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At least 253 records · Page 14Linked to original sources
PubMed1996

[Surgical experiences of fenestrated total cavopulmonary connection in patients under four year of age].

The fenestrated Fontan operation is an interim steps for patients who considered to be at high risk for one step Fontan procedure. We performed total cavopulmonary connection with baffle fenestration in five patients under four year of age (33 month of mean age at operation). All patients previously underwent palliative surgery (Blalock shunt in 3, PA banding in 2). Three patients weighed less than 10 kg. Pulmonary vascular resistance index (PARI) were 2.03 +/- 0.18 U/BSA and exceeded 2 U/SQm in 3 patients. Nakata's indice were ranged from 282 to 644 (mean 394) mm2/BSA. Bidirectional cavopulmonary shunt was considered to be alternative pathway for three patients in staged Fontan strategy. Postoperative hemodynamics were relatively stable in all patients and weaned from mechanical ventilation within 5 days with various arterial oxygen saturation. There was no pleural effusion lasting longer than 1 week. One patient died of ileus caused from congenital malrotation. Follow up catheter examination at 1 year showed 83 to 96% of SaO2 and survived patients were doing well. Fenestrated TCPC can be applied safely in younger patients who are considered to need surgical treatments in staged Fontan strategy. Whether fenestration should be closed has to be wait further studies.

Age Factors↗
PubMed1996

[Saccular aneurysm associated with fenestration of the distal segment of basilar artery].

A 32-year-old man who presented with subarachnoid hemorrhage was found to have a saccular aneurysm arising from the proximal end of the fenestration formed at the distal third of basilar artery. The aneurysm dome was directed anteriorly and measured 3mm in diameter. It was successfully clipped via subtemporal transtentorial approach and the patient returned to his previous job. Basilar artery fenestration is angiographically found in 0.23-0.6%. The fenestration is most frequently located in the proximal basilar trunk close to the vertebro-basilar junction. In this report a rare case with an aneurysm associated with fenestration in the distal part of the basilar artery will be presented.

Adult↗
PubMed1998

The abdominal aortic fenestration procedure in acute thoraco-abdominal aortic dissection with aortic branch artery ischemia.

OBJECTIVE: Diagnostic work-up and treatment strategies have improved the prognosis of acute thoraco-abdominal aortic dissection. Little attention to aortic branch artery ischemia or even failed restoration following prosthetic repair of thoraco-abdominal dissection still merit a problem with high morbidity and mortality. SETTING: Department of Vascular Surgery, Technische Universität München, Germany. PURPOSE: Reflecting on visceral and neurological ischemic complications in acute thoraco-abdominal aortic dissection indications and limitations of the abdominal-aortic-fenestration procedure are discussed with a review on our own clinical experience and the results reported in the literature. CONCLUSIONS: The abdominal-aortic-fenestration procedure is accomplished with minimal deterioration of the critically ill patient. In new onset or relief of aortic branch ischemia, following initial prosthetic repair of either type A or B dissection aortic fenestration is found to be an effective and secure adjunctive procedure to restore the blood flow of compromised organs. Primary abdominal aortic fenestration is recommended instead of prosthetic repair in cases of acute type B dissection. It is the treatment of choice because of branch artery ischemia becoming the focal point of deterioration.

Acute Disease↗
PubMed1998

Incidence and distribution of dehiscences and fenestrations on human skulls.

The aim of this study was to determine the incidence and distribution of dehiscences and fenestrations of the alveolar plate. The sample used in the study consisted of 163 adult jaw bones (78 maxillae and 85 mandibles) of a recent population from the north-western Croatia. The skulls are part of the skull collection of The Anatomy Institute, Zagreb, Croatia. The number and location of dehiscences and fenestrations for each tooth area above the total number of 2038 teeth were registrated. The total number of 696 (26.67%) dehiscences and 190 (9.32%) fenestrations was measured. Among the maxillary teeth, canines exhibited greatest and most frequent dehiscences and fenestrations. In the mandible, canines were most commonly associated with both defects, too. It was concluded that the canines were most frequently associated with either of the osseous defects.

Adult↗
PubMed1976

Effect of hepatic venous outflow obstruction on pores and fenestration in sinusoidal endothelium.

The ultrastructure of pores and fenestrations in hepatic sinusoidal endothelial cells was examined following partial surgical occlusion of the suprahepatic portion of the inferior vena cava. Within 12 h after partial obstruction of hepatic venous outflow, endothelial pores (less than 0-1 mum in diameter) and sieve plates in the distal halves of sinusoids were greatly reduced in number or were totally absent, and they were replaced by large fenestration (less than 1-0 mum in diameter). These results suggest that pores forming sieve plates may fuse to form large fenestrations. The findings also indicate that sinusoidal hypertension and hypoxia associated with obstruction of hepatic venous outflow alter the distribution of pores and fenestrations in sinusoidal endothelium

Animals↗
PubMed1978

Cochlear reserve in otosclerosis. A long-term follow-up study of fenestration cases.

