Wrist Arthrography

The ligaments of the proximal row of carpal bones and the triangular fibrocartilage (TFC) strongly influence the function and stability of the wrist. Injury to the ligaments may result in chronic wrist pain or instability. Wrist arthrography is valuable in the investigation of such damage when surgical intervention is considered and plain radiography is unrewarding. There are also several technical modifications of the standard radiocarpal arthrography available. Owing to the possibility of congenital perforations and degenerative changes in these ligaments the arthrographic findings should be related to the clinical signs and the age of the patient. CT has less diagnostic importance in this respect while MR imaging is an alternative and may become the method of choice. Both these methods have great potential in the evaluation of soft tissues of the wrist other than the TFC.

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Restricted Wrist Rotation after an Ulnar Head Fracture: A Report of Two Cases

Journal of Wrist Surgery ◽

10.1055/s-0040-1716862 ◽

2020 ◽

Author(s):

Tomoyuki Kato ◽

Koji Abe ◽

Kazuki Sato ◽

Toshiyasu Nakamura

Keyword(s):

Range Of Motion ◽

Soft Tissues ◽

Surgical Intervention ◽

Restricted Range ◽

Case Description ◽

Rare Entity ◽

Loose Bodies ◽

Ulnar Head ◽

Triangular Fibrocartilage ◽

Restriction Of Range

Abstract Background Isolated ulnar head fracture is a rare entity, and the restriction of range of motion in the wrist is rarely reported. Case Description We report two cases of conservatively treated ulnar head malunion with restricted supination and pronation. The increased tension of the volar portion of the triangular fibrocartilage complex was observed, and the surgical treatment significantly improved the range of motion. Literature Review There are a few reports on isolated ulnar head fracture. Other causes of restricted supination and pronation of the wrist are mostly due to the interposition of soft tissues or loose bodies. Clinical Relevance Malunion after ulnar head fracture can cause restriction of wrist supination and pronation. Surgical intervention may be considered if restricted range of motion remains after conservative treatment.

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Diagnosis, treatment and postsurgical complications in a dog with epileptic seizures and a naso-ethmoidal meningoencephalocele

Acta Veterinaria Scandinavica ◽

10.1186/s13028-021-00591-1 ◽

2021 ◽

Vol 63 (1) ◽

Author(s):

Abtin Mojarradi ◽

Sofie Van Meervenne ◽

Alejandro Suarez-Bonnet ◽

Steven De Decker

Keyword(s):

Surgical Resection ◽

Medical Management ◽

Surgical Intervention ◽

Clinical Signs ◽

Epileptic Seizures ◽

Nasal Discharge ◽

Dural Defect ◽

Drug Resistant ◽

Tension Pneumocephalus ◽

Postsurgical Complications

Abstract Background Naso-ethmoidal meningoencephalocele is usually a congenital anomaly consisting of a protrusion of cerebral tissue and meninges into the ethmoidal labyrinth. The condition is a rare cause of structural epilepsy in dogs. We report the clinical presentation, surgical intervention, postoperative complications and outcome in a dog with drug resistant epilepsy secondary to a meningoencephalocele. Case presentation A 3.3-year-old male neutered Tamaskan Dog was referred for assessment of epileptic seizures secondary to a previously diagnosed left-sided naso-ethmoidal meningoencephalocele. The dog was drug resistant to medical management with phenobarbital, potassium bromide and levetiracetam. Surgical intervention was performed by a transfrontal craniotomy with resection of the meningoencephalocele and closure of the dural defect. Twenty-four hours after surgery the dog demonstrated progressive cervical hyperaesthesia caused by tension pneumocephalus and pneumorrhachis. Replacement of the fascial graft resulted in immediate resolution of the dog’s neurological signs. Within 5 months after surgery the dog progressively developed sneezing and haemorrhagic nasal discharge, caused by sinonasal aspergillosis. Systemic medical management with oral itraconazole (7 mg/kg orally q12h) was well-tolerated and resulted in resolution of the clinical signs. The itraconazole was tapered with no relapsing upper airway signs. The dog’s frequency of epileptic seizures was not affected by surgical resection of the meningoencephalocele. No treatment adjustments of the anti-epileptic medication have been necessary during the follow-up period of 15 months. Conclusions Surgical resection of the meningoencephalocele did not affect the seizure frequency of the dog. Further research on prognostic factors associated with surgical treatment of meningoencephaloceles in dogs is necessary. Careful monitoring for postsurgical complications allows prompt initiation of appropriate treatment.

