No abstract available.
Tibia*

An inferior vena cava (IVC) filter is a useful treatment to prevent a pulmonary embolism (PE) in patients with DVT. Since the introduction of IVC filters more than 30 years ago, there has been a steady improvement in the design, ease and safety of the delivery system. The use of a temporary filter has also increased as performing thrombolysis and thrombectomy has increased. Today all of the commonly used filters can be placed via a peripheral vein by using the standard percutaneous Seldinger (Ed note: check the spelling) technique. However this typically requires fluoroscopy, intravenous contrast agents, radiation exposure and transport of the patient to the interventional or operating suite. As the multiple trauma injured or critically-ill intensive care unit patients often require inotropic and ventilator support, transporting these patients to these facilities can be hazardous. The following report describes two cases of VTE patients who underwent percutaneous placement of an IVC filter with using duplex ultrasound guidance. Identification of the renal vein and artery is important to decide the infrarenal level. The first case was an 84 years female with right ilio-femoral DVT and pulmonary embolism. To prevent recurrence of PE, we decided to insert an IVC filter. The second case was a 47 years female with right femoral DVT together with left pulmonary embolism and infarction. She also had thrombocytopenia, which is a contraindication for anticoagulation. IVC filter insertion can be safely performed under ultrasound guidance. This technique will reduce the risk and complexity of inserting an IVC filter in selected multiple injured trauma patients.
Arteries ; Contrast Media ; Female ; Fluoroscopy ; Humans ; Infarction ; Intensive Care Units ; Multiple Trauma ; Pulmonary Embolism ; Recurrence ; Renal Veins ; Thrombectomy ; Thrombocytopenia ; Veins ; Vena Cava Filters ; Vena Cava, Inferior ; Ventilators, Mechanical

PURPOSE: There is a traditional belief that the oriental squatting position could be harmful to a femoral artery-graft anastomosis. Should patients be advised not to squat after a femoral artery bypass-graft? We studied the morphological changes during squatting to determine if there were any negative effects on the anastomosis configuration. METHOD: For a fluoroscopic marker, after the anastomosis at least five 2 mm Hemo-clips(R) (Telefix, Inc., US) with an interval of 1 mm, were left along the PTFE graft and native artery in eight patients. Five patients (10 limbs) were evaluated by fluoroscopy at 2 weeks post surgery. X-rays were taken serially for lateral views of the hip joint supine, in hip flexion (90 degrees) and in the knee to chest position, which simulated squatting. The angle of the graft-artery at each position was measured in the PACS computer screen. RESULT: The angle for each position in the 10 limbs was studied. The mean angle changed from supine to the knee-chest position and was 22.2 degrees. The larger angle between the abdominal wall and the graft was reduced in all cases, which means that the shape of the graft-artery became T-shaped. CONCLUSION: The configuration of the graft-artery after squatting became T-shaped, which was contrary to our belief that the angle would decrease between the abdominal wall and the graft. There is no evidence that this configuration would have a negative influence on the graft patency.
Abdominal Wall ; Arteries ; Extremities ; Femoral Artery ; Fluoroscopy ; Hip ; Hip Joint ; Humans ; Knee ; Knee-Chest Position ; Polytetrafluoroethylene ; Thorax ; Transplants

The obturator bypass operation is not a common procedure. In 1963, Shaw and Baue first described performing bypass surgery through the obturator foramen as a technique to deal with infected arterial prostheses in the groin. This operation has been used to reconstruct patients with groin infection, irradiation ulcer, mycotic aneurysm, trauma and excessive scar tissue in the femoral region. We experienced one case of transobturator foramen bypass surgery from a Dacron iliac limb to the popliteal artery.
Aneurysm, Infected ; Cicatrix ; Extremities ; Groin ; Humans ; Polyethylene Terephthalates ; Popliteal Artery ; Prostheses and Implants ; Ulcer

PURPOSE: Sometimes, there are endograft shortenings during endovascular aneurysm repair (EVAR). They are associated with various changes of endograft position in a 3-dimensional (3D) space. The purpose of this study is to evaluate the accuracy of central luminal line (CLL) measurements and understand the degree of endograft shortenings. METHODS: Preoperative 3D computed tomographic (CT) scans were evaluated for every EVAR case. Preoperative working lengths were measured with computerized software that allowed for centerline measurements on 3D reconstructions based on CT data. We compared preoperative CLL measurements and used the endograft length. In this study, the ipsilateral limb length comparisons were excluded, because the overlapped stent-graft length can influence the total ipsilateral limb length. Hence, only the contralateral limb lengths were compared with each other. RESULTS: Preoperative contralateral lengths in the 9 limbs were studied. There was no large difference (below 10 mm) in almost all cases except for one (15 mm shortening), which was very tortuous aortoiliac anatomy. The mean difference between preoperative CLL measurements and the used stent-graft length was 4.48 mm. CONCLUSION: Although these shortenings can be overcome with the deployment technique, the operator should prepare various length extensions in tortuous anatomy.
Aneurysm ; Aortic Aneurysm, Abdominal ; Extremities ; Phenobarbital

