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At least 127 records · Page 7Linked to original sources
PubMed2004

Traumatic anterior dislocation of the hip associated with ipsilateral femoral shaft fracture in a child: a case report.

Traumatic anterior dislocation of the hip joint in children is rare, and only one case with ipsilateral femoral fracture has been reported in Japan. We report a case of such dislocation and a review of the literature. The patient was a 31-month-old girl who was injured in a car accident while asleep on a tilted front passenger seat. Radiographic examination showed dislocation of the right obturator foramen and transverse fracture of the ipsilateral femoral shaft. The dislocation of the right hip was easily reduced without anaesthesia during radiography. We applied Bryant traction after reduction for 4 weeks, followed by cast application for 3 weeks. Walking with support and full weightbearing were permitted 14 weeks and 16 weeks after the injury, respectively. Radiography at 4.5 years after the injury showed a mildly enlarged right femoral head and femur overgrowth of approximately 8 mm. Magnetic resonance imaging showed no evidence of suspected avascular necrosis of the femoral head. The patient has no subjective or objective symptoms, and is able to engage in all usual activities. The detailed mechanism of the injury is unknown. We assume that the lower leg was dislocated through abduction during flexion, or abducent, external flexion, considering that the child was sleeping at the time of the accident. Since she was hurled to the back seat, it was assumed that strong external force was vertically added to the femur, which caused the abducent force.

Accidents, Traffic↗
PubMed1992

The role of 3D CT in the assessment of acetabular fractures.

A total of 16 patients with acetabular fractures were evaluated by plain radiography, axial computed tomography (CT) and three dimensional (3D) CT. It was possible to classify the fracture type in each case from the plain radiographs alone. Axial CT gave additional detail in certain areas, notably the region of the teardrop, the obturator foramen and the acetabular roof. Intra-articular and impacted roof fragments and associated soft tissue injuries were also shown. 3D CT provided the best and most easily interpreted overall assessment of the fractures. In addition to projections equivalent to the plain radiographs, two other views were of particular clinical value in demonstrating surgically inaccessible areas, namely the view of the pelvis from above and the view of the inner aspect of the fractured hemipelvis. However, fracture lines demonstrated on plain radiographs and axial CT were not always apparent on the 3D CT scans. Although 3D CT is a valuable addition to the imaging of acetabular fractures, it is not a substitute for good quality plain radiography and analysis of the axial CT images.

Acetabulum↗
PubMed1976

Symposium: Congenital anomalies of the middle ear. II. Vascular anomalies of the middle ear.

Of all the abnormal situations that one encounters in performing a tympanotomy, probably the last one to be thought of is vascular anomalies, and yet, potentially, this is one of the most hazardous of anomalous problems with which we have to deal. Most of the anomalies which have been reported concern the persistent stapedial artery. This artery arises from the stump of the second aortic arch (stapedio-hyoid artery), it traverses the developing stapes bone, leaving behind a monument to its existence - the obturator foramen of the stapes. The artery exits from the middle ear along the horizontal portion of the facial nerve, traversing this area for a variable distance and then usually divides into an intra-cranial branch and a sphenoidal branch. The stapedial artery in its development before its regression, gives rise to the anlage of many important cranial arteries. These vessels are usually anastomosed with and distributed by the branches of the internal maxillary artery and the ophthalmic artery. The hyoid artery is represented in the adult by the carotico tympanic artery. Anomalies involving the internal carotid artery are much more rare. The anomalies that have thus far been reported are: 1. Absence of the internal carotids. 2. Aneurysms. 3. Unusual courses. Venous anomalies are generally uncommon and are usually represented by an abnormally placed jugular bulb which can simulate a glomus jugulari tumor.

Aneurysm↗
PubMed1989

Measurement of acetabular erosion. The effect of pelvic rotation on common landmarks.

