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Fenestrated capillaries in the periodontal ligaments of the erupting and erupted rat molar.

Quantitative ultrastructural studies were conducted on eight rats (four aged 21 days and four aged 8 weeks) using the periodontal tissues around the mesial root of the mandibular first molar. The periodontal ligament of the erupting tooth contained significantly more capillary fenestrations than the erupted tooth, both in terms of the number per unit area of endothelium (2.2/microns2) and in terms of total number per cubic millimetre of tissue (30.5 X 10(6)/mm3). Differences were also discerned with respect to the percentage of capillaries in the tissue. Thus, the periodontal vasculature demonstrates marked morphological changes which may be related to the eruptive phase of the tooth.

Animals↗

Treatment of a plunging ranula with fenestration and continuous pressure.

We present a new method of fenestration and continuous pressure as a simple, effective and uninvasive procedure for the treatment of plunging ranulas. We have recently used in four female patients, aged 10-29 years old. After treatment, the patients remained symptom-free and assessment by magnetic resonance imaging (MRI) showed regression of the ranula in all cases. The procedure resulted in satisfactory healing and we advocate it as a simple and effective treatment that is better for patients than conventional treatment.

Adolescent↗

Aortic dissection: percutaneous management of ischemic complications with endovascular stents and balloon fenestration.

PURPOSE: The purpose of this study was to evaluate endovascular stenting (EVS) and balloon fenestration (BF) of intimal flaps for the management of lower extremity, renal, and visceral ischemia in acute or chronic aortic dissection. METHODS: Twenty-two patients (16 male, 6 female) with a median age of 53 years (range 35 to 77 years) underwent percutaneous treatment for peripheral ischemic complications of 12 type A (five acute, seven chronic) and 10 type B (nine acute, one chronic) aortic dissections. RESULTS: Ten patients had leg ischemia, 13 had renal ischemia, and 6 had visceral ischemia. Sixteen patients were treated with EVS including 11 with renal, 6 with lower extremity, 2 with superior mesenteric artery, and 2 with aortic stents. Three patients had BF of the intimal flap, and three had BF in combination with EVS. Revascularization with clinical success was achieved in all 22 patients. Two patients died 3 days and 13.4 months after the procedure was performed, respectively. Of the remaining 20 patients, 1 is lost to follow-up, and 19 have persistent relief of clinical symptoms. Mean follow-up time is 13.7 months (range 1.1 to 46.5 months). One case was complicated by guidewire-induced perinephric hematoma. CONCLUSION: EVS and BF provide a safe and effective percutaneous method for managing peripheral ischemic complications of aortic dissection.

Acute Disease↗

Fracture of a fenestrated metal backing of a tibial knee component. A case report.

The case of a metal-backed tibial component that failed by metal fracture is reported. Fracture occurred through fenestrations in the metal plate surrounding the central metal stem. The fracture followed loss of bony support beneath the medial tibial plateau, which had allowed varus deformity of the replaced joint. A high tibial osteotomy procedure had preceded replacement of the joint.

Aged↗

Percutaneous fenestration of the aortic dissection membrane in malperfusion syndrome.

We present two cases of malperfusion syndrome due to aortic dissection type-B. A supra-renal blind sac phenomenon resulted in renal failure and absent femoral pulses in both patients. Additionally, one patient suffered from spinal cord ischemia, the other from severe abdominal pain. By interventional techniques, catheter perforation of the blind sac was achieved. The resulting re-entries were enlarged with a balloon catheter. Distal perfusion without pressure gradients was restored by this technique in both patients and resulted in complete relief of symptoms. Percutaneous fenestration of the aortic dissection membrane may be an alternative to operative treatment in malperfusion syndrome.

Adult↗

Fenestration of the Fontan baffle: Benefits and complications.

Using a baffle fenestration or adjustable atrial septal defect in a modified Fontan operation is now a common practice. Hemodynamic benefits include increased cardiac index and systemic oxygen transport, as well as lower systemic venous pressure. The incidence and duration of pleural effusions is also reduced by this approach. Potential complications include those associated with the closure mechanism (snare or umbrella) as well as the possibility of paradoxical embolism. This review addresses our current understanding of the risks and benefits of this procedure. Copyright 1998 by W.B. Saunders Company

Journal Article↗

[Endoscopic fenestration as a treatment for asymmetrical hydrocephalus due to obstruction of the foramen of Monro].

Unilateral dilatation of the lateral ventricle is a rare condition. The most common causes are tumors of the lateral ventricles or in the area of the third ventricle, acute or chronic inflammatory gliosis, cysticercosis or congenital atresia of the foramen of Monro. We report a case of asymmetrical dilatation of the lateral ventricle in an adult patient presenting with a raised intracranial pressure syndrome caused by narrowing of the foramen of Monro which was occluded by a thin membrane. The patient underwent successful endoscopic fenestration of the Foramen of Monro.

Adult↗

Endoscopic fenestration of choanal atresia.

We report two cases of unilateral choanal atresia and one of choanal stenosis treated successfully by endoscopic fenestration, with no recurrence at a mean follow-up of 18 months. Rigid endoscopy and axial CT scanning confirm the clinical diagnosis and this technique avoids the need for stenting or prolonged post-operative stay.

Adolescent↗

Comparative atomic force and scanning electron microscopy: an investigation on fenestrated endothelial cells in vitro.

