Sixteen tenorrhaphies were performed at the mid-metatarsal region in eight buffalo calves under lignocaine epidural analgesia. A 2 cm long gap was created in the superficial digital flexor (SDF) tendon and immediately repaired with acellular grafts in animals of group I, 1% glutaraldehyde-preserved tendon allografts in group II. In group III, the defect was repaired with autografts. This group served as control. The contralateral limb in each animal was operated after an interval of 60 days and the animals underwent the same procedure according to the designed groups. Diclofenac sodium and Enrofloxacin was given post-operatively for 5 days. Clinical examination revealed significant increase (P < 0.05) in rectal temperature, heart and respiratory rate for 3-4 postoperative days in all the animals. Mild pain and exudation as well as early restoration of tendon gliding movements and weight-bearing were observed earlier in group I in comparison with group II. Air-tendograms revealed early organization, minimal adhesion formation and lesser thickening of tendon at the reconstructive site in the acellular group whereas in the glutaraldehyde group dense homogenous swelling with adhesions was seen along the flexors. Angiography on day 30 showed that the area of proximal and distal host tendon graft junction appeared hypervascularized, whereas the area occupied by the graft appeared relatively less vascularized. Normal vascularization was observed on day 90 in all the three groups.
Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern.We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab. To our knowledge, this is the first case of an acute flow diversion performed using only aspirin as the sole oral antiplatelet agent.
Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern.We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab. To our knowledge, this is the first case of an acute flow diversion performed using only aspirin as the sole oral antiplatelet agent.
Sixteen tenorrhaphies were performed at mid-metatarsal region in eight buffalo calves. A 2-cm long gap was created in the superficial digital flexor (SDF) tendon in all animals. The gap was immediately repaired with acellular grafts in animals of group I, 1% glutaraldehyde-preserved tendon allografts in group II, and in group III the defect was repaired with autografts (control group). The contralateral limb in each animal was operated after an interval of 60 days and the animals underwent the same procedure according to the designed groups. Gross observation revealed filling of host tendon-graft junction with fibrous connective tissue. Increased vascularity was seen in group I when compared with group II and III. Graft was resorbed in animals of group I and III, whereas partial absorption of graft was seen in group II. Histological observations on day 30 revealed restoration of cellularity in acellular graft and fragmentation and resorption of glutaraldehyde-preserved graft. Graft was replaced by newly formed fibrous connective tissue. Tissue reaction around polygalactin suture consisted of plasma cells, lymphocytes and macrophages. On day 90, most of the acellular graft was replaced by newly formed fibrous connective tissue. In group II the majority of graft portion remained at the site and was in a state of resorption. In the control group it was difficult to distinguish between the host tendon and the graft. Scanning electron microscopical observation showed densely packed neoformed tissue at host tendon-graft junction. Hydrolysis and invasion of connective tissue between polygalactin suture filaments, resorption of graft with cavity formation and dissolution of ground substance were observed.
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