Spontaneous closure of pseudoaneurysm after transapical aortic valve implantation

Transcatheter aortic valve implantation by an apical approach has been developed as an alternative to conventional aortic valve replacement. Complications with these relatively new procedures are being reported. We report a case of transapical transcatheter aortic valve implantation, in which a pseudoaneurysm at the apex of the left ventricle as a complication of the procedure developed in the patient and was treated without surgery. The defect spontaneously closed.     

Surgical treatment of pulmonary artery leiomyosarcoma: a good survival without adjuvant therapy

Primary pulmonary artery leiomyosarcoma is a rare tumor that can be misdiagnosed as acute or chronic pulmonary thromboembolic disease. In this report, we present a case of a 58-year-old woman initially diagnosed with chronic thromboembolic pulmonary disease, but who was later found to have pulmonary artery leiomyosarcoma. A complete mass resection was performed surgically. The definitive pathologic examination was consistent with pulmonary artery leiomyosarcoma. Although the patient did not receive adjuvant therapy after the surgery, she had a good outcome and was free of disease 8 months after surgery.     

A simple technique to rule out occlusion of right coronary artery after aortic valve surgery

Mechanical occlusion of the right coronary artery during aortic valve surgery is an infrequent but serious complication. Early recognition and expeditious management are important to reduce mortality. We developed a safe, quick, and easy technique to assess right coronary artery flow after aortic valve surgery. Direct intraoperative right coronary artery flow was measured by placing a transit-time flowmeter probe around the right coronary artery. We were able to promptly detect severe right coronary artery insufficiency in patients with acute unexpected right ventricular failure after aortic valve replacement.     

Plate fixation for Letenneur type I Hoffa fracture: a biomechanical study

BackgroundA coronal fracture of the posterior femoral condyle, also known as a Hoffa fracture, is an unusual injury, and there are only a handful of case reports or series exploring it. The optimal fixation method of these intraarticular fractures remains controversial; improper or unstable fixation usually lead to an unsatisfactory prognosis. The use of posterior–anterior or reversed lag screw fixation is still a popular method. Additional buttress plating is also recommended for fixation of these difficult fractures. The purpose of this study was to compare the mechanical strength of four different fixation patterns for this uncommon fracture.Material and methodsSixteen sawbone simulated models of Letenneur type I Hoffa fractures were created with one of four fixation patterns: two screws implanted in the anterior–posterior (AP) direction or posterior–anterior (PA) direction; one screw in the PA direction with a plate implanted in the posterior position of the distal femoral condyle or with a plate in the lateral position. Biomechanical testing was performed to determine the post-fixation axial stiffness, the maximum load to failure and the fragment vertical displacement for each of the four constructs.ResultsThe plate fixation patterns whether implanted in the posterior or lateral position were shown to provide higher overall axial stiffness and load to failure, and less vertical displacement than the other two patterns of pure screw fixation. Among these constructs, the lateral plate fixation was found to provide the highest stiffness and load to failure and the least displacement for the posterior condylar fragments, followed by the posterior plate fixation. The lowest overall stiffness and load to failure and the largest vertical displacement were found in the construct with the AP direction placed screws.ConclusionIt was concluded that the lateral position implanted plate is biomechanically the strongest fixation method for Letenneur type I Hoffa fractures. However, this plate fixation is not recommended for all cases. The choice of internal fixation pattern depends on the surgeons.     

The pivotal role of the coronal fracture line for a new three-dimensional CT-based fracture classification of bicondylar proximal tibial fractures

IntroductionClassical fracture classifications (AO/OTA, Schatzker) are commonly used to characterize bicondylar proximal tibial fractures. However, none of these classifications allows for a treatment algorithm. The aim of our study was to use 3D appearance of these fractures in CT imaging to improve the clinical value of the classification.Materials and methods3D appearance of 81 CT scans of bicondylar proximal tibial fractures were systematically analyzed and were classified in 3 subtypes, based on the fracture lines orientation. The novel classification was compared for reliability and for clinical relevance with AO and Schatzker classification.ResultsA total of 159 fracture lines were identified which were most frequently oriented in sagittal (89/159), and in coronal (41/159) direction. Based on the orientation of the major fracture lines three fracture types were defined. A special emphasis was drawn to the coronal fracture line of the medial plateau leading to a surgical treatment algorithm. Interobserver reliability was analyzed for all 81 patients resulting in an excellent reliability of К = 0.936 for the 3D classification scheme compared to К = 0.720 for the AO/OTA, К = 0.785 for the Schatzker classification. Correlations with clinical parameters were only observed for the 3D classification.DiscussionThe presented classification scheme based on the 3D geometry of bicondylar proximal tibial fractures demonstrates a good reliability of clinical relevance.     

