Anthropometric measurements of the foot cannot predict the screw diameter for fifth metatarsal fractures intramedullary fixation.

PURPOSE: The present study aimed to evaluate the accuracy of anthropometric foot measurements in predicting the diameter of the intramedullary screw for fifth metatarsal fracture fixation. Secondary aim was to identify whether the fifth metatarsal intramedullary canal diameter is correlated to the fifth metatarsal length and the foot dimensions. METHODS: In 29 cadaveric feet, the maximum length of the plantar surface of the foot (PL) and the perimeter of the foot at the level of the fifth metatarsal base (PBFM) were measured using a measuring tape. Subsequently, the fifth metatarsal was excised. Using Computed Tomography scan, the metatarsal length (FML), and the horizontal (HDI) and vertical diameter (VDI) at the isthmus level were measured. The HDI values were grouped in 5 mm increments to correspond to the recommended screw diameter (RSD) for intramedullary fixation. A univariate linear regression analysis considered RSD and HDI as the dependent variables and FML, PL, PBFM as the independent variables. A multivariate regression analysis was performed to examine the predictive value of the two anthropometric measurements. A p-value < 0.05 was considered statistically significant. RESULTS: All six univariate analyses revealed that the dependent variable was significantly correlated with the independent variable. However, the multivariate regression models showed that the anthropometric measurements were not significantly correlated with the RSD and HDI. CONCLUSION: The current study found an association between the fifth metatarsal intramedullary canal diameter and the fifth metatarsal length and foot anthropometric dimensions. However, the anthropometric measurements of the foot presented a low predictive value for the decision of an intramedullary screw diameter in the treatment of fractures of the base of the fifth metatarsal.

Immediate Change in Suprarenal Neck Angulation After Endovascular Aneurysm Repair: Comparison of the Ovation Stent-Graft Inflatable Sealing Rings to a Conventional Self-Expanding Stent-Graft.

PURPOSE: To compare the immediate suprarenal neck angulation change between the Ovation stent-graft, with its inflatable sealing rings, and a stent-graft with a conventional sealing mechanism. METHODS: A case-control study was conducted in which 30 consecutive patients (mean age 67 years; all men) with abdominal aortic aneurysm (AAA) treated with the Ovation stent-graft (group O) were retrospectively compared with 24 patients (mean age 77 years; all men) contemporaneously treated with the Endurant stent-graft (group E) at 3 high-volume tertiary vascular centers. The variables recorded were the aortic neck length, preoperative and postoperative angulation, minimum and maximum diameters of the infrarenal neck, as well as the maximum AAA diameter. All patients had undergone preoperative and postoperative (within 30 days) computed tomographic angiography. Multiple regression analysis compared the relative contribution to neck angulation change of each geometric parameter and the type of endograft. Data are presented as the mean ± standard deviation. RESULTS: The mean preoperative suprarenal neck angulation in group O was 23.2°±18.0° compared with 23.8°±22.9° in group E (t test, p=0.91). The neck lengths were 29.2±14.6 and 23.2±11.0 mm in groups O and E, respectively (p=0.1). Similarly, the minimum and maximum neck diameters were 22.4±2.6 and 25±3.5 mm, respectively, in group O vs 23.3±3.6 mm and 27.0±5.7 mm, respectively, in group E (p=0.3 and 0.12, respectively). The maximum transverse diameters of the AAA in the 2 groups were comparable, that is, 57.0±9.0 mm in group O vs 53.2±11.1 mm in group E (p=0.17). The Ovation stent-graft caused greater decrease in the aortic neck angulation postoperatively compared with the Endurant device (13.2°±16.1° vs 6.1°±5.9°, p=0.04). Multiple regression analysis revealed that preoperative neck angulation (ß coefficient 0.37, p<0.001) and the type of endograft (ß coefficient -7.91, p=0.01) had significant influence on the postoperative neck angulation change. The intraclass correlation coefficient ranged from 0.951 to 0.990 for the preoperative measurements and from 0.911 to 0.999 for the postoperative measurements for each examiner or the total of estimates at the measurement time points. CONCLUSION: The Ovation stent-graft induces greater postoperative reduction in the AAA neck angulation compared to an endograft with stent-supported graft seal. Expanded research to infrarenal angle as well to greater angles and correlation to clinical events is justified.

