Diagnosis and treatment of free floating thrombus in carotid artery / 中华普通外科杂志

Objective To evaluate diagnostic method and treatment strategy for free floating thrombus in carotid artery.Methods From Ju12016 to Oct 2017,7 patients with free floating thrombus in carotid artery was diagnosed at our department.The medical history,symptoms,diagnosis,treatment strategy and prognosis of those patients were analyzed retrospectively.Results Among 7 patients,4 were symptomatic;4 patients were concomitant with severe carotid artery stenosis and 3 with mild to moderate stenosis.3 received carotid endarterectomy and patch angioplasty.4 received carotid artery stenting with distal cerebral protection divice.There was no perioperative and 30-day stroke,myocardial infarction,death or hyperperfusion syndrome occurred.The 12-month follow up showed no restenosis,no free floating thrombus recurrence and no ischemic cerebrovascular event.Conclusion Free floating filling defect in carotid artery is a typical sign for unstable plaque.Both carotid endarterectomy and carotid artery stenting can be used for the treatment of free floating thrombus.

A Case of Left Atrial Free-Floating Thrombus / 계명의대학술지

A 74-year-old woman who had paroxysmal atrial fibrillation without mitral stenosis was hospitalized for syncope and right-sided weakness. Echocardiography revealed a large free-floating thrombus in the left atrium, sometimes prolapsing partially into the left ventricle in diastole. Because of her poor neurological status, she was managed with anticoagulation. On the 12th day, the thrombus had disappeared on the follow-up echocardiography, and aortoiliac embolization was later detected on computed tomography. Unfortunately, she developed various complications of stroke and limb infarction, and died after 4 months of hospital care. In addition to this case report, we reviewed a total 70 cases of left atrial free-floating thrombus. Atrial fibrillation and mitral pathology were two major causative factors. All the cases, except 1, were confirmed on echocardiography. The most common presentation that led to echocardiography was systemic embolization, followed by heart failure. Others were acute hemodynamic decompensation from mitral obstruction, chest pain, palpitation, and bacteremia. Cardiac thrombectomy was the preferred treatment modality with favorable outcomes.

Research of correlative factors between the ultrasonography of trauma-caused deep venous free-floating ;thrombus of lower limbs and the prognosis / 中华超声影像学杂志

Objective To analyze the color Doppler ultrasonography of trauma-caused deep venous free-floating thrombus(FFT)of lower limbs,discuss the relations between sonography and the prognosis. Methods Clinical data and color Doppler ultrasound examination results of 130 cases with trauma-caused deep venous FFT of lower limbs were retrospectively analysed.Univariate analysis was conducted to identify the statistically significant factors of patients' prognosis,non-conditional logistic regression analysis was performed to analyse the independent prognostic factors of FFT.Results The non-conditional logistic regression analysis showed that the position of FFT,thrombosis edge definition,floating degree and the volume of detouring blood around the thrombus were independent factors of patients'prognosis(P <0.05). The FFT prognosis of iliofemoral vein was more likely to be fixed than the FFT prognosis of popliteal vein. The FFT prognosis with blurring edges was more likely to be fixed.The more obvious the floating degree of FFT,the higher chance that the FFT prognosis is recanalized.More detouring blood flow around FFT indicated more possibilities that the prognosis could be recanalized.Conclusions The color Doppler ultrasound is able to evaluate the relations between the deep venous free-floating thrombus of lower limbs and prognosis of the patients,which is beneficial for early detection and early treatment,as well as reducing mortality and disability resulted from deep venous thrombus during the orthopaedic perioperative period.

Spontaneous Thrombolysis of Multiple Thrombi at Distal Region of Hypoplastic Vertebral Artery After Stent-assisted Angioplasty on Vertebral Artery Origin Stenosis: Angiographic Follow-up

Vertebral artery hypoplasia (VAH) can be easily overlooked if the contralateral side vertebral artery is intact, because of compensation by the contralateral artery or cerebral collateral network. The clinical relevance and hemodynamic impact of VAH is still controversial. However, VAH has recently been considered a risk factor for posterior circulation ischemia. Ischemic stroke is seldom caused by free floating thrombi (FFT) in the artery. Pathophysiology of FFT has not yet been clarified. The state of reduced blood flow such as a vertebral artery origin stenosis may cause FFT. Their instability may make them sources of recurrent artery to artery embolism. Patients with FFT will require appropriate medical and endovascular treatment. The current case illustrates a short-term angiographic change of spontaneous thrombolysis of VAH and multiple thrombi at the distal region of the stenosed lesion after stent-assisted angioplasty for a vertebral artery origin stenosis.

