bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recovery of Muscle Strength after Late Repair of Distal Biceps Brachii Tendon
Authors: Ryhänen J. , Kaarela O. , Siira P. , Kujala S. , Raatikainen T. 
Published: January 2017

Background and Aims: Ruptures of the distal part of the biceps brachii tendon are rare. The diagnosis is often delayed and only late repair can be considered. In this study, the recovery of muscle strength after late repair of the distal biceps brachii tendon was evaluated. Materials and Methods: Sixteen patients with a ruptured distal biceps brachii tendon were analysed. The mean delay from the primary trauma to the operation was 35 weeks. The tendon was anatomically re-attached with bone anchors. In three cases a tendon graft was needed. The operated arms were immobilised postoperatively for four weeks, after which mobilisation was allowed. Maximal static flexion and supination strength was measured after an average follow-up time of 124 weeks by using a computer-based isokinetic dynamometer. Results: Patient satisfaction and overall muscle strength recovery were very good. Compared to the non-operated side, average flexion strength recovery was 90% and corresponding recovery of supination strength 78%. Weakness on supination remained in the cases where a tendon graft was used. One patient needed a re-operation for a re-rupture. There were three cases of transient paresthesia of the cutaneous nerve. All patients resumed their previous work. Conclusion: Late anatomical repair of the biceps brachii tendon restores very good flexion and moderate supination strength. This operation should always be considered when the primary diagnosis is delayed.
The Increasing Incidence and Difference in Sex Distribution of Achilles Tendon Rupture in Finland in 1987–1999
Authors: Nyyssönen T. , Lüthje P. , Kröger H. 
Published: January 2017

Background and Aims: There have been reports about the increasing number of Achilles tendon ruptures. The most of the reports are based on records in a few hospitals only. We wanted to verify the increasing trend by investigating the epidemiology of Achilles tendon rupture in a very large population. Material and Methods: The retrospective data was collected from 1987 to 1999 in finnish National Hospital Discharge Register. The study includes 7 375 tendon rupture patients. We recorded their age, gender, home district and the date of admission in a hospital. Results: The incidence of operatively treated Achilles tendon rupture was 11.2/105. The number of the patients was increasing particularly in the old age-groups. The change during the study period was statistically significant (p=0.015). The females with a tendon rupture were on average 2–3 years older than men (p<0.01). The urban areas around the capital city had a higher occurrence of tendon ruptures than the rural areas (p<0.05). Conclusion: The number of Achilles tendon ruptures is increasing, but the reasons for this remain unknown. The geographical variations in rupture rate might indicate the role of the urban life-style as a risk factor. One reason for the differences between the men and the women might be the different level of the sport activities, especially ball-games.
Intraoperative Pressure Measurement in Radial Artery Harvest. A Tool with Additional Value?
Authors: Kohonen M. , Teerenhovi O. , Taskinen P. , Nissinen J. , Loponen P. , Luther M. , Tarkka M. 
Published: January 2017

Objectives: The radial artery is widely used as a graft in coronary artery bypass surgery (CABG). Due to its location and function it should be screened prior to harvesting to avoid ischaemic complications of the hand. In acute situations the Allen test is often the only preoperative screening method available. As has been noted earlier, a negative Allen test does not mean a non-harvestable radial artery. We endeavoured to find out whether intraoperative pressure measurement could be used as a complement while screening the radial artery. Design: Ninety patients planned for elective CABG with radial artery as a conduit were examined preoperatively with the Allen test, handheld Doppler and pletysmography of the second and fourth digits. Radial artery pressure was measured intraoperatively. Symptom scale was recorded pre- and postoperatively. Results: There were ten patients with a positive Allen test. The intraoperative index of radial artery pressures was 0.868 in the Allen positive group and 0.885 in the Allen negative group with no statistically significant difference (P value .68). Tolerance of exercise and cold was significantly impaired postoperatively, P values .002 and .001 respectively. No ischaemic complications occurred. Conclusions: Intraoperative pressure measurement can be used when screening radial arteries are to be harvested and no metric preoperative screening methods are available.
Celiac Trunk Coverage in Endovascular Aneurysm Repair
Authors: Delle M. , Lönn L. , Henrikson O. , Formgren J. , Vogt K. , Falkenberg M. 
Published: January 2017

