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Radiology. 2002 Dec;225(3):736-43.
Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella.
Elias DA, White LM, Fithian DC.
Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, University of Toronto, 600 University Ave, Toronto, Ontario, Canada M5G 1X5.
PURPOSE: To assess magnetic resonance (MR) imaging findings after acute lateral patellar dislocation (LPD) with emphasis on the medial patella restraints and to describe a medial patellar impaction deformity. MATERIALS AND METHODS: Knee MR images obtained within 8 weeks after LPD were evaluated for medial retinacular and medial patellofemoral ligament (MPFL) disruption, vastus medialis obliquus (VMO) edema and/or elevation, and other derangements. One hundred patients with no evidence of prior LPD were evaluated as controls. The Student t test was used for statistical comparisons. RESULTS: Eighty-two examinations were performed in 81 patients with LPD (mean age, 20 years; age range, 9-57 years). Seventy-six percent (62 of 82 examinations) showed medial retinacular disruption at its patellar insertion; 30% (25 of 82), at its midsubstance. The MPFL femoral origin was identified in 87% (71 of 82); of these, 49% (35 of 71) showed injury. Forty-eight percent (39 of 82) showed more than one site of injury to the medial stabilizers; 45% (37 of 82) showed edema or hemorrhage at the inferior VMO. Mean VMO elevation in the coronal plane of the adductor tendon was 2.2 cm, with a range of 0.6-4.5 cm (in control subjects, 0.9 cm; range, 0.1-2.5 cm; P <.001). At the inferomedial patella, 70% (57 of 82) of LPD examinations showed osteochondral injury and 44% (36 of 82) showed concave impaction deformity (0 of 100 control subjects). Other examination findings in LPDs included contusions of the lateral femoral condyle (66 [80%] of 82 examinations) or medial patella (50 [61%] of 82), intraarticular bodies (12 [15%] of 82), effusion (45 [55%] of 82), medial collateral injury (nine [11%] of 82), and meniscal tear (nine [11%] of 82). CONCLUSION: Injury to the medial retinaculum, MPFL, and VMO may be identified at MR imaging after acute LPD. Concave impaction deformity of the inferomedial patella is a specific sign of prior LPD.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12461254&dopt=Abstract hemorrhage
Rev Stomatol Chir Maxillofac. 2002 Nov;103(5):281-7.
[Vascular complications after cranio-facial trauma]
[Article in French]
Heymans O, Nelissen X, Gilon Y, Damme HV, Flandroy P.
Departement de Chirurgie Plastique et Reconstructive, CHU Sart Tilman, 4000 Liege, Belgique, France.
Despite recent advances in automobile safety, facial trauma remains a common event. Cranio-facial trauma, which usually occurs within a context of multiple trauma, can, in some patients, lead to serious life-threatening vascular complications. Such injury usually involves the carotid system (hemorrhage, aneurysm, dissection). Management of these vascular injuries must be given the same priority as other multiple trauma injuries. We present few typical cases illustrating carotid-cavernous or vertebro-vertebral fistulae, false aneurysms, arterial dissections or oro-facial bleeding. Bleeding is generally controlled by ligation or compression, other lesions being diagnosed secondarily by arteriography depending on the particular clinical situation. Treatment may involve endovascular procedures to achieve intravascular embolism or vascular occlusion.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12461463&dopt=Abstract hemorrhage
Int J Biometeorol. 2002 Dec;47(1):13-20. Epub 2002 Oct 23.
A study of weekly and seasonal variation of stroke onset.
Wang H, Sekine M, Chen X, Kagamimori S.
Department of Welfare Promotion and Epidemiology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama, 930-0194 Japan. wanghs.toyama.mpu.ac.jp
A registry based study was conducted to assess the variation in first-onset stroke with weekdays and seasons, in relation to the effects of age. Between 1 December 1991 and 30 November 1998, 10,729 first-onset stroke patients aged 25 or more were registered in Toyama Prefecture, Japan. We compared the weekly and seasonal variation in first-onset stroke by a one-way goodness-of-fit chi(2)-test. The relationship between seasonal variation in stroke onset and age was also evaluated by the method of Kendall's tau-b R x C tables with ordered categories. The frequency of onset of all strokes and cerebral infarctions (CI) was significantly higher on weekdays than at weekends (P < 0.01). More men had strokes and CI on a Monday (P < 0.01), and more women had cerebral hemorrhage (CH) on a Monday and CI at the end of the week. Stroke incidence was higher in patients aged less than 60 years (20.6%) than in those aged 60 years or over (18.7%) on a Monday compared to the weekend. By chi(2)-test, comparing observed with expected numbers of stroke onsets, weighted by the number of days in each 3-month period, the incidence of all strokes, CI and CH was significantly higher in winter and spring than in summer. The seasonal variation in the onset of stroke declined with age: all strokes (P < 0.001) and CH (P < 0.001) in both genders; subarachnoid hemorrhage (P < 0.001) only in men. Our study shows that the onset of stroke is more frequent on weekdays than on weekends, and may be associated with changes in psychophysiological stresses between working days and the weekend. We also observed a clear negative dose response relationship between seasonal variations in occurrence and age. It may be speculated that younger people have more change to work outdoors, exposing themselves to the winter environment. Their lifestyle and physiological condition may be different from those of older people.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12461606&dopt=Abstract hemorrhage
Neurosurgery. 2003 Feb;52(2):283-93; discussion 293-5.
Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy.
Zhang YJ, Barrow DL, Cawley CM, Dion JE.
Department of Neurological Surgery, Emory University School of Medicine and the Emory Clinic, Atlanta, Georgia 30322, USA.
OBJECTIVE: With the increased use of endovascular therapy, an increasing number of patients with incompletely treated intracranial aneurysms are presenting for further surgical management. This study reviews our experiences with such patients. METHODS: During a 7-year period, 38 patients with 40 intracranial aneurysms who were initially treated with endovascular therapy underwent surgical obliteration of refractory or recurrent lesions. All patients were recorded in a prospective registry, and their clinical data and imaging studies were analyzed retrospectively. RESULTS: Twenty-six anterior and 14 posterior circulation aneurysms were treated. Four aneurysms were on the cavernous internal carotid artery, 13 were on the distal internal carotid artery, 6 were on the anterior communicating artery complex, 2 were on the middle cerebral artery, 3 were on the posteroinferior cerebellar artery, 1 was at the vertebrobasilar junction, 3 were on the superior cerebellar artery, 4 were at the basilar apex, 2 were on the posterior cerebral artery, and 1 was on the distal vertebral artery. Two pseudoaneurysms-one on the petrocavernous segment of the internal carotid artery and one on the distal VA-also were treated. The median time until recurrence was 6 months. Thirty-one aneurysms were clip-ligated, and six were treated with trapping. Three extracranial-intracranial bypasses were performed. One aneurysm was treated with muslin wrapping. Two aneurysms required the use of surgical approaches that involved hypothermic circulatory arrest. Nine aneurysms required coil mass extraction and/or complex vascular reconstruction to complete lesion obliteration. All aneurysms except the single wrapped aneurysm were successfully excluded from the intracranial circulation. Two deaths occurred as a result of the operative procedures, and another patient died as a result of subarachnoid hemorrhage-induced massive myocardial infarction. Ultimately, 86.8% of patients achieved an excellent or good recovery. CONCLUSION: With endovascular therapy assuming an increasing role in the treatment of patients with intracranial aneurysms, more lesions that are refractory to initial treatment will require surgical management. Our experience indicates that good results are attainable, although technical challenges are frequently encountered.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12535356&dopt=Abstract hemorrhage
Presse Med. 2002 Nov 9;31(36):1700-3.
[Necrotic eosinophilic angiitis with ileal perforation and peritonitis secondary to abdominal angiostrongyliasis]
[Article in French]
Vuong PN, Brama P, Bonete R, Houissa-Vuong S, Catanzano-Laroudie M, Baviera E.
Unite d'anatomie et de cytologie pathologiques, Hopital Saint-Michel 33, rue Olivier de Serres, 75730 Paris. vuongocphaanadoo.fr
INTRODUCTION: Abdominal angiostrongyliasis caused by the filiform nematode Angiostrongylus costaricensis, is an endemic disease in Central and South America. A case of necrotic eosinophilic angeitis with ileum perforation and peritonitis due to abdominal angiostrongyliasis is reported. OBSERVATION: A 32 year-old man, living in a Paris suburb, underwent segmentary resection of the ileum with end to end anastomosis for perforation with generalized peritonitis. The anatomopathological examination revealed eosinophilic necrotic lesions with thrombosis on the borders of the ileum perforation. The discovery of a section of A. costaricensis in the lumen of a nearby muscular artery initiated an epidemiological survey, revealing that the patient had visited French Guyana 2 months earlier. DISCUSSION: Angiostrongylus costaricensis is a nematode parisiting certain forest rodents that become its permanent host. The intermediate hosts are earth molluscs or slugs of the same family. Humans are accidentally infected following ingestion of vegetables infested with L3 larvae or slugs carrying the disease. The clinical symptomatology is unspecific: prolonged fever, anorexia, and right iliac fossa pain with eosinophilia of the blood. Often benign, the progression of abdominal angiostrongylosis is punctuated by complications: occlusive syndrome, generalised peritonitis due to intestinal perforation and mass syndrome. Hemorrhage, infarct, pseudo-tumoural fibrosis and ulcers represent the surgical or macroscopic rearrangements. In the tissue, 4 lesions characterize abdominal angiostrongylosis: eosinophilic necrotic angeitis, foreign body granulomas, eosinophilia in the digestive wall, and the presence of A. costaricensis in the lumen of the vessels. There is presently no medical treatment and surgery is the only therapeutic option.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12467150&dopt=Abstract hemorrhage
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