Initial single-center experience with the Ovation stent-graft system in the treatment of abdominal aortic aneurysms: application to challenging iliac access anatomies.

BACKGROUND: To present our preliminary results with the Ovation(™) abdominal stent-graft system in abdominal aortic aneurysms (AAA) with narrow (≤7 mm) or angulated iliac vessels. METHODS: From April 2012 to January 2014, 42 patients (97% men; mean age, 71 years; range, 55-89 years) with AAAs of 55.5 mm (50-79 mm) were treated with the Ovation device. Primary end points included technical success and freedom from early secondary interventions, any type of endoleak, and aneurysm-related death. Limb occlusion was studied with respect to iliac access diameter and angulation. Iliac angulation between 90° and 120° or <90° was considered moderate or severe, respectively. RESULTS: The postoperative follow-up was 7.8 ± 4.6 months (mean ± standard deviation). Infrarenal neck angulation was 26° ± 26°. AAA neck length and diameter were 27.3 ± 10.5 and 24.1 ± 3.2 mm, respectively. Forty-five percent of patients had at least 1 vessel of ≤7-mm diameter, and almost half of patients (24 of 44) had at least 1 iliac artery of moderate or severe angulation. Technical and treatment success were 100% and 95%, respectively. No stent-graft migration or type I, III, or IV endoleaks occurred. Type II endoleaks were identified in 5 patients, leading to sac enlargement in 2 and necessitating an embolization attempt that was unsuccessful in 1 case. No limb occlusion occurred, irrespective of the iliac diameter or angulation. CONCLUSIONS: Our 1-year results of the Ovation stent-graft system demonstrate excellent safety and effectiveness. The easy navigation through highly angulated and stenosed iliac vessels ensures high technical success in cases of challenging iliac anatomy. Follow-up is ongoing.

Chimney and periscope technique for emergent treatment of spontaneous aortic rupture.

Aortic rupture comprises a potentially fatal condition necessitating emergent treatment. Endovascular sealing of the rupture site is often combined with the use of chimney- and periscope stent placement to preserve perfusion of aortic branches. We present a case of successful endovascular management of contained aortic rupture in a 78-year-old patient. The left brachial access facilitated stenting of the celiac and superior mesenteric arteries, whereas the left femoral route served stenting of the renal artery. One-month follow-up confirmed complete sealing, stent patency, and absence of endograft migration. The combined periscope and chimney technique is feasible and effective in the emergency setting.

Benign multicystic peritoneal mesothelioma: a case report.

INTRODUCTION: We report the case of a patient with a benign multicystic peritoneal mesothelioma and describe its appearance on computed tomography scans and ultrasonography, in correlation with gross clinical and pathological findings. CASE PRESENTATION: A 72-year-old Caucasian woman presented to our emergency department with acute abdomen signs and symptoms. A clinical examination revealed a painful palpable mass in her left abdomen. Abdominal ultrasonography and computed tomography demonstrated the presence of a large cystic mass in her left upper abdomen, adjacent to her left hemidiaphragm. The lower border of the mass extended to the upper margin of her pelvis. A complete resection of the lesion was performed. Pathological analysis showed a benign multicystic peritoneal mesothelioma. CONCLUSIONS: Benign multicystic peritoneal mesothelioma is a rare lesion with a non-specific appearance on imaging. Its diagnosis always requires pathological analysis.

Imaging of ectopic intrathoracic multinodular goiter with pathologic correlation: a case report.

INTRODUCTION: We present a case of ectopic intrathoracic multinodular goiter and correlate the magnetic resonance imaging appearance with the histological findings. CASE PRESENTATION: A 72-year-old man was referred to our institute with a two month history of cough. The chest radiograph showed a mass located in the mediastinum. A chest computed tomography scan, showed an enhancing mass at the right side of the middle mediastinum where magnetic resonance images, demonstrated a multicystic mass. The mass was excised through a right lateral thoracotomy and histologically it proved to be an ectopic multinodular goiter. CONCLUSIONS: Although ectopic intrathoracic multinodular goiter is a rare entity, it should be considered in the differential diagnosis of mediastinal masses. The preoperative diagnosis is important as, unlike substernal goiter which is surgically approached through the neck, the ectopic thyroid is treated by thoracotomy.