ABSTRACT
BACKGROUND AND PURPOSE: Intracranial hemorrhage represents a severe complication of brain arteriovenous malformation treatment. The aim of this cohort was to report the rate of hemorrhagic complications after transvenous endovascular embolization and analyze the potential angioarchitectural risk factors as well as clinical outcomes. MATERIALS AND METHODS: During an 11-year period, 57 patients underwent transvenous endovascular embolization. All cases of hemorrhagic complications were identified. We analyzed the following variables: sex, age, hemorrhagic presentation, Spetzler-Martin grade, size of the AVM before the transvenous treatment, number of venous collectors, pattern of drainage, presence of dilated veins, and technical aspects. Univariate and multivariate multiple regression analyses were performed to evaluate the potential risk factors for procedure-related hemorrhagic complications. RESULTS: Hemorrhagic complications (either intraprocedural or periprocedural) unrelated to a perforation due to micronavigation occurred in 8 (14.0%) procedures. Significant (mRS > 2) and persistent neurologic deficits were present in 2 (3.5%) patients at 6-month control. Larger nidi, especially >3 cm (P = .03), and a larger number of venous collectors have shown a statistically significant correlation with hemorrhagic complications. Only the number of venous collectors was identified as an independent predictor of hemorrhagic complications in the multivariate analysis (OR, 8.7; 95% confidence interval, 2.2-58.2) (P = .006). CONCLUSIONS: Larger nidus sizes and an increased number of venous collectors may increase the risk of hemorrhagic complications when implementing transvenous endovascular treatment of AVMs. The technique is effective and promising, especially with small nidi and single venous collectors.
Subject(s)
Arteriovenous Fistula/therapy , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Intracranial Arteriovenous Malformations/therapy , Intracranial Hemorrhages/etiology , Adolescent , Adult , Aged , Arteriovenous Fistula/pathology , Child , Embolization, Therapeutic/adverse effects , Endovascular Procedures/adverse effects , Female , Humans , Intracranial Arteriovenous Malformations/pathology , Male , Middle Aged , Multivariate Analysis , Patient Selection , Postoperative Complications/etiology , Risk Factors , Treatment Outcome , Veins/pathology , Young AdultABSTRACT
Laryngeal haemangiomas can commonly be seen in children, and first-line treatment is usually propranolol. However, in adults, cavernous haemangioma of the vocal cord(s) is an extremely rare condition - with this being the only published adult case presenting with acute respiratory distress - the mainstay of treatment is surgical excision under microlaryngoscopy. Presentation in adults can be unpredictable, but primarily consists of hoarseness which can be associated with, dyspnoea, dysphagia, and haemoptysis - and in one documented case stenosis of the aero-digestive tract led to death. Due to these airway difficulties, surgery can often prove challenging. In this study, we explore the unusual case of a previously well 71-year-old gentleman presenting to the Emergency Department, with worsening shortness of breath as his primary complaint. Uniquely, in this case, an awake fibre-optic intubation was undertaken to manage the difficult airway and a microlaryngoscopy was performed. A 20x10x15mm lesion was excised, which had characteristics in keeping with a cavernous haemangioma on microscopic examination.
Subject(s)
Hemangioma, Cavernous/complications , Laryngeal Neoplasms/complications , Respiratory Distress Syndrome/etiology , Vocal Cords , Aged , Hemangioma, Cavernous/diagnosis , Hemangioma, Cavernous/surgery , Humans , Laryngeal Neoplasms/diagnosis , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Laryngoscopy , Male , Microsurgery/methods , Respiratory Distress Syndrome/diagnosisABSTRACT
One of the major flow phenomena associated with low Reynolds number flow is the formation of separation bubbles on an airfoil's surface. NACA4415 airfoil is commonly used in wind turbines and UAV applications. The stall characteristics are gradual compared to thin airfoils. The primary criterion set for this work is the capture of laminar separation bubble. Flow is simulated for a Reynolds number of 120,000. The numerical analysis carried out shows the advantages and disadvantages of a few turbulence models. The turbulence models tested were: one equation Spallart Allmars (S-A), two equation SST K-ω, three equation Intermittency (γ) SST, k-kl-ω and finally, the four equation transition γ-Reθ SST. However, the variation in flow physics differs between these turbulence models. Procedure to establish the accuracy of the simulation, in accord with previous experimental results, has been discussed in detail.
Subject(s)
Models, Theoretical , ViscosityABSTRACT
The potential of Salmonella population to rebound on non-washed and washed roma tomatoes and jalapeño peppers in humid storage at 4°C, 10°C, 15°C, 21°C, or 35°C for ≤12 days was investigated. The initial inoculation levels of Salmonella on peppers and tomatoes were 5.6 and 5.2 log CFU/cm(2), respectively. Air-drying of fruit surfaces resulted in contamination levels of 3.9 and 3.7 log CFU/cm(2) on inoculated peppers and tomatoes, respectively. At 21°C and 35°C, the levels of air-dried Salmonella inoculums on produce surfaces increased ≥2 log cycles, with the most rapid growth in the first 3 days. Mechanical washing on rollers (rinsing; R-treatment) or revolving brushes (rinsing and brushing; RB-treatment) with water decreased Salmonella counts by ≥2.5 log CFU/cm(2) on both peppers and tomatoes. After R- or RB-treatment, peppers stored at 21°C and 35°C permitted residual Salmonella (≤1.4 log CFU/cm(2)) to grow to 2.6-3.9 log CFU/cm(2). During storage, residual Salmonella (≤1.0 log CFU/cm(2)) on washed tomatoes increased to 3.1 log CFU/cm(2) at 35°C following R-treatment and 3.8 log CFU/cm(2) at 21°C following RB-treatment. Cold storage at 4°C and 10°C effectively prevented the proliferation of Salmonella on both washed and non-washed produce. The current study on jalapeño peppers and roma tomatoes demonstrated that Salmonella population can rebound on produce in humid storage before or after washing. The finding highlights the benefit of uninterrupted cold storage for safer produce operations.
Subject(s)
Capsicum/microbiology , Food Contamination/prevention & control , Food Handling/methods , Salmonella/growth & development , Solanum lycopersicum/microbiology , Colony Count, Microbial , Consumer Product Safety , Food Contamination/analysis , Food Microbiology , Food Preservation/methods , Humans , Humidity , Salmonella/isolation & purification , Salmonella Food Poisoning/microbiology , Salmonella Food Poisoning/prevention & control , TemperatureABSTRACT
Prostate cancer rarely metastasis to the rectum. Findings in the patient reported here emphasize the importance of the relationship between urinary and gastrointestinal symptoms in detecting prostatic neoplasms in older male patients.
Subject(s)
Adenocarcinoma/diagnosis , Bone Neoplasms/diagnosis , Prostatic Neoplasms/diagnosis , Rectal Neoplasms/diagnosis , Adenocarcinoma/drug therapy , Adenocarcinoma/secondary , Bone Neoplasms/drug therapy , Bone Neoplasms/secondary , Humans , Male , Middle Aged , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/pathology , Rectal Neoplasms/drug therapy , Rectal Neoplasms/secondaryABSTRACT
Ten cases of necrotizing fasciitis are reviewed. Three patients died but only two of these deaths were due to uncontrolled septicaemia. All isolated organisms were sensitive to a combination of piperacillin and ampicillin which we now regard as the initial antibiotic combination of choice. Prompt and aggressive surgical debridement remains the cornerstone of management.