3D rotational angiography: use of propeller rotation for the evaluation of intracranial aneurysms

We compared two methods of 3D digital subtraction angiography (DSA)--propeller and standard rotation--for the assessment of aneurysmal morphology and its relation to neighboring vessels. Aneurysms were correctly visualized and localized with both techniques. 3D DSA with propeller rotation technique seems to be effective and allows us to reduce the amount of contrast material related to a shortened acquisition time. Technical progress including propeller rotation allows a larger range of rotation and faster rotational speeds.     

Endovascular treatment of intracranial aneurysms with matrix coils: a preliminary study of immediate post-treatment results

A new, coated bioactive coil has been developed to improve the long-term results of endovascular treatment of intracranial aneurysms. The purpose of this preliminary study was to assess the feasibility and safety of selective embolization of intracranial aneurysms with Matrix coils in 20 consecutive patients.     

Selective endovascular treatment of intracranial aneurysms with sapphire coils

BACKGROUND AND PURPOSE: Endovascular treatment with detachable coils is an accepted alternative to surgical clip placement for intracranial aneurysms. The purpose of this study was to evaluate the safety and reliability of the Sapphire coil, a new platinum coil for the treatment of intracranial aneurysms. METHODS: Between August and September 2003, 20 consecutive patients (13 women, seven men; mean age, 49 years; range, 33-77 years) with 20 intracranial aneurysms were referred to our department for endovascular treatment. Fifteen patients presented with subarachnoid hemorrhage, whereas five had asymptomatic, unruptured aneurysms. All patients were treated by selective endosaccular coil placement with the new coils. The remodeling technique was used in five wide-neck aneurysms. Clinical outcomes were assessed with the modified Glasgow Outcome Scale. RESULTS: Aneurysmal occlusion with the new coils alone was successful in 16 patients and resulted in 12 complete occlusions and four neck remnants. Because of the limited Sapphire product line, additional Guglielmi detachable coils (GDCs) were required in four patients, two of whom received one 3D GDC of 3 mm diameter and two of whom received Ultra-Soft GDCs. Technical complication (stretching of a coil) occurred in one patient. Clinical outcomes were excellent in 14 patients and good in two. CONCLUSION: Although the study was limited by its small patient population, the results show that selective endovascular treatment of intracranial aneurysms with Sapphire coils was not associated with an unexpected incidence of adverse events. Excellent anatomic and clinical results that were obtained in most patients suggest that Sapphire coils may have value in the treatment of intracranial aneurysms.     

Human Escherichia coli O157:H7 genetic marker in isolates of bovine origin

The antiterminator Q gene of bacteriophage 933W (Q933) was identified upstream of the stx2 gene in 90% of human disease-origin Escherichia coli O157:H7 isolates and in 44.5% of bovine isolates. Shiga toxin production was higher in Q933-positive isolates than Q933-negative isolates. This genetic marker may provide a useful molecular tool for epidemiologic studies.     

Malignant non-Hodgkin lymphoma presenting with Garcin's syndrome

INTRODUCTION: R Garcin described progressive unilateral cranial nerve palsy in 1926. Garcin syndrome is characterized by progressive involvement of the cranial nerves culminating in total unilateral paralysis of all cranial nerves. Carcinoma of the skull base or ENT regions is the most common etiology. CASE REPORT: A 74-year-old man developed signs involving the left Vth (V2 and V3) cranial nerve then the VIth, VIIth and VIIIth cranial nerves and finally the IXth and Xth. MRI showed involvement of these cranial nerves with gadolinium uptake and involvement of the pons at the terminal phase. Careful ENT explorations failed to reveal a cause. The lymphocyte count was elevated in the cerebrospinal fluid. The patient died one year after diagnosis and the general autopsy was normal. The neuropathological studies led to the post-mortem diagnosis of type B non-Hodgkin lymphoma. CONCLUSION: In patients with Garcin syndrome, lymphoma is a possible diagnosis when carcinoma of the ENT regions or of the skull bases are not present.     

Oral risperidone plus oral lorazepam versus standard care with intramuscular conventional neuroleptics in the initial phase of treating individuals with acute psychosis

Although atypical antipsychotics are now considered first line treatments for schizophrenia, intramuscular (i.m.) conventional neuroleptics are often still considered necessary in emergency treatment of acute psychoses. This European, multicentre, open-label, active-controlled trial compared oral risperidone plus oral lorazepam to standard care with i.m. conventional neuroleptics with or without lorazepam in the emergency treatment of acutely psychotic patients. Patients were allowed to choose either oral risperidone (a single dose of 2 mg and 2.0-2.5 mg lorazepam; 121 patients) or standard i.m. treatment (conventional neuroleptic with or without lorazepam; 105 patients). No additional treatment was allowed for 2 h. Primary outcome was the percentage of patients with treatment success (asleep or at least much improved on Clinical Global Impression-global improvement scale) 2 h after treatment initiation. Baseline characteristics were similar in both treatment groups. Oral risperidone plus oral lorazepam was more successful at 2 h (66.9%) and significantly non-inferior compared to standard i.m. care (54.3%; P=0.0003), and the incidence of extrapyramidal symptoms (EPS) was lower (1.7%) compared to standard i.m. care (9.5%). In acutely psychotic patients requiring emergency treatment, oral risperidone/oral lorazepam was at least as effective as i.m. conventional neuroleptic treatment with or without lorazepam. Oral risperidone plus lorazepam rapidly reduces symptoms, including aggression, and causes fewer EPS.     

Cost-effectiveness analysis of fecal occult blood screening for colorectal cancer

OBJECTIVES: Clinical trials have demonstrated that fecal occult blood screening for colorectal cancer can significantly reduce mortality. However, to be deemed a priority from a public health policy perspective, any new program must prove itself to be cost-effective. The objective of this study was to assess the cost-effectiveness of screening for colorectal cancer using a fecal occult blood screening test, the Hemoccult-II, in a cohort of 100,000 asymptomatic individuals 50-74 years of age. METHODS: A decision analysis model using a Markov approach simulates the trajectory of the cohort allocated either to screening or no screening over a 20-year period through several health states. Clinical and economic data used in the model came from the Burgundy trial, French population-based studies, and Registry data. RESULTS: Modeling biennial screening versus the absence of screening over a 20-year period resulted in a 17.7 percent mortality reduction and a discounted incremental cost-effectiveness ratio of 3357 Euro per life-year gained among individuals 50-74 years of age. Sensitivity analyses performed on epidemiological and economic data showed the strong impact on the results of colonoscopy cost, of compliance to screening, and of specificity of the screening test. CONCLUSIONS: Cost-effectiveness estimates and sensitivity analyses suggest that biennial screening for colorectal cancer with fecal occult blood test could be recommended from the age of 50 until 74. Our findings support the attempts to introduce large-scale population screening programs.