Geniculate arterial pseudoaneurysm formation following trauma and elective orthopaedic surgery to the knee: 2 case reports and a review of the literature.

Arterial pseudoaneurysm formation of the genicular vessels following orthopaedic surgery to the knee is an extremely rare occurrence. Here we report the successful management of two cases as a complication of total knee arthroplasty and a tibial interlocking nail, utilising coil embolisation by interventional radiological techniques and negating the need for further surgery. To our knowledge this is one of the few reported cases of pseudoaneurysms of the descending genicular artery secondary to drain placement and only the second following tibial interlocking nail placement.

The occurrence of arterio-venous fistula during lower limb subintimal angioplasty: treatment and outcome.

OBJECTIVES: To describe our experience with iatrogenic arterio-venous fistula (AVF) occurring during lower limb subintimal angioplasty, their management and the final clinical, radiological outcome. DESIGN: Retrospective review of case series from two centres, from a computerised database over a period of five years. MATERIAL: Twelve patients whose lower limb subintimal angioplasty was complicated by Iatrogenic AVF. RESULTS: The Majority of AVF occurred at the popliteal trifurcation vessels. And the incidence of this complication in our case series was 0.8%. This was managed with a variety of techniques-Coil embolisation, balloon tamponade, alternative dissection and stent placement. In one patient, the fistula was left open intentionally. All twelve patients had a successful angioplasty. The overall technical success rate for AVF ablation was eighty percent. CONCLUSIONS: AVF is a potential complication of angioplasty. The majority can be managed by endovascular means during the angioplasty procedure with good technical success.

The results of subintimal angioplasty in a district general hospital.

OBJECTIVES AND DESIGN: we report a prospective study to determine if subintimal angioplasty can be performed in non-teaching centres and to establish its learning curve. MATERIALS AND METHODS: subintimal angioplasty was performed on 50 limbs in 46 patients (34 male) with a median age of 72 years (range 45-93 years). Indication was critical limb ischaemia (27 limbs) or intermittent claudication (23 limbs). Occlusions were located in the superficial femoral artery in 44 limbs, popliteal artery in 4 limbs and the peroneal artery in two limbs. At a median of 7.9 months patients had colour duplex imaging of the vessels that underwent angioplasty to assess vessel patency. RESULTS: primary technical success was achieved in 39 cases (78%). Primary technical success was greater in the second group of 25 consecutive limbs to undergo angioplasty at 92% (23 cases) compared with the first 25 consecutive limbs at 64% (16 cases). At 6 months the overall vessel patency rate on duplex imaging was 57%, improving to 64% in the group having a primarily successful procedure. The equivalent rate of symptomatic improvement was 59 and 66% respectively. Complications occurred in five procedures, most were minor, but a single fatality was directly attributable to the procedure. CONCLUSION: subintimal angioplasty can reasonably be performed outside major teaching institutions. There is a short learning curve associated with the procedure.

Cerebellar encephalomalacia on magnetic resonance imaging after removal of acoustic tumor.

MRI is widely used for postoperative surveillance of patients undergoing surgery for removal of acoustic neuroma. The purpose of this study was to investigate the frequency and pattern of postoperative changes in the cerebellum and brain stem on MRI after removal of acoustic neuroma. A retrospective study was conducted in 30 consecutive patients who underwent postoperative MRI between 1994 and 1995. The timing of the scans after surgery ranged from 12 months to 10 years. T2 -weighted turbo spin-echo images revealed cerebellar encephalomalacia in 17 of 30 cases. Cerebellar encephalomalacia was found more consistently in patients who had large tumors and was more frequent after the suboccipital approach. Encephalomalacia is largely caused by gliotic changes in the adjacent cerebellar tissues after tumor removal.

Topical anesthetic as an adjunct to local anesthesia during pulpectomies.

A technique is described using topical anesthetic to supplement local anesthesia. It is the author's opinion that it enhances patient comfort during pulpectomies on teeth with irreversible pulpitis.

Bacteriological comparison of ultrasonic and hand instrumentation of root canals in dogs.

This study compared the effectiveness of hand and ultrasonic instrumentation for removing a standardized inoculum of pigmented Serratia marcescens from the root canal system of premolars in dogs. Forty-four premolars from nine beagle dogs were divided into two experimental groups of 20 and 24 teeth, respectively. The experimental teeth were inoculated with approximately 10 colony-forming units of S. marcescens. After the bacterial were allowed to colonize for 1 wk, the experimental teeth were instrumented with either hand instruments or the Cavi-Endo device. The teeth were extracted, crushed, and assayed for recoverable colony-forming units of S. marcescens. Statistical comparisons of the ratio of inoculated to recovered colony-forming untis were made. The results indicated that the difference between the positive controls and the experimental groups was significant. There was no significant difference between the two instrumentation groups.