distal segment
Recently Published Documents


TOTAL DOCUMENTS

393
(FIVE YEARS 112)

H-INDEX

31
(FIVE YEARS 3)

2022 ◽  
Vol 8 ◽  
Author(s):  
Ruizheng Hao ◽  
Yongxin Huo ◽  
Hui Wang ◽  
Wei Liu

BackgroundTo explore the clinical effect of digital dorsal fascial island flap combined with crossfinger flap to repair distal degloving injury and sensory reconstruction.MethodsA total of 19 patients with distal fingertip degloving injuries treated with digital dorsal fascial island flap combined with crossfinger flap in our hospital from April 2018 to August 2020 were retrospectively included. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the fingers, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were evaluated.ResultsFive cases with post-operative flap blisters were treated at the time of dressing changes until successful scab formation. Three cases with post-operative arterial crisis of finger arterial dorsal branch vessel were relieved after suture removal and tension reduction. All other skin flaps and skin grafts survived. Nineteen patients received follow-up between 3 and 26 months (average 14.6 months). The active ROM of metacarpophalangeal (MCP) and interphalangeal (IP) joints of the injured fingers were satisfactory.ConclusionThe digital dorsal fascial island flap combined with the crossfinger flap for repairing the distal degloving injury of the distal segment of the finger is a good surgical method, which is simple and easy to operate, can repair a large area of soft tissue defect, and obtain a satisfactory effect.


2021 ◽  
Vol 7 (1) ◽  
pp. 54-60
Author(s):  
Dileep Reddy Ayapaneni ◽  
Surekha Srikonda ◽  
Krishna Teja Nerella ◽  
Latha P. Reddy

Introduction: The posterior inferior cerebellar artery (PICA) often exhibits anatomical variations at the craniovertebral junction. Few studies investigated variations of the posterior inferior cerebellar artery, and the prevalence of other variations has not been reported. The study aimed to identify variations of the posterior inferior cerebral artery using cerebral Digital Subtraction Angiography (DSA). Method: 50 patients underwent 64-slice cerebral Digital Subtraction Angiography. Four types of variations were observed. Results: Out of a total of 50 patients, 23 (46%) were males and 27 (54%) females (all age groups). Our study has shown the utility of the 2 sequences - fluoroscopy and cine. All 2 sequences have their significance in evaluating anatomical variations in PICA. Only 20% of the 50 patients had all the posterior inferior cerebellar artery without anatomical variations. Anatomic variations commonly involve the distal segment of the vertebral artery (VA). Most of them are seen arising from the C1, C2, and both C1 and C2 origins. Anatomic variations involve arising from the C1 origin in 9 patients, C2 origin in 11 patients, C1 & C2 origin in 8 patients, and other variations observed in 12 patients. Conclusion: Variations of the posterior inferior cerebellar artery can be easily evaluated by cerebral Digital Subtraction Angiography (CDSA). Recognizing and reporting them at cerebral CDSA may be clinically important. Surgeons should be mindful of this variation during operations.


Author(s):  
D. A. Maximkin ◽  
J. M. Bolivogu ◽  
A. G. Faybushevich ◽  
A. G. Chepurnoy ◽  
Z. Kh. Shugushev

