IntroductionTransaortic valve implantation (TAVI) has a well-established position in the treatment of high-risk and inoperable patients with severe aortic stenosis (AS). The TAVI protocol requires a pre-dilatation for native valve preparation.AimTo assess the safety and feasibility of TAVI without pre-dilatation and to compare it with the procedure with pre-dilatation.Material and methodsOut of 101 TAVI patients, in 10 the procedure was performed without balloon predilatation, and 8 patients were included in the analysis. The procedural, echocardiographic, and clinical outcomes were compared with a case control matched cohort (1: 2 ratio). A 12-month follow-up was done in all cases.ResultsThe procedure was successfully completed in all patients in the study group (SG), but there was one procedural failure in the control group (CG). All patients received a CoreValve (Medtronic) bioprosthesis. There was a significant immediate decrease in transvalvular gradients (TG) in both study arms after the procedure (SG: mean TG: from 46.0 ±14.0 mm Hg to 10.0 ±4.8 mm Hg, p < 0.001; CG: mean TG: from 55.9 ±12.0 mm Hg to 9.9 ±2.9 mm Hg, p < 0.001). A marked increase in the effective orifice areas was observed in both cohorts (SG: 1.63 ±0.13 cm2 and CG: 1.67 ±0.25 cm2, p = 0.75). The periprocedural complication rate was equally distributed in both arms. The 12-month all-cause mortality was 12.5% in both groups.ConclusionsThe direct TAVI approach seams to be safe and feasible. The clinical and echocardiographic results are not different from those achieved in patients treated with standard TAVI protocol with pre-dilatation.

SummaryBackgroundDiaphragmatic injuries occur in 0.8–8% of patients with blunt trauma. The clinical diagnosis of diaphragmatic rupture is difficult and may be overshadowed by associated injuries.Diaphragmatic rupture does not resolve spontaneously and may cause life-threatening complications.The aim of this study was to present radiological findings in patients with diaphragmatic injury.Material/MethodsThe analysis of computed tomography examinations performed between 2007 and 2012 revealed 200 patients after blunt thoraco-abdominal trauma. Diaphragmatic rupture was diagnosed in 13 patients. Twelve of these patients had suffered traumatic injuries and underwent a surgical procedure that confirmed the rupture of the diaphragm. Most of diaphragmatic ruptures were left-sided (10) while only 2 of them were right-sided. In addition to those 12 patients there, another patient was admitted to the emergency department with left-sided abdominal and chest pain. That patient had undergone a blunt thoracoabdominal trauma 5 years earlier and complained of recurring pain. During surgery there was only partial relaxation of the diaphragm, without rupture.The most important signs of the diaphragmatic rupture in computed tomography include: segmental discontinuity of the diaphragm with herniation through the rupture, dependent viscera sign, collar sign and other signs (sinus cut-off sign, hump sign, band sign).ResultsIn our study blunt diaphragmatic rupture occurred in 6% of cases as confirmed intraoperatively.In all patients, coronal and sagittal reformatted images showed herniation through the diaphragmatic rupture. In left-sided ruptures, herniation was accompanied by segmental discontinuity of the diaphragm and collar sign. In right-sided ruptures, predominance of hump sign and band sign was observed.Other signs were less common.ConclusionsThe knowledge of the CT findings suggesting diaphragmatic rupture improves the detection of injuries in thoraco-abdominal trauma patients.

