Risk Factor Analysis of Recanalization Timing in Coiled Aneurysms: Early versus Late Recanalization

BACKGROUND AND PURPOSE:Long-term documentation of anatomic and angiographic characteristics pertaining to the timing of recanalization in coiled aneurysms has been insufficient. Our intent was to analyze and compare early and late-phase recanalization after coiling, identifying respective risk factors.MATERIALS AND METHODS:A total of 870 coiled saccular aneurysms were monitored for extended periods (mean, 30.8 ± 8.3 months). Medical records and radiologic data were also reviewed, stratifying patients as either early (n = 128) or late (n = 52) recanalization or as complete occlusion (n = 690). Early recanalization was equated with confirmed recanalization within 6 months after the procedure, whereas late recanalization was defined as verifiable recanalization after imaging confirmation of complete occlusion at 6 months. A multinomial regression model served to assess potential risk factors, the reference point being early recanalization.RESULTS:Posterior circulation (P = .009), subarachnoid hemorrhage at presentation (P = .011), second attempt for recanalized aneurysm (P < .001), and aneurysm size >7 mm (P < .001) emerged as variables significantly linked with early recanalization (versus complete occlusion). Late (versus early) recanalization corresponded with aneurysms ≤7 mm (P = .013), and in a separate subanalysis of lesions ≤7 mm, aneurysms 4–7 mm showed a significant predilection for late recanalization (P = .008). However, the propensity for complete occlusion in smaller lesions (≤7 mm) increased as the size diminished.CONCLUSIONS:Although long-term complete occlusion after coiling was more likely in aneurysms ≤7 mm, such lesions were more prone to late (versus early) recanalization, particularly those of 4–7 mm in size. Long-term follow-up imaging is thus appropriate in aneurysms >4 mm to detect late recanalization of those formerly demonstrating complete occlusion.

Endovascular coiling is widely used in treating intracranial aneurysms. Despite continued improvement in related techniques and devices, the potential for recanalization remains. Risk factors linked to recanalization have been studied widely through comparative analysis, examining SAH at presentation, larger aneurysms, posterior locations, and other variables.^1,2 Coiled aneurysms showing major recanalization are subsequently in need of additional coiling, given the odds of rebleeding. Raymond et al³ found that 46.9% of all recanalizations occurred within 6 months of procedures, with nearly 40% showing major recanalization.⁴ As a function of the follow-up duration, aneurysm size and neck diameter and initial postembolization status were associated with the recanalization of coiled aneurysms monitored for 17 months.³ However, in coiled aneurysms followed for <17 months, the initial postembolization status emerged as the sole significant risk factor for recanalization. Such a discrepancy may imply that risk factors inherent in aneurysm configuration have a greater long-term impact on recanalization.^4,5 Therefore, an association between the timing of recanalization and related risk factors is feasible. Most previous studies in this setting have limited risk factor analysis to patients showing either recanalization or complete occlusion, without considering time to recanalization. In this study, coiled saccular aneurysms were monitored over a longer term to analyze and compare early and late-phase recanalization, thereby identifying respective risk factors.     

Factors for improving the diagnostic efficiency of the rapid urease test from the gastric corpus

Objective: This study aimed to evaluate the optimal biopsy site for Helicobacter pylori detection by comparing the results of rapid urease test (RUT) between the gastric corpus and the antrum.

Methods: A biopsy specimen from each subject was obtained from the corpus and from the antrum. For each subject, the two specimens were separately immersed in two different RUT kits. Positive reaction times were measured at 20?minutes and 1, 3, and 24?hours. If either of the two RUT kits showed a positive reaction, H. pylori infection was confirmed.

Results: A total of 310 H. pylori-infected subjects were eligible for study inclusion. Compared with the antrum, positive RUT reaction times in the corpus were shorter when the degree of gastric atrophy was moderate or severe (p?=?.001 and p?p?=?.021) and severe gastric atrophy (OR?=?2.41; 95% CI?=?1.13–5.13; p?=?.023). Also, severe gastric atrophy was an independent factor associated with positive RUT reaction only in the corpus (OR?=?5.12; 95% CI?=?1.55–16.88; p?=?.007).

Conclusions: In subjects aged ≥50 years or with severe gastric atrophy, biopsy of the corpus mucosa optimized the efficiency of H. pylori detection through a faster positive RUT reaction.     

Diagnostic Value of Small Bowel Capsule Endoscopy in Isolated Ileitis: A CAPENTRY Study

Digestive Diseases and Sciences - Capsule endoscopy (CE) has proven to be highly effective at detecting small bowel lesions, but studies regarding the diagnostic impact of CE on ileitis are rare....     