Rat liver sinusoidal endothelial cells (LEC) contain fenestrae, which are clustered in sieve plates. Fenestrae control the exchange of fluids, solutes and particles between the sinusoidal blood and the space of Disse, which at its back side is flanked by the microvillous surface of the parenchymal cells. The surface of LEC can optimally be imaged by by scanning electron microscopy (SEM), and SEM images can be used to study dynamic changes in fenestrae by comparing fixed specimens subjected to different experimental conditions. Unfortunately, the SEM allows only investigation of fixed, dried and coated specimens. Recently, the use of atomic force microscopy (AFM) was introduced for analysing the cell surface, independent of complicated preparations techniques. We used the AFM for the investigation of cultured LEC surfaces and the study of morphological changes of fenestrae. SEM served as a conventional reference. AFM images of LEC show structures that correlate well with SEM images. Dried-coated, dried-uncoated and wet-fixed LEC show a central bulging nucleus and flat fenestrated cellular processes. It was also possible to obtain height information which is not available in SEM. After treatment with ethanol or serotonin the diameters of fenestrae increased (+6%) and decreased (-15%), respectively. The same alterations of fenestrae could be distinguished by measuring AFM images of dried-coated, dried-uncoated and wet-fixed LEC. Comparison of dried-coated (SEM) and wet-fixed (AFM) fenestrae indicated a mean shrinkage of 20% in SEM preparations. In conclusion, high-resolution imaging with AFM of the cell surface of cultured LEC can be performed on dried-coated, dried-uncoated and wet-fixed LEC, which was hitherto only possible with fixed, dried and coated preparations in SEM and transmission electron microscopy (TEM).

Animals↗

Aortic dissection with branch vessel occlusion: percutaneous treatment with fenestration and stenting.

Aortic dissection involves a tear in the intimal and medial layers of the aortic wall. Early surgical treatment of this condition can be fraught with complications especially when the procedure to be performed involves treatment of renal and visceral vessels. Additionally, patients with this problem can have severe compromise of the flow to branches or the entire aortic distribution. Methods of endovascular therapy for these problems limit the surgical stress and often can be performed in less time than surgical revascularization might require. The use of endovascular stenting to improve vessel perfusion and fenestration of the dissection membrane to decrease pressure within the false lumen can be performed to relieve ischemic vascular beds and potentially decrease the risk of aneurysmal dilatation of the aorta. The increasing use of these techniques may allow stabilization of these patients before open repair of more proximal aortic dissection or a combination of therapy with endovascular stent grafting techniques.

Aortic Dissection↗

Loosening of a fenestrated femoral prosthesis: a case report with histomorphologic analysis.

The explanted loose stem of a trabecular cementless femoral prosthesis (Holz-Copf) was histologically analyzed revealing soft tissue 3 mm thick between the metal of the prosthesis and the cancellous bone. Direct contact between the implant and bone could not be found. Removal of the prosthesis was impossible by simple extraction so that a transfemoral approach was required. Prostheses with large fenestrations may be loose but at the same time ingrown with sufficient bone to require invasive procedures for their removal.

Arthritis↗

Ultrasound-guided endoscopic fenestration of the third ventricular floor for non-communicating hydrocephalus.

Conventional valve shunting for treatment of hydrocephalus has a high rate of long-term complications. Endoscopic ventriculostomy by fenestration of the third ventricular floor, a minimally-invasive technique, avoids many of the drawbacks of extracranial shunting. Endoscopy was performed in 12 hydrocephalic patients with MRI-diagnosed aqueductal stenosis and neurological signs. Intraoperative ultrasound guidance allowed aiming the tip of the rigid endoscope to the foramen of Monro, and direct entering of the enlarged third ventricle. This technique is as exact as stereotaxy but is faster and easier. No complications were seen due to the surgical procedure. Nine patients were cured from their complaints, in 3 cases there was a subjective improvement of neurology. Long-term patency of the third ventriculostomy was confirmed by movement-sensitive MRI.

Adult↗

Fenestrated anterior cerebral artery.

Two rare cases of fenestrated anterior cerebral artery associated with aneurysms are described. The importance of identifying this unusual anatomical anomaly and its implication during surgery is discussed.

Anterior Cerebral Artery↗

Laser-assisted flexible endoscopic fenestration of giant cyst of the septum pellucidum.

The use of the flexible neuroendoscope and laser fenestration in the surgical management of a symptomatic cyst of cavum septum pellucidum is reported. Successful communication was established between the cyst cavity and the lateral ventricles using this technique. Satisfactory clinical and radiological improvement as seen on MRI confirmed the operative success.

Brain Diseases↗

Clipping of an aneurysm of a fenestrated basilar artery.

We describe the case of a fenestrated basilar artery aneurysm successfully clipped by means of a right presigmoid petrosal approach. Three-dimensional CT angiography enabled the surgeon to plan an approach to an aneurysm in this unique location, and the presigmoid petrosal approach was suitable for clipping of the aneurysm.

Cerebral Angiography↗

Laparoscopic fenestration of giant posterolateral liver cyst.

A patient with a giant liver cyst in the posterolateral aspect of the right lobe successfully underwent laparoscopic fenestration. The procedure was facilitated by placing the patient in the lateral position, which provided direct access to the cyst.

Cysts↗

Pericardial biopsy and fenestration.

Employing a video thoracoscopic pericardial fenestration constitutes a promising technique for the investigation and treatment of chronic pericardial effusions. It combines the benefit of low invasiveness with the advantages of open biopsy. The procedure simultaneously allows both an accurate diagnosis under visual control (inspection, aspiration, well-targeted biopsy of pathological processes) and the performance of effective therapeutic intervention. Without imposing unacceptable stress, it also facilitates rapid symptom relief in patients with advanced malignant disease whose general condition is severely impaired.

Aged↗