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In two patients, a detachment of the macula occurred following a branch retinal vein occlusion. Vitreoretinal relationships were investigated and documented by biomicroscopic photography. Both eyes showed partial posterior vitreous detachment with dense adhesions to a preretinal membrane at the macula. Vitreous contraction and traction appeared to be responsible for the detachment.
Traction detachment of the macula from extensive disc neovascularization developed after a branch vein occlusion. This rare complication was effectively treated by vitrectomy with membrane segmentation.
Traction lesions of the brachial plexus are severe and disabling. All too often the patient is young, and many will be unable to return to work. Diagnosis has become more precise with the introduction of CT, with contrast, of the cervical spine, and the detection of cortical-evoked responses at operation.
A series of 508 patients with traction injuries of the brachial plexus (birth trauma excluded) has been investigated over a period of 11 years. Severe cases with root avulsions, ruptures of nervous pathways or severe disorganization of funiculi do not heal spontaneously or heal poorly. Whether these patients can benefit from modern microsurgical techniques (neurolyses, autologous nerve grafts and neurotizations with intercostal or other nerves) is presently under investigation. Operations were performed on 164 patients of whom 114 had root avulsions and 16 had 2 level injuries. Surgical treatment was planned according to the severity of the lesion. In about 10% no reconstruction was possible, or was of doubtful value. There is a striking difference in results of supraclavicular and distal, infraclavicular lesions. Only 55% positive of 58 patients of the first group were improved while 85% of 20 patients of the second group were benefited to some extent. None of the patients belonging to the first or second group recovered hand intrinsic function if pathways coming from C8 and T1 were injures. None recovered tactile gnosis. The effect on pain was sometimes ameliorative, but generally unpredictable.
Immobilization after surgical treatment of Achilles tendon rupture with calf-muscles in a slackened position induces extensive degeneration of the tonic muscle fibres. The optimal treatment in view of maintained muscle structure should be immobilization with kept tone in the muscles. This may be possible to achieve by using a traction suture. In this investigation such a method has been applied on rabbits. It was found that in spite of the occurrence of degenerative morphologic changes the total relative fibre area was numerically larger and separation of tendon ends was significantly smaller than when the routine method had been performed. It was concluded that the investigated technique offers some advantages with regard to the muscle fibre structure.
Traction diverticula of the mid-esophagus are usually incidental findings on barium swallow or upper endoscopy. They are thought to arise secondary to adjacent inflammation in the mediastinum, usually from granulomatous infection such as histoplasmosis. They are usually asymptomatic. Rarely, erosion or extension of the inflammatory process into the adjacent lung or bronchial arteries can result in clinical symptoms such as pneumonia or gastrointestinal bleeding. Diagnosis is often delayed due to the rarity of clinical symptoms. We present a case of massive upper gastrointestinal bleeding due to a mid-esophageal diverticulum.
A case of primary Intracranial Hypotension (PIH) is described. This syndrome consists of spontaneous lowering of CSF pressure with traction headache. It is a benign disorder and is self-limited. The cause is unknown, but local choroid plexus vasospasm, possibly due to a hypothalamic disturbance, has been suggested, as has leakage of CSF through spontaneous arachnoid tears. Transient symptomatic relief was achieved with 5% CO2 inhalation, apparently due to increase in cerebral blood flow.
During the past few years, an increasing number of farmers examined cows at parturition and attempted delivery of calves. Frequently, the veterinarian is merely called in to perform caesarean section. From the point of view of obstetrics, quite a number of caesarean sections could have been avoided if a thorough examination of the cow had been made. Examination and treatment of cows at parturition is described in detail. Particular attention is paid to the mechanical features of delivery. The advantages and disadvantages of manual and mechanical traction are discussed.