Poikiloderma Vasculare Atrophicans Showing Features of Ashy Dermatosis in the Beginning

Poikiloderma vasculare atrophicans (PVA) is a rare poikilodermatous variant of early-stage mycosis fungoides characterized by generalized poikiloderma, atrophy, mottled dyspigmentation, and telangiectasia. In 2001, a 14-year-old male presented with asymptomatic brownish-gray polymorphic macules throughout the body with flexural accentuation. A skin biopsy showed increased melanophages with focal hydropic changes. Ashy dermatosis was considered a possible diagnosis. In 2005, the lesions began to show darkening and lichenification in the lower part of the trunk. In 2011, his skin showed definite poikilodermatous changes, and a biopsy showed band-like inflammatory infiltrations of atypical lymphocytes, epidermal atrophy, and epidermotropism of predominantly CD4^-CD8⁺ atypical T cells. In addition, results of T-cell receptor gene rearrangement analysis were positive. Based on the aforementioned findings, he was diagnosed with PVA. If a patient shows long-standing and progressive hyperpigmentary skin changes, periodic follow-up and repeated skin biopsies are recommended to determine the underlying condition.     

Diagnosis of Helicobacter pylori infection: Current options and developments

Accurate diagnosis of Helicobacter pylori (H. pylori) infection is a crucial part in the effective management of many gastroduodenal diseases. Several invasive and non-invasive diagnostic tests are available for the detection of H. pylori and each test has its usefulness and limitations in different clinical situations. Although none can be considered as a single gold standard in clinical practice, several techniques have been developed to give the more reliable results. Invasive tests are performed via endoscopic biopsy specimens and these tests include histology, culture, rapid urease test as well as molecular methods. Developments of endoscopic equipment also contribute to the real-time diagnosis of H. pylori during endoscopy. Urea breathing test and stool antigen test are most widely used non-invasive tests, whereas serology is useful in screening and epidemiological studies. Molecular methods have been used in variable specimens other than gastric mucosa. More than detection of H. pylori infection, several tests are introduced into the evaluation of virulence factors and antibiotic sensitivity of H. pylori, as well as screening precancerous lesions and gastric cancer. The aim of this article is to review the current options and novel developments of diagnostic tests and their applications in different clinical conditions or for specific purposes.     

Is endoscopic submucosal dissection safe for papillary adenocarcinoma of the stomach?

AIM: To identify the clinicopathological predictors of lymph node(LN) metastasis and evaluate the outcomes of endoscopic submucosal dissection(ESD) in papillary adenocarcinoma-type early gastric cancers(EGCs).METHODS: From January 2005 to May 2013, 49 patients who underwent surgical operation and 24 patients who underwent ESD for papillary adenocarcinomatype EGC were enrolled to identify clinicopathological characteristics and predictive factors of LN metastasis and to evaluate the outcomes of ESD for papillary adenocarcinoma-type EGC.RESULTS: Most papillary adenocarcinoma-type EGCs were located in the lower third of the stomach and had an elevated macroscopic shape. The overall prevalence of LN metastasis was 18.3%(9/49). The presence of lymphovascular invasion was found to be a predictor of LN metastasis(P = 0.016). According to current indication criteria of ESD, 6 and 11 of the 49 patients had absolute and expanded indications for ESD, respectively. Two patients(11.8%) with expanded indication for ESD had LN metastasis. Of the 24 patients who underwent ESD, 13(54%) achieved out-of-ESD indication, with 9 of those 13 patients undergoing surgical operation due to non-curative resection. CONCLUSION: The use of ESD should be carefully considered for papillary adenocarcinoma-type EGC with suspected ESD indication after pre-treatment work-up because of the higher frequency of LN metastasis and additional surgeries.     

A Contribution of MdfA to Resistance to Fluoroquinolones in Shigella flexneri

In this study, we measured the drug resistance conferred by mdfA mutations in two Shigella flexneri strains. A mutant in mdfA genes was constructed by polymerase chain reaction–based, one-step inactivation of chromosomal genes. The antimicrobial susceptibility of parent and mutant strains to fluoroquinolones was determined by minimal inhibitory concentration (MICs). The △mdfA mutants were somewhat more susceptible to fluoroquinolones than the parent strains. The low level changes in MICs of the △mdfA mutants suggest that mdfA contributed the fluoroquinolone resistance in S flexneri. This finding found that the increased expression level of an MdfA efflux pump mediated fluoroquinolone resistance, but it is not likely a major effecter of higher resistance levels.