Prophylactic Placement of Internal Iliac Balloons in Patients with Abnormal Placental Implantation: Maternal and Foetal Outcomes.

PURPOSE: To report on outcomes following the use of prophylactic internal iliac artery occlusion balloons in patients with abnormal placental implantation. METHODS: A retrospective analysis was undertaken of patients with abnormal placental implantation who underwent prophylactic iliac balloon placement prior to delivery in a University Maternity Hospital. Various clinical and technical factors were analysed, including technical success of balloon placement, blood loss and number of blood units transfused, duration of surgery, length of stay, hysterectomy rates, complications related to the balloon insertion, foetal pH and infant Apgar scores. RESULTS: Twenty-two patients with placenta accreta or a variant thereof underwent caesarean section after first undergoing prophylactic placement of bilateral internal artery balloons. Average follow-up duration was 2.08 years. The average gestational age was 37 weeks 6 days, and the mean gravidity was 2.8. The mean number of previous caesarean sections was 2.4, while the mean maternal age was 35 years. The mean intraoperative blood loss was 1.4 L, and the mean number of blood units transfused was 2. Mean duration of surgery was 90 min, mean total length of hospital stay 7.5 days, while the mean duration of ICU/HDU stay was 1.2 days. The balloons were inflated in 60% of cases and two patients (2/22-9%) underwent subsequent hysterectomy. There were no major maternal complications due to the procedure. CONCLUSION: Prophylactic placement of arterial balloons prior to caesarean section in patients with placenta accreta is well tolerated and leads to satisfactory maternal and foetal outcomes with minimal complications.

Intraneural ganglion cyst involving the tibial nerve-a case report.

Intraneural ganglia are rare non-neoplastic cysts that are caused by an accumulation of thick mucinous fluid. This occurs within the epineurium of peripheral nerves, which is encased in a dense fibrous capsule. The most common presentation of this tumour is local and/or radiating pain. Involvement of the tibial nerve is extremely uncommon, with less than 18 reported cases in the literature. We present a case of an intraneural tibial nerve ganglion cyst in a young male. We also discuss the current literature and proposed pathogenesis and treatment of this rare entity.

Age prediction formulae from radiographic assessment of skeletal maturation at the knee in an Irish population.

Age estimation in living subjects is primarily achieved through assessment of a hand-wrist radiograph and comparison with a standard reference atlas. Recently, maturation of other regions of the skeleton has also been assessed in an attempt to refine the age estimates. The current study presents a method to predict bone age directly from the knee in a modern Irish sample. Ten maturity indicators (A-J) at the knee were examined from radiographs of 221 subjects (137 males; 84 females). Each indicator was assigned a maturity score. Scores for indicators A-G, H-J and A-J, respectively, were totalled to provide a cumulative maturity score for change in morphology of the epiphyses (AG), epiphyseal union (HJ) and the combination of both (AJ). Linear regression equations to predict age from the maturity scores (AG, HJ, AJ) were constructed for males and females. For males, equation-AJ demonstrated the greatest predictive capability (R(2)=0.775) while for females equation-HJ had the strongest capacity for prediction (R(2)=0.815). When equation-AJ for males and equation-HJ for females were applied to the current sample, the predicted age of 90% of subjects was within ±1.5 years of actual age for male subjects and within +2.0 to -1.9 years of actual age for female subjects. The regression formulae and associated charts represent the most contemporary method of age prediction currently available for an Irish population, and provide a further technique which can contribute to a multifactorial approach to age estimation in non-adults.

Epiphyseal maturity indicators at the knee and their relationship to chronological age: results of an Irish population study.

Skeletal maturation is divisible to three main components; the time of appearance of an ossification center, its change in morphology and time of fusion to a primary ossification center. With regard to the knee, the intermediate period between appearance and fusion of the ossification centers extends over a period of greater than 10 years. This study aims to investigate radiographically the age at which morphological changes of the epiphyses at the knee occur in a modern Irish population. Radiographs of 221 subjects (137 males; 84 females) aged 9-19 years were examined. Seven nonmetric indicators of maturity were assessed using criteria modified from the Roche, Wainer, and Thissen method and Pyle and Hoerr's atlas of the knee. Reference charts are presented which display the timeline for each of the grades of development of the seven indicators. Mean age was found to increase significantly with successive grades of development of each of the seven indicators. A significant difference was noted between males and females at the same grade of development for six of the seven indicators. The narrowest age range reported for a single grade of development was 2.2 years for Grade 2 of development of the tibial tuberosity for males. The information on changing morphology of the epiphyses at the knee in the present study may provide an adjunct to methods used for evaluation of skeletal maturity before surgery for orthopedic disorders or to evaluate skeletal age in clinical scenarios where either delayed or precocious skeletal maturation is suspected.