Nanoentrapped polyphenol coating for sustained drug release from a balloon catheter.

Peripheral artery disease is a cardiovascular disease characterized by a narrowing of arteries that supply blood to the extremities, particularly, the legs. When surgical intervention is warranted, the primary approach is balloon angioplasty. Drug coated balloons (DCB) designed to release antimitogenic agents to the site of the blockage are a relatively new product aimed at reducing artery re-narrowing, or restenosis, after intervention. However, first generation DCB utilize mainly direct application of the chemotherapy drug paclitaxel, along with hydrophilic excipients to facilitate uptake into the tissue, and the majority of drug is released from the DCB systemically. We thus designed a drug-eluting nanoparticle delivery system for firm attachment to the balloon surface and only slow release of its entrapped drugs within a fluid environment. We furthermore chose the relatively nontoxic polyphenols resveratrol and quercetin as active agents we've shown reduce smooth muscle cell proliferation and inflammatory cell and platelet activation, all contributing events in restenosis. A polymeric nanoparticle (pNP) system based on poly(lactic-co-glycolic) acid but possessing a positive charge was designed for firm attachment to the balloon matrix, followed by adhesion to the negatively charged bilayer of the vascular wall. As a first step toward testing its biologic properties, drug elution into a simulated blood fluid was determined, as well as the fold enrichment of cells with drug after exposure to the drug-entrapped pNPs compared to drugs only. Cytotoxicity to vascular smooth muscle cells was assessed, along with their biocompatibility, determined as their ability to promote red blood cell lysis. The drug-entrapped pNP system showed excellent biocompatibility with limited cytotoxicity. In addition, the pNPs released the two drugs only very slowly over 10 days. Development of a spray process for delivering the drug-entrapped pNPs to a balloon surface and in vivo testing in small animals appears warranted. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 00B: 000-000, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 646-651, 2019.

Giant pediatric aneurysmal bone cysts of the occipital bone: case report and review of the literature.

Cranial aneurysmal bone cysts are uncommon. Cranial aneurysmal bone cysts of the occipital bone are exceedingly rare. A 2-year-old toddler with this rare cyst presented with a large space-occupying lesion of the posterior fossa, with cerebellar tonsillar herniation. The patient experienced complete recovery after total excision of the lesion. We review the literature regarding this rare presentation, and discuss the origin, pathogenesis, pathologic features, imaging characteristics, and treatment of cranial aneurysmal bone cysts.

Cochlear implantation in a patient with Paget's disease.

Hearing loss in Paget's disease, a metabolic bone disease, has been reported in as many as 60% of cases, and is presumably related to changes in mineral density of the otic capsule. We describe a 59-year-old man with Paget's disease who had severe to profound hearing loss and was referred to us for cochlear implantation. Preoperative evaluation revealed poor communication skills despite significant residual hearing, raising concerns about postimplantation outcome. Nevertheless, implantation was successful. As our literature search yielded only one report of cochlear implantation in Paget's disease, we record our clinical experience and discuss the hearing rehabilitation dilemmas in this case.

Aberrant carotid artery as an incidental finding before tonsillectomy.

Injury to the internal carotid artery during routine pharyngeal surgery is a rare and potentially catastrophic complication. Aberrations of the cervical blood vessels that might cause lethal post-tonsillectomy bleeding are clearly important but largely unpredictable, even when associated with pediatric head and neck syndromes. We describe a patient in whom aberrant cervical carotid artery was an incidental finding prior to a scheduled tonsillectomy.

Unilateral blindness following septoplasty.

Visual loss following routine nasal surgery is an extremely rare and devastating complication. We report a case of unilateral blindness due to orbital apex syndrome following septoplasty. We also review the literature and discuss probable causes. To the best of our knowledge, this is only the second published report of this complication.

Endovascular embolization of a hemorrhagic jugular bulb diverticulum.

A jugular bulb diverticulum (JBD) is considered to be a rare venous anomaly. In exceptional cases it extends into the middle ear cavity with no bony covering, and slight oozing to massive bleeding might be encountered during routine middle ear surgical procedures. We report a case of massive bleeding from a dehiscent jugular bulb diverticulum that appeared during myringotomy and was successfully managed by endovascular embolization. This report emphasizes the value of interventional neuroradiology in otosurgical cases in which preoperative control of blood vessels or vascular malformations is crucial to avoid severe complications.

Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension.

BACKGROUND: It is uncertain whether ambulatory blood-pressure measurements recorded for 24 hours in patients with treated hypertension predict cardiovascular events independently of blood-pressure measurements obtained in the physician's office and other cardiovascular risk factors. METHODS: We assessed the association between base-line ambulatory blood pressures in treated patients and subsequent cardiovascular events among 1963 patients with a median follow-up of 5 years (range, 1 to 66 months). RESULTS: We documented new cardiovascular events in 157 patients. In a Cox proportional-hazards model with adjustment for age, sex, smoking status, presence or absence of diabetes mellitus, serum cholesterol concentration, body-mass index, use or nonuse of lipid-lowering drugs, and presence or absence of a history of cardiovascular events, as well as blood pressure measured at the physician's office, higher mean values for 24-hour ambulatory systolic and diastolic blood pressure were independent risk factors for new cardiovascular events. The adjusted relative risk of cardiovascular events associated with a 1-SD increment in blood pressure was 1.34 (95 percent confidence interval, 1.11 to 1.62) for 24-hour ambulatory systolic blood pressure, 1.30 (95 percent confidence interval, 1.08 to 1.58) for ambulatory systolic blood pressure during the daytime, and 1.27 (95 percent confidence interval, 1.07 to 1.57) for ambulatory systolic blood pressure during the nighttime. For ambulatory diastolic blood pressure, the corresponding relative risks of cardiovascular events associated with a 1-SD increment were 1.21 (95 percent confidence interval, 1.01 to 1.46), 1.24 (95 percent confidence interval, 1.03 to 1.49), and 1.18 (95 percent confidence interval, 0.98 to 1.40). CONCLUSIONS: In patients with treated hypertension, a higher ambulatory systolic or diastolic blood pressure predicts cardiovascular events even after adjustment for classic risk factors including office measurements of blood pressure.

Selective embolization for head and neck vasculopathies.

INTRODUCTION: Selective, transarterial embolization of vascular lesions through angiographic catheters, which in superficial vasculopathies is often accompanied by intralesional local administration of sclerosing agents, has been used for more than 65 years. However, the reported experience with this therapeutic modality for head and neck lesions is rather limited. METHODS AND MATERIALS: In the current study we describe our experience with all 12 patients having major head and neck vasculature pathologies who were admitted and treated by selective embolization in our institution during a 5-year period. RESULTS: Eight patients had congenital malformations, and 4 had acquired lesions induced by trauma, irradiation, or anticoagulant therapy. Four cases were potentially life-threatening because of severe blood loss and were thus treated immediately. In only 3 cases was subsequent surgical resection of the lesion necessary. The therapy administered is reported, and its outcome is discussed in respect to the available updated literature. CONCLUSIONS: The reported high rate of success with no complications may be the result of careful techniques and appropriate preoperative imaging, as well as the intraoperative and perioperative treatment with steroids and the multiple intralesional puncture sessions administered as necessary.