Tearing Of Vessels Research Articles

Midterm Outcomes of Endovascular Pulmonary Artery Debanding in Children.

Pulmonary artery banding (PAB) palliates pulmonary over-circulation, while endovascular debanding (ED) offers a less invasive alternative to repeat surgery. To evaluate our experience with ED. Retrospective review of single-center data (2015-2023) on children with single, multiple, or "Swiss-cheese" muscular ventricular septal defects (MVSDs) undergoing ED. Ten patients (50% male) underwent ED at a median age of 5 years (IQR, 1.8-6.8) and weight of 15 kg (IQR, 10.6-19.7). Four patients had single MVSD, six had multiple MVSDs. Debanding occurred at a median of 52.8 months (IQR, 18.4-76.6) post-PAB, utilizing six non-compliant Numed Z-MED and four semi-compliant Balt Cristal high-pressure balloons. Median pulmonary valve annulus (PVA) diameters were 15.5 mm (IQR, 12.5-16.8) angiographically. Median balloon-to-PVA diameter ratio was 1 (IQR, 1-1), and median balloon-to-band diameter ratio was 2 (IQR, 1.8-2). Median trans-PAB gradient decreased from 100 mmHg (IQR, 86-108) to 40 mmHg (IQR, 26-46) (p < 0.01) and oxygen saturation improved from a median of 92% (IQR, 86%-97%) to 98% (IQR, 96%-98%) (p < 0.05). There were no procedural complications. Four patients underwent MVSD device closure a median of 7 months (IQR, 3-15) before ED, while seven had concomitant closures, including two with prior closures. Over a median follow-up of 91.7 months (IQR, 71.8-130.7), two patients required redo ED at 23 and 36 months, one with a contained vessel tear. Last recorded maximal Doppler gradient was 27 mmHg (IQR, 9-39). Total ED is safe with satisfactory midterm outcomes, though repeat dilations may be necessary during follow-up.

Sealing of Iatrogenic Distal Coronary Artery Perforation by Liquid Embolization Agent—A Case Report

Percutaneous coronary intervention (PCI) is one of the most commonly performed cardiovascular interventions to treat significant coronary artery stenosis. Although a safe procedure, it carries the risk of complications like coronary artery perforation (CAP), bleeding, stroke, and acute kidney injury rarely resulting in death. The incidence of CAP is 0.84% of all PCI procedures and the incidence is increasing as cardiologists are accepting more and more challenging cases. CAP is caused by a guidewire (GW) or a vessel tear from balloon angioplasty, stenting, or rotational atherectomy. Though the majority of CAPs do not result in cardiac tamponade, some do lead to tamponade and death. The majority of distal wire perforations respond to prolonged balloon inflation, coils, glue, or fat embolization. Herein, we report a case of distal CAP in a 63-year-old woman occurring following left circumflex artery PCI caused by the exiting of coronary GW. The CAP was successfully sealed by the liquid embolization technique using ONYX. First described in 1990, Onyx is an elastic polymer composed of ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide and mixed with micronized tantalum powder (Onyx). The Onyx is predominantly used by interventional radiologists while performing neurovascular and peripheral vascular interventions. There were only a few case reports of plugging of CAPs using Onyx. Our case highlights the safety and feasibility of closing distal CAPs using Onyx.

Amyloid β interferes with wound healing of brain microvascular endothelial cells by disorganizing the actin cytoskeleton

Cerebral amyloid angiopathy (CAA) is a disease in which amyloid β (Aβ) is deposited in the cerebral blood vessels, reducing compliance, tearing and weakening of vessel walls, leading to cerebral hemorrhage. The mechanisms by which Aβ leads to focal wall fragmentation and intimal damage are not well understood. We analyzed the motility of human brain microvascular endothelial cells (hBMECs) in real-time using a wound-healing assay. We observed the suppression of cell migration by visualizing Aβ aggregation using quantum dot (QD) nanoprobes. In addition, using QD nanoprobes and a SiR-actin probe, we simultaneously observed Aβ aggregation and F-actin organization in real-time for the first time. Aβ began to aggregate at the edge of endothelial cells, reducing cell motility. In addition, Aβ aggregation disorganized the actin cytoskeleton and induced abnormal actin aggregation. Aβ aggregated actively in the anterior group, where cell motility was active. Our findings may be a first step toward explaining the mechanism by which Aβ causes vascular wall fragility, bleeding, and rebleeding in CAA.

