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Raeder's syndrome after embolization of a giant intracavernous carotid artery aneurysm: pathophysiological considerations
Tatsui, Claudio Esteves;Prevedello, Daniel Monte-Serrat;Koerbel, Andrei;Cordeiro, Joacir Graciolli;Ditzel, Leo Fernando da Silva;Araujo, Joao Candido;
Arquivos de Neuro-Psiquiatria , 2005, DOI: 10.1590/S0004-282X2005000400024
Abstract: we present the case of a 47 years old woman submitted to an endovascular trapping of a left cavernous internal carotid artery aneurysm, in which the distal balloon was inflated, as usually done, within the cavernous segment of the internal carotid artery, different from the proximal one which was inflated inside the carotid canal due to technical problems. consequently, a clinical picture of raeder's paratrigeminal neuralgia took place. this is the first case report in the literature with theses characteristics. a review of the anatomic pathways and further considerations about the possible pathophysiological mechanisms involved are presented.
Reconstruction of the anterior cruciate ligament of the knee
Nikoli? Dragan,Dra?kovi? Vlajko,Vulovi? Rajko
Vojnosanitetski Pregled , 2006, DOI: 10.2298/vsp0611945n
Abstract: Background/Aim. Numerous papers on reconstruction of the anterior cruciate ligament of the knee (ACL) contribute to the significance of this method. The aim of this study was to analyze the outcome of the use of this surgical treatment method regardless the type of surgical intervention, graft, and the choice of the material for fixing. Methods. The study included 324 patients treated within the period from April 1997 to April 2004. Arthroscopically assisted ACL reconstruction was typically performed using the central one-third of the patellar ligament, as a graft, with bone blocks. Fixing was performed using screws (spongy or interferential, Mitek type). In the cases who required revision of the surgery, we used a graft m. semitendinosus and m. gracilise (STG) or a graft of the patellar ligament (B-Pt-B). Fixation in these cases was performed using absorptive wedges according to the Rigidfix technique or metallic implants. Results. The analysis included the results of the reconstruction of the anterior cruciate ligament of the knee (B-Pt-B or STG graft) in 139 of the knees. Chronic injuries were revealed in 132 (94.9%) of the knees. According to the anamnesis and clinical findings, the feeling of instability prevailed in 132 (94.9%) of the knees, pain in 72 (51.7%), effluents in 24 (17.2%), and blockages in 13 (9.3%). Early and late postoperative complications were noticeable in 3.5% each. Hypotrophy of the upper knee musculature up to 2 cm was present in 53.9% of the operated knees, while minor contractions in 13.6% of them. The final result of the reconstruction graded begusing the Lysholm Scale was 85.2, simultaneous reconstructions of other ligaments 75.3, and revision surgery 68.0. First-grade degenerative postoperative changes according to the K/L Scale were found in 55.0% of the surgically treated knees, while the worst, four-grade one in 2.5%. Conclusion. On the basis of these findings, we can conclude that this method is the method of choice in preventing further "worsening" of the chronically instable knee. The surgical technique of choice is arthroscopically assisted reconstruction using a B-Pt-B or STG graft.
Diagnosis and Treatment of Anterior Knee Pain  [cached]
Banu Kuran,Beril Do?u
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2009,
Abstract: Patellofemoral pain syndrome (PFPS) is a common and painful musculoskeletal condition that affects physically active young adults. It presents as diffuse anterior or retropatellar knee pain that is aggravated by activities which repetitively load the patellofemoral joint. The etiology of PFPS appears to be multifactorial which includes biomechanical, muscular and overactivity theories. For most patients, a careful history and physical examination are sufficient to make the diagnosis. Treatment can be initiated without imaging. When symptoms continue despite appropriate management, radiological investigation is indicated to exclude pathologies such as osteochondritis dissecans, patella bipartita, and neoplasms. The initial treatment plan must be nonoperative and should include a comprehensive rehabilitation program with temporary activity modifications.Turk J Phys Med Rehab 2009; 55 Suppl 1: 20-5.
