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At least 73 records · Page 4Linked to original sources
PubMed1991

Anatomic consideration for sacral screw placement.

Instrumentation of the lumbosacral spine increasingly involves screw fixation to the sacrum. Recommended locations and techniques for screw placement vary, particularly when bicortical purchase of the sacrum is performed. The purpose of this study was to describe the critical anatomy and potential injuries to neurovascular and visceral structures anterior to the sacrum. Lack of awareness can lead to life-threatening complications. The study included 22 fresh human cadavers with no prior spinal surgery. Specimens were placed in a prone position, and the lumbosacral spine was exposed. Two 6.5-mm screws were inserted using one of two techniques, respectively: Starting just inferior to the S1 facet one screw was angled 25 degrees caudally and 30 degrees laterally; in the second technique, lateral inclination was increased to 45 degrees. In addition, all specimens had screws placed in the S2 pedicles. An anterior dissection was performed to allow evaluation of the neurovascular and visceral structures at risk for injury by, or adjacent to, the screw tips. All significant neurovascular structures in the area of concern were constant in position. The internal iliac vein and the lumbosacral nerve trunk were most at risk for injury by the 30 and 45 degrees laterally directed screws. The sigmoid colon, though close to the S2 screw, was protected by its mesentery. Screws placed in the S1 pedicle were least likely to injure the neurovascular bundle. A lateral and a midline safe zone were identified.

Aged↗
PubMed1990

Gluteal necrosis after acute ischemia of the internal iliac arteries.

Ligation of the internal iliac artery mostly remains without consequences because of the well established collateral network. In patients with compromised collateral circulation however, acute interruption of both hypogastric arteries during aorto-iliac surgery or transluminal embolisation can lead to necrosis of the gluteal muscles and other adjacent organs (rectum, bladder, lumbosacral plexus). Experience with 3 similar cases after aorto-iliac surgery demonstrates two main intraoperative mechanisms: 1. Embolisation, 2. Ligature of both internal iliac arteries in patients with compromised arteriosclerotic collaterals. Despite of adequate therapy, mortality is over 70%. The most important feature during aorto-iliac operations is to preserve at least one internal iliac artery by either reimplantation of the main stem or by an additional bypass to this artery.

Aged↗
PubMedDate not supplied

[Lumbosacral plexopathy as a form of presentation of an aneurysm of the iliac artery].

INTRODUCTION: The etiology of lumbosacral plexopathy is often due to compression. One of the less common causes of this is aneurysm of the iliac artery. However, 13% of the patients with this disorder initially have symptoms of plexus irritation or deficit. CLINICAL CASE: We describe the case of a 42 year-old-man, with no previous medical history, who complained of right-sided sciatica for the previous three months. On examination there were clinical signs of a lesion of the right lumbosacral plexus. On CT of the pelvis and MR of the lumbar spine there were images compatible with an aneurysm of the right iliac artery. This diagnosis was confirmed on arteriography. Treatment was surgical (aneurysmography and right iliofemoral by-pass). The pain disappeared and the motor deficit improved considerably. CONCLUSION: When a patient presents with lumbosacral plexopathy, an iliac aneurysm should be considered as a possible etiological factor. In such cases early diagnosis is essential, since surgical treatment will usually resolve the clinical problem.

Adult↗
PubMedDate not supplied

[Varicocele as a symptom of renal venous hypertension].

Regional trans-scrotal antegrade venotesticulophlebography was used to study elements of renocaval anastomosis in 154 males suffering from varicocele. In 153 patients varicocele was caused by renal vein obstruction and hypertension, in 1 patient it resulted from iliac vein aneurysm obstructive for pelvic veins. In cases of renal vein obstruction on the left all the venous blood runs from the kidney along the testicular vein to the pampiniform plexus flowing further to the system of the iliac veins. Ligation or endovascular embolization of the testicular vein aggravates renal venous hypertension, but varicocele collapsed. The authors suggest discussion on methods of varicocele treatment.

Adolescent↗
PubMedDate not supplied

[Spinal canal stenosis syndrome by venous collateralization of an inferior cava thrombosis].