Background and Aims: This retrospective study was undertaken to examine the risks associated with obstruction of the coeliac trunk in the process of treating aneurysms with endografting. Material and Methods: 120 patients were treated by endografting for aneurysmal disease. Of these, a subgroup of 9 patients had their celiac trunk covered. If possible, a preoperative angiography was performed to evaluate collateral flow from the superior mesenteric artery. This was considered to predict the risk for ischemia. Results: None of the patients had any severe clinical event of the celiac trunk occlusion or clinical signs of intestinal ischemia. Three patients had transient increase of liver enzymes. Conclusions: In cases where the distal landing zone of the descending thoracic aorta is to short for endografting, covering of the celiac trunk may be an option if no other surgical alternative is apparent. Preoperative angiography to visualise the presence of collateral vessels from the superior mesenteric artery is recommended.
High Leg Salvage Rate after Infrainguinal Bypass Surgery for Ischemic Tissue Loss (Fontaine IV) is Compromised by the Short Life Expectancy
Authors: Söderström M. , Arvela E. , Aho P.-S. , Lepäntalo M. , Albäck A. 
Published: January 2017

Background and Aims: Most studies analysing the prognosis of infrainguinal bypass surgery (IBS) in patients with critical leg ischemia (CLI) have combined the outcome of patients with rest pain and tissue loss. The aim of the present study was to evaluate amputation-free survival (AFS) after IBS in patients with the most advanced form of peripheral arterial disease, CLI with tissue loss (Fontaine IV), and to analyse the risk factors for an adverse outcome. Patients and Methods: 636 patients with CLI and tissue loss who underwent unilateral IBS between January 2000 and December 2006 at our institution were included in this retrospective study. Results: At one year, the leg salvage, survival and amputation-free survival rates were 83%, 71% and 55%, respectively, and at five years 76%, 38% and 30%, respectively. In univariate analysis, diabetes was associated with decreased AFS. In multivariate analysis, age, coronary artery disease, chronic pulmonary disease, gangrene and renal insufficiency were independent risk factors for decreased AFS. Conclusion: Infrainguinal bypass grafting results in a high rate of leg salvage. Amputation-free survival was low during the follow-up due to the high mortality of patients with CLI and tissue loss. Several co-morbidities of the CLI patients were associated with decreased amputation-free survival.
A Model for Structuring the Donor Discussion in Emergent Transplant Procedures
Authors: Clarke Alex , Malloy Jonathan , White Paul , Simmons Jon , Gwanmesia Ivo , Withey Simon , Butler Peter E. M. 
Published: January 2017

Objective To investigate the potential for maximizing organ and tissue donation by identifying an empirical basis for structuring donor discussions. Design Intentions to donate organs and tissues were recorded in 2 separate samples of participants and analyzed separately by using Guttman scaling, the second sample providing a replication of the findings from the first. Participants 304 participants were recruited from the Royal Society Summer Science Exhibition 2004, and 200 health professionals were recruited from the Royal Free Hospital. Results High coefficients of scalability and reproducibility in both samples indicate a one-dimensional scale for intentions to donate organs and tissues, with solid organs more likely to be donated than corneal, hand, and facial tissue. Thus donor discussions can be structured in a robust order, with the potential for reliable use of cutoff points once donation of a particular organ or tissue has been refused. Conclusions This reliable pattern can be used to maximize organ and tissue donation rates and to underpin emergent transplant techniques.
Endovascular Treatment of Ruptured Intracranial Aneurysms Using Platinum Coils in Patients over 70 Years of Age
Authors: Sawada M. , Kaku Y. , Hayashi K. , Ueda T. , Yoshimura S. , Sakai N. 
Published: January 2017