A Case of Pigmented Free-Floating Posterior Vitreous Cyst

PURPOSE: To report a case of a 59-year-old female with a free-floating monolateral vitreous cyst localized in the posterior vitreous in the left eye. CASE SUMMARY: A 59-year-old female who complained of an intermittent floater in the left eye for 3 months visited our clinic. She had been suffering from visual disturbance for approximately 3 months. There was no previous history of trauma, infection, or inflammatory disorders. The best corrected visual acuity was 20/20 in both eyes. On fundoscopic exam, a 3-4 disc diameter (DD) sized, brown-colored pigmented vitreous cyst was detected at the inferior temporal side of the posterior vitreous in her left eye. B-scan ultrasound confirmed the presence of an echo-free cystic formation that was free from surrounding vitreous strands or other adhesions located at the posterior vitreous. No specific findings or leakage were observed on fluorescein angiography. We followed-up the patient periodically (1 month, 3 months, and 6 months after the initial visit) and monitored whether the size or location of the cyst had changed. At every follow-up exam, the size or location of the cyst was stationary and the patient's visual acuity was 20/20 in the affected eye, thus we suggested she should be followed-up periodically for her cyst without any intervention. CONCLUSIONS: We report a case of a patient with no previous ocular history or impaired vision who had a free-floating vitreous cyst localized in the posterior vitreous in the left eye. The disease did not appear to progress or become aggravated over a short-term follow-up period and no specific treatment was required.

The ichthyofauna of drifting macrophyte mats in the Ivinhema River, upper Paraná River basin, Brazil

We describe the fish assemblages associated with drifting macrophyte mats and consider their possible role as dispersal vectors in the Ivinhema River, a major tributary of the upper Paraná River, Brazil. Fish associated with drifting mats were sampled in the main river channel during January and March 2005, when the wind and/or the increased water level were sufficient to transport macrophyte stands. Fish in the drifting mats were sampled with a floating sieve (4 m long x 2 m wide x 0.6 m high, and 2 mm mesh size). In the laboratory, larvae, juvenile, and adult fish were counted and identified to the lowest possible taxonomic level. In four drifting macrophyte mats we captured 218 individuals belonging to at least 28 species, 17 families, and 6 orders. Aphyocharax dentatus, Serrasalmus spp., and Trachelyopterus galeatus were the most abundant taxa associated with the mats, but species richness ranged from 6 to 24 species per mat. In addition, 85 percent of the total number of individuals caught was larvae and juveniles. Although preliminary and based on limited samples, this study of drifting macrophyte mats was the first one in the last unregulated stretch of the Paraná River remaining inside Brazilian territory, and alerts us to the potential role of macrophytes mats as dispersers of fish species in the region.

Nesse trabalho as assembleias de peixes associadas a bancos de macrófitas flutuantes à deriva foram descritas. Além disso, foi considerado o possível papel desses bancos como vetores de dispersão no rio Ivinhema, importante tributário do alto rio Paraná, Brasil. Os peixes associados aos bancos à deriva foram amostrados no canal principal desse rio, entre os meses de Janeiro a Março de 2005, quando o vento e/ou o aumento no nível da água foram suficientes para transportar os bancos de macrófitas. Os peixes foram amostrados com uma rede flutuante (4 m de comprimento x 2 m de largura x 0,6 m de altura e 2 mm de tamanho de malha). No laboratório, larvas, jovens e adultos foram contados e identificados ao menor nível taxonômico possível. Nos quatro bancos de macrófitas flutuantes a deriva foram capturados 218 indivíduos pertencentes à pelo menos 28 espécies, 17 famílias e 6 ordens. Aphyocharax dentatus, Serrasalmus spp. e Trachelyopterus galeatus foram os táxons mais abundantes associados aos bancos de macrófitas à deriva, mas a riqueza de espécie variou entre 6 e 24 espécies por banco. Além disso, 85 por cento do total do número de indivíduos capturados foram larvas e juvenis. Embora preliminar e baseado em amostragens limitadas, este estudo, conduzido em bancos de macrófitas flutuantes à deriva, foi o primeiro no último trecho não regulado do rio Paraná em território brasileiro, e alerta para o papel potencial que os bancos de macrófitas têm como dispersores de peixes na região.