Total Knee Arthroplasty Considerations in Rheumatoid Arthritis  [PDF]
Jonathan R. Danoff,Garrett Moss,Barthelemy Liabaud,Jeffrey A. Geller
Autoimmune Diseases , 2013, DOI: 10.1155/2013/185340
Abstract: The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success. 1. Introduction Over the past thirty years, major advances have been realized in the understanding of the pathogenesis and treatment of rheumatoid arthritis (RA). As an immune mediated process, all joints are affected, as synovitis leads to destruction of cartilage, which may ultimately result in bone loss and joint deformity. Joint contractures, fixed flexion and valgus deformities, and ligamentous laxity are especially evident in large joints, complicating treatments. With the advent of highly effective biologic therapies, fewer individuals with rheumatoid arthritis suffer this end-stage joint destruction [1]. Despite this success, approximately 20–25% of afflicted individuals develop advanced arthritis in their joints, with the knee being one of the most commonly affected joints contributing to patient pain and overall disability [2, 3]. Total knee arthroplasty (TKA) has proven to be a highly successful treatment for advanced rheumatoid arthritis. The orthopedic surgeon must pay special attention to the unique challenges presented by this population of patients during preoperative, intraoperative, and postoperative planning in order to maximize successful outcome and quality of life for these patients. 2. Preoperative Considerations Rheumatoid arthritis is a systemic disease, which creates a unique set of challenges and considerations when treating patients afflicted with this disease. Care is often delivered by a variety of specialty physicians, including rheumatologists and orthopedic surgeons. Preoperative communication is vital among these providers to maximize outcomes. Surgeons and anesthesiologists alike must be aware of the increased risk to the cervical spine as 80% of patients have atlantoaxial instability [4]. The cervical spine also is at elevated risk of basilar invagination and subaxial instability, and thus preoperative radiographic investigation via flexion and extension images should be obtained, as intubation
Coupling Characteristics of Anterior Cruciate Ligament and Gait Analysis on Anterior Instability of Knee  [cached]
Zeng-yu TAO,Lu-quan REN,Li-mei TIAN,Dan-yang ZHOU
Advances in Natural Science , 2010, DOI: 10.3968/942
Abstract: Knee is the largest and most complicated joint in the human body. Since in humans the knee supports nearly the whole weight of the body, it is the joint most vulnerable to acute injury. Normal knee joint movements are accomplished via an intricate balance between passive ligamentous and active muscular components to maintain knee stability and prevent injury. The anterior cruciate ligament (ACL) is a critical passive component to normal knee function which acts to resist anterior rotatory motion of the tibia relative to the femur. The objective of this study is to investigate the coupling characteristic of the ACL, also try to search the kinematics and kinetic coupling characteristic make the quadriceps asymmetry after the ACL injured. Meanwhile this paper mainly presents some lower extremity data of the patients who had the anterior instability on the knee due to the ACL injury based on a infrared reflective marker system using stereophotogrammetry techniques. The compensatory mechanism and the biological coupling characteristic are analyzed in the paper. The results of this paper provide fundamental information on further study of kinematics and segmental coupling. The results of time-distance parameters indicate that the efficiency of walking is lower to some extent by decreased gait frequency and speed and prolonged gait circle that lead to unsteadiness of knee after injury. The kinematics data results demonstrate that the joint angle of extremity have adaptable changes produced by nervomuscular control system after injury. The kinemics data show that the other joints of affected extremity and joints of unaffected extremity both have adaptable changes, which is compensation profiting knee stability after injury. Keywords: biological coupling; kinematic coupling; compensatory mechanism
Review for the generalist: evaluation of anterior knee pain
Kristin M Houghton
Pediatric Rheumatology , 2007, DOI: 10.1186/1546-0096-5-8
Abstract: Anterior knee pain (see Figure 1) is one of the most common musculoskeletal complaints seen in the pediatric population. A fairly extensive differential diagnosis exists as anterior knee pain is a fairly nonspecific phenomenon. A thorough history and physical examination with attention to anatomic location of the pain, inciting factors, relationship of associated symptoms as well as a general assessment of growth and development will aid in the evaluation and treatment of this disorder. An awareness of typical injury patterns can aid the physician in narrowing the differential diagnosis. Identification of worrisome signs and symptoms will also help in defining which cases may require further evaluation. All pediatric patients presenting with knee pain require evaluation for ipsilateral hip and lumbar spine disorders. This article will review common causes of chronic anterior knee pain in the pediatric population with a focus on patellofemoral pain. It is not meant to be an exhaustive review and will not review acute traumatic knee injuries. Lateral, medial or posterior knee pain will be covered in a subsequent article.The clinical history should include a thorough description of the pain characteristics (location, character, onset, duration, change with activity or rest, aggravating and alleviating factors, night pain); trauma (acute macrotrauma, repetitive microtrauma, recent/remote); mechanical symptoms (locking or extension block, instability, worse during or after activity); inflammatory symptoms (morning stiffness, swelling); effects of previous treatments and the current level of function of the child. Patients with overuse anterior knee pain may report a sensation of giving way or instability. This sensation is usually a pseudo-giving way due to what is coined the "quadriceps inhibitory reflex" or a neuromuscular inhibition that occurs secondary to pain, muscle weakness, patellar instability or joint instability. It is important to note that true instability
