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Current treatment of complex aortoiliac occlusive disease (AIOD) includes the aortobifemoral bypass or the femoral-femoral bypass. However, because of bilateral groin exposure and associated risks, there is a significant morbidity...
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Current treatment of complex aortoiliac occlusive disease (AIOD) includes the aortobifemoral bypass or the femoral-femoral bypass. However, because of bilateral groin exposure and associated risks, there is a significant morbidity associated with these procedures. In appropriate patients with unilateral AIOD, the iliofemoral bypass graft (IFBPG) via a lower abdominal retroperitoneal incision can be an acceptable alternative. The purpose of this study is to review the safety and efficacy as well as long-term outcomes of IFBPG in patients with unilateral AIOD. From July 1997 through June 2006, 40 patients (64.3 +/- 11.2-years-old, range 41-89-years-old, 57.5% critical limb ischemia, 70% male, 95% smokers) with unilateral AIOD were treated with IFBPG. Perioperative complications and symptom resolution were measured and Kaplan-Meier life table analysis was used to analyze outcomes of primary and secondary patency, survival, limb salvage, contralateral intervention, and maintenance of ambulation and independent living status. The perioperative complication rate was 12.5 per cent (n = 5) including one patient who developed atrial-fibrillation and one who developed acute renal failure. Both patients experienced resolution of these symptoms before discharge. Other complications included one limb thrombosis and two wound infections. There were no perioperative deaths. Secondary patency was 97.5 per cent and 93.3 per cent at 1 and 5 years. Limb salvage in patients with critical limb ischemia (CLI) was 85.1 per cent and 79.1 per cent at 1 and 5 years. Limb amputation occurred due to infection (n = 2), or failed IFBPG (n = 2). Thirty-one patients (77.5%) experienced symptom resolution including 15 (88.2%) of the patients treated for claudication. Two patients (5%) required contralateral iliac intervention. Patient survival was 97.5 per cent and 64.5 per cent at 1 and 5 years. Greater than 90 per cent of patients maintained their functional independence at 5 years. IFBPG achieved excellent technical and functional outcomes, particularly in patients treated for vasculogenic claudication. This procedure is relatively safe and efficacious in a population of patients with complex unilateral AIOD and can be an acceptable alternative to the aortobifemoral bypass or fem-fem procedure.
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The aim of this study was to assess the success of the technique of open septoplasty with bipedicled flaps in achieving long-term closure and control of symptoms. Between 1993 and 2000, 32 patients underwent surgery for nasal sept...
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The aim of this study was to assess the success of the technique of open septoplasty with bipedicled flaps in achieving long-term closure and control of symptoms. Between 1993 and 2000, 32 patients underwent surgery for nasal septum perforation. Twenty patients with large perforations underwent posterior edge repair only. The remaining 12 patients (five female, and seven male) with perforations less than 20 mm in diameter underwent open septoplasty and a unilateral bipedicled flap closure. A retrospective review involving a symptom scores assessment and follow-up examination was conducted. One patient died of unrelated illness, and was excluded. Results showed 10 of the remaining 11 patients achieved closure after a mean follow up of 10 months. The symptoms of crusting (p < 0.0001), epistaxis (p < 0.02), discharge (p < 0.012), whistling (p < 0.011), and overall discomfort (p < 0.02), were all significantly improved. We conclude that by using this technique on patients with small perforations less than 20 mm, it is possible to achieve up to a 90 per cent perforation closure rate, and a significant improvement in patients' symptoms.
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摘要 :The aim of this experiment was to investigate whether vestibular compensation following unilateral vestibular deafferentation (UVD) is associated with changes in the expression of GABAA receptor subunits in the guinea pig vestibul...
