1/11. Treatment of condyle fracture caused by mandibular angle ostectomy.A prominent mandibular angle is considered to be unattractive in Asian countries because it gives the face a square and muscular appearance. Successful correction by angle ostectomy has been reported, but one of the serious complications of angle reduction ostectomy is fracture of the mandibular condyle. If the ostectomy line is misdirected vertically, the condyle may be fractured. The authors experienced two cases of condylar fracture during angle reduction. Case 1 was a pulled-out condylar fracture, where an L-shaped miniplate was then attached by external approach, and intermaxillary fixation (IMF) with arch bar was used on postoperative day 14. With release of the IMF, a systematic approach for a jaw-opening exercise was begun. On postoperative day 21, the elastics were placed to assist in guiding protrusion of the mandible anteriorly 24 hours a day. After postoperative day 28, it was possible to completely abandon daytime elastic fixation. The exercise was modified to lateral movement. Case 2 was green-stick condylar fracture, with the IMF with arch bar applied on postoperative day 10. After releasing the IMF, the exercise involved the daily use of several tongue blades, and range of motion increased by wedging additional blades until postoperative day 21. More aggressive stretching was continued with 22 blades on postoperative day 28. On the removal of the arch bar, the occlusion was stable and followed by more aggressive stretching and physical therapy. Both cases were successfully restored and had good results. The authors believe the exercise protocols and algorithms they used may serve as a standard procedure of treatment in condylar fracture caused by angle ostectomy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/11. Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction: three cases of acute perioperative hypotension in noncardiac surgery.In this report we describe three cases of severe perioperative hypotension in noncardiac surgery patients. As systolic anterior motion of the mitral valve in combination with subaortic left ventricular outflow tract obstruction is an unrecognized cause for hypotension in noncardiac surgery patients, delayed diagnosis can result in erroneous treatment regimen. The aim of the present report is to provide an informative and brief synopsis of the pathophysiological consequences and diagnostic/therapeutic strategies for the perioperative management of systolic anterior motion.- - - - - - - - - - ranking = 6keywords = motion (Clic here for more details about this article) |
3/11. Anterior transposition of the inferior oblique muscle for a snapped inferior rectus muscle following functional endoscopic sinus surgery.A 55-year-old woman was referred with a 4-month history of diplopia following functional endoscopic ethmoidectomy for chronic sinusitis. She had right hypertropia of 14 prism diopters in the primary position that increased to 30 prism diopters in down gaze. Her right eye showed a moderate limitation of motion in down gaze. Orbital imaging demonstrated a snapped right inferior rectus muscle. The inferior oblique muscle was transposed as an initial treatment for the snapped inferior rectus muscle. After surgery, the patient was orthophoric and obtained fusion in the primary position.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/11. Rapid diagnosis and management of intraoperative myocardial infarction during valvular surgery: using intraoperative transesophageal echocardiography followed by emergency coronary artery bypass grafting without coronary angiography.A 68-year-old man was admitted to undergo elective mitral valve surgery. Although the preoperative coronary angiography was normal, the patient suffered a myocardial infarction that resulted in untreatable collapsed hemodynamics. After inferring the responsible occluded coronary artery from the segmental wall motion abnormality detected in intraoperative transesophageal echocardiography, together with the anatomy found in preoperative coronary angiography, we performed an emergency coronary artery bypass graft surgery without a new angiography. This procedure resulted in survival of a potentially life-threatening situation. In selected cases, this therapeutic strategy may lead to reduction of mortality as a result of the intraoperative myocardial infarction.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/11. Intrapelvic migration of the trial femoral head during total hip arthroplasty: is retrieval necessary? A report of four cases.When testing intra-operative range of motion during a total hip arthroplasty procedure with trial components, there is potential for the femoral head to dissociate from the trial neck. We report the dissociation of the trial femoral head with migration of the head into the pelvis while checking for anterior stability of the total hip arthroplasty construct. Options for retrieval of the head are outlined.