Endovascular treatment of intracranial aneurysms using platinum coils was performed in 26 patien with age over 70 years. The patients ranged from 70 to 86 years old (mean 77.5). Preoperative World Federation of Neurological Surgeons (WFNS) scale revealed that 6 patients were in grade I, 5 in grade II, 2 in grade III, 12 in grade IV, and 1 in grade V. The location of aneurysms are as follows; 10 were in the internal carotid artery, 7 in the anterior cerebral artery, 1 in the middle cerebral artery, and 8 in the vertebro-basilar system. Intra-aneurysmal occlusion was accomplished in 25 patients, resulting in 6 complete occlusion (24%), 3 neck remnant (12%), 11 body filling (44%), and both of neck remnant and body filling in 5 (20%). In one patient with vertebral artery union aneurysm, the parent artery was occluded just proximal to the aneurysm. Eleven of 13 patients with good clinical grade (grade I, II, and III) resulted in good clinical outcome, whereas 11 of 13 patients with poor clinical grade (grade IV and V) showed poor outcome. Periprocedural complications such as thromboembolism and intra-procedural rupture occurred in 5 patients (19.2%). Each of the complications was attributed to severe atherosclerotic changes of parent arteries. Symptomatic cerebral vasospasm occurred in only one patient (3.8%). In conclusion, endovascular coil emboilization is a useful therapeutic alternative for treating ruptured intracranial aneurysms in patients over 70 years of age, especially in patients with good clinical grade (better than grade III).
Detection of Unstable Plaques in Patients with Carotid Stenosis Using B-Mode Ultrasonography
Authors: Kobayashi E. , Ono J. , Hirai S. , Yamakami I. , Saeki N. , Yamaura A. 
Published: January 2017

Distal embolism is a detrimental complication of stent placement for the carotid artery stenosis. To evaluate usefulness of B-mode ultrasonography (US) for the detection of unstable plaques in patients with carotid artery stenosis, we examined US in 46 arteries of 35 patients with carotid stenosis of >30%. The echogenicity of 46 carotid plaques was hyperechoic in 20 plaques, hypoechoic in 15, and mixed-echoic in 11. The echogenicity of carotid plaques was correlated with severity of carotid stenosis, ipsilateral stroke or T1A, heart attack, and risk factors of systemic atherosclerosis. Hypoechoic plaques were associated with severe carotid stenosis and ipsilateral ischemic event. Mixed-echoic plaques had a high incidence of past history of heart attack. Hyperechoic plaques were less likely to associate with risk factors of systemic atherosclerosis. We developed a new method of echodensity analysis. Using a computer software, echodensity values of seven plaque components were determined by comparing US findings and pathology of surgical specimens. The echodensity value was defined as a relative value to the arterial lumen. The calcified part of plaques had the highest echodensity of 6.24 ± 0.86 (mean ± 2 S.D.); fibrosis or hyarynoid degeneration of 2.05 ± 0.40, foamy histiocytes of 1.47 ± 0.05, necrosis of 1.32 ± 0.16, cholestelin clefts of 1.28 ± 0.13, intraplaque hemorrhage of 1.02 ± 0.09, and intraluminal thrombus of 1.27 ± 0.07. Constructed from the echodensity value, an echo-densitometry color mapping of the carotid plaque illustrated the exact location and extent of plaque component. B-mode US of carotid plaques represents clinical characteristics relating distal embolism and systemic atherosclerosis. A new method of echodensity analysis and echo-densitometry color mapping of the carotid plaque is useful to detect unstable plaques in patients with carotid stenosis.
The Reconstructions for Vertebral Artery Stenosis at the Origin
Authors: Yoshino K. , Terai Y. , Fujimoto S. , Kamata I. , Kinugasa K. , Nishimoto A. 
Published: January 2017

To date in our hospital, surgical reconstructions and percutaneous transluminal angioplasty (PTA) were carried out in 168 patients with vertebral artery (VA) stenosis at the origin. In this article, we discuss the comparison between surgical reconstructions and PTA, especially regarding long term follow up, patency and complications. PTA is a less invasive treatment for VA stenosis at the origin than surgical reconstructions. However, restenosis after PTA occurred in 20% of the patients. On the other hand, restenosis after surgical reconstructions did not emerge even in long term follow up. An embolism after PTA occurred in 2.6% of the cases. However, the embolism occurred in only the first 10 patients of our series, after that there was no embolism. We concluded that PTA was the first choice for VA stenosis at the origin, if the angiogram did not reveal any PTA difficulty. If restenosis after PTA was performed, we selected surgical reconstruction for VA stenosis at the origin.
Multiple Intracranial Aneurysms
Authors: Mont'Alverne F. , Tournade A. , Riquelme C. , Musacchio M. 
Published: January 2017