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The aim of this experiment was to investigate whether vestibular compensation following unilateral vestibular deafferentation (UVD) is associated with changes in the expression of GABAA receptor subunits in the guinea pig vestibular nuclear complex (VNC) at 2, 10, and 30 h post-surgery. Using Western blotting, the α1 and γ2 subunits (but not the β2 subunit) were detected in the VNC of labyrinthine-intact animals. However, there were no significant differences in the protein expression of the α1 and γ2 subunits within the ipsilateral or contralateral VNC at any time post-UVD compared to sham and anesthetic controls. Furthermore, UVD did not induce the expression of the β2 protein. These results suggest that vestibular compensation in guinea pig, as in the rat, is not associated with changes in the protein levels of the GABAA receptor subunits α1, β2, and γ2 in the VNC. However, a limitation of this study is that the Western blotting technique can detect only changes that are larger than 30% and therefore small changes cannot be excluded.
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Vertical retraction is a special form of retraction syndrome. In the past, the cause of this retraction has been thought to be a limiting fibrous band at the level of the inferior rectus muscle rather than co-contraction. Here the...
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Vertical retraction is a special form of retraction syndrome. In the past, the cause of this retraction has been thought to be a limiting fibrous band at the level of the inferior rectus muscle rather than co-contraction. Here the authors present a girl with unilateral retraction in upgaze and report the magnetic resonance imaging findings associated with retraction and narrowing of the palpebral fissure.
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摘要 :
Vertical retraction is a special form of retraction syndrome. In the past, the cause of this retraction has been thought to be a limiting fibrous band at the level of the inferior rectus muscle rather than co-contraction. Here the...
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Vertical retraction is a special form of retraction syndrome. In the past, the cause of this retraction has been thought to be a limiting fibrous band at the level of the inferior rectus muscle rather than co-contraction. Here the authors present a girl with unilateral retraction in upgaze and report the magnetic resonance imaging findings associated with retraction and narrowing of the palpebral fissure.
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BACKGROUND: Restless legs syndrome (RLS) is characterized by sensorimotor symptoms that usually are localized in both legs, but may present considerable asymmetry. Patients with strictly and persisting unilateral manifestations ha...
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BACKGROUND: Restless legs syndrome (RLS) is characterized by sensorimotor symptoms that usually are localized in both legs, but may present considerable asymmetry. Patients with strictly and persisting unilateral manifestations have not yet been reported. METHODS: We describe the clinical and electrophysiological characteristics of three RLS patients with unilateral symptoms. RESULTS: All essential RLS criteria were fulfilled in each patient. Neuroimaging and electrophysiological studies did not reveal structural lesions. All patients showed a predominance of periodic limb movements in sleep (PLMS) ipsilaterally to the RLS symptoms. Treatment response to dopaminergic drugs was favourable only in one patient. CONTROLS: Our observations suggest the existence of unilateral RLS with predominantly ipsilateral PLMS as a (so-far unrecognized) variant of RLS.
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Cerebral palsy (CP) has been historically viewed as a 'disorder of movement and posture due to a defect or lesion of the immature brain.'Recently; this description has been modified whereby only those movement disorders causing ac...
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Cerebral palsy (CP) has been historically viewed as a 'disorder of movement and posture due to a defect or lesion of the immature brain.'Recently; this description has been modified whereby only those movement disorders causing activity limitations, as defined by the International Classification of Functioning, Disability and Health (ECF), are defined as CP. This modification is welcomed, but it raises an interesting dilemma: How do we quantify 'activity limitations,' particularly in individuals who are relatively high functioning, such as in hemiplegic CP? For these individuals, a limited ability to participate in activities requiring two hands may be of utmost importance. Unfortunately, few existing tests of pediatric hand function have been designed for children with unilateral impairments, and until recently, none has focused on activity limitations as they pertain to bimanual performance.
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BACKGROUND: Unilateral craniofacial microsomia is characterized by soft-tissue and bony deficiencies. Mandibular distraction osteogenesis can be used to augment the hypoplastic skeleton and improve facial symmetry. The aim of this...
