Unintended consequences can occur when complex VT detection parameters interact with specific pacing modes. At times, nonconventional programming can avoid these interactions while still achieving effective AAI(R) pacing.
This is the first case series reporting tibial diaphyseal fractures following tibial tuberosity advancement without plate stabilisation. The authors report here a wide spectrum of potential fixation strategies should one of these fractures occur.
in a very valuable paper on this subject, quotes Roth 8 as calling attention to the origin of retention cysts from Meckel's diverticulum. il Such cysts are divided into two classes, according as their cavity is continuous or discontinuous with that of the intestine. The wall is composed of the various layers found in the intestine." Roth describes a cyst of this kind occurring in a child one year and four months old. " It was connected with the concave surface of the ileum, near the mesenteric insertion twenty-six inches above the ileo-csecal valve. The pedicle having become twisted, a haemorrhagic infiltration and necrosis of the mucous membrane had occurred, also acute peritonitis."The case here reported is unique, but this case of Roth's resembles it in several important particulars. In both cases the diverticulum was strangulated by twisting of the pedicle, and acute peritonitis followed.These cases are sufficient to establish the fact that strangulation of Meckel's diverticulum is one of the causes of acute peritonitis. This fact has an additional interest at the present moment in that the diverticulum resembles the vermiform appendix, and the two lesions may easily be confounded, clinically, as in the present case. While the diverticulum is often without a mesentery and is therefore freer and more likely to suffer from strangulation by twisting of its pedicle, yet it not infrequently has a mesentery ; in which case it must be liable to the same pathological processes (though evidently much less frequent) as the appendix.Such cases are not wanting. Fitz mentions a case reported by Dr. Beale,4 where acute peritonitis followed perforation of a diverticulum, in the cavity of which were a cherry-stone, the coriaceous covering of several orange-pips and other substances ; and also a case of adherent diverticulum described by Houston.4 This diverticulum was filled with a hard matter, apparently inspissated faeces. " The omentum aud intestines in the neighborhood were closely joined to the tumor by adhesions, the result of former inflammatory attacks, and the woman had complained for many years before her death of occasional severe pain in the abdomen."The symptoms of inflammation of these two intestinal pockets are the same, as they both cause peritonitis. The only points ' in the differential diagnosis which the writer is able to suggest, are that a history of a discharge from the umbilicus (this occurred in a case of intestinal obstruction due to diverticulum in the practice of Dr. John Homans) would suggest the presence of a diverticulum, while a history of previous attacks of pain would be significant of either an inflamed appendix or diverticulum, as, according to Fitz, " In nearly one-half the cases of vitelline remains previous attacks of pain were recorded." The presence of a tumor or tenderness near the umbilicus should favor the theory of inflamed diverticulum as against the appendix. It will be remembered that iu the case here reported a distinct tumor could be felt just below and slightly to the right...
Materials and MethOds: A multi-centre retrospective review was conducted, searching for skeletally immature dogs presenting with proximal metaphyseal curvilinear tibial fractures between January 2009 and September 2020. Signalment, fracture description and case management data were retrieved.Outcome was assessed by retrospectively evaluating follow-up radiographs, hospital records and an owner questionnaire.results: Twenty-five dogs met the inclusion criteria. All but one fracture was a result of minimal trauma. Twenty fractures were managed with internal fixation, two with external fixation and three conservatively. All 25 fractures healed. Eight major complications occurred in seven of 25 (28%) dogs.Twelve minor complications occurred in 10 of 25 (40%) dogs. Owner questionnaire data were available for 12 of 25 dogs; 11 of 12 were reported as having full function and one of 12 as having acceptable function at the time of questioning (median 34.5 months following presentation). At final follow-up, either by clinical examination or owner questionnaire, full function was achieved in 22 of 25 patients and acceptable function in three of 25.clinical significance: This study reported a series of proximal metaphyseal tibial fractures in skeletally immature dogs. The most common fixation method was internal fixation, which frequently resulted in full limb function at final follow-up. Owners reported outcome as fully functional in all dogs that underwent surgery at first presentation and had owner follow-up available, though positive outcomes may have been affected by participation bias. FIG 1. Proximal metaphyseal curvilinear tibial fracture. Radiographs demonstrate caudo-medial displacement and caudo-lateral angulation
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