We evaluate endovascular treatment (EVT) as an option to deal with multiple intracranial aneurysms(MA). From 1994 to 2001, 24 patients underwent EVT for 59 MA. Patients were followed-up clinically and angiographically in a period ranging from 6 to 93 months (mean time of 22.2) and from 4 to 69 months (mean time of 19.3), respectively. Ten patients (41.6%) were treated either by EVT (n=7, 29, 16%) or by mixed treatment (EVT and surgery; n=3, 12.5%). Reasons for treating just ruptured aneurysms: six (25%) had aneurysms smaller than 5 mm; three (12.5%) deaths; two (8.33%) were in the subacute period; two (8.33%) lost to follow-up; one (4.17%) authorised no procedure. No rebleeding was detected at the clinical follow-up, but there were five deaths. At immediate arteriographic control: 28 (85%) aneurysms were fully occluded, four (12%) with neck flow and one (03%) with sac flow. For 20 aneurysms followed-up: stability of occlusion was reached in seven cases (35%) and repermeabilization in 13 (65%). Management of recanalization was close arteriography in seven (54%), re-embolization in five (38%) and surgery in one (08%). When treating MA, EVT is advisable either alone or in mixed therapy. As a high degree of repermeabilization was disclosed, strict arteriographic control is required. The mechanisms underlying aneurysmal formation may be also involved in the recanalization phenomenon, a possible new manifestation of the fragility of the arterial wall.
Management of Paragangliomas
Authors: van den Berg R. , Rodesch G. , Lasjaunias P. 
Published: January 2017

Head and neck paragangliomas are highly vascular tumors with variable clinical behavior. The goal of this paper is to determine specific clinical and radiological findings and extract from these findings a treatment algorithm. Twenty-three patients with paragangliomas were referred from different surgical centers for angiography and pre-operative embolization. Clinical records were analyzed retrospectively, and focused on impairment of cranial nerves. Angiographic features of paragangliomas, such as arterial supply, tumor flow characteristics, and venous drainage, were evaluated to find characteristic angioarchitectural patterns. All but one patient presented with a single tumor. All eight jugular and four of five vagal paragangliomas caused a lower cranial nerve deficit. Tympanic paragangliomas presented with hearing loss and tinnitus. The ascending pharyngeal artery was the main feeder and contributed to the supply in every tumor. Jugular and vagal paragangliomas typically compromise the patency of the jugular vein with resulting antegrade or retrograde flow through collateral venous systems. Surgical resection of vagal and jugular paragangliomas was especially performed when unifocal paragangliomas were present. In all of these patients, the tumor caused a cranial nerve deficit. The supply from an enlarged ascending pharyngeal artery is typical for paragangliomas. The venous drainage pattern of jugular and vagal paragangliomas allows differentiation from other vascular lesions at the skull base.
Multiple Dural Arteriovenous Fistulas
Authors: Goddard A.J.P. , Khangure M.S. 
Published: January 2017

Dural arteriovenous fistulas are most probably acquired lesions. However, they have been rarely encountered de novo. We present a unique case of a 71-year-old woman who initially presented with right-sided dural arteriovenous fistula (DAVF), which spontaneously resolved after diagnostic arteriography. She later developed asymptomatic occlusion of the left transverse sinus. Five years after her initial presentation she developed left-sided pulse-synchronous tinnitus. MRA and catheter angiography showed a complex type IV DAVF between the left transverse sinus and multiple dural branches arising from both left and right external carotid arteries. The left transverse sinus was isolated from the torcula herophili, with stenosis of the sigmoid sinus. Extensive cortical venous drainage was demonstrated. Endovascular cure was effected by polyvinyl alcohol particle and absolute alcohol occlusion of the dominant dural supply, and transvenous coil occlusion of the left transverse sinus. The patient's symptoms resolved almost immediately. This unique case demonstrates that dural sinus occlusion and DAVFs may co-exist, but there may not be a causal relationship. It is likely that both DAVFs and sinus occlusion are manifestations of the same disease process characterised by a pro-thrombotic state and secondary angiogenesis. It is important to recognise that changes in symptomatology, even long after apparent disappearance of a lesion may indicate recurrence, and careful follow up is advocated.
Spontaneous Thrombosis of the Pseudoaneurysm of Right SCA after an Attempt at Embolisation
Authors: Szajner M. , Jargiello T. , Trojanowski T. , Szczerbo-Trojanowska M. 
Published: January 2017