In this long-term follow-up study of fenestration cases, a remarkable stability in sensorineural hearing levels is demonstrated. Since the focus of otosclerosis was not removed at the time of fenestration surgery, this bone conduction stability is an indication that the ear can withstand the presence of an otosclerotic lesion that produces stapes fixation for long periods of time without sensorineural deterioration. It would seem that the otosclerotic lesion in ears suitable for fenestration surgery has had little tendency to invade deeply into the cochlear capsule.

Adult↗
PubMedDate not supplied

Fenestration tympanoplasty: an adjunctive technique for hearing restoration.

Two-staged fenestration tympanoplasty is a form of total tympanoplasty type V that incorporates the mastoidotympanomastoidectomy (radical mastoidectomy) and revives the Lempert horizontal semicircular canal fenestration operation. It is valuable when the usual and customary single or two-staged tympanoplasty procedures fail to conserve or restore hearing in the operative management of otitic disease. Two-staged fenestration tympanoplasty is also indicated in audiometric failure tympanoplasties, in oval window surgery failures in the absence of supporting ossicles and in the presence of a fibrosed or sclerosed oval window, and in severe otitic oval window-round window-posterior tympanic recess-tympanic orifice eustachian tube infection, which can only be completely removed by the mastoidotympanectomy. Total tympanoplasty type V as described here has produced serviceable hearing for human conversation and the speech frequencies to the 15-dB to 25-dB levels, and a 20 dB average in 19 of 21 patients operated on for a 90% success rate.

Adolescent↗
PubMed1979

The fenestration operation in 1979.

While it is rarely indicated today, fenestration of the horizontal semicircular canal has left its mark in otologic history. A significant number of patients with fenestrated ears are alive today requiring continued care. A review of both the technique of fenestration as well as the particular postoperative problems is presented to familiarize younger otologists involved in their management.

Fenestration, Labyrinth↗
PubMed1998

[Juliusz Lempert (1890-1959): the author of the fenestration technique].

Juliusz Lempert was born in 1890 in Poland. A few years later the poor Jewish family emigrated to the United States. Lempert obtained his MD degree at Long Island Medical College, and soon after that established a small hospital of his own in Manhattan. Later he bought an old five-storey building and converted it into a new otological medical center, which he called Endaural Hospital. His life was rather difficult with the wave of antisemitism in the United States and the adversity which he encountered so many times. However his contribution to the microsurgical treatment of conductive deafness is immense. He elaborated and introduced a new method of mastoidectomy and, first of all, fenestration--a new one-stage surgical technique to be applied in cases of otosclerosis. This precise, sophisticated operation revolutionized surgical treatment. With a dentist's drill Lempert created a new window on the horizontal canal, in this way the sound wave could stimulate the inner ear. He was to call it "fenestration nov-ovalis". Lempert was never a member of any ENT society and worked in his hospital alone. When suddenly his only son was stricken with leukemia and died, Lempert was completely broken, and never returned to this work. The next blows were new operative methods of otosclerosis: stapes mobilisation introduced by Rosen and stapedectomy by Shea. He never accepted these new techniques. It was a painful experience for a surgical genius who had at so many times been hurt during his life. He could not believe that his fenestration was definitely gone. Lempert quickly deteriorated physically and mentally, and died in 1958.

Fenestration, Labyrinth↗
PubMed1988

Results of optic nerve sheath fenestration for pseudotumor cerebri. The lateral orbitotomy approach.

Twenty-eight patients with pseudotumor cerebri underwent 40 optic nerve sheath fenestrations for relief of visual loss or to preserve vision. Twenty women and eight men underwent 16 unilateral fenestrations and 12 bilateral operations. Papilledema disappeared or was strikingly reduced in 24 of 28 patients. The other four patients had gliotic discs (two patients) or were followed up for only a short time. Visual acuity improved in 12 of 40 eyes and remained the same in 22 of 40 eyes. Seventeen eyes had preoperative visual acuity of 20/30 or better. In six eyes visual acuity decreased. Of eight eyes operated on that had visual acuity of 20/200 or worse, only three showed improvement. Visual fields improved in 21 of 40 eyes and remained the same in ten eyes. Five of the ten eyes that did not change had poor vision before surgery. Eight eyes in five patients continued to lose acuity postoperatively. Each of these eight eyes had a concomitant loss of visual field. An additional two eyes developed visual field loss with preserved visual acuity. The indications for surgery are early evidence of progressive loss of visual field or acuity in a patient with pseudotumor cerebri. Severe vision loss presents little opportunity for improvement but fenestration may be used in a last effort to preserve or restore vision.