Using dried bones which could be tilted and rotated, we assessed the accuracy of published radiographic methods for measuring the migration of prosthetic acetabular components and compared the results with a new method. The new line linking acetabular margins was significantly more accurate for proximal migration than the teardrop, the sacroiliac line or the sacroiliac-symphysis line. For medial migration, a new line tangential to the brim and through the horizontal mid-point of the obturator foramen was more accurate than Köhler's line, the ilio-ischial line or the iliopubic line. In combination, the two new lines can give a more accurate assessment of acetabular erosion than previous methods, since they are less affected by the differences in rotation commonly found in a series of radiographs.

Acetabulum↗
PubMed1995

Can a Persistent Stapedial Artery be Safely and Effectively Removed? A Case Report with Therapeutic Implications.

In the past, a persistent stapedial artery was frequently cited as a reason to discontinue stapes surgery, however, several authors have had success operating on the oval window despite the presence of a persistent artery. We present a case of a patient with conductive hearing loss and tinnitus successfully treated with removal of a persistent stapedial artery that was filling the obturator foramen. This experience, in conjunction with a review of the literature and a discussion with several neurotologic colleagues, leads us to suggest that a stapedial artery can be safely removed allowing unhindered access to the oval window.

Journal Article↗
PubMed2000

[A case of infected renal cyst extending to leg abscess].

A 45-year-old woman was referred to our hospital with the chief complaint of left flank pain, left leg pain and loss of appetite. Computed tomography scan and magnetic resonance imaging demonstrated a large cystic mass in the left kidney, which we diagnosed as an infected renal cyst. Under ultrasonic guidance, percutaneous puncture and drainage of the renal cyst were performed. After her leg pain worsened, computed tomography revealed abscesses in the left leg, suggesting an infected renal cyst extending to the leg through the obturator foramen. Under general anesthesia, incision and drainage were performed. Cultures from the cyst and abscess fluid showed Klebsiella pneumoniae. Our case is the 82nd case of an infected renal cyst in the Japanese literature.

Abscess↗
PubMed2002

[Traumatic anterior dislocation of the hip associated with ipsilateral femoral neck fracture: a case report].

A thirty-nine-year-old female patient was brought to the emergency room following an automobile accident. Radiographic examination revealed a subcapital fracture of the left femur associated with anterior femoral head dislocation, and a contralateral comminuted femoral shaft fracture. Computed tomography showed that the acetabulum was empty, with the femoral head dislocated anteriorly close to the obturator foramen. Uncemented total hip arthroplasty and locked intramedullary nailing were performed on the left and right sides, respectively. Sixty-two months after surgery, she had no difficulty in performing daily activities.

Accidents, Traffic↗
PubMed2003

[Mechanisms and frequency of urologic complications in 73 cases of unstable pelvic fractures].

OBJECTIVES: To analyse the urological complications of unstable pelvic fractures and to try to establish a correlation between the type of urological complication observed and the type of pelvic fracture. MATERIAL AND METHODS: The urological complications of 73 unstable pelvic fractures observed between 1977 and 1996 were analysed. Fractures of the obturator foramen were excluded from the study. Pelvic fractures were classified according to the criteria of the Tile classification, comprising 3 main types: type A corresponds to stable fractures not involving the pelvic brim; type B corresponds to fractures with rotary instability and type C corresponds to fractures with vertical instability. RESULTS: 12 men (12.5%) developed urological complications: 7 ruptures of the membranous urethra (3 type C, 4 type B), 4 intraperitoneal ruptures of the bladder (3 type C and 1 type B) and one extraperitoneal rupture of the bladder (type A). The mean age of these patients was 37 years (range: 14 to 56). The mortality was 50%. CONCLUSION: Urological complications are rare after pelvic fractures, but must be systematically investigated. The Tile classification is useful to understand the mechanisms responsible for urological complications of pelvic fractures. Unstable fractures (type B and C) are at greatest risk of urological complications. Type B or C fractures are not correlated with a specific type of urological complication.

Adolescent↗
PubMed2003

[Transobturator tape (Uratape). A new minimally invasive method in the treatment of urinary incontinence in women].

