1/47. Marked increase in flow velocities during deep expiration: A duplex Doppler sign of celiac artery compression syndrome.Symptoms of chronic mesenteric ischemia develop when the celiac artery is constricted by the median arcuate ligament of the diaphragm. Lateral aortography is the primary modality for diagnosing ligamentous compression of the celiac artery. However, duplex Doppler sonography performed during deep expiration can cause a marked increase in flow velocities at the compressed region of the celiac artery and suggest the diagnosis of celiac arterial constriction due to the diaphragmatic ligament.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/47. Surgical rescue for life-threatening hypoxemia caused by a mediastinal tumor.We recently encountered a patient with a large anterior mediastinal tumor who developed severe hypoxemia during general anesthesia. This life-threatening hypoxemia was treated by extracorporeal membrane oxygenation using emergent percutaneous cardiopulmonary support followed by extirpation of the tumor. We found that total arteriovenous shunt resulting from compression by the mediastinal tumor caused this severe hypoxemia (total obstruction of left main bronchus and of the right pulmonary artery).- - - - - - - - - - ranking = 0.00094021836765992keywords = membrane (Clic here for more details about this article) |
3/47. celiac artery compression syndrome.celiac artery compression syndrome occurs when the median arcuate ligament of the diaphragm causes extrinsic compression of the celiac trunk. We report a case of a 65-year-old woman who presented with a three-month history of postprandial abdominal pain, nausea and some emesis, without weight loss. There was a bruit in the upper mid-epigastrium and the lateral aortic arteriography revealed a significant stenosis of the celiac artery. At operation, the celiac axis was found to be severely compressed anteriorly by fibers forming the inferior margin of the arcuate ligament of the diaphragm. The ligament was cut and a vein by-pass from the supraceliac aorta to the distal celiac artery was performed. The patient remains well and free of symptoms two and a half years since operation.In this report we discuss the indications and the therapeutic options of this syndrome as well as a review of the literature is being given.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/47. Repair of common bile duct injury with the round and falciform ligament after clip necrosis: case report.Occasionally, as abdominal surgeons, we are confronted with common bile duct injury noted during video laparoscopic or open cholecystectomy. Usually this is solved by endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy and stent, or enteric bypass, suture repair and tube drainage. However, after such procedures, there is a significant number of patients with postoperative stenosis. Another alternative to repair common bile duct injury and correct postoperative stenosis is using the round and falciform ligament as circumferencial patch. Due to their closeness to the common bile duct and their adequate blood supply, they make a perfect autologous biological graft.- - - - - - - - - - ranking = 1.6666666666667keywords = ligament (Clic here for more details about this article) |
5/47. Hydatid cyst of the liver presenting as an inferior vena cava obstruction.A 48-year-old woman presented with clinical features suggestive of an obstruction of the inferior vena cava (IVC). Abdominal sonography showed a 15- x 14-cm cystic mass involving the medial segment of the left hepatic lobe and the anterior segment of the right hepatic lobe. We visualized multiple intracystic floating membranes, a detached endocyst, and a daughter cyst within the main cyst. The cyst was compressing and effacing the intrahepatic portion of the IVC and the right atrium. Sonography of the right and left hepatic veins showed blood flow in the normal direction, but spectral analysis showed that the flow was continuous, possibly owing to extrinsic compression of the IVC at the site where the hepatic veins drained into the IVC. The patient responded well to percutaneous treatment of the hydatid cyst. This case represents a rare presentation of a hydatid cyst of the liver.- - - - - - - - - - ranking = 0.00094021836765992keywords = membrane (Clic here for more details about this article) |
