11/56. Treatment of type III endoleak with an aortouniiliac stent graft.The purpose of this study was to present a novel treatment method for repair of a type III endoleak due to separation of modular components of an AneuRx (Medtronic AVE, Sunnyvalle, CA) stent graft as a result of graft kinking. A 73-year-old male had undergone endovascular repair of a 8.2-cm abdominal aortic aneurysm (AAA) 2 years previously. An aortic extender cuff was required to secure the proximal graft. Computed tomographic (CT) follow-up revealed a type III endoleak at 6-month follow-up. Plain radiographs showed separation between the main graft body and the aortic extender cuff. A second custom-made 28 mm x 5.5 cm aortic extender cuff was placed to seal the type III endoleak. Follow-up CT showed a persistent endoleak with an increase in AAA size to 10.5 cm. The patient underwent remedial AAA repair with an aortouniiliac endograft placed within the previous stent graft and a femorofemoral bypass. At 3-month follow-up there was no detectable endoleak. This constitutes an alternative endovascular therapy for modular device separation (type-III endoleak) after endoluminal AAA repair in patients who cannot undergo repair with a second bifurcated graft.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
12/56. Open surgical intervention to recurrent aortic dissection after endovascular stent grafting.We report the case of a 49-year-old man who received open-heart surgery for recurrent aortic dissection after endovascular stent grafting. Stent grafting had been successfully performed in the acute phase. Recurrent dissection became obvious 5 months later, and at the same time, aneurysmal change was detected between the left subclavian artery and the proximal end of the stent graft. We employed a "Y arch" surgical procedure and "elephant trunk" technique to treat, and the entry tear was completely sealed and the aneurysm was excluded by elephant trunk segment. We believe that this approach could be a new option for treatment for complicated aortic aneurysms.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
13/56. Recurrent auricular pseudocyst: a new treatment recommendation with curettage and fibrin glue.BACKGROUND: Pseudocyst of the auricle is a rarely seen fluctuant swelling of the ear. Although various hypotheses on the etiology have been suggested, the exact cause still remains unclear. Chronic minor trauma, which is believed to create intracartilaginous cavity, is accepted to be the most probable cause. Several treatment methods have been used for this benign lesion, but higher recurrence rates can be seen if not properly treated. OBJECTIVE: To discuss a new treatment modality for this rare disorder. METHOD: A 44-year-old man presented with a large pseudocyst of the auricle that had been treated several times previously with unsuccessful outcomes. For its treatment, we performed curettage and then used fibrin glue as a sealer between the two leaves of the cartilage. RESULTS: At postoperative 6-months follow-up, there was no evidence of recurrence. The cosmetic outcome was excellent. CONCLUSION: The use of fibrin glue both to obliterate the pseudocyst space and to make the two leaves of the cartilage adhere to each other should be kept in mind in this rare disorder in order to avoid recurrences.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
14/56. Osteofibrous dysplasia of the tibia treated by bracing.Osteofibrous dysplasia of the tibia in children will commonly recur after surgical resection. The use of a leg brace until puberty offers a useful method of conservative management. Seven female patients, age three months to nine years at the time of brace treatment, have been followed for 3.5 to 18 years, an average of nine years, with evidence of satisfactory healing of the lesions in all. Three of the cases had recurred after surgery, two with fibular grafts and one required leg lengthening. The use of a brace to control bowing of the tibia while awaiting spontaneous regression is advised until epiphyseal closure.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
15/56. Chronic recurrent multifocal osteomyelitis with MR correlation: a case report.Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disorder of unknown etiology. The main characteristics on plain x-rays are a lytic destruction in the metaphyseal region of the long bones followed by progressive sclerosis. The symmetrical pattern and the frequent involvement of the sternoclavicular joints and vertebrae are typical. An association with palmoplantar pustulosis has also been described. Laboratory findings are nonspecific. Although MRI is not necessary to make the diagnosis of chronic osteomyelitis, it is useful in assessing the extent and the evolution of the lesions. CRMO of the tibial and fibular bones is described in a 14-year-old girl, who suffered from pain and soft tissue swelling in both ankles. Initial plain x-rays and laboratory findings were normal. After relapsing clinically, progressive sclerosis of both fibular bones occurred. Lytic lesions in the left tibia and both fibular bones were visible. Scintigraphic examination showed pathologic tracer accumulation in both legs. The diagnosis of CRMO was suggested based on CT and MRI findings. CRMO was confirmed after curettage and bone biopsy. Histopathological findings were consistent with active chronic osteomyelitis.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