No abstract available.
Adenoids* ; Carcinoma, Adenoid Cystic*

A temporary balloon occlusion of internal carotid artery (ICA) was performed in 3 patients for carotid artery endarterectomy and 1 patient require sacrifice ICA with neck malignancy. EEG monitoring and neurologic evaluation was done during the test. In one patient who has bilateral ICA stenosis more than 95% shows slurred speech and aphasia during test. Another 3 patients shows no clinical change during test, and operation was done without shunt. There were no postoperative neurologic complication. We believe that preoperative balloon occlusion of ICA provide another helpful criteria to decide using shunt. But it needs another hemodynamic analysis tool according to other's report.
Aphasia ; Balloon Occlusion ; Carotid Arteries* ; Carotid Artery, Internal ; Constriction, Pathologic ; Electroencephalography ; Endarterectomy ; Hemodynamics ; Humans ; Neck

BACKGROUND: Video-assisted thoracoscopic surgery(VATS) has been established as a new method for treatment of spontaneous pneumothorax. We compared the clinical results of VATS with those of thoracotomy performed during the recent 5 years. MATERIAL AND METHOD: We analyzed 126 patients whose medical records were available among the 154 patients who underwent operations for spontaneous pneumothorax from 1992 to 1996. The mean age was 27.1 years(15 to 75 years). 87 patients were operated on by VATS(Group A) and the other 39 by thoracotomy(Group B). The mean follow-up period was 14.7 months. RESULT: The operation time was shorter in group A than in group B(90.6+/-38.6minutes: 117.2+/-58.9minutes, p<0.05). The duration of postoperative hospital stay was shorter in group A than in group B(6.7+/-4.2: 9.4+/-3.3 days, p<0.05). The amount of analgesics(nalbuphin HCl, ketoprofen) used postoperatively were 2.4+/-2.8 ampules in group A, which is less than the 6.5+/-5.6 ampules in group B(p<0.05). The number of staples used in group A was smaller(2.7+/-1.3 in group A, 1.76+/-1.1 in group B, p<0.05). The duration of chest tube indwelling(4.3+/-4.0 days in group A, and 5.6+/-3.0 days in group B, NS), the recurrence rate(13.8% in group A, 2.6% in group B, NS), and the duration of air leakage(1.3+/-3.3 days in group A, and 1.0+/-2.5days in group B, NS) were not statistically different between the two groups. CONCLUSION: The application of VATS for the treatment of spontaneous pneumothorax has brought in better clinical results(shorter operation time, shorter hospital stay, less pain, and better cosmetic merits) than the thoracotomy without increasing any morbidity. However no advantages in recurrence rates and duration of postoperative air leakages are revealed.
Chest Tubes ; Follow-Up Studies ; Humans ; Length of Stay ; Medical Records ; Pneumothorax* ; Recurrence ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy*

PURPOSE: To assess the significance of alteration of the anterior cruciate ligament (ACL) axis as seen on magnetic resonance imaging of anterior cruciate ligament tear. MATERIALS AND METHODS: ACL angle (angle between lateral tibial plateau and ACL) and ACL-Blumensaat line angle (angle between ACL and Blumensaat line) were measured in 76 patients with ACL tear and 55 patients with normal ACL. The significance of the change in orientation of the ACL was evaluated. RESULTS: ACL angle was significantly smaller in the tear group (35.07 degrees +/- 10.34 degrees, mean+/-standard deviation) than in the normal group(54.11degrees+/-4.61degrees)(p<0.001); when cutoff value was less than 45 , sensitivity, specificity and accuracy were 85.5%, 98.2% and 90.8%, respectively. The ACL-Blumensaat line angle was significantly greater in the tear group (20.33degree+/-9.56degree) than in the normal group (2.55degree+/-4.86degree)(p<0.001). when cutoff value was more than 10degree, sensitivity, specificity and accuracy were 90.8%, 94.5%, and 92.4%, repectively. CONCLUSION: The change in orientation of the ACL was an important associated finding in cases of ACL tear. We suggest that cutoff values should be an ACL angle of less than 45 , and an ACL-Blumensaat line angle of more than10degree .
Anterior Cruciate Ligament* ; Axis, Cervical Vertebra* ; Humans ; Magnetic Resonance Imaging ; Sensitivity and Specificity

PURPOSE: In this study, we analyzed the results of transesophageal echocardiography (TEE) in acute peripheral arterial occlusion patients. METHOD: Over the course of eight years, 124 patients were treated for acute peripheral artery occlusion, and 51 patients underwent transthoracic echocardiogram (TTE) and TEE postoperatively to evaluate for a possible cardiac source of thromboemboli. TEE findings in atrial fibrillation (AF) patients were compared with TEE findings in patients who had AF without thromboembolic events. RESULT: AF was the most common cardiac pathology (35/51). Remnant cardiac thrombi were found in 15 patients, all in the left atrium. The average thrombus size was 1.22x0.99 cm. Surgical thrombectomy was performed in two patients, and oral anticoagulation was performed in the others. During a mean follow-up period of 38 months, 7 patients (13.7%) had recurrent thromboembolic events, even while being treated with anticoagulation. Eleven of 15 patients with remnant cardiac thrombus showed no specific clinical events during the follow-up period. CONCLUSION: Remnant cardiac thrombus was found in 1/3 of patients with acute peripheral arterial occlusion caused by AF. The remnant thrombus could be safely treated with anticoagulation. Left atrial enlargement and spontaneous echogenicity were found to be risk factors for thromboembolism in AF.
Arteries ; Atrial Fibrillation ; Echocardiography, Transesophageal ; Embolism ; Follow-Up Studies ; Heart Atria ; Heart Diseases ; Humans ; Risk Factors ; Thrombectomy ; Thromboembolism ; Thrombosis