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Repeated Plastic Stentings of Common Hepatic Duct for Portal Vein Aneurysm Compression in a Patient Unsuitable for Surgery

Case Reports in Gastroenterology ◽

10.1159/000492812 ◽

2018 ◽

Vol 12 (3) ◽

pp. 570-577 ◽

Cited By ~ 1

Author(s):

Jeffrey Sun ◽

Cheuk-Kwan Sun ◽

Cheuk-Kay Sun

Keyword(s):

Portal Vein ◽

Surgical Intervention ◽

Vascular Malformations ◽

Imaging Modality ◽

Hepatic Duct ◽

Therapeutic Option ◽

Clinical Signs ◽

Common Hepatic Duct ◽

Low Grade ◽

Portal Vein Aneurysm

Portal vein aneurysms are rare vascular malformations with unclear etiologies and optimal treatment guidelines. Although Doppler ultrasonography is the most commonly used diagnostic tool, there is no gold standard imaging modality. Despite recommendations of surgical treatment for symptomatic aneurysms, there are limited options in the management of portal vein aneurysm-related complications in patients unfit for surgical intervention. We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis. Endoscopic retrograde cholangiopancreatography revealed a common hepatic duct stricture and concomitant intraductal ultrasonography identified adjacent aneurysmal portal vein dilatation. The final diagnosis of portal vein aneurysm was made using contrast computerized tomography scan. The patient was considered unsuitable for surgery due to his advanced age and multiple comorbidities. Instead, an endoscopic biliary plastic stent was inserted as a therapeutic alternative, which successfully achieved complete resolution of symptoms 3 days after the procedure. The patient was regularly followed at the outpatient clinic with repeated stent replacements every 3 to 4 months. After a follow-up of over 3.5 years, the patient remained symptom-free without signs of portal vein aneurysm compression. The result suggests that repeated stent replacements may be a therapeutic option for biliary compression by portal vein aneurysm in patients contraindicated for surgical intervention.

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Pulmonary Valve Insufficiency as a Complication of Radical Surgical Treatment of Tetralogy of Fallot

Acta Facultatis Medicae Naissensis ◽

10.1515/afmnai-2017-0020 ◽

2017 ◽

Vol 34 (2) ◽

pp. 179-188

Author(s):

Milovan Stojanović ◽

Marina Deljanin-Ilić ◽

Aleksa Vuković ◽

Dejan Petrović

Keyword(s):

Surgical Treatment ◽

Tetralogy Of Fallot ◽

Pulmonary Valve ◽

Surgical Intervention ◽

Ultrasound Examination ◽

Clinical Signs ◽

Common Complication ◽

Pulmonary Valve Insufficiency ◽

Valve Insufficiency ◽

Additional Imaging

Summary Tetralogy of Fallot is the most common cyanogenic congenital heart defect. The diagnosis is based on clinical signs, ECG examination, ultrasound examination of the heart, additional imaging methods and invasive testing. The therapeutic approach to the patient with tetralogy is complex and based on conservative and radical methods. Patients who have not undergone a radical surgical intervention have a poor prognosis, whereas the prognosis is much better for patients who have been operated. The most common complication of the surgical treatment is the pulmonary valve insufficiency which usually requires reintervention, as was the case with our patient.

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Patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability have reduced rotational torque in the forearm

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415622342 ◽

2016 ◽

Vol 41 (7) ◽

pp. 732-738 ◽

Cited By ~ 11

Author(s):

J. K. Andersson ◽

P. Axelsson ◽

J. Strömberg ◽

J. Karlsson ◽

J. Fridén

Keyword(s):

Joint Instability ◽

Clinical Signs ◽

Case Series ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Wrist Arthroscopy ◽

Level Of Evidence ◽

Independent Observer ◽

Radioulnar Joint ◽

Triangular Fibrocartilage

A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar joint instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a significant loss of both pronation and supination torque. Level of evidence: Case series, Level IV.

