Comparing vascular morphology and hemodynamics in patients with vein of Galen malformations using intracranial 4D flow MRI.

BACKGROUND AND PURPOSE: Vein of Galen malformation (VOGM) is the most common congenital cerebrovascular malformation, and many patients suffer high mortality rates and poor cognitive outcomes. Quantitative diagnostic tools are needed to improve clinical outcomes. MATERIALS AND METHODS: A prospective study of children with VOGM was conducted by acquiring 4D flow MRI to quantify total blood inflow to the brain, flow in the pathologic falcine sinus, and flow in the superior sagittal sinus. Linear regression was used to test the relationships between these flows and age, clinical status, and the mediolateral diameter of the lesion's outflow tract through the falcine or straight sinus (MD), which is a known morphological prognostic metric. RESULTS: In all 11 subjects (mean age 22±17 weeks [SD]), total blood flow to the brain always exceeded normal levels (1063±403 ml/min [mean±SD]). Significant correlations were observed between falcine sinus flow and MD, the posterior/middle cerebral artery flow ratio and age at scan, and between superior sagittal sinus flow proximal to malformation inflow and age at scan. CONCLUSIONS: Using 4D flow MRI we established the hemodynamic underpinnings of MD, and investigated metrics representing parenchymal venous drainage that could be used to monitor the normalization of hemodynamics during embolization therapy. ABBREVIATIONS: ACA = anterior cerebral artery; BA = basilar artery; MD = falcine or straight sinus mediolateral diameter; NAR = neonatal at risk; PCA = posterior cerebral artery; PCom = posterior communicating artery; SSS = superior sagittal sinus; VOGM = vein of Galen malformation.

Assessment of the effects of gabapentin on activity levels and owner-perceived mobility impairment and quality of life in osteoarthritic geriatric cats.

OBJECTIVE Toevaluate effects of gabapentin on activity levels and owner-perceived mobility impairment and quality of life (QOL) in osteoarthritic geriatric cats. DESIGN Blinded, placebo-controlled, randomized crossover-design study. ANIMALS 20 osteoarthritic cats (≥ 10 years old). PROCEDURES Cats received gabapentin (10 mg/kg [4.5 mg/lb]) or placebo treatment, PO, every 12 hours for 2 weeks, followed by the alternate treatment (with no washout period). Activity was assessed with a collar-mounted accelerometer. A client-specific outcome measure (CSOM) questionnaire was used weekly to collect owner assessments of 3 selected activities in which their cats had impaired mobility; QOL ratings (worse, the same, or improved) following crossover to each treatment and for the overall study period were collected at the end of the investigation. Activity counts, CSOM and QOL data, and deterioration in impaired activities (ie, decrease of ≥ 2 points in CSOM scores) associated with treatment crossover were assessed statistically. Adverse events were recorded. RESULTS Gabapentin administration was associated with significantly lower mean daily activity counts (48,333 vs 39,038 counts/d) and significantly greater odds (approx 3-fold change) of CSOM ratings indicating improvement in impaired activities, compared with results for the placebo treatment. A greater proportion of cats had deterioration in impaired activities after the crossover from gabapentin to placebo than when the opposite occurred, but the proportion of cats with worsened QOL did not differ between sequences. Adverse events were noted for 10 cats (9 that completed the study) during gabapentin treatment (sedation, ataxia, weakness, and muscle tremors) and 1 cat during placebo treatment (lethargy). CONCLUSIONS AND CLINICAL RELEVANCE Gabapentin treatment was associated with improvement in owner-identified impaired activities of osteoarthritic cats. Activity levels were lower than those during placebo treatment, and sedation was the most common adverse effect.

Evaluation of tramadol for treatment of osteoarthritis in geriatric cats.

OBJECTIVE To evaluate tramadol for treatment of signs of pain and impaired mobility in geriatric cats with osteoarthritis. DESIGN Randomized controlled crossover trial. ANIMALS 24 client-owned geriatric (≥ 10 years old) cats with osteoarthritis. PROCEDURES Otherwise healthy cats with owner-identified mobility impairment and clinical and radiographic evidence of osteoarthritis involving at least 1 appendicular joint were enrolled in the study. Cats were treated with tramadol orally at dosages of 0 (placebo), 1, 2, and 4 mg/kg (0, 0.45, 0.9, and 1.8 mg/lb) twice a day for 5 days, with a 2-day (weekend) washout period between treatments. Mobility was assessed with a collar-mounted activity monitor system, and impairments in activity were assessed with a client-completed questionnaire. RESULTS 17 cats completed the study; 7 cats were withdrawn. There was a significant increase in activity with the 2-mg/kg dosage of tramadol, compared with activity when cats received the placebo. Significantly more owners (11/18) considered their cats to have improved with the 2-mg/kg treatment, compared with all other dosages (6/19 to 8/21). Most owners (17/20 [85%]) considered their cat's global quality of life to have improved during the study. Adverse events, predominantly euphoria, dysphoria, sedation, decreased appetite, and diarrhea, were significantly more frequent with the 4-mg/kg (8/19) and 2-mg/kg (6/18) treatments but not with the 1-mg/kg (2/21) treatment, compared with frequency of adverse events with the placebo (0/21). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested a beneficial effect of twice-daily oral administration of tramadol at a dosage of 2 mg/kg in geriatric cats with osteoarthritis. Adverse events were dose dependent, and caution should be exercised in cats that have concurrent disease or are receiving other drugs that may produce adverse gastrointestinal effects.

Services integration and cost-effectiveness.

Alcohol treatment services are increasingly combined with other health and social services to address the needs of multiple-problem clients. Hence, it has been of growing policy interest to find the most effective and the most cost-effective ways of linking these services. This symposium presents some recent studies in this area. The small but growing body of studies in this area has great potential to inform public policy debates.