Adult↗
PubMed1996

Fenestration in the myelin sheath of nerve fibers of the shrimp: a novel node of excitation for saltatory conduction.

Giant nerve fibers of the shrimp family Penaeidae conduct impulses at the velocity highest among all animal species (approximately 210 m/s; highest in mammals = 120 m/s). We examined these giant and other small nerve fibers morphologically using a differential interference contrast microscope as well as an electron microscope, and found a very specialized form of excitable membrane that functions as a node for saltatory conduction of the impulse. This node appeared under the light microscope as a characteristic pattern of concentrically aligned rings in a very small spot of the myelin sheath. The diameter of the innermost ring of the node was about 5 microns, and the distance between these nodes was as long as 12 mm. Via an electron microscope, these nodes were characterized by a complete lack of the myelin sheath, forming a fenestration that has a tight junction with an axonal membrane. Voltage clamp measurements by a sucrose gap technique demonstrated that the axonal membrane at these fenestration nodes is exclusively excitable and that the large submyelinic space is a unique conductive pathway for loop currents for saltatory conduction through such fenestration nodes.

Animals↗
PubMed1986

Capillary permeability in the pancreas and colon: restriction of exogenous and endogenous molecules by fenestrated endothelia.

The permeability properties of fenestrated capillaries in the colon and exocrine and endocrine pancreas to exogenous and endogenous molecules were examined. The exogenous tracers horseradish peroxidase (Einstein-Stokes radius [ESR], 3.0 nm), hemoglobin (ESR, 3.2 nm), and ferritin (ESR, 6.1 nm) were injected intravenously and allowed to circulate for 5-90 min. Tissues were removed and processed for cytochemical or standard electron microscopic examination. The endogenous plasma proteins albumin (ESR, 3.5 nm) and IgG (ESR, 5.5 nm) were localized by immunocytochemistry using the protein A-gold technique. All vessels examined were permeable to HRP in less than 5 min. In contrast, these vessels were restrictive to the slightly larger hemoglobin molecule (60-min circulation) and to ferritin (90-min circulation). Capillaries in the exocrine and endocrine pancreas were restrictive to albumin and IgG. These results demonstrate the presence of fenestrated capillary beds, in addition to the choriocapillaris, that are restrictive to molecules with ESR greater than or equal to 3.2 nm. Capillaries in the mucosa of the colon were restrictive to hemoglobin and ferritin but did not restrict albumin or IgG. This indicates that these vessels are of the permeable type. However, the rate of transendothelial movement of molecules is slower than that of other permeable vessels, such as in the ileo-jejunum. This study has provided further evidence for the existence of fenestrated endothelia that are restrictive to exogenous and/or endogenous molecules.

Animals↗
PubMed2005

Closure of a moderately large atrial septal defect with a self-fabricated fenestrated Amplatzer septal occluder in an 85-year-old patient with reduced diastolic elasticity of the left ventricle.

Percutaneous closure of an atrial septal defect (ASD) in the elderly with reduced diastolic elasticity of the left ventricle poses a significant management challenge. We report on the case of an 85-year-old patient who was admitted for percutaneous device closure of a moderately large secundum atrial septal defect. Hemodynamic evaluation documented an increase in left atrial pressure from a mean of 12 mm Hg to a mean of 32 mm Hg after balloon test occlusion of the ASD. Two months later, after adequate pretreatment with diuretics and afterload-reducing substances, he underwent successful closure of the ASD using a self-fabricated fenestrated Amplatzer septal occluder, which resulted in a postimplantation left atrial pressure of a mean of 18 mm Hg. Recovery was unremarkable and the fenestration has remained patent for 3 months since implantation of the device. This unique case highlights the feasibility of using a self-fabricated fenestrated Amplatzer septal occluder to close interatrial communications in elderly patients with diastolic dysfunction of the left ventricle.

Aged↗
PubMedDate not supplied

Management of tracheal wall resection for thyroid carcinoma by tracheocutaneous fenestration and delayed closure using auricular cartilage.