Free Floating Thrombus of the Aorta: An Unusual Cause of Peripheral Embolization

PURPOSE: Free-floating thrombus (FFT) of the aorta is very rare but has a high risk of distal embolization. While the necessity of treating such a condition is evident, the diagnostic and therapeutic modalities remain controversial. Thus, we reviewed seven cases of FFT of the aorta. METHODS: A retrospective study was performed usings even patients diagnosed with FFT of the aorta at the Catholic University of Korea between January 1999 and December 2008. We excluded those patients who had thrombi with concomitant atherosclerotic or aneurysmal aorta. RESULTS: The mean patient age was 59.6+/-13.6 years old. The male-to-female ratio was 3:4. Embolization to arteries of the extremities occurred in two patients and to visceral arteries in four patients. Of these seven patients, four were initially treated with anticoagulation, and two were initially treated with thrombectomy; one patient refused any kind of treatment. Of the four patients treated with anticoagulation, three experienced complete dissolution of the thrombi while anticoagulation proved ineffective in the remaining patient who subsequently underwent thrombectomy. In all of the three patients who had received thrombectomy, postoperative anticoagulation was employed. There was no recurrence of FFT of the aorta during the follow-up period. CONCLUSION: Were commend systemic anticoagulation with low molecular weight heparin (LMWH) as the first line of treatment for FFT of the aorta. If the thrombus persists or recurrent embolism occurs during anticoagulation therapy, surgery should be undertaken.

Inmunomarcación de neuronas dopaminérgicas en cortes flotantes de hipotálamo de rata: Preservación alternativa del tejido nervioso antes del corte / Immunohistochemical studies of dopaminergic neurons on free floating sections: Alternative cryopreservation method of nervous tissue before cutting

Se realizó un estudio inmunohistoquímico de la enzima tirosina hidroxilasa (marcador de neuronas dopaminérgicas) en el hipotálamo de ratas Wistar machos adultas en cortes flotantes de muestras fijadas por perfusión. Debido a que el número de cerebros que se procesaron fue superior al número que pueden ser cortados inmediatamente, el material debió almacenarse congelando los cerebrosenteros a -80ºC. Pero por un desperfecto técnico del equipo de refrigeración, las muestras debieron trasladarse a -20ºC resultando en el deterioro de las mismas. Ante este inconveniente, los sucesivos cerebros fueron almacenados en sacarosa al 30%p/v en buffer fosfato salino (PBS) con 0,01% de azida sódica y mantenidos a 4ºC durante tiempos variables (de semanas a meses) hasta ser congelados con gas clorofluorado y cortados. Estos cerebros no mostraron alteración en la estructura morfológica del tejido. Esta metodología de preservación aquí descrita sería una alternativa de elección válida para aquellos laboratorios que no cuenten con un equipo de refrigeración de -80ºC.

In central nervous system histological studies, free-floating sections of perfusion-fixed samples are frequently used. Samples storage may be performed freezing either the entire brain at -80ºC or sections at -20ºC. When studying hypothalamic tyrosine hydroxylase enzyme(dopaminergic neurons marker) by immunohistochemistry in adult male Wistar rats, entire brains were stored at -80ºC. Due to an abrupt freezer technical failure, samples should be thawed to -20ºC with the resulting samples damage. To avoid this situation, subsequent brains were stored in 30% sucrose in saline phosphate buffer (PBS) with 0.01% sodium azide and kept at 4ºC for different periods (weeks to months) until they were frozen with chlorofluorade gas and cut. These brains showed no morphological alterations of tissue structure. This preservation method appeared to be an alternative valid option to laboratories with no -80ºC freezing equipment.

Singular perturbation composite control of a free-floating flexible dual-arm space robot / 药物分析学报

The Free-floating Flexible Dual-arm Space Robot is a highly nonlinear and coupled dynamics system. In this paper, the dynamic model is derived of a Free-floating Flexible Dual-arm Space Robot holding a rigid payload. Furthermore, according to the singular perturbation method, the system is separated into a slow subsystem representing rigid body motion of the robot and a fast subsystem representing the flexible link dynamics. For the slow subsystem, based on the second method of Lyapunov, using simple quantitative bounds on the model uncertainties, a robust tracking controller design is used during the trajectory tracking phase. The optimal control method is designed in the fast subsystem to guarantee the exponential stability. With the combination of the two above, the system can track the expected trajectory accurately, even though with uncertainty in model parameters, and its flexible vibration gets suppressed, too. Finally, some simulation tests have been conducted to verify the effectiveness of the proposed methods.

