UNASSIGNED: Bone is one of the common sites of metastasis in lung cancer. Pathological fractures of the femur significantly reduce patients\' quality of life and increase the risk of death. However, there is still no consensus on the optimal treatment of pathological femoral fractures. The authors\' report provides a treatment method for a patient with pathological fracture of lung cancer with preoperative HIFU lesion ablation followed by combined intramedullary nail fixation.
UNASSIGNED: A 61-year-old Chinese woman was hospitalized with severe pain in her right thigh. X-ray and CT examination at admission considered pathological fracture of the right femur. MRI showed a comminuted fracture of the middle and lower part of the right femur, swelling of the surrounding soft tissue, and effusion. WBS showed an abnormal concentration of imaging agent at the right femoral fracture end and abnormal bone metabolism. After a lung biopsy, it was diagnosed as lung cancer with femoral metastasis and pathological fracture.
UNASSIGNED: The patient underwent HIFU ablation before surgery to reduce the lesion, and a re-examination MRI showed that the signal at the lesion was significantly reduced, and the lesion volume was significantly reduced. The operation was performed by open reduction and intramedullary nail fixation, focal excision, and bone cement filling. After 6 months of follow-up, the patient\'s bone metastasis was not aggravated, and there was no loosening or fracture of the right femoral intramedullary nail.
UNASSIGNED: This is a case of pathological fracture of the femur caused by bone metastases from pulmonary cancer. The patient used HIFU to reduce the lesion before the operation and combined it with intramedullary nail internal fixation to treat the pathological fracture. A satisfactory therapeutic effect was obtained. The authors believe that this is a safe and effective treatment. This case may be beneficial to the treatment of pathological fracture of bone metastasis of lung cancer.

BACKGROUND: Endovascular treatment of the common femoral artery (CFA) and its branches is often challenging. Sometimes, stent placement cannot be avoided. Furthermore, stent placement in this area carries several risks for complications. We present a challenging case in which we used a rotational atherectomy device percutaneously in cross-over-technique to recanalize the external iliac artery in combination with the femoral bifurcation, all in one session - and - without the need for a femoral stent in a multimorbid patient. We also tried to gain more insights in the patient\'s perspective and we took a validated health status evaluation into account.
METHODS: The patient was presented due to chronic open wounds on the left foot for months (Stadium Fontaine IV). Duplex sonography and CT angiography showed a complete occlusion of the left external iliac artery with involvement of the left common femoral artery. Due to the pre-existing chronic diseases and the high risk of prolonged anesthesia, the patient was not suitable for open reconstruction of the common femoral artery. We aimed for endovascular therapy using a crossover maneuver to minimize anesthesia time as much as possible. The percutaneous treatment was performed with a rotational atherectomy device and drug-coated balloon angioplasty with satisfying angiographic results and complete blood-flow restoration. No peri-procedural complications occurred. We gained experience with this endovascular-treatment-device in our teaching hospital and more difficult cases can now be treated. The patient\'s perspective and health status were assessed during follow-up visit.
CONCLUSIONS: The endovascular treatment of severe calcifications in peripheral arterial occlusive disease (PAOD) seems to be a good solution for selected patients, significantly minimizing surgical trauma. The newly combined rotational atherectomy and thrombectomy devices have demonstrated positive outcomes in areas where conventional treatment has traditionally been the standard. The groin types of peripheral arterial occlusive disease (PAOD) are quite often challenging to operate. Open treatment of the common femoral artery has been the standard procedure until modern endovascular possibilities provide a new concept in this treatment, emphasizing a minimal invasive approach in multi morbid patients. The case description results in an illustrated follow up period of 6 months and is presented in line with the recommendations of the consensus-based surgical case reporting guideline development.
CONCLUSIONS: Managing peripheral arterial occlusive disease in the groin region poses a continual challenge. Traditionally, open treatment of the common femoral artery has been - and is - the established procedure. However, contemporary endovascular options now introduce a new paradigm in this treatment, highlighting minimally invasive approaches in multi morbid patients and its patient satisfaction.