BACKGROUND: In the case of advanced thyroid carcinoma invading the trachea, surgical procedures for tracheal resection are selected in relation to the degree of invasion. We created a tracheocutaneous fenestration that was later closed with a free auricular cartilage autograft. We present a simple and effective method for permanent closure of tracheostoma. METHODS: The surgical procedure for delayed closure consists of three steps: (1) preparing the hinge flap with additional undermining of the subcutaneous layer and the strap muscles; (2) removing a portion of the conchal cartilage from the auricle, which is easily performed with a semicircular skin incision along the anthelix of the ear; and (3) placing the conchal cartilage with its convex surface upward just over the sutured hinge flap layer. RESULTS: Under local anesthesia, we successfully employed this reconstructive procedure for 5 patients. Unfortunately, however, in one patient, we had to reopen the closed tracheocutaneous fenestration on the second postoperative day because of an acute problem that was independent of the closure surgery. Four patients remain in satisfactory condition for more than 2 years since the closure of tracheostoma. CONCLUSIONS: The auricular cartilage free graft is a relatively simple procedure which supplies tracheal wall skeletal support for the permanent closure of the tracheocutaneous fenestration.

Aged↗
PubMed1994

Neuropeptide-Y neurons projectioning to the medial septum-diagonal band do not have access to fenestrated capillaries in the rat brain.

The aims of this study were to (1) determine the localization of neuropeptide-Y (NPY)-containing perikarya which project to the medial septum-diagonal band (MSDB), a brain region rich in gonadotropin-releasing hormone (GnRH) producing perikarya, and (2) determine if NPY neurons have access to fenestrated capillaries as well. Fluorescent retrograde tracing after microinjection of fluororuby (FR) into the MSDB, and peripheral injection of fluorogold (FG), was used in combination with immunofluorescence for NPY. Injection of FR into the MSDB resulted in retrograde labeling of neurons in the hypothalamic arcuate nucleus (ARC) and brainstem noradrenergic cell groups A1 and A2, as well as other regions. The largest populations of NPY neurons were located in the ventromedial ARC and several of these perikarya contained FR indicating that they project to the MSDB. Defined cell groups in the areas A1 and A2 of the brainstem also contained large numbers of NPY neuron perikarya, and several of these contained FR. In addition, we observed isolated incidences of FR-labeled NPY perikarya in the amygdala and hippocampus. A small population of NPY neurons in the ARC contained FG, indicating that they are in contact with fenestrated capillaries and hence are neuroendocrine cells; however, none of these neurons contained FR. We suggest that NPY neurons in the ARC modulate GnRH function via innervation of the MSDB and LH release via release into fenestrated capillaries of the hypophysial-portal system.

Animals↗
PubMed1992

Fenestration of intraventricular cysts using a flexible, steerable endoscope.

Multiloculated hydrocephalus with multiple intraventricular septae due to meningitis associated with ventriculitis and other CSF containing intraventricular cysts can be treated by endoscopic fenestration. Seven patients with various CSF containing intraventricular cysts were treated using a flexible steerable endoscope and the argon laser. The experience using several currently available steerable endoscopes for treatment of this neurosurgical problem is reviewed. Emphasis is placed on the use of the laser for cyst fenestration. Successful decompression of the ventricular cyst(s) was accomplished in five cases with the endoscope alone. Craniotomy was required in two patients in order to complete cyst fenestration. It is the author's impression that laser assisted ventriculoscopy with steerable flexible endoscopes is an alternative and oftentimes superior method of treating CSF containing cysts within the lateral ventricles of hydrocephalic patients. Steerable flexible endoscopes designed specifically for neurosurgical use are needed.

Adolescent↗
PubMed1986

The endothelial pocket. A new structure in fenestrated endothelia.

A new endothelial cell structure, named the endothelial pocket, has been found by combined transmission and scanning electron microscopic studies of renal peritubular capillaries. Transmission EM observations made on these and other fenestrated capillaries demonstrated that each pocket consists of an attenuated fold of fenestrated endothelium that projects approximately 200 nm into the lumen above the rest of the endothelial surface. Beneath this luminal fold, there is a space and then another layer of fenestrated endothelium which abuts the basal lamina. The linear density of endothelial pockets was measured in the capillaries of the kidney cortex, intestinal mucosa and exocrine pancreas in mice and determined to be 0.067, 0.017 and 0.007 pockets X micron-1 respectively. Cationic ferritin decoration of the anionic sites on the luminal surface of the endothelium in these capillary beds revealed that both unlabelled and labelled diaphragms are clustered. In such specimens, the majority of the luminal diaphragms on endothelial pockets did not have cationic ferritin binding sites detectable by either scanning or transmission EM. On this account as well as on account of their general morphology, endothelial pockets appear to be multifold versions of the simple transendothelial channel.

Animals↗