Objective Assessment of the role of intravascular imaging methods in choosing the surgical strategy of myocardial revascularization.Material and Methods The study included 62 patients with diffuse and multivessel coronary artery disease, who underwent percutaneous coronary infervention (PCI) using intravascular imaging methods. Measurement of fractional flow reserve (FFR) in diffusely altered arteries was performed under conditions of maximum hyperemia, sequentially between stenoses, using the sensor, starting from the distal segment. Initially, the most distal hemodynamically significant stenosis was stented. Then, a repeated measurement of FFR was performed, and the issue of the need for stenting of other stenoses was solved. The results of stenting, as well as determination of the area of stent implantation were carried out by the method of optical coherence tomography (OCT).Results After FFR measurement the number of arteries with hemodynamically significant stenoses decreased by 24.7% (from 93 to 70). It was also noted that in patients with two-vessel lesions, the average number of such stenoses decreased from 2.95 ± 0.65 to 1.82 ± 0.88, and in patients with three-vessel lesions – from 2.96 ± 0.6 to 2.24 ± 0.76 respectively (p = 0.0024). Complete (functionally adequate according to FFR measurements) myocardial revascularization was achieved in 88.7% of patients. The second-generation drug eluting stents were implanted in 82 (47.1%) patients, and the third generation stents – in 92 (52.9%) patients. At the same time, the success rate of recanalization of occlusions was 100%. Overall, optimal stent implantation was achieved in all patients. Major cardiovascular complications were observed in 1 (1.6%) patient, which required additional interventions.Conclusion Complex use of intravascular imaging methods (OCT and FFR measurements) allows a differentiated approach to the assessment of each stenosis of the affected artery in patients with diffuse and multivessel coronary lesions, to achieve a high frequency of complete myocardial revascularization, as well as to reduce the number of unnecessary interventions and intraoperative complications.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Salvatore Giordano ◽  
Sabato Sorrentino ◽  
Annalisa Mongiardo ◽  
Antonio Bellantoni ◽  
Fabiola Boccuto ◽  
...  

Abstract Aims Transcatheter implantation of a balloon-expandable aortic valve is associated with an acute stent recoil . Conversely, the acute effects of nitinol-based stent frame- self expandable valve on post-deployment dimensions have not been reported. Accordingly, the aim of this study was to assess the occurrence and degree of acute prosthetic dimension changes after Evolute R valve implantation. Methods A total of 58 consecutive patients undergoing transcatheter aortic valve intervention (TAVI) with a widely used nitinol based self-expandable device (Evolute R, Medtronic, Minneapolis, USA) were included in this study. We measured valve diameters at three different sections: a) distal (aortic) level, b) central (annulus) level, and c) proximal (ventricular) level. Valve expansion was calculated as the difference between the diameters calculated immediately after valve deployment (A) and at the end of the procedure (B). The absolute and relative acute stent recoil were defined as B-A and (B-A)/B*100, respectively. A linear regression model was performed to test the association between the degree of valve extension, with baseline, as well as procedural characteristics. Results Final stent diameters were significantly higher compared to those achieved immediately after valve implantation in proximal (20.87±3.20 mm versus 20.37±3.27 mm, P <0.001), central (19.58±1.63 mm versus 19.12±1.75 mm, P <0.001) as well as distal (26.99±1.53 mm versus 26.41±1.57 mm, P <0.001) segments. The mean absolute and relative enlargement of the valve was respectively 0.50±0.51 mm and 2.48±2.57% in the proximal, 0.46±0.57 mm and 2.39±2.96% in the central and 0.58±0.59 mm and 2.14±2.14% in the distal segment. Among baseline and procedural characteristics assessed in the logistic regression model no association was observed between pre-dilation and valve expansion across all the segments (proximal: r2=0.004, P=0.885, central: r2=0.004, P=0.637, and distal r2=0.05, P=0.10). Of interest, post dilation affected only the expansion of the central segment (r2=0.241, P<0.001), while no association was observed for the proximal (r2=0.059, P=0.065) and distal (r2=0.0002, P=0.916) parts. The expansion of the proximal segment was associated with higher maximum/minimum diameter ratio measured by CT (r2=0.08, P=0.045), while no association was observed for the central (r2= 0.020; P=0.992) and distal (r2=1.111, P=0.683) segments. Conclusions This is the first study that documented a significant degree of post-deployment recoil of the Evolute R self-expandable valve, that was consistent across all the segments. The stent-valve expansion of the proximal segment was associated with a greater annulus dissymmetry reported by the maximum and minimum diameter ratio assessed by CT scan. However, further studies are required to assess the short and long-term time-course of self-expandable valve enlargement and the clinical relevance of this finding.