Spontaneous thrombosis of intracranial aneurysms rare, mostly affecting giant aneurysms with narrow necks. We present the case of 34 y/o man with pseudoaneurysm that developed in the course of SAH. The initial CT scan showed an isolated, well-defined hematoma within the right cerebellar hemisphere, digital subtraction angiogram (DSA) performed in a regional hospital showed an irregular shaped aneurysm of the distal segment of the right SCA. The patient was sent to our department, where diagnostic DSA, performed before embolisation revealed an entirely different morphology of the aneurysm. It became larger, round and no other functional branches distal to it were found (picture of “a balloon on a string”). During supraselective catheterization, when microcatheter and microguidewire were already in the right SCA a technical problem of our angio-machine occurred, so the intervention had to be postponed. A week later, a second attempt at embolisation was made. This time an initial DSA showed a lack of filling of the aneurysm sac and thrombosis of the main trunk of the right SCA. The patient remained clinically stable. He was discharged from our hospital five days later.
Comparison of Endovascular and Surgical Treatment for Ruptured Cerebral Aneurysms with Respect to Short and Long-Term Outcome
Authors: Fukui K. , Suzuki O. , Ito S. , Miyazaki M. , Hattori K. , Osawa H. 
Published: January 2017

We compared the treatment for ruptured aneurysms from the clinical and radiological follow-ups after endovascular (GDC) or surgical treatment. There were 142 surgically treated cases and 38 endovascular treated cases from May 1997 to December 2001. In endovascular cases there were four A-com, four MCA, 12 ICA and 18 posterior circulation aneurysms. In surgical cases, there were 53 A-com ACA, 51 MCA, 36 ICA and two posterior circulation aneurysms. The clinical outcomes of endovascular and surgical treatments were correlated with the H & H grades before treatments. At short stage, 71% of endovascular and 78.2% of surgical cases showed a favorable outcome (GOS GR or MD) (p = 0.3). Long-term clinical follow ups (14.5 to 58 months) showed 77.7% of endovascular and 87.7% of surgical cases resulted in GR or MD (p = 0.17). In endovascular cases, 22.2% showed recurrence during the follow-up period and five of them needed re-treatment. We experienced failed endovascular approach at acute stage in seven cases which changed to surgery. In conclusion, the short and long term clinical results of endovascular treatment were acceptable comparing surgical clipping. High recurrence rate after GDC treatment did not permit future completeness of the treatment. Still the treatment alternative between endovascular or surgical treatment may change depending on the criteria of each institution, attention should be paid to the disadvantages of endovascular treatment as the first choice for ruptured aneurysms.
Cortical Venous Aneurysm Isolated Cerebral Varix
Authors: Hoell T. , Hohaus C. , Beier A. , Holzhausen HJ , Meisel HJ 
Published: January 2017

Venous aneurysms so-called isolated cerebral varix, are known as a related pathology in arteriovenous malformations (AVM) due to the arterial pressure on venous drainage16. They are also observed in combination with developmental venous anomalies (DVA)2,4,8,15. However, isolated varix is a rare entity1,7,11,13. They appear in most cases without neurological deficits. Some of the cases mimic a meningioma due to their manifestation in CT and MR imaging and their axial cortical localization. The case presented here is a isolated varix of a cortical vein located rostral to the motor strip. The patient was operated on successfully. The MRI and the histology of the case are presented.
Endovascular Pressure Measurements: Validation with a Pulsatile Flow Model and Haemodynamic Assessment of Brain AVMs
Authors: Secca M. Forjaz , Vilela P. , Ferreira J.L. , Lopes F.C. , Goulão A. 
Published: January 2017

Intravascular pressure measurements for several types of endovascular catheters were obtained in an in vitro model to validate the pressure readings obtained during the interventional procedures of brain AVM embolization. An experimental model was used where the beat rate, flow and pressures were as close as possible to the average human values of interest. It is shown that the corrections increase with the decreasing inner diameter of the catheter used and with increasing vascular pressure. We have also shown that there were no differences between measurements made with the catheter in the direction of flow or against it. An average pressure reading corrections for the various microcatheters to compensate the readings obtained during in vivo monitoring is presented. The haemodynamic assessment of 81 brain AVMs was performed using the endovascular measurement of arterial pressure in 389 feeding arteries during embolization. Mostly, the feeders' arterial median pressure was half the systemic arterial pressure but there was a wide variability of AV shunts in brain AVMs not only from one brain AVM to another but also within the same brain AVM. Measurement of arterial feeder pressure is an inexpensive, quick and accurate tool to evaluate the type of AV shunts within brain AVM.