Variability of the obturator vessels

The obturator artery and vein are usually described as branches or tributaries of the internal iliac vessels although variations with connections to the external iliac or inferior epigastric vessels have been reported. Because these anomalous vessels are at risk in groin or pelvic surgeries that require dissection or suturing along the pelvic rim, we measured the frequency of these variations in 105 pelvic walls (45 in the United States and 60 in China). Our data show that 70-82% of pelvic halves and 83-90% of whole pelves had an artery, vein, or both in the variant position. Arteries were most often found in the normal position only but normal and anomalous veins were most frequently found together. These data show that it is far more common to find a vessel coursing over the pelvic rim at this site than not and have implications for both pelvic surgeons and anatomists.     

Pubic osteotomy in obturator gliding hernia

Hernias of the obturator foramen are rare. They are described mostly in elderly female patients in poor health. Often the correct diagnosis is stumbled upon as a result of surprising intraoperative findings. Surgical therapy is indicated often by the clinical symptoms of an incarcerated hernia. Herniation of the entire urinary bladder with hemorrhagic infarction has never been described before. For an anatomical reduction of the hernia it was necessary to resect the superior pubic ramus. For plastic reconstruction a marlex mesh was used.     

Swing-lock design considerations for obturator frameworks

The conventional and swing-lock (S/L) obturator prostheses can be highly effective in restoring maxillary defects when careful attention is paid to the principles of framework design. Although the S/L modality has been available since the mid 1960s, its use in maxillofacial prosthetics has been limited, and little information is available in the literature to guide the practitioner. This modality offers a conservative design option that lies somewhere between the conventionally designed obturator prosthesis and the prosthesis designed to use extensive fixed reconstruction or endosseous implants. When the S/L obturator is considered, single, double, or dual labial bar designs are possible and may be required by the length and complexities of the arc of closure. Such designs provide a flexible labial bar that transmits less stress to abutment teeth. This article reviewed conventional obturator framework designs and compared them with S/L designs for similar patient categories.     

Refining hollow obturator base using light-activated resin

Inclusion body myositis (IBM) is a separate class of the inflammatory myopathies with recently proposed clinical and pathological diagnostic criteria. An association between inflammatory myopathies and malignancy has been questioned in the literature. Recent reviews of the inflammatory myopathies suggest that only dermatomyositis is associated with malignancy. The largest study to date of patients with IBM found that 15% had a malignancy (6 of 40). We report the first documented case of IBM and concurrent transitional cell carcinoma of the bladder. We suggest that a causal relationship between IBM and malignancy may exist because of significantly improved functional strength gained after tumor removal.     

Use of pleural obturator after pneumonectomy]

The authors suggested and employed in 34 patients a balloon-devise, that is inflated in the pleural cavity following a removal of the lung. This lessens plasma and hemorrhages, thus contributing to the prophylaxis of postoperative empyemas.     

Voluntary palatal tremor in two siblings

We report two siblings with palatal tremor (PT) and ear clicks who can voluntarily elicit or suppress both PT and ear clicks by just "thinking" about starting or stopping the sounds. The patients were also able to voluntarily modulate the frequency of their ear clicks and PT. They did not have any signs of cerebellar, brain stem, or other neurologic disease. These familial palatal movements may represent a variant of palatal tremor but can not satisfactorily be classified as either symptomatic or essential PT.     

The value of obturator canal bypass. A review

OBJECTIVE: To review the value of obturator canal bypass with respect to long-term results. DESIGN: Case series and literature review. SETTING: University of Vienna Medical School in Austria. PATIENTS/METHODS: Personal experience with 34 consecutive patients and 125 cases published since 1982 with respect to patient data, patency, and survival are compared and jointly analyzed retrospectively. INTERVENTIONS: Patients received obturator canal bypass for lesions of the pelvic or common femoral vessels precluding orthotopic reconstruction. MAIN OUTCOME MEASURES: The rates of patient survival, limb salvage, and graft patency were analyzed. RESULTS: The postoperative mortality rate in the present series was 14.7%. The limb salvage rate after 5 years was 76.5%. One- and 5-year secondary patency rates were 75.3% and 54.9%, respectively. All grafts in patients without atherosclerosis were patent at a median of 34 months. For 57 cases documented in the literature, 1- and 5-year patency rates were 70.8% and 59.7%, respectively. Combined analysis of 90 obturator canal bypasses revealed rates of 72.7% and 56.9% of patent grafts at 1- and 5-years, respectively. CONCLUSIONS: The use of obturator canal bypass is recommended in deep groin infections and especially in patients with lesions of the pelvic vessels due to other occlusive vascular disease.