STUDY ON EFFECTIVENESS OF HIK POTHU KETAKELADHI PASTE FOR ANKLE SPRAIN (ULUKKUWA)

Sprain emerged in society as a prominent disease at the present. Sprain is an injury to the soft tissue around joint, muscles, ligaments and tendons which are attached to bones, serve both to move them and to hold them in place, an injury to soft tissues surrounding of joints, with stretching and tearing or partial tearing of muscles, ligaments, tendons and blood vessels. The life of the people affected by such disorders become so impaired and severely disabled that they may not be able to perform their routine work and causes inefficiency of the person and it may affect the economy of the country. Demanding lifestyle has boosted the incidence of soft tissue injury. Aim of the study is to role of Hik Pothu Ketakeladhi Paste ((Indigenous paste) in the effect of ankle sprain as an external application. 30 patients of Ankle sprain were selected from OPD, Ayurveda Teaching Hospital, Borella and private medical centre based on the diagnostic, inclusion and exclusion criteria. Stem bark of Hik Pothu (stem bark of Calesiam grande Kuntze), Kahata pothu (stem bark of Careya arborea), Ketakela pothu (stem bark of Brideliaretusa), Magul karada pothu (stem bark of Pongamia pinnata), Madan pothu (stem bark of Calyptranthes capitellata), Amu kaha ala (Rhyzome of curcuma longa), Wada kaha (Acorus calamus) Viyandunbulu (powder of Soot), Ran kubalmatti (Powder of wasp’s residence), Kithulpeni (Caryota urens) and Meepeni (Bees honey) present in this paste. The paste was applied at the affected site twice daily for 15 days and removed before it dried. Assessment was done every 07 days. Age distribution showed 40% them belongs to age group of 51-60 years with male predominance of 60%. Occupation wise labourer ranked more. Mode of injury dominates 37% of them had unusual bending due to wearing high heel and patients 63.3% of them had first degree ankle sprain. The study showed percentage of improvement in the clinical features of ankle sprain as pain by 100%, tenderness by 89%, swelling by 83%, Loss of function 1.75 and discolouration by 92%. All the sign and symptoms were gradually reduced at the end of 15 days. Treatment of Hik Pothu Ketakeladhi Paste and they were statistically significant at the level of P&lt; 0.0001. Hik Pothu Ketakeladhi Paste provided significant relief in the signs and symptoms of the ankle sprain. Therefore, Hik Pothu Ketakeladhi Paste can be used as sprain (Ulukkuwa). KEYWORDS: Hik Pothu Ketakeladhi Paste, ankle sprain (Ulukkuwa), soft tissue injury

The spectrum of computed tomography findings in blunt trauma of the subclavian/axillary artery: a pictorial essay.

Traumatic injuries of the subclavian and axillary arteries are uncommon but have high morbidity and mortality. In contrast to penetrating injuries, which are often lethal, blunt injuries present a wide and heterogeneous spectrum of imaging findings. If a vessel tear or transsection is a life-threatening circumstance, minor injuries might be overlooked in an emergency setting but could cause or aggravate the functional loss of a limb. The aim of this pictorial essay is to acquaint radiologists with the spectrum of imaging findings that could be encountered during the radiological evaluation of the subclavian/axillary artery (SAA) in trauma patients and offer tips and tricks to improve the diagnostic workup of patients with suspected blunt SAA injuries.

P18 Assessment of da Vinci robotic system for paediatric laparoscopic procedures

Abstract Introduction We aimed to evaluate the da Vinci surgical system in its application for robotic-assisted laparoscopic surgery in paediatric patients. Methods A narrative review of the literature on the use of this technology was performed following ENTREQ guidelines using PubMed/Medline, EMBASE, and Google Scholar databases with no setting or language restrictions. Results A total of 16 publications were selected for inclusion. Although the literature on the accuracy and precision of this technology are encouraging, its use in paediatric patients are still in its early stages and has yet to be explored in great detail. In addition to the technical intricacies, training and learning curve, port placement complications, cost, we identified concerning shortcomings including its bulkiness and lack of force feedback, which lead to procedural injuries notably, tearing of muscles, blood vessels, and nerves, as well as surgical error. For both, we propose sensory haptic feedback systems, soft tissue model, image-guided or virtual reality simulation training to reduce these injury-related complications. However, this does not replace the necessity for “supervised trial and error” operation of the robotic system in surgical settings. Conclusion Innovations in educational training for robotic surgery include tele-presence surgeries and robotic tele- mentoring, whereby expert surgeons share the same surgical field of view and controls as the training surgeon. In spite of this, there are inevitable risks associated with training when training surgeons must practice through trial and error on real patients and an emphasis must be placed on apposite pre-procedural surgical training. Take-home message Though promising, the use of the Da Vinci robotic system in children is still emerging and thus warrants further evaluation, training, and development prior to its routine implementation for use.

