Diagnosis and treatment of vein of Galen aneurysmal malformations

Introduction

Vein of Galen aneurysmal malformations (VGAM) are rare but clinically significant intracranial arteriovenous shunt lesions that most often present in neonates and infants.

Methods

Retrospective clinical data were collected for patients evaluated with a diagnosis of VGAM from 1994 to 2007.

Results

Thirteen patients with VGAM were evaluated from 1994 to 2007. Seven patients presented emergently with medically intractable cardiac failure, and six were treated in the first 2 weeks of life. Five children treated after this period (1.5–31 months of age) manifested enlarging head circumference, abnormal development, or subarachnoid hemorrhage. Eleven patients were managed endovascularly. Four disease or procedure-related complications occurred. Two complications were associated with poor outcome, both of which occurred in patients treated at less than 2 weeks of age. Two other patients experienced transient neurological deficits with no evidence of permanent sequelae. Outcome in the six patients treated emergently in the first 2 weeks of life included two patients who developed normally, one with mild to moderate neurological deficits, one with severe neurological deficits, and two deaths. Outcome in the five older patients (treated between 1.5 and 31 months) was considerably better than in the group treated early and included three with normal outcome and two with mild neurological deficits.

Conclusions

Contemporary endovascular techniques remain the preferred treatment for VGAM in all age groups. Early diagnosis and multimodality treatment are essential for the best management and treatment of the complex constellation of clinical problems often arising from this disorder.     

Public-academic partnerships: Public-academic partnerships to address the need for child and adolescent psychiatric services

There is a severe shortage and a maldistribution of child and adolescent psychiatrists in the United States. Public-academic collaborations play a major role in attempting to address these conditions. This column describes examples of two types of collaborations: newer programs that emphasize consultation, education, and support to primary care providers and more traditional efforts that provide consultation to general psychiatrists and psychiatric nurse practitioners. In both cases videoconferencing plays a role in reaching difficult-to-serve populations. Residency programs for both child and adolescent psychiatrists and primary care providers should include training in collaborative treatment approaches.     

油酸多相脂质体(139)注射液包封率测定方法的研究

本文提出了油酸多相脂质体139注射液中脂质体的药物包封率和药物含量的测定方法,以凝胶过滤法Sephadex G-50柱测定139注射液中多相脂质体的重量包封率Qw平均为94.2%;同时又以显微镜照像及统计方法测量了脂质体的体积包封率Qv平均为97.1%。并讨论了影响脂质体中药物包封率的各种因素。