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/11. Sudden development of intraoperative left ventricular outflow obstruction: differential and mechanism. An intraoperative two-dimensional echocardiographic study.Systolic anterior motion (SAM) of the mitral valve, once considered to be pathognomonic of hypertrophic cardiomyopathy, has been reported in the absence of asymmetric septal hypertrophy. Of the 1,000 open heart operations performed with intraoperative two-dimensional epicardial echocardiography monitoring, four patients developed intraoperative dynamic left ventricular outflow obstruction associated with systolic anterior motion of the mitral valve that was not present preoperatively: three cases of mitral valve annuloplasty with Carpentier ring insertion and one of coronary artery bypass grafting. Though no patient had asymmetric septal hypertrophy or echocardiographic evidence of outflow obstruction by either preoperative cardiac catheterization or echocardiography, intraoperative two-dimensional epicardial echocardiography revealed SAM, and hyperdynamic left ventricles with three of these patients having documented left ventricular outflow tract gradients causing hemodynamic compromise. (Case 4 was hemodynamically stable following mitral valve repair, but had SAM and significant residual mitral regurgitation [MR] requiring reinstitution of cardiopulmonary bypass and re-repair). Measurement of mitral annular dimension demonstrated a normal decrease in size from diastole to systole in control operative subjects but not in the patients who developed outflow obstruction. The pathophysiology, treatment, and role of intraoperative echocardiography of dynamic left ventricular outflow tract obstruction are discussed.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
7/11. Characteristics of left ventricular thrombus resulting in perioperative embolism. A complication of coronary artery bypass grafting.A review of perioperative complications of cardiac procedures at Tampa General Hospital revealed a distinct preoperative finding in several patients having embolism after coronary artery bypass grafting (CABG). From a total of over 10,000 cardiac catheterization procedures, four patients had ventricular wall motion abnormalities with discrete, mobile, pedunculated filling defects noted during ventriculography. Three of these patients eventually underwent CABG, and each had a postoperative embolic episode. A similar catheterization finding was noted in a fourth patient, who later had an embolic event. Thus, even in the absence of a discrete aneurysm, this observation suggests the need for an aggressive surgical approach to CABG patients with these ventricular filling defects.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/11. Ocular dipping in anoxic coma.patients with anoxic coma had a cyclic, downward dipping motion of the eyes. The sign is different from ocular bobbing, seizure-related eye deviation, oculogyric crisis, and roving eye movement. Its distinguishing characteristics are slow downward with rapid upward movement, a nadir at the extreme of downgaze, and spontaneous roving horizontal eye movements. Based on necropsy findings in one case and lesions of the basal ganglia evident on computerized tomographic scan in another, it is proposed that cortical dysfunction with damage to the basal ganglia may cause ocular dipping.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/11. The pressure rate quotient is not an indicator of myocardial ischemia in humans. An echocardiographic evaluation.BACKGROUND: The pressure rate quotient (PRQ; mean arterial pressure/heart rate [MAP/HR]) less than one (PRQ < 1) has been proposed as a simple, clinically available hemodynamic index of myocardial ischemia. Recent investigations using electrocardiography (ECG) detection of myocardial ischemia have not found this index reliable. We prospectively compared PRQ < 1 to detection of myocardial ischemia via transesophageal echocardiography (TEE) and ECG in patients undergoing elective coronary artery bypass graft. methods: Forty-six of 50 patients admitted into the study had acceptable data acquisition. Calibrated ECG leads II and V5 were recorded with a computerized ST-segment analyzer. Hemodynamic data were stored at 2-min intervals. After tracheal intubation, a 5.0-MHz TEE probe was inserted. electrocardiography-detected ischemia was defined as new onset ST-segment deviation (> or = 1 mm) lasting for > 1 min. Transesophageal echocardiography determination of ischemia was worsening of wall motion > or = 1 grade and lasting > 1 min. PRQ < 1 was compared to ECG and/or TEE as a predictor or indicator of myocardial ischemia. RESULTS: electrocardiography ischemia occurred during 230 intervals in 10 patients, and in only 41 of 230 (18%) was PRQ < 1. Transesophageal echocardiography-defined ischemia occurred during 592 intervals in 9 patients, and in 119 of 592 (20%) PRQ < 1. Compared to ECG and TEE, PRQ < 1 had a low sensitivity (21%) and poor positive predictive value (25%). CONCLUSIONS: Pressure rate quotient < 1 is an unreliable indicator and predictor of myocardial ischemia when evaluated by ECG, TEE, and the combination of these modalities in patients undergoing coronary artery bypass graft surgery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/11. Unintentional intraoperative awareness during sufentanil anaesthesia for cardiac surgery.PURPOSE: The aim of this clinical report is to describe a case of unintentional intraoperative awareness during sufentanil anaesthesia in a patient undergoing elective aortocoronary bypass grafting. CLINICAL FINDINGS: After premedication with morphine (5 mg) and scopolamine (0.2 mg), this 51-yr-old woman received sufentanil (10 micrograms.kg-1), midazolam (4 mg) and isoflurane (0.3-0.4% end-tidal). The patient recalled specific events and discussions which took place in the operating room during surgery. This patient's report was clear and corroborated by operating room personnel. The patient denied having felt pain, anxiety or emotional distress. CONCLUSION: Although awareness during opioid anaesthesia has been previously described with morphine and fentanyl, as far as we know this is the first clinical report of awareness with sufentanil. Given that recent efforts of early extubation in cardiac surgery patients may involve a reduction in the amount of opioid administered, this report serves as a reminder of the ever present potential for this disturbing complication.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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