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At least 415 records · Page 23Linked to original sources
PubMed2006

Causality of pediatric brainstem infarction and basilar artery fenestration?

Pediatric arterial thromboembolic stroke is an uncommon condition and rarely is reported to be associated with a cerebral artery fenestration. This clinical report discusses the case of a child with brainstem infarction and basilar artery fenestration. A cardiac source of thromboembolic events could be excluded; however, detailed coagulation analysis revealed in addition an apoliopoprotein(a) size polymorphism. Because we assume that the two concurrent pathologies in combination caused the arterial thromboembolic stroke, the evaluation of all potential triggers including vascular anomalies and coagulation disorders should be considered in unexplained pediatric infarction.

Basilar Artery↗
PubMed2005

Ruptured saccular aneurysm of distal vertebral artery fenestration managed with Guglielmi detachable coils and intraventricular tissue plasminogen activator.

BACKGROUND: Aneurysms associated with vertebrobasilar fenestrations are uncommon. We report on an unusual presentation of such aneurysm with a dedicated arterial pedicle, manifesting with significant intraventricular hemorrhage. Equally important, the aneurysm was managed in a multidisciplinary fashion, which, we think, greatly contributed to a good outcome. CASE DESCRIPTION: A 55-year-old man presented in good condition after subarachnoid and massive intraventricular hemorrhage. The aneurysm location and the extent of intraventricular hemorrhage both presented concerns regarding treatment approach. The aneurysm was first treated with transarterial coil obliteration, and intraventricular tissue plasminogen activator (tPA) infusion was given, with rapid resolution of evolving hydrocephalus. The patient had an excellent outcome. CONCLUSION: To our knowledge, this is the first report of a vertebrobasilar fenestration saccular aneurysm with a dedicated pedicle projecting toward the foramen of Magendie with significant intraventricular hemorrhage. In addition, this patient was successfully managed with endovascular obliteration and intraventricular tPA infusion.

Aneurysm, Ruptured↗
PubMed1997

Transcatheter fenestration dilation and/or creation in postoperative Fontan patients.

There are very few therapeutic options for severely symptomatic Fontan patients after spontaneous complete or virtual fenestration closure. Its reopening in 14 such patients led to dramatic hemodynamic improvement in most. The clinical experience with transcatheter fenestration creation and/or dilation in symptomatic Fontan patients is reported demonstrating feasibility, safety, and a novel management option for these patients.

Adolescent↗
PubMed1996

Subtenon's local anesthesia for optic nerve sheath fenestration.

PURPOSE: We used subtenon's local anesthesia for optic nerve sheath fenestration as an alternative to either general or retrobulbar anesthesia. METHODS: Thirty patients with pseudotumor cerebri, who were unresponsive to medical treatment, underwent optic nerve sheath fenestration after administration of topical and subtenon's local anesthesia. RESULTS: When topical tetracaine, in conjunction with subtenon's anesthesia, was administered at the beginning of the procedure, excellent anesthesia and maximal patient comfort were achieved. CONCLUSIONS: The use of local anesthesia allows for a pain-free, expeditious operation with fewer potential anesthetic complications.

Anesthesia, Local↗
PubMed2003

The fenestrated Kawashima operation for single ventricle with interrupted inferior vena cava.

An 8-month-old boy with double outlet right ventricle with hypoplastic left ventricle, heterotaxy, left atrial isomerism, bilateral superior vena cavae without bridging vein, and interruption of the inferior vena cava with azygous continuation to the left superior cava underwent a bilateral bidirectional cavopulmonary anastomosis. A calibrated 3-mm connection between the right pulmonary artery and the common atrium was constructed with the proximal right superior vena cava to allow right to left shunting, analogous to a fenestration in a Fontan operation. We hypothesize that in small young patients undergoing the Kawashima operation a fenestration may improve postoperative hemodynamics.

Cardiac Surgical Procedures↗
PubMed1997

Thoracoabdominal fenestration for aortic dissection with ischemic colonic perforation.