Point-of-care ultrasound evaluation of blunt abdominal trauma.

An 18-year-old male without any significant medical history presented to the emergency department (ED) for evaluation of severe generalized abdominal pain that began immediately after sliding head first into second base during a baseball game. He also reported 2 episodes of non-bloody, non-bilious vomiting. Upon arrival, the patient was in moderate distress secondary to pain and with the following vital signs: temperature 36.8°C, blood pressure 117/75 mmHg, heart rate 127 beats per minute, respiratory rate 19 breaths per minute, and oxygen saturation 100% on room air. Physical examination revealed significant diffuse abdominal tenderness to palpation; however, the abdomen was without rebound, guarding, or peritoneal signs. A focused assessment with sonography for trauma (FAST) examination was subsequently performed that demonstrated intra-abdominal free fluid (Figure 1). General surgery was immediately consulted based on the abnormal point-of-care ultrasound (POCUS) findings. Computed tomography of the abdomen/pelvis confirmed a moderate amount of fluid and blood within the peritoneal cavity as well as a localized mesenteric hematoma of the right mid lower abdomen (Figure 2). The patient was taken for emergent diagnostic laparoscopy converted to an open small bowel resection with findings of a large mesenteric hematoma with intra-abdominal hemorrhage secondary to a mesenteric vessel tear at a ruptured Meckel's diverticulum. Mesenteric hematoma with intra-abdominal hemorrhage from ruptured Meckel's diverticulum. The FAST examination, which is highly specific for detecting intra-abdominal free fluid, is an essential bedside tool for the ED evaluation of trauma.1-5 To the best of our knowledge, this is the first description of emergency physician-performed FAST, which identified a rare complication of intra-abdominal hemorrhage from a ruptured Meckel's diverticulum. Pertinent to our case, a positive FAST conveys valuable prognostic information in normotensive patients with blunt abdominal trauma.6, 7 The POCUS ultrasound findings were critical in expediting confirmatory imaging and emergent surgical consultation. This report illustrates the imperative role of a timely FAST for hemodynamically stable patients in the particular setting of blunt abdominal trauma. The authors have nothing to disclose. This research was supported in part by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Osteological studies of skull base neurovascular area in reference to infratemporal approach to skull basec

Surgical approaches to the lateral skull base often lead to tearing of vessels and piecemeal removal of the tumour. This study is aimed to delineate exact relationship of the various foramina at the lateral skull base. The coronal dimensions of the jugular foramina are larger as compared to sagittal with right sided dominance also noticed in the case of carotid canal. The width of “Keel” separating the carotid and jugular foramina normally varies from 0.4 to1.4 centimetres and may not always suggest the erosion of the foramen of skull base scans, unless the erosion is associated with irregularity or demineralization the thickness of this keel really depends upon relative size of the vessels and location of foramina. Area between stylomastoid foramen, carotid canal and jugular foramen is roughly wedge shaped. The angle subtended by carotid and jugular at the stylomastoid foramen is about 36.84whereas the location of stylomastoid foramen and internal carotid axis pose an angle of 83:16. The angle subtended by stylomastoid and jugular at carotid on an average 59:31. The space between these structures is measured to be 0.642centimetres which can be verified on tomograms. By using these measurements, the precise location of the upper end of the vessels could be predicted, whereas the superior stump could be clamped with minimal exposure of the skull base and identification and location of the last four cranial nerves is found out. This could avoid injuries and subsequent morbidity while carrying out surgery in this region.

Usefulness of Virtual Fluoroscopy in Emergency Interventional Radiology.

Interventional radiology (IR) embolization requires image guidance to steer catheters to the site of bleeding, where embolic agents such as Gelfoam or coils are administered to stem blood flow. In addition to treating iatrogenic trauma, embolization is suitable for injuries precluding surgery such as blush-bleeding of the liver or kidney and for locating and treating intimal blood vessel tears. However, during hospital off-hours (such as nights and holidays), experienced IR personnel are not always available. In such situations, there is a dire need to build a coordinated IR team to treat seriously injured patients rapidly and reliably. This article reviews the current principles and techniques used in IR such as virtual fluoroscopy and their usefulness, and makes a convincing case for emergency IR.