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BACKGROUND: Unilateral craniofacial microsomia is characterized by soft-tissue and bony deficiencies. Mandibular distraction osteogenesis can be used to augment the hypoplastic skeleton and improve facial symmetry. The aim of this study was to determine how the vector of unilateral mandibular distraction affects treatment outcomes. METHODS: A retrospective chart and radiographic review was conducted of all patients treated with external mandibular distraction osteogenesis between October of 1990 and February of 2004 (n = 185). A subset of 42 patients underwent primary unilateral, uniplanar, external distraction, and 13 patients were found to have satisfied inclusion criteria and had adequate predistraction and postdistraction lateral and posteroanterior cephalograms. Cephalometric tracings were made and multiple points and planes were assessed before and after distraction. RESULTS: A strong correlation was noted between the vector of distraction and the movement of the mandible. A horizontal vector of distraction resulted in minimal increase in ramal length but a marked shift in the mandibular midline (r = 0.68, p < 0.05). In contrast, a vertical vector of distraction resulted in marked mandibular ramus lengthening but minimal mandibular midline shift (r = 0.73, p < 0.05). Mathematical formulas were derived to correlate the distraction vector and mandibular movements to improve preoperative planning. CONCLUSIONS: Successful distraction is dependent on accurate preoperative planning and prediction of outcomes. This study demonstrates a predictable relationship between the vector of unilateral distraction and the mandibular response.
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Cherubism is an autosomal dominant fibro-osseous disease of childhood that is more common in males and is characterized by a painless bilateral expansion of the mandible and/or maxilla. The disease progresses through puberty and t...
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Cherubism is an autosomal dominant fibro-osseous disease of childhood that is more common in males and is characterized by a painless bilateral expansion of the mandible and/or maxilla. The disease progresses through puberty and then stabilizes or regresses. It has been mapped to chromosome 4p16.3 with a pathogenesis attributed to a mutation of the SH3BP2 gene. Heterozygous cherubism mutations occur either as de novo mutations or are inherited as an autosomal dominant trait. Except for extremely rare cases, cherubism is always bilateral. Treatment is generally “watchful waiting” but surgical intervention may be considered. We present a case of unilateral cherubism in a family with a history of bilateral cherubism. To the best of our knowledge, this is the first documented case of unilateral cherubism with the SH3BP2 mutation.
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OBJECTIVE: To evaluate the influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss. DESIGN: Prospective study. SETTING: Ear, nose and throat department...
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OBJECTIVE: To evaluate the influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss. DESIGN: Prospective study. SETTING: Ear, nose and throat departments in three hospitals. SUBJECTS: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss participating in a randomized controlled training study were included. MAIN MEASURES: Electronystagmography testing was performed within one week after onset of symptoms and after 10 weeks. The outcome measures clinical static balance tests (sharpened Romberg's test with eyes closed, standing on foam with eyes closed, and standing on one leg with eyes open and closed) and subjective symptom ratings on a visual analogue scale were done after one week, 10 weeks and six months. The correlation between age and asymmetry of vestibular caloric response, respectively, and the outcome measures were analysed. RESULTS: Greater caloric asymmetry correlated with poorer performanceat the sharpened Romberg's test and standing on one leg with eyes closed at all three follow-ups (rho = -0.31 to -0.54), and with higher symptom ratings at the 10-week and six-month follow-ups (rho = 0.30-0.60). Higher age was associated with poorer performance on the sharpened Romberg's test and standing on one leg at all three follow-ups (rho = 0.31-0.64), but did not change over time. Higher age was also associated with higher ratings of vertigo at the six-month follow-up, and less reduction of vertigo between the 10-week and six-month follow-ups (rho = 0.29-0.48). CONCLUSIONS: A higher degree of asymmetry of vestibular caloric response and high age seem to be associated with poor outcome in balance and perceived symptoms after acute unilateral vestibular loss.
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