Previous attempts at repair of aortic dissection complicated by intestinal infarction requiring concomitant bowel resection have been fatal. Presented is a case of distal aortic dissection resulting in colonic infarction and perforation. Thoracoabdominal aortic fenestration with concomitant right hemicolectomy was successful. In patients with aortic dissection complicated by mesenteric ischemia, we recommend urgent graft replacement of the thoracoabdominal aorta when feasible. When peritoneal contamination precludes the use of prosthetic grafts, thoracoabdominal fenestration is an effective option.

Adult↗
PubMed1983

Surface charges associated with fenestrated brain capillaries. I. In vitro labeling of anionic sites.

Ferritin derivatives with different pI values and the basic dye ruthenium red have been used as cationic probes to localize anionic sites associated with fenestrated brain capillaries. Cationic ferritin was found in the endothelial basement membrane and the basement membrane of the perivascular cellular linings in amounts far exceeding those observed with anionic derivatives, the degree being greater for the more cationized ferritin molecules. Labeling of the luminal endothelial front with cationic ferritin was only achieved when a serum- or albumin-free medium was applied. Furthermore, the striated collagen fibers were coated with cationic ferritin molecules in a highly ordered fashion. Ruthenium red localized to the same sites. The findings suggest the existence of a perivascular charge filter around fenestrated capillaries of the brain. Some physiological roles of this filter are discussed, as related to its possible function in regulating homeostasis of cerebrospinal fluid.

Affinity Labels↗
PubMed1983

Surface charges associated with fenestrated brain capillaries. II. In vivo studies on the role of molecular charge in endothelial permeability.

We report on the effect of the net charge of a tracer (ferritin) on its permeability in fenestrated capillaries of the brain. Our experiments show that the charge of this tracer actually influences its interaction with the endothelium. Three phases of tracer-endothelial interaction could be discriminated. Anionic and slightly cationic derivatives (pH 4.5-7.8) do not show any affinity to the luminal endothelial membrane. Ferritin derivatives with a pI value between 7.8 and 9.3 result in the labeling of the fenestrae without coating additional luminal plasmalemmal structures (i.e., coated pits and plasmalemmal vesicles). Tracers with a high positive net charge (pI greater than 9.3) led to their endocytotic uptake and extravasation by some transcytotic mechanism. Extravasated cationic ferritin accumulates in the endothelial basement membrane and binds to striated collagen fibrils. It is suggested that the pericapillary collagen fibrils of fenestrated brain capillaries act as a charge filter with respect to macromolecules.

Affinity Labels↗
PubMed1975

Fenestrated endothelium of the adrenal gland: freeze-fracture studies.

Little is known of how adrenal hormones pass from the interstitial to the vascular space. We have begun to examine the adrenal endothelium as a barrier to hormone passage, by the freeze-fracturing technique. The endothelium of both cortex and medulla is fenestrated. Fractures from both regions show endothelial cells to be extremely thin in regions where fenestrations are abundant. En face fractures show fenestrae disposed in tracts; the fenestrae reaching a distribution of 35/mu2. In both cortex and medulla there are areas of continuous endothelium which contain caveolae. Structures believed to represent fenestra diaphragms contain randomly disposed particles and occasional pits. We have not identified in replicas the central ring and pore described in thin-sectioned material (Elfvin, 1965). The main differences between freeze-fractured aspects of cortical and medullary endothelium are the greater abundance of caveolae in the medulla and the size of the fenestrae (fenestra rims in the medulla are 525-780 A in diameter; in the cortex 570-1660 A). These differences may reflect the different embryological origins of the medulla and cortex. While caveolae may participate in hormone transport, there is no evidence for this. In the medulla the caveolae are more numerous and may have a function not necessarily related to transport. Possibly, caveolae play a role in processing hormones and related substances. For example, ATP and specific proteins are released as well as epinephrine during exocytosis from chromaffin cells. Epinephrine enters the vascular space but ATP does not. ATPase enzymes are a common feature of caveolae of other endothelia and may occur as well in adrenal endothelium.

Adrenal Cortex↗
PubMed1997

Cyst of the velum interpositum treated by endoscopic fenestration.