OBJECTIVE: To evaluate the one-year results of transobturator suburethral tape for the treatment of female stress urinary incontinence. MATERIAL AND METHODS: Suburethral tape was implanted via the transobturator technique. UraTape non-woven, non-elastic polypropylene tape with a 15 mm wide central (suburethral) silicone-coated zone was inserted without tension in a horizontal plane underneath the middle of the urethra from one obturator foramen to the other. The lateral ends of the tape were tunnelled percutaneously with a tunnelling device. The retropubic space was preserved and cystoscopy was not required. From May 2000 to February 2002, 32 patients with a mean age of 64 years (range: 50 to 81 years), suffering from stress urinary incontinence without associated prolapse, were operated by the same surgeon (ED). All patients were evaluated before the operation by clinical and urodynamic examination: 5 patients presented sphincter incompetence (maximum closing pressure < 20 cmH2O); five patients presented recurrent urinary incontinence after Burch or TVT; 18 patients presented mixed incontinence and detrusor instability was demonstrated on cystometry in 6 of them. The results were evaluated by two independent doctors (clinical examination, uroflowmetry, cough test). Voiding disorders suggestive of bladder outflow obstruction were defined by the presence of the following two criteria: Qmax < 15 ml/s, residual volume > 20%. RESULTS: The mean follow-up of the study was 17 months (range: 13 to 29 months). The mean operating time was 15 minutes. No intraoperative complication was observed. One patient presented complete postoperative bladder retention that resolved after 4 weeks of self-catheterization. 29/32 patients (90.6%) were cured and 3/32 (9.4%) were improved. No urethral erosions were observed. No residual pain and no functional impairment related to the tape was observed. 5/32 patients presented voiding disorders suggestive of bladder outflow obstruction. Two patients developed de novo urge incontinence. CONCLUSIONS: Transobturator Uratape is a simple and effective procedure with a follow-up of one year for the treatment of female stress urinary incontinence. The transobturator approach avoids the risks of bladder, intestinal and vascular injuries. Evaluation of the results with a longer follow-up is necessary to validate this technique.

Aged↗
PubMed2004

Tension-free transobturator approach for female stress urinary incontinence.

AIM: UraTape is a new sling for female stress urinary incontinence (SUI) inserted via a transobturator percutaneous approach. We report the safety, feasibility and short-term results of this new surgical procedure. METHODS: UraTape (Porgès-Mentor) is a non-elastic polypropylene tape, with a silicone coated central part. The sling is placed tension-free under the mid-urethra and extended through the obturator foramen bypassing the posterior face of the ischiopubic ramus. From September 2002 to May 2003, 80 females affected by SUI associated with urethral hypermobility and without severe uro-genital prolapse (with cystocele 1st grade) received UraTape. Mean age was 56 (39-79) years. Sixty-two out of 80 had a positive Q tip test; 16/80 had recurrent incontinence after Burch or colpoplasty according to Kelly; 22/60 had mixed incontinence. Preoperative evaluations included: complete history and physical examination, urinalysis, urodynamic investigations, abdominal and pelvic ultrasound. Quality of life assessment was carried out pre- and postoperatively. RESULTS: Mean operative time was 16 (11-36) minutes. No major intraoperative complications were observed. One bladder neck laceration occurred and was treated intraoperatively. No cystoscopy was performed. Mean hospital postoperative stay time was 1.1 (1-6) days. All patients were examined periodically at 7, 30 and 90 days from intervention (mean follow-up 4 months, 1-8). There was no urethral erosion. One vaginal erosion with inguinal abscess was diagnosed and treated without removing the sling. Two de novo urge incontinence was observed. The objective and subjective cure rates were 92% and 97%; 96% expressed good quality of life (satisfied/very satisfied). CONCLUSION: This procedure is a safe, effective new technique for the treatment of female SUI. The easy technique, the short learning curve and the very high grade of satisfaction of the patients show that this approach is based upon effective anatomical and physiological criteria. Further follow-up is necessary in order to evaluate urodynamic changes and overall satisfaction.

Adult↗
PubMed2004

The transobturator sling: newest tension-free suburethral sling for treatment of stress urinary incontinence.