Occipital Artery Arising from the Anterior Aspect of the Internal Carotid Artery Identified by Three-Dimensional Computed Tomography Angiography
Toshinori Iwai,Toshiharu Izumi,Tomio Inoue,Jiro Maegawa
Iranian Journal of Radiology , 2012,
Abstract: Variation of the branches of the external carotid artery (ECA) is well known, but it is extremelyrare for the occipital artery (OA) to arise from the internal carotid artery (ICA). A87-year-old man was found to have this anatomical variation on the right side by threedimensionalcomputed tomography angiography for vascular mapping of the carotidarteries before superselective intra-arterial catheterization for advanced tongue cancer.Imaging showed the OA arose from the anterior aspect of the right ICA with the origin located8.8 mm distal from the carotid bifurcation. The inner diameter of the origin of theOA was 2.1 mm and the angle between the OA and the ICA was 62 degrees. It is importantto recognize this anatomic variation of the branches of the ECA before head and neck microsurgicalreconstruction or superselective intra-arterial chemotherapy for oral cancer
Role of carotid ultrasonography in the evaluation of cardiovascular risk in patients with rheumatoid arthritis
Miguel A Gonzalez-Gay, Carlos Gonzalez-Juanatey, Jose A Miranda-Filloy, Javier Martin, Javier Llorca
Arthritis Research & Therapy , 2010, DOI: 10.1186/ar3186
Abstract: With respect to these interesting observations, we would like to further emphasize the importance of carotid ultrasonography in the evaluation of the cardiovascular risk of patients with RA and the importance of the duration of the disease as a predictor of severity, so it can influence the development of cardiovascular events in these patients. We previously reported that, in long-standing RA patients with no classic cardiovascular risk factors at the time of the carotid assessment, the duration of the disease was the best predictor of carotid plaques [2]. On the other hand, RA is a chronic inflammatory disease, and even in the apparently quiescent phases of the disease, the cumulative effect of the chronic inflammatory burden may account for the progression of the atherosclerosis disease. In this regard, we observed that the mean values of C-reactive protein (CRP) over an extended follow-up rather than a single determination of CRP at the time of the carotid ultrasonography evaluation were associated with the carotid IMT [3]. Moreover, we found that carotid artery IMT had a high predictive power for the development of cardiovascular events over a 5-year follow-up period in 47 patients with RA without clinically evident cardiovascular disease at the time of the carotid ultrasonography evaluation [4]. In our study, carotid IMT categorized in quartiles was strongly associated with the development of cardiovascular events [4]. When logistic regression models were performed, carotid IMT at the time of the ultrasonographic study yielded a high predictive power for the development of cardiovascular events over the 5-year follow-up period. On the other hand, the duration of the disease is also considered an important risk factor of future cardiovascular events [5].Taking all of these considerations together, we propose that ultrasonographic assessment of the carotid artery be performed on all patients with RA in order to establish a subgroup of patients with a high risk o
Dr. Navin Kumar Karn,Dr. Guru Prasad Khanal,Dr. Mahi Pal Singh
Internet Journal of Medical Update - EJOURNAL , 2010,
Abstract: A case of long standing unreduced anterior dislocation of the knee for 2 months has been reported which was treated first with open reduction and external fixation at 70° flexion of knee followed by gradual extension of knee. Once full extension was achieved, the cylindrical cast was applied for 3 months. The final range of movement of knee at one year follow up was 5-70o along with painless weight bearing. To conclude, this conservative treatment could be one of the valuable option for the patients who can not undergo major surgery because of genreral health problem, or unable to afford for the surgery especially in developing countries, or not willing for arthrodesis.
Long-standing unreduced anterior dislocation of the knee - a case report
NK Karn, GP Khanal, MP Singh
Internet Journal of Medical Update - EJOURNAL , 2010,
Abstract: A case of long standing unreduced anterior dislocation of the knee for 2 months has been reported which was treated first with open reduction and external fixation at 70° flexion of knee followed by gradual extension of knee. Once full extension was achieved, the cylindrical cast was applied for 3 months. The final range of movement of knee at one year follow up was 5-70o along with painless weight bearing. To conclude, this conservative treatment could be one of the valuable option for the patients who can not undergo major surgery because of genreral health problem, or unable to afford for the surgery especially in developing countries, or not willing for arthrodesis. KEY WORDS: Knee joint; Dislocation; Conservative treatment
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