Treatment of iatrogenic internal carotid artery laceration and carotid cavernous fistula with endovascular stent-graft placement

The risk of fatal injury of the internal carotid artery (ICA) and surrounding anatomy during transsphenoidal surgery for pituitary adenoma is the most severe potential complication associated with this particular approach. We present a case in which iatrogenic injury to a patient's ICA and resultant carotid cavernous fistula and massive hemorrhage was successfully managed with the emergency placement of an endovascular stent-graft. Both findings in the relevant literature and practical considerations concerning both stent-grafts and other more commonly used options for the treatment of iatrogenic ICA injury are discussed.     

MR imaging findings of spinal dural involvement with Wegener granulomatosis

Involvement of the brain and meninges is rare in cases of Wegener granulomatosis, occurring in 2% to 8% of cases. Meningeal involvement in association with Wegener granulomatosis has scarcely been reported as being confined to the dura mater of brain on images and is thought to represent granulomatous infiltration. There are a few reported cases of Wegener granulomatosis that document involvement of dura at the level of the spinal cord. We present the case of a 52-year-old man with Wegener granulomatosis involving the cervical spinal dura and include detailed MR imaging findings.     

Formation of the aqueous humor

1. Glaucoma is a worldwide disease affecting approximately 1-2% of the population aged over 35 years in industrial countries and is a major cause of blindness. 2. Glaucoma is usually associated with an increased intraocular pressure reflecting an imbalance between the rate of production of fluid (the aqueous humor) by the ciliary epithelial cells and its drainage from the eye. Therefore, it is important to understand how this secretion is produced. This requires a knowledge of ciliary epithelial cell composition, which has, in the past, proved difficult to obtain in mammalian preparations. 3. We have recently used the technique of electron-probe X-ray microanalysis to determine this composition under a variety of in vitro conditions. 4. Our results have led to a new model for this secretion that emphasizes the potential secretory role of the Na+/K+/2Cl- cotransporter.     

Abnormalities in the cerebral arterial system in osteogenesis imperfecta

A 9-year-old girl with osteogenesis imperfecta (OI) type 4 was admitted to the hospital because of choreatic movement. Cerebral angiography demonstrated bilateral symmetrical stenosis of the proximal cavernous segment of internal carotid artery, prethrombotic occlusion of the M1 segment of left middle cerebral artery, and moyamoya-like collateral vascular structure arising from the right lenticulostriate arteries. After a literature review, these findings were interpreted as vasculopathic changes secondary to vascular fragility caused by the collagen abnormality in OI.     

Endovascular treatment of Behçet's disease-associated intracranial aneurysms: report of two cases and review of the literature

Behçet's disease (BD) is a well-known multisystem inflammatory disorder of unknown etiology. Aneurysms of the cerebral arteries are not commonly described in patients with BD. There are few cases of intracranial aneurysms with BD reported in the literature. In this study, we report endovascular treatment of BD-related ruptured intracranial aneurysms in two cases, and present a wide literature review of intracranial arterial aneurysms related to BD.     

Behçet's disease: diagnostic and prognostic aspects of neurological involvement

This study was conducted to describe clinical and prognostic aspects of neurological involvement in Behçet's disease (BD). Patients referred for neurological evaluation fulfilled the criteria of the International Study Group for Behçet's Disease. We analyzed disability and survival by the Kaplan-Meier method, using Kurtzke's Extended Disability Status Scale (modified for BD) and the prognostic effect of demographic and clinical factors by Cox regression analysis. We studied 164 patients; of the 107 diagnostic neuroimaging studies: 72.1% showed parenchymal involvement, 11.7% venous sinus thrombosis (VST) and the others were normal. CSF studies were performed in 47 patients; all with inflammatory CSF findings (n=18) had parenchymal involvement. An isolated increase in pressure was compatible with either VST or normal imaging. The final diagnoses were VST (12.2%), neuro-Behçet's syndrome (NBS) (75.6%), isolated optic neuritis (0.6%), psycho-Behçet's syndrome (0.6%), and indefinite (11%). VST and NBS were never diagnosed together. Ten years from onset of BD 45.1% (all NBS) reached a disability level of EDSS 6 or higher, and 95.7±2.1% of the patients were still alive. Having accompanying cerebellar symptoms at onset or a progressive course is unfavorable. Onset with headache or a diagnosis of VST is favorable. Two major neurological diagnoses in BD are NBS and VST. These are distinct in clinical, radiological, and prognostic aspects, hence suggesting a difference in pathogenesis.     

Halogenated inhalation anesthetic agents decrease transepithelial electrical measurements across the isolated iris-ciliary body

Transmembrane electrical measurements were performed on the isolated rabbit iris-ciliary body (I-CB) to study the direct effects of halogenated inhalation anesthetic agents on the ciliary epithelium. Addition of either halothane, enflurane, or isoflurane to the control 95% O2:5% CO2 gas mixture resulted in a dose-dependent decrease in the short-circuit current (SCC) and potential difference (PD). This response was reversible after the anesthetic gas was discontinued. Pretreatment with either alpha-adrenergic or beta-adrenergic antagonists (phentolamine or timolol) had no effect on the halothane-induced decrease in SCC. Delivery of the analgestic gas N2O did not alter baseline electrical measurements across the isolated I-CB.     