T his innovative sling system places the sling between the obturator foramens using a perineal approach while preserving an intact retropubic space. Potential complications associated with tension-free sling systems that use needle-carrier placement through the retropubic space, such as the tension-free vaginal tape (TVT, Gynecare, Ethicon, Somerville, NJ, USA), are eliminated and routine cystoscopy is not required. The procedure is effective and safe for the primary treatment of stress urinary incontinence in patients with urethral hypermobility, intrinsic sphincter deficiency, or both. It is equally efficient in treatment of recurrent and mixed urinary incontinence. Short-term results are similar to those of the retropubic tension-free slings.

Aged↗
PubMed2004

[Compression of the bulbar urethra by transobturator suburethral tape: anatomical study].

INTRODUCTION: The management of female stress urinary incontinence has been markedly improved by the suprapubic tension-free vaginal tape (TVT) and transobturator tape techniques. The objective of our study was to assess the feasibility of this type of technique in males based on cadavre dissection. MATERIAL AND METHOD: A 300 mm x 15 mm polypropylene tape was inserted via a transobturator approach on a cadavre stored in the refrigerator at 4 degrees C and on three cadavres stored in formalin. The technique was almost identical to that used in females. It requires a midline perineal incision in the raphe and two small lateral incisions. The deep transverse muscle of the perineum was opened with scissors. The needle was introduced via the lateral incisions and its progression was guided by a finger introduced into the perineal orifice. The cadavre was then sectioned sagittally to verify the course of the tape and its relations to adjacent structures. RESULTS: The operative technique did not raise any particular problems. Dissection revealed that the tape crossed the deep transverse muscle of the perineum and the levator ani muscle, before travelling towards the obturator foramen. The tape avoided the bladder, prostate, corpora cavernosa, and pudendal pedicle. CONCLUSION: The transobturator tape technique therefore appears to be feasible in males. It does not appear to comprise any particular risks for adjacent organs. This anatomical study appeared to be essential before considering an in vivo application.

Cadaver↗
PubMedDate not supplied

[Female urinary stress incontinence: transobsturator technique].

The wide use of retropubic TVT has been associated with various complications. To avoid these, alternative procedures have been developed and continence rates obtained with these new routes have been quite similar to those after classic TVT. In the transobsturator technique (TOT) described by Delorme and colleagues in 2001, the tape is inserted through the obturator foramens from outside to inside and is positioned without tension under the urethra. Another surgical technique allows the passage of a tape from inside to outside. The aim of this paper is to describe a new, simple surgical technique for the treatment of female urinary stress incontinence and to evaluate its feasibility.

Equipment Design↗
PubMed2005

[Management of serious infectious complications of transobturator suburethral tape: report of 2 cases].

Suburethral TVT tape has become immensely popular since its invention in 1995. A new transobturator surgical approach was proposed in 2001, resulting in a modification of the quality of the tape available from various suppliers. The authors present 2 cases of obturator foramen abscess related to suburethral Uratape, occurring a long time after the procedure and requiring complete removal of the tape. These infections can be prevented by using good quality tape, which must be made from monofilament large-mesh woven polypropylene. The tape must be completely removed as early as possible in the case of vaginal erosion, even asymptomatic, via a transobturator approach, if necessary.

Abscess↗
PubMed2006

[Anterior approach sacrospinous colpopexy in a patient with vaginal vault prolapse, stress urinary incontinence and cystocoele with lateral defect].

We present a case of vaginal vault prolapse after hysterectomy associated with cystocoele with central and lateral defect and stress urinary incontinence, that was treated surgically with employment of sacrospinous colpopexy through anterior approach (from paravesical space), combined with anterior colporrhaphy by double TOT approach method (that is a butterfly-shaped polipropylen mesh, which arms were carried through upper and lower parts of obturator foramens by tension-free method). There were no postoperative complications. A control examination at 1 and 3 months after the operation showed maintenance of normal anatomic relations, which were obtained as a result of repair, total control of urinary continence and full patient's satisfaction from the operation.