In addition to human donor bones, bone models made of synthetic materials are the gold standard substitutes for biomechanical testing of osteosyntheses. However, commercially available artificial bone models are not able to adequately reproduce the mechanical properties of human bone, especially not human osteoporotic bone. To overcome this issue, new types of polyurethane-based synthetic osteoporotic bone models have been developed. Its base materials for the cancellous bone portion and for the cortical portion have already been morphologically and mechanically validated against human bone. Thus, the aim of this study was to combine the two validated base materials for the two bone components to produce femur models with real human geometry, one with a hollow intramedullary canal and one with an intramedullary canal filled with synthetic cancellous bone, and mechanically validate them in comparison to fresh frozen human bone. These custom-made synthetic bone models were fabricated from a computer-tomography data set in a 2-step casting process to achieve not only the real geometry but also realistic cortical thicknesses of the femur. The synthetic bones were tested for axial compression, four-point bending in two planes, and torsion and validated against human osteoporotic bone. The results showed that the mechanical properties of the polyurethane-based synthetic bone models with hollow intramedullary canals are in the range of those of the human osteoporotic femur. Both, the femur models with the hollow and spongy-bone-filled intramedullary canal, showed no substantial differences in bending stiffness and axial compression stiffness compared to human osteoporotic bone. Torsional stiffnesses were slightly higher but within the range of human osteoporotic femurs. Concluding, this study shows that the innovative polyurethane-based femur models are comparable to human bones in terms of bending, axial compression, and torsional stiffness.

暂无摘要。

暂无摘要。

OBJECTIVE: Femoral hernia accounts for 22% of groin hernia operations in women and for 1.1% in men. Numerous surgical approaches have been reported but there is no consensus. Many of the recurrence rates are reported in old literature, while recent reports are scarce. The aim of the present study was to review rates of recurrences in patients who underwent open repair of a primary femoral hernia.
METHODS: We conducted a systematic search in the electronic literature, using the search terms \"femoral hernia\" and \"recurrence\". We included studies published from 2002 that had as primary or secondary endpoint to evaluate the recurrence after surgery. Risk of bias was assessed by the Cochrane risk of bias tool for RCT and by the Newcastle-Ottawa Scale for cohort studies.
RESULTS: Fifteen eligible articles were included in our systematic review. A total of 1087 procedures were performed according to the defined criteria. The metanalytic evaluation highlighted a higher probability of recurrence for non-mesh than mesh repairs (6.5% vs 1.9%; RR 0.924, 95% CI: 0.857 - 0.996). In patients treated in emergency settings the rate of recurrences was 3.7%; in patients who received elective repairs it was 0.71%. Six studies reported that most of recurrences occurred within the first post-operative year.
CONCLUSIONS: We found that crude recurrence rate after open repair of a primary femoral hernia is about 4%. This rate is higher in case of non-mesh techniques and in emergency surgery. Our results support the recommendation that femoral hernias should be repaired with mesh techniques.

BACKGROUND: Reactivation of the varicella zoster virus (VZV) results in herpes zoster (HZ), which is a painful unilateral rash with a typical dermatomal distribution. HZ may be followed by postherpetic neuralgia (PHN), vasculopathy, myelopathy, retinal necrosis, and cerebellitis. Vasculopathy can cause ischemic stroke, aneurysms, arterial dissection, transient ischemic attack, and rarely, peripheral arterial disease (PAD). The possible mechanism is that the VZV travels to the arteries through the sensory ganglia, leading to inflammation and pathological vascular remodeling, which result in vasculopathy.
METHODS: Here, we describe a rare case of femoral artery occlusion induced vasculopathy 5 years after HZ. A 65-year-old woman visited our pain clinic with persistent pain following HZ that occurred 3 months earlier. She had several rash scars on the right thigh along with a continuous throbbing, shooting, and sharp pain. The patient was diagnosed with PHN and prescribed with medications that relieved the leg pain. The symptoms remained stationary for almost 5 years. She presented again with complaints of a paroxysmal tingling sensation in the right thigh and claudication due to increased pain, which had begun 6 months prior. She reported leg pain after walking for 10 minutes. Lumbar spine magnetic resonance imaging (MRI) revealed foraminal stenosis at the level of right L2, with no abnormality below L2. Subsequently, the patient was evaluated for vascular diseases. Lower extremity ultrasonography and computed tomography (CT) angiography revealed stenosis and thrombotic occlusions in the right superficial femoral and tibial arteries as well as the left middle femoral and tibial arteries. Surgical revascularization via percutaneous angioplasty was performed bilaterally. The leg pain was relieved after the procedure and the claudication improved.
CONCLUSIONS: Peripheral artery occlusion is a rare phenomenon following HZ. In cases involving changes in HZ symptoms, further evaluation is required for potential vasculopathy.