The broad clinical utilization of the internal thoracic artery (ITA), including the role of its branches in supplying circulation to the sternum, requires explicit anatomic knowledge of this vessel. Fifty‐six ITAs (28 right, 28 left) were dissected from their point of origins after injection with a mixture of contrast medium and latex after perfusion with saline and immersion in 4% formaldehyde. All ITA branches were studied according to their course, size, and distribution within intercostal spaces with the aid of an operating microscope. The branches were divided in two main groups: proper (solitary) branches and common trunks. The proper branches consisted of four types: sternal, perforating, intercostal, and mediastinal. The four types of common trunks were: sternal/perforating, sternal/intercostal, perforating/intercostal, sternal/perforating/intercostal. Points of most frequent origin from main trunk of the vessel were established for each type. Mean external diameter of proper branches was 0.72 mm and common trunks was 1.06 mm. Mean length of common trunks was 3.0 mm. Those parameters (adequate diameter and length) allow for ligation of the common trunks close to the ITA so that their points of division can be preserved. This fact is crucial for creation of collateral blood supply to the sternum after bilateral ITA mobilizations. Clin. Anat. 12:307–314, 1999. © 1999 Wiley‐Liss, Inc.

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SummaryBackground:The purpose of this article is to present computed tomography (CT) and magnetic resonance imaging (MRI) findings of rare pancreatic lipomas.Material/Methods:The analysis covered 13 patients (7 men and 6 women, aged 47–88, average: 65.6 years), with 13 pancreatic lipomas, whose cases constituted the basis for 10 contrast-enhanced CT and 5 MRI studies.Results:Lipomas measured from 6 mm to 32 mm (average 12.8 mm) and were located in the pancreatic head (n=7), body (n=2), tail (n=3) and uncinate process (n=1). Most lesions (n=11) were homogenous, well-circumscribed.On contrast-enhanced CT scans, macroscopic fat (<−30 HU) was present in 9 lipomas. In one case (10 mm lesion) the density was −20 HU and the lesion was poorly circumscribed with septations, which altogether made it difficult to precisely characterize its contents.On MR scans fat was demonstrated in all studied cases (n=5).Conclusions:Lipomas are rare, small, homogenous and well-circumscribed pancreatic tumours. The most important feature, decisive for the diagnosis and distinguishing them from pancreatic carcinoma, is detection of fatty tissue on CT and MR scans. In these cases differential diagnosis includes other rare fatty tumours of the pancreas (focal fatty infiltration, teratoma, liposarcoma).

Objectives. To determine safe distances within the orbit outlining reliable operative area on the basis of multislice computed tomography (MSCT) scans.Patients and Methods. MSCT of orbits of 50 Caucasian patients (26 males and 24 females, mean age 56) were analysed. Native scans resolutions were in all cases 0.625 mm. Measurements were done in postprocessing workstation with 2D and 3D reconstructions. The safe distances values were calculated by subtracting three standard deviations from the arithmetical average(X=AVG-3  STD). This method was chosen because this range covers 99.86% of every population.Results. The results of the measurements in men and women, respectively, are as follows (1) distance from optic canal to supraorbital foramen, mean 46,49 mm and 43,29 mm, (2) distance from the optic canal to maxillozygomatic suture at the inferior margin of the orbit mean 45,24 mm and 42,8 mm, (3) distance from the optic canal to frontozygomatic suture 46,15 mm and 43,58 mm, (4) distance from the optic canal to anterior lacrimal crest 40,40 mm and 38,39 mm, (5) distance from superior orbital fissure to the frontozygomatic suture 34,06 mm and 32,62 mm, and (6) distance from supraorbital foramen to the superior orbital fissure 42,32 mm and 39,39 mm.Conclusion. The most probable safe distances calculated by adopted formula were for the superior orbital fissure 23,39–30,58 mm and for the orbital opening of the optic canal 31,9–38,0 mm from the bony structures of the orbital entrance depending on the orbital quadrant.

Post-traumatic aortic injuries are more common in victims of aircraft accidents than in motor vehicle accidents, and are a leading cause of on-site and delayed mortality, regardless of cause. In this case report, we present a history of a nearly isolated aortic post-traumatic injury in a victim of a paragliding accident. The rarity of this case lies in 2 factors, that is, the lack of the other life-threatening injuries usually present in high-energy accidents, and an unusual, exfoliative type of injury not matching more closely the typical classifications made use of currently in clinical practice.

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