Free-floating Pigmented Iris Cyst in the Anterior Chamber

PURPOSE: The aim of this project is to report the successful removal of a free - floating pigmented iris cyst in a patient ' s anterior chamber, which was causing visual disturbance. CASE SUMMARY: A 27 - year - old man visited our hospital because of an intermittent visual disturbance in his right eye developed two months prior to admission. There was no history of ocular trauma, surgery, inflammation, or a general medical problem. On slit lamp examination, we found a free - floating translucent pigmented iris cyst, which was ovoid in shape and about 3 mm in size in the right eye near the pupil margin. Moving in the anterior chamber, the cyst caused visual disturbance because it partly covered the pupil. It was also near the endothelium. Through the clear cornea incision, the iris cyst was removed successfully. From histopathologic investigation of the cyst, the tissue was found to consist of mature pigment epithelium, including pigment granules CONCLUSIONS: A free - floating pigmented iris cyst in the anterior chamber generally does not result in any complications and maintains its condition stably without changing in size. Hence, as long as it does not cause complications, no treatment is necessary. However, if it causes visual disturbance or it damages endothelial cells or causes glaucoma or any other intraocular complication, it needs to be treated. In the case of our patient, visual disturbance did occur and we removed the iris cyst through an operation. Such a case has not been reported before in South Korea.

Assessment of fetal lung maturity by free-floating particles in amniotic fluid and biparietal diameter by ultrasonography.

The accuracy of Free-floating particles (FFPs) and biparietal diameter (BPD) detected and measured by ultrasonography for assessment of fetal lung maturity were compared with the lecithin/sphingomyelin (L/S ratio) which was used as the gold standard. One hundred pregnant women in the lately third trimester who required amniocentesis for fetal lung maturity testing, from July 1998 to August 1999 at Siriraj Hospital, were included in this study. Ultrasonography was performed to evaluate the presence of FFPs in the amniotic fluid and the BPD was measured. Amniotic fluid for L/S ratio was obtained by amniocentesis. The presence of FFPs had a 58.3% specificity and a 41.7% false positive rate. A BPD value of at least 94 millimeters had 100% specificity and no false positives. When the presence of FFPs and a BPD value of at least 93 millimeters were used in combination, the test gave 100% specificity and no false positives. The presence of FFPS and a BPD value of at least 93 millimeters detected by real time ultrasonography may be used as predictive parameters to indicate fetal lung maturity.

A Case of Free-floating Cyst in the Anterior Chamber Associated with Ciliary Body Cyst

A 37-year-old patient visited the clinic with driness of eyes and 3 brown colored free-floating cyst was found in his right anterior chamber incidentally. Bilateral ciliary body cyst were also detected by ultrasound biomicroscopy. Stool examination was positive for Metagonimus yokogawai. The cyst was removed through clear cornea incision. Histopathologically, the wall of the cyst. was composed of old red blood cells and fibrotic tissue. It was speculated that a ciliary body cyst. was disloged by blunt trauma and moved into the anterior chamber.

Evaluation of fetal lung maturity by using free-floating particles in amniotic fluid ultrasonography.

The examination of amniotic fluid for the presence or absence of free-floating particles (FFPs) by real-time ultrasound was performed in 100 non-diabetic patients undergoing amniocentesis for maturity testing. A modified lecithin to sphingomyelin ratio (L/S ratio) was the gold standard of the test. The sensitivity and specificity were 97.6% and 62.5% respectively. The presence of FFPs had 93.2 positive predictive value and 83.3% negative predictive value. FFPs grade 2, 1, 0 had 100%, 70% and 16.7 positive predictive value respectively. The mean value of L/S ratio varied with the FFPs grading, with the mean of 5.09+ 2.48, 2.84 + 0.71, 2.02+ 0.01 in grade 2, 1 and 0 respectively. This study suggests that the presence of FFPs especially FFPs grade 2 on real-time ultrasound may be used to confirm fetal lung maturity.