Author(s):  
Liu xuebing ◽  
Chun-Mei Li

We reported a patient with chest pain, but the coronary angiography was normal. ATP stress myocardial contrast electrocardiography(MCE) was performed. There was apical ventricular septal perfusion delay before ATP stress, and the perfusion delay areas were significantly reduced at the peak period, which was similar to the “reverse redistribution” perfusion characteristics of nuclear myocardium in coronary vasospasm, The areas of delayed perfusion in the recovery period were larger than that before stress, the increase of blood flow spectrum resistance in the distal segment of left anterior descending coronary artery and the occurrence of chest pain all showed that ATP induced myocardial microvascular spasm. The MCE perfusion characteristics and the changes of coronary spectrum had certain clinical value in the diagnosis of myocardial microvascular spasm.


2021 ◽  
Vol 8 (12) ◽  
pp. 3735
Author(s):  
Shashwat Vyas ◽  
Pankaj Porwal

Traumatic pancreatic injury is a rare entity which is associated with severe morbidity and mortality. The management varies according to the American association for the surgery of trauma-organ injury scale (AAST-OIS) grading of injury, hemodynamic status and time of definitive diagnosis. Non-operative versus operative management has potential risks and benefits and long term debate on the ideal management is still ongoing. A 19-year boy, with severe, generalised pain abdomen was admitted after road traffic accident. Upon admission, the investigations: ultrasonography (USG) and computed tomography (CT) scan abdomen, showed traumatic pancreatic injury (AAST-OIS, grade V), was taken for exploratory laparotomy which revealed lacerated head of pancreas along with normal distal segment of pancreas with no associated injury to nearby hollow viscera, vascular structures. He underwent primary closure of head of pancreas with distal segment pancreaticogastrostomy. Postoperatively he recovered well with no complications. In the present case, as he had traumatic pancreatic injury (AAST-OIS, grade V) and there was no involvement of hollow viscera and vascular structures, the operative intervention can decrease morbidity as by pancreaticogastrostomy we have diverted the pancreatic fluid into stomach, subsequently decreasing the chances of pseudocyst, fistula, necrosis of pancreas. Thus we conclude, high grade blunt traumatic abdomen injuries should be managed with adequate resection and subsequent reconstruction and/or drainage procedure. Pancreaticoduodenectomy, distal pancreatectomy, pancreaticogastrostomy, pancreaticojejunostomy are the available options to be used according to the grading of injury and associated injuries.


Diversity ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 590
Author(s):  
Hyun Woo Bang ◽  
Heejin Moon ◽  
Jinwook Back

Benthic harpacticoids were collected from Korean waters. Two species were identified as members of the genus Longipedia Claus, 1863, because they have an extremely elongated distal segment of the P2 endopod. Longipedia koreana sp. nov. is morphologically most closely related to L. nichollsi Wells, 1980 and L. scotti Sars, 1903, but it can clearly be distinguished from both species based on the following morphological characteristics: P1 coxa with strong spinules near the outer margin and the distal element being much bigger than the proximal elements, P2 coxa with a small inner seta on the anterior surface, P4 exopod first segment without an inner element, and the P5 with a rectangular exopod (more than 3.5 times as long as wide). L. ulleungensis sp. nov. is similar to L. brevispinosa Gurney, 1927, L. spinulosa Itô, 1981, and L. weberi Scott A., 1909. However, L. ulleungensis sp. nov. is characterized by the P2 coxa with a reduced inner seta, the P4 exopod second segment without an inner seta, and the anal operculum with a long median projection, a single spine, and a group of outer spines on each side. In a molecular analysis using the mitochondrial cytochrome c oxidase subunit I (COI) and 18S ribosomal RNA (18S rRNA) genes, the inter-specific variation was 22.525–23.102% and 1.325–1.382% of COI and 18S rRNA between the two new species, respectively. A key to the family Longipediidae is provided herein.