Reference for the 2011 revision of the International Standards for Neurological Classification of Spinal Cord Injury

The latest revision of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) was available in booklet format in June 2011, and is published in this issue of the Journal of Spinal Cord Medicine. The ISNCSCI were initially developed in 1982 to provide guidelines for the consistent classification of the neurological level and extent of the injury to achieve reliable data for clinical care and research studies. This revision was generated from the Standards Committee of the American Spinal Injury Association in collaboration with the International Spinal Cord Society's Education Committee. This article details and explains the updates and serves as a reference for these revisions and clarifications.     

胸椎黄韧带骨化症的CT分型及手术方式选择

目的:探讨胸椎黄韧带骨化症的CT分型及手术治疗方法.方法:1997年1月至2006年12月手术治疗胸椎黄韧带骨化症患者48例102个节段,根据CT表现分为3型,单侧型18个节段,双侧型45个节段,两侧融合型39个节段.单侧型将椎板、关节突内侧和未骨化处磨薄,再把骨化物对侧和头尾侧充分减压使其孤立,用枪状咬钳将关节突内侧磨薄处咬开使其游离,齿镊夹住骨块轻提起由中间向外侧剥离摘除骨块;双侧型将椎板、关节突内侧和未骨化处磨薄,先将骨化物头尾侧充分减压,将中间未骨化黄韧带咬除分隔,使两侧骨化物孤立,再按单侧型手术方法逐块处理;两侧融合型将椎板、关节突内侧和未骨化处磨薄,先将骨化物头尾侧充分减压,从对侧关节突内侧磨薄处咬开使骨化物孤立,再将术侧关节突内侧磨薄处咬开使骨化物游离,齿镊夹住骨块轻提起由对侧向术者侧剥离摘除骨块.术前术后采用改良JOA下肢运动功能评分评价运动功能.结果:全部患者顺利完成手术.手术时间平均2.8h,出血量平均290ml.术后无症状加重病例,1例出现脑脊液漏,经保守治疗后痊愈.40例患者随访5～62个月,平均28个月,JOA下肢运动功能评分术前1.8±1.1分,末次随访时为3.7±0.6分,与术前比较差异有显著性(P<0.01).疗效按JOA评分改善率优32例,良6例,可2例,优良率为95%.结论:对胸椎黄韧带骨化症患者根据CT分型采取不同的手术方式可取得满意的治疗效果.     

Renal allograft biopsies in the era of C4d staining: the need for change in the Banff classification system.

C4d immunostaining in the peritubular capillaries (PTC) is a marker of antibody-mediated rejection (AMR). We evaluated the histopathologic diagnoses of 388 renal transplant biopsies since the implementation of routine C4d immunostaining at our center. Of these, 155 (40%) biopsies had evidence of acute cellular rejection (ACR), out of which 119 (77%) had pure ACR, 31 (20%) had ACR with concomitant features of AMR, and five (3%) had ACR with focal C4d staining. Sixty-four (16%) biopsies exhibited features of AMR [33 (52%) pure AMR, and 31(48%) concomitant AMR and ACR]. One hundred and fifty-five (40%) biopsies had features of interstitial fibrosis and tubular atrophy (IFTA). Of these, 20 (13%) had concomitant AMR [13 (8.5%) had pure AMR and seven (4.5%) had concomitant ACR and AMR]. Creatinine at the time of biopsy was higher in patients with mixed ACR and AMR and the clinical behavior of mixed lesions is more aggressive over time. Despite having a lower serum creatinine at the time of biopsy, patients with IFTA experienced gradual decline in graft function over time. The pathologic findings in renal allograft biopsies are often mixed and mixed lesions appear to have more aggressive clinical behavior. These findings suggest the need for change in the Banff classification system to better capture the complexity of renal allograft pathologies.     

产瘫的早期显微外科治疗

目的报道产瘫早期显微外科治疗的经验及分型.方法总结临床发现产瘫类型,应用显微外科技术对产瘫早期进行神经松解、移植及移位手术治疗309例.结果随访二年以上168例,优良率82.35%.结论探讨产瘫临床分型及术式选择;早期诊断治疗很重要.     

Ultrasonic quantification of geniohyoid cross-sectional area and tissue composition: a preliminary study of age and radiation effects

BACKGROUND: This study developed and used a new, noninvasive approach to quantify cross-sectional area and tissue composition within the geniohyoid (GH) muscle in normal adults and head and neck cancer patients. METHODS: B-mode ultrasound was used to measure GH cross-sectional area at rest and during four speech gestures and GH tissue composition at rest in normal young adults, patients with SCC head and neck cancer treated with primary radiotherapy, and normal older adults age matched with the patients. RESULTS: Patients exhibited significantly greater GH cross-sectional area than young subjects at rest and in effortful conditions. Significantly greater muscle tissue variability across GH quadrants was observed in patients compared with normal subjects and in older compared with younger subjects. CONCLUSIONS: B-mode ultrasound area analyses and tissue classification techniques can be used to quantify muscle changes, such as those resulting from age, radiotherapy, or rehabilitation for head and neck cancer.