We described in 1988 the case of a young patient with a right iliac vein and vena cava thrombosis who developed lubagoes and intermittent claudication of paralytic type. A digital venography by left femoral approach showed a derivation via the lumbar vein towards the spinal plexus. Later, the patient experienced a left external iliac vein thrombosis. Subsequently, collaterization went through the truncal veins and the clinical manifestations of the tight spinal canal disappeared. Since then, several cases of chronic thrombosis of the left primary iliac veins have been discovered. These also showed unexplained lumbagoes of the same duration. The idea of a relation of cause and effect was seldom accepted by the patients, which prevented us to proceed to many venous catherisms. Also, we performed only one operation until now: the cesarean of an ascending lumbar vein. In this very case, the tight spinal canal symptoms disappeared but appeared again after a few month-time for unknown reasons. Only one acute case has been found up to now: a woman who delivered by ligation suffered from lumbagoes and sciaticae. A dilatation of spinal veins and a lower vena cava thrombosis were showed by tomography. This woman had no leg symptom and lumbagoes disappeared with the partial recanalization of the cava.

Acute Disease↗
PubMed1984

Vein to artery grafts. An experimental study of reinnervation of the graft wall.

Iliolumbar vein to iliac artery grafts were placed in 21 rats by microsurgical techniques. Graft innervation was examined at five time intervals between 1 and 32 weeks after surgery. Nerve fibers were demonstrated microscopically by formaldehyde-induced fluorescence of catecholamines. The morphology and degree of graft innervation were assessed, semiquantitatively, relative to the contralateral iliac artery (control) within each animal. Nerves were seen in the graft region as early as 2 weeks, but it was not until 4 weeks that they were present along its length (5 mm). The formation of a nerve plexus in the adventitia surrounding the graft was evident at 8 weeks. By 16 weeks the degree of innervation in the graft had increased to a level that was greater than the control iliac artery in three of four animals examined. Grafts at 32 weeks were also hyperinnervated. However, the morphology of this innervation was different from the control arteries; nerve fibers were finer, not varicosed, and were located at a greater distance from the outer layer of smooth muscle cells. The origin of the nerves appeared to be collateral sprouts from nerves supplying the adjacent iliac vein and also from invading vasa vasorum. The host iliac artery nerve plexus did not contribute to graft innervation.

Animals↗
PubMed1999

Anterior lumbar fusion with titanium threaded and mesh interbody cages.

The authors report their experience with 42 patients in whom anterior lumbar fusion was performed using titanium cages as a versatile adjunct to treat a wide variety of spinal deformity and pathological conditions. These conditions included congenital, degenerative, iatrogenic, infectious, traumatic, and malignant disorders of the thoracolumbar spine. Fusion rates and complications are compared with data previously reported in the literature. Between July 1996 and July 1999 the senior authors (C.I.S., R.P.N., and M.J.R.) treated 42 patients by means of a transabdominal extraperitoneal (13 cases) or an anterolateral extraperitoneal approach (29 cases), 51 vertebral levels were fused using titanium cages packed with autologous bone. All vertebrectomies (27 cases) were reconstructed using a Miami Moss titanium mesh cage and Kaneda instrumentation. Interbody fusion (15 cases) was performed with either the BAK titanium threaded interbody cage (in 13 patients) or a Miami Moss titanium mesh cage (in two patients). The average follow-up period was 14.3 months. Seventeen patients had sustained a thoracolumbar burst fracture, 12 patients presented with degenerative spinal disorders, six with metastatic tumor, four with spinal deformity (one congenital and three iatrogenic), and three patients presented with spinal infections. In five patients anterior lumbar interbody fusion (ALIF) was supplemented with posterior segmental fixation at the time of the initial procedure. Of the 51 vertebral levels treated, solid arthrodesis was achieved in 49, a 96% fusion rate. One case of pseudarthrosis occurred in the group treated with BAK cages; the diagnosis was made based on the patient's continued mechanical back pain after undergoing L4-5 ALIF. The patient was treated with supplemental posterior fixation, and successful fusion occurred uneventfully with resolution of her back pain. In the group in which vertebrectomy was performed there was one case of fusion failure in a patient with metastatic breast cancer who had undergone an L-3 corpectomy with placement of a mesh cage. Although her back pain was immediately resolved, she died of systemic disease 3 months after surgery and before fusion could occur. Complications related to the anterior approach included two vascular injuries (two left common iliac vein lacerations); one injury to the sympathetic plexus; one case of superficial phlebitis; two cases of prolonged ileus (greater than 48 hours postoperatively); one anterior femoral cutaneous nerve palsy; and one superficial wound infection. No deaths were directly related to the surgical procedure. There were no cases of dural laceration and no nerve root injury. There were no cases of deep venous thrombosis, pulmonary embolus, retrograde ejaculation, abdominal hernia, bowel or ureteral injury, or deep wound infection. Fusion-related complications included an iliac crest hematoma and prolonged donor-site pain in one patient. There were no complications related to placement or migration of the cages, but there was one case of screw fracture of the Kaneda device that did not require revision. The authors conclude that anterior lumbar fusion performed using titanium interbody or mesh cages, packed with autologous bone, is an effective, safe method to achieve fusion in a wide variety of pathological conditions of the thoracolumbar spine. The fusion rate of 96% compares favorably with results reported in the literature. The complication rate mirrors the low morbidity rate associated with the anterior approach. A detailed study of clinical outcomes is in progress. Patient selection and strategies for avoiding complication are discussed.