BACKGROUND: Approximately 20 % of femoral fragility fracture patients take anticoagulants, typically warfarin or Direct Oral AntiCoagulant (DOAC). These can impact timing of surgery affecting patient survival. Due to several possible approaches and numerous factors to consider in the preoperative workup of anticoagulated patients, potential for variations in clinical practice exist. Some hospitals employ dedicated anticoagulation management protocols to address this issue, and to improve time to surgery. This study aimed to determine the proportion of hospitals with such protocols, compare protocol guidance between hospitals, and evaluate the effectiveness of protocols in facilitating prompt surgery.
METHODS: Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the UK. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Information from dedicated anticoagulation management protocols were collated on several domains relating to perioperative care including administration of reversal agents and instructions on timing of surgery as well as others. Logistic regression was used to evaluate effects of dedicated protocols on time to surgery.
RESULTS: Dedicated protocols for management of patients taking warfarin and DOACs were present at 41 (52.6 %) and 43 (55.1 %) hospitals respectively. For patients taking warfarin, 39/41 (95.1 %) protocols specified the dose of vitamin k and the most common was 5 milligrams intravenously (n=21). INR threshold values for proceeding to surgery varied between protocols; 1.5 (n=28), 1.8 (n=6), and 2 (n=6). For patients taking DOACs, 35/43 (81.4 %) and 8/43 (18.6 %) protocols advised timing of surgery based on renal function and absolute time from last dose respectively. Analysis of 10,197 patients from 78 hospitals showed fewer patients taking DOACs received surgery within 36 h of admission at hospitals with a dedicated protocol compared to those without (adjusted OR 0.73, 95% CI 0.54-0.99, p=0.040), while there were no differences among patients taking warfarin (adjusted OR 1.64, 95% CI 0.75-3.57, p=0.219).
CONCLUSIONS: Around half of hospitals employed a dedicated anticoagulation management protocol for femoral fragility fracture patients, and substantial variation was observed in guidance between protocols. Dedicated protocols currently being used at hospitals were ineffective at improving the defined targets for time to surgery.

BACKGROUND: Schwannomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells, and affecting single or multiple nerves. The tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area. Retroperitoneal pelvic schwannomas often present with non-specific symptoms leading to misdiagnosis and prolonged morbidity.
METHODS: We report the case of a 59-year-old woman presenting with a feeling of heaviness in the lower abdomen who was found to have a retroperitoneal pelvic schwannoma originating from the right femoral nerve. She had a history of two resections of peripheral schwannomas at four different sites of limbs. After conducting magnetic resonance imaging, this pelvic schwannoma was misdiagnosed as a gynecological malignancy. The tumor was successfully removed by laparoscopic surgery. Pathological analysis of the mass revealed a benign schwannoma of the femoral nerve sheath with demonstrating strong, diffuse positivity for S-100 protein.
CONCLUSIONS: Although retroperitoneal pelvic schwannoma is rare, it should be considered in the differential diagnosis of pelvic masses, especially in patients with a history of neurogenic mass or the presence of neurogenic mass elsewhere.

BACKGROUND: This study is the first multicentric report on the safety, efficacy, and technical performance of utilizing a large bore (0.081″ inner diameter) access catheter in neurovascular interventions.
METHODS: Data were retrospectively collected from seven sites in the United States for neurovascular procedures via large bore 0.081″ inner diameter access catheter (Benchmark BMX81, Penumbra, Inc.). The primary outcome was technical success, defined as the access catheter reaching its target vessel. Safety outcomes included periprocedural device-related and access site complications.
RESULTS: There were 90 consecutive patients included. The median age of the patients was 63 years (IQR: 53, 68); 53% were female. The most common interventions were aneurysm embolization (33.3%), carotid stenting (12.2%), and arteriovenous malformation embolization (11.1%). The transradial approach was most used (56.7%), followed by transfemoral (41.1%). Challenging anatomic variations included severe vessel tortuosity (8/90, 8.9%), type 2 aortic arch (7/90, 7.8%), type 3 aortic arch (2/90, 2.2%), bovine arch (2/90, 2.2%), and severe angle (<30°) between the subclavian artery and target vessel (1/90, 1.1%). Technical success was achieved in 98.9% of the cases (89/90), with six cases requiring a switch from radial to femoral (6.7%) and one case from femoral to radial (1.1%). There were no access site complications or complications related to the 0.081″ catheter. Two postprocedural complications occurred (2.2%), unrelated to the access catheter.
CONCLUSIONS: The BMX™ 81 large-bore access catheters was safe and effective in both radial and femoral access across a wide range of neurovascular procedures, achieving high technical success without any access site or device-related complications.