The clinical value of high frequency ultrasound combined with color Doppler flow imaging in diagnosis and classification of trauma of penis

Objective To investigate the value of high frequency ultrasound combined with color Doppler flow imaging in diagnosis and classification of trauma of penis on the clinical treatment. Methods The sonographic features of 48 cases with penile trauma were analyzed and compared with treatment outcomes. Results The ultrasonic findings of penile trauma ranged from penis contusion to penis fracture. According to the sonographic features, the trauma of penis was grouped as follows: Type 1, penis bruise (7 cases) presented with images of continuous penis skin and tunica albuginea, inhomogeneous echoes of subcutaneous tissue. Type 2, corpora cavernosa bruise (4 cases) showed images of continuous tunica albuginea, inhomogeneous internal echoes of corpora cavernosa without abnormal flow signal. The corpora cavernosa swelling into honeycomb-like, anechoic area of cavernosa with high-speed artery Doppler signals when accompanied by cavernous artery injury. Four cases were treated conservatively. Type 3, the skin and subcutaneous tissue contusion (6 cases) manifested images of incontinuous and inhomogeneous echoes of skin and subcutaneous tissue but homogeneous echoes of corpora cavernosa and tunica albuginea. Six cases of patients underwent debridement and sutured by local anesthesia. Type 4, rupture of tunica albuginea(26 cases) revealed images of incontinuous and irregular local tunica albuginea, a hematoma seen between the tunica albuginea and subcutaneous tissue. Type 5, penile fracture (5 cases) revealed mostly or fully disconnected skin and corpora cavernosa, tearing of blood vessels. The patients of type 4 and 5 were all treated surgically. Conclusions Color Doppler ultrasonography could provide accurate assessment and classification for trauma of penis, which is helpful to offer a reliable basis for clinical treatment scheme. Key words: Ultrasonography; Penis; Rupture; Trauma

Residual Arch Tears and Major Adverse Events After Acute DeBakey Type I Aortic Dissection Repair

Tear-oriented surgical procedure is considered a standard treatment for acute DeBakey type I aortic dissection (AIAD). However, long-term surgical outcomes, including aortic growth and rate of major adverse aortic events (MAAEs), have yet to be clarified. Of the 274 patients who underwent surgical repair for AIAD between 2009 and 2016, 105 patients with both predischarge and follow-up computed tomographic scans were enrolled. The surgical extent was determined by primary entry tear location. We measured aortic diameters (pulmonary artery bifurcation, maximum diameter of the descending thoracic aorta [maxDTA], andceliac axis) and compared MAAEs (aorta growth rate ≥ 5 mm/year or maxDTA ≥ 55 mm according to surgical extent). Twenty-nine patients underwent total arch replacement (TAR); 76 underwent non-TAR. In the non-TAR group, patients with or without residual tears in the arch vessels were classified as having complete arch repair (non-TAR-CAR, n= 52) or incomplete arch repair (non-TAR-IAR, n= 24). Considerable differences were found in the aortic growth rate between the TAR and non-TAR groups and the non-TAR-CAR and non-TAR-IAR groups. Freedom from MAAEs at 5 years was considerably higher in the non-TAR-CAR group than in the non-TAR-IAR group (84.5% versus 31.1%). However, no differences were observed in the aortic growth rate and freedom from MAAEs between the TAR and non-TAR-CAR groups. Classic tear-oriented surgical procedure is insufficient for optimal long-term surgical outcomes, mainly regarding aortic dilation. CAR without residual arch vessel tears leads to favorable aortic remodeling in the residual DTA and prevents MAAEs after AIAD repair.

Where Does the Transplanted Fat is Located in the Gluteal Region? Research Letter

ABSTRACTIntroduction: Liposuction is one of the most popular plastic surgery procedures. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have been reported. A possible explanation is the puncture and tearing of gluteal vessels during the procedure, especially when a deep injection is planned. Objective: To identify the places where fat can be located after injection during a fat graft in the gluteus. Methods: An experimental study was done in which colorant was injected in four directions using four different quadrants of the gluteus. We Injected 10 cc six times following clock hands until 60 cc were injected, and the cutaneous flap and the muscles were then elevated. Our main purpose was to describe where the colorant went and if it was in contact with the vessels (superior and inferior gluteal vessels). In total, four gluteus muscles were injected and dissected. Results: Injection in the lower lateral quadrant was mainly into the muscle, and colorant was observed in the hypogastric vessels. The injection in the upper quadrants stayed mainly in the subcutaneous tissue. Conclusions. During surgery, it is important to identify the location of the perforators and to avoid a deep injection, especially from the lower lateral quadrant to the superior medial quadrant (Q4 to Q1), as the probability of puncturing and injecting fat into the main vessels from this direction is higher.

