Management of multiligament knee injuries

Up to 18% of multiligament knee injuries (MLKI) have an associated vascular injury. All MLKI should be assessed using the ankle brachial pressure index (ABPI) with selective arteriography if ABPI is < 0.9. An ischaemic limb following knee dislocation must be taken to the operating theatre immediately for stabilization and re-vascularization. Partial common peroneal nerve (CPN) injury following MLKI has better recovery than complete palsy. Posterior tibial tendon transfer is offered to patients with complete CPN palsy if there is no recovery at six months. Operative treatment with acute or staged reconstructions provides the best outcome in MLKI. Effective repair can only be performed within three weeks of injury. There is no difference between repair and reconstruction of medial collateral ligament and posteromedial corner. Posterolateral corner reconstruction has a lower failure rate than repair. Early mobilization following MLKI surgery results in fewer range-of-motion deficits. Cite this article: EFORT Open Rev 2020;5:145-155. DOI: 10.1302/2058-5241.5.190012

Investigation of Vascularization of Human Pancreas Using Method of Selective Arteriography with Insight Into Significance to a Surgical Approach for this Organ

This study explored arterial vascularisation of celiac trunk and superior mesenteric artery using method of selective arteriography in series of arteriogram which were done in 39 patients of Institute for Radiology. There were no pathological findings in a single case at pancreas or duodenum. Arteries which arise for vascularization of pancreas had a common spot of arising, flow and ramification. Pancreatic duodenal arteries arcade, which supply blood to the duodenum and the body of the pancreas, were shown in arteriogram. The branches which provide blood supply to the body and the tail of the pancreas were found. There was one case where lower pancreatic artery arose from gastroduodenal artery and in one case a direct anastomosis for celiac trunk and superior mesenteric arteries, better known as Tandler’s anastomosis.

Preoperative identification of bleeding site caused by angiodysplasia of the small bowel by means of selective arteriography and application of methylene blue

Background. Small bowel hemorrhages are rare and account for 2-10% of all gastrointestinal bleedings. In case that surgery is necessary, identification of the bleeding site is the most important problem. Case report. We presented here the case of a 65-year old man, admitted for urgent care of massive lower gastrointestinal bleeding. After reanimation and normalization of vital parameters, selective arteriography was done. A contrast extravasation site was identified at the level of jejunal branches of a. mesenterica superior and labeled by means of methylene blue application. Immediately after we performed conservative resection of the labeled jejunal loop in 10 cm length and terminoterminal anastomosis. The preparation was sent for histopathologic examination - small bowel angiodysplasia was identified. The patient was monitored in three month intervals in the next two years and new bleeding events were not observed. Conclusion. Bleeding caused by small bowel angiodysplasia is a significant diagnostic problem in cases in whom urgent surgery is required. Combined preoperative selective arteriography and methylene blue application make possible precise identification of the bleeding site as well as conservative small bowel surgery, avoiding thus the risk and danger of malabsorption syndrome.

Post-Sternotomy Hemorrhage due to Left Internal Thoracic Artery Pseudoaneurysm

We describe a case of pseudoaneurysm of the internal thoracic artery, which was probably caused by infection. Four weeks after aortic valve replacement and coronary artery bypass surgery, an 84-year-old woman suddenly developed painful sternal instability and hypotension, with active hemorrhage from a left parasternal swelling. Selective arteriography revealed a pseudoaneurysm of the left internal thoracic artery. It was surgically excised, and the patient recovered uneventfully.

Introduction: Spinal Vascular Malformations

From the earliest observations of spinal vascular malformations, successful management has been challenging. Initially the challenges were diagnosing, understanding, and treating these lesions. They were originally considered all to be the same, or at least to be a single general type, of disease. With the introduction of selective spinal arteriography in the 1960s and more recently with the introduction and widespread use of MR imaging, the initial challenge of diagnosing spinal vascular malformations was overcome, and significant progress has been made in understanding their anatomy as well as the pathophysiology that underlies the myelopathy commonly associated with them. The anatomical features defined by selective arteriography and the observations permitted with the operating microscope ultimately led to distinctions between the major categories of the vascular lesions affecting the spinal cord; these distinctions were based on the lesions' anatomy, epidemiology, and the mechanism of spinal cord injury.

Su di un caso di liposarcoma renale: Considerazioni diagnostiche e terapeutiche: A case of renai liposarcoma: Clinical and therapeutic considerations

The Authors report a case of renal liposarcoma 1.5 cm in diameter, found in a 45-year-old woman with a normal contralateral kidney. Since diagnosis was not completely clear after preoperative imaging-studies, like intravenous pyeloureterography, computed tomography and selective arteriography, an open biopsy was performed after the renal vessels were clamped: the intraoperative frozen-section report was benign lipomathoid lesion and an enucleo-resection was performed. The final pathological findings were of a well-differentiated renal liposarcoma with typical lipoblastic cell. Diagnosis and treatment are briefly discussed with reference to recent literature.