16/56. Paraprosthetic leak unmasked by thrombolysis for thrombosed mitral valve.Prosthetic valve thrombosis (PVT) is classically a cardiothoracic surgical emergency. Case series, however, report thrombolysis as first line management for PVT. A case of mitral PVT treated successfully with thrombolysis is described. Immediately after thrombolysis a trivial paraprosthetic leak noted on pretreatment transoesophageal echocardiography had increased significantly in severity. The paraprosthetic leak subsequently required repeat mitral valve replacement. It is speculated that the thrombolytic treatment interfered with the usual healing process by disrupting the fibrin deposited at the valve ring margin. This suggests that fibrin is important in the formation of the annular seal of the prosthetic valve and that patients receiving thrombolysis should be monitored for this complication.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
17/56. Relapsing Mooren's ulcer after amniotic membrane transplantation combined with conjunctival autografting.PURPOSE: To report a patient with Mooren's ulcer that relapsed 2 months after amniotic membrane (AM) transplantation and conjunctival autografting and its subsequent retreatment. DESIGN: Interventional case report. methods: We performed multilayered AM transplantation and conjunctival autografting from the opposite healthy eye to treat a corneoscleral perforation caused by Mooren's ulcer in a 60-year-old woman. MAIN OUTCOME MEASURES: Reformation of the anterior chamber, absence of inflammation, and restoration of visual acuity. RESULTS: The perforated corneoscleral lesion was sealed successfully by the AM and conjunctiva graft and led to a stable condition for 2 months. Relapsing corneal edema, keratic precipitates, and cell infiltration occurred along the margin of the conjunctival graft with severe vessel engorgement. After removing the conjunctival graft and regrafting of additional AM, the lesion subsided for at least 1 year. CONCLUSIONS: Amniotic membrane transplants may be useful in treating corneal perforation of immunologic origin, but conjunctiva and its vessels may play a role in the process of peripheral corneal destruction of Mooren's ulcer.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
18/56. Recurrent meningitis and a congenital perilymph fistula.In any child with recurrent meningitis, the presence of a congenital perilymph fistula must be entertained. All of the patients must have an audiologic assessment, and if a sensorineural loss is demonstrated, CT of the temporal bones should be performed. CT is excellent in identifying malformations within the temporal bones, fistulous tracts, soft tissue densities in the middle ear, and defects in the tegmen tympani. Although MRI may provide superior discrimination of the audiovestibular and facial nerves and cerebellopontine angle, presently it does not offer any distinct advantages over CT in evaluation of the inner ear. When a fistula is suspected, an exploratory tympanotomy is recommended, and any CSF leak is sealed with muscle.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
19/56. Endoscopic fibrin sealing of congenital pyriform sinus fistula.pyriform sinus fistula is a very rare branchial apparatus malformation, often appearing in the form of a cervical inflammatory process (abscess or suppurative thyroiditis), especially in infants. Failure to diagnose this lesion may result in unexpected recurrence. A case of recurrent suppurative thyroiditis caused by pyriform sinus fistula in a 9-year-old girl is reported. In the latency period of infection, the fistula tract was identified by a barium meal contrast study. Direct endoscopy showed the fistula internal orifice at the apex of the left pyriform fossa. The fistula was completely obliterated by injection of fibrin glue. Suppurative thyroiditis is reported mainly in the pediatric literature, and the reported case is the first to be managed endoscopically by injection of fibrin adhesive.- - - - - - - - - - ranking = 4keywords = seal (Clic here for more details about this article) |
20/56. Covered stents to treat partial recanalization of onyx-occluded giant intracavernous carotid aneurysm.PURPOSE: To present the application of a covered stent for the management of a left internal carotid artery (ICA) aneurysm that had recanalized following embolization with Onyx. CASE REPORT: A 54-year-old man had a giant intracavernous aneurysm of the left ICA successfully occluded with Onyx. recurrence of symptoms 5 months later prompted control angiography, which showed partial recanalization of the aneurysm. The aneurysm neck was successfully sealed by placing 2 polytetrafluoroethylene-covered stents across it. Control angiography performed at 12 months after stent placement showed no stenosis or signs of recanalization of the aneurysm. CONCLUSIONS: Recanalization of giant intracavernous carotid aneurysms post-Onyx treatment may be safely treated with placement of covered stents across the aneurysm neck.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
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