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Fenestration of the aortic valve is a common anatomic finding. Although spontaneous rupture of the semilunar cusps is infrequent, it leads to rapidly progressive heart failure and death. We present, to our knowledge, the first case of successful treatment by valve reconstruction. A 2 year follow-up demonstrates excellent clinical results.
A 69-year-old female was admitted to our clinic on August 19, 1985 with a 5 year history of intermittent left facial pain. She had undergone various types of medical treatment and multiple procedures of nerve blocking which resulted in only a temporary relief of pain. On admission, the intermittent facial pain and hypesthesia were recognized in the 2nd and 3rd divisions of the left trigeminal nerve. CT scan with contrast enhancement showed a shift of the basilar artery to the left side. An elongated and tortuous vertebral artery was recognized at the left cerebello-pontine angle both by CT scan and vertebral angiograms. This tortuous vertebral artery compressed the trigeminal nerve entry zone causing neuralgia. Vascular decompression was carried out by inserting a muscle piece sandwiched in the lyodura between the artery and brain stem. Facial pain disappeared but recurred nine months after this operation. At the 2nd operation, the vertebral artery was passed through the fenestrated aneurysm clip and fixed on the petrous bone. With this procedure the vertebral artery was successfully transposed and the patient was discharged without any episodes of facial pain.
The authors describe a new method of surgical treatment of compression forms of lumbar osteochondrosis using puncture fenestration and decompression of intervertebral disks. They also present the results of the treatment of 200 patients (the effect was good in 71% of the patients) and a follow-up of 160 patients for as long as 2.5 years after the operation (the result was good in 70% of the patients).
Two dogs were nonambulatory and tetraparetic following cervical disk fenestration used as the treatment for cervical disk disease. Severe pain and cervical muscle fasiculation also were evident. The site of disk extrusion was localized radiographically, and cervical ventral decompression was used to remove the disk material. Recovery in both cases was complete.
A new method for the treatment of peritonitis, fenestration of the peritoneal cavity with a mersilen net, has been used in two patients. Drainage by mersilen net window proved adequate for weeks. No complications occurred and the disadvantages of the conventional method were not encountered.
The results of 30 operations of disk fenestration in instability of spinal segments in cervical osteochondritis are generalized. Most operations were conducted on disks CIII-IV and CIV-V whose impaired fixation capacity caused the syndromes of cervicalgia and vertebral artery affection. The operative technique comprised the formation of an opening in the anterior parts of the fibrous ring the nucleus pulposus was not removed. An immobilizing cotton-gauze Schanz's collar was then applied for 4 to 6 weeks. Stabilization of the spinal segment due to fibrotization of the operated on disk occurred in 80% of cases. It brought complete relief from the reflex pain syndromes of cervical osteochondrosis.
In a series of over 125 cases, complications associated with the dorsolateral muscle-separating approach for thoracolumbar intervertebral disk fenestration have been pneumothorax, hemorrhage, and neuromuscular deficits. Most of the complications were neuromuscular in origin and of short duration. It was concluded that the approach provides excellent visualization and is rapid, precise, and unlikely to lead to permanent complications.
Ontogenetic changes in butyrylcholinesterase (BuChE) activity of fenestrated capillaries in the rat Area postrema lying outside of the blood-brain barrier were investigated by means of light and electron microscopic histochemical methods. Marked enzyme activity could be demonstrated in the capillary endothelial cells of the neonatal rat. The intensity of the light microscopically detectable BuChE activity in the capillaries decreased gradually during the postnatal ontogenesis, but the capacity of the enzyme synthesis of the endothelium remained unchanged in the adult rat, too. Our results do not indicate any direct correlation between BuChE positivity of capillaries and the existence of the blood-brain barrier.
The ultrastructure of the blood capillaries has been analyzed in the adenohypophysis, the pineal body, the thyroid and the suprarenal gland of chick embryos of 7, 14 and 19 days of incubation and, respectively, of the adult fowl. During the organogenesis of these endocrine glands the vascular primordia, precociously appearing among the epithelial components, undergo morphological maturative changes leading to the formation of capillaries built of a fenestrated endothelium and an underlying thin layer of pericytes included in a splitting of the endothelial basement lamina. The capillary differentiation processes, almost identical in the mentioned glands, follow a different chronological sequence, occurring precociously in thyroid and suprarenal and later on in adenohypophysis and pineal body. The relationships between the structural modifications of the capillary wall and the morphological and functional differentiation of the endocrine cells during the organogenesis of the glands have been briefly discussed.