6/47. Otologic manifestations of amyloidosis.OBJECTIVE: To describe otologic manifestations of amyloidosis. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. patients: Case report of a patient with bilateral external auditory meatal stenosis secondary to amyloidosis. RESULTS: The patient is a 60-year-old man who presented with several months' history of bilateral ear blockage and drainage. physical examination revealed markedly thickened skin in each ear in the area of concha and meatus that was associated with fissuring. The meatus were markedly stenosed. The medial aspect of the external auditory canal and the tympanic membrane were normal. He had partial improvement on medical therapy with topical steroid-containing eardrops and ointment. Past medical history was positive for multiple myeloma. Meatal biopsy was performed. Grossly, the tissue was hypovascular and markedly thickened. Histopathologic examination was consistent with amyloidosis. The patient was continued on topical steroid ointments, frequent ear cleaning, and close follow-up. He was subsequently diagnosed with systemic amyloidosis. A review of the literature was done. head and neck involvement with amyloidosis is reviewed, with emphasis on otologic manifestations. CONCLUSION: Otologic involvement with amyloidosis is extremely rare. The pathophysiology may be related to the local factors in the external auditory canal.- - - - - - - - - - ranking = 0.00094021836765992keywords = membrane (Clic here for more details about this article) |
7/47. Embolization in a patient with ruptured anterior inferior pancreaticoduodenal arterial aneurysm with median arcuate ligament syndrome.In median arcuate ligament syndrome, the root of the celiac artery is compressed and narrowed by the median arcuate ligament of the diaphragm during expiration, causing abdominal angina. aneurysm may be formed in arteries of the pancreas and duodenum due to a chronic increase in blood flow from the superior mesenteric artery into the celiac arterial region. We report a patient saved by embolization with coils of ruptured aneurysm that developed with markedly dilated anterior inferior pancreaticoduodenal artery due to median arcuate ligament syndrome.- - - - - - - - - - ranking = 2.3333333333333keywords = ligament (Clic here for more details about this article) |
8/47. An uncommon association of abdominal vascular compression syndromes: Dumbar and Nutcracker.abdominal pain associated with nausea and vomiting in a young patient led to a diagnosis of median arcuate ligament syndrome. The presence of mild haematuria was associated with a concomitant Nutcracker syndrome. diagnosis was achieved by a computed tomography scan, which showed compression of the vessels of the coeliac axis and left renal vein. These syndromes are very rare, and their association in the same patient has not been described before. There is no relationship in the aetiology of these entities. In this report we discuss the diagnosis and therapeutic options, and review the literature.- - - - - - - - - - ranking = 0.33333333333333keywords = ligament (Clic here for more details about this article) |
9/47. Reformation of the posterior atlanto-occipital membrane following posterior fossa decompression with subsequent constriction at the craniocervical junction.The posterior atlanto-occipital membrane (PAO) contributes little to craniocervical stability and is generally underappreciated and incised with most suboccipital craniectomies. We report a case of a child who underwent posterior fossa decompression for Chiari I malformation with syringomyelia whose symptoms had not resolved months after surgery. A secondary exploratory operation revealed a healed constricting PAO which had been incised linearly at the initial operation. This patient's symptoms improved soon after the second surgery. We propose that attention be given to this membrane, and if it is incised with underlying dura mater as in a standard posterior fossa decompression, it should be removed or cauterized separately and laterally to inhibit its reformation.- - - - - - - - - - ranking = 0.0056413102059595keywords = membrane (Clic here for more details about this article) |
10/47. A case report of CUAVD with azoospermia: a proposal of a rational diagnostic approach.Since its introduction in 1992, intracytoplasmic sperm injection (ICSI) has made the treatment of severe male infertility possible, particularly that of azoospermia, both secretory and secretory. Some azoospermic subjects have a pathological development of the seminal pathways, and in particular of the vas deferens and/or ejaculatory ducts. A large part of these subjects show, like patients affected by cystic fibrosis, mutations in the cystic fibrosis transmembrane regulator (CFTR) gene. Some of these azoospermic subjects are indeed paucisymptomatic fibrosis cystic patients who bear the risk of transmitting cystic fibrosis, seminal pathways alterations and, possibly, renal malformations to their offspring. We describe a case of an infertile patient with right CUAVD and azoospermia previously treated by crossed epididimovasostomy in the absence of any genetic and an adequate anatomic evaluation. He was then found to be CFTR mutation positive and without demonstrable spermatozoa in the vesicular fluid despite ultrasound evidence of left ejaculatory duct obstruction. During the second TESA-ICSI cycle an ongoing pregnancy was obtained. An extensive genetic examination for CFTR mutations and a through anatomical study is, therefore, mandatory in these patients to select the most appropriate treatment in CFTR mutation positive and negative CUAVD patients.- - - - - - - - - - ranking = 0.00094021836765992keywords = membrane (Clic here for more details about this article) |
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