Journal Article↗
PubMedDate not supplied

Urogenital complications of anterior approaches to the lumbar spine.

The superior hypogastric plexus of the sympathetic nervous system is the only major innervation of the urogenital system which is normally at risk in anterior exposures of the lower lumbar spine. When this is injured, one can expect to see disturbances of urogenital function with retrograde ejaculation or sterility in males. Failure of penile erection is not anticipated unless the patient has, in addition, advanced peripheral vascular disease. The superior hypogastric plexus may be spared by careful dissection about the iliac arteries and lumbosacral junction or by approaching the spine laterally through a retroperitoneal exposure.

Arthrodesis↗
PubMed1999

Simple O-acylated derivatives of lysergol and dihydrolysergol-I: synthesis and interaction with 5-HT2A, 5-HT2C and 5-HT1B receptors, and alpha1 adrenergic receptors.

A series of simple O-acylated derivatives of the naturally occurring clavine alkaloids lysergol and dihydrolysergol-I were synthesized and tested in-vitro for their ability to interact with 5-HT2A receptors in rat tail artery, 5-HT2C receptors in piglet choroid plexus, 5-HT1B receptors in guinea-pig iliac artery and alpha1-adrenergic receptors in rat aorta. In contrast to the classical ergoline 5-HT2A receptor antagonists methysergide and LY53857, the compounds produced competitive antagonism of the 5-HT response in rat tail artery. Affinities of ergolines 3-14 were higher (pA2 values of 7.33-8.40) than those of the parent alcohols lysergol (1) and dihydrolysergol-I (2), respectively. The introduction of an isopropyl substituent at the N(1) position of the compounds failed to enhance 5-HT2A receptor affinity. Compounds 3-14 exhibited lower affinities for alpha1-adrenergic receptors than for 5-HT2A receptors. In particular, those lysergol derivatives that had an isopropyl substituent at the N(1) position were highly specific 5-HT2A receptor antagonists (ratio 5-HT2A/alpha1 = 302-3548). Selected derivatives of lysergol (3-5, 9-11) which were assayed for radioligand binding at 5-HT2C receptors in piglet choroid plexus had affinities that were similar to those found in rat tail artery. Additionally, lysergol and its N(1)-unsubstituted derivatives were found to be partial agonists (alpha of 0.2-0.4) for 5-HT2C receptor-mediated inositol phosphate accumulation in piglet choroid plexus. On the other hand, analogues with an isopropyl substituent at N(1) showed no measurable agonist activity. The observation that N(1)-unsubstituted derivatives of lysergol possessed agonist properties at 5-HT2C receptors whereas their agonist activity at 5-HT2A receptors was marginal (alpha of 0.05 for compound 3 at 1 microM) or not measurable, suggests that these compounds have different abilities to cause conformational change at the two receptor types. Selected derivatives of lysergol (3-5, 9-11) which were examined as ligands for 5-HT1B receptors in guinea-pig iliac artery caused insurmountable blockade of the contractile effect of 5-HT. N(1)-isopropyl derivatives had 30-50-fold lower affinities for 5-HT1B receptors of this tissue than their N(1)-unsubstituted analogues. It is concluded that O-acylated derivatives of the clavine alkaloids lysergol and dihydrolysergol-I mimic therapeutically relevant ergolines due to the complexity of their pharmacological profile as partial agonists and antagonists at 5-HT2A, 5-HT2C and 5-HT1B receptors, and at alpha1-adrenergic receptors.

