Developmental venous anomaly coexisting with a true arteriovenous malformation: a rare clinical entity.

Two patients diagnosed with arteriovenous malformation (AVM) in close association with a developmental venous anomaly (DVA) are reported. The first patient presented with episodes of left extremity weakness and numbness as well as chronic headaches. The second patient presented with spontaneous intracerebral hemorrhage. Cerebral angiography showed that both the AVM and the transmedullary veins of the DVA drained through the transcortical vein. The AVMs were treated by highly selective transarterial embolization with Onyx embolic agent while preserving the DVAs. It is suggested that the cause of the presentation in both patients was secondary to the association of the AVM with the delicate hemodynamic balance and less robust angioarchitecture of the DVA.

Endovascular management of symptomatic vertebral artery origin stenosis in the presence of an acute thrombus.

A woman in her early 60s with hypertension and hyperlipidemia was undergoing investigations for anemia of unknown etiology. She developed a sudden reduction in visual acuity and bilateral visual field impairment. MRI and angiography revealed acute infarcts in the posterior circulation and severe narrowing of the left vertebral artery origin. Digital subtraction angiography demonstrated a high-grade stenosis of the left vertebral artery origin with a thrombus just distal to the stenosis. The patient developed recurrent infarcts while on antithrombotic therapy. The lesion was successfully treated by vertebral artery origin angioplasty and stenting (VOAS) using a flow reversal technique and distal embolic protection. She was discharged to a rehabilitation facility 4 days later without worsening or new neurological deficits. A search of the literature yielded a similar report managed with anticoagulation and subsequent VOAS after complete lysis of the thrombus. Our report highlights the technique, safety and feasibility of VOAS in the presence of a thrombus using a flow reversal technique and distal protection.

Sonographic assessment of postvoid residual urine volumes in patients with benign prostatic hyperplasia.

OBJECTIVE: To derive a formula that defines the postvoid residual (PVR) urine volume more accurately in patients with prostatic gland enlargement. DESIGN: Prospective. SETTING: Department of Radiology, University of Ilorin Teaching Hospital, Ilorin. SUBJECT: Fifty-two consecutive patients with benign prostatic hyperplasia. The mean age was 64.98+/-9.57 years. METHOD: PVR urine was evaluated by ultrasonography. Each patient had two examinations, the first of which was with a full bladder and the second of which was immediately after voiding. Two orthogonal diameters were measured on each bladder section (longitudinal and transverse) in the supine position. Fifty-two paired sets of ultrasonic measurements were thus obtained. Catheterized postvoid urine residue was regarded as the gold standard. RESULTS: Using these measurements, an equation--[PVR(CUBIC)=374.057+(-196.94+V1)+(32.5539+V1(2))+(-1.1480+V1(3)) where V1=average of the length (L), width (T), and the anteroposterior distance on transverse section (Dt) of the postvoid urinary bladder]--more accurate than previously existing ones was obtained by cubic regression analysis. Mean ultrasound estimated volume was 220.51 ml as against 220.76 ml after catheterization. The mean difference was 0.25 ml (not significant, p<0.01) with 95% confidence interval of +/-10 ml. With this equation, the ultrasonographic residual urine volume showed a higher correlation coefficient with the catheterized volume at p<0.01 (Pearson r=0.982, r2=0.96) than previously defined formulas. The standard error of the mean was 5.11 ml (mean=220.5+/-190.4 ml). CONCLUSION: With the above equation, we consider conventional transabdominal ultrasonography a reliable method for assessing the residual urine volume in patients with benign prostatic hyperplasia. This equation, though complex when compared to some of the pre-existing formulas, can be integrated into the memory of modern ultrasound machines for easy and faster computation.