Modeling the overall survival of patients with advanced‐stage non‐small cell lung cancer using data of routine laboratory tests

Cancer patients undergo routine clinical monitoring with an array of blood tests that may carry long‐term prognostic information. We aimed to develop a new prognostic model predicting survival for patients with advanced non‐small cell lung cancer (NSCLC), based on laboratory tests commonly performed in clinical practice. A cohort of 1,161 stage IIIB or IV NSCLC patients was divided into training (n = 773) and testing (n = 388) cohorts. We analyzed the associations of 32 commonly tested laboratory variables with patient survival in the training cohort. We developed a model based on those significant laboratory variables, together with important clinical variables. The model was then evaluated in the testing cohort. Five variables, including albumin, total protein, alkaline phosphatase, blood urea nitrogen and international normalized ratio, were significantly associated with patient survival after stepwise selection. A model incorporating these variables classified patients into low‐, medium‐ and high‐risk groups with median survival of 16.9, 7.2 and 2.1 months, respectively (p < 0.0001). Compared with low‐risk group, patients in the medium‐ and high‐risk groups had a significantly higher risk of death at 1 year, with hazard ratio (HR) of 1.95 (95% CI 1.62–2.36) and 5.22 (4.30–6.34), respectively. These results were validated in the testing cohort. Overall, we developed a prognostic model relying entirely on readily available variables, with similar predictive power to those which depend on more specialized and expensive molecular assays. Further study is necessary to validate and further refine this model, and compare its performance to models based on more specialized and expensive testing.     

Early and midterm results of complex cerebral aneurysms treated with Silk stent

Introduction

Endovascular treatment of intracranial aneurysms has been an effective treatment option. In this paper, we report our experience with the Silk stent (SS) for endovascular treatment of complex intracranial aneurysms and present periprocedural events, immediate results, delayed complications, and imaging and clinical follow-up results.

Methods

We retrospectively examined angiographic images and clinical reports of 76 consecutive patients with 87 intracranial aneurysms who were treated with SSs between March 2008 and June 2011.

Results

All aneurysms could be successfully covered technically using implanted SSs, with an overall mortality of 6.6?%. Two transient morbidities (2.6?%) and three permanent morbidities due to embolic events (3.9?%) were observed. Unexpected procedural technical events occurred in 18 procedures (18/78, 23.1?%). Control angiographies were performed in all 71 patients with 82 aneurysms (100?%). Mean angiographic follow-up time was 17.5?±?11.1?months [range 2?C48?months]. Sixteen of the 71 patients with 19 aneurysms had only early angiographic controls in the first 6?months while remaining 55 patients with 63 aneurysms (77.5?%) had late controls after 6?months. Overall control angiographic occlusion rates were as follows: 87.8?% (72/82) total occlusion, 8.5?% residual aneurysm filling, and 3.7?% residual neck filling. The general in-stent stenosis rate in controls was 5.6?% and the stented parent artery occlusion rate was 4.2?%. Five (6.6?%) aneurysms ruptured after stent implantation in our series.

Conclusion

The Silk stent is an effective tool for the treatment of challenging aneurysms, which have previously demonstrated higher re-growth rates and technical problems, despite unexpected higher hemorrhage rates after treatment and deployment difficulties.     

Contraction kinetics of striated muscle fibres following quick changes in load

1. The contraction kinetics of single striated muscle fibres and small fibre bundles from the frog and the toad were measured when the load was changed from P(0) to L < P(0). Simultaneous recordings were made of displacement at one end and force at the other end of the preparation.2. After the load was changed, the contractile force generally reached a steady value before the contraction velocity became steady. The amount of time required for isotonic contraction to become steady depended on the change in fractional load and on the temperature; it did not depend on sarcomere length in the range 2.2-3.0 mu or on the number of fibres in the preparation. The characteristics of the non-steady state are described in terms of the displacement deviation (the difference between the actual displacement at a given time and the back extrapolation of the steady phase of the displacement record) and the null times (the times at which the displacement deviation became zero, measured relative to the time at which the contractile force first reached the value of the load).3. The time average of the transient velocity was approximately equal to the final steady velocity.4. The product of the null time following a given relative force step and V(max), the steady velocity of unloaded contraction, was found to be independent of temperature. This is taken as evidence that the isotonic velocity transients originate in the contractile mechanism.5. The non-steady state following step changes in load is identified with the motion of cyclic contraction mechanisms. The motion of the specific model formulated by A. F. Huxley (1957) was compared with that of frog muscle fibres and, although the transients in the two systems differ in detail, the characteristic dimensions are of the same order.