Recent reports have suggested that channels of the surface-connected or open canalicular system (OCS) in discoid blood platelets represent a reservoir of membrane that can be evaginated following activation and shape change and contribute to an increased ratio of surface area to volume. The present study has used electron cytochemistry and freeze-fracture to examine the organization of the OCS in unaltered platelets. Results of the investigation indicate that channels of the OCS are seldom if ever single tubular invaginations of the surface membrane. Each channel joins with other canaliculi of the OCS to form an anastomosing network of fenestrated conduits spreading throughout the cytoplasm from one side of the platelet to the other. The multiple connections of the interlocked channels to different sites on the platelet surface, their association in a continuous labyrinth, and participation with elements of the dense tubular system to form membrane complexes suggest that the OCS would have to be torn apart or undergo radical rearrangement before it could be evaginated and contribute to an increased surface area on activated cells.
The authors describe 3 cases of the extracranial Vertebral artery fenestration. This anomaly is a rare case seen in autopsy and angiographically, and in literature too the cases described are few and prevalently by Japanese authors. This anomaly is important because frequently is associated with others congenital intra and extracranial vascular abnormalities.
The fine structure of dermal blood vessels of male Wistar rats was studied in paw regions. Electron microscopy revealed a well-developed plexus of fenestrated capillaries in papillary dermis and adjacent to skin appendages. Intravenously injected ferritin escaped from some of these capillaries. It is suggested that these blood vessels play a role in the exchange of substances at sites of high epithelical turnover.
A 61-year-old woman was examined because of unilateral nonpulsatile tinnitus involving the right ear. CT scanning showed a soft-tissue mass in the hypotypanum. Angiographically, the mass was identified as a fenestrated or duplicated internal carotid artery associated with persistence of the stapedial artery. Embryologic considerations are discussed.
Author describes thoracoscopic fenestration applied to treat pericardial effusion in an elderly patient with etiologically not identified chronic pericarditis. The operation can be performed easily, quickly and with minimal functional harm with the help of minimal invasive method. Thoracoscope gives a detailed view of the inner surface of the pericardial sac and the epicardium and the cutting of the pericardial window can be performed safely. Apart from description of operation technique applied the author gives a brief summary of place and significance of minimal invasive pericardial intervention in the treatment of the ever growing pericardial effusion.
Symptomatic post-transplantation renal lymphoceles are usually treated with Byron's technique--medical laparotomy, internal drainage with fenestration, transperitoneal marsupialization and epiploplasty. The same procedure was performed laparoscopically in a 34 year old obese man who had a renal transplantation 18 months earlier. The procedure, together with its advantages are discussed.
The liver sieve, formed by the fenestrated hepatic sinusoidal endothelium, is a dynamic biofilter separating the hepatic blood from the plasma within the space of Disse. It filters macromolecules of differing sizes, especially lipoproteins. More specifically, it acts as a barrier to the large triglyceride-rich parent chylomicrons, while permitting the smaller triglyceride-depleted but cholesterol- and retinol-rich remnants to enter the space of Disse. There the remnants contact specific receptor sites on the hepatocyte microvilli. Thus, the liver sieve is the first site of hepatic selection and consequent metabolism of dietary cholesterol and fat-soluble vitamins, as well as rejection of dietary triglycerides. Therefore, perturbations of the porosity of the sieve, whether from changes in size, number of fenestrae, or composition of the underlying extracellular matrix within the space of Disse, will have a profound influence on the metabolism of lipoproteins. This disturbance of the homeostasis of lipids, including fat-soluble vitamins and cholesterol, as well as other macromolecules, may tilt the balance between health and disease in a variety of organs and tissues, such as the liver, kidney and arteries.
Surgical treatment of pericardial effusions are, in general, treated by methods using a subxiphoid or a transthoracic route. The former is criticized for the high recurrence rate, the latter for the high incidence of respiratory complications. To minimize these problems and in view of the growing enthusiasm for using minimal invasive techniques, we treated one patient with pericardial effusion by using video-assisted thoracoscopy for the creation of a pericardial window. We achieved an adequate drainage, and the postoperative pain and pulmonary dysfunction were minimal. The operative technique and pitfalls are discussed in this report. Thoracoscopic pericardial fenestration might facilitate a much less aggressive transthoracic approach to the pericardium which is of great importance, as many of these patients are already in a poor clinical condition.
Fenestration of the choriocapillaris may be lost and regained in various pathologic conditions. The purpose of this study was to observe the gradual disappearance of fenestrae with the scanning electron microscope. Pigmented rats were treated with an intravenous injection of sodium iodate. Changes in the choriocapillaris were produced by damaging retinal pigment epithelium. The eyes were processed for styrene embedded cracking on the third, fifth, and seventh days. Dense clusters of fenestrae were seen at the luminal surface facing retina on the third day. These clusters were surrounded by protrusion of cellular surface. The clusters of fenestrae were smaller with some variation in size on the fifth and seventh days. The protrusion between the clusters became flatter and wider. Some endothelial cells had a flat surface with tiny clusters of fenestrae. Although there was loss of fenestrae with smaller clusters and some variation in size, the tendency of the fenestrae to cluster was sustained in the same way as during the reformation of fenestrae in the choriocapillaris after laser photocoagulation.