Animals↗
PubMed2004

[Autonomic innervation of the female pelvis. Anatomic basis].

The pelvic plexus with its sympathetic (hypogastric nerves, sacral sympathetic trunk) and parasympathetic (pelvic splanchnic nerves) sources provides and distributes the autonomic nervous supply for the pelvic organs. This homogeneous autonomic nerve plate is located within and deeply to the peritoneal fold (recto-uterine in the female pelvis) lying medially to the internal iliac vessels. Autonomic nerve fibres emerge from the pelvic plexus and travel to the anterolateral aspect of the rectum and the inferolateral and posterolateral aspects of the bladder and female genital tract. In addition, pelvic organs are innervated by nerves accompanying the vessels and the ureter which penetrate the pelvic plexus. Knowledge of the topography of the pelvic plexus indicates the most common sites for iatrogenic lesions and should help us in avoiding postoperative autonomic dysfunction.

Autonomic Pathways↗
PubMed1979

Venous drainage of the urinary bladder.

The venous drainage of the urinary bladder was studied in 20 pelvic halves (14 males and 6 females). Vesical and prostatic plexuses draining the bladder (vesical only in females) were found in 16 cases; they supplied blood to the internal iliac vein--usually by two to five veins--the most common number being three. One vein always drained the prostatic plexus. The vesical and prostatic plexuses were absent in 4 male cases, where the vesical veins issuing from the bladder wall drained directly the internal iliac vein. Their number in such cases was minimal: between one and two only, on each side. The union of a vesical vein issuing from any of the two mentioned plexuses (when found) with the obturator, prostatic or vaginal vein was common. A shunt from a common trunk of united obturator and vesical veins to the external iliac vein was noticed in some cases. Occasionally, an inferior vesical vein ending in the obturator vein accompanied an inferior vesical artery initiating from the obturator artery.

Female↗
PubMed1978

Upper extremity complications of axillofemoral grafts.

Four patients sustained five upper extremity complications after axillobifemoral grafting including brachial plexus injuries, axillary artery thrombosis, and arterial steal. To avoid these problems, the following precautions are recommended: (1) proper positioning of the patient to prevent hyperabduction of the shoulder; (2) adequate exposure of the axillary artery during dissection and gentle handling of the nerve trunks; (3) meticulous technic during construction of the proximal anastomosis and avoidance of undue tension on the graft; and (4) careful preoperative assessment of the axillary-subclavian artery as a potential donor vessel.

Aged↗
PubMed2004

The control of severe intraoperative bleeding using an overlay autogenous tissue (OAT) patch: case reports.

BACKGROUND: Severe intraoperative bleeding cannot always be controlled by standard surgical techniques. We recently reported a new technique to repair serious vascular injury using a free graft of omentum or rectus abdominus fascia as an overlay autogenous tissue (OAT) patch in the experimental sheep model. We now describe the successful clinical use of this patch in three patients. CASE REPORTS: Radical surgery was performed on three patients with pelvic malignancy with resulting uncontrollable bleeding from the internal iliac vein, pelvic side wall and paravaginal venous plexuses, respectively. Hemostasis was secured using an OAT patch made of abdominus rectus fascia in two cases and appendix epiploicae as an omental substitute in the other. DISCUSSION: The utility of the OAT patch is described in three different clinical situations. It is suggested that this technique may be especially useful to gynecologic oncologists when standard surgical techniques fail to control bleeding or there is limited access to the site of injury.

Aged↗
PubMedDate not supplied

[Chances of avoiding amputation in an arteritis patient with gangrene].

During the period 1970-1974, restorative surgery was carried out 324 times in patients with gangrene or severe ischaemia caused by arteritis of the lower limbs. In 67 percent of the cases major excision surgery, such as amputation at the thigh or of the whole leg, was avoided and the support was retained. In 61 cases (19 percent) amputation was necessary either immediately or within a few weeks or months. Death occurred in 47 patients (14 percent) either in the operative period or in the 3 following years.

Amputation, Surgical↗