Cataract Surgery after Retinal Detachment Surgery with Arruga's Sutures: Case Report.

A 56-year old female patient presented to our clinic with a complaint of low vision in her right eye. Twenty-two years earlier she had undergone a scleral buckling operation in her right eye because of retinal detachment. She indicated that vision in her right eye was good after the surgery but had recently been gradually declining. Best-corrected vision acuity was counting fingers at 1 meter in the right eye and 8/10 in the left eye. Anterior segment examination revealed stage 3 nuclear cataract in the right eye. Examination of the right eye was blurred and revealed an area of chorioretinal atrophy posterior to the equator, approximately 3 disc diameters in the peripapillary zone and about 2 disc diameters in the nasal papilla zone. Anteriorly of the equator there was an area of chorioretinal atrophy as well as a narrow, sharply demarcated, shiny 360⁰ suture with high buckling pressure, situated intraretinally but extending into the vitreous in some places. The structure was thought to be made of polyethylene. Around the suture there were retinal atrophic changes. After detailed explanation of the possible surgical complications and after obtaining informed consent, the right eye cataract was removed by phacoemulsification and a foldable intraocular lens was placed into the capsule. During the operation, we worked under low fluid pressure and as atraumatically as possible due to the possibility of intraocular pressure changes and the risk of the suture causing retinal and blood vessel tears or passing completely into the eye and causing intravitreal hemorrhage. A month after an uncomplicated surgery, the posterior segment examination demonstrated a reattached retina and the patient’s best corrected visual acuity was 6/10.

Emerging Subspecialties in Neurology: Pediatric stroke and cerebrovascular disorders.

In 1895, a neuropathologist at the University of Vienna observed that “a large number of cases of infantile cerebral palsy is caused by the same factors that bring about the majority of cases of cerebral paralysis of adults: by tearing, embolism, and thrombosis of cerebral vessels.”1 While Sigmund Freud would go on to become better known for other endeavors, his observation that children can have strokes paved the way for the development of the emerging subspecialty of pediatric stroke and cerebrovascular disorders.

Histopathological study of the outer membrane of the dura mater in chronic sub dural hematoma: Its clinical and radiological correlation.

Background:A chronic subdural hematoma is an old clot of blood on the surface of the brain between dura and arachnoid membranes. These liquefied clots most often occur in patients aged 60 and older with brain atrophy. When the brain shrinks inside the skull over time, minor head trauma can cause tearing of blood vessels over the brain surface, resulting in a slow accumulation of blood over several days to weeks.Aim of the Study:To evaluate the role of membrane in hematoma evaluation and to correlate its histopathology with clinic-radiological aspects of the condition and overall prognosis of patients.Material and Methods:The study incorporated all cases of chronic SDH admitted to the Neurosurgery department of JLN Hospital and Research Centre, Bhilai, between November 2011 and November 2013. All such cases were analyzed clinically, radiologically like site, size, thickness in computed tomography, the attenuation value, midline shift and histopathological features were recorded.Criteria for Inclusion:All cases of chronic subdural haematoma irrespective of age and sex were incorporated into the study.Criteria for Exclusion:All cases of acute subdural haematoma and cases of chronic sub dural hematoma which were managed conservatively irrespective of age and sex were excluded from the studyResults:In our series of cases, the most common histopathological type of membrane was the inflammatory membrane (Type II) seen in 42.30% of cases followed by hemorrhagic inflammatory membrane (Type III) seen in 34.62% of cases while scar inflammatory type of membrane (Type IV) was seen in 23.08% of cases. No case with noninflammatory type (Type I) was encountered.

Diffuse axonal injury at ultra-high field MRI.