BACKGROUND: The cavum veli interpositi is a not infrequent radiologic finding in both children and adults, as confirmed by computed tomography (CT) and magnetic resonance (MR). A moderate enlargement of the cavum may sometimes be observed; on the other hand, a true large cyst may be considered exceptional, with only one reported case. CASE HISTORY: This 9-year-old boy with psychomotor retardation and epileptic seizures had a large CSF cyst in the region of the cavum veli interpositi, diagnosed by CT and MR. The patient was treated by endoscopic surgery, with introduction of the endoscope into the occipital horn of the right lateral ventricle and multiple fenestrations from the right ventricle to the cyst, and then from the cyst to the left lateral ventricle. The surgery resulted in decrease in the size of the cyst and reduction of the frequency of seizures. DISCUSSION AND CONCLUSIONS: Children with dilated or cystic cavum veli interpositi present with a large head, mental retardation, seizures, and hydrocephalus. On CT and MR, the cyst shows a typical triangular configuration on the axial plane and lies on the roof of the third ventricle in the coronal plane. Endoscopic ventricular fenestration is the treatment of choice for these as well as all other intraventricular and intracerebral CSF cysts, because it ensures communication between the cyst and the ventricular system and avoids definitive shunting of the cyst.

Brain Diseases↗
PubMed1998

Do cerebral aneurysms originate at the site of medial defects? Microscopic examinations of experimental aneurysms at the fenestration of the anterior cerebral artery in rats.

BACKGROUND: The role of medial defects on cerebral aneurysm formation remains obscure. To examine whether cerebral aneurysms originate at the site of medial defects, we determined the exact locations of both the origin of experimental aneurysms and medial defects at the apex of fenestrations of the anterior cerebral artery (ACA) in rats. METHODS: Cerebral aneurysms were induced in rats by means of the combination of ligation of the unilateral common carotid artery and induced hypertension. The ACA opposite the ligation was examined under a light microscope. RESULTS: Medial defects, which could be observed in approximately one-half of the fenestrations, existed always around the lateral margin of the intimal pads. On the contrary, early aneurysmal lesions exclusively occurred at the portion just medial to the intimal pads. Subsequently, both pads and defects seemed to be involved in aneurysm walls. CONCLUSION: These results clearly indicate that cerebral aneurysms do not originate at the site of medial defects.

Animals↗
PubMed1991

Evaluation of optic nerve sheath fenestration in pseudotumor cerebri using automated perimetry.

Evaluation of the efficacy of optic nerve sheath fenestration in pseudotumor cerebri has been hindered by a lack of quantitative indicators of visual function before and after treatment. Nine patients (14 eyes) were treated who had pseudotumor with optic nerve sheath fenestration, in whom automated perimetry was used as a major parameter in the decision to undertake surgery and in evaluating the results. Visual field results demonstrated significant improvement in this group of patients. Seven of 8 eyes with total loss less than 1500 dB had improvement or no further deterioration. Using results of the last preoperative examination as baseline, it was found that six of the eight had improvement over 150 dB. In one patient, a slight deterioration occurred postoperatively. Those eyes with total loss above 1500 dB demonstrated stabilization of fields postoperatively. Statistical analysis of total loss preoperatively and postoperatively for this group of patients demonstrated significant improvement for five of the six comparisons investigated. Average preoperative total loss and average postoperative total loss were not significantly different. Comparisons of results of the last preoperative examination to those of the first postoperative and most recent follow-up examinations, and evaluation of average total loss postoperatively showed significant improvement had occurred. Results of the first postoperative examination and those of the most recent follow-up examination showed significant improvement from the average preoperative total loss.

Adult↗
PubMed1998

Occlusive ligature and standardized fenestration of a Baerveldt tube with and without antimetabolites for early postoperative intraocular pressure control.

