrist Presenting as Acute Median Nerve Compression

1985 ◽  
Vol 10 (2) ◽  
pp. 261-262
Author(s):  
D. R. A. GOODWIN ◽  
R. ARBEL
Keyword(s):  
Median Nerve ◽  
Upper Limb ◽  
Calcium Pyrophosphate ◽  
Nerve Compression ◽  
Median Nerve Compression ◽  
Septic Condition

Two cases are reported of acute median nerve compression due to calcium pyrophosphate deposition in the wrist, masquerading as a septic condition. There have been recent reports in the literature of the effects of calcium pyrophosphate in joints of the upper limb (Resnick 1983 and Hensley, 1983) These conditions are uncommon and the presentation and initial symptomatology of our case led in the first patient to misdiagnosis and an unnecessary operation, which was avoided in the second case.

scholarly journals Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study

2018 ◽  
Vol 104 (6) ◽  
pp. 552-557 ◽  
Author(s):  
Seilesh Kadambari ◽  
Serena Braccio ◽  
Sonia Ribeiro ◽  
David J Allen ◽  
Richard Pebody ◽  
...  
Keyword(s):  
White Cell Count ◽  
Clinical Information ◽  
Neurological Complications ◽  
Surveillance Period ◽  
Live Births ◽  
Young Infants ◽  
Hearing Test ◽  
Surveillance Unit ◽  
The Uk

ObjectivesThis study aimed to prospectively collect detailed clinical information for all enterovirus (EV) and human parechovirus (HPeV) meningitis cases in infants aged <90 days in the UK and Ireland.Participants, design and settingProspective, active national surveillance during July 2014 to July 2015 through the British Paediatric Surveillance Unit. Reporting paediatricians completed questionnaires requesting information on clinical presentation, investigations, management and outcomes at hospital discharge and after 12 months.Main outcome measuresTo describe the clinical burden of EV and HPeV meningitis in infants aged <90 days.ResultsDuring the 13-month surveillance period, 703 cases (668 EV, incidence0.79/1,000 live- births; 35 HPeV, 0.04/1,000 live-births) were identified. The most common clinical presentations were fever (EV: 570/668(85%); HPeV: 28/35(80%)), irritability (EV: 441/668(66%); HPeV: 23/35(66%)) and reduced feeding (EV: 363/668(54%); HPeV 23/35(66%)). Features of circulatory shock were present in 27% (182/668) of EV and 43% (15/35) of HPeV cases. Overall, 11% (76/668) of EV and 23% (8/35) of HPeV cases required intensive care support. Nearly all cases (678/703, 96%) were confirmed by cerebrospinal fluid (CSF) PCR, with 52% (309/600) having normal CSF white cell count for age. Two infants with EV meningitis died (2/668, 0.3%) and four survivors (4/666, 0.6%) had long-term complications at 12 months’ follow-up. Infants with HPeV meningitis survived without sequelae. Overall 189 infants had a formal hearing test and none had sensorineural hearing loss.ConclusionThe incidence of laboratory-confirmed EV/HPeV meningitis in young infants is more than twice that for bacterial meningitis. Less than 1% will develop severe neurological complications or die of their infection. Further studies are required to formally assess long-term neurodevelopmental sequelae.

Sign in / Sign up

Export Citation Format

Share Document