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MR Imaging of Intra- and Periarticular Soft Tissues and Subchondral Bone in Knee Osteoarthritis

Radiologic Clinics of North America ◽

10.1016/j.rcl.2009.04.001 ◽

2009 ◽

Vol 47 (4) ◽

pp. 687-701 ◽

Cited By ~ 13

Author(s):

Michel D. Crema ◽

Frank W. Roemer ◽

Monica D. Marra ◽

Ali Guermazi

Keyword(s):

Mr Imaging ◽

Knee Osteoarthritis ◽

Subchondral Bone ◽

Soft Tissues

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Male Stress Urinary Incontinence Following Surgical Intervention: Procedures, Technical Modifications, and Patient Considerations

Male Stress Urinary Incontinence ◽

10.1007/978-3-319-19252-9_4 ◽

2015 ◽

pp. 45-72 ◽

Cited By ~ 2

Author(s):

Ryan W. Dobbs ◽

Ervin Kocjancic ◽

Simone Crivellaro

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Surgical Intervention ◽

Male Stress Urinary Incontinence ◽

Technical Modifications

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A Non-surgical Intervention for Triangular Fibrocartilage Complex Tears

Physiotherapy Research International ◽

10.1002/pri.1672 ◽

2016 ◽

Vol 21 (4) ◽

pp. 271-276 ◽

Cited By ~ 3

Author(s):

Susan J. Barlow

Keyword(s):

Surgical Intervention ◽

Triangular Fibrocartilage Complex ◽

Triangular Fibrocartilage

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Transsphenoidal surgery in Cushing disease: 10 years of experience in 34 consecutive cases

Journal of Neurosurgery ◽

10.3171/jns.2004.100.4.0634 ◽

2004 ◽

Vol 100 (4) ◽

pp. 634-638 ◽

Cited By ~ 34

Author(s):

Charlotte Höybye ◽

Eva GrenbäcK ◽

Marja Thorén ◽

Anna-Lena Hulting ◽

Lars Lundblad ◽

...

Keyword(s):

Mr Imaging ◽

Transsphenoidal Surgery ◽

Cushing Syndrome ◽

Preoperative Evaluation ◽

Clinical Signs ◽

Pituitary Hormone ◽

Years Of Experience ◽

Cushing Disease ◽

Content Type ◽

Fine Print

Object. Cushing disease is a rare disorder. Because of their small size the adrenocorticotropic hormone (ACTH)—producing tumors are often not detectable on neuroimaging studies. To obtain a cure with transsphenoidal surgery (TSS) may therefore be difficult. In this report the authors present 10 years of experience in the treatment of patients with Cushing disease who were followed up with the same protocol and treated by the same surgeon. Methods. Thirty-four patients, 26 of them female and eight of them male (mean age 40 years, range 13–74 years) were studied. All had obvious clinical signs and symptoms of Cushing syndrome. Magnetic resonance (MR) imaging was performed in all patients, and inferior petrosal sinus (IPS) sampling was done in 14. In 12 patients MR imaging indicated a pituitary tumor; 10 were microadenomas and two were macroadenomas. In six patients with no visible tumor, the results of IPS sampling supported the diagnosis. All patients underwent TSS; the mean follow-up duration was 6 ± 0.5 years. Selective adenomectomy was performed in 32 and hemihypophysectomy in the other two patients. A cure was obtained in 31 patients (91%) after one TSS and in two more patients after further TSS; one patient was not cured despite two TSSs and one underwent bilateral adrenalectomy. Disease recurrence was seen in two patients after 3 years, and they were successfully treated with stereotactic gamma knife surgery. Half of the patients had an ACTH deficiency postoperatively, whereas one third had other pituitary hormone insufficiencies. There were no serious complications attributable to the surgical intervention. Conclusions. Transsphenoidal surgery with selective adenomectomy is an effective and safe treatment for Cushing disease. In the patients presented in this study, the surgical outcome seemed to depend on careful preoperative evaluation and the surgeon's experience. For optimal results in this rare disease the authors therefore suggest that the endocrinological, radiological, and surgical procedures be coordinated in a specialized center.

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