OBJECTIVE: To determine the effectiveness of a surgical modification for a nonvalved aqueous tube shunt in controlling intraocular pressure (IOP) in the early postoperative period. The effect of antimetabolite use on IOP also was studied. DESIGN: A retrospective study of consecutive patients who underwent modified Baerveldt 350-mm2 implant with varied, nonrandomized, exposure to antimetabolites. PARTICIPANTS: Fifty-one eyes of 46 patients with uncontrolled glaucoma were examined. INTERVENTION: Identical surgical modification of a Baerveldt 350-mm2 tube was performed in all cases and consisted of placement of an occlusive 7-0 polyglactin suture just anterior to the plate followed by a through-and-through penetration of the tube just anterior to the occlusive ligature with a standardized 15 degrees blade. Seventeen eyes were not exposed to antimetabolite, while 2 groups of 17 eyes had 3 minutes' episcleral exposure to either 5-fluorouracil 50 mg/ml or mitomycin C 0.4 mg/ml at the location corresponding to the fenestration. The Tenon's layer and conjunctiva were not exposed because of concerns regarding conjunctival erosion over the device. MAIN OUTCOME MEASURE: Intraocular pressure and number of antiglaucoma medications required were analyzed. RESULTS: For the group, mean IOP before surgery and on postoperative days 1, 4, 10, 21, 42, 63, 84, and 112 was (in millimeters of mercury) 34.6, 20.1, 17.0, 17.2, 22.0, 17.3, 18.7, 17.4, and 15.6, respectively. There was an elevation of IOP at day 21 relative to fibrotic blockage of the fenestration before suture autolysis. This was temporized with antiglaucoma medication until suture autolysis occurred or treated with laser suture lysis (8 eyes). On day 1, hypotony occurred in 3 (6%) eyes whereas IOP greater than 30 mmHg was observed in 13 (26%) eyes. By day 10, the frequency had decreased to one (2.1 %) eye and three (6.4%) eyes, respectively. The use of antimetabolites did not result in lower IOP or less medication needed for any group at any interval (analysis of variance). CONCLUSION: This modification of a nonvalved glaucoma tube shunt device provides adequate IOP control in the early postoperative period with a low rate of hypotony and surgical complications. If elevation of IOP occurs before suture autolysis, it generally is well controlled by antiglaucoma medications or laser suture lysis. Antimetabolite exposure did not influence early postoperative IOP in this study.

Aged↗
PubMed2001

Optimizing effectiveness of laser tympanic membrane fenestration in chronic otitis media with effusion. Clinical and technical considerations.

OBJECTIVE: To describe the patient, disease and clinical characteristics that optimize the effectiveness of laser tympanic membrane fenestration (LTMF) to treat chronic otitis media with effusion (OME). SETTING: Four pediatric otolaryngology tertiary referral centers. IRB approved; participation by informed consent. METHODS: An observational clinical effectiveness trial was conducted in 164 ears (94 children), who had chronic OME. All patients were candidates for insertion of pressure equalization tubes (PETs) but agreed to undergo LTMF instead. Clinical and audiologic follow-up are reported at 90 days after LTMF. OUTCOME MEASURES: Clinical effectiveness was defined as an effusion free middle ear at otoscopy with A or C1 tympanogram and normal hearing. RESULTS: At 90 days, 66% of the 95 evaluable ears were effusion free, all with normal hearing. Children younger than 4 years (P<0.04), who had shorter durations of effusion (P<0.009), and who experienced longer duration of fenestration patency (FP) (P<0.009) correlated to improved outcomes. CONCLUSIONS: The use of LTMF to create 2--3 weeks of middle ear ventilation in patients with chronic OME (middle ear effusion (MEE) for 3 months or greater) is effective in 66% of 95 (58%) of ears evaluable at 90 days follow-up. This study provides basic information needed to optimize the use of LTMF today and enhance research efforts in the future.

Child↗
PubMedDate not supplied

Fenestrated atrial septal aneurysm: diagnosis by transesophageal echocardiography.

The diagnosis of atrial septal defect by transthoracic echocardiography remains difficult in a small subset of patients because of either suboptimal acoustic windows or unusual anatomy, for example, fenestrated defects. We report the case of a 55-year-old woman with a fenestrated atrial septal aneurysm that was incompletely visualized by transthoracic echocardiography. Subsequent transesophageal echocardiography demonstrated three defects within the atrial septal aneurysm with left-to-right shunting across each defect. Normal pulmonary venous connections were also defined. All echocardiographic findings were confirmed at surgery. This case demonstrates the additional diagnostic accuracy of transesophageal echocardiography for detecting disease of the atrial septum.

Echocardiography↗