ObjectiveDiffuse axonal injury (DAI) is a specific type of traumatic brain injury caused by shearing forces leading to widespread tearing of axons and small vessels. Traumatic microbleeds (TMBs) are regarded as a radiological marker for DAI. This study aims to compare DAI-associated TMBs at 3 Tesla (T) and 7 T susceptibility weighted imaging (SWI) to evaluate possible diagnostic benefits of ultra-high field (UHF) MRI.Material and Methods10 study participants (4 male, 6 female, age range 20-74 years) with known DAI were included. All MR exams were performed with a 3 T MR system (Magnetom Skyra) and a 7 T MR research system (Magnetom 7 T, Siemens AG, Healthcare Sector, Erlangen, Germany) each in combination with a 32-channel-receive coil. The average time interval between trauma and imaging was 22 months. Location and count of TMBs were independently evaluated by two neuroradiologists on 3 T and 7 T SWI images with similar and additionally increased spatial resolution at 7 T. Inter- and intraobserver reliability was assessed using the interclass correlation coefficient (ICC). Count and diameter of TMB were evaluated with Wilcoxon signed rank test.ResultsSusceptibility weighted imaging revealed a total of 485 TMBs (range 1-190, median 25) at 3 T, 584 TMBs (plus 20%, range 1-262, median 30.5) at 7 T with similar spatial resolution, and 684 TMBs (plus 41%, range 1-288, median 39.5) at 7 T with 10-times higher spatial resolution. Hemorrhagic DAI appeared significantly larger at 7 T compared to 3 T (p = 0.005). Inter- and intraobserver correlation regarding the counted TMB was high and almost equal 3 T and 7 T.Conclusion7 T SWI improves the depiction of small hemorrhagic DAI compared to 3 T and may be supplementary to lower field strengths for diagnostic in inconclusive or medicolegal cases.

Left spermatic vein retrograde sclerosis: comparison between sclerosant agent injection through a diagnostic catheter versus through an occluding balloon catheter.

The aim of this study was to compare the technical success between left spermatic vein (LSV) scleroembolisation achieved with the injection of sclerosant through a diagnostic catheter and through an occluding balloon (OB), in the treatment of male varicocele. From January 2012 to September 2013, we prospectively enrolled 100 patients with left varicocele and an indication for LSV scleroembolisation related to symptoms or spermiogram anomalies; patients were randomised to two groups (we wrote a list of 100 lines assigned casually with A or B and each patient was consecutively allocated to group A or B on the basis of this list). Patients in group A underwent injection of the sclerosing agent through an angiographic diagnostic catheter (free catheter technique) and patients in group B through an OB catheter (OB technique). In cases of incomplete occlusion of the LSV, the procedure was completed with coils. Total occlusion of the LSV at post-treatment phlebography during a Valsalva manoeuvre before any coil embolisation was considered a technical success. The rate of complications was also evaluated. The Fischer's test was used for statistical analysis. We evaluated a total of 90 patients because five patients for each group were not included in the statistical analysis owing to technical problems or complications. In group A we had a technical success of 75.6 versus 93.4% in group B, and the difference was statistically significant (P=0.003); in particular, we had to complete the embolisation with insertion of coils in 11 cases (24.4%) in group A, and in three cases in group B (6.6%). In group A, LSV rupture occurred in four cases (8%) so the procedure was completed by sclerosant injection through the OB located distally to the lesion. These patients were not considered for evaluation. In another case, a high flow shunt towards the inferior vena cava was detected, so the patient underwent OB injection to stop the flow to the shunt, and was not included for statistical evaluation. In group B, vein rupture with contrast leakage was noted in six cases (12%); nonetheless, all the procedures were completed because the OB was positioned distally to the vessel tear, obviating any retrograde leakage of sclerosant. In group B, in five cases (10%), we were unable to advance the OB though the LSV ostium so the procedures were completed with the diagnostic catheter and not considered for statistical evaluation. On the basis of our data, the embolisation of the LSV obtained by injecting the sclerosant through an OB rather than through a diagnostic catheter seems to be more effective in achieving total vein embolisation, as well as allowing a controlled injection of sclerosant even in cases of vein rupture.