2021 ◽  
pp. 105566562110531
Author(s):  
Etkin Boynuyogun ◽  
Figen Ozgur

Proboscis lateralis (PL) is a rare congenital craniofacial anomaly and it is represented by rudimentary, tube-like nasal structure measuring 2–3 centimetre (cm) length and generally attaches to medial canthal region. A 22-month-old male patient was referred to our clinic with a PL hanging from the right medial canthus and a coloboma on the medial third of the right lower eyelid. Physical examination revealed that the PL was 4 cm long and 1.5 cm in diameter. There was a blind cavity with dimple at its distal segment. The right side of the nose and the nasal airway was aplastic. Before surgical correction, neuroradiological evaluation should be performed to obtain the characteristics and relationship of the lesion with adjacent structures and associated anomalies Many reconstructive options have been described in the literature, however, these options are insufficient to obtain natural contour and define alar crease, especially. We described the laterally-based skin flap from the medial wall of the left heminose and adapted to the lateral edge of the de-epithelialized skin of PL for defining supra-alar crease.


2021 ◽  
Vol 14 (11) ◽  
pp. e245688
Author(s):  
Prashanth Reddy ◽  
Mudassar Kamran ◽  
Satya Narayana Patro

An elderly patient presented with acute-onset right-sided weakness and aphasia. A large penumbra was noted in the left middle cerebral artery (MCA) territory without any infarct core. The patient was noted to have a carotid–carotid bypass. This posed certain technical challenge in accessing the intracranial circulation across the carotid bypass; however, the guiding catheter with soft distal segment was successfully navigated coaxially over the aspiration catheter across the bypass and intracranial circulation was accessed for mechanical thrombectomy. Complete recanalisation and reperfusion were achieved with significant neurological recovery of the patient post-thrombectomy. The aim of this report is to emphasise on this rarely encountered situation in thrombectomy and its successful management. The procedure should not be delayed or deferred due to lack of operator experience.


Author(s):  
Clemens Schirmer ◽  
Charles C Matouk ◽  
Ameer E Hassan ◽  
Adnan H Siddiqui ◽  
R. Dana Tomalty ◽  
...  

Introduction : Larger‐bore access catheters can improve endovascular therapy by facilitating delivery of interventional devices and reducing the number of exchange maneuvers needed. Advances in technology have allowed for the manufacture of larger‐bore access catheters that maintain necessary performance characteristics, such as a stiffer proximal segment for stability and a flexible distal segment for vessel catheterization. The purpose of this study was to report our initial experience of using a large‐bore (0.096” inner diameter) access catheter in neurovascular interventions. Methods : Data were prospectively collected from 7 sites in the US for procedures performed using a large‐bore (0.096” inner diameter) access catheter from January 15, 2020, to April 21, 2021. Effectiveness outcome was technical success, defined as successful access to the target vessel. Safety outcomes were access‐related and device‐related related complications. Results : One hundred and fourteen patients were included in this study (Table). The mean age of the patients was 67.6 years (SD 16.1), and about half (49.6%, 56/113) were female. The most common treatment conditions were stroke, 64 (56.1%); aneurysm, 24 (21.1%); carotid atherosclerosis, 19 (16.7%); and intracranial atherosclerosis, 3 (2.6%). Most approaches were by the femoral (66.4%, 73/110) or radial (33.6%, 37/110) artery and the most common target vessels were the left (49.1%, 55/112) or right (42.9%, 48/112) carotid artery. Anatomic variations included severe vessel tortuosity (32.1%, 26/81), type 2 aortic arch (19.3%, 17/88), type 3 aortic arch (15.9%, 14/88), bovine arch (15.4%, 16/104), severe angle (<30°) between the subclavian and target vessel (14.9%, 11/74), and subclavian loop (8.9%, 7/79). The median access time to branch was 18 minutes (IQR 11–28, N = 75). The most common treatments were mechanical thrombectomy, 51 (44.7%); stenting, 25 (21.9%); Pipeline/flow diversion, 10 (8.8%); and stent‐assisted coiling, 8 (7.0%). Technical success was achieved in most (94.7%, 108/114) patients. Access site complications occurred in 3 patients (2.6%). Two complications (1.8%) were related to the large‐bore access catheter. Conclusions : A large‐bore (0.096” inner diameter) access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications.


Sign in / Sign up

Export Citation Format

Share Document