Endocardial pacemaker electrodes rely in part upon endocardial fixation proximal to the electrode tip to prevent ejection of the tip from the ventricular apex. Fixation of these electrodes to the superior vena cava and tricuspid valve, in particular, has been reported. Infection of endocardial electrodes necessitates their removal. This report concerns avulsion of a tricuspid valve leaflet during traction on an infected electrode. With the availability of new methods of apical fixation, the utilization of electrode sheathing materials which discourage endocardial fixation would increase the safety of their removal under the circumstances reported herein.
Mesenteric traction syndrome (MTS) consists of decreased systemic vascular resistance, increased cardiac output, facial flushing and palmar erythema. Local production of PGI2 is thought to be the cause. We experienced a rare case of MTS that occurred during coronary artery bypass graft surgery (CABG). A 64-year-old man was scheduled for CABG for the treatment of angina pectoris. Hemodynamic variables were stable until 50 minutes after surgical incision. Blood pressure fell down suddenly from 110/50 to 70/40 mmHg, accompanied by obvious facial flushing and palmar erythema, when the surgeons were preparing the right gastroepiploic artery. Hemodynamic changes and cutaneous hyperemia returned to the baseline level in about 40 minutes. After this episode, the operation was performed uneventfully. The time sequence between the onset of the surgical procedure and the hemodynamic and cutaneous findings strongly suggest the release of PGI2 and MTS. In patients undergoing CABG with the gastroepiploic artery graft, pretreatment with NSAID might avoid sudden circulatory changes of MTS.
Presenting 3 examples, the author deals with the traction damage of the N. radialis in which the lesion was located in the region of the elbow. In each case, the injury of the nerve was caused by a violent hyperflexion of the wrist when the back of the hand was struck by a heavy blow. The symptoms were produced immediately after the trauma. Complete recovery was achieved in all patients after a few weeks.
The retrospective study of 26 consecutive cases of idiopathic epimacular membrane and vitreomacular traction syndrome treated by vitrectomy with a mean follow-up of 19 months showed very good functional results. The visual acuity at the last visit improved by 2 lines or more when compared with the preoperative visual acuity in 77% of pseudophakic eyes and eyes with clear lens. The metamorphopsia disappeared or significantly diminished in half the cases. The main postoperative complication was the appearance or progression of nuclear sclerosis, which could mask the good functional results of vitrectomy.
A easily performed test which can be carried out at the patient's bedside has been described. It is referred to as the femoral nerve traction test. Clinical evidence suggests it may have merit as an aid in the diagnosis of disc herniations that affect the upper lumbar spine.
This paper is concerned with the provision of an upper limb prosthesis in the presence of an axillaris nerve paralysis and additional injuries such as clavicular and scapular fractures, dislocation of the shoulder and major psychological changes. Such paralysis and injuries exclude the use of a myoelectric prosthesis. The shoulder muscles were trained to provide traction forces which controlled an MGH-S hand (VIENNATONE).
One method for treating chronic incapacitating acromioclavicular dislocation is to resect the external extremity of the clavicle and to stabilise the stump by ligamentoplastic procedures, using the coracoclavicular ligament. The purpose of this work was to evaluate the mechanical quality of the ligamentoplastic approach. Twelve fresh cadavers, average age 80 years, were studied. The samples taken were 24 coracoclavicular ligaments, 24 coraco-acromial ligaments, 9 tendons from the palmaris longus muscle and 9 iliotibial tracts. The ligaments removed were tested in a Instron traction machine at a speed of 10 cm/mn. The mechanical properties of the coracoclavicular and coraco-acromial ligaments were studied. For comparison, those of the tendon of the palmaris longus muscle and the iliotibial tract were also studied. The results show the pre-rupture resistance of the coraco-acromial ligament to be 50% lower than that of the trapezoid and conoid parts of the coracoclavicular ligaments taken together. These results suggest the validity of ligamentoplastic treatment using the coraco-acromial ligament, but that reinforcement, using a tendon from the palmaris longus muscle or a piece of the iliotibial tract, may also be necessary, especially for subjects taking part in sports or with well-developed musculature.
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