Use of covered Cheatham-Platinum stents in congenital heart disease

BackgroundControversy remains regarding the use of covered stents in congenital heart disease (CHD). We evaluate the possibilities and safety of covered Cheatham-Platinum (CCP) stents in CHD. MethodsSingle-center retrospective CHD-database study of all CCP stents, 2003–2012. Three study groups: aortic coarctation (CoA), right ventricular outflow tract pre-stenting for percutaneous revalvulation (RVOT), and miscellaneous. Continuous data expressed as median (range). Results114 CCP stents in 105 patients, age 16.8years (4.2–71.2).CoA group: 54 CCP stents in 51 patients: 3/54 for aneurysm exclusion, in 51/54 covering used “prophylactically” because of increased risk for vessel tear. Overall, CCP stenting increased the coarctation diameter from 6mm (0–15) to 15mm (10–20) (p<0.001).RVOT group: 39 CCP stents in 37 patients (34 with RVOT graft, 3 with transannular patch): the graft lumen had shrunken from nominal 21mm (10–26) to 13mm (5–22); with the CCP stent the RVOT was redilated to 22mm (16–26, p<0.001 vs stenosis).Miscellaneous group: 21 CCP stents in 17 patients: closure of Fontan-circuit fenestration (n=5), restoration of superior caval vein (n=2) or pulmonary artery (n=3) patency, relief of supra-pulmonary stenosis (n=2), exclusion of aberrant pulmonary arteries (n=1), cavopulmonary conduit expansion (n=2), Blalock–Taussig shunt flow reduction (n=1), and defibrillator lead protection from sharp stents (n=1). Hybrid procedures performed in 3/17 patients. CCP stent was used as rescue treatment in 2/patients to seal iatrogenic bleeding. ConclusionCCP stents can safely be applied in CHD patients. The covering allows adequate sealing of existing or expected tears, thereby increasing the safety margin with more complete dilation.

Significance of Contre-Coup Injury in Trauma to Brain for Concluding Manner of Death: A Case Report

Traumatic brain injury is defined as an alteration in the brain function, or other evidence of brain pathology, caused by an external force. Injuries to brain can be classified as those occurring due to primary damage and secondary damage. Primary damage is that occurs at the time of actual impact. There are multiple types of primary damages that may occur. These include: skull fracturebreaking of skull bone, contusion/bruise, hematoma/blood clot, laceration, and nerve damage (diffuse axonal injury). While secondary damage is the damage that occurs over time after the actual brain injury; may include infection, hypoxia (oxygen deprivation), edema (brain swelling), elevated intracranial pressure, infraction (death of brain tissue which results in loss of blood supply to that region of the brain) and hematoma (focal area of bleeding in the skull due to tearing of blood vessels). When one considers the various types of intracranial lesion produced by trauma to the head, there is one type of injury which excites much speculation as to the application in solving medico legal cases, namely, contre-coup injury a type included in closed head injury. Coup contre-coup injury describes contusions that are both at the site of the impact and on the complete opposite side of the organ. This occurs when the force impacting is not only great enough to cause a contusion at the site of impact, but also is able to move the organ and cause it to slam into the opposite side of the hard protective wall of the organ, which causes the additional contusion. It can be seen in brain, heart[1], spleen and lungs[2,3]. Commonly, it is seen in brain. In most head injuries - notably traffic accidents and falls-there is marked deceleration of the moving head on contact with a fixed surface, though there might still be a ‘coup’ lesion at the site of impact, there is often cortical damage on the opposite side of the brain-the ‘contre-coup’ lesion[4]. Practical points to be considered are - there may be no coup damage at all, only contre-coup. There need be no fracture of skull, even in the presence of severe coup and contrecoup lesions. The most common site for contre-coup injury is in the frontal and temporal lobes. It is often at the tips and on the undersurface of these lobes, and may be symmetrical, if a fall on the occiput has occurred. In temporal or parietal impacts, the contre-coup lesions are on contralateral regions but exact geometrical correspondence is not necessary[5]. Few authors opine that in absence of other injuries to head and brain contre-coup injury is most dangerous. The authors describe here a case where the understanding of coup and contre-coup injury helped in solving the case and administration of justice.

Innovative Technique of Vascular Repair in Intra-Operative IVC Rupture During Lumbar Microdiscectomy: A Case Report

BackgroundMajor vascular injury during a spinal surgery is a rare but most dreaded complication.Case PresentationA 39 years old female undergoing microscopic lumbar discectomy suddenly developed severe hypotension on table. The procedure was abandoned and the patient turned supine. It was diagnosed to be a major vessel tear and the patient was taken up for immediate successful vascular repair. To best of our knowledge such a repair procedure has not been described in literature.ConclusionsMajority of such vascular injuries are dealt with primary repair of the defect by a vascular surgeon; however in our case the rent was big and placed on the undersurface making it very difficult for the vascular surgeon to approach or repair it primarily.