Colpotomy↗
PubMed2006

[The preliminary evaluation of surgical treatment of pelvic organ prolapse with polypropylene mesh by double transobturator approch technique (double TOT)].

OBJECTIVES: The aim of this study was to evaluate preliminary results of a new, simple surgical technique with the use of polypropylene mesh (double TOT) used for the treatment of cystocele associated / not associated with urinary incontinence in females. MATERIAL AND METHODS: 19 women, aged 49-76, BMI 24-40, with cystocele associated or not with urinary incontinence, were operated on at the 1st Department of Obstetrics and Gynaecology in Warsaw, using double TOT technique. In this technique, described by Theobald, the trapezoidal polypropylene four-arm vaginal mesh is inserted through the obturator foramens from the outside to the inside and is positioned without tension under the urethra. RESULTS: 9 patients qualified for the operation were grade III in POPQA, 5--grade IV, 4--grade II and one patient grade I. 16 women had additional operations performed beside double TOT. The duration of operations varied from 30 to 135 minutes. No intra-operative complications were observed. There were no complications in short 6 weeks follow-up. CONCLUSIONS: Double Transobturator technique is simple, easy to learn, safe and, at the same time, efficient surgical procedure for the treatment of pelvic organ prolapse and female urinary stress incontinence. The results of longer follow-up on a larger group of operated patients will be more accurate.

Adult↗
PubMed2006

Comparison of sacropelvic morphology between normal adolescents and subjects with adolescent idiopathic scoliosis.

Previous studies suggest that the pelvic morphology may be abnormal in adolescent idiopathic scoliosis. This study compares the sacropelvic morphology between normal adolescents and subjects with adolescent idiopathic scoliosis (AIS) in both sagittal and coronal planes. The sacropelvic morphology was assessed from the postero-anterior and lateral standing radiographs of 27 normal adolescents and 29 subjects with AIS presenting a major Cobb angle greater than 30 degrees . Sacropelvic morphology was characterized by 19 parameters in the sagittal plane and 26 parameters in the coronal plane. There was no difference in sacropelvic morphology between the two groups in the sagittal plane. In the coronal plane, significant differences were found for right pelvic length, right iliac height, left and right pubic length, left obturator foramen width, bicristal distance, bituberal distance, biacetabular distance, pubic symphysis width, pelvic inlet, and subpubic angle. There was no significant pelvic asymmetry in AIS subjects. This is the first study that specifically evaluates the sagittal and coronal sacropelvic morphology in AIS. The results suggest that the coronal sacropelvic morphology is distorted in AIS. A longitudinal study is required in order to evaluate the influence of sacropelvic morphology in the progression of AIS.

Adolescent↗
PubMed1991

A unique inlet [the ascending aorta] for extra-anatomic bypass of infected arterial prostheses.

Infection is the most dreaded complication associated with implantation of a prosthetic arterial graft. The reported incidence of primary graft infection varies from 1.3% to 6.0%, with a mortality rate from this complication as high as 75%. Although remote bypass followed by complete removal of the infected prosthesis has proven to be a satisfactory method of treatment, in certain instances remote bypass alone is not feasible and other modes of surgical treatment must be employed. Such conservative methods of management of infected aorto-iliac-femoral prosthesis sometimes irradicate infection. The only certain cure, however, is obtained by totally removing the graft. And the success of extra-anatomic axillofemoral techniques has led to its extended use. The addition of a cross-limb on an axillo-unilateral femoral graft to form an axillobilateral femoral graft was described by Sauvage and Wood, reasoning that the higher flow rate in the axillary limb of the axillobilateral femoral graft would result in an improved patency rate compared with that of axillounilateral femoral grafts. Additionally, both medial (obturator foramen) and lateral extra-anatomic remote bypass of infected femoral prosthesis have been used, successfully. The current case illustrates the complexity of management, once sepsis occurs. It further focuses on groin, retroperitoneal and bilateral axillo-femoral tract infection with prolonged (apparently innocuous) graft exposure and finally points out the utility of the ascending aorta as an alternative extra-